Plato uses the notion of a ‘physician of souls’ to emphasize a skill of the philosopher who understands the effect of different kinds of knowledge on the soul, whereas church fathers identify this role of physician primarily with Christ. Based on the theory and vocabulary of Hippocratic medicine, these Christian writers illustrate Christian spiritual principles through medical imagery, particularly, analogising salvation as medical healing of humanity, and the wounds of the passions (disordered impulses) as the illnesses of the soul.
Experienced in empirical observation like Galen, Evagrius created a diagnostic system for people to discern their inner conflicts and spiritual struggles. He describes the complex relationships between thoughts, passions, and evil influences within the inner self. This fourth-century diagnosis of innermost life is closely related to contemporary concerns for emotion, volition, cognition, coping and the longing for transcendent reality as John Peteet raises the issues concerning the “existential struggles” of depressed people and their quest for “spiritual answers.”
Evagrius distinguishes thoughts by three sources: angels, humans and demons. Angelic thoughts are insights inspired by heavenly sources. Human thoughts are originated from physical senses. Demonic thoughts are described as arrows shot from darkness by evil influences. For Evagrius, a demonic thought is a tempting persuasion arising in the heart that can take root in the mind if we do not examine it immediately. Once the thought takes hold the mind, it can turn into a passion that compels the mind to misuse God’s creation. It distorts the soul’s natural functions. Thus, a disordered impulse is formed. To recover from distorted human nature, redirect disoriented desires, and restore inner peace, Evagrius suggests practising the imageless prayer. To practise this spiritual prayer is a lifelong discipline. Prayer, for Evagrius, is not a therapeutic tool but a way of life to orient oneself constantly toward God, to participate in the divine healing presence, and to experience transformation of one’s humanity.
As a pastoral theologian whose research concentrates on spiritual theology, I developed a spiritual intervention for depression, called the 3R program, based on Evagrius’ model of spiritual progress and his prayer teaching. The 3R stands for reconnect, reorient and reintegrate, and the program aims to help people who suffer from depression to reconnect with their true nature, reorient their desires, and reintegrate their divided self. I designed six spiritual practices accompanying with several experiential group activities in the 8-week 3R program. I named these spiritual practices as developing spiritual senses, examining troublesome thoughts, “talking back” with divine assurance, nurturing inner silence, caring for others, and chanting psalmody which is the backbone of practices that connects all of them. I also employed Evagrius’ eight generic thoughts to structure the 8 weekly group discussion. I name the themes of eight sessions: Taste and See, Embraced by God, Security and Spiritual Wealth, Transforming Sadness, Calming Your Anger, Persevering in Despondency, Celebrating God’s recognition, Growing Humility. The details of the program are written in the 3R treatment manual.
To find out if the 3R intervention has potential to achieve its goal, I conducted a pilot study to test its feasibility and preliminary efficacy. Due to the limited time and resources for a one-person PhD project, I had managed to recruit 18 qualified participants from the communities around Durham University, U.K., to try out this program. This is primarily a qualitative study, although I have collected both qualitative and quantitative data (via the assessments of PHQ-9, CES-D, and GAD-7 instruments). The qualitative evaluation analysed content from initial interviews, sessional discussions along the course of the program, follow-up interviews, the researcher’s field notes and participants’ self-evaluation reports.
The results are promising. Data analysis showed that some participants’ depressive and anxious symptoms were reduced, measured by the three instruments (via pre- and post-scores). Some revealed that they experienced the disappearance of other physical syndromes such as irritable bowel syndrome and parasomnia. Some reported achieving emotional healing and the lifting up of apathy. Many reflected on their changed perspectives on their approaches to the challenges of life. Encouragingly, those who felt that they were falling from grace or angry at God reported that they regained hope to find peace with God or were restoring an inner peace.
The following is an example, from a participant’s self-evaluation report:
The 3R programme helped to provide me with a spiritual and psychological grounding. I was pleasantly
surprised to see the difference in myself which practising the daily psalm chanting led to… During the
programme I noticed that I would look forward to my daily chanting practice and derived a strong sense of
wellbeing and accomplishment from it…It brought both a sense of purpose and meaning to my daily life. I
felt more attached to and engaged with reality as a result of it…
It was particularly helpful to study the thought patterns/structures which we may encounter. Understanding our thoughts as potentially demonic meant that I was less susceptible to falling into this way of thinking. Instead, I
sought to notice and cultivate angelic thought patterns…
The programme brought about a noticeable change within myself – in my attitude to my work, my person, the
past and others. I was helped in ways which I would like others to be helped in as well.
Before attending the 3R program, Mr. X had struggled with depression for four years since his last year of high school. Whenever he got anxious or depressed, he spent time in blank apathy during his university years. He often felt psychological and physical pain in his heart when his memories of being bullied were stirred up. However, by practising psalmody and combating demonic thoughts, he was able to engage with reality in a more courageous and resilient way. After having completed the 3R program, he overcame his lack of confidence, graduated from university, and even got into his dream master’s program successfully.
Undoubtedly, the pilot study has its limitations and it requires further study to verify its replicability and wider applications. It is worth further research in the relationships among thoughts, passions, spiritual senses and spiritual struggles by a bigger-size study with a control group in the next stage.
 Plato, Protagoras, 313c4-313e5.
 Luke Dysinger, Psalmody and Prayer in the Writings of Evagrius Ponticus, (New York: Oxford University Press, 2005), 104-123.
 John R. Peteet, Depression and the Soul: A Guide to Spiritually Integrated Treatment (New York: Routledge, 2010), 2, 29.
 Evagrius, Thoughts 8.
 Evagrius, Thoughts 19.
 This 17,500-word manual is in Appendix 1 of my PhD thesis: Participating in God: A Pilot Study of a Novel Intervention for Depression Based on the Spirituality of Evagrius Ponticus.