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This chapter surveys the theory, development, and practice of Orthodox Psychotherapy as related to the treatment of spiritual / psychological disorders and pathologies. It summarizes and expands upon the exploratory studies of Bouton (2004) and DiLeo (2007), and addresses (a) the foundational presuppositions of Orthodox psychotherapeutic theory and practice; (b) the etiology of spiritual / psychological disorders and pathologies; (c) the 'cycle of temptation'; (d) neptic treatment; and (e) depressive symptomatology and comorbid anxiety from the perspectives of the DSM-IV and the Holy Fathers. The literature review provides a backdrop to the present study, which hypothesizes that Orthodox Psychotherapy, can play a central role in the treatment of depressive symptomatology and comorbid anxiety.

2.1 Foundational Presuppositions of Orthodox Psychotherapy

In contrast to Western psychologies and therapies, which are principally symptom-relief oriented, the treatment emphasis in Orthodox Psychotherapy is holistic. This approach has extensively established and confirmed benefits and was also once the unquestioned orthodoxy of the Western medical tradition for the two millennia prior to the nineteenth century (Hastings, Fadiman, & Gordon, 1980). According to Metropolitan Hierotheos Vlachos (1997), the foundational and critical tenet of Orthodox Psychotherapy is that pathologies are the product of a darkened nous and an impure heart. When a person is inwardly healed, when the noetic part of the psyche is purified and nous is freed, spiritual, psychological, emotional, developmental and often, physical pathologies, disappear.

2.1.1 The Psyche and the Nous

According to the American Heritage Medical Dictionary (2004), psyche is defined as the mind functioning as the center of thought, emotion, and behavior and consciously or unconsciously mediating the body's responses to the social and physical environment. In Western psychological paradigms, the psyche is considered as a subjectively perceived, functional entity, based ultimately upon physical processes but with complex processes of its own that govern the total organism and its interactions with the environment. It is the human faculty for thought, judgment, and emotion. It is the mental life, including both conscious and unconscious processes; the mind in its totality, as distinguished from the body (Cavarnos, 1987). Its precise nature and functions, however, are not defined (Vlachos, 1993).

Conversely, in order to discuss Orthodox Psychotherapy, it is necessary to specifically understand, describe, and delineate the nature and operational functions of the psyche (Chrysostomos, 1994). This is the principal weakness of Western schools of psychology. In modern Western psychological systems, the nature and operationality of the psyche are matters of subjective discourse (Vlachos, 1993; 1997). This is not the case in the East.

In Orthodox terminology, psyche is concretely identified with the life-principle, commonly called the soul. According to Cavarnos (1987), the Orthodox Church teaches:

...that the psyche is a simple, uncompounded, incorporeal, self-active, wholly imperishable substance, which acts upon the body and is acted upon by it, and possesses 3 main powers: the rational, the spirited, and the appetitive.... [the Holy Fathers] insistently affirmed the immortality of the human soul; and some of them, such as St. Athanasius, St. Gregory of Nyssa, and St. Maximus the Confessor, undertook to prove its immortality by rational arguments as well as by reference to the Holy Scripture. The soul they assert, does not perish when the body dies. It survives in its entirety the death of the body, as a conscious, personal being, and will experience either happiness or suffering, depending on the quality of its life on earth, until the day of the Resurrection and Judgment, when the souls will be invested with spiritual, indestructible bodies. Thereafter the soul will share with the body in unspeakable blessings [Heaven] or in unspeakable torments [Hell]. (p. 9)

To recap, according to Orthodox dogma, the psyche is an entity distinct from the body. It is a created immaterial substance, simple, uncompounded, indivisible, self-active, self-conscious, rational, free, and immortal. The immortality of the psyche depends ultimately on the justice, goodness, wisdom, and power of God (Vlachos, 1997).

Metropolitan Hierotheos Vlachos (1993; 1997) explains that the psyche is the life-principle that exists in every creature, including plants and animals. However, in the Holy Scripture, the psyche is commonly referenced as it relates to wo/man (Vlachos, 1997). Psyche is the life-principle that exists in wo/man, and it is also every individual wo/man who has life (Vlachos, 1991; 1992; 1993; 1997). Additionally, psyche refers to that life which is the spiritual element or dimension of wo/man's existence. It signifies the way in which life is manifested in wo/man. It does not simply refer to one aspect or component / compartment of human existence, i.e., the spiritual vs. material, but refers to the whole wo/man, as a single living hypostasis (Vlachos, 1991; 1992; 1993; 1997). The psyche does not merely reside in the body, but is expressed by the body. "Consequently, man is a psyche, man is a human being, man is someone, for the psyche is not the cause of life, it is, rather, the bearer of life" (Vlachos, 1997, p. 98).

The word ' psyche' is used by the Lord Jesus Christ and the Apostles to denote life, as in the case of the angel who spoke with St. Joseph the Betrothed: "Arise, take the young Child and His mother, and go to the land of Israel, for those who sought the young Child's life [psyche] are dead" (Matthew 2:20 KJV). Again, the Lord, referring to Himself, said: "I am the good shepherd. The good shepherd gives his life [psyche] for the sheep" (John 10:11 KJV). In a similar manner, the Apostle Paul, writing about Priscilla and Aquila, says: "[they] risked their own necks for my life [psyche]" (Romans 16:4 KJV). In these cases the term used for 'life' is 'psyche' (Vlachos, 1993; 1997).

Psyche is also used to indicate the spiritual dimension or component of wo/man's existence [see Matthew 10:28 and Luke 12:20]. The difference between psyche as the spiritual dimension in human existence, which is mortal by nature but immortal by grace, and psyche as the life-principle is accentuated by the Lord when he says: "For whoever desires to save his life [psyche] will lose it, but whoever loses his life [psyche] for My sake will find it" (Matthew 16:25 KJV). In the first case, the Lord uses the term psyche as referring to the spiritual dimension of wo/man's existence and in the second case it refers to the life-principle (Vlachos, 1991; 1992; 1993; 1997). In his letter to the Thessalonians, the Apostle Paul prays: "Now may the God of peace Himself sanctify you completely; and may your whole spirit, soul [psyche], and body be preserved blameless at the coming of our Lord Jesus Christ" (I Thessalonians 5:23 KJV). The term 'spirit' refers here to the grace of God, the charisma, which the psyche receives (Vlachos, 1991; 1992; 1993; 1997). Additionally, and notwithstanding the clear distinction between psyche and body, the word ' psyche' is also used to refer to the whole wo/man (Vlachos, 1997). The Apostle Paul states: "Let every soul [psyche] be subject to the governing authorities" (Romans 13:1).

The Orthodox understanding of psyche is clear and precise (Chrysostomos, 2000b; 2007; Nahum, 2001; Vlachos, 1993; 1997). The psyche animates the body and gives it life (Vlachos, 1991; 1992; 1993; 1997). It is wo/man's immaterial nature, created, but eternal, comprising wo/man's cognitive, conative, and affective faculties, both conscious and the unconscious. Psychic health, therefore, precedes salvation (Chrysostomos, 2007). In order to encapsulate the meaning of the word 'psyche' in English, the meanings of at least five English words must be combined, i.e., soul, life, breath, psyche, and mind (Vlachos, 1991; 1992; 1993; 1997). In the New Testament and in the writings of the Holy Fathers, the psyche is sometimes identified with the nous and the two terms are often, but not always, used interchangeably (Romanides, 2007).

Nevertheless, understanding the workings of the nous is also a necessary pre­requisite to understanding Orthodox psychotherapeutic theory and method (Vlachos, 1991; 1992; 1993; 1997). As in the case of the psyche, no single English word conveys the exact meaning of the word 'nous' (Vlachos, 1993; 1997). Nous has been translated as: mind, thought, reason, attitude, intention, purpose, understanding, discernment, etc. (Zacharias, 2006). However, the combination of English words that best conveys the meaning of the Greek word 'nous' is probably the 'transcendent apperceptional power of the psyche' (DiLeo, 2007). In addition to this, the term nous also has other meanings. The Holy Fathers sometimes refer to the nous as the heart, or the essence, of the psyche (St. Maximus the Confessor, 1985). More particularly, it constitutes the innermost aspect of the heart. St. John of Damascus (1979) refers to the nous as the 'eye of the psyche' and St. Macarius of Egypt and St. Isaac the Syrian (as cited in St. Nikodemos & St. Makarios, 1983) identify the nous with the organ of theoria, which is engaged in pure prayer.

The psyche is closely identified with the nous. Wo/man's psyche is triadic, i.e., it is nous, logos, and spirit (Vlachos, 1991; 1992; 1993; 1997). Since the nous is identified with the psyche, it also has three powers (Vlachos, 1991; 1992; 1993; 1997). While the nous is one of the powers of the psyche, it is, at the same time, the psyche. As God has essence and energy, the psyche, which is in the image of God, has essence and energy (Vlachos, 1991; 1992; 1993; 1997). The nous, being identified with the psyche, also has essence and energy (Chrysostomos, 2007; Nahum, 2001; Vlachos, 1993).

The nous is also called the essence of the psyche, i.e., the heart. In the Holy Scriptures and the writings of the Holy Fathers, the terms 'nous' and 'heart' are often used interchangeably (Vlachos, 1991; 1992; 1993; 1997). The Lord blesses the pure in heart: "Blessed are the pure in heart, for they shall see God" (Matthew 5:8 KJV). God is revealed in the heart and it is in the heart that wo/man comes to know God. The Apostle Paul writes that God's illumination is in the heart and that God has caused His light to shine "in our hearts to give the light of the knowledge of the glory of God in the face of Jesus Christ" (II Corinthians 4:6 KJV). The same Apostle prays "that the God of our Lord Jesus Christ, the Father of glory, may give to you the spirit of wisdom and revelation in the knowledge of Him, the eyes of your hearts being enlightened that you may know..." (Ephesians 1:17-18 KJV). The heart receives the revelation of the knowledge of God. In other references of the Holy Scriptures the term 'heart' is replaced by 'nous' (Vlachos, 1991; 1992; 1993; 1997). After the resurrection, the Lord: "opened their [His disciples'] understanding [nous] that they might comprehend the Scriptures" (Luke 24:45 KJV). Since wo/man comes to know God through the opening of the eyes of his / her heart and through purifying his / her heart, the phrase 'He opened their understanding' is the same as 'He opened their hearts' (Vlachos, 1991; 1992; 1993; 1997). In a similar manner, "Blessed are the pure in heart, for they shall see God" is, according to Metropolitan Hierotheos Vlachos (1993; 1997) linked with the apostolic passage: " transformed by the renewing of your mind [nous]" (Romans 12:2 KJV).

The nous is called heart and the two terms 'nous' and 'heart' are interchangeable. St. Maximus the Confessor (1985), interpreting Christ's saying: "But rather give alms of such things as you have; then indeed all things are clean to you" (Luke 11:41 KJV), says: "This applies to those who no longer spend their time on things to do with the body, but strive to cleanse the nous (which the Lord calls 'heart') from hatred and dissipation (Vlachos, 1997). For these defile the nous and do not allow it to see Christ, who dwells in it by the grace of holy baptism" (p. 109). So the nous is called the essence of the psyche, i.e., the heart. In this conception nous and heart are identical, since Christ dwells in the nous (Vlachos, 1993; 1997).

The energy of the nous, 'consisting of thoughts and conceptual images', is also called nous. The Apostle Paul writes to the Corinthians: "For if I pray in a tongue, my spirit prays, but my understanding [nous] is unfruitful. What is the conclusion then? I will pray with the spirit, and I will also pray with the understanding [nous]. I will sing with the spirit, and I will also sing with the understanding [nous]" (I Corinthians 14:14-15). In this passage the spirit is the gift of tongues, and the nous is reason. So here 'nous' is identified with reason, intellect, or intelligence (Vlachos, 1991; 1992; 1993; 1997).

In addition to St. Maximus the Confessor (1985) identifying the nous with intelligence and the heart, i.e., the center of wo/man's being, through which s/he acquires the knowledge of God, St. Maximus also presents the distinction and energy of each function of the nous. He states: "A pure nous sees things correctly. A trained intelligence puts them in order" (p. 82). The nous is that which sees things clearly and therefore should be purified, and the intelligence is that which formulates and expresses that which has been seen (Vlachos, 1997).

The nous is wo/man's highest faculty (St. Nikodemos & St. Makarios, 1983). When cleansed, the nous resides and operates from within the heart (Vlachos, 1991; 1992; 1993; 1997). It can perceive God and the spiritual principles that underlie creation. It is cognitive, conative / visionary and voluntary, and affective / intuitive (Vlachos, 1991; 1992; 1993; 1997). After wo/man's fall and the fragmentation' of the psyche, the nous invariably identifies itself with reason, or the mind, imagination, senses, or body, losing sight of its pure unalloyed state (Chrysostomos, 2007; Nahum, 2001; Peters, 1970; Vlachos, 1993; 1997).

In the West, the understanding of the functions of the nous has been lost, and Westerners identify the nous with intelligence or intellect (Vlachos, 1973). The post­modernist Western civilization is the culture of the loss of nous (Vlachos, 1991; 1992; 1993; 1997). The heart has died, the nous has been darkened, and the psyche cannot even perceive the nous' presence (Vlachos, 1991; 1992; 1993; 1997). For this reason this explanation is necessary. The wo/man who has the Holy Spirit residing within him / her, who has been purified and illumined, does not need clarifications, because s/he him/herself knows from experience the presence and existence of the nous (Chrysostomos, 2007; George, 2006; Vlachos, 1973; 1997; Zacharias, 2006).

Notwithstanding, the clarification of the functionalities of the psyche and nous is necessary to the understanding of Orthodox Psychotherapy, which is intrinsically connected to hesychasm, and which is in turn rooted in the mystagogy of the Orthodox Church (George, 2006; Vlachos, 1973; 1997; Romanides, 2007; Zacharias, 2006). The foundational concepts of Orthodox mystagogy include precise teaching regarding the natures and powers of the psyche and nous (Farrell, 1987).

According to St. Maximus the Confessor (as cited in Vlachos, 1993), the basic powers of the psyche are the theoretikon, called nous, and the praktikon, called logos. St. Maximus (1985) explains that the powers of the psyche are numerous. The noetic powers of the psyche include (a) nous, (b) wisdom, (c) vision of God, (d) knowledge, and (e) enduring knowledge (Vlachos, 1997). These are directed to truth. In the logos vector, the powers of the psyche are (a) logos, (b) prudence, (c) action, (d) virtue, and (e) faith (Vlachos, 1993). These are directed to spiritual and moral growth and development. Progress, or motion, of both the nous and the logos are necessary for healing and union with God (Vlachos, 1991; 1992; 1993; 1997).

As previously stated, nous, not thinking or reason, is the transcendent apperceptional power of the psyche (Vlachos, 1997). Nous moves towards the vision of the uncreated Light as it acquires the true knowledge of God. The practical power of the psyche is logos, which moves towards action and the acquisition of virtue (Vlachos, 1997). This action is the purification of the heart (Vlachos, 1991; 1992; 1993; 1997).

The nous moves in order to attain enduring knowledge and truth. This truth is revealed and infallibly known (Vlachos, 1991; 1992; 1993; 1997). The nous is in constant motion, because it moves in relation to the infinite God, who is the Truth (Vlachos, 1997). The logos moves through prudence, action, virtue, and faith, to purification, but its motion stops (Chrysostomos 2000; George, 2006; Nahum, 2001; Romanides, 2007; Vlachos, 1991; 1992; 1993; 1997).

When the psyche, by the grace of the Holy Spirit, in synergy with its own attentiveness, effort, and diligence, has succeeded in achieving a balanced union of logos and nous, prudence and wisdom, action and vision, virtue and knowledge, and faith and enduring knowledge, then the psyche will be united with God by participation in His Energies (Vlachos, 1991; 1992; 1993; 1997). Motion that advances to action, purification, acquisition of virtue and the encounter of faith, institutes the divinization of man (Behr-Siegel, 1992; St. Maximus the Confessor, 1985; Vlachos, 1992; 1993; 1997).

The division of the psyche into nous, logos, and spirit refers to its energies. However, the Holy Fathers use multiple operational divisions of the psyche in order to facilitate conceptualization and action. There are no critical or essential differences between these syllogisms (Vlachos, 1991; 1992; 1993; 1997). The division used corresponds operationally to that which is to be examined. For example, in reference to the psyche and the passions, which need healing, the psyche is divided into the intelligent, the appetitive, and incensive powers (Vlachos, 1997). When referring to the unity of the psyche's triple nature, the psyche is divided into noetic, intelligent and sensible powers (Vlachos, 1997). When considering the turning of the psyche to itself and its ascent to God, the psyche is divided into nous, knowledge, and love. In any case, these triads reflect the truth that the psyche is in the image of the Trinity and cannot be healed without God (Vlachos, 1992; 1993; 1997).

The psyche is closely connected with the body. Illness of the psyche affects the body, as the illness of the body can affect the psyche (Vlachos, 1997). Because of this intimate relationship between the psyche and the body, and although the psyche desires communion with God, the body, because of the passions, refuses to follow the psyche and physical, emotional, and psychological fatigue occurs (Vlachos, 1991; 1992; 1993; 1997). Orthodox tradition establishes that the course of the psyche is parallel to that of the body (St. Maximus the Confessor, 1985; Vlachos, 1993; 1997). Hesychasm cures the body in numerous ways (Vlachos, 1997). When wo/man receives God's grace, the body is also changed, e.g., Moses, whose face shone with the shekhinah glory [see II Corinthians 3:7­8], the face of the Archdeacon Stephen was transformed into the face of an angel [see Acts 7:59], etc. There is a definite distinction between the psyche and the body, but it is not possible for either to exist independently (Vlachos, 1997). At death, the psyche is violently separated from the harmony and affinity of this natural bond. Wo/man is a psychobiological being (Nahum, 2001; Romanides, 2007; Vlachos, 1992; 1993; 1997).

St. Gregory Palamas (as cited in Meyendorff, 1974) teaches that different pathoi develop in each power of the psyche. For example, disbelief, heresy, pride, and ambitiousness spring forth from the intelligent power of the darkened psyche; love of gratification / pleasure, greed, and avarice from the appetitive power; and the passions of wrath, anger, malice, and gluttony from the incensive, or irascible, power of the psyche.

2.1.2 Pathology

Where are wo/man's spiritual, behavioral, and psychological disorders and pathologies located? What are the causes of these pathologies? Wo/man's entire being is ill. However, the seat of pathology is located in the nous. The diseased nous infects and contaminates the entire human being with its sickness (Vlachos, 1992; 1993; 1997).

The psyche is both logical and noetic (Vlachos, 1997). The energy of the nous is distinguished from the energy of reason. The nous is the eye of the psyche. It is capable of acquiring the experience of God. Adam's nous saw God and his reason had the ability to formulate this experience (Vlachos, 1991; 1992; 1993; 1997). If the nous is healthy, the logos is also (Vlachos, 1997). If the nous is ill, the logos is also ill. The same applies to the spirit, which is the noetic love of the psyche. If the nous is healthy, love is healthy, because it turns to God, activating the intoxication of the spirit and the ecstasy of the mind (Vlachos, 1991; 1992; 1993; 1997). If the nous is ill, wo/man falls from true love, and experiences the idol of love, i.e., impious love (Chrysostomos 2000; George, 2006; Nahum, 2001; Romanides, 2007; Vlachos, 1993; 1997).

Orthodox, consider the nous as the basis of all theology, but Westerners place reason at the center of their ideology (Vlachos, 1997). Fallen wo/man has a darkened nous and a hypertrophic reason (Vlachos, 1992). After the Fall, wo/man's nous was darkened and confined. Blindness of the nous occurred. The Fall was in essence the rebellion of reason against the nous, and reason overthrew the nous (Vlachos, 1992). It attempted to abolish God's commandment. Nous was itself virtually abolished and re-identified with reason (Vlachos, 1997). The nous, instead of governing reason, became subject to it (Behr-Siegel, 1992; Chrysostomos 2000; Romanides, 2007; Vlachos, 1997).

The Fall and its consequences therefore translate into the following: (a) the malfunctioning of the nous; (b) the identification of nous with reason, which has lead to the deification of reason in the West; and (c) the nous' subjugation to the passions, anxiety, and external conditions. As when the eye of the body is harmed, the whole body is dark, when the eye of the psyche, i.e., the nous, is blinded, wo/man's entire spiritual being becomes sick and falls into deep darkness (Vlachos, 1991; 1992; 1993; 1997). The Lord refers to this when He says: "if therefore the light that is in thee be darkness, how great is that darkness" (Matthew 6:23 KJV). The darkening of the nous results in the disruption of the entire inner functioning of the psyche, but it also results in external disruption (Vlachos, 1997). The wo/man with the darkened nous begins to approach God, his / her fellow humans, the world, and the whole creation in a different way (Vlachos, 1991; 1992; 1993; 1997). Reason attempts to have an encounter with God, since the nous has no communion with Him. Idols, idolatrous religions, and heresies are spawned (George, 2006; Nahum, 2001; Romanides, 2007; Mother Michaela, 1983; Vlachos, 1997; Zacharias, 2006). The wo/man with a darkened nous sees others through reason, distorted through the lens of the passions (Vlachos, 1997). This results in exploitation. Other humans become the instruments or objects of his / her pleasure, and s/he begins to idolize creation (Vlachos, 1991; 1992; 1993; 1997). The Apostle Paul states: "professing themselves to be wise, they became fools, and changed the glory of the incorruptible God into an image made like to corruptible man, and to birds, and four-footed beasts, and creeping things" (Romans 1:22-23 KJV).

St. Gregory Palamas (as cited in Meyendorff, 1974) refers to the darkening of the nous as the direct result of its separation from God. He states that, separated from God, the nous becomes either beastly or satanic. According to St. Gregory (as cited in Chrysostomos, 2007), when the nous is darkened, the energies of the psyche and body are altered, twisted, and distorted, and ultimately become deformed. Metropolitan Hierotheos Vlachos (1993) agrees, and states that the nous: (a) loses its innate movement and goes astray from its natural course; (b) begins to crave money and material possessions and finds no satiation; (c) seeks sensual gratification, often through promiscuity, and is willing to hurt, and even destroy, the souls of others in order to fulfill its sinful and selfish wantonness, dissipation, and immorality; (d) is dominated, through fantasy, by false ideas and images, which serve to rationalize its behavior, and assuage its conscience until it is seared; (e) is impressed by and begins to love the wisdom of this world, and begins to seek out those of like mind, in order to reinforce its own delusion. St. Gregory Palamas (as cited in Meyendorff, 1974) contends that the man with a darkened nous: (a) disgraces his own manly image; (b) craves to be honored; (c) seeks flattery; and (d) demands agreement and cooperation. If anyone fails to comply with his ideas, opinions, whims, or modus operandi, he becomes filled with rage. Metropolitan Nahum (2001) states that the anger and aggressiveness of the man with a darkened nous against those around him, even those who may have a natural love toward him, transform him into the likeness of the beastly serpent. Created in the image and likeness of God, the man with a darkened nous becomes a 'murderer' of bodies and souls, i.e., with full premeditation, he subtly and purposefully leads others into sin and spiritual death through cunning and manipulation in order to satisfy his own corrupt and base desires. In this he reflects and resembles Satan. St. Gregory (as cited in Meyendorff, 1974) submits that this happens when the nous has strayed from the fear and remembrance of God, and yields itself to cooperation with the devil. Metropolitan Hierotheos Vlachos (1997) states that the separation of the nous from God transforms wo/man into a devilish beast, which in turn can lead to the development of a plethora of spiritual, behavioral, and psychological disorders and pathologies, including delirium and cognitive disorders, substance and alcohol related disorders, schizophrenia and psychotic disorders, depression and mood disorders, anxiety disorders, somatoform disorders, dissociative disorders, sexual disorders, eating disorders, sleep disorders, impulse-control disorders, adjustment disorders, personality disorders, etc.

With the malfunctioning of the nous, the passions rage and wo/man becomes unreasonable (Vlachos, 1997). Metropolitan Hierotheos Vlachos (1993) states that the demons know this and wage an endless war to darken wo/man's noetic faculty. With a darkened nous, demons can manipulate wo/man into doing their will, deceive him / her into thinking that his / her sinful self-destroying actions are justified, induce him / her into believing that his / her circumstances are extraordinary and that the Divine commandments do not apply in his / her situation because they were given for another place and time disconnected from his / her reality, convince him / her that s/he is acting in his / her own self interest, and cause him / her to confuse his / her basest desires with needs. For this reason, the wo/man with a darkened nous will often become uncontrollably enraged and violent when even those of his / her own household, in concern for his / her wellbeing, lovingly call to his / her attention his / her misdeeds (George, 2006; Nahum, 2001; Vlachos, 1992; 1993; 1997; Zacharias, 2006).

Metropolitan Nahum (2001) proffers that wo/man, under such conditions, can easily enter a state of madness. S/he feels that s/he is losing control. S/he cannot behave normally. His / her behavior becomes antisocial and s/he begins to exhibit a wide range of spiritual, behavioral, and psychological disorders and pathologies. Fantasy is excited through the demonic thoughts that dominate his / her conscience and memory (Vlachos, 1991; 1992; 1993; 1997).

2.1.3 Fantasy

Fantasy is a natural energy-power of the psyche (Vlachos, 1997). Having become energized after the Fall, it is dominated by images and false ideas (Vlachos, 1991; 1992; 1993; 1997). When a wo/man is purified and attains theoria, s/he is delivered from fantasy, i.e., it becomes inactive and free of images. Fantasy is a post-Fall phenomenon. Angels have no fantasy (Vlachos, 1991; 1992; 1993; 1997). Humans and the demons have fantasy, and for this reason, the demons activate images and arouse the imagination (George, 2006; Nahum, 2001; Romanides, 2007; St. Nikodemos & St. Makarios, 1983; Vlachos, 1992; 1993; 1997; Zacharias, 2006).

Spiritual, behavioral, and psychological disorders and pathologies are then the result of logismoi that are energized in fantasy (Vlachos, 1997). The more wo/man is spiritually ill, the more s/he is plagued by the images engendered by fantasy. Spiritual health requires the eradication of fantasy (Vlachos, 1991; 1992; 1993; 1997). When the nous is freed and illumined, all the activities of fantasy cease (Vlachos, 1997). For this reason the Holy Fathers teach that theology is not associated with fantasy. When wo/man, through synergy, is delivered from the images that fantasy creates, s/he can become a theologian (Vlachos, 1991; 1992; 1993; 1997).

St. Nikodimos and St. Makarios (1983) state that this aspect of spiritual and psychological life is of extreme importance. The darkness of the nous activates fantasy. In that illusionary world, wo/man creates idols. As psychological illness increases, imagination is stirred up (Vlachos, 1991; 1992; 1993; 1997). Illusions, delusions, time­space disorientation, fantastic images, etc. are often the symptomalogical markers of spiritual, behavioral, and psychological disorders and pathologies. Psychological malfunction is, first and foremost, a spiritual disease resulting from the darkened nous, and at the same time, darkening the nous (Bouton, 2004; Chrysostomos, 2007; Vlachos, 1997).

2.1.4 Emotions

Emotions are connected to the passions of pleasure-loving (Vlachos, 1997). They are not completely identified with the passions, but can often be permeated by the passions. The faith of a wo/man with an illumined nous is not based upon his / her psychological or emotional state (Vlachos, 1997). Additionally, s/he sees in creation the uncreated governing Energy of God. St. Isaac the Syrian (as cited in St. Nikodemos & St. Makarios, 1983) says that faith based on theoria, which is attained at the illumination of the nous, is a gate to the mysteries of God.

The transformation of emotions to genuine and authentic experiences is accomplished by repentance (Vlachos, 1993). Repentance leads wo/man from a painful and tragic monologue to a dialogue with the living God (Vlachos, 1991; 1992; 1993; 1997). It transforms his / her sensory perceptions. Through repentance, self-condemnation and humility, emotions are transformed to spiritual experiences (Vlachos, 1997). The more a wo/man's emotions are transformed, the more his / her nous is illumined; s/he is at the state of illumination. However, when images of fantasy intervene, they create the preconditions for serious psychological anomalies (Vlachos, 1997). Only true and complete repentance can cleanse psychological and emotional states (Vlachos, 1991; 1992; 1993; 1997). The nous must be led from its movement contrary to nature to that which is according to nature and, moreover, above nature, where it can be illumined and united with God and cured from fantasies and inordinate emotions (George, 2006; Nahum, 2001; Romanides, 2007; Vlachos, 1993; Zacharias, 2006).

2.1.5 The Movement of the Nous

St. Mark the Ascetic (as cited in St. Nikodemos & St. Makarios, 1983) teaches that there are three movements / states of the nous: (a) that which is according to nature, (b) that which is contrary to nature, and (c) that which is above nature (Vlachos, 1993). When a wo/man's nous moves contrary to nature, although s/he him/herself mistakenly believes that s/he is moving in conjunction with nature, s/he cannot understand the mysteries of God, and is at enmity with all creation (Vlachos, 1991; 1992; 1993; 1997). S/he believes that s/he is unjustly treated and takes offense with all; s/he is angered by everything. When the nous moves contrary to nature it abandons God and is dispersed / lost in the creation through the senses. However, when a wo/man's nous moves according to nature, s/he considers him/herself responsible for his / her own evil thoughts and deeds. S/he knows the causes of his / her passions and confesses his / her sins. S/he struggles to be cured (Vlachos, 1991; 1992; 1993; 1997). When a wo/man receives the fruits of the Holy Spirit, his / her nous moves above nature (Vlachos, 1997). In this state the nous is united with God. The nous that is illumined and united with God, becomes formless and shapeless, because it is delivered from images, fantasies, and logismoi. It has good thoughts and thus it feels free from inner restraints (Vlachos, 1997). Evil thoughts, which turn against God, and against his / her fellow humans are a result of the nous' illness (Nahum, 2001; Romanides, 2007; St. Nikodemos & St. Makarios, 1983; Vlachos, 1992; 1993; 1997; Zacharias, 2006).

2.2 Etiology of Disorders / Pathologies According to the Holy Fathers, the etiology of spiritual, behavioral, developmental, and psychological disorders and pathologies are organized into two categories: (a) external stimuli, i.e., those that originate outside of the individual; and (b) internal stimuli, i.e., those that the individual engenders within him/herself (Bouton, 2004; Scupoli, 1987). The Holy Fathers attribute external stimuli to demonic powers. St. Philotheos states: "There is within us, on the noetic plane, a warfare tougher than that on the plane of the senses" (as cited in St. Nikodemos & St. Makarios, 1983, p. 16). This concept is consistent with St. Paul's admonition to the Ephesians: "For we wrestle not against flesh and blood, but against principalities, against powers, against the rulers of the darkness of this world, against spiritual wickedness in high places" (6:12).

The Holy Fathers teach that demonic powers do not cause behavior / conduct, but rather act / operate as stimuli or temptations (Bouton, 2004; DiLeo, 2007). It is through 'thoughts' or 'logismoi' that evil spirits wage war against the psyche (St. Maximus the Confessor, 1985; St. Nikodemos & St. Makarios, 1983). St. Philotheos asserts "...for they wage war upon us through our thoughts and are full of anger against us" (as cited in St. Nikodemos & St. Makarios, 1983, p. 26).

The incensive powers of the psyche are attacked by demonic powers through the bombardment of the nous, with logismoi (Bouton, 2004; DiLeo, 2007). St. Philotheos states:

.the enemy in his turn tries to subvert this commandment by stirring up strife and thoughts of rancor and envy within us. For he too knows that the intelligence should control the incensive power; and so by bombarding the intelligence with evil thoughts - with thoughts of envy, strife, contention, guile, self-esteem - he persuades the intelligence to abandon its control, to hand the reins over to the incensive power and to let the latter go unchecked. (as cited in St. Nikodemos & St. Makarios, 1983, p. 22)

This assault continues in the form ofphantasia, or mental / rational images used by the demonic forces to entice / attract the imagination and mind of wo/man (DiLeo, 2007).

The devil weaves a kind of mental net in order to undermine its effect. He does not attack us by exciting desire through an actual physical woman, but he operates inwardly by projecting into our intellect lascivious figures and images, and by insinuating words that rouse desire, and by other methods of this kind which those who have experience of the intellect know about. (St. Nikodimos & St. Makarios, 1983, p. 22)

The primary purpose of demonic attacks is to cause wo/man to replicate Satan's evil behavior and attitudes (Bouton, 2004; DiLeo, 2007) as described in Genesis [3:14].

Forcing his way into our intellect, our enemy tries to compel us - created in God's image though we are - to eat the dust and to creep on our bellies as he does [cf. Gen 3:14]. (St. Nikodemos & St. Makarios, 1983, p. 27)

The intent of the demons is to pervert behavior. Satan desires to steal the Word of God from wo/man's heart, and to entice him / her to act wickedly (Bouton, 2004; DiLeo, 2007).

Our Lord Jesus Christ, speaking of the various attitudes of those who hear the words of the Gospel, says: 'Then comes the devil, and snatches the word out of their hearts' - that is to say, he steals it by inducing them to forget it - 'lest they should believe and be saved' [Luke 8:12]. (St. Nikodemos & St. Makarios, 1983, p. 28)

Another external stimulus that tempts wo/man to undesirable and sinful behavior / conduct, and that subsequently leads to spiritual, behavioral, and psychological disorders and pathologies, is identified by the Holy Fathers as unexpected or traumatic events and / or misfortunes (Bouton, 2004; DiLeo, 2007). These events serve only as stimuli and are not the cause of any particular behavior / conduct (Bouton, 2004). However, an unanticipated or traumatic event or misfortune, calamity, or hardship significantly disturbs / disrupts attentiveness / focus (Bouton, 2004). By dislodging the nous from its concentration on virtue, it is diverted towards sin and internal strife (Bouton, 2004; DiLeo, 2007). The cause of this overthrow is the lack of attention to the attacks of the adversary (St. Maximus the Confessor, 1985; St. Nikodemos & St. Makarios, 1983).

External stimuli can be summarized as: (a) demonic attacks that tempt / entice wo/man to cognitive distortions, or erroneous and non-Christocentric thinking; (b) images that stimulate / excite the imagination and distract wo/man from God; (c) the use of a combination of erroneous thinking and distracting images to tempt wo/man to act in a demon-like manner and with demon-like motives; (d) the distraction of wo/man from focus on and / or awareness of God; and (e) the use of unexpected or traumatic events and misfortunes to tempt wo/man to incorrect thinking (Bouton, 2004; DiLeo, 2007; St. Maximus the Confessor, 1985; St. Nikodemos & St. Makarios, 1983).

The internal stimuli are reactions to the varying external stimuli (Bouton, 2004; DiLeo, 2007). The first of these is termed 'soul chatter' (DiLeo, 2007). This includes both the spoken word that comes out of the mouth of wo/man, as well as his / her inner thoughts (Bouton, 2004; DiLeo, 2007). It is based upon cognitive distortions. Nothing is more disconcerting than talkativeness and more pernicious than an unbridled tongue (Bouton, 2004; DiLeo, 2007). Talkativeness is disruptive and disturbing of the psyche's proper state (Bouton, 2004). "The soul's chatter destroys that which has been built each day and scatters that which has been laboriously gathered together" (St. Philotheos as cited in St. Nikodemos & St. Makarios, 1983, p. 17).

This principle includes those thoughts and words that come from within wo/man, and how s/he reacts to the words of others (Bouton, 2004). This type of cognitive distortion misrepresents / perverts the words of others and finds offences that are used as cause or justification for inappropriate and sinful behavior / conduct (Bouton, 2004). Idle talk can provoke hatred in those who listen, especially when they note the foolishness of the words that have been spoken, i.e., those spoken in abuse, sarcasm, and / or derision (Bouton, 2004; DiLeo, 2007). At times, 'soul chatter' defiles the conscience and brings God's condemnation but, most fearful of all, it can cause an offense / sin to be committed against the Holy Spirit (Bouton, 2004; St. Maximus the Confessor, 1985; St. Nikodemos & St. Makarios, 1983).

The principle of guarding the thoughts and self-talk or 'soul chatter' proposed by the Holy Fathers is similar to those proposed by cognitive psychology (Bouton, 2004). 'Self-talk', 'self-demands', 'internal scripts', 'faulty thinking', etc., refer to the same cognitive concept of paying attention to internal self-talk and thoughts (Bouton, 2004; DiLeo, 2007; McMullin, 2000). Many writers and researchers have employed different terms for this same concept.

Albert Ellis, for example, identifies this concept as the ABCs of Rational Emotive Behavioral Therapy (REBT). In 'A', an activating event occurs. In 'B', belief and thinking follows. This is coupled with self-talk based on the individual's belief system, resulting in 'C', an emotion or behavioral consequence (Ellis & MacLaren, 1998). This corresponds to the teachings of the Holy Fathers regarding the 'cycle of temptation' (Bouton, 2004; DiLeo, 2007). The major difference is that Ellis does not subscribe to the principles in Holy Scripture as the basis for challenging the individual's belief system (Bouton, 2004).

Backus' (2000) 'Misbelief Therapy' also follows the same cognitive path. Both Backus (2000) and the Holy Fathers (St. Nikodemos & St. Makarios, 1983) propose paying attention to thoughts and self-talk, and challenging those statements and beliefs that are not Scriptural and / or Christ-centered (Bouton, 2004; DiLeo, 2007). Backus and Chapian (1995) refer to self-talk as "the words we tell ourselves about people, self, experiences, life in general, God, the future, the past, the present; it is specifically, all of the words you say to yourself all the time... where do lies and misbeliefs start? The answer to that is in your self-talk" (Backus & Chapian, 1995, p. 28). Backus and Chapian also proffer that using Christ-centered thinking to challenge the demonic generated cognitive distortions or 'misbeliefs' of self-talk is the path to healing (Bouton, 2004). Aaron Beck's cognitive therapy also involves tuning into 'automatic thinking patterns'. This corresponds to the concept of the Holy Fathers of the guarding the nous, from the psyche's chatter' (Bouton, 2004; DiLeo, 2007). In the broadest sense, cognitive therapy consists of those approaches that alleviate psychological distress through the medium of correcting faulty conceptions and self-signals (Bouton, 2004; DiLeo, 2007). The emphasis on thinking, however, should not obscure the importance of the emotional reactions that are generally the immediate source of distress (Bouton, 2004). It simply means that emotions are addressed through cognitions. By correcting erroneous beliefs, excessive, inappropriate emotional reactions can be altered (Beck, 1976).

Seeking physical pleasures is stimulus that leads wo/man to cognitive distortions or non-Christocentric thought and behavior (Bouton, 2004). The Holy Fathers do not condemn pleasure, but see the corrupt desire to seek pleasure as an enticement to undesirable behavior (Bouton, 2004; DiLeo, 2007).

For, bound as we are to this wretched flesh, which always 'desires in a way that opposes the Spirit' [Gal. 5:17], we cannot when sated with food stand firm against demonic principalities, against invisible and malevolent powers; 'for the kingdom of God is not food and drink' [Rom 14:17], and 'the will of the flesh is hostile to God: for it is not subject to the law of God, nor indeed can it be' [Rom. 8:7]. It is clear that it cannot be because it is earthly, a compound of humors, blood, and phlegm and always gravitating downwards. Thus it is always attached to earthly things and relishes the corrupting pleasures of the present life. 'For the will of the flesh is death' [Rom. 8:6]. (St. Nikodemos & St. Makarios, 1983, p. 19)

St. Philotheos (as cited in St. Nikodemos & St. Makarios, 1983) identifies wo/man's reaction to images given by the demonic forces to his / her imagination as a cause of inappropriate behavior (Bouton, 2004; DiLeo, 2007). This involves taking the demonic-given image and beginning to entertain it in the imagination, creating new images, which are mixed with the senses for the sake of seeking gratification and pleasure (Bouton, 2004). An image projected by demonic forces, once entertained by man in the imagination, especially if mixed with sensual pleasure, evolves into sin (St.Nikodemos & St. Makarios, 1983). The initial demonic image is an external stimulus, but wo/man's manipulation of the image in his / her imagination / mind and the adding of sensual pleasure, becomes an internal stimulus to inappropriate / sinful behavior and ultimately leads to pathology (Bouton, 2004). The combined actions of these internal and external stimuli lead wo/man to sin and the darkening of the nous (Bouton, 2004; DiLeo, 2007). The enemy of wo/man, wanting to overpower the nous first confuses it with gluttonous and / or promiscuous thoughts, treating it disdainfully and dismissing it from its command (Bouton, 2004). Anger and desire are then employed as servants of wo/man's own will (Bouton, 2004; DiLeo, 2007). Free from the control of the nous, these powers, i.e., the desiring and incensive powers, use the five senses as aids in sinning (Bouton, 2004). These are the sins into which wo/man then falls: (a) his / her eyes become inquisitive, not having the nous controlling them from within; (b) his / her ears love to hear frivolous things; (c) his / her senses becomes effeminate (not in terms of sexuality, but in terms of preferences, inclinations, self-attention, and love of comfort / pleasure), (d) his / her tongue becomes unbridled; and (e) his / her hands touch what they ought not to touch (DiLeo, 2007). With these, go injustice instead of justice, foolishness / stupidity instead of moral judgment, licentiousness, dissolution and self-indulgence instead of self-restraint, and slavishness instead of courage and / or manliness (St. Nikodemos & St. Makarios, 1983).

2.3 The Cycle of Temptation

Building upon the internal and external stimuli upon which wo/man can act in inappropriate ways, the Holy Fathers describe the 'cycle of temptation', from which wo/man moves from the point of the initial stimulus to sin and to the development of disorders of the psyche that are reflected in his / her behavior or conduct (Bouton, 2004; DiLeo, 2007; Maloney, 2003). This cycle draws upon the work of both St. Mark the Ascetic, On the Spiritual Law, and step 15 of St. John Climacus' (1979) The Ladder of Divine Ascent (Bouton, 2004; DiLeo, 2007). It is frequently cited by the Holy Fathers, and is quoted in its entirety in St. Nikodimos and St. Makarios (1983). The cycle involves the following:

Prosvoli. This is a provocation or suggestion, and is the initial incitement to evil. St. Mark the Ascetic (as cited in St. Nikodemos & St. Makarios, 1983) speaks of it as an 'image-free stimulation of the heart'. As long as prosvoli does not involve any image, i.e., mental or cognitive image, it does not involve any guilt in wo/man (Bouton, 2004; DiLeo, 2007). Prosvoli are demonic assaults that come from outside wo/man's free will, and wo/man is not morally responsible for them (Bouton, 2004). St. Symeon the New Theologian (1980) states that wo/man has no power to prevent prosvoli but has the power to maintain nepsis, i.e., watchfulness, to guard against them (Maloney, 2003).

Pararripismos. This is a momentary disturbance of the intellect. Pararripismos occurs without any movement or working of bodily passion (Bouton, 2004; Chryssavgis, 2004; Vlachos, 1993; 1997). It is cognition by the nous of the prosvoli. It is 'taking note' of the prosvoli or logismoi, which are rationalizations that can evolve into sin (Bouton, 2004; DiLeo, 2007). Logismoi are not just simple thoughts but rational suggestions associated with images and stimulations brought on by sight or hearing or by both together (Bouton, 2004). Logismoi, therefore, are images and stimulations with an intrinsic suggestion (Bouton, 2004; DiLeo, 2007). The Holy Fathers teach that wo/man can at a certain point of spiritual development and growth avoid momentary disturbance (Bouton, 2004; Hodges, 1987; Zacharias, 2008).

Homilia, i.e., communion, (or syndyasmos, i.e., coupling). At this point, without entirely assenting to the demonic prosvoli, a wo/man may begin to 'entertain' it or dialog with it (Bouton, 2004). This means to converse with it, or toy with it, turning it over in the mind pleasurably, but still hesitating whether or not to act upon it (Bouton, 2004; DiLeo, 2007). At this point, prosvoli is no longer 'image-free' (Bouton, 2004; Hodges, 1987). It has become logismos or thought even though it still has not been acted upon. Wo/man is morally responsible for having allowed homilia or syndyasmos to take place (Bouton, 2004; DiLeo, 2007; Maloney, 2003).

Synkatathesis, i.e., assent. This goes beyond homilia or syndyasmos. In addition to entertaining the thought, wo/man now consents and resolves to act upon it (Bouton, 2004; DiLeo, 2007). There is no doubt in regard to his / her moral responsibility (Maloney, 2003). Wo/man decides, or is determined, now to act upon the specific logismos (Bouton, 2004). Desire comes into the process and the commitment to sin is effected (Bouton, 2004; Hodges, 1987; Johansen & Rosenmeier, 1998; Palmer et al., 1983). Even if circumstances prevent him / her from actually acting out his / her sin, God judges wo/man according to the intentions of his / her heart [cf. Matthew 5:28].

Prolipsis, i.e., prepossession. This is a state of prejudice that results from repeated acts of sin that predispose a wo/man to yield to a particular temptation, and is commonly referred to as captivity (Amis, 1995; Bouton, 2004; DiLeo, 2007; Zacharias, 2008). S/he develops a history of following the path of a particular temptation (Bouton, 2004; DiLeo, 2007). In principle, s/he retains his / her free choice and can reject the demonic prosvoli, but in practice, the force of habit makes it increasingly difficult to resist (Bouton, 2004; DiLeo, 2007; Maloney, 2003; Zacharias, 2008).

Pathos, i.e., passion. In Greek, the word pathos suggests a passive experience (Bouton, 2004; DiLeo, 2007). Pathos is an appetite or impulse, such as anger, desire, or jealousy that violently dominates the psyche (Palmer et al., 1983; Peters, 1970; St. Nikodemos & St. Makarios, 1983; Zacharias, 2008).

It should be noted that many reputable contemporary mental health workers and theoreticians view sin as an essential factor in psychological disorders and pathologies, and believe that secular psychology and ideology have dismissed sin as a part of the disease process (Bouton, 2004; Hodges, 1987). In modern Western culture, labeling actions as 'sinful' is politically incorrect (Bouton, 2004). Secular thought has replaced sin with lists of psychological illnesses (Bouton, 2004; DiLeo, 2007). For example, self­esteem replaces sinful pride, victim-hood replaces envy, being disadvantaged replaces being greedy, etc. (Backus, 2000).

Backus (2000), for example, in accordance with the teachings of the Holy Fathers, sees sin as part of the disease process and proffers that sin is something larger than a mere action or thought (Bouton, 2004). He believes that sin is an internal power, a 'driving motivation'. This drive influences and / or manipulates actions, but it is not identical to actions (Backus, 2000).

Backus (2000) asserts that every sin results from a cycle of events, the first of which, he refers to as the 'antecedent stimulus'. This is merely an incident, thought, situation or circumstance upon which a man can choose or refuse to act (Bouton, 2004). His second stage involves 'reaction' to the 'antecedent stimulus'. Backus' third stage is the resulting behavior. He proffers that 'self talk' about the 'antecedent stimulus' determines action / reaction to it (Backus & Chapian, 1984).

Backus' first stage combines the first two stages of the Holy Fathers, i.e., those of prosvoli and pararripismos (Bouton, 2004; DiLeo, 2007). His second stage corresponds to the Holy Fathers' third step, i.e., homilia or syndyasmos (Bouton, 2004). His last stage coincides with the Holy Fathers' fourth step, assent, i.e., synkatathesis (Bouton, 2004). He does not address the remaining two steps of the 'cycle of temptation' proposed by the Holy Fathers (Bouton, 2004; DiLeo, 2007). Nevertheless, he does imply that there are factors in the 'cycle of temptation' that are beyond acting on behavior, and proffers that the drive to keep on sinning is almost unstoppable (Bouton, 2004; DiLeo, 2007). According to Backus, "when it comes to sin, people can't 'just say no'; that isn't the whole picture" (2000, p. 44).

2.4 Neptic Treatment

Having identified the etiology of spiritual / psychological disorders and pathologies, the Holy Fathers propose a series of interventions to address these disorders (Bouton, 2004; DiLeo, 2007). These interventions follow the path of the triad of nepsis, ascesis, and hesychia (Vlachos, 1997). It is often difficult to divide any one intervention into any single aspect of the classic triad, as in the thinking of the Holy Fathers, one cannot occur in the absence of the others (Bouton, 2004; Zacharias, 2008).

The interventions of the Holy Fathers for psychological disorders and pathologies are grouped into three categories: (a) cognitive interventions, i.e., interventions that treat cognitive distortions, i.e., incorrect or sinful thinking; (b) conative interventions, i.e., interventions directed to the development of an accurate self-concept (erroneously referred to as self-esteem), will, and self-capacities, which are connected to characterologic difficulties associated with identity, emotional, and attachment / relational schemata, etc.; and (c) behavioral interventions, i.e., interventions directed to the development of self-control / self-discipline, which are often related to inadequately developed affect and / or tolerance regulation skills (DiLeo, 2007). These interventions are designed to pre-empt the process of the 'cycle of temptation' at a point before moral involvement (Bouton, 2004; DiLeo, 2007).

2.4.1 Cognitive Interventions

The majority of interventions offered by the Holy Fathers involve correction of cognitive distortions, i.e., incorrect / sinful and non-Christocentric thinking (Bouton, 2004; DiLeo, 2007). The Holy Fathers propose interventions to curtail incorrect thinking at its very origin, at the point of prosvoli and recommend use of the practices of the unceasing 'Prayer of the Heart' or 'Jesus Prayer', keeping watch with the nous, participation in the Holy Mysteries, (especially Confession and Holy Communion), and keeping true remembrance of God to struggle againstpararripismos (Bouton, 2004; Gillet, 1987; Zacharias, 2008). This type of intervention is designed to be preventative, and is akin to Seligman's (1998) 'Positive Psychology' (DiLeo, 2007). It requires considerable practice to develop.

From dawn we should stand bravely and unflinchingly at the gate of the heart, with true remembrance of God and unceasing prayer of Jesus Christ in the soul; and keeping watch with the intellect, we should slaughter all the sinners of the land (cf. Ps. 101:8, Septuagint). Given over in the intensity of our ecstasy to the constant remembrance of God, we should for the Lord's sake cut off the heads of the tyrants [cf. Hab. 3:14, Septuagint], that is to say, should destroy hostile thoughts at their first appearance. (St. Nikodemos & St. Makarios, 1983, p. 16)

The Holy Fathers (St. Nikodemos & St. Makarios, 1983) address the concept of challenging internal 'self-talk' and inappropriate 'thoughts' or thinking. Calling thoughts and self-talk the 'soul's chatter', they point out, as noted above, that these destroy that which has been built up and scatter that for which man labors to gain (Bouton, 2004; DiLeo, 2007). The Holy Fathers prescribe interventions to challenge the thoughts and keep them in check, not letting them run wild over neurotic ideologies, creating doubts by raising and dwelling on false 'ifs' (Bouton, 2004; DiLeo, 2007). St. Philotheos, for example, contends that "the tongue has to be restrained, checked by force and muzzled, so to speak, and made to serve only what is needful" (as cited in St. Nikodemos & St. Makarios, 1983, p. 17).

St. Nikodimos and St. Makarios (1983) propose watchfulness, or a conscious awareness of what a wo/man thinks and says to him/herself, in terms of self-talk as an intervention. They recommend not dwelling on thoughts of things that are negative, and /or not necessary, and promote increasing positive thoughts that advance towards God (Bouton, 2004; DiLeo, 2007). Therefore, there must be a focus on the goal of advancing towards God, using the methods of hesychia, including prayer, and remembrance of death and judgment, to become one with God, as a measure of what constitutes appropriate and inappropriate thought (Bouton, 2004). To achieve this, St. Nikodimos and St. Makarios (1983) point out that self-control is needed. This is not an attribute that comes quickly, but must be developed over time.

The first gate to entry into the noetic Jerusalem - that is, to attentiveness of the intellect - is the deliberate silencing of your tongue, even though the intellect itself may not yet be still. The second gate is balanced self-control in food and drink. The third is ceaseless mindfulness of death, for this purifies the intellect and the body. (p. 17)

The imagination can quickly become involved if one does not intervene to ward off sinful thinking. If with the Lord's help through careful watchfulness you guard your intellect from error and observe the attacks of the demons and their snares woven of fantasy, you will see from experience that this is the case. (St. Nikodimos & St. Makarios, 1983, p. 18)

This type of watchfulness is based on challenging thoughts through meditation upon the life and teachings of Christ as the only true measure. For we have been commanded to purify the heart precisely so that, through dispelling the clouds of evil from it by continual attentiveness, we may perceive the sun of righteousness, Jesus, as though in clear sky; and so that the principles of His majesty may shine to some extent in the intellect. (St. Nikodimos & St. Makarios, 1983, p. 18)

A Christ-centered focus for self-talk is St. Nikodimos and St. Makarios' (1983) next recommendation for intervention (Bouton, 2004; DiLeo, 2007). They emphasize the importance of using the life and teachings of Christ as a source of spiritual wisdom and as a measure by which to gauge the acceptability of the topics of our self-talk.

Guarding the intellect with the Lord's help requires much humility, first in relation to God and then in relation to men. We ought to do all we can to crush and humble the heart... the detailed remembrance of our Lord's Passion, the recollection of what He suffered, greatly humbles and abashes our pride, and this, too, produces tears. (p. 20)

The example of Jesus' life and the wisdom of the Holy Scriptures serve as a faithful rule and guide:

Let us study His life in the flesh, so that in our own life we may be humble. Let us absorb His sufferings, so that by emulating Him we may endure our afflictions patiently. Let us savor His ineffable incarnation and His work of salvation on our behalf, so that from the sweet taste in our soul we may know that the Lord is bountiful (cf. Ps. 34:8). Also, and above all, let us unhesitatingly trust in Him in what He says; and let us daily wait on His providence towards us. And whatever form it takes, let us accept it gratefully, gladly and eagerly, so that we may learn to look only to God, who governs all things in accordance with the divine principles of His wisdom. (St. Nikodimos & St. Makarios, 1983, p. 24)

Practicing virtues is not enough unless Christ-centered watchfulness over the thoughts is also practiced. 

Many monks are not aware how the demons deceive the intellect. Being naive and undeveloped, they tend to give all their attention to the practice of the virtues and do not bother about the intellect. They move through life, I fear, without having tasted purity of heart, and are totally ignorant of the darkness of the passions within. Such people, unaware of the battle about which Paul speaks [cf. Eph. 6:12] and not imbued with personal experience of true goodness, regard as lapses only those sins which are actually put into effect. They do not take into account the defeats and victories that occur on the plane of thought, for these, being internal, cannot be seen by natural sight and are known only to God our judge, and to the conscience of the spiritual contestant. But for those who have a divine desire to cleanse the vision of the soul there is another form of activity in Christ and another mystery. (St. Nikodimos & St. Makarios, 1983, p. 30)

Interventions to deal with how individuals utilize self-talk and thinking with reference to external provocations are also addressed (Bouton, 2004). St. Philotheos (in St. Nikodimos & St. Makarios, 1983) encourages avoiding provocation to be turned into a harmful or sinful action. He emphasizes the use of watchfulness over the thoughts using both the goal of becoming one with God and the wisdom drawn from the life of Christ and the Holy Scriptures as the measure by which judgments are made (Bouton, 2004).

As an intervention to provocations of anger, the Holy Fathers propose the following:

But the insulting words and their consequences could have been avoided had their initial provocations been expelled from the heart through prayer and attentiveness. (as cited in St. Nikodimos & St. Makarios, 1983, p. 22)

Continuing in this line of thought, they propose that the intervention of using watchfulness over thoughts, can keep problems away before they start (Bouton, 2004). The Holy Fathers give instruction that when anger is felt, it is best directed at the demons who bombard the individual with the provocations, rather than at others. You must direct your wrath only against the demons, for they wage war upon us through our thoughts and are full of anger against us... It is through unceasing watchfulness that we can perceive what is entering into us and can to some extent close the door against it, calling upon our Lord Jesus Christ to repel our malevolent adversaries. (as cited in St. Nikodimos & St. Makarios, 1983, p. 26) The ability to be watchful over thoughts and self-talk permits the individual to perceive the demonic purpose of cognitive distortions (Bouton, 2004). St. Nikodimos and St. Makarios (1983) contend that the individual can prevent injury to him/herself by practicing this type of intervention and explain:

None of the painful things that happen to us every day will injure or distress us once we perceive and continually meditate on their purpose. It is on account of this that St. Paul says: 'I take delight in weakness, insults and hardships' [II. Cor. 12:10]; and: 'All who seek to live a holy life in Christ Jesus will suffer persecution' [II Timothy 3:12]. (p. 31)

The remaining proposal on this type of intervention involves the use of remembrance of the reality of death and judgment as a means of staying focused on the real goal in life, to become one with God (Bouton, 2004; DiLeo, 2007). This mindfulness is a strong defense against the assaults of provocations (Bouton, 2004). Vigilance over thoughts helps wo/man avoid pride that can cause delusion. He who really redeems his life, always dwelling on the thought and remembrance of death, and wisely withholding the intellect from the passions, is in a far better position to discern the continual presence of demonic provocations than the man who chooses to live without being mindful of death. The latter, by purifying the heart through spiritual knowledge alone, but not keeping in mind any thought of grief, may sometimes appear to control all the destructive passions by his skill; yet he is unwittingly fettered by the worst of all - pride. Such a person must be very vigilant lest, deluded by conceit, he becomes deranged. (St. Nikodimos & St. Makarios, 1983, pp. 25-25)

Addressing the problem, from the view of the 'cycle of temptation', of creating images in the imagination, neptic psychology proposes two therapeutic interventions to cut off the formation of such images at the very start, and in particular, not to involve the senses in the creation of images in the imagination (Bouton, 2004; DiLeo, 2007). The formula is proposed that the state of dispassion (apathia) is equal to not entertaining the imagination with 'what ifs' (Bouton, 2004; DiLeo, 2007). This 'toying' is not a rhetorical exercise but rather a movement towards the acting out of an undesirable behavior. The person who rebuffs the initial provocation, or who regards it dispassionately, has at one stroke cut off all the sinful stages that follow... So let us wage noetic war against the demons, lest we translate their evil purposes into sinful actions. (St. Nikodimos & St. Makarios, 1983, pp. 29­30)

This intervention also addresses the problem of allowing the imagination to toy with cognitive distortions or non-Christocentric thinking and negative self-talk (Bouton,2004). Entertaining such thoughts leads the individual to act on them, and the Holy Fathers call for focus on God and not on the ideas and values of the world.

Consequently, with the Lord's help, we must cleanse ourselves within and without. We must guard our senses and free each of them from impassioned and sinful influences. And just as, ignorant and full of futility, we used to live in the world with intellect and senses enslaved to the deceit of sin, so now, having changed to the life according to God, we must dedicate intellect and senses to the service of the living and true God, and of God's justice and will. (St. Nikodimos & St. Makarios, 1983, p. 29)

To the problem of finding oneself assaulted by waves of evil thoughts, the type that threaten to totally engulf focus, the Holy Fathers suggest an intervention of focusing on the opposite (Bouton, 2004; DiLeo, 2007). This means to involve the self with ideas and activities that are totally opposite of the flood of evil thoughts (DiLeo, 2007). This could be, for example, but is not limited to, such things as prayer, and meditation on death and judgment, etc.

Be extremely strict in guarding your intellect. When you perceive an evil thought, rebut it and immediately call upon Christ to defend you...when this whole detachment of the enemy has been put out of action through prayer, again turn your attention to your intellect. There you will see a succession of waves worse than before, with the soul swimming among them. But again, awakened by His disciple, Jesus as God will rebuke the winds of evil [cf. Matt 8:23-27]. Having found respite, hours perhaps, or for a moment, glorify Him who has saved you, and meditate on death. (St. Nikodimos & St. Makarios, 1983, p. 26)

St. Nikodimos and St. Makarios (1983) conclude their proposed interventions into the domain of distorted cognitions with four basic summaries: (a) watchfulness cleanses the conscience and makes it lucid; (b) in all evaluation of thinking and self-talk, wo/man must constantly keep the goal of becoming one with God present, through prayer, the Holy Mysteries, and remembrance of death; (c) in times of crisis, wo/man needs to be even more focused on Christ-centered thinking; and (d) when wo/man fails in the guarding of thoughts, there is always the path of repentance by means of the Mystery of Confession (Bouton, 2004; DiLeo, 2007).

Watchfulness cleanses the conscience and makes it lucid. Thus, cleansed, it immediately shines out like a light that has been uncovered, banishing much darkness. Once this darkness has been banished through constant and genuine watchfulness, the conscience then reveals things hidden from us. Through the intellect it teaches us how to fight the unseen war and mental battle. (St. Nikodimos & St. Makarios, 1983, p. 25)

St. Philotheos (as cited in St. Nikodimos & St. Makarios, 1983) also talks about the kind of intervention needed when wo/man fails in the previous interventions and ends up committing undesirable acts. This intervention is called 'repentance'. He states:

But if, being inattentive, it is defeated by the devil's provocations and its powers are thrown into the confusion, it breaks the divine commandments. Such violation, if not followed by the appropriate degree of repentance, will certainly lead to chastisement in the future. (p. 23)

He also advises:

So it [the watchful intellect] should not be evaded, since it tells us inwardly how to live in conformity to God's will, and by severely censuring the soul when the mind has been infected by sins, and by admonishing the erring heart to repent, it provides welcome counsel as to how our defective state can be cured. (St. Philotheos as cited in St. Nikodimos & St. Makarios, 1983, p. 27)

2.4.2 Conative, Identity and Self-Concept Interventions

The Holy Fathers contend that correct self-concept, or sense of self-worth, is based on understanding and accepting the true relationship between God and wo/man (Bouton, 2004; DiLeo, 2007). The rule of measure is not the ideas of the world, but wo/man's actual standing in relation to God (Bouton, 2004). They contend that pride is the destructive force that leads to false self-esteem and that humility is the healing force that brings a true sense of self-worth (DiLeo, 2007). St. Philotheos proposes:

We ought to make ourselves each day such as we should be when we appear before God... And St. Paul states: 'Let us cleanse ourselves from all pollution of the flesh and spirit' [II Cor. 7:1]... And our Lord Jesus Christ said: 'Cleanse first the inside of the cup, so that the outside may also be clean' [Matt. 23:26]. (as cited in St. Nikodimos & St. Makarios, 1983, p. 19)

Humility plays an important position in the interventions to correct the sin of self-esteem (Bouton, 2004; DiLeo, 2007). St. Nikodimos and St. Makarios (1983) contend that humility prevents the taking of offence and provides a realistic view of the self and the rest of the world. They explain:

Do you see, proud man, how the saint was not forgetful of his former life? Indeed, all the saints, from the beginning of creation to the present day, have put on the lowliest holy cloak of God. Our Lord Jesus Christ Himself, being God incomprehensible, unknown and ineffable, wishing to show us the way of eternal life and holiness, was clothed in humility during His whole life in the flesh. Let us humble ourselves in soul and body, in thought and will, in words and ideas, in our outer bearing and our inner state. (pp. 20-21)

In order to obtain humility, St. Philotheos contends that both recurrent prayer and remembrance of God, established through watchfulness is necessary. Where humility is combined with the remembrance of God that is established through watchfulness and attention, and also with recurrent prayer inflexible in its resistance to the enemy, there is the place of God. (as cited in St. Nikodimos & St. Makarios, 1983, p. 17) 

To overcome pride requires guarding the nous with humility, remembering one's place before God, and remembering in trials that Christ also suffered. 

Guarding the intellect with the Lord's help requires much humility, first in relation to God and then in relation to men. To achieve this we should scrupulously remember our former life in the world, recalling and reviewing in detail all the sins we have committed since childhood. In addition, the detailed remembrance of our Lord's Passion, the recollection of what He suffered, greatly humbles and abashes our pride. (St. Nikodimos & St. Makarios, 1983, p. 20)

Finally, the Holy Fathers warn that in the absence of humility and self-reproach, wo/man obtains a false sense of self-esteem, one in which the individual presumes a position of false superiority (Bouton, 2004). St. Nikodimos and St. Makarios (1983) explain that "In the absence of self-reproach and humility, spiritual knowledge puffs us up, making us feel superior to others" [cf. I Corinthians 8:1] (p. 28).

2.4.3 Behavioral Interventions

The final series of interventions proposed by the Holy Fathers involve issues of developing self-discipline / self-control (DiLeo, 2007). This aspect of intervention is most strongly related to the concept of ascesis in the triad of the method of the cure of the ill psyche (Bouton, 2004; DiLeo, 2007). As previously stated, no one part of the triad can be completely practiced without the other two being present, but the practice of ascesis is most often viewed as developing self-control and self-restraint (Bouton, 2004; Zacharias, 2008).

According to Harton (1964), the purpose of Christian asceticism is to render the psyche responsive to Divine grace and to reach perfection. This is a gradual and progressive process by which the psyche proceeds through the stages of the spiritual life (Bouton, 2004; DiLeo, 2007).

Asceticism is a term derived from the Greek verb ascesis, meaning strenuous practice or exercise. Athletes were therefore said to go through ascetic training, and to be ascetics. This alludes to both the manner of living and to the results attained (Kohler & Hirsch, 2002). The theological implications are clearly discernible. From the arena of physical contests, the word readily passed over to that of spiritual struggles. Even pre-Christian writers speak of the ascesis of the psyche or of virtue, the discipline of the psyche, or the exercise in virtue. The physical idea, no less than the moral, underlies the meaning of the term used by Christians. The monastery, as the place where the required life of abstemiousness is lived under rigorous regulation and discipline, becomes the asketerion, a word used in classical Greek for a place reserved for physical exercise. Consequently, monks are ascetics, i.e., those under discipline and training unto perfect practice. The Greeks used the word to designate the exercise of athletes, whereby the powers dormant in the body were developed and the body itself was trained to its full potential.

Asceticism is therefore a strict, purposeful life, expressed in spiritual labors, the directing of the mind toward God, frequently in conjunction with corresponding physical undertakings, and simultaneously with abstention from any negative activity and unnecessary natural gratifications of the sensual desires (Baikalov-Latyshev, 1977). Asceticism is practiced through prayer, fasting, struggle with the sensual passions, partaking of the Holy Mysteries, and other spiritual exercises. This is apodvig, or act of ascetic struggle. However, ascesis is not the end, but only the means of purification, illumination, and theosis.

Christian ascetics do not struggle against nature, but against derangement in their own natures, due to the darkening of the nous. This derangement, or psychosis, causes the wo/man with a darkened nous to exceed the bounds prescribed in nature by God. Wo/man in such a state of psychosis is prone to excuse or dismiss his / her own actions, and to minimize his / her self-destructive behavior by attributing it to human weakness, or human nature, rather than recognizing it as harmatema, or willful sin and rebellion against God that leads to the further darkening of his / her nous and captivity to the passions (Bouton, 2004; DiLeo, 2007).

In order to be true to nature, wo/man must practice ascesis. Even the ancient pagan philosophers realized this (Bouton, 2004; DiLeo, 2007). The Christian who desires purification, illumination, and theosis, keeps God's commandments, eats and sleeps little, prefers coarse foods to gourmandizing, and is careful with wine. Podvigs are accessible to all, even if only during the fasting periods prescribed by the Church or before the reception of Holy Communion (Zacharias, 2008).

Intense spiritual and psychological pathologies, and especially the chronic ones, manifested in the eight deadly passions, including: (a) gluttony, (b) lust and fornication, (c) avarice, i.e., greed and love of money, (d) anger, (e) sorrow, (f) listlessness, i.e., acedia, or spiritual paralysis, (g) vainglory, or self-esteem, and (h) pride, are healed only by intensive remedies (Bouton, 2004; DiLeo, 2007; Zacharias, 2008).

The eight passions have different sources and different influences. Six, including gluttony, fornication, avarice, anger, sorrow and acedia are related, so that the excess in one gives rise to the next. Therefore, gluttony naturally gives rise to lust and fornication, lust and fornication to avarice, avarice to anger, anger to despondency, and despondency to acedia. For this reason, it is necessary to battle with them in that order. For example, in order to conquer acedia, despondency must be driven out; to drive out despondency, anger must be extinguished; in order to extinguish anger, avarice must be defeated; in order to break free of avarice, carnal lust must be subdued; in order to crush carnal lust, the passion of gluttony in food, drink, and intoxicants must be curbed. The last two passions, i.e., vainglory and pride, are also related and an increase in one of them increases the other. Vainglory gives birth to pride. And in order to destroy pride, vainglory must be crushed. At the same time, vainglory and pride are not in any way related to the first six passions, because wo/man particularly succumbs to these two, even after s/he has vanquished the other passions. The eight passions work in pairs in the following manner: carnal lust and fornication joins with gluttony (in food, drink, and intoxicants) in a special union, anger joins with avarice, acedia with despondency, and pride joins with vainglory (Chrysostomos, 2007; St. John Cassian,1979).

Each passion appears in more than one form. Gluttony occurs in three forms, and can include (a) eating at other than the appointed hour, (b) overeating without due regard as to the quality of the food, drink, or intoxicants, or (c) gourmandizing or insisting on delicacies. These produce dissolute overindulgence, which engender various psychological and physical disorders (Chrysostomos, 2007; St. John Cassian, 1979).

Lust and fornication have three faces. The first is committed through the coupling of two people. The second occurs without the participation of another person, and the third is committed in the mind and heart (Chrysostomos, 2007; St. John Cassian, 1979).

There are three kinds of anger. The first is the one that burns inside. The second erupts in words, conduct, and tantrums, and the third simmers internally and is referred to as a grudge (Chrysostomos, 2007; St. John Cassian, 1979).

Despondency occurs in two forms. The first appears after an angry eruption, or is caused through perceived forfeiture, losses, or offenses and / or through unrealized aspirations. The second occurs through the fear of one's fate or from excessive concern for the things of this world (Chrysostomos, 2007; St. John Cassian, 1979).

Acedia has two manifestations. One makes a person sleepy, and the other seeks entertainment (Chrysostomos, 2007; St. John Cassian, 1979).

Vainglory has many faces, but principally appears in two forms. The first occurs when a wo/man elevates him/herself with physical advantages and possessions, and the second occurs when a wo/man has a burning thirst for secular glory due to his / her spiritual or psychological advantages or prowess (Chrysostomos, 2007; St. John Cassian,1979).

Pride has two faces. One is physical and the second is spiritual. The spiritual one is more ruinous than the physical. It especially tempts those who succeeded in acquiring even the smallest virtue (Chrysostomos, 2007; St. John Cassian, 1979).

Although these eight passions tempt all people, they do not always assail every wo/man in the same manner or degree. Therefore, in one wo/man, the spirit of lust prevails, and in another, the spirit of anger. In another wo/man, vainglory holds sway, while in another pride rules (Chrysostomos, 2007; St. John Cassian, 1979). Having identified the passion that is particularly injurious to the individual, the struggle must be concentrated purposely against it, utilizing every effort toward nepsis and the ultimate crushing and eradication of that passion. It must not be dismissed as human nature or human weakness, for this can lead to an assault by all eight spirits and to utter captivity (St. John Cassian, 1979).

Ascesis is, therefore, the transfer of the struggle with evil from the realm of flesh and blood to the invisible world of the instigators of sin, i.e., the evil spirits. The wo/man who has not begun to struggle with these enemies cannot understand the cost (Bouton, 2004; DiLeo, 2007). The higher ascetic podvigs are the pursuit of those who have chosen them; but asceticism as a principle is accessible and necessary for every Orthodox Christian according to the measure of his / her strength and level of spiritual growth (Harton, 1964).

In response to this reality, the Holy Fathers propose developing the habit of a disciplined lifestyle, following Scriptural admonitions. The Orthodox practice of fasting is central to this (DiLeo, 2007). Fasting in the Orthodox tradition is more of an abstinence from certain foods than it is a total abstaining from food and drink, although there are short periods of total abstinence from food (Bouton, 2004). St. Philotheos proposes his intervention for the development of self-control and the ordered life:

Our Savior says: 'Watch yourselves, lest your hearts be weighted down by dissipation, drunkenness and worldly cares' [Luke 21:34]; and St. Paul says: 'The person engaged in spiritual warfare exercises self-control in all things' [I Cor. 9:25]. Aware of all that is said to us in the divine Scripture, let us lead our life with self-control, especially in regard to food. Let us accustom our body to virtuous and orderly habits, nourishing it with moderation. For in this way the upsurges of the soul's desiring power are more easily calmed and subdued by its sovereign aspect, the intelligence; and in fact the same is true where the soul's incensive power is concerned, as well as our other faults. For those with experience regard virtue as consisting in all-inclusive self-control, that is, in the avoidance of every kind of evil. (as cited in St. Nikodimos & St. Makarios, 1986, p. 21)

Emphasizing the need to practice asceticism, the Holy Fathers note that ascetic practices must be combined with watchfulness of the thoughts and self-talk, i.e., watchfulness relating to the nous:

We should not reject the practice of bodily asceticism; for as wheat comes from the earth, so from such practice grows spiritual joy and benediction. Nor should we try to evade our conscience when it speaks to us of things conducive to salvation that we ought to do, and constantly tells us what is right and what is our duty. This it does especially when purified through active, applied, and meticulous watchfulness of the intellect. (St. Nikodimos & St. Makarios, 1986, p. 27)

Fasting, in Orthodox monastic practice, has always been the most obvious and common form of ascetic practice (Bouton, 2004; DiLeo, 2007). To the Western Christian, the Orthodox concept of the purpose and benefits of fasting is often misunderstood (Bouton, 2004). Metropolitan Isaiah of Denver (1997) in an article entitled, And Then They Will Fast, describes the basic and correct understanding of fasting in Orthodox Christian tradition.

Throughout the penitential period of the Fast or Great Lent, the Church encourages Her people to increase their time of prayer, both private and corporate, while at the same time invites them to abstain and to fast from those things in life which identify one as belonging to the world. The purpose of this discipline is to strengthen one's spirit, so that the mind and the heart begin to dwell on the things not of this world. In this regard the believer runs a parallel course to that which Christ traveled in the wilderness for forty days and forty nights before he went forth to be tempted by Satan. Relative to the temptations which Christ faced, the practicing Christian is also expected to defeat the three temptations which Christ experienced and which identify one with the world: the temptations of pride, power, and possessions. In today's world we would use the terms, egotism, self-esteem, control, and unabated consumerism... Christian fasting is blessed by God Himself for it is the message of the believer to God that he desires the eternal blessings that are to come rather than the finite blessings of this life. Its benefits include increased spiritual strength, true obedience to God and total patience with one's fellow man. It assists the believer to take control of his lower appetites that involve the physical senses. The believer becomes mentally alert and sensitive to what is happening all around him. Moreover his understanding of life is also expanded. Fasting for an Orthodox Christian is what physical and mental exercise are to a professional athlete who aspires to win the big title and the trophy. Fasting of the mind and body to the Christian, based on the obedience of prayer, renews the health of soul, which in most people is parched and possibly dying. (para. 1)

The Holy Fathers place great emphasis on the practice of fasting for developing self-control, and state that it is the beginning of the path to healing of the psyche, and the key to obtaining true hesychia.

It is very rare to find people whose intelligence is in a state of stillness [hesychia]. Indeed, such a state is only to be found in those who through their whole manner of life strive to attract divine grace and blessing to themselves. If, then, we seek - by guarding our intellect and by inner watchfulness - to engage in the noetic work that is the true philosophy in Christ, we must begin by exercising self-control with regard to our food, eating and drinking as little as possible. (St. Nikodimos & St. Makarios, 1986, p. 17)

Fasting is so central to the method of the Holy Fathers, that Holy Fathers call it the 'second gate of entry to the noetic Jerusalem', with watchfulness being the first gate and mindfulness of death being the third gate (Bouton, 2004). Here again the triad of ascesis, nepsis and hesychia are demonstrated as the path to healing (St. Nikodimos & St. Makarios, 1986).

Finally, as a matter of self-control, the Holy Fathers encourage a commitment to cure. The one seeking healing of the psyche needs to commit to the course of therapy, even when, or if, s/he finds it will often be difficult to carry out some of the interventions (Bouton, 2004; DiLeo, 2007). St. Philotheos contends that Christ, invoked through prayer, will come to aid the individual through this trial. This is similar to St. Paul's statement to St. Timothy:

For I know in whom I have believed, and am persuaded that he is able to keep that which I have committed unto him against that day. (II Timothy1:12)

St. Philotheos explains:

Smoke from wood kindling a fire troubles the eyes; but then the fire gives them light and gladdens them. Similarly, unceasing attentiveness is irksome; but when, invoked in prayer, Jesus draws near; He illumines the heart; for remembrance of Him confers on us spiritual enlightenment and the highest of all blessings. (as cited in St. Nikodimos & St. Makarios, 1986, p. 27)

2.4.4 Hesychia and the 'Prayer of the Heart'

For Western readers, probably the most confusing of interventions used in disrupting the 'cycle of temptation' that leads to sin and to spiritual and psychological disorders and pathologies, is hesychia (stillness) (Bouton, 2004; DiLeo, 2007). Western Christians could best understand hesychia in the context of Psalm 46: "Be still [i.e., surrender and empty yourself] and know that I am God" (Psalm 46:10, KJV). This passage from the Psalms is virtually the foundation stone of the Orthodox concept of hesychia (Bouton, 2004). Rather than using the literal translation of the Greek word as 'stillness', it would conceptually be more correctly translated as 'focus' (Bouton, 2004; DiLeo, 2007). The concept of hesychia includes practices designed to focus the self entirely upon God. The triad of nepsis, ascesis, and hesychia must be understood in their holistic sense (DiLeo, 2007). It is virtually impossible to correctly practice one without practicing simultaneously the other two (Bouton, 2004). The ideal practice of the 'Jesus Prayer' is much more than repetition of the prayer (Maloney, 2003). It involves the practices of nepsis and ascesis. This could include, but is not limited to, prayer, fasting, the reading and study of the Holy Scripture, Divine worship, participation in the Holy Mysteries, and the eschatological principles of the remembrance of death and final judgment (Bouton, 2004; DiLeo, 2007).

In most English literature on Orthodoxy, hesychia is so strongly identified with the recitation of the 'Jesus Prayer' that the necessity for the holistic practice of the triad is sometimes overlooked (Bouton, 2004; DiLeo, 2007). There are elements, which could also be identified as ascesis or nepsis that are essential to the proper practice of hesychia.

Notwithstanding, to clearly understand the interventions proposed by the Holy Fathers it is important to understand hesychia as meaning 'focus' (DiLeo, 2007).

Focus on personal prayer has long been a tradition in the spirituality of the Orthodox Church (Bouton, 2004; DiLeo, 2007). The most ancient and accepted prayer method has been the 'Jesus Prayer'. Its origins reach back into the Old Testament belief that God's very name communicates Divine energy. This belief was shared by the first Christians in regard to the name of Jesus [see John 16:23-24; Acts 4:10]. A common repetitious prayer and petition was, and indeed still is, 'Kyrie eleison' (i.e., 'Lord, have mercy'). Eventually, the statement of the tax collector in the Gospel according to St. Luke, 'God, have mercy upon me, a sinner' (18:13), became the basis of the 'Jesus Prayer', of which the most widely accepted form is: 'Oh Lord Jesus Christ, Son of God, have mercy upon me, a sinner' (Anonymous, 1952).

The Holy Scriptures give the 'Jesus Prayer' its concrete form and theological content. The 'Prayer of the Heart' is grounded in the Holy Scriptures. It is brief and simple. It fulfils our Lord's command that in prayer, Christians are not to heap up empty phrases as the heathen do [see Matthew 6:7-8]. According to the Holy Scriptures, the power and glory of God are present in His name (DiLeo, 2007). In the Old Testament to invoke God's name was to enter into His Presence. 'Jesus', which means 'God saves', is the living Word addressed to humanity. 'Jesus' is the final name of God. 'Jesus' is 'the name which is above all other names' and it is written that 'all beings should bend the knee at the name of Jesus' [see Philippians 2:9-10]. In the name of Jesus, devils are cast out [see Luke 10:17], prayers are answered [see John 14:13-14], and the sick and lame are healed [see Acts 3:6-7]. The name of Jesus is spiritual power. The words of the 'Jesus Prayer' are themselves based on the very texts of the Holy Scripture, including the cry of the blind man sitting at the side of the road near Jericho, "Jesus, Son of David, have mercy upon me" (Luke 18:38); the ten lepers who "called to him, Jesus, Master, have mercy upon us" (Luke 17:13); etc. The 'Jesus Prayer' is a prayer in which the first and foundational spiritual step is taken, i.e., the recognition of personal sinfulness and estrangement from God. The 'Jesus Prayer' is a prayer in which the desperate need of a Savior is acknowledged (Orthodox Christian Information Center, 2009c).

According to St. Ignatius Brianchaninov (1965) in his book On the Prayer of Jesus, the prayer is a Divine institution.

After the mystical supper among other sublime, final commandments and orders, the Lord Jesus Christ instituted prayer by His name. He gave this way of prayer as a new, extraordinary gift, a gift of infinite value. The Apostles partly knew already the power of the name of Jesus; they healed incurable diseases by it, they reduced devils to obedience, conquered, bound and expelled them by it. This most mighty, wonderful name the Lord orders us to use in prayer. He promised that such prayer will be particularly effectual. Whatever you ask, he said to the holy Apostles, the Father in My name, I will do, that the Father may be glorified in the Son. If you ask anything in My name, I will do it (John 14:13). Truly, truly, I tell you, if you ask anything of the Father in My name, He will give it to you. Till now you have asked nothing in My name; ask and you will receive, that your joy may be full [John 15:23]. (pp. 18-19)

The 'Jesus Prayer' is psychotherapy. As medicine, the 'Jesus Prayer' is destructive of the passions and powerful in changing behavior (Bouton, 2004; DiLeo, 2007). Just as a doctor places a dressing on a patient's wound, and the dressing works without the patient knowing or understanding how it works, calling on the name of Jesus 'removes the passions' in spite of wo/man's inability to comprehend its power (Maloney, 2003). The holy name of Jesus, when repeated quietly, penetrates the psyche like a drop of oil, spreading out and impregnating a cloth (Bouton, 2004; DiLeo, 2007).

The modern translation of 'mercy' of the Greek word eleison is limited and insufficient. Eleison has the same root as elaion, which means 'olive' and / or 'olive oil'. In the Middle East, olive oil is used to provide physical healing for many sicknesses, particularly respiratory (DiLeo, 2007). 'Have mercy' then means to anoint the psyche with 'healing oil'. The Holy Fathers teach that praying or invoking the name of Jesus changes personality (DiLeo, 2007). The 'Jesus Prayer' functions as therapy, much like healing oil, transforming personality from overstrain to joy [see John 16:24]. Through continued prayer, these changes become permanent.

However, the 'Jesus Prayer', is not practiced simply to access 'some benefit'. Prayer is not simply a method to reduce stress, strengthen the immune system, lose weight, add years to life, etc. (Orthodox Christian Information Center, 2009d). On the contrary, to pray the 'Jesus Prayer' is to follow Christ, to become open to Him, and His way, i.e., the Way of the Cross (Maloney, 2003). Elder Joseph of Vatopedi, (as cited in Nahum, 2002) a spiritual child of Elder Joseph the Hesychast, teaches that prayer is the sole obligatory and indispensable occupation and virtue for all rational beings, both sentient and thinking, human and angelic, and for this reason Christians are enjoined to the unceasing practice of the prayer (Orthodox Christian Information Center, 2006b).

The Holy Fathers refer to the 'Jesus Prayer' as noetic because it is done with the nous. They also call it 'sober watchfulness' (DiLeo, 2007). The Holy Fathers describe the nous as free and inquiring. It does not tolerate confinement and is not persuaded by that which it cannot conceive on its own. Primarily for this reason, the Holy Fathers have selected just a few words in a single, simple prayer, 'Oh Lord Jesus Christ, Son of God, have mercy upon me, a sinner', so that the nous would not require a great effort in order to hold on to a long, protracted prayer (DiLeo, 2007). Secondly, the Holy Fathers turned the mind within, to the center of reason, where it resides motionless with the meaning of the Divine invocation of the most sweet name of our Lord Jesus, in order to experience as soon as possible the Divine consolation. It is impossible, according to the Holy Fathers, for our all-good Master, being so called upon continuously, not to hear (Orthodox Christian Information Center, 2009a).

Just as a natural virtue that is aspired to can only be achieved by conducive means, so also this holy work requires some indispensable rudiments: (a) a degree of quiet; (b) freedom from cares; (c) avoidance of learning about and spreading news of things going on, or 'giving and taking' as the Holy Fathers put it; (d) self-discipline in all things; and (e) an overall silence which stems from these (Bouton, 2004; DiLeo, 2007; Maloney, 2003). This habit will not be unattainable for devout people who take an interest in this holy activity. The habit of a regular prayer time, morning and evening, always about the same time, are a good beginning (Orthodox Christian Information Center, 2009a).

Perseverance is the most indispensable element in prayer (Tsichlis, 2003). Rightly it is stressed by St. Paul, "Continue steadfastly in prayer" (Colossians 4:2). In contrast to the rest of the virtues, prayer requires effort throughout our entire lifetime, and for this reason, those who attempt it should not feel encumbered, nor consider the very need to struggle for endurance as a failure in this sober-minded work (Maloney, 2003).

In the beginning it is necessary to say the prayer in a whisper, or even louder when confronted by duress and inner resistance. When this good habit is achieved to the point that the prayer may be sustained and said with ease, then it can be turned inwardly with complete outer silence (Bouton, 2004; DiLeo, 2007). Persistence and effort, and repeating the prayer are needed. This will bring control of the mind, at which time the presence of grace will be manifested (Orthodox Christian Information Center, 2009d).

As every virtue has a corresponding result, so also prayer has as a result, the purification of the mind and enlightenment. It arrives at the highest and perfect good, union with God, i.e., theosis (Bouton, 2004; DiLeo, 2007). However, the Holy Fathers also say that it lies with wo/man to seek and strive to enter the way which leads to the city; and if by chance s/he does not arrive at the endpoint, not having kept pace for whatever reason, God will number him / her with those who finished (Bouton, 2004; DiLeo, 2007).

By the presence of the 'Jesus Prayer', wo/man is not given over to temptation, because its presence is sober watchfulness and its essence is prayer; therefore "the one who watches and prays does not enter into temptation" [cf. Matthew 26:41, KJV]. Additionally, s/he is not given over to darkness of mind so as to become irrational and err in his / her judgments and decisions (Bouton, 2004; DiLeo, 2007). S/he does not fall into indolence and negligence, which are the basis of many evils. Moreover, s/he is not overcome by passions and indulgences where s/he is weak, and particularly when the causes of sin are near at hand. On the contrary, his / her zeal and devotion increase. S/he becomes eager for good works (Romanov, 1993). S/he becomes meek and forgiving. S/he grows from day to day in his / her faith and love for Christ and this inflames him / her towards all the virtues (Maloney, 2003).

Consequently, the 'Jesus Prayer' is a duty for each one of the faithful, of every age, nationality, and status; without regard to place or time (Orthodox Christian Information Center, 2009c). With the prayer, Divine grace becomes active and provides solutions to the problems and trials that trouble the Christians, so that, according to the Holy Scriptures, "Everyone that calls on the Lord shall be saved" (Acts 2:21 KJV).

It is of the utmost importance that when the prayer is being said that no image at all be portrayed in the mind, neither of our Lord Jesus Christ, nor of the Lady Theotokos, nor of any other person. By means of the mental image the mind is scattered. Likewise, by means of images the entrance for thoughts and delusions is created. The mind should remain in the meaning of the words, and with much humility the person should await Divine mercy (Bouton, 2004; DiLeo, 2007). The chance imaginations, lights, or movements, as well as noises and disturbances are unacceptable as diabolic machinations towards obstruction and deception (Orthodox Christian Information Center, 2009d). The manner in which grace is manifested to beginners is by spiritual joy, by quiet and joy-producing tears, or by a peaceful and awe-inspiring fear due to the remembrance of sins, leading to an increase of mourning and lamentation (DiLeo, 2007).

Gradually, grace becomes the sense of the love of Christ, at which time the confusion of the mind ceases completely, and the heart becomes warmed in the love of Christ. This, as well as various other forms of aid and comfort, is found in the initial stages by as many that try to say and maintain the prayer, inasmuch as it depends on them, and is possible (DiLeo, 2007). Every wo/man that is baptized and lives in an Orthodox manner should be able to put this into practice and to stand in this spiritual delight and joy, having at the same time the Divine protection and help in all his / her actions and activities.

Therefore, whenever one is seated, moving about, or working, or even in bed, and generally wherever and however one finds oneself, one can say the 'Prayer of Jesus' which contains within itself faith, confession, invocation, and hope (DiLeo, 2007). With such little labor and insignificant effort the universal command to 'pray without ceasing' (I Thessalonians 5:17) is fulfilled to perfection. It alone constitutes the most powerful means of success in Christ.

The Holy Fathers admonish Christians to press forward: those who are doubtful, despondent, distressed, ignorant, those of little faith, and those who are suffering trials of various kinds; forward to consolation and to the solution to all problems (Rose, 1974). The Lord Jesus Christ proclaimed, "without Me you can do nothing" (John 15:5). Therefore, calling upon Him continuously, wo/man is never alone, and consequently can and will do all things through Him [see Philippians 4:13]. "Call upon Me in your day of trouble and I will deliver you, and you shall glorify Me" (Psalm 49[50]:15). It is necessary to call upon the name of Jesus continuously; so that the mind may be enlightened and not enter into temptation (DiLeo, 2007). If anyone desires to step even higher, s/he must first pass through this beginning point. The rest will be spoken to or revealed regarding Him, upon arrival.

2.4.5   Overview of Neptic Treatment

Within the context of the healing of the psyche, the Holy Fathers offer five basic interventions to disrupt the 'cycle of temptation' that leads to sin and spiritual / psychological disorders and pathologies (DiLeo, 2007). Accordingly, the individual must: (a) maintain focus on God through prayer, fasting, remembrance of death and judgment,

study of Holy Scripture, and especially the unceasing practice of the 'Jesus Prayer' or 'Prayer of the Heart'; (b) guard his / her thoughts and self-talk, challenging them, using the teachings of the Holy Scripture, the life of Christ, and constantly focusing on the goal of becoming one with God; (c) avoid toying with evil thoughts in the imagination, not allowing these thoughts to create an image in the imagination, and especially not allowing the imagination to combine them with the senses through challenging images in the same way that distorted cognitions and self-talk are challenged; (d) dispel pride and embrace humility through understanding self-concept in the light of wo/man's relationship with and position before God and not according to the values of the world; and (e) practice self-control, which is to be strengthened in an incremental fashion, beginning with such ascetic practices as fasting (Bouton, 2004; DiLeo, 2007).

2.5 Depression and Anxiety

Depression and anxiety are among the leading causes of disability in the world and are the most common and widespread of psychological / psychiatric pathologies and disorders. Depressive disorders affect over 20 million American adults or about 9.5% of the total U.S. population. Similarly, anxiety disorders affect approximately 40 million American adults, or approximately 19% of the total population (World Health Organization, 2007).

Although depression and anxiety are distinct disorders, they are commonly seen together in clinical practice. Comorbidity, or mixed anxiety-depressive disorders are encountered so frequently that a diagnostic category of 'mixed anxiety-depressive disorder' appears in the appendix of the DSM-IV (Howland & Thase, 2005).

Recent studies indicate that the two are the result of a single underlying problem, or at the least, are closely related syndromes that feed off each other (Kessler, Chiu, Demler & Walters, 2005). Indications that depression and anxiety are linked include that individuals with anxiety disorders have much higher rates of depression than do the rest of the population (Bakish, 1999) and, approximately 50% of all individuals suffering with depression also have an anxiety disorder (Fava, Rankin, Wright, Alpert, Niernberg, Pava, Rosenbaum, 2000; Regier, Kaelber, Rae, Farmer, Knauper, & Kessler, 1998).

In the National Comorbidity Survey, 58% of individuals with Major Depressive Disorder (MDD) were found to have an anxiety disorder (Nisenson, Pepper, Schwenk, & Coyne, 2005). Among these, the rate of comorbidity with Generalized Anxiety Disorder (GAD) was 17.2%, and with panic disorder, 9.9%. Individuals with a diagnosed anxiety disorder also had high rates of comorbid depression, including 22.4% of patients with social phobia, 9.4% with agoraphobia, and 2.3% with panic disorder also had depression (APA, 2003; Morrison, 1995). For many, the symptoms of both depression and anxiety are subsyndromal to justify a primary diagnosis of either MDD or an anxiety disorder (Comer, 2004), and patients are categorized as having mixed anxiety-depressive disorder. These patients have a significantly increased risk of developing full-blown depression or anxiety (Kessler, Nelson, McGonagle, Liu, Swartz, & Blazer, 2005).

2.5.1 Depressive Disorders in the DSM-IV

The term depression is often used to refer to any of several depressive disorders (Reber, 1985). Three of these disorders are classified in the DSM-IV-TR by specific symptoms: (a) major depressive disorder, (b) dysthymia, and (c) depressive disorder not otherwise specified. Two others are classified by etiology: (a) depressive disorder due to a general physical condition and (b) substance-induced depressive disorder. In Western psychologies and / or therapies, treatment often includes psychopharmacological interventions and / or psychotherapy (DSM-IV-TR, 2005).

The exact etiology of depressive disorders is unknown, but probably involves heredity, changes in neurotransmitter levels, altered neuro-endocrine function, and psychosocial factors. Heredity has an uncertain role. Depression is more common among first-degree relatives of depressed patients, and concordance between identical twins is high. Hereditary genetic polymorphisms for the serotonin transporter active in the brain may be triggered by stress (Goldberg & Lecrubier, 1995; Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996). People who have a history of child abuse / neglect or other major life stresses and have the short allele for this transporter are about twice as likely to develop depression as those who have the long allele (DSM-IV-TR, 2005).

Other theories regarding the etiology of depression focus on changes in neurotransmitter levels, including abnormal regulation of cholinergic, catecholaminergic (noradrenergic or dopaminergic), and serotonergic (5-hydroxytryptamine) neurotransmission (Goldberg & Lecrubier, 1995; Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996; Regier et al., 1998). Neuroendocrine deregulation may be a factor, with particular emphasis on 3 axes: (a) hypothalamic-pituitary-adrenal, (b) hypothalamic-pituitary-thyroid, and (c) growth hormone (Gorman & Coplan, 1996; Keller & Hanks, 1994; Liebowitz, 1997; Marcus, Marquis, & Sakai, 1997).

Psychosocial factors also are involved in etiology. Major life stresses, especially separations and losses, commonly precede episodes of major depression. However, such events do not usually cause lasting, severe depression except in people predisposed to a mood disorder (Gorman & Coplan, 1996; Keller & Hanks, 1994; Liebowitz, 1997; Marcus et al., 1997).

People who have had an episode of major depression are at higher risk of subsequent episodes. People who are introverted and who have anxious tendencies may be more likely to develop a depressive disorder (Gorman & Coplan, 1996; Keller & Hanks, 1994; Liebowitz, 1997; Marcus et al., 1997). Such people often lack the social skills to adjust to life pressures. Depression may also develop in people with other mental disorders (Goldberg & Lecrubier, 1995; Magee et al., 1996; Regier et al., 1990).

Additionally, women are at higher risk. Possible factors include greater exposure to or heightened response to daily stresses, higher levels of monoamine oxidase (the enzyme that degrades neurotransmitters considered important for mood), and endocrine changes that occur with menstruation and at menopause. In postpartum depression, symptoms develop within 4 weeks after delivery (Gorman & Coplan, 1996; Keller & Hanks, 1994; Liebowitz, 1997; Marcus et al., 1997). Endocrine changes have been implicated, but the specific cause is unknown. Also, thyroid function is more commonly dysregulated in women.

In seasonal affective disorder, symptoms develop in a seasonal pattern, typically during autumn or winter. The disorder tends to occur in climates with long or severe winters. Depressive symptoms or disorders may occur with various physical disorders, including thyroid and adrenal gland disorders, benign and malignant brain tumors, stroke, AIDS, Parkinson's disease, and multiple sclerosis (Smith, 1979). Certain drugs, such as corticosteroids, some ß-blockers, antipsychotics (especially in the elderly), and reserpine, can also result in depressive disorders. Abuse of some recreational drugs (e.g., alcohol, amphetamines, etc.) can lead to or accompany depression. Toxic effects or withdrawal of drugs may cause transient depressive symptoms (Gorman & Coplan, 1996; Keller & Hanks, 1994; Liebowitz, 1997; Marcus et al., 1997).

According to the DSM-IV, the most common symptoms in depressive disorders include the following: (a) difficulty concentrating, remembering details, and making decisions; (b) fatigue and decreased energy; (c) feelings of guilt, worthlessness, and / or helplessness; (d) feelings of hopelessness and / or pessimism; (e) insomnia, early-morning wakefulness, or excessive sleeping; (f) irritability and restlessness; (g) loss of interest in activities or hobbies once pleasurable, including sex; (h) overeating or appetite loss; (i) persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment; (j) persistent sad, anxious, 'empty', or 'void' feelings; and (k) thoughts of suicide and suicide attempts (DSM-IV-TR, 2005).

2.5.2 Anxiety Disorders in the DSM-IV

The anxiety disorders are also among the most common, or frequently occurring, mental disorders. They encompass a group of conditions that share extreme or pathological anxiety as the principal disturbance of mood or emotional tone. Anxiety, which may be understood as the pathological counterpart of normal fear, is manifest by disturbances of mood, as well as of thinking, behavior, and physiological activity.

The anxiety disorders include panic disorder (with and without a history of agoraphobia), agoraphobia (with and without a history of panic disorder), generalized anxiety disorder, specific phobia, social phobia, obsessive-compulsive disorder, acute stress disorder, and post-traumatic stress disorder (DSM-IV-TR, 2005). In addition, there are adjustment disorders with anxious features, anxiety disorders due to general medical conditions, substance-induced anxiety disorders, and the residual category of anxiety disorder not otherwise specified (DSM-IV-TR, 2005).

Anxiety disorders are ubiquitous across human cultures (Kessler et al., 1994; Regier et al., 1993; Weissman et al., 1997). In the United States, 1-year prevalence for all anxiety disorders among adults from 18 to 54 exceeds 16%, and there is significant overlap or comorbidity with mood and substance abuse disorders (Goldberg & Lecrubier, 1995; Magee et al., 1996; Regier et al., 1990). The longitudinal course of these disorders is characterized by relatively early ages of onset, chronicity, relapsing or recurrent episodes of illness, and periods of disability (Gorman & Coplan, 1996; Keller & Hanks, 1994; Liebowitz, 1997; Marcus et al., 1997). Although few psychological autopsy studies of adult suicides have included a focus on comorbid conditions (Conwell & Brent, 1995), it is likely that the rate of comorbid anxiety in suicide is underestimated. Panic disorder and agoraphobia, particularly, are associated with increased risks of attempted suicide (American Psychiatric Association, 1998; Hornig & McNally, 1995).

The symptoms of anxiety in the DSM-IV include: (a) uncontrollable and irrational worry / fear that is disproportionate to the actual source of concern; (b) excessive distress over everyday matters, e.g., health issues, money, death, family problems, relationships and / or work; (c) these are accompanied by physical symptoms, including fatigue, restlessness, headaches, nausea, muscle tension and aches, difficulty swallowing, trembling, irritability, sweating, insomnia, hot flashes, etc.; (d) these symptoms are consistent and on-going for a period of 6 months or more.

2.5.3 Depression and the Holy Fathers According to Smith (1979), Hippocrates, in his Aphorisms, characterized all long-lasting fears and despondencies as being symptomatic of melancholia. The Holy Fathers commonly used this term, i.e., melancholia, as well as dejection and / or despondency, i.e., kataptoisis, in describing depression, and extensively discussed its etiology and effects (Herman, 1995).

The Holy Fathers proffer that depression has multiple etiologies (St. John Cassian, 1979). Since it is not induced voluntarily, and there is an aversion to it because it causes much distress, it is considered to be a demonic manifestation or assault upon an individual (St. Evagrius, 1981). Depression is considered to be a satanic energy, i.e., a diabolic breath and a poisonous thought that injures the injudicious (St. Peter Damascene as cited in Herman, 1995), and is likened to suicide because it kills the eagerness and vivacity of the psyche and casts it into deadly sorrow and sluggishness. The Holy Fathers agree that this trick of the devil primarily enslaves the ignorant, who do not understand the character of Christ and His infinite goodness (Vranos, 1984).

The Holy Fathers proffer that demons generally encourage the psyche to love pleasure. However, the demon of depression corrupts the thoughts of those he enters by cutting off every pleasure of the psyche and drying it up [see Proverbs 17:22] through dejection (Vranos, 1984). According to the Holy Fathers, boredom and depression are the primary enemies of salvation (St. Peter of Damascene as cited in Herman, 1995).

St. Gregory of Sinai (as cited in Herman, 1995) states that when depression becomes firmly established, a great battle must be waged by the psyche. He submits that this cruel and oppressive spirit is either combined with the spirit of sadness, or follows after it. He proffers that when the fierce wars of this passion rise and sweep through the heart, all hope is eradicated and wo/man believes that s/he suffers in spite of Divine Providence.

St. Evagrius the Solitary (as cited in St. Nikodemos & St. Makarios, 1983) identifies the demon of despondency, calling him the noonday demon [see Psalm 90:6]. "It attacks in about the fourth hour [i.e., 10:00 a.m.] and whirls the psyche round and round till about the eighth hour [i.e., 2:00 p.m.]" (St. Evagrius as cited in St. Nikodemos & St. Makarios, 1983, p. 18). The demon of despondency spreads his nets to provoke discontent related to the attachment to the things of this world. Discontent comes from a deprived pleasure, whether actual or expected. This enemy cannot be overcome until earthly attachment is transcended (St. Evagrius as cited in St. Nikodemos & St. Makarios, 1983).

According to St. Ignatius Brianchaninov (1983), in his book titled, The Arena, demons who have acquired in the struggle with wo/man uncommon skill and experience through practice, keep the heart in an irresolute state and fill the mind with doubt. They weary and gradually exhaust the powers of a wo/man's psyche. S/he then presents the following symptoms: (a) sadness; (b) inaction, (c) apathy; (d) distress; (e) hopelessness; (f) lack of interest in activities; and (g) breakdown in relationships. The psyche that is filled with sorrow is unable to accept advice. It flees others as if they were the cause of the sorrow, and fails to understand that the cause is from within (St. Seraphim of Sarov, 1980).

Even at prayer, the demons suggest an imaginary need or desire, a feeling of emptiness and / or sense of void for various unlawful things, in reality unattainable, and then stir up remembrance of these fantasies, inciting the nous to pursue them. When such fantasies are momentarily realized, the darkened psyche experiences a fleeting satisfaction, but when the psyche is faced with the transitory nature of these fantasies, it becomes depressed and miserable. Even when the nous is at prayer, the demons attempt to keep filling it with the thought of these things, in order to deceive the psyche into believing that fantasies will become permanent satisfactions, thereby destroying the fruitfulness of the nous' prayer (St. Evagrius the Solitary, 1981).

According to St. John Cassian (1979), wo/man's principal struggle is against the demon of gloom or depression, who obscures the psyche's capacity for spiritual contemplation, prayer, reading Holy Scripture with profit and perseverance, and who keeps it from all good works. Undermining all of the psyche's salutary resolutions, weakening its persistence and constancy, the demon of depression leaves the psyche senseless and paralyzed, tied and bound by its despairing thoughts.

Long and excessive desire for any imaginary need or desire for the sensory brings sorrow to the heart and darkens and disturbs the nous. It banishes pure prayer and all tenderness from the psyche and brings a painful pining or longing in the heart. This leads to measureless hardness and insensibility, and for this reason the demons usually bring depression upon those who have undertaken to lead a spiritual life. For example, ascetics, who attempt to live an angelic life, i.e., a life on a higher plane, are particularly affected by such fantasies as the demons of depression and anxiety often attack them, implanting in their minds an idealized vision of the fulfillment and earthly bliss to be found in the communion with women and / or in the marital state, when in reality, after the initial excitement of the passions passes, man is left to that which is described by the Holy Apostle Paul as anxiety for the things of this world and great distraction [see I Corinthians 7] (St. Symeon the New Theologian, 1995).

The demon of depression devours a wo/man's psyche. It persuades him / her to spurn every helpful encounter and stops him / her from accepting advice from his / her family and true friends or giving them a courteous and peaceful reply. Seizing the entire psyche, it fills it with bitterness and listlessness. Then it suggests to the psyche that one should avoid people, and / or judges them to be the cause of his / her agitation. It does not allow the psyche to understand that its sickness does not come from without, but lies hidden within, manifesting itself when temptations attack the psyche because of ascetic efforts or purpose. A wo/man can be harmed by another only through the causes of the passions that lie within him/herself. In avoidance and distraction, the causes of depression are not eradicated but exchanged, since the sickness that lies hidden within will show itself again in other circumstances (St. John Cassian, 1979).

Wo/man must struggle with the demon of depression who casts the psyche into despair. This demon did not allow Cain to repent after he had killed his brother and caused Judas to commit suicide after he had betrayed the Lord. The only form of sorrow that should be cultivated is that which is the product of repentance for sin and is accompanied by hope in God (St. Gregory of Sinai, 1995). It was of this sorrow that the Holy Apostle Paul said: "Godly sorrow produces a saving repentance which is not to be repented of" (II Corinthians 7:10). This 'godly sorrow' nourishes the psyche through the hope engendered by repentance, and it is mingled with joy. That is why it makes wo/man obedient and eager for every good work: accessible, humble, gentle, forbearing and patient in enduring all of the suffering or tribulation that God may send. Possession of these qualities shows that a wo/man enjoys the fruits of the Holy Spirit, i.e., love, joy, peace, long-suffering, goodness, faith, and self-control [see Galatians 5:22]. But from depression, wo/man comes to know the fruits of the evil spirit: listlessness, impatience, anger, hatred, contentiousness, despair, sluggishness in praying, etc. (Macarius of Optina, 1995). This can only be healed by prayer, hope in God, meditation on Holy Scripture, and by living with godly people (St. John Cassian, 1979).

Therefore, it is clear that the fight is against the passions within. Because wo/man has lost his / her preeminence and his / her nous is darkened, s/he should also look within him/herself for the causes of depression. St. Seraphim of Sarov (1980) warns:

Beware of the spirit of despondency, for it gives birth to every evil. A thousand temptations come from it: agitation, rage, and blame, complaint at one's fate, profligate thoughts, and constant change of place. The soul then avoids people, believing them to be the cause of its trouble, and does not understand that the cause of its illness is within itself. (p. 47-48)

According to St. Seraphim, depression is born of cowardice, or fear [see I John 4:18], idleness, and useless chatter (p. 49). Depression is related to an inadequate relationship with Christ; and the principal causes are unbelief and / or lack of true commitment. For the Holy Fathers, in order to embrace the spiritual life, wo/man must inwardly resolve to commit him/herself unreservedly, to the end. It is precisely this resolution that frightens the cowardly and effeminate, so that they feel compelled to serve two masters. This becomes the source of many sorrows (St. Gregory of Sinai, 1995).

This is the result of pride or trusting in the self excessively. The Holy Fathers argued that one can be saved anywhere and one can also perish anywhere. For example, Satan was the highest of angels, standing always before God, and yet he fell by pride. Judas Iscariot was one of the twelve apostles, and yet because of his love for money, he betrayed the Lord and later committed suicide because of depression and despair. Many have perished in a similar manner and for similar reasons (New Martyr Valentin Sventitsky as cited in Herman, 1995).

Depression, according to the Holy Fathers, has its etiology in faintheartedness and from seeking comfort in the temporal. It is often based upon obstinacy and the rejection of God's wisdom and laws (Palmer, Sherrard, & Ware, 1983). Since its etiology is ungodly, and accordingly not capable of giving spiritual satisfaction to the psyche, wo/man's whole being moans in sadness, lacking God's illumination. If wo/man continues to seek humanistic, earthly, momentary, and temporal gratifications or consolations, s/he will increase the pain of depression until the psyche becomes pathologically disordered, and utterly sick and tired of itself, feeling confined, like a caged bird, pressured by this psychological routine of demonic, and at the same time self-induced, deceit, and consequently will be literally and completely depressed (Elder Nectarius of Optina as cited in Herman, 1995).

St. Gregory of Sinai (1995) teaches that intemperance and attachments to the fleeting gratifications of this world cause torrents of passions to flood the heart and deposit there all the mud and filth of inordinate and insane thoughts, confusing the mind, darkening the heart, and weighing down the body. In the heart and the psyche they produce negligence, darkness and death, and deprive them of the feeling and disposition natural to them.

The Holy Fathers proffer that wo/man must know the purpose of life to be free. God allows the demons to attack us for five reasons. The first is that, through being attacked and fighting back, wo/man should learn to distinguish virtue from sin. The second is that, having acquired virtue by struggle and labor, wo/man should keep it firm and unalterable. The third is, that progressing in virtue, wo/man should not think highly of himself but learn humility. The fourth is that having experienced in practice the wickedness of sin, wo/man should hate it with perfect hatred. Finally, the fifth and most important is that having been freed from passions, wo/man should not forget his / her weakness and the strength of God, who has helped him / her (St. Maximus the Confessor, 1985).

To recap, from distraction comes drowsiness and a dark, insatiable sleep. From darkness comes falling into sin. From falling into sin comes despondent torment of the psyche and depression. Since the darkness of the mind comes from the wandering and distraction of thoughts and the failure to restrain the senses, wo/man must flee the temptations of the world, guard his / her senses, and hold them back as a horse by the reins from harmful incidents without giving them a free hand, that by guarding them s/he may flee from all evil deeds (St. Paisius Velichkovsky, 1976). It is necessary to be attentive and vigilant, and to hold fast to the grace of God, lest sin should creep unnoticed into the psyche and / or body and drive away this grace. But if with carelessness and inattention sin enters, and particularly the one sin to which a wo/man's weak flesh is especially addicted, defiling the body and the psyche, then grace will depart, leaving him / her stripped, naked, and lonely. Then sorrow, which is given for the purpose of inducing repentance, salvation, and protection, will heavily trample the sinner, will crush him / her with sadness, depression and despair, as one who holds the gift of God, without due reverence for the gift. For this reason, the Holy Fathers urge men and women to bring back their hearts to purity in true and resolute repentance, and through purity to the gift of patience, since this gift of the Holy Spirit dwells in only the pure (St. Ignatius Brianchaninov, 1983).

The new martyr Alexandra Romanov (as cited in Herman, 1995) gives a perfect definition and description on the mystery of 'godly sorrow' [II Corinthians 7:10]:

It will steady our faith and help us to trust in times of suffering and trial if we understand that nothing is purposeless, nothing accidental, that nothing is meant to harm us, that everything is intended to help us toward noble character and fuller, richer life. (p. 123)

Pain, including depression, is therefore meant to yield blessing to him / her who endures it. Those who witness and note the manliness, courage, and victory with which suffering, pain, and depression are borne, are also blessed. Therefore, it is because of God's love for wo/man that wo/man is called and / or permitted to suffer (Cavarnos, 1985).

The Holy Fathers dealt with the etiology and treatment of depression holistically before modern Western psychotherapies feigned reinvention. Nevertheless, both the Holy Fathers and modern psychology, agree on the symptoms of depression: (a) lack of pleasure in almost all activities and inappropriate mood reactivity to induced pleasure; (b) distinct quality of sadness in the depressed mood; (c) depression is regularly worse in the morning; and (d) noticeable psychomotor retardation or agitation.

2.5.4 Anxiety and the Holy Fathers

In the West, the term anxiety was innovatively used in 'theology' by Danish philosopher S0ren Kierkegaard, who described anxiety as dread or angst, i.e., unfocused fear (Evans, 1990). He used the word 'dread' or 'anxiety' to describe a profound and deep-seated spiritual condition of insecurity or existential malaise and despair in the free spirit of every human being. Kierkegaard believed that the freedom given to wo/man leaves him / her in a constant fear of failing his / her responsibilities towards God (Evans, 1990). For Kierkegaard, anxiety is primarily an illness of the human psyche or soul.

The Holy Fathers, commonly used the Greek word, merimna, which is related to merizo, i.e., to draw in different directions or distract, to characterize what is now identified as anxiety [see Matthew 13:22; Mark 4:19; Luke 8:14; Luke 21:34; II Corinthians 11:28; and I Peter 5:7]. It should be noted that as in sadness and depression, which lead to repentance, the Holy Fathers proffer that merimna can sometimes be positive. For example, in response to the turmoil in the church at Corinth, the Holy Apostle Paul urged that the local members should subordinate their self-interests and merimnosin, i.e., may-be-being-in anxiety, one for one another (I Corinthians 12:25). Anxiety in this case was the antidote for contention.

The Holy Apostle Paul admonishes Christians to: "Be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all comprehension, will guard your hearts and minds in Christ Jesus" (Philippians 4:4-7). In this passage, the word 'anxious' is a translation of the Greek merimnate, from merimnao, meaning 'to be divided or distracted'. The Latin word, anxius, carries the added nuance of 'choking or strangling', actually this sensation appears as a symptom in the DSM-IV. Therefore, anxiety threatens to strangle wo/man's life or psyche, leaving wo/man asphyxiated by fear and gasping for hope.

St. Neilos the Ascetic (1979) writes about anxiety in his Ascetic Discourse. He reminds Christians that: "All the life of the ungodly is spent in anxiety" (Job 15: 20) and emphasizes detachment from worldly concerns, because "it is characteristic of an imperfect soul to be worn down with anxiety about material things" (p. 244). St. Neilos counsels that the wo/man who wishes to be free from anxiety should emulate and live like a "lily among thorns" [see Song of Solomon 2:2] referring to Christ's words in St. Matthew 6:28-29. St. Neilos proffers that: is indeed ungodly to pass one's whole life worrying about bodily things and to give no thought to the blessings of the age to come - to spend all one's time on the body, though it does not need much attention, and not to devote even a passing moment to the soul, though the journey before it is so great that a whole lifetime is too short to bring it to perfection. (p.245)

St. John of Karpathos (1979), in his instructions to the monks of Ethiopia, confirms St. Neilos' teaching and recommends that wo/man should avoid being burdened down with anxiety over bodily needs and / or cares of this world (p. 308).

In Orthodoxy, the etiology of anxiety is seen as being related to missing the purpose of wo/man's calling in life. If wo/man is not focused on fulfilling God's plan, then s/he becomes distracted and fragmented. This, in turn, leads to a worldview founded on the darkened nous, leading to the emptiness of the psyche, and fantasies of fulfillment that are the consequences of the separation from God. The attachment to the transient things of the world and sinful passions become the only reality, which leads to anxiety, as the psyche lives in a state of constant flux, dreading the loss of temporary gratification and comfort.

The consequence of this fragmented existence that is inevitably focused on self-gratification and comfort is expressed by the Venerable Macarius the Great (as cited in Orthodox Photos, 2009) when he states that:

Hatred comes for harboring ills, harboring ills comes from pride, pride comes from vanity, vanity comes from lack of faith, lack of faith comes from hard-heartedness, hard-heartedness comes from negligence, negligence comes from laziness, laziness comes from despondency, despondency comes from anxiety, anxiety comes from impatience, impatience comes from conceit. (para. 8)

St. Leo the Great (in Christian Classics Ethereal Library, 2009) gives a more holistic view of the etiology and treatment of anxiety. He states that:

When the Savior instructed His disciples about the coming of God's Kingdom and the end of the world, and taught His whole Church, in the person of the Apostles, He said: Take heed lest haply your hearts be overcharged with surfeiting and drunkenness, and care of this life (Luke 21:34). And assuredly, we acknowledge that this precept applies more especially to us, to who undoubtedly the day denounced is near, even though hidden. For this coming, it is necessary for every man to prepare himself, lest it find him given over to gluttony, or entangled in cares of this life. For by daily experience... it is proved that the mind's edge is blunted by over-indulgence of the flesh, and the heart's vigor is dulled by excess of food, so that the delights of eating are even opposed to the health of the body, unless reasonable moderation withstands the temptation and the consideration of future discomfort restrains us from the pleasure. For although the flesh desires nothing without the soul, and receives its sensations from the same source as it receives its motions also, yet it is the function of the same soul to deny certain things to the body which is subject to it, and by its inner judgment to restrain the outer parts from things irrational and unseasonable, in order that it may be free from bodily lusts, and have leisure for Divine wisdom in the palace of the mind, where, away from all the noise of earthly cares and from the anxiety emanating there from, it may in silence enjoy holy prayer and eternal delights. And, although this is difficult to maintain in this life, yet the attempt can frequently be renewed, in order that we may the oftener and longer be occupied with spiritual cares rather than fleshly cares and anxiety; and by our spending ever greater portions of our time on higher cares, even our temporal actions may end in gaining the incorruptible riches. (p. 1)

To recap, the Holy Fathers deal with the etiology of anxiety holistically and place an ontological focus on its treatment. Notwithstanding, the Holy Fathers and modern psychology, agree on the symptoms of anxiety: (a) uncontrollable and irrational worry that is disproportionate to the actual source of worry; (b) excessive concern over everyday matters, e.g., health issues, money, death, family problems, relationships and / or work; (c) these symptoms are accompanied by a variety of physical symptoms, including fatigue, restlessness, headaches, nausea, muscle tension and aches, difficulty swallowing, trembling, irritability, sweating, insomnia, hot flashes, etc.; (d) these symptoms are consistent and on-going, and persist.

2.6 Summary

The Holy Fathers propose a model that embraces a cognitive, conative, and behavioral approach in the framework of neptic psychology and is consistent with much of the theory, practice, and methods of Cognitive Behavioral Psychology. However, Orthodox Psychotherapy, or the neptic-psychotherapeutic model, is based on an Orthodox Christianphronema, or worldview, emphasizes synergy, and incorporates aspects of both human and Divine action and cooperation. The cognitive, conative, and behavioral aspects or practices of the various interventions require direction by spiritual therapists, and synergy, in conformity with Orthodox praxis, on the part of the wo/man who is treated (DiLeo, 2007). The Patristic triad of ascesis, nepsis, and hesychia, as a method of healing the ill psyche of spiritual, behavioral, and psychological disorders and pathologies, is realized by both the effort of wo/man to change and move towards God, and the Energies of God moving in wo/man to bring about that change.

The model derived from the Holy Fathers provides the following framework: (a) investigation to determine the etiology of spiritual, behavioral, and psychological disorders and pathologies; (b) analysis to understand the mechanisms by which wo/man moves from the point of causative / contributory factors in the 'cycle of temptation' to undesired conduct, and from there to the development of spiritual, behavioral, and psychological disorders and / or pathologies; and (c) neptic-psychotherapeutic interventions based on the Holy Scriptures as a method of obtaining the desired change (DiLeo, 2004). In the following chapter, the methodology of the present study is discussed and explained. 


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Page created: 11-2-2011.

Last update: 11-2-2011.