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Introduction

The word catharsis is derived from the Greek word which is translated as cleansing or purification. Most of the definitions emphasize two essential components of catharsis: the emotional aspect (strong emotional expression and processing) and the cognitive aspect of catharsis (insight, new realization, and the unconscious becoming consciousness) and as a result - positive change. Aristotle defined catharsis as purging of the spirit of morbid and base ideas or emotions by witnessing the playing out of such emotions or ideas on stage [1]. Breuer and Freud described catharsis as an involuntary, instinctive body process, for example crying [2]. Schultz and Schultz (2004) followed the psychodynamic tradition and defined catharsis as the process of reducing or eliminating a complex by recalling it to conscious awareness and allowing it to be expressed [3]. The American Psychological Association [4] also associates catharsis with the psychodynamic theory and defines it as the discharge of affects connected to traumatic events that had previously been repressed by bringing these events back into consciousness and reexperiencing them.

Scheff [5] emphasized both essential components of catharsis: emotional-somatic discharge and cognitive awareness which he called distancing, when the person experiencing catharsis is maintaining the 'observer' role rather than the participant, which involves a sense of control and full alertness in person's immediate environment. Scheff also indicated that it is most common that towards the end of somatic-emotional discharge the detailed, vivid recalling of forgotten events and insights often occur. There is a certain amount of confusion and misunderstanding about the definition and interpretation of catharsis: some of the researchers perceive catharsis as emotional discharge, equating it with the behavior of expressing strong emotions, some emphasize the cognitive aspect and the new awareness that emerges after reliving traumatic events from the past.

Catharsis in medicine, religion, and cultural rituals

The idea of catharsis in medicine is similar to that in literature. It means purging, purification, although in a medical sense this implies a physical release, for example, expectoration of the sputa implies healing of cold. It was not until Hippocrates, that menstruation, diarrhea, and vomiting were regarded as cathartic processes [5]. Hippocrates associated catharsis with healing, because it's role of a "purification agent" affecting the course of disease (both physical and mental). The spiritual meaning of catharsis is very much the same: discharging everything harmful from one's mind and heart, so that one can become pure. The ritual of purification usually implies that a person had engaged in some prohibited actions or sins. Catharsis helped to return to the previous status - before the violation of generally accepted rules and norms. In various religious practices, the action of purification is fulfilled with the help of water, blood, fire, change of clothes, and sacrifice. The rituals are often considered as part of a person's healing from the devastating effect of guilt.

Further, the key mission of mysticism is to understand the return or unification of one's soul with God. The ritual of baptism (purifying person with water) in Christianity has cathartic meaning of revival. Confession has the same underlying assumption, and it is similar to the concept of cathartic treatment introduced by Freud and Breuer, because confession involves the recall, revealing, and release of forbidden thoughts, actions, and repressed emotions.

Spiritual and cultural rituals have been known throughout the history to help people process collective stress situations, such as death or separation, or major life changing events like rites of passages, weddings, and such. Traditional societies have ceremonies of mourning, funeral rites, and curing rituals, which most often include cathartic activities, such as crying, weeping, drumming, or ecstatic dance [6].

Similarly, modern forms of mass entertainment can provoke massive cathartic experiences, for example, movies like the Passion of the Christ directed by Mel Gibson, attracted mass audiences and became the socially acceptable way for collective crying. Another good example is the popularity of horror movies because they evoke intense fear emotions. It is apparent that collective forms of emotional reexperiencing and discharge in social, cultural, spiritual, or athletic events are highly popular, attract massive audiences and are known to provide relief and increase group cohesiveness and solidarity [3].

Effect of catharsis on emotional recovery

This cathartic release of emotions is often believed to be therapeutic for affected individuals. Many therapeutic mechanisms have been seen to aid in emotional recovery. One example is interpersonal emotion regulation, in which listeners help to modify the affected individual's affective state by using certain strategies Reeck; Ames; Ochsner, [7] Expressive writing is another common mechanism for catharsis. Frattaroli published a meta-analysis suggesting that written disclosure of information, thoughts, and feelings enhances mental health [8].

However, other studies question the benefits of social catharsis. Finkenauer and colleagues found that non-shared memories were no more emotionally triggering than shared ones. Other studies have also failed to prove that social catharsis leads to any degree of emotional recovery [9]. Zech and Rimé asked participants to recall and share a negative experience with an experimenter. When compared with the control group that only discussed unemotional topics, there was no correlation between emotional sharing and emotional recovery [10].

Some studies even found adverse effects of social catharsis. Contrary to the Frattaroli study, Sbarra and colleagues found expressive writing to greatly impede emotional recovery following a marital separation [11]. Similar findings have been published regarding trauma recovery. A group intervention technique is often used on disaster victims to prevent trauma-related disorders. However, meta-analysis showed negative effects of this cathartic "therapy [11].

Uses of catharsis

With the growth of behaviorism, the role of catharsis as a beneficial psychological technique was underestimated until Moreno introduced Psychodrama in the1930s. Moreno used the concept of catharsis as Aristotle and Freud suggested it and developed it into a new psychotherapeutic modality. Reenacting scenes from one's past, dreams, or fantasies helps the client bring the unconscious conflicts into consciousness, eventually experience catharsis, and thus achieve relief and positive change [13].

According to Moreno, catharsis helps to reunite the separated (unconscious) parts of the psyche and the conscious self [14]. Although there are a lot of ways how unconscious may be expressed, for instance, delusions, forgetting, and dreams [15], such expression is mild, and does not allow the release - it is rather an indication that the problem exists. Therefore, catharsis was successfully used in psychodrama to reveal deep and long-standing negative emotions and neutralize the negative impact of related traumatic experiences [14].

In the early 1970s, Janov [16] elaborated on Freud's ideas and claimed that if infants and children are not able to process painful experiences fully (cry, sob, wail, scream, etc.,) in a supported environment, their consciousness 'splits', pain gets suppressed to the unconscious and reappears in neurotic symptoms and disorders in later life. Painful experiences become 'stored' and need to be 'released' in therapy by reliving and discharging suppressed feelings. Janov claimed that cathartic emotional processing of painful early life experiences and the process of connecting them with the memory of the original event could fully free clients from neurotic symptoms. Janov argued that cognitive remembering of suppressed traumatic experiences is not enough for healing to occur.

As it was practiced in the early 1970s, Primal therapy seemed to be focused on emotional discharge without appropriate safety and distancing. Therefore, it appeared to be damaging for some clients, especially for those with severe mental illness, personality disorders, or other more severe conditions when, for instance client's ego strength is not sufficient to process strong feelings, which might lead to disintegration, or if client already experiences confusion between present and past realities. Therefore, Primal therapy was perceived as dangerous and rejected by the majority of mental health professionals.

Greenberg [17] concluded that emotional arousal and processing within a supportive therapeutic relationship is the core element for positive change in therapy. He emphasized the cognitive aspect of catharsis and the need to understand and make sense of emotions. Greenberg argued that awareness, healthy emotional expression, and cognitive integration of emotions combined produce positive change. It appears that Emotion-Focused therapy appropriately addressed the cognitive component of catharsis and safety issues. Emotion-Focused therapy developed techniques to help clients recognize and validate their strong feelings, and coached and supported clients to express hurtful emotions safely, as well as, to find meaning for their experiences. Emotion-Focused therapy employs empty chair technique, introduced by gestalt therapy, for clarification of inner conflicts, as well as for finishing unresolved relationship issues from the past. Greenberg, Warwar, and Malcolm [18] proved that Emotion-Focused therapy using empty chair technique was more effective than psychoeducation in facilitating forgiveness and 'letting go' for individuals who had painful emotional experiences with their significant others. Empty chair technique can be a useful a tool to facilitate catharsis, as well as to help clients to increase distance from their inner conflicts and overwhelming emotions, for example by asking them to sit in a third chair and assume the role of an observer or mediator.

Recommendations

1. Catharsis brought about through drama and music was a means of producing a moderation and balance of the emotions, and of connecting the passions with reason and wisdom.

2. It helps in facilitating forgiveness among individual and lead to permanent resolution.

3. Catharsis is an overwhelming spiritual experience of repentance and renewal.

4. The responsiveness increased levels of intimacy and satisfaction within the relationship.

References

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13. Moreno JL. 1946. Psychodrama: Vol 1. Beacon, NY: Beacon House. Nichols, M. P. (1974). Outcome of brief cathartic psychotherapy. Journal of Consulting and Clinical Psychology. 42: 403-410. [Ref.]
14. Kipper DA. 1997. Classical and contemporary psychodrama: A multifaceted action oriented psychotherapy. International Journal of Action Methods. 50: 99-107. [Ref.]
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16. Janov A. 2007. Primal Healing. Franklin Lakes, NJ: Career Press.[Ref.]
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