Recently, I found a real lu-lu in the "8th Annual Year in Ideas" from the New York Times Magazine of 12 December 2008:
Scrupulosity Disorder by Jascha Hoffman
In a paper published in the August issue of The Journal of Anxiety Disorders, Chris Miller and Dawson Hedges of Brigham Young University estimate that as many as one million Americans may suffer from a moral-anxiety-cum-mental-illness known as “scrupulosity disorder.” They define it as obsessive doubt about moral behavior often resulting in compulsive religious observance — and they warn that it can lead to depression, apathy, isolation and even suicide.
As the believing man’s version of obsessive-compulsive disorder, the diagnosis raises questions about where, exactly, the line is to be drawn between probity and perversity. It isn’t obvious how to treat someone who can’t sleep for worrying about their rectitude — or a devout Christian who is seized by the urge to exclaim, Goddamn! and repeatedly reproaches himself for it. Rather than try to fight off obsessive worrying, therapists might ask patients to give in to it, so that they can see that their supposed transgressions might be harmless. “If you believe in a God that’s all-knowing, you should trust him to know these blasphemous thoughts are mental noise and not what’s in your heart,” says Jon Abramowitz, director of the Anxiety and Stress Disorders Clinic at the University of North Carolina at Chapel Hill.
The diagnosis might raise some difficult issues. Ritual hand washing could seem compulsive in an atheist, but surely it isn’t for a Muslim, for whom such behavior is ordinary religious observance. Are the anxieties and fears that may accompany a passionate religious life themselves pathological? Abramowitz, who has treated scrupulous Christians, Muslims and Jews, is confident that a therapeutic approach to obsessive spirituality does not threaten religion. He says that when patients are gradually released from crippling doubt about their own virtue, they can emerge with a new sense of faith.
Compare this, if you will, to the entry for "Scrupulosity" from Donald Attwater's "Catholic Dictionary" (Macmillan Company, N.Y.C., 1931):
Scruples: The promptings of a conscience which is led by insufficient motives to imagine sin where none exists or to regard as mortal sin that which is only venial. (This is the only use of the term recognized by spiritual writers and moral theologians.) Scruples have their use in inciting to greater care in the service of God, but they are dangerous to the health both of soul and body, especially in one who relies entirely on his own judgement. The best, and frequently the only, remedy is humble submission to the advice of one's confessor.
When we note that the Catechism of the Council of Trent (issued by order of Pope Pius V in 1556) deals quite clearly in condemning "despair of salvation," leading us in a foot-note to a lengthy discussion of scrupulosity in Thomas Aquinas' "Summa Theologica" from the thirteenth century, it becomes clear that this "new discovery" of scrupulosity is centuries old at the very least.
Saints have been afflicted with, and have over come, scrupulosity. Perhaps the most popular being Saint Thérèse of Lisieux who wrote the story of her life and spiritual progress through fear and scrupulosity to a deep understanding of the Fatherly love and mercy of God.
So why should scrupulosity be so remarkable now? Probably because of its rarity. Even fifty years ago, psychiatrists probably encountered this frequently (calling it "obsessive compulsive disorder"), but as the pieties of old have faded, not only must this have become more rare, but has probably become rarefacted in those who suffer from it.
We can draw a lesson from this "discovery" when we note that the opposite of scrupulosity is the sin of presumption - the belief that God will save me regardless of what I do, simply because He is all loving and all powerful, and therefore cannot allow me to be lost. How often do we hear people express the notion that they will be saved because "I'm basically a good person." Take my word for it, in this modern age, no psycologist will diagnose a plague of "Presumption Disorder."