The Struggle with Scrupulosity

Note from the editor: Earlier this year, having learned of his forthcoming book on scrupulosity, I contacted Kevin Vost with some interview questions on what has been revealed as a topic of much interest among the Catholic faithful. It was only shortly after I received his answers that Kevin unexpectedly passed away. With Scrupulosity now available for sale, we elected to publish this, what turned out to be Kevin’s last piece for Catholic Answers Magazine Online, both to draw attention to a much-needed book on an important topic and as a token of our affection for a departed friend whom we sorely miss.

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There seem to be a lot of misconceptions about scrupulosity in the modern secular world. What exactly is it? Are there any distinctions between how the term is used in Catholic circles and secular circles?

The word scrupulosity derives from the Lain word scrupulis, which means “a small, sharp stone or pebble.” People with scrupulosity walk around as if they have annoying little pebbles grating and irritating their minds and souls, and they just can’t seem to shake them out.

Scrupulosity produces feelings of doubt, guilt, and anxiety. It typically involves seeing mortal sin where there is only venial sin or obsessively focusing on possible or imaginary sins that may not be sinful at all.

The psycho-spiritual “pebbles” that make up scrupulosity come in a great number of varieties, though they can be classed into a few common categories: scruples of potential sins involving sexual, violent, or blasphemous thoughts; prayer practices; and reception of the sacraments, especially confession and the Eucharist.

Scrupulosity is certainly not unique to Catholics, and the content of scruples tends to accord with various religions’ more fundamental beliefs. For example, one study showed more scrupulous responses among Turkish Muslims than Canadian Christians on a “fear of God” scale of a psychological test used to measure scrupulous tendencies.

Still, religion in general is not necessarily the “cause” of scrupulosity. We must recall that most religious people do not experience any severe or prolonged problems with scrupulosity. Second, we should note that some people who do not go to church and describe themselves as non-religious do experience religious scruples—fearing that they have offended God! Third, there is a related form of scrupulosity, found at times in both the religious and the non-religious, that has been called a secular or moral scrupulosity, centered on issues of right and wrong or potential harm to others without specific religious content.

That this kind of scrupulosity should exist should be no surprise to Catholics. Let’s recall these words of Saint Paul:

When the gentiles who have not the Law do by nature what the Law requires, they are a law unto themselves, even though they do not have the Law. They show that what the law requires is written on their hearts, while their conscience also bears witness and their conflicting thoughts accuse or perhaps excuse them on that day when, according to the gospel, God judges the secrets of men by Jesus Christ (Rom. 2: 15-16).

There is a “natural law” written in the hearts of every one of us, whether or not we recognize that it derives from God’s “divine law.” The human capacity of conscience, this innate capacity to discern right from wrong, is there in every one of us, and in certain circumstances, it can be misdirected into unneeded doubts and worries, into scrupulous thoughts and behaviors.

What prompted you to devote a book to this topic? Do you find that scrupulosity is more of a problem now than in ages past?

I was invited to write this book after giving a talk on Dominican spirituality to a group of lay Dominicans, one of whom was an editor at Our Sunday Visitor. She knew of my background as a psychologist. I accepted the invitation, because although I was no expert on the topic at the start, I knew several devout and accomplished friends who struggled with the problem, and I felt that it would be worthwhile for me to learn more about it, and hopefully pass on to others the best insights I would uncover in my research.

The prevalence of scrupulosity is difficult to gauge because we really don’t have much in the way of precise statistics on it. A small percentage of people seek professional medical help or spiritual direction, but many more likely suffer from it on their own. In my own informal surveys of priests, I’ve come across some who’ve reported encountering very few cases and others who specialize in providing spiritual direction to the scrupulous. There are some Catholic websites and organizations dedicated to helping the scrupulous.

Is scrupulosity a medical problem or a spiritual problem—or both? How is it “treated”?

I believe that it is both a spiritual and a psychological problem that in some cases may also have a biological basis in the brain, though that does not mean it is incurable. At least one Catholic psychologist has noted a form of “developmental scrupulosity” that some people experience, especially in adolescence, that tends to fade away over time. Others with a longer-lasting “emotional scrupulosity” may suffer doubt, anxiety, and distress to such an extent that they meet the criteria for Obsessive-Compulsive Disorder (OCD).

In psychiatric terminology, religious scrupulosity is considered a subtype of OCD in which distressing, obsessive thoughts, and the compulsive behaviors used to curb the distress, focus on religious issues, rather than other common obsessions regarding things like cleanliness or orderliness. According to the latest statistics, only about 2.3% of Americans obtain the diagnosis of OCD throughout their lifetimes.

There are a variety of psychological treatments for more severe scrupulosity. The most common and effective is called Exposure and Response Prevention. In a nutshell, people with scrupulosity work with a therapist to list things that prompt scrupulous thoughts and behaviors for them. Then, working with the therapist, they are exposed first to the mildest triggers while suppressing their compulsive behaviors used to counteract them. This helps them see that nothing bad happens if they simply ignore and let intrusive, obsessive thoughts fade away without actively curbing them. For treatments like this, however, the therapist should be well versed in Catholic morality or work in consultation with the client’s priest, with the client’s permission, of course, to be sure that the behaviors encouraged in therapy are truly not sinful in themselves.

As for its spiritual nature, even great saints battled scrupulosity and won (e.g., St. Ignatius Loyola), or endured it throughout lives and did great things for God and the Church despite it (e.g., St. Alphonsus Liguori). Some priests and spiritual directors have expertise in dealing with people with scrupulous thoughts and behaviors working on their own, or in conjunction with therapists. St. Alphonsus advised that anyone troubled by scrupulosity should find one holy and competent spiritual director and follow that person’s advice.

There are people crippled by scrupulosity, and then there are people who dismiss any concern about sin as scrupulosity. How can we take a middle road between these two extremes when we examine our conscience?

Very true. Vices involve missing the golden mean, the middle road between opposing vices of excess and deficiency, too much and too little.

Those crippled with scrupulosity worry too much about sin. They see sin where there may be no sin at all or worry excessively that they might have committed some sin. On the other hand, the unscrupulous miss the mark of true virtue by dismissing sin altogether. The atheist philosopher Bertrand Russell contended in a book on happiness that the world’s problems are due not to sin, but to belief in sin. Ironically, one of his chapters is on the negative impact of envy—one of the seven deadly sins!

How we might take the middle road when examining our own consciences for sin takes us to our last question.

How can the Church’s understanding and treatment of scrupulosity benefit our non-Christian relatives and friends?

The Church’s understanding and treatment of scrupulosity can be of benefit to even non-Christian relatives and friends because the Church is so firmly grounded both in faith and in reason. Even those who deny the Catholic faith possess a human nature, a conscience, powers of emotion, reason, and will, that the Church understands most deeply. In fact, when I, having possessed a doctorate in clinical psychology for seven years, first encountered the writings of St. Thomas Aquinas on human nature, I considered his understanding greater than any of the great modern psychologists and psychiatrists.

For Catholics with scrupulosity, a deeper understanding of what the Church actually teaches can also be of immense benefit. For example, people with scrupulosity often treat temptations, or spontaneous unwanted thoughts, images, or memories, as if they were sins. They would do well to deepen their understanding of the Church’s teachings on the difference between temptation and sin, and how sin requires a deliberate act of will regarding any temptation.

Ironically, too, the sacraments of reconciliation and the Eucharist are often the subject matter of people’s scrupulous thoughts and behaviors, and yet, when properly understood and embraced, they can supply us the grace and spiritual balm to overcome, or at least endure, scrupulosity. Also of great importance is a deeper meditation upon the love and limitless mercy of Jesus Christ, who gives himself to us in the Eucharist. He told us he wants us to live in peace, with hearts untroubled and unafraid (John 14:27).

There is always hope for the scrupulous, even for those who worry that they may never overcome it. As St. James advised us: “Count it all joy, my brethren, when you meet various trials, for you know the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing” (James 1:2-5).

With that thought in mind, I’ll close with the encouraging words of Dominican theologian Blessed Henry of Susso:

We may conclude that persons who suffer from scruples are the most favored by divine love, and the most certain of reaching Heaven when they bear this trial in patience and humility. Scrupulous souls die continually, they suffer a continual purgatory, and so they leave the earth to fly to Heaven purified and free from sins to expiate.