Treating Spiritual Sickness

In treating mental health conditions, are psychotherapy and medications enough to do the job? In our discussion on this subject last week, some suggested that there may even be another dimension of care needed: a spiritual dimension. Perhaps it is possible to be psychologically healthy, yet spiritually sickened, even dead? Obsessive compulsive disorder and one of its manifestations—scrupulosity—is a vexing condition for therapists and psychiatrists to treat. I have written a book on this subject, and was extremely surprised one day to hear that John Cardinal O'Connor had used it as the basis for a sermon at St. Patrick's. Cardinal O'Connor went beyond the talking, behavioral, and psychopharmacological therapies I had evaluated in the book:

Dr. Van Ornum did a survey of an organization that you might not know ever existed called “Scrupulous Anonymous.” It is much like Alcoholics Anonymous or Over-Eaters Anonymous. He received replies from a thousand people and discovered and verified everything that he had learned in his work. They depicted immense suffering and anguish caused by scrupulosity. This is not limited to those of us who are ordinary people. A number of the saints had problems with scrupulosity: the great St. Catherine, St. Alphonsus of Liguori, even St. Ignatius who founded the Jesuits.

This gives us one of the fundamental causes for scrupulosity. It itself is a horrifying condition, the belief that we are intrinsically no good. We may be considered the most brilliant people in the world, the most handsome people, the most beautiful people, the most talented people, but beneath the surface we feel we are no good. Therefore everything we do is evil and sinful. It does not matter how much praise we get. We are convinced that we are absolutely useless. Not only that nobody loves us, but that we are incapable of being loved for ourselves as persons. It is the thought, “If anybody knew what I am really like inside then that person would hate me, even God.”

What could this [book] possibly have to do with today’s extraordinary Gospel [Jn. 4:5-42] about the Samaritan woman, the woman who had been “married five times but had never really been married”? To her our Lord says, “The man you are living with now is not your husband.” What would that have to do with scrupulosity?

In this Gospel, we find that this woman does things that scrupulous people do with Almighty God–she plays games with the Lord. She tries to fence with him. “You are a Jew and I am a Samaritan. How come you are even talking to me? Jews are not to talk to Samaritans.” Ah, if you knew who it is who is talking to you! “Give me some water,” Jesus says. She says, “You want me to use my bucket to get water? Jews are not supposed to drink water out of a bucket that belongs to a Samaritan.” And so on. She was avoiding the issues, avoiding the fact that she has lived with five or six men, avoiding the fact that our Divine Lord is confronting her with the truth. But what is the truth with which he is confronting her? With his love, with his mercy, with his compassion. Initially, she thinks she is beyond that.

Then suddenly, because of our Lord’s great grace and mercy, it hits her. She runs to tell all the other people, “I have found the Messiah!” Because of things that our Lord said to her, because of his word, she believed she had found the Messiah. This is of the very nature of our Divine Lord and this is what Lent is all about.

This Gospel is the perfect summary of Lent–an encounter with Christ in which ultimately we are moved toward pleading for his forgiveness because we know that he has come to suffer and to die for us and that the God who gave his Son to be so horribly tortured and put to death for us is the same God who does not want to see us lost. Christ came to pick up the pieces of broken lives, your life and my life–not to condemn us. But he wants us to ask his forgiveness, in the confessional if this is necessary, outside the confessional if that is adequate. We are not going to ask forgiveness unless we believe we need forgiveness and unless we believe he will grant forgiveness.

This story is the great reminder that God is love, that love drives out fear. If there be any here who are afraid, whether victims of the spiritual disease of scrupulosity or not, if there are any here who are afraid, it is our Divine Lord himself who says to us as, in essence, he would say to the Samaritan woman, Be not afraid. God is love. God drives out fear. Come to me for my mercy. Come to me to be bathed in my love.'

Cardinal O'Connor was later kind enough to write a Foreword to my book. There he notes how difficult it can be to weave together the respective contributions of psychology and spirituality when working in the mental health field:

Psychiatrist Robert Coles of Harvard University expresses understandable perplexity that so many officials of so many churches refer their clergy for therapy instead of turning to the spiritual or sacramental resources within religion itself. I can testify to the phenomenon but am not surprised by it. As one with a certain background in clinical psychology and psychiatry combined with more than fifty years of active priesthood, I am most grateful for what these sciences do offer, quite aware that neither faith nor theology is an adequate substitute when psychology or psychiatry is essential. The reverse of that truism, of course, is equally important.

Part of what I hope to do with my essays for "In All Things" is to start a conversation between the fields of psychology and spirituality. Thanks to all our readers and respondents for helping to keep this conversation going.

William Van Ornum

Comments

After reading this article over a couple times, I was still only beginning to understand the differences between a psychological and spiritual problem. While neither is visible on the outside, it is nearly impossible to diagnose without cooperation from the person himself. Perhaps this is why the anonymous study is the first I’ve heard of this type of self-image. I also began to wonder about the origin of such a belief. While the article suggests that scrupulosity leads to feelings of sufferings and anguish, is it possible this is yet another example of the “chicken and the egg” phenomenon? Is it possible that people who are unhappy turn to perfection in search of spiritual relief?
I do believe that along with medication, spiritual care is sure to direct towards the source of the problem, rather than masking its symptoms. In the case of OCD however, it is largely up to the individual to accept and acknowledge the disorder before beginning to work towards improvement. The foundation of the illness may differ from person to person however, since it has uncountable possible origins. According to WebMD, “abuse, changes in living situation, illness, death of a loved one, work-or-school related changes or problems, and relationship concerns” list only a few. It is because of this reason that I believe medication helps only to an extent, and possibly only by theory of the placebo effect. It is spiritual healing that truly helps those suffering from OCD.

http://www.webmd.com/anxiety-panic/guide/obsessive-compulsive-disorder?page=2

Today’s society has become extremely secular. People buy into what commercials and others tell them. People buy into the material world even if it is against their beliefs. In a world where anything can be at your finger tips, we have to remember that there are so many out there that do not have as much as we have. Therefore, it is times like lent where we need repentance and to get focused again. We need to remember to pray and meditate. We do not need everything that we have in surplus. As a society, we have a “spiritual sickness”. It is a disease with symptoms such as greed, lust, envy and gluttony. We have to remind ourselves that what we have is so great. We have the opportunity to live, the opportunity to love and be loved and the opportunity to receive an education. For those that have veered off their spiritual path, lent is a time to re-connect and find their way. I will be the first to admit, I get off track at times. I am not perfect. However, it is the person that finds their way back and makes changes in their life for the better and tries to be the best person that they can be that helps heal their “spiritual sickness”. Instead of buying more for ourselves, we should buy more for others that have less. Instead of harboring feelings if detest, let us forgive. As a person, we will feel a lot better about our own lives to live a simpler, happier more spiritual life.

It is refreshing to read about the effect of scrupulosity on a person's overall feeling. I believe it's an interesting if not essential aspect of the human psyche for psychologist and psychiatrists to investigate. We typically think of two methods to ''fix'' people who require therapy, medication and talk therapy. Sometimes these two things whether separate or combined are ineffective. It has me wondering if a connection to spirtuality and a loss of the scrupulosity attitude may be the key so many frustrated mental health professionals are looking for. It may sound simple but in my opinion there are only 3 basic overall view we can have on humans we are good, bad, or a mixture of the two. It is obvious to me how depressing life would be if there appeared to be no way, if we are all to fail and never built upon the goodness of ourselves. After reading this article, I feel that all professionals in the mental health field should be educated on this topic and be aware of how it can affect some individuals. Of course, I don't believe that a psychologist should be the same religion as his or her patient, but I do believe it would be beneficial for psychologists to be familiar with other religions so that he or she would be capable of having an open discussion about the religious or spirtual aspect of their patient's life. Research from the American Journal of Sociology indicates that spirtituality and a connection to religion can help one live longer and a healthier life. For this reason, I have to question why isn't spirituality one of the first topics addressed at all mental health meetings.

http://www.jstor.org/stable/2781506

I did not know you wrote a book! After reading this article, I began to think how people should not rely on medical attention for mental health conditions. I personally think somebody’s mentality can receive help from therapy. It is difficult to imagine people in this world finding themselves useless despite everything they have to offer. Although scrupulosity is more severe, people have had some extreme cases that they have consulted a therapist to converse with and have made progress. It is understandable that in extreme cases medicine is what some need to use, however, as stated, spiritual sickness can be treated while attending a confessional which is essentially talk therapy.

I have never really thought about any other ways of treating mental health conditions besides psychotherapy and medications. I didn’t think that a spiritual dimension of care could be a possible way of treating mental conditions. In addition, I have never heard of scrupulosity before. I was a little confused about it, so I looked it up. I learned that it is a condition in which a person has obsessive concerns that have to do with religious or moral things. I think it is a really interesting condition. I never even knew that scrupulosity can be part of obsessive compulsive disorder. When I was searching online about scrupulosity, I found out that it is a pretty common feature of OCD and religion was the 5th “most common obsessional theme in the DSM-IV field trial for OCD” (On the Nature and Treatment of Scrupulosity, p.40). I also learned about some things that some people do that have scrupulosity. They sometimes have excessive trips to confession, repeatedly do cleansing/purifying rituals, and repeating passages from sacred scriptures in their head (International OCD Foundation). I wondered if scrupulosity happens only to those people who were religious to begin with or if they became obsessive about religion just randomly. It seems pretty obvious though that scrupulosity would be more common in those that are very religious to begin with. I found that it is true that it is really common in those who are really religious. I wonder though if scrupulosity is more common with certain religions than others. Also, I wonder if people become this way because of church making them fear sin to an extreme point.
I can understand how a spiritual dimension of care can help because some people may have issues that have to do with religion, like scrupulosity. The usual type of treatments like medication and psychotherapy could work, but I think there should be a spiritual dimension of care too. That could probably help some people a lot more. One way I learned that people with scrupulosity can be treated is having religious leaders from their faith community help clarify a “religious institution’s stance on a particular issue relevant to the scrupulosity sufferer” (International OCD Foundation). Also, some people may be very religious or spiritual and would want a spiritual way of being treated. However, I think that a spiritual dimension of care might not be good for everyone because some people may not want this kind of treatment.
In the article, you said: “Perhaps it is possible to be psychologically healthy, yet spiritually sickened, even dead?” I think that it is not really possible to be psychologically healthy and spiritually sickened. I feel like being psychologically unhealthy and spiritually sickened go together. If you are spiritually sickened, then you are having some issues, which could be counted as psychologically unhealthy. However, I don’t think that if you are psychologically unhealthy, you are always spiritually sickened. To be psychologically unhealthy does not mean you have to have the typical issues (like ADD, OCD, and depression). I think you could be counted as psychologically unhealthy if you do not have faith in anything/yourself or if you are having trouble in believing in something.

http://www2.scc.rutgers.edu/journals/index.php/pcsp/article/viewFile/932/2329

http://www.ocfoundation.org/uploadedFiles/MainContent/Find_Help/IOCDF_Scrupulosity_fact_sheet.pdf

I thought this article, “Treating Spiritual Sickness,” was very interesting. When thinking about psychology and psychiatry you usually don’t think about them being connected to religion, most people would immediately think about the medical aspects of these fields. If you really think about it however, it does make a lot of sense that these fields cannot fix all problems, just like any other medical field, they can’t solve every problem. Pairing these fields with a spiritual aspect definitely makes sense in terms of creating some sort of complete care, as spirituality can help many people simply on its own. Pairing the two seems like it would be extremely effective for many people, but obviously it is not the answer for everyone and every situation, but that does not mean we should look over it.

I really enjoyed this article. I find it interesting to examine the benefits of both spirituality and psychology. As a Christian, I believe that a strong spiritual foundation can serve as a positive part of a person’s life. However people may feel anxious about religion and try to avoid it because they feel as though they are too sinful or not worthy enough to make it apart of their lives. When people focus on every aspect of their life that is not perfect according to their religion, religion becomes more of a worry rather than a piece of mind. I think of religion as more of a safe haven, something that offers assurance. As seen in Cardinal O’Conner’s sermon, God’s purpose is not to pick out every flaw you have and his main aim is not to solely condemn you. I believe that god wants us not only to be aware of our sins but also he wants us to realize in amazement and gratitude that these sins can be forgiven! So many people focus on being perfect that they become lost spiritually. When a person is going through a difficult time in their lives, religion offers hope and a piece of mind. I think that this is especially true when psychology does not have concrete answers to hard life situations, such the concept of death. With that being said, I do think that the use of psychology along with spirituality can be very beneficial in helping those with mental illnesses or other issues. I feel both areas can help people in turning their life around for the good.

I have to agree I think psychology and spirituality or religion can be considered a separate thing and while I don’t think they are one entity I do believe that in certain circumstances that they should be used together to benefit the client being treated. If a person is highly intertwined with their own spirituality or religion it is probably appropriate to intertwine psychology and spirituality when treating this person and to focus on the persons mind and overall spirit. While some will argue that there is only the mind and nothing else many do not believe this theory so it is important to try and suite the need of the client.
Also I think there needs to be a distinction between religion and spirituality. For example I have a close friend who isn’t religious but can be considered very spiritual. While the opposite doesn’t hold true for other people I do believe psychologists should be well versed in different religions so they can treat a person of any religion appropriately will not dishonoring or offending the person. I have to say myself that I don’t think I would enjoy therapy that incorporated spirituality and religion to treat me. I would prefer we focused on my issues and ways of coping and how I can change my behaviors that are ruining my life and later concern myself with issues of spirituality. I think religion and spirituality can get in the way of truly finding an answer to a person’s issues.

I totally agree that someone can be spiritually sickened. Like Angeline just said, most people have mild forms of certain disorders such as OCD, which can be prevented by means of faith or practice of religion. This disorders may have initially been triggered by a sense of chaos or stess, and finding ones faith can create a feeling of peace or satisfaction that may eliminate such symptoms.
I find it extremely interesting that John Cardinal O'Connor mentioned your book in his sermon. I like how you always try to connect psychology to religion in some way.

Stacey (#84) I am also very familiar with OCD. I am also familiar with people with bipolar disorder, and schizophrenia. Unfortunately some of their disorders are acute, which sounds like the person you know. People that have disorders that effect their daily lives so much (in my opinion) require medication.

Most of us however have mild forms of these disorders, which I just consider quirks. When they are mild, these people can usually be manipulated by faith, or just suggestive advise from those they view as authorities on the subject.

I am not saying that faith and religion are merely manipulative means, but rather they provide feelings they elicit provide a self-satisfying feeling, which can cure emotional distraught.

Knowing someone who has Obsessive Compulsive Disorder, I have seen the struggles that it can cause every day. Being close enough with this individual, they have shared with me both some of their obsessions and compulsions. This particular individual often has scary thoughts of death running through their mind, as if someone keeps hitting the rewind, and play buttons of their mind over and over again. These thoughts are enough to bring this person to tears; they were enough to bring me to tears as I listened. These repeated thoughts sadly prohibit him or her from living life normally. Seeing how these thoughts can control this person, I can only imagine how debilitating it must also be to constantly be overrun with guilt about moral or religious issues, and believing that God, all merciful and loving does not even love you for who you are.
Never before have I realized the strength of the connection between spirituality and psychology. For through knowing God, and trusting in him, those who are struggling psychologically, as well of course as those who are not, can feel at peace. Once the Samaritan woman realized that God loved her no matter what she was, in a sense, set free. Her excitement as she ran to tell others the good news proves this. It was like an enormous amount of weight had been lifted off her shoulders. However, it is obvious that spirituality alone is not always enough to treat those who are psychologically troubled. Even those “higher up,” members of the clergy, must sometimes seek professionals when their psychological struggles are too great for spirituality alone. As Cardinal O’Connor stated, “…neither faith nor theology is an adequate substitute when psychology or psychiatry is essential. The reverse of that truism, of course, is equally important.”

Although I am very interested in both psychology and spirituality, I hadn't truly ever tried to connect or relate these two separate aspects of life to each other. In addition, I had never heard of scrupulosity before, and was intrigued to hear of such a disease. The concept of scrupulosity is a new one to me, and when thinking about how it could be handled or treated, I remained unsure of which option would be better: spirituality or psychology. I discovered, with some research, that scrupulosity is related to Obsessive Compulsive Disorder, but is a personal, strong feeling of guilt for moral or spiritual reasons. When reading about the possibility that the church could be to blame for the problem of scrupulosity, I became shocked and a little offended and uncomfortable. Since I was a young girl, I always remember hearing in church that God was to be feared. When I was younger, I sometimes understood this, however I also became worried and concerned that I was too comfortable and not fearful enough of God. I don't personally feel that I could ever blame the Catholic church for scrupulosity, but simply a great concern for one's spiritual well-being.

While studying for the past years all about psychology and psychological disorders, I have never stumbled upon the topic of scrupulosity. Scrupulosity is a disorder in which one has feelings of pathological guilt about moral or religious issues. One who suffers from this disorder could have social functioning impairments and is characterized with obsessions of being an evil person or fear of retribution for sins. Before reading this posting and researching further into the subject of scrupulosity, I would have never hypothesized that religion could contribute to such a debilitating and difficult disorder.
I feel that religion, no matter what religion you are, is meant to uplift you and help you become the best person you can be. Yes, every person is destined to make errors throughout their own lives. But if you truly have faith in your religion, then you will understand that forgiveness is a necessary component of that religion and all will be well. I feel that the guilt devised from this disorder can negate from the true meaning and interpretation of one’s religion. It undermines one’s ability to truly live and be happy. If you let your religion drive you to such an extent of obsession, perhaps you would need to take a step back and remember the true happiness that religion can bring to you.

David (multiple posts) I found your questions very interesting. The true definition of faith is believe in something without proof of its existence. Spiritual involves your soul and/or religion, which requires faith. It is okay if a person does not believe they have a soul, or that there is not a higher power, but if they feel guilt about not believing, then maybe they believe more than they want to admit. It is hard to believe in something we cannot see, especially now in a world where science has shown us how almost everything works and how they exist, but not why.

The human body can be explained by science, the human mind can be explained by psychology, but the human reactions, emotions, beliefs, thoughts and our constant need to ask how and why cannot always be explained. Sometimes having spiritual belief just makes a person feel safer, and fear the inevitable death less. Even if that is the only reason for spiritual beliefs, it puts a person's mind at ease.

"Mill believed that empiricists who argued that the mind was merely similar to a machine in its operations had not gone far enough. The mind was a machine - it functioned in the same predictable, mechanical way as a clock. It was set in operation by external physical forces and run by internal physical forces" (Schultz & Schultz, 2008).

If James Mill was right and humans are machines, why did his son turn out the way he did?

Schultz, D. P., & Schultz, S. E. (2008). A history of modern psychology (9th ed.).

(pp. 57). Belmont, CA: Thompson/Wadsworth.

I think that obsessive compulsive disorder can be treated in a spiritual manner, or at least in some part. I find it interesting that scrupulosity has been linked to many saints and also that fear of sinning and punishment is higher in Catholics and Protestants than Jews, as mentioned in some comments earlier. Since the diagnosis of scrupulosity can be linked to religion it only makes sense that the treatment involves some form of religion or spirituality.
The problem with this idea is that a person that does not want to be treated spiritually most likely will not be. There will not be many situations like the Samaritan woman where people will almost be forced into a spiritual treatment of scrupulosity. One must be open to this idea in order to receive treatment of this sort and that is where problems may arise. Since scrupulosity is a manifestation of obsessive compulsive disorder, it is commonly seen as a psychological disorder which should be treated as such. It is important to make people aware that scrupulosity, and possibly other psychological disorders, can have roots in other areas. Once people are cognizant of this information, they can start accepting treatments of other forms that may be beneficial to them.

I think for many people, the idea of being ‘spiritual’ is a foreign concept for them. Many people lead their life without connecting to their ‘inner self’ or what some refer to as their ‘soul’ without God being the guiding force. For people suffering from scrupulosity, there is a divide in what they should do to make their life bearable. For psychologists, the current answer to this problem is medication or talk therapy. Both are effective in their own way, however, I do believe spiritual healing, especially in this case, could be an extremely valuable method of treatment.
If a person is suffering from the belief that they are never able to fully please God, then maybe by connecting to their inner ‘soul’ they may find a certain clarity that cannot be provided through regular treatment. Because this mental health disease is related specifically to religion, why not solve the problem using a form of religion itself? I think this kind of treatment is unique and should not be dismissed as a means of helping someone.

This blog truly made me realize how much of a role spirituality truly does play in both mental and psychological health. Although I had never thought of spirituality as a potential treatment to this kind of sickness, I can definitely understand how it could be. For people who depend on a higher power to get them through difficult times, praying and simply talking to God can definitely help someone get through low points in their lives.
Although this treatment may not work for everyone, I thoroughly believe it can help those who consider themselves spiritual. Knowing that there is a God, and that he has power and control over our lives can serve as the light at the end of a dark tunnel for many people. The constant knowledge that God is available to listen to our problems and bless us with miracles on Earth is a positive and uplifting thought. Treating spiritual sickness by relying on a higher power is a method that could undoubtedly save a person’s life.

Before reading this article, I was not aware what spiritual sickness was. When I heard that people had inner issues, I automatically assumed they were psychological, but because of this article I can now think differently. I am very concerned for those people who have scrupulosity or feel that no matter what they do they are bad. No person should feel this way, but these people cannot help it.
The idea of scrupulosity at first seems bizarre and I wonder why people feel this way. I think it may be due to their lack of love or religion. As Cardinal O’Connor said in his sermon, religion and God can be the cure to this sickness. Some people may not realize the good religion brings to their lives and therefore they feel that they cannot help but feel they are bad. It is a scary thought to think about.
I agree with Robert Coles as he says that the fields of religion and psychology must work together. Many people will experience different sicknesses within their lifetimes. If they are dealing with depression, I feel that a psychiatrist may be more suited for the therapy. If a person is dealing with scrupulosity, I hope they can be lead to their religion to see the good they have in themselves. Spiritual sickness is a new idea to me and this article has really opened my eyes to its seriousness and cure. I hope this article is able to help those who are dealing with issue!

It is extremely interesting to think can one be physically healthy but spiritually sickened? I personally believe it can be true. Spirituality does not necessarily mean you have to believe in God or religion; spirituality can simply be the inner path that one takes but it is still a belief in something.
It’s hard to imagine if one has a healthy spiritual life that they would have scrupulosity issues. I believe there is a strong correlation between spirituality and psychology. It may be difficult for some strong believers to see the connections but ultimately there is a relationship. I feel that have a positive spiritual life would enable one to heal and foster positive feelings rather than always recognizing the negative in oneself.
As a side notes, it is very shocking to read that multiple saints has issues with scrupulosity. Who would have thought?!

"Perhaps it is possible to be psychologically healthy, yet spiritually sickened, even dead?"

I personally don't believe that it is possible. For those who are not religious, it is their soul, their spirit that must be cared for. It is what makes us move, keeps us going, determines how we live. If a person's soul is weakened, then how could they by psychologically healthy? The weaker the soul, the more problems psychologically, mentally, and physically a person becomes. This all applies to those who are religious too, although they have an extra aspect. Their spirituality is intertwined with their faith. If they have given God control of their lives, they will be spiritually alive and psychologically healthy. The moment they stop relying on God is the moment they open the door to problems of all kinds, including psychological. Every believer has stories of a chaotic time due to a drift away from God. This is not to say that becoming a Christian and maintaining a spiritual life does not allow for problems, but it is to say that keeping spiritually strong allows for those problems to be better handled.

I never really heard of scrupulosity until I read this blog. I have found that it is guilt about moral or religious issues. St Ignatius who repeatedly attended confession had a fear of spiritual unworthiness, and he became a saint. So I think that even if you worry about things and have a special form of fear, you can overcome this and learn to deal with your thoughts and fears.

I also found out that Ciarrocchi, a professor and priest at Loyola College also deals with scrupulosity and Obsessive Compulsive Disorder, and thinks that you need to teach people with OCD strategies to help them deal with the disorder. When you remember that “God is love and that love drives out fear”, you will be able to do and overcome all of those negative thoughts and compulsive thoughts that you might have. You just need to place your life into God’s care.

Dr. Van Ornum,
     First off, Congratulations on having your book used in Cardinal O'Connor's sermon. That's quite an honor to receive such recognition. As a few others have mentioned, I had never heard the term scrupulosity before. This condition is intriguing in that it appears so different from the typical mental health conditions seen today. However, as you pointed out, it does seem to fit within the same pattern of thinking shown in those with Obsessive Compulsive Disorder. Is scrupulosity considered a branch of OCD? Also, is this a common condition that you have seen within your work experience?
     It would be interesting (atleast to me) to see how common scrupulosity is within different cultures and religion. Would it affect more Protestants than Muslims, more Jews than Buddhists? I wonder how it would all pan out, and if there is a correlation between the strictness of the religion and number of people with this condition. Or perhaps it doesn't have to do with the religion's specific beliefs, but comes down solely to a personal matter. Does people with this disorder show any other signs of personal hatred, or does it only relate to religious matters?
     From personal experience, I have seen sprirituality greatly help someone deal with past addiction and the wrongs they had done. Now I know addiction is not the same as OCD, however I feel that there can be benefits of spritiuality used within both conditions. The person I know has been alcohol free for over 30 yeas, but occasionally still struggles with feelings of guilt over hurt relationships with family members, and other events that occured during the time of addiction. It seems difficult to put these feelings completely in the past. This struggle to forgive oneself is where I find that spirituality helps. Any form of spirituality, such as a belief in a higher power in any form, or a spirituality with nature provides one with a mediator to reach their own self. By believing within a higher power for instance, one can perhaps feel less sorrow and guilt about themselves by trusting that this "God/power/etc" has already forgiven them. In addition, sprituality brings one closer to their inner self by allowing for deep reflection and meditation. Once a person reaches forgiveness or content with their own being, spirituality doesn't stop. It provides the person with a model and guidance to conitue on in their spiritual path involving the people and world around them.
      Perhaps I am biased because I have seen firsthand how spirituality has greatly benefited someone in my life struggling with mental issues. However, I do think that it can have a positive effect on others dealing with various conditions. I believe that most conditions probably do contain some aspect of self loathing or struggle with forgiveness. From my experience and research, most people with mental health disorders do not wish to be the way they are. Therefore, by coming to accept, forgive, and be at peace with oneself, these people may have a much more successful treatment and life.

    I just typed in "Buddhism and Self Forgiveness" on google books and found a page that seems to go along partly with what I was saying about self forgiveness. It also mentions and interesting study done with people of different religions and their levels of self forgiveness. The book continues to discuss psychological well being in accordance with self forgiveness. The book is called Handbook of Forgiveness by Everett L. Worthington. Seems like an interesting read.

Link to specific page from book: http://books.google.com/books?id=emUQqCtrBSAC&pg=PA150&dq=buddhism+and+self+forgiveness&hl=en&ei=OAiZTc-N_KH0QGQmpjwCw&sa=X&oi=book_result&ct=result&resnum=1&ved=0CDAQ6AEwAA#v=onepage&q=buddhism%20and%20self%20forgiveness&f=false

Regarding Sickness my ideas of the difference between psychology and spirituality.....spirit equals soul (to me) my mom used to tell me when I was first was going out "make sure someone is with you who cares about your soul." I think we have a lot of friends and people who care about us....but not all of those care about our soul. Someone who cares about your soul is not always the same as someone who will be there for you whenever you need them. Sometimes people will be there because they just thrive on your drama....if they truly care about your soul, they will not let anything bad happen to you...wont let you make a fool of yourself....wont walk away from you if you get too drunk, will make sure you're safe, will stick up for you if someone is mean to you. They will hurt for you and with you. So when I think of spirit, I think of when someone says, "she has a quite spirit....she has a kind spirit....they broke her spirit." Its not the same as personality, right? Its different...its your soul, your spirit.

I think psychology deals with your personality and physical aspect of your brain and your upbringing and background and events that happened in your life to make you the way you are. Spirituality deals more with the inner you...the center of your being that only you and God know....your soul. For me, having ADHD is psychological.
So......spiritual sickness or "scrupulosity" or psychological sickness.....You talk about scrupulosity as being the feeling that underneath we are absolutely no good. I think that is a spiritual sickness that can be treated spiritually or psychologically. I think medicine can help to a certain extent, actually a lot, and having the belief that you are precious in the eyes of God and that you are loved unconditionally can help a lot too. Think about it.....how much better do you feel when you know you are accepted by all your friends. When you know they pretty much love you unconditionally now and you feel the same about them. You have a bond. That goes a long way to make you feel good about yourself and know you are worth a lot. So, the other side of it - those who don't have that bond with anyone feel pretty worthless and no good, unlovable, how awful that must be, of course it would come out in their personality and how they live their lives. How could they have a healthy relationship with anyone if they hate themselve and feel unloveable? In the Gospel of the samaritan woman at the well with Jesus and how she comes to realize that he doesnt hate her because shes a samaritan.....she gets it. Shes not worthless. and he talks about asking God for forgiveness....you have to believe hes gonna give you forgiveness or why even ask. If you know hes gonna give it....then you know you are loved by God.

After reading this article, it is hard to imagine living life thinking that you are not worthy of anything. Sure there are times where people do not necessarily feel great about themselves, but it is very different to be constantly down on oneself and never feel any joy about one's accomplishments or positive characteristics. It is essential that people who are scrupulous find a way to realize that they are not worthless.
One statement that Cardinal O'Connor wrote in the forward of the book that I thought was interesting is "As one with a certain background in clinical psychology and psychiatry combined with more than fifty years of active priesthood, I am most grateful for what these sciences do offer, quite aware that neither faith nor theology is an adequate substitute when psychology or psychiatry is essential. The reverse of that truism, of course, is equally important." I agree with what Cardinal O'Connor says. I think it is possible to always find some way to "heal" oneself, whether that be through the use of medicine or spiritual beliefs. It is essential that people who do have a problem they need to fix to figure out a way to "heal". I think that it is also important to acknowledge that there is not always one remedy to a person's problem; some things work better than others depending on the individual. However, both psychology and religion have been helping people for a long time, and I think that people should look into one or both of these options if they are having an issue that needs to be fixed.

The end the article reflects the idea “neither faith nor theology is an adequate substitute when psychology or psychiatry is essential. The reverse of that truism, of course, is equally important.” Does proper treatment require both faith and therapy in order to work appropriately? I believe both needs to be present in order for patients to be fully healed in treatment. And at times, there are some mental illnesses that need more than just faith and theology to effectively work. People who have bipolar disorder experience mood changes, changes in thinking and beliefs and changes in ones behavior. In order to properly treat this particular disorder its best to use medication, therapy, social support as well as change in a person’s life style. With that being said, when it comes to social support, a group or community such as a religious one may be beneficial. The following article provides some useful information with proper treatment for bipolar disorder: doi: 10.1017/S0033291710002266
Similarly, I mentioned schizophrenia. This type of mental illness needs medication because it starts earlier in a person’s live and it can never be cured. In order for schizophrenia to be treated successfully multiple factors such as therapy, medication and support groups need to be implemented. The medication that is used to treat this mental illness is essential for treatment, so something like religion or faith to “overcome” the illness would not be useful. Yet, the combination may be helpful, correspondingly to the treatment for bipolar. People who have schizophrenia also need social support due to the side effects that may be presented with the treatment. It is also necessary to have a strong support system from family and friends because relationships can be hindered from such a severe illness. Again, the following article provides useful information with proper treatment for schizophrenia: doi: 10.1177/0022167810373394

This is an interesting topic to discuss. I think spirituality and psychology are definitely relatable topics.
I think faith plays a major part in treating mental health conditions. Looking to the higher power for guidance may be that additional support needed. It is important to keep a positive outlook when times are rough, and spirituality might be the answer. If God is a part of your life, why not turn to him? It is comforting to know that someone is always watching over you to protect and guide you.
It is so cool that your book was used in a sermon! I guess you really got your message across, and started getting other people thinking about spirituality and mental health.

David (#56): There is a fairly large body of evidence that indicates that those who practice a religion tend to be healthier. However, it's not really clear if it is actually the faith and believing in something that causes it or that those individuals usually have stronger community ties. Research also shows that faith and spirituality are associated with elevated levels of happiness and even a longer lifespan. Of course there are exceptions to every rule, but it seems that generally speaking faith has numerous benefits. Here is one article I found, but there are plenty more out there including more empirical studies: http://www.suite101.com/content/find-spirituality-positive-psychology-research-a113231

I too never made a connection between psychological health and spiritual health. I feel that some people probably have a better "spiritual health" than others if they are very religious and have strong feelings towards their God and the Bible. I don't know how I feel about trying to fix people's spiritual health because I don't think it's anyone's place to tell them to become more spiritual or not. For those who are not religious, are we going to say they have a bad spiritual health, therefore need psychological help? I still do not connect the two: psychology and spiritual. I think they should not be compared to be similar other than the fact that if you need psycholical or spiritual help, you need someone to talk to. Psychological health problems are often remedied a therapist or perscribed medication. I don't think any medication will make you more spiritual; even talking to someone - I don't think it's right to try and influence someone's religious beliefs to make them more spiritual.
I consider myself religious; I have been confirmed at my Presbyterian Church, and even though I have not been to Church in a long time, I do still think I am religious to a degree. I would not consider myself spiritually unhealthy, nor would I say I'm in the best "spiritual health" of my life. However, I don't think I need a therapist telling me I should be more connected to spiritual thoughts, etc. I don't think people are unhealthy if they are not religious; i think that is a matter of opinion and everyone is entitled to believe what they want with out being told if they need a spiritual advisor...I mean that's why we live in America right?

   Reading this article was very interesting to me becasue I never really connected being psychologically healthy with spritually healthy. It's true though, some people can be mentally stable but there is something else that is sickening. It would be a lack of spiritual salvation. Whatever God people believe in I feel as if most need an outlet to turn to. When all else fails in the world around them, and they are in despair, the spiritual soul can be nourished to bring their mental stability back to health.
  It relates again to the dependency on medication in our society. When people are mentally distraught or upset, it could very well be due to a mental sickness, but it could also be something that does not need medical attention. It could be a belief in a higher power that will alleviate all problems. It may not be politically correct to say but sometimes the best medication is to let go and let God.

Prior to reading this entry, I had never heard the term scrupulosity before but I was intrigued and did further research. According to Rev. Thomas Santa, "In Catholic moral teaching, scrupulosity defines the spiritual and psychological state of a person who erroneously believes he is guilty of mortal sin and is therefore seldom in a state of grace. A scrupulous person has difficulty making choices and decisions even though he desires above all else to please God and to follow God's law. For a scrupulous person, it isn't that he doesn't "carefully attend to the sacred and certain teaching of the Church" (as the Catechism teaches), but that he becomes overwhelmed with the details and nuances that may be present in the decision (http://www.catholicculture.org/culture/library/view.cfm?recnum=3739)." Such a condition sounds like a horrible thing to deal with. I had heard the phrase 'Catholic Guilt' and this sounds like a much more intense version of what I considered to be the guilt laid on children in religion classes for each small sin they commit. I was Catholic for a small portion of my life (before switching to an Episcopalian church), and many of my memories from religion class consist of discussing sin, discussing penance, and the need to go to Confession weekly. When I switched churches, my religious education classes were taught from a very different perspective. We were taught to love and respect everyone, despite how they treated us or if we agreed with what they believed. We were taught that God will forgive all our sins if we do wrong and that we were not going to Hell unless we did something incredibly wrong. Maybe this was just my experience, but I feel that all of my memories of the Roman Catholic religious education system revolved around guilt. We were required to confess to God and a Priest if we said a curse word, while I like to believe God has more important sins to be worrying about. Not to disregard or offend the Catholic Church, but is it possible that their way of teaching (or at least the way MY Catholic Church taught) is to blame for this condition? Growing up believing that everything you do will upset God must have some affect on the conscience and human mind. It is unhealthy to allow guilt of any kind to overtake your life, but I can't imagine feeling guilt towards God for everything I do or don't do.

Dr. VanOrnum,

Interesting article! I never even considered that spirituality may play a role in mental and psychological health. However, after reading your article, and remembering personal experiences and observations, I truly agree! Spirituality plays a significant role in the way an individual may attend to his or her feelings or emotions. In example, a friend of mine once experienced a very traumatic situation and was severely upset. She continued to discuss the good in the Lord and his decisions for such a situation happening. With the trust of her spirituality, she avoided what could have turned to clinical depression.
I think it is very interesting and amazing that the Cardinal used your book in his sermon, Wow! That is so impressive, considering the article you wrote was on spirituality and a Cardinal found your opinions so important that he highlighted them in his sermon.
I find your articles extremely interesting and thought provoking. Glad we are able to view them, keep them coming!

Defense of That a forgiving God loves the damned as they roast in Hell for all eternity
Because the damned have being (Catholics are not annihilationists), and being is good, and God loves what's good, God loves the damned. Damned or not, the meaning of getting to be a be-er is "God loves you." And the God that loves the damned can be a forgiving God, because whether or not God is forgiving does not depend upon whether humans receive that forgiveness by their repentance. And what is takes to be in Hell is not receiving that forgiveness by acts of repentence. So having people in Hell does not conflict with a forgiving, loving God.
Another approach: For the sake of argument, let's say Jesus is God and is forgiving and the Bible records some of what he said. The Bible has him saying, "Depart from me ye cursed into everlasting fire prepared for the devil and his angels." So we've got damned and we've got a forgiving and loving God, together.
David, am I helping you become de-fascinated :), or is this not really working?

Several comments mention God's love and forgiveness, and that’s always nice to see. However, because in the Catholic story a forgiving God loves the damned as they roast in Hell for all eternity, making the point that God loves and forgives us does not affect the setting scrupulosity responds to. I would like to say something about that setting, something that gives non-scrupulous folks a way into understanding scrupulosity as the sober response of an honest heart to the gospel of eternal damnation, and not as sickness.

All it takes for scrupulosity to be rational is RCC teaching that eternal damnation awaits those who fail to repent of each and every mortal sin. Self-monitoring decreases the odds of failing to repent. And because the payoff is eternal damnation, no finite amount of self-monitoring could ever be too much. So go for it! There's no comparison between the pain of eternal damnation and the pain of a lifetime of sick-making self-hatred, agony, and terror.

When the brain aneurysm or the texting driver or the lightning bolt comes and ends it all for you, if you have not repented of each and every act of freely taking pleasure in the thought of placing your hands where a woman's waist meets her hips, you're toast for all eternity. ''Watch ye therefore,'' said Jesus, maybe.

Want to help the scrupulous? Go to the root. Invite the scrupulous to consider whether we any longer have access to facts that would decide the matter of whether Jesus or anybody else acted with divine authority to set up a teaching authority that would be the sole authentic interpreter of divine revelation. Invite them to consider whether we any longer have access to facts that would decide the matter of whether any revelation has ever been made at all. Set them free.

I think Alyssa raises a good question (#46). Currently, I can't think of an answer, but this is something that I am going to think about for a while!

In an objective, unbiased sense, does the Church have anything to GAIN when the people are taught to believe that they are constantly being judged and that all people are inherently evil? Why, as Catholics, are we more prone to becoming scrupulous? Do we have to follow more strict and harsh rules that scare us?

Maybe we are lead to be afraid in order to prevent us from sinning, though I think that would be doing us a huge disservice, because even righteous people that do incredible things have some level of fear.

Also, was it established whether these scrupulous people donate or volunteer their time? I am curious about whether they are active in their community, especially if they think that people are inherently evil; why help them? Or does this give them reason to help others?

When I think about the field of psychology I consider all different kinds of disorders and treatments. The key word here is treatments, because it is nice to think that everyone has equal opportunity to find a cure to their disease and find happiness in life. Until now, I had never even heard of scrupulosity. It makes sense to me that it would exsist because your religious beliefs (or lack there of) help an individual to define their own identity. Different people take on different understandings of religious scriptures and this shapes the person they will become. Having said this, it is much harder to cure a disease that is rooted in spirituality because their is no concrete rational behind it. Therefore, a spiritual healer or psychologist could potentially be talking in circles with a patient for years and still never be able to cure a person suffering from this cynical disorder.
I found it absolutely devastating to learn that some people truely feel they are incapable of being loved and that they are intrinsically evil. This goes beyond being an upsetting way of life, to a point of self-destruction. A human being can simply not survive if they are incapable of loving themselves and creating meaningful relationships with others. Life is full of tumultuous rollercoasters, and the people we surround ourselves with are what helps us get through the pitfalls. When everything goes wrong and loved ones are not there for us, it is nice to thin that there is some kind of higher being or transcendent form of love that is there for us. Unfortunately, people who are suffering from this disease do not feel this way and instead take part in destructive and sinful behaviors. These people can not ask for forgiveness from God because they do not feel that God (or anyone else for that matter) will ever love them. There are missing out on the mere essence and greatest joy in life, which is happiness, by always thinking so negatively through such tainted shades. Cardinal O'Connor's quote, ''We are not going to ask forgiveness unless we believe we need forgiveness and unless be believe he will grant forgiveness'' captures this idea perfectly. If these poor people do not stray away from their diseases through immense help, then these individuals have a futile future.

Walter (47) I would 100% agree with your take on it; maybe sometimes some are too hard on themselves, and forget the forgiving and loving nature of God.

The disorder of scrupulosity raises an interesting issue about the connection between spirituality and psychology. In many ways religious leaders are like psychologists in that they are there to help counsel individuals and get them through difficult times in their lives. Despite this similarity, faith and science are seen as two completely different realms with little to no overlap.
While organized religion may not be for everyone, I think there is something to be said for the role of spirituality in mental health. Having faith in something, regardless of what that belief may be, seems extremely beneficial. Changing a behavior alone is not enough to fix a problem, so for many disorders, successful treatment could come from a combination of traditional psychological methods and spiritual measures.

Before having read this article, I had never learned of scrupulosity before. As a psychology major, I have yet to think about any cure to a psychological disorder, other than the two most common and obvious; talk therapy and medication. The spiritual aspect of psychology is easy to link to the psychological aspect of it. In order to believe in yourself and the people around you, you have to make connections on a deeper level with other people in order to feel 'normal' by relating to other people's emotions,feelings, and problems. Through talk therapy, patients are able to release their emotions as a therapist interprets their feelings that may be hard to uncover unless the therapist is digging deep into the mind of the patient. Medication within the field of psychology seems to definitely impact patients and their disorders, but much of the time leads to a possible drug addiction or misuse of the drug that was once "helping" them.
'Scrupulosity is a psychological disorder characterized by pathological guilt about moral or religious issues. It is personally distressing, objectively dysfunctional, and often accompanied by significant impairment in social functioning'. With a psychological disorder like scrupulosity, talk therapy or medication don't seem to be the cure that the patient needs. A patient with this disorder needs something more direct and in-depth in order to help them overcome or even just weaken their symptoms of the disorder. Spiritual efforts must be made in order to help these patients become more open to the religious world and believe in God on a deeper level than just "saying" they believe in God. Attending church even helps to make me feel less stressed and more relaxed because I look to God whenever I am in a situation that I feel I can't deal with alone. Spiritual therapy definitely seems as if it would be an impressive and growing 'medication' for any patients with this disorder, or any psychological order for that matter.

After reading Vanessa’s post referencing a study that showed that devout Jews evidenced fewer fears of sin and punishment from God compared to devout Protestants or Catholics, it made me think: Is the church responsible for scrupulosity? Does the church teach that God is always judging us? This is never a feeling I received in my years of religion classes and my experience as an altar server. However, if this is true for some, it would make therapy for clergy members all the more important, rather than seeking spiritual therapy.

Kristin #40

More than once the thought has also crossed my mind that organized religion has much to do with scrupulosity! :-) / :-(

Thank you for affirming the efficacy of higher powers, kindness, and support. bvo

#39 David and #40 Michelle

Thanks for keeping the conversation going. This has been debated since before Chrisitanity and honorable people in all ages have held different viewpoint. best, bill

#36 Christine & #37 CBenjamin

I am impressed by your humility and openness. best bvo

Spiritual direction should also be mentioned. It has the talk therapy of psychology and it can help the seeking person to sooner reach a spiritual goal.
You can find spiritual directors by calling retreat centers, asking religious sisters doing pastoral work in parishes and also contact Episcopal parishes as they seem to be taking a lead in certifying spiritual directors.

A Franciscan priest from the San Luis Mission is giving a series of lenten talks at my parish. He is age 71, has had lots of experience and currently is counseling persons who were molested by clergy.. His subject today was "forgiveness" and it was very enlightening and healing for me. He gave the holistic view: the act of forgiveness is both psychologically and spiritually healing. Persons who were abused by those older and/or in positions of authority suffer an excrutiatingly painful betrayal of trust. From my own experience of many years ago, I thought I had forgiven the therapist. I had made an act of will of forgiveness. That apparantly was not sufficient for my healing. Like a wound covered by a scab the anger from the abuse festered at some sub or unconscious level for many years and recently emerged. The expression of that anger was dumped on a totally innocent friend and ruined our friendship which was vey important to me. At today's talk and the priest's readings from Scripture I was overwhelmed with feelings of sorrow and forgiveness. A great blessing from God through one of his priests. Again, ABBA does provide.

"Therefore, since we are justified by faith, we have peace with God through our Lord Jesus Christ, through whom we have obtained access to this grace in which we stand; and we boast in ouir hope of sharing the glory of God. And not only that, but we boast in our sufferings, knowing that suffering produces endurance, and endurance produces character and character produces hope, and hope does not disappoint us, because God's love has been poured into our hearts through the Holy Spirit that has been given to us." Romans 5:1-5

I agree that spirituality plays in important role in mental and psychological health. Based on personal experiences, I think that spirituality can play an important role in the treatment of certain problems like addiction. For example, an important part of AA is acknowledging a higher power and surrendering to that power. Another essential part of the program and is the kindness and support you receive from the other members. Similar to the story of the woman and the Samaritan there are no judgments. The people in the group are there to help each other no matter how many times they may need that help.
I do feel that sometimes we equate organized religion with scrupulosity. We sometimes feel inadequate and that we don't measure up to what is expected of us. We feel that God is judging us. This article implies that scrupulosity is the belief that people are intrinsically no good. It is certainly a healthier attitude to take the view that God is loving and all forgiving. This belief would be an important component along with psychotherapy and medication in the treatment of mental health conditions.

David wrote: " I don't see how we can discuss treating it if we don't know what it is...."

I don't know that your questions can be adequately answered. Humans are such complex beings, with our physical, emotional, spiritual selves so entertwined I feel that in many cases it is fairly impossible to tease out what is causing what. Especially when you begin looking closely. There are physical expressions of psychological illness, and medical doctors are taught to rule out the physical before deciding on the psychological. But then trying to discern between psychological and spiritual sickness adds a whole new layer of complexity. If you believe man is just an exceptionally complex machine, and all our actions/reactions/illnesses/neuroses, etc... can be explained by physical realities (biochemical, nutritional, etc...), then I think trying to add in and figure out where spiritual illness lies just isn't going to fit into that model. Maybe it is all chemistry (etc..), but I feel strongly that the soul, or spiritual part of us whatever we want to call it, is not bound by these physical rules.

Perhaps one can't tell just by looking if something is spiritual or psychological. Or perhaps they are in many ways the same, but the optimal treatment for a particular patient may lie with one or the other focus. Perhaps a spiritual sickness can be defined after-the-fact, when spiritual therapy yields results? Pehaps most things are spiritual in nature and we just fail to acknowledge this dimension? Perhaps you are correct, and everything really is just a product of our physical nature, and we just haven't discoverd the cause yet. Lot of perhapses. It is my belief, and I can't back this up with a definition or any data, that much of what is wrong with our world today is from a long-standing spiritual deficit. Just an opinion, a belief ... is that enough?

Have you read Viktor E Frankl's Man's Search for Meaning ? Excellent book, which on some level may help to clarify the line we are looking to draw: a line which by its nature is not entirely solid.

Though I am not the most spiritual person around, I strongly believe that ones spirituality has one of the greatest impacts on their lifesytles but especially on their pschyological state. I think that we can see this correlation with people who believe that their bodies need to be modified in some way shape or form and are unsatisfied with the body that was given to them at birth. Arent these the people who we often see suffering from depression or develop a psychological problem because of where their spirit lies? One who is in one with their spirit may realize that the lord chose them to look, act and feel in such a way and noone...absolutely noone is exactly the same as they are. I believe that each individual needs to become one with their spirituality in order to be one with their psyche. This posting made me reflect on alot of things...thank you

Despite three years as a psychology major, I had never given much thought to the relationship between psychology and spirituality. This topic had never been discussed in my psychology classes and I see now that it is an important aspect of personality that warrants consideration. An individual’s spirituality or religious affiliation plays a large role in their sense of identity and acts as another facet of life to be considered by psychologists.

In terms of scrupulosity, there is an evident relationship between spirituality and psychology. Like Kayna’s posting, I found the description of scrupulosity much like that of body dysmorphic disorder (BDD). People with BDD have obsessive thoughts about a perceived deficit in their body image. This is much like the perceived personality deficit perceived by individuals suffering from scrupulosity.

A 2005 study entitled “Scrupulosity in patients with obsessive compulsive disorder: relationship to clinical and cognitive phenomena” investigated the relationship between religious affiliation and scrupulosity. Results found that Protestant participants had a significantly higher number of scrupulous people than those without a religious affiliation. Results also showed that scrupulosity in Catholics was significantly higher than that of Protestant participants.

http://ocdtherapist.com/PDFs/ScrupulosityinOCD.pdf

Jaclyn,

Nice article from Psychology Today. I think it has relevance for those of us wanting to be teachers-you will want to have an awareness and sensitivity of the many different spiritual traditions present in any contemporary classroom. This adds to one's understanding of students, families, and co-workers. best, bill

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