Children preparing to receive their First Holy Communion are being afflicted with irrational fears of hell and becoming psychologically scarred in the process, according to a leading psychiatrist.

Anton Grech, head of psychiatry at Mount Carmel Hospital, said that in his private practice he often encountered children with obsessive behaviour towards religion.

“At around this time of year, in the run-up to Holy Communion, I always get to see several six-year-olds who have irrational fears of hell or of dying,” he said.

Although Dr Grech specified he had not yet carried out any scientific research, he had been observing this “worrying” pattern over the years.

Children spend a year attending extra religion lessons outside school in preparation for their sacrament of Holy Communion, when the children receive the Eucharist for the first time. It is also the time when they face their first confession.

Dr Grech said children he saw at his clinic had “a fear of sinning lest they end up burning for eternity”.

He said that at this tender age children only knew how to think “concretely” – if they kicked a car, they believed the car would be hurt.

“So it’s certainly not the right age to introduce the concept of hell,” he cautioned.

Every year, around this time, about 4,000 children are prepared for their Holy Communion.

Approximately half of them attend MUSEUM catechism for about two hours a week. Others attend lessons organised by parishes or schools.

However, Tonio Caruana, MUSEUM general executive president, said nowadays, catechism was more about storytelling and activities through play.

He said the main focus on Holy Communion preparation and confession was “that Jesus is our friend”.

“We do not introduce abstract concepts such as hell or punishments – at the age of six children cannot understand such things,” he said, adding that MUSEUM catechists had weekly in-house training, not just on how to impart the faith but also on how to teach it.

The problem was the Maltese culture and religious ignorance, Mr Caruana said, concurring that he often came across children who were still exposed to antiquated teachings from their families.

MUSEUM general secretary Joe Galea said: “How often do we hear children being threatened with, ‘If you’re naughty, you won’t go to heaven!’ – and not just from elderly grandmothers. There is a lot of ignorance among young couples.”

Children who harbour such fears suffer from a form of obsessive compulsive disorder (OCD), a very common form of anxiety disorder.

According to Dr Grech, patients with OCD in Malta exhibit a lot of religious obsessions.

“In Malta religion is part of the national psyche and any mental illness has to be put in the context of where someone lives.”

He said he saw at least three adult clients a week with religion-related problems, namely anxiety about sinning, coveting, and excessive scruples: he never came across anything of the sort in his long years of practice in London.

“The concept of religiosity in the Maltese is very strong and we are very much influenced by religion,” he said, citing examples of people who panicked if they did not manage to go to confession twice a day.

According to Dr Grech, the concept of confession was psychologically healthy because regrets carried a lot of anxiety and tension, so having someone forgiving you was good. However, it was a different matter for children.

“The focus – especially for children – should not be on what is a sin or not but on what is good and how to make life better,” he said.

“There should be more emphasis on the joyful aspect of religion.”

Dr Grech said one way of curbing religious-related fear in children was to do away with the “scruples” mentality and to stop exalting perfectionism.

Parents should be on the lookout for obsessive behaviour. He recommended speaking with teachers and not putting undue emphasis on religion.

Usually professional help came in the form of cognitive therapy, which teaches children to control thoughts through pictures and paintings. “They learn that it’s OK to say stop to their irrational fears,” said Dr Grech.