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Sin of sadness: acedia vel tristitia between sociocultural conditionings and psychological dynamics of negative emotions.

Throughout much of western civilization, emotions have been the focus of attention of philosophers, religious moralists and psychologists. The social consensus won by each of these perspectives has varied over time. In the twentieth century the youngest among the three mentioned disciplines gained undisputed social prevalence over the other two.

Psychologists from different backgrounds have often displayed a supercilious attitude toward philosophers' and moralists' treatment of emotions. Secular psychologists have been inclined to dismiss religion-based strategies for the management and development of personality as a devalued residue of a pre-scientific approach to human reality.

More recently, religiously committed psychotherapists have warned against the risks implied in such a reductionistic approach. Among them, Solomon Schimmel has written, "Amoral psychology is uncomfortable with 'oughts'--it prefers to think that it can deal with facts about human nature, shunning values" (1997, p. 5). In Schimmel's view, the rejection of the religiously informed moral tradition would amount to the wasting of a highly valuable lore. "The theologians and moralists ... were profound psychologists. Not only did they excel in analyzing human personality, but because they wanted to guide us to self-improvement they were very action oriented" (1997, p. 4). According to Schimmel, a wide understanding of moralistic literature on sin could be clinically useful to most psychotherapists, even if personally uninterested in religious experience.

Within the framework of a religiously informed and highly relational theory of emotions, G. Simon Harak (1993) has called attention to each man's responsibility to control, transform and correctly develop his own emotions. In fact, in the second half of the last century the awareness of the moral dimension our emotions entail has gathered increasing consensus also among philosophically oriented ethicists (Salomon, 2003).

Among human emotions, sadness can be a particularly valuable subject for discussing the potential benefits which a deeper understanding of moral literature on passions could offer to contemporary clinicians. In fact, sadness intense and persistent--is the core symptom of a highly prevalent, disabling, and not rarely lethal psychiatric condition: major depression. As such it is the target of many psychiatric and psychological therapeutic strategies. At the same time, sadness has been for over two thousand years the focus of enhanced attention by philosophers and ascetics.

In fact, the early society felt a certain uneasiness when confronted with the experience of sadness. on the one hand, since Hippocratic times medicine has conceptualized prolonged sadness as a sign of a derangement of the healthy functioning of the human mind (Jackson, 1986). On the other hand, the highly influential philosophical school of stoics listed Aunt] (sadness) among the passions which can potentially deviate the soul from its due moral path (Diogenes Laertius, trans. 1925).

The development and triumph of Christian religion did mark the end of the impact of stoic philosophy but, as it was repeatedly underscored (e.g., Bonhoffer, 1911), the new religion, or at least its ethic, showed many parallels with the most eminent moral philosophy of the imperial age. From our point of view, it is particularly interesting to take notice that the Christian ascetic displayed, since his earlier written documents, an evident hostility toward mental pain. Specifically, a couple of forms of expression of mental pain (i.e., acedia and tristitia) were considered to be mortal sins within Christian thought all through the Middle Ages.

Within the framework of his advocacy for a general rediscovery of religious moral theology, Schimmel (1997) has suggested that strategies drawn from moralistic literature on the sin of acedia vel tristitia may produce a large impact on the treatment of depressive states, at least for the believing patient. He believes that loss of meaning and carelessness toward religious obligations and others' needs not only reinforces sadness and vice versa, but also substantially contributes to the development of clinically significant depression. He therefore proposed to adopt from moral literature strategies for fostering positive emotions as a valuable supplement to conventional treatments of depression.

An immediate transduction of moral teachings to clinical practice is, however, all but unproblematic. Religious morality has its own history, tradition, and language. The meaning of acedia has undergone important shifts through church history. Specifically, while in contemporary religious teachings sloth is conceptualized in terms of poor interest in God and others, late antique and medieval formulations of the sin of acedia vel tristitia implied a damnation of sadness and related feelings.

The damnation of sadness as a socially reproachable behavior for which humans bear responsibility differs deeply from the attitude informing contemporary clinical work. While treating depression, we assume it is a reaction to adverse events or the product of dysfunctional mental or cerebral processes. Generally speaking, in psychopathological and psychotherapeutic views, the depressed patient is thought of as the passive recipient of external and internal negative influences. From this point of view, the immediate extension to clinical work with depressed patients of moralistic strategies for overcoming the sin of acedia vel tristitia does not lack obvious theoretical difficulties.

If we are to fully appreciate the contribution of moral literature to the understanding and treatment of depression, we must preliminarily understand this widely shared and long-lasting conceptualization of sadness as sin. In order to make possible a fruitful communication between the fields of clinical psychology and moral theology we need not only to review the historical origin and development of the concept of acedia, we must also be able to formulate religiously based statements in a language consistent with our own current psychological thinking. We must be able to embed them in a consistent theory of sadness and of its role in the processing of human experiences.

From this point of view the works by Wilfred R. Bion may offer a particularly valuable framework for formulating emotional pain. In fact, the conceptualization of mental pain as a specific ingredient of psychoanalytic process makes this model uniquely suitable as a base to our investigation.

In the present paper we will therefore rely on Bion's unique conceptualization of core dependency relationships (relations to the breast in Klein's terms) in order to develop a deeper understanding of the moral evaluation of sadness as a sin. We will follow the emergence of the moral damnation of sadness from late antique Christianity to the highest artistic and theological achievements of medieval Christianity, as represented by Dante Alighieri's and Thomas Aquinas's works. Finally we will show how an embrionary attitude of reproach toward mental pain can be traced back as early as to apostolic times.

Based on Bion's theory of mental pain and projective identification we will show that the damnation of mental pain and its communication entered within Christian community experience due to social and group dynamic pressing toward the control of the free communication of pain experience. Before we set off on our historical journey, we will now summarize the main dimensions in Bion's thought in order to help the reader to contextualize better our subsequent analysis.

Wilfred Bion's Conceptualization of Core Dependency Relations

Wilfred R. Bion (1897-1979)--a pupil of Melanie Klein's--formulated, mainly in the first decades after World War II, a highly original theory of the functioning of the human mind (see Symington & Symington, 1996, for a general introduction to Wilfred Bion's thought). In Bion's view, emotional experience surfaces within the self in a highly primitive state. He termed these primary emotional events beta ([beta]) elements (Bion, 1962, pp. 6-7).

Beta elements lack almost completely a representational component. Rather, they may immediately reflect in somatic symptoms, psychotic symptoms or raw undeliberate actions. They may become the material of unconscious experience only in as much as they are further processed. Bion believed the resources of the human mind included the ability to transform [beta] elements in higher order experiential ([alpha]) elements, which could be amenable to the operations of the conscious and unconscious mind. These [alpha] elements could in turn be the basic bricks of dreams, interpersonally meaningful narratives and neurotic symptoms (Symington & Symington, 1996, pp. 61-62).

According to Bion, then, the processing of emotional experiences represents the core task of the human mind. He admitted this processing entails an intrapsychic dimension. At the same time, however, he believed emotions could circulate widely within close interpersonal relationships. Melanie Klein (1946) had previously termed this direct and unconscious exchange of emotions between the partners of an intimate relationship projective identification. Through projective identification, human beings would be able to exchange--or better actively insert into others distressing emotions. Bion realized the use of projective identification is not restricted to early developmental stages or severe regression states. Rather it would allow a continuous emotional interrelationship within couples and groups.

In Melanie Klein's (1946) conceptualization of the human mind, the interaction between the suckling infant and the mother's breast is a basic metaphor for intimate relationship. In fact, it would amount to the basic template shaping all child and adult dependency relationships. Bion (1962) realized that humans turn to love objects not only to receive the physical and emotional care they are in need of. He proposed that the mother plays a core function also in the development of the child's thought processes.

In Bion's view, intense negative emotions, including anxiety and sadness elicited in early interaction with the mother and the environment, would be prone to overflow the infant's processing resources and to surface in that indigested form we have earlier referred to as [beta] elements. The latter ones may be poured--through projective identification--into the mother's mind. The mother's ability to adequately contain these raw materials and to hand them back to the child in a milder, more tolerable form--as [alpha] elements, in Bion's terms--would be the basic perquisite for normal psychological development in humans (Bion, 1962, pp. 90-91; Symington & Symington, 1996, pp. 58-59).

Bion (1963/1977) was well aware sadness was prominent among emotional contents exchanged through such projective mechanisms. The concept of mental pain was the object of psychoanalytical inquiry since Freud published Hemmung, Symptom und Angst (Inhibition, Symptom and Anxiety) in 1926. In the last addendum to that work, he differentiated pain from other distressing emotions, namely mourning and anxiety, and referred its source chiefly to a (reversible) separation from the love object. Among psychoanalysts inspired by the works and teachings of Melanie Klein, and particularly within the works of Wilfred R. Bion, mental pain received a deeper attention.

Bion (1963/1977) considered mental pain to be a basic element of psychoanalysis. Bion believed the working through of painful emotional experiences should be deemed a core task for a healthy functioning of the mental apparatus. He even advocated that the practice of psychoanalysis should aim at enhancing the individual's capacity to experience, tolerate and understand mental pain:

An analysis must be painful, not because there is necessarily some value in pain, but because one can not believe that an analysis in which pain is not observed and discussed has tackled one of the central reasons for which the patient is there. ... The need ... that the analytical experience enhance the patient's capacity for suffering, even if the patient and the analyst can hope to ease their pain. (Bion, 1963/1977, p. 77)

Origins of the Sin of Sadness: Evagrius Ponticus and Joannes Cassianus

The Egyptian desert ascetic, like the stoic philosopher, aimed at reaching the full control of his own passions. For the intellectual Evagrius Ponticus (345-399), who systematized the experiences of monks in the Egyptian desert, the goal of the ascetic path ([TEXT NOT REPRODUCIBLE IN ASCII.]) was impassiveness ([TEXT NOT REPRODUCIBLE IN ASCII.]). And [TEXT NOT REPRODUCIBLE IN ASCII.] had been already the main goal of personal development for the stoic philosopher. Though the ultimate aims were undoubtedly different, as were the instruments and the ways for realizing this path to perfection, both the stoic wise man and the Christian ascetic worked hard for freeing himself from passions.

The eight bad thoughts ([TEXT NOT REPRODUCIBLE IN ASCII.] or devils ([TEXT NOT REPRODUCIBLE IN ASCII.]), continuously menacing the impassiveness of the monk's heart, are essentially affects and drives: gluttony, lust, covetousness, sadness, anger, acedia, vainglory and pride. Among the serious dangers for the monk, two were explicitly related to the experience of emotional pain: sadness ([TEXT NOT REPRODUCIBLE IN ASCII.]: Latin tristitia) and acedia ([TEXT NOT REPRODUCIBLE IN ASCII.]), the latter term referring to a state of dejection, idleness, negligence and indolence (Jackson, 1986, pp. 65-77).

Tristitia

The damnation of sadness was handed down from the stoical theory of passions (Diogenes, trans. 1925, VII, 110-112) to Evagrian ascetics, without any evident break. However, the reasons for not trusting sadness did change. For Evagrius, sadness was not an unfounded feeling, lacking any apparent or intellectually shared basis. Evagrius believed sadness was morally unacceptable because it is generated by the frustration of wishes (trans. 1971, X, 1). Although the wishes tormenting the ascetic could be widely shared with reference to the ethics of laymen and religious men living within the general society, they were guilty for Evagrius as they tended to move the monk away from his life condition. "owing to the frustration of wishes, it takes place as follows: certain bad thoughts, presenting themselves, bring the mind to the memory of home, the parents and the previous kind of life" (trans. 1971, X. 2-5).

The condemnation of sadness elaborated within Eastern ascetics was diffused to Western Christianity through the works by Joannes Cassianus. In his De Coenobiorum Institutis (edit. 1846) written at the request of Castor, bishop of the now French town of Apt, in the first half of the fifth century A.D.--Cassianus offered to western monks the principles regulating the religious life of their Egyptian brothers, whose ascetic experience possessed already a long tradition and enjoined a very high standing.

Joannes Cassianus made a wide use of the ascetic works by Evagrius Ponticus and he drew from them the list of the eight bad thoughts. Then, Cassianus too warned the monk against the danger of sadness, and like Evagrius he traced back the roots of sadness to the frustration of wordly wishes. Taking advantage of a point of view essentially not far from the one supported by imperial age stoicism, Cassianus deemed that the indifference towards material goods was the only way leading to the freedom from pain:

We will be able to expel from ourselves this very harmful passion only as far as we are able to heave our mind, so that, through spiritual meditation, it is continuously engaged with the future hope and the contemplation of the promised happiness.... Always happy because of the vision of the eternal and future things, and steadily keeping on, we will be neither dejected by current adversities, nor elated by current lucky events, looking at both as at short-lasting and soon-passing things. (Cassianus, edit. 1846, col. 360)

The Western Cassianus proposed a more articulate understanding of the experience of sadness than did Evagrius in his [TEXT NOT REPRODUCIBLE IN ASCII.]. In fact, Cassianus (edit. 1846), drawing on 2 Corinthians 10, differentiated two forms of sadness: sadness generating repentance and worldly sadness. The two conditions would be distinguished by their different origins, but above all by their different spiritual sequelae. The sadness coming from the awareness of sin "is obeying, affable, humble, meek, sweet, patient, in as much as it comes from the love of God" (edit. 1846, col. 358). on the other hand, the sadness implying the frustration of the wish is "very harsh, unpatient, hard, full of grudge and fruitless pain, and guilty hopelessness, hindering and calling back that whom it had encompassed from initiative and salutary pain" (edit. 1846, col. 358). We will discuss more in detail the Pauline source of this differentiation later on in the article.

Now, if we consider the sin of tristitia in light of contemporary psychological views of sadness, we may appreciate that it represents only a component of modern depressive syndromes. The latter ones, while featuring sadness as their basic and most prominent symptom, encompass a wider symptom constellation, including bodily rhythm changes and a general loss of motivational drive. on the other hand, a closer parallel with contemporary depression may emerge if we come to extend our review to a second capital sin in Evagrius's list: the sin of acedia.

Acedia

As we mentioned shortly above, Evagrius took into account--beside sadness--a second bad thought displaying a wide overlapping with the experience of emotional pain: acedia. Contrary to sadness, acedia was substantially ignored by the preceding philosophical tradition, but will enjoy an extraordinary success throughout the following thousand years. In classical Greek [TEXT NOT REPRODUCIBLE IN ASCII.] means "neglect, indifference." By the seventies, the Biblical translation of the term had taken on the meaning of discouragement. Although the term had been sporadically present in anchoretic literature (Guillaumont, 1971), there is no doubt that it was Evagrius who introduced it within the main vices of western and eastern monastic literature.

Since late antiquity, acedia was felt to be a mental state very near to sadness. Through the centuries acedia and sadness even came to be thought of as interchangeable terms. Gregorius Magnus (edit. 1862), in as early as the sixth century A.D., considered them as expressions of an essentially unitary emotional state and referred to them with the common term of tristitia. Since then, experiences of pain-discouragement-dejection and forms of poor commitment or sloth in the practice of religion were essentially thought of in unitary terms by ascetics as well as by moralists and theologians, and were indifferently known either as acedia or tristitia.

Actually, in Evagrius Ponticus's work, the two subjective experiences of sadness and of acedia appear clearly distinct. While in his description of [TEXT NOT REPRODUCIBLE IN ASCII.] Evagrius did not essentially move away from preceding and subsequent linguistical tradition, [TEXT NOT REPRODUCIBLE IN ASCII.] does not seem to be simply a synonym of inertia or poor activism, as can be inferred from the following excerpt:

And at first it makes the sun appear as though it is moving slowly or not at all, showing as if the day is lasting 50 hours. Afterwards, compels [the monk] to continuously peer out of the shutters, and walk out of the cell, in order to assess the position of the sun and measure how long it will take to the ninth hour, and to look around in case one of the brothers may be turning up. In addition, it elicits a hate for the place, and even for monastic life, and for manual work: adding that the brothers' love has abandoned [the monk] and that there is no one comforting him: and if someone has also hurt the monk in those days, the demon brings forth this too in order to enhance the hate. And it leads him to the wish of other places in which it would be easy to find what is needed and to follow a more comfortable and prosperous craft. (Evagrius Ponticus, trans. 1971, XII, 4-16)

The devil of acedia approaches the monk at a specific time of the day ("... it approaches the monk towards the fourth hour, and surrounds his soul till the eighth hour"; Evagrius Ponticus, trans. 1971, XII, 2-4) and the feature more specifically characterizing it in the above mentioned excerpt is a state of anxious expectation for the presence of other anchorite brothers. (1) Feelings of rancor towards the absent brothers and fantasies of immediate wish satisfaction--in terms of reduced physical labor and more rewarding material results--were associated with waiting and implicit wishing.

The fantasy dominating the anchorite who is prey of acedia seems to allude to the wish to meet as early as possible the human beings he shares his life with and to the obvious experience of frustration enforced by the rigid rules of the coenobium. In it the monk was allowed to enjoy interpersonal relationships only within very restricted temporal boundaries (essentially only at the evening meal during weekdays). From such frustration experiences did omnipotent fantasies stem, based on projective identification phenomena, within which the experience of frustration and dependency were inverted and it was left to the brothers to suffer the abandonment and the rejection from our ascetic, leaving for new lands.

We can guess how much basic for Evagrius was the meeting with his brothers from the remedies he proposed to the evil thought of acedia. Evagrius was generally very harsh towards himself, his own body and his own passions. To those unable to sustain the very rigid dietary regimen of the anchorites he intimated: "reduce bread and even water" (trans. 1971, XVI, 1-2). That's why we are so surprised by the sweetness he can show to the soul laboring from acedia:

Whenever we give in to the demon of acedia, then splitting the soul with tears let us make it into two parts, the first one comforting, the second one comforted, diffusing good hopes for ourselves and singing the words by saint David: "Why are you sad, my soul, and why do you upset me? Hope in God, because I will attest to him: savior of my face and my God." (trans. 1971, XXVII, 1-2)

The sweetness and attention characterizing the remedy proposed for acedia are in sharp contrast with the strict attitude, imbued with a perceivable charge of sadistic drives, Evagrius displays when confronted with other devils. We clearly feel the presence of a maternal, caring function, showing extended overlapping with those maternal cares which in Winnicott's (1958) view are the core engine of both human development and the psychoanalytic process.

Both Cassianus (edit. 1874, coll. 397 A-B), and Evagrius (trans. 1971, XXIX, 1-7) supplemented the description of the vice of acedia with the narration of an autobiographic episode. In both cases our ascetics sought the advice of a master who was older or more experienced in resisting the devil of acedia. Cassianus specifies that precisely to this aim he had left his cell, during a savage attack of this malicious spirit. Cassianus left his cell under the pressure of a desperate wish to meet a human being, to gratify compelling needs for contact and dependence. But he met no acceptance; rather, the experienced ascetic blamed him and invited him to stay in his cellar. Neither did Evagrius find acceptance--who, by the way, did not specify at which time he expressed his request for advice:

And our master, saint and experienced with the ascetic life, used to say: the monk needs always to prepare himself as if he was to die the morrow, but on the other hand to use his body as though he should survive for many years. In fact, the former attitude--he said--hinders the bad thought of acedia and prepare the monk to be more ready: the latter guards safe the body and keeps always constant his abstinence. (trans. 1971, XXIX, 1-7)

The piece of advice he received appears frankly moralistic and trivial, but it stresses again the intensity of anxieties connected with the time, that is, with the expectation of the object. The solitary ascetic in his afternoon hours is then split between the longing to get in touch with the brothers he loves and the experience which was likely to be customary if we have to assign exemplary value to the concrete episode referred by Cassianus--that outside the predefined limits he could not find them available.

Under this point of view then, the devil of acedia alludes to separation anxieties as they can be perceived in a setting regulating very rigidly the experiences of interpersonal contact, and among subjects for whom the forces driving away from interpersonal relations can easily prevail on the efforts to establish a more intense contact. In fact, Cassianus himself was aware that acedia is "experienced mostly by those erring in loneliness" (edit. 1874, col. 363A).

However, beside this component, related to interpersonal contact needs, Evagrian acedia obviously contains another feature: a difficulty in concentrating on prayer and work--an inertia, or better an inhibition, often giving way to sleepiness. This feature may be less evident in the discussion of acedia Evagrius included in the Praktikos. on the other hand, in the Eight Evils of Maliciousness (trans. 1863), Evagrius underscores more sharply this dimension, more in line with the core etimology of the word acedia:

When reading, the man troubled by acedia yawns a lot, and easily falls asleep, rubs his face, and extends his hands, and, moving the eyes away from the book, examines the wall, turning back again, he reads a little, and wastes his time turning over the pages in order to see where the text ends, counts the leaves, and calculates the number of the quaternions, finds fault with the hand-writing and the ornamentation, finally, having closed the book, puts his head on it and sleeps quite a superficial sleep, in fact then the hunger awakes his soul, and he takes care of his business. (col. 1159B)

On his side, Cassianus (edit. 1874) insisted that the intolerance for the cell is associated with a slowing and blurring of mental processes:

And so, owing to a certain irrational confusion of mind, it is filled by a dark fog, and becomes idle and empty in any spiritual action, so that he thinks that in no other thing can a remedy be found for such an opposition, than in visiting some brother or in only the restoration of sleep. (col. 367)

We may now ask ourselves which rapport ties the restlessness and the intolerance for the loneliness of the cell with the poor productivity and the difficulty in concentrating. The blurring of mental processes Cassianus is talking about can, in our view, be interpreted in light of the original theory of thought by Wilfred R. Bion. The phenomenon described by Cassianus can then be conceptualized as the effect of an excess of [beta] elements, that is, of emotion or precursors of emotions which saturate the subject's cognitive and affective elaborative potential.

The sufferance and helplessness content of [beta] elements comes to be expressed through a feeling of fatigue or creative inhibition, while manic defenses, activated in order to contain the excess of pressure on the mind, find phenomenic manifestation in the effort at evading the frustration experience through action (getting out from the cellar, seeking the comfort of the advice from an older monk). Acedia, then, in Evagrius's and Cassianus's thought, seems to allude to experiences in which the overcharge of the mental apparatus gets associated with the effort at finding in the interpersonal encounter emotional containment and emotional nurture. Phenomenologically, acedia expresses the difficulties which hinder the satisfaction of these needs within the rigid limits regulating interpersonal relationships in anchoretic communities.

If we now examine the main features of Evagrius's acedia in terms of a parallel with modern depressive syndromes, we may note it includes a number of symptoms psychiatrists commonly associate with major depression: hypersomnia, diminished ability to concentrate, fatigue, loss of (religious) and intellectual interests. The overlap with modern depression is striking.

If we consider the cognate vices of tristitia and acedia together, we can see that the two sins associated with sadness in Evagrius's list could outline the clinical picture of a full blown psychiatric depression. From the point of view of descriptive psychopathology, we must acknowledge that traditional moralistic literature on the sin of tristitia vel acedia may have wide relevance to our current psychological and psychotherapeutic practice.

Acedia Outside the Monastic Walls

Acedia and Productivity

When the concept of acedia, and more generally the reflection on capital vices, became more widely diffused and exceeded the borders of the monastery, particularly in Western Christendom, it tended to lose the features correlating it in a specific way to the experience of ascetic life. In the works by Cassianus, acedia had already gone through a semantic extension, and had come to encompass, beside fatigue and somnolence, poor productivity and effectiveness based on a proper lack of motivation. This shift produced a wide overlap with idleness, and within this perspective acedia represented more a character trait than a mind or soul state.

Cassianus is thinking of laziness and sloth when he proposes an extended exegesis of the second letter of Saint Paul to the Thessalonians in the context of his discussion of the spirit of acedia. The author of that text stigmatizes the attitude of those who, within the Christian community of Thessalonica, adopted a parasitic and rowdy style of life, refusing to dedicate themselves to productive work (cf. 2 Thessalonians 3:6-13). These life choices, perhaps dictated by spiritual motivations, made the author very fearful. He is likely to have been afraid that millenaristic expectations could endanger the integration of the Christian community in the social and productive body, and so, in the long run, make impossible its survival within the pagan society. Cassianus seemed to agree with the Pauline point of view and to share the intense anxiety that low productivity can corrupt the entire social body:

So it is necessary to withdraw from those who do not want to work, and cut them away as limbs corrupted by the rottenness of idleness; so that the illness of idleness, like a killing contagious, does not corrupt also the healthy limbs due to the diffusion of the sickness. (Cassianus, edit. 1874, col. 375A)

In the first letter to the Thessalonians, Saint Paul had already underscored the ethic value of work: "working day and night in order not to be a burden to any of you we announced you God's Gospel" (1 Thessalonians 2:9). And even more sharply will the author of the second letter to Thessalonians express himself, "and in fact when we were with you, we prescribed to you that who do not want to work shouldn't eat either" (3:10).

As we have seen, Paul and the authors of the second letter to Thessalonians were chiefly worried with the relationship between a parasitic life style and moral disorder, a behavior the latter defined as "spending the life inordinately" (2 Thessalonians 3:6). Cassianus adopted the same point of view:

In fact the idle man's mind can think of nothing other than of foods and the bowel, as long as, having found at a certain time the company of any man or woman paralyzed due to the same lack of energy, he gets involved in their things and needs; and so little by little he is made imprisoned in noxious occupations, so that, held tightly--so to speak--by snake coils, he is never again able to free himself in order to come back to the perfection of his old way of life. (edit. 1874, col. 370)

With Cassianus, then, acedia acquired a new dimension. In the East the passion of acedia had been designating a specific difficulty of the monk in concentrating on the ascetic and mystical experience. While reaching the West, acedia came to include into its semantic horizon the more trivial and lay phenomenon of the love for rest. Acedia had been changing from a difficulty in concentrating to a deficit of the will, frankly overlapping with sloth, bordering with social parasitism.

The reliance on the ethical role of work has been one of the core features of western Christendom from Benedictus of Norcia to Calvin, and later imbued the lay values of bourgeois society (Weber, 1905). With Cassianus the hostility toward dependence and parasitism is incorporated within the Christian religious value system. The discussion of acedia is the way through which he implemented such operation.

Conceptualization of Acedia in Lay Literature

The reflection on passions which are negative for monks and Christians will persist through all centuries of medieval Christendom. But the prevailing and later the only form adopted by such reflection, will not be the eight vices list by Evagrius and Cassianus, but rather the seven vices list by Gregorius Magnus (trans. 1862, col. 620-622). As we have mentioned earlier, in his gigantic meditation on the book of Job, Gregorius reformulated and simplified Evagrius's system. The two vices associated with the experience of mental pain (Aunt] and [TEXT NOT REPRODUCIBLE IN ASCII.]), were grouped under the common name of tristitia.

Actually, from now on Christian ethics will condemn, either under the name of tristitia or under the name of acedia, three well defined classes of emotional experiences: a) states of depression and desperation, b) inertia, sleepiness, psychomotor slowing, and c) laziness or poor activity in matters spiritual (Casagrande & Vecchio, 2000, pp. 78-95; Jackson, 1986, pp. 6577). The relative weight received by each of these three aspects of the vice--called acedia vel tristitia in the Middle Ages by Petrus Lombardus as well as by Ugus from San Vittore--varied widely according to several social factors, till the increasing prevalence of the mundane component in the centuries leading from the end of Middle Ages to Renaissance.

We can find extended evidence of such evolution in lay literature of the Thirteenth Century, displaying a deep interest into the configuration of human personality and its distortions. Numerous literary texts treating vices and virtues during this time period discuss the sin of acedia vel tristitia. We will review two prominent examples.

Sadness as a handicap for courtly lovers.

The first part of the Roman de la Rose, written around 1230 by Guillaume de Lorris (trans. 1992), expresses in the form of a refined allegory the values and erotic ideals of French aristocracy at the beginning of the Thirteenth century, still dominated at the time by the paradigm of courtly love. In order to get access to the garden of Deduit, where love rituals are celebrated, the main character of this first part of the romance must get through a wall. on it a representation has been depicted of all the bad inclinations and life styles which were deemed incompatible with the loving life as conceived by aristocratic ideals.

The vice of acedia vel tristitia is represented on the wall under the heading of Tristece. Guillaume's (1230/1992) description particularly stresses a lowered mood and the reduction in appetite and weight, the loss of interests and the lack of reactivity towards positive stimulations.

Beside envy to some distance painted/ was sadness on the wall./ But it well appeared because of its colour/ that it had a great pain at its heart./ It seemed to have jaundice,/ and you would value nothing covetousness/ in terms of paleness and slimness,/ because the worries and the sadness/ and the heaviness and the nuisance/ that it suffered day and night,/ had made it become very icteric/ and become slim and pale./ Never anyone born to such a martyrdom/ was put, nor had such an anger/ as it seemed to have./ I believe no one could/ do to it anything that could please it/ nor that it would want to withdraw/ nor be comforted under any condition/ from the pain that it had in its heart. (vv. 291-310)

In Guillaume's (1230/1992) view, sadness is incompatible with love religion because it quenches the motivational forces driving the subject to the interaction with the opposite sex:

It did not care of amusing herself,/ nor of embracing or kissing,/ because the one whose heart is aching a lot,/ you must know in truth that he has no interest/ in amusement or dancing./ None could be moved,/ among those having pain, to be merry/ because happiness and pain are two opposite things. (vv. 331-338)

From the vantage point of courtly erotic literature, idleness did not constitute per se a disturbing feature of mental pain. It was not listed within the negative features characterizing sadness. on the contrary, the disengagement from productive activity represented the most typical condition of the aristocratic class and of the love follower who shared its values. In the allegoric construction by Guillaume (1230/1992), the guardian of the access of the garden of Deduit is Oiseuse. The word means idle, and a generous reservoir of time and emotional resources to be devoted to the rites of beauty and love were perquisite for the practice of courtly love:

I let me--she said--idle/ be called by my acquaintances;/ I am a rich and powerful woman,/ and I take a lot of happy time from a thing,/ because I spend my time in nothing else/ than in amusing and entertain myself/ and in combing and plaiting my hair. (vv. 582-588)

Over the following two centuries the progressive clipse of a feudal productive system as the basis of the economical system caused deep changes in social values. It is no wonder then that the lay conceptualization of acedia went through parallel transformations, as we will see in the following section.

Dante Alighieri's sympathy towards sinners of acedia. Dante Aligieri's Divina Commedia (edit. 1987) was composed at the beginning of '300, in Florence, in a society dominated by a mercantile and financial bourgeoisie which was going through a breath-taking expansion. The Divina Commedia probably represents the highest poetical achievement of medieval civilization. The poem thrives on all layers of medieval science, philosophy, theology, and ethics. From such exhaustive sources Dante was able to draw a poetically effective representation of human afterlife. Three Cantiche or sections respectively depict the condition of souls in Hell, Purgatory, and the Paradise.

With his Commedia, Dante did not only offer a description of an ultra-mundane world, he also allegorically attempted to draw a global map of human condition and all the devilish or spiritual forces operating within the society and the individual. The ethical reflection over acedia could therefore not be omitted.

Accidiosi in Purgatory. In Dante's ultra-mundane universe, accidiosi are located both among the hell-damned souls and among the purgatory penitents. In the fourth circle (2) of Dante's Purgatory accidiosi (the slothfuls) espy "negligence and delay/ by us for tepidity in well doing displayed" (edit. 1987, II, XVIII, vv. 107-108). According to the law of contrappasso (3), connecting the guilt to the penalty within Dante's conceptualization of afterlife, souls prone to acedia during earthly life are the prey, after their bodily death, of a penitential hurry bordering with the grotesque.

Rapidly they were over us, as running/ all that big crowd moved on;/ and two in front of the others shouted as they wept:/ 'Mary ran in a hurry to the mountain;/ and in order to submit Ilerda, Caesar pricked Marseilles and then ran to Spain'./ 'Fast, fast, so that the time will not be wasted/ for lack of love', shouted the others behind them, 'as the effort of doing well makes grace green again'. (II, XVIII, vv. 97-105)

Accidiosi run fast. In Dante's view, then, the element which antithetically characterizes most the sin of acedia is slowness and the slowing of goal-directed activities. The rise of Florentine trading and manufacturing bourgeoisie was associated with an ever increasing attention toward the times needed for implementing productive activities, as a key factor of effectiveness and competition performance (Le Goff, 1960). It is therefore not surprising that within such framework the slowness in the execution of admittedly spiritual tasks had become the essential feature of the sin of acedia.

However, in the description of the expiation of accidiosi, Dante's fantasy builds a situation not lacking altogether comical traits: accidiosi are overrun by sacred zeal to the point that they are unable to communicate with Dante as a pilgrim and cannot even comply with the most elementary social norms of salutation and conversation.

We know that Dante's father, although belonging to the aristocracy, practiced usury (Piattoli, 1950). Dante was always extremely severe toward this kind of financial activity and generally kept to an obviously critical attitude toward the values of Florentine bourgeoisie. Accidiosi's grotesque hurry seemed to disguise an implicit empathy for the sin they committed during their earthly life. By the way, it was right in the fourth ring of the Purgatory that Dante (edit. 1987) showed a sudden somnolence:

Then when they were from us so far divided/ those shadows, that they could not be seen any more,/ a new thought pushed itself within me,/ and from that other and different ones were born;/ and to such an extent I raved from one to another,/ so that my eyes I closed due to sleepiness,/ and the thought into a dream I changed. (II, XVIII, vv. 139-145)

As the reader will remember, somnolence, the inability to concentrate on manual and intellectual activities, was among the most notable characteristics of Evagrius's acedia. By falling asleep in the Fourth Circle, Dante seems then to implicitly admit his identification with accidiosi of the Purgatory, claiming even to be one of them. And the admission of this identification appears particularly illuminating with reference to the representation of accidiosi Dante gives in the first Cantica of Commedia, the Hell.

Accidiosi in Hell. In the third Ring of Hell accidiosi lie in the Stygian Swamp, beside the wrathfuls, but they pay the penalty for their guilt under the level of waters:

And I also want that you believe for truth/ that there is people groaning under the water,/ and that they make bubble this water above,/ as your eye can tell you, wherever it moves./ Thrust in the mud they say: "sad were we/ in the sweet air, rejoicing from the sun,/ bringing within us the smoke of acedia:/ now we are sad in the black mud."/ This anthem do they gurgle in their throat,/ as they can not pronounce it with a complete word. (Dante, edit. 1987, I, VII, vv. 117-126)

The Commedia reflects then the dispute between pauperism and bourgeois values of effectiveness which dominated the latter part of Middle Ages in Italy and abroad and found religious and cultural expression in the birth of the order of the Minor Friars and, subsequently, in the fight for the survival of the spiritual wing of the movement. over the next centuries social transformations got more and more rapid. The feudal productive system was by that time turning to its decline, while the development of trading and urban classes went on incessantly over the entire continent of Europe. Acedia tended to be characterized more and more as a guilty inaction, a character trait more loosely associated with religious practice (Jackson, 1986, p. 73). Acedia made a decisive turn in its more than thousand year long journey, leading it to move farther and farther away from the experience of mental pain and to carry with it messages and prescriptions more relevant to social organization.

Thomas Aquinas's Rational Approach to the Sin of Sadness

In discussing the potential benefit religious literature on sin could offer to modern psychology, Schimmel (1997, p. 195-197) has expressed the belief that poor responsivness to God's love toward man as well as to the needs of our fellow human beings substantially contributes to the development and persistence of depressive symptoms. However, our historical reappraisal of the features and scope of the sin of sadness indicates Schimmel has relied on a restricted conceptualization of acedia.

A lack of love and investment in God as a love object has always been a component of the sin of acedia, among others. In the long history of acedia, its meaning has been much wider, including sadness, general lack of interest, and cognitive slowing as core features. For centuries, sadness and a constellation of associated symptoms was per se equated to a sin within both Eastern and Western Christianity.

Jesus' [TEXT NOT REPRODUCIBLE IN ASCII.] had been characterized by an extremely open attitude towards human physical and mental pain. While late antique and medieval theology could easily overlook the resulting contradictions between ethics of the church and the New Testament, or be satisfied with the reliance on some poorly consistent scriptural quotation, the systematic reflections by Thomas Aquinas in the eighth century could not be contented with analogous devices.

Thomas Aquinas (1225-1274) was the most prominent Christian thinker in the Middle Ages. His philosophical and theological studies represented an extraordinary effort to achieve the maximum possible integration between rational methods and procedures, and the contents of faith. His influence on mature medieval thinking cannot be overestimated. Dante Alighieri's conceptualization of an afterlife world relies heavily on Thomistic concepts, giving evidence of Thomas's deep impact on medieval culture outside philosophical schools. His main theses are currently officially accepted by the Catholic Church. over the last century, Jacques Maritain (1925) and other eminent philosophers have widely shown the fertility of Thomas Aquinas's insight for contemporary man.

Thomas aimed at building a consistent theological system, based on absolutely rational relations between the various contents constituting it. In the Questiones disputatae de malo, Thomas's (trans. 1996) reflections on capital vices identified a specific criterion enabling the thinker to differentiate and categorize human drives under an ethical perspective.

Thomas found such criterion in the impact each human drive exerts on the relationship between man and God. God too is the object of human drives and emotions. Even in the introjected relation with the Summum Bonum, humans express at least in potentia tendencies which are written within the configuration of their soul. God, as far as God is the Summum Bonum, is the authentic and natural object of any human appetite. Every appetite of the human personality can then be judged as good or bad on the basis of its relationship with the most important love object. "Therefore, in addition two elements are said to exist in every sin, a movement towards a changeable good and a movement away from an unchangeable good" (q. 8, a. 1, ad 1).

Vices are therefore, in Aquinas's view, only drives or life habits pushing the man away from the Summum Bonum. In his approach, the integration of theoretical reflections within church tradition was an essential requirement guiding intellectual formulations. Specifically, with regard to the subject at issue, he could not in any way think of reshaping the list of capital sins handed down by the church tradition to his contemporary society. To solve this dilemma, Thomas was bound to redefine, in fact reduce, the semantic field of the vice acedia. That he did through the following sentence: "Sloth then is annoyance or sadness about spiritual and inner good" (q. 8, a. 1).

Acedia, in this new meaning, was only sadness and lack of interest specifically in reference to religious experience. Within the semantic field of Thomistic acedia, neither the poor productivity in the economic and working field nor states of prostration and desperation differently motivated or basically unexplainable could easily be conceptualized. Thomas even thought acedia was a capital sin only if it was met with a voluntarily adherence by the man's soul:

The sin per se and properly lies in the will, as Augustinus says. And therefore if acedia refers to the act of will fleeing from the inner and spiritual good, it can have a perfect quality of sin, but if we refer with it to the act of the sensitive appetite it does not have the quality of a sin unless it has it due to the will, scilicet as far as such a move can be prohibited by the will: and therefore, if it is not prohibited it has some quality of a sin, although not a perfect one. (q. 11, a. 1)

If acedia means willful lack of interest with regard to God, its essentially sinful nature is at last demonstrated in terms of rational thinking, as a contemporary philosopher acknowledged while recently reviewing the history of the sign of acedia (Colapietro, 1997). But through this change process acedia became something which was essentially different from the acedia of tradition. The same sign was now referring to a different thing. No more silent apathia, long-lasting sufferance, rather subtle hostility towards God and his love, Thomas's acedia is no more than the representation of a frequent and socially relevant emotional experience.

The impact of the Thomistic conceptualization on pastoral practice will be limited, but toward the end of the Middle Ages, acedia will cease to be a valued instrument for thinking and communicating the relation of society with painful experiences. Within the vice of acedia, "the neglect-idleness-indolence aspect became more and more the focus; and the trend toward the use of sloth and related terms became more predominant" (Jackson, 1986, p. 75). In the experience of Reform the concern for one's own earthly task and productivity will clearly become prevailing. Pain and hopelessness will become essentially associated with the practice of medicine.

Social Attitudes Towards Mental Pain and the Experience of Saint Paul

Our historical journey has shown that for over a thousand years sadness was a vice or capital sin for the whole of Christendom. The sin of acedia was generally understood as including sadness as a core component in both ascetic and lay literature. We will now try to trace back the sources of this damnation to the very dawn of Christian experience. In fact, we are at a loss when trying to understand the foundations of the blame shed on mental pain, in light of the evangelical precept of love. In the mountain speech Jesus stated, "Blessed are those who mourn, for they will be comforted" (Mt. 5:4), and again in a different context, "Come to me, all you who are weary and burdened, and I will give you rest" (Mt. 11:28). Neither were acedia nor sadness included in the list of vices Saint Paul mentioned in his letter to the Galatians (5:19-21).

The moral damnation of sadness enjoyed a wide consensus within the pagan philosophy. But how did it insert itself within Christian reflection? Can we simply explain such long lasting phenomenon in terms of the passive assimilation of pagan models active at the time of the first organization of a Christian theology?

If some sign of uneasiness with respect to mental pain can ever be found in the New Testament, it is likely to be in Saint Paul's Letters, as Cassianus acutely realized. In 2 Corinthians, Paul talked about his sufferance and the danger of violent death he recently escaped from. Two concepts led his reflection: [TEXT NOT REPRODUCIBLE IN ASCII.] (pain and consolation). And he made clear that the sharing of his experience of persecution with the brothers from Corinth and Achaia was for him a great factor of consolation.

However, the letter follows a previous exchange, including also another letter we are lacking. About such a letter, sent by Paul to the Corinthians some time before 2 Corinthians, he writes "In fact I wrote to you because of severe affliction and anguish of heart among many tears, not with the aim of hurting you, but so that you can know the extraordinary love I have towards you" (2 Cor. 2:4). Inferring from the general context of the letter, Saint Paul's anguish of heart is likely to be related to the room the Corinthians granted to some undefined adversaries of his. We cannot try here to reconstruct in detail this delicate relational issue between the apostle and his flock. We want, rather, to underscore that Paul had apparently been specifically accused to have shared his sadness with his followers, therefore inducing or transmitting to them a similar affect. And from such an imputation he tried to defend himself:

Because, even if I have hurt you with the letter, I do not regret it: even if I had regretted it, I see [in fact] that even if at the time that letter hurt you, I now rejoice, not because you have been hurt but because you have been hurt for your conversion. (2 Cor. 7:8-9)

We can infer that within Paul's social and cultural environment, that of imperial age Greek cities, sadness as the pain of the mind was not completely approved of. Above all, the communication of such sufferance seems to have been stigmatized by Corinthians as a reproachable behavior. Confronting such a point of view, Paul appears to be defensive. He speaks about a worldly sadness, but apparently only with the aim of stressing it in opposition to the regenerating role of sadness according to God. Paul is not in the position to confute the assumption that emotional pain is a substantially unacceptable affect under an ethical point of view, as it was felt in the society in which he carried out his pastoral mission, but explains that the expression of one's own pain was to be deemed acceptable in light of a conversion aim.

Paul had to defend himself from the charge to have transmitted emotional pain to his brothers. But the anthropology and ethics of late antiquity and the medieval church went much farther than that and qualified sadness as a devilish inclination. Cassianus interpreted Saint Paul's sentences about [TEXT NOT REPRODUCIBLE IN ASCII.] as the biblical foundation of the damnation of sadness and the communication of it, but it is an evident distortion. And to reconcile this position with the evangelical message appears frankly problematical.

Concluding Remarks

In the first section of this article we have presented Wilfred Bion's unique understanding of mental pain. We have stressed that in Bion's view the processing of mental pain represents a core task for the human mental apparatus. However, as the process of accepting and working through mental pain involves an unavoidable aching component, the mental apparatus has to face forces pressing for easier ways to get rid of such painful experiences.

The balance between the modification or the evacuation of mental pain was conceived of by Bion (1962, p. 48-49) as a core dimension in the genesis of psychopathology. A mind chiefly oriented towards the evasion from mental pain would make wide use of primitive defense mechanisms like projection, acting out and projective identification. This would make the individual adopting this basic attitude towards mental pain prone to develop a number of severe mental disorders such as psychosis, drug dependence and severe characterological disorders. on the other hand, Bion believed the modification of mental pain, through understanding and awareness, should represent the main way to the development of a mature personality.

The psychological forces pressing toward the rejection and the evacuation of mental pain can in my opinion act as well at the level of social forces and motives. In the present paper we have shown how the rejection of experiences of mental pain found a relevant role within the ideal anthropology late antiquity ascetics and then the more generally defined Christian shepherds proposed to their flocks.

The above presented discussion of Saint Paul's Second Letter to the Corinthians reveals how this watchful attitude with regard to the communication of mental pain began to find a way within Christian tradition: the expression of pain began to be felt as a sinful behavior within early Christian groups when the apostolic tradition got in touch with Greek-Roman imperial world urban communities. As 2 Corinthians shows, such context was overtly sympathetic with the blaming of any public expression of sorrow. on the other hand, it is well known that the same context gave high value to the medical conceptualization of prolonged sadness as a brain disease (Jackson, 1986) and kept in high esteem the stoic philosophy, which equated the most natural forms of human sorrow with the by-product of an intellectual error (Epictetus, trans. 1928).

The correspondence between Paul and the Corinthians shows how the apostolic style, open to a widely free communication of painful emotions, had to face a fierce criticism and be reformulated. We assume that this incident is paradigmatic of a more general and diffuse phenomenon taking place whenever the Christian religion was transmitted to people inhabiting the more developed areas of the Roman empire during the first century after the death of Jesus Christ.

Pain had, in some way, to be hidden or negated if the new message was to be accepted. The history of the sin of acedia can be conceptualized as a product of the action of such social and psychological forces. We are now in the position to answer more safely the question which stimulated the present investigation: can the awareness of a patient's moral responsibility help clinicians in the psychological treatment of depression? I think our formulation of the issue can now be historically and semantically accurate.

If we refer to acedia according to a restricted and modern usage, we may say yes. A patient's active effort to fully appreciate the worth of his or her deeper values and to deepen one's interaction with fellow human beings may be generally helpful. But therapists have to be carefully aware that a moral approach to depression may entail the risk of implicitly casting blame on sadness, on mental pain itself. We have shown that historically the sins of tristitia and acedia have been introduced specifically with the aim of condemning sadness and cognate psychological experiences. We have also shown that powerful psychological motives drive individuals and groups to blame these emotional states. Contemporary clinicians relying on moral literature should be acutely alert to the possibility that the depressed patient might feel personally stigmatized for his or her depressive condition rather than encouraged to make full use of available resources.

References

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Notes

(1.) The monk's expectations are so intense that "the door squeezed, and he starts, he hears a noise, and he rushes at the window" (Evagrius Ponticus, trans. 1863, col. 1145A-1164D).

(2.) Dante's Purgatory is conceptualized as a mountain. Along its slopes seven plains or Circles let themselves be identified. Each one of them hosts souls expiating a specific capital sin.

(3.) Which might be rendered as opposed and corresponding retaliation.

Correspondence concerning this article should be addressed to Paolo Azzone, G. Salvini Hospital, Via Statuto 9, 20020--Lainate (MI)--ITALY. E-mail: paoloazzone@hotmail.com

Author

Paolo Azzone (M.D., University of Milan) is a psychiatrist and psychoanalyst. He works at the "G. Salvini" Hospital, Garbagnate (Milan, Italy). Dr. Azzone's interests include psychodynamic treatment of depression and the intersections between psychoanalysis and philosophy, history and religious experience. He is co-editor of La mente dell'anima (The Mind of Soul, 2008) and author of Depression as a Psychoanalytic Problem (2012).

Paolo Azzone

G. Salvini Hospital, Garbagnate Milanese, Italy
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