First of Two Parts
Voltaire said, “If you wish to converse with me, define your terms.” This is no easy challenge in regard to either Christianity or psychiatry, with the one divided into as many variations in viewpoint as the other.
“Christianity” I define as that faith based on Jesus of Nazareth as the Christ and as God, as set forth in that remarkably short book the New Testament and, in even briefer fashion, in the ancient universal creeds. This orientation to Christianity I accept with all its supernatural implications centering in and deriving from the life, death, and bodily resurrection of Jesus. In short, it is the belief that God has broken into space and time, into history, and that he cares for us.
As a Christian I find in the Jesus of history the peace of knowing a still point in this rapidly turning world. I am also in agreement with Walter Barton when he says:
As a psychiatrist I don’t believe that scientific technology has replaced God’s truth. Nor do I believe that psychiatric jargon satisfies man’s search for meaning in his life. By the same reasoning I reject psychotherapy as a substitute for the confessional forgiveness and reconciliation. My belief doesn’t diminish the effectiveness of psychotherapy as a tool to heal the sick in mind [in Healer of the Mind, ed. by Paul Johnson, Abingdon, 1972, p. 12].
Leo Bartemeier also said something that I would like to have said first:
I am a child of God, a product of my ancestors, my family, my parish and a physician among other physicians. My concept of being a child of God is completely apart and unrelated to the psychological concept of immaturity. My spiritual relation with God supersedes all my human relations and is as eternal as my immortal soul. My soul is not the same as my psyche, my mind or my mental processes. But it is through these that I conceive of the existence of my soul and its relationship to God [“Presidential Address,” American Journal of Psychiatry, July, 1952].
The problem of the existence of God is not a problem in psychology but one in history and in metaphysics. Bartemeier makes an exquisite point in saying, “If there is no God, then indeed is religion an illusion.”
Interestingly, a satisfactory definition of “psychiatry” is not as easy to find as one for Christianity because psychiatry has not been as careful as the Church in defining its terms. For working purposes it can be regarded as both a medical specialty and a social science.
As medical specialists, we psychiatrists realize that while our responsibilities are heavy, our objectives are clear. We belong to a noble tradition based on the simple yet profound philosophy that a live person is better off than a dead one, and that a well person is better off than a sick one.
As physicians, with a clear mandate to treat our fellow citizens who suffer from mental diseases, we are charged with an awesome responsibility necessitating the strictest probity. As Francis Braceland expresses it, “the codes of behavior in the case of medicine must be stringent, for we deal with the lives of men.” The parameters of mental diseases are not always clear, the methods of therapy are often very personalistic, and the decisions we make as we deal with our patients can affect, for good or for ill, the most intimate aspects not only of their lives but of those of their loved ones as well.
The prime responsibility of the physician is to do the best for his patient, and he must take, and show that he takes, the patient’s side. Bartemeier states:
The whole tradition of medicine is based on healing and caring for the sick as persons through constant personal contact between the doctor and the patient … and within this tradition psychotherapy has always been the keystone of psychiatry which wished to bridge the chasm between so-called normality and mental alienation [“Presidential Address,” American Journal of Psychiatry, July, 1952],
Gregory Zilboorg adds a correct, winsome, and almost religious note when he says:
One cannot heal or cure anyone unless one can identify one’s self with the sick person in question, with the culprit in question, with the guilty one in question and thus becomes the psycho-therapeutic agent of the person and not of society [in Searchlights on Delinquency, ed. by K. R. Eissler, International Universities Press, 1949, p. 329].
This he sees as the “essence, and the inherent postulative psychology of our specialty”—and so it is.
Dr. R. O. Jones, my own esteemed mentor, while standing firmly within the legitimate domain of psychiatry, takes us very close to religious matters in his 1972 address to the Royal College of Physicians and Surgeons of Canada when he says:
More difficult to deal with than these social factors in the prevention and treatment of disease are problems seemingly inherent in the human personality: our greeds, our lusts, our aggressions, present major difficulties for preventative and therapeutic medicine, and for society. These are the very problems that psychiatry has struggled with over the past forty years. We need to increase our effectiveness in dealing with the human personality. In the meanwhile we can do better than we are now doing by psychological support, by counseling and truly accepting the model that we care for people irrespective of their disease [“Psychiatry, Medicine and the 1970’s,” Annals of the Royal College, 1972, p. 114].
What is this but a modern expression of the Great Commandment?
Psychiatrists affirm and would practice this noble tradition of medicine, with its stern ethic based squarely on the presupposition of the inherent worth of man as an individual. For our patient we desire not only a sound body but also a sound, conflict-free mind. Our specialty would bring the full spectrum of the knowledge and methods of biology, psychology, and the other social sciences to the benefit of the patient. We stand ready to give of ourselves over many hours of mind-stretching, gut-grinding psychotherapy in intense one-to-one relationship with our patient, to bring this often unverbalized presupposition to fruition in his life. In this, our identity as physicians is secure.
However, our identity as social scientists does not rest upon such a secure presuppositional base. The body of knowledge and technique of modern dynamic psychiatry is irrevocably linked to the brilliant pioneering work of Sigmund Freud, that great Columbus of the unconscious. His achievements were monumental, and our debt to him is enormous.
Despite his greatness, Freud was a man of his age. In full accord with the scientific temper of his era, he saw everything in terms of mechanistic deterministic philosophy. In his student days Freud was exposed to the aggressive materialism of Ernst von Brücke for six years, and according to Ernest Jones (Sigmund Freud: Life and Work) was captivated by it. Brücke belonged to a club of nineteenth-century Viennese scientists who were pledged to destroy vitalism, and it was he who coined the canny statement: “Teleology is a lady without whom no biologist can live, yet he is ashamed to show himself in public with her.”
It is in response to this deterministic philosophical orientation, and not only in resistance to his brilliant discoveries, that the roots of the opposition that so quickly arose against Freud are found. In this opposition—fundamentally shaped by Adler and Jung—we also find a valuable part of our legacy in psychiatry.
Adler (whose orientation was always strongly toward the social side of man) in the maturity of his career increasingly identified “social interest,” with its corollary, “social consciousness,” as the legitimate goal of psychotherapy. He saw clearly that the runner runs not because he is kicked off the starting block but because of the prize at the other end; that “the most important question of the healthy and diseased mind is not whence, but whither?”; and again, that “the creative power of the individual is a third determining force superordinated to nature and nurture as dominant determiners.”
Jung discerned a being suffused and dominated by his purposive, inherent, collective unconscious with its many potent component archetypes. He said, “The unconscious is continually active, combining its material in ways which serve the future.” One of the enduring contributions was his recognition of the importance of religious outlook to mental health, particularly in the second half of life. Jung steadfastly insisted that psychotherapy could not be value-free, and that it was the responsibility of the therapist to know his own value system in order not to impose it on his patient—“the question of moral responsibility is inherent in analytic practice.”
And this reaction has continued: Rank with his “will therapy” and emphasis on “the recognition of the self in the other”; Meyer and his “commonsense” psychobiology; Sullivan with his stress on interpersonal relations; Horney with her “healthy striving toward self-realization”; Fromm with his “basic need for relatedness”; Erikson with his “nuclear conflicts,” ranging from basic trust versus mistrust, through identity versus role diffusion, to integrity versus disgust, despair; Franckl with his “will to meaning”; Tournier with his “therapy of the whole person”; and the so-called Third Force in psychology, Allport and Matson et al., with their constant emphasis on the importance of “the self.” Within orthodox psychoanalysis there has also been a move away from the strict psychogenetic determinism of Freud. This was initiated by Anna Freud in The Ego and the Mechanisms of Defence, and brought to the forefront by the ego psychologists, led by Hartmann with his postulates of both a “primary autonomy” and a “secondary autonomy” of the ego. How to distinguish between an ego with this degree of “autonomy” and the ages-old concept of the soul I leave to others more artful than myself to discern.
This overview of the varied origins of our profession would be less than complete without mention of the continuing vigorous expression of mechanistic deterministic philosophy within scientific psychology. In his book Battle for the Mind, William Sargant raises an important warning regarding the dangers of the manipulation of man that are inherent in Pavlovian conditioning and other brainwashing techniques. As examples of these techniques Sargant cites abreaction and “certain forms of psychotherapy,” as well as the Wesleyan revival. But he seems to fall into the very trap he deplores when he sees man as so much like a dog, rather than from the perspective of Shakespeare’s “What a piece of work is man!… In action, how like an angel, in apprehension how like a god.”
The expression of this doctrine has not abated in the seventies. Kenneth Clark, in his 1971 presidential address to the American Psychological Association, advocated the use of drugs to contain human cruelty and destructiveness, and proposed that “a requirement imposed upon all power-controlling leaders and those who aspire to such leadership … would be that they accept and use the earliest perfected form of psychotechnological, biochemical intervention.” In the same year B. F. Skinner (Beyond Freedom and Dignity) decried the freedom, dignity, and individual worth of man and proposed the survival of the culture as the ultimate good. He cogently articulates the logically consistent development of the philosophy of determinism in the moral sphere. How quickly within this philosophical framework the study of man’s behavior turns toward making men behave! Science in the service of man can be turned against man. [To be continued]
