Second of Two Parts
From the cursory review in Part I of the background of psychiatry as a social science I would draw two points: the rich but diverse profusion of philosophical assumptions of those who have molded the psychological-science side of psychiatry underlies much of the identity confusion that we experience today; secondly, as we attempt to help our patients with their personal problems, this same variety of orientations gives us a philosophical legacy from which we can draw, extending far beyond the narrow confines of mechanistic determinism.
Even granting the full force of this second point, the side of our profession rooted in the social sciences lacks the firm philosophical base that would allow us to integrate it fully with the side rooted in medicine, with its strong presupposition that the patient really does matter. These two thought-worlds of the psychiatrist do not always easily come together. I would propose that in Christ and in the Judaeo-Christian view of man, these seemingly dual allegiances of our profession can become one, and that here we will also find a full-bodied sense of meaning for our vocation.Both psychiatry and Christianity are relentlessly empirical at their pith. Psychiatry at its best would proceed, in its dealings with man, from the observation of man as he is and from the collection of information and interpretation of data rather than from philosophical ideas about the nature of man. In the like manner, the Old Testament does not start from philosophical speculation about the nature of God; its revelation of God to man is unfolded in the actions and deeds of God in history. Similarly the New Testament focuses upon the actual historical facts of the life, the death, and the bodily resurrection of Jesus. The issue it presents is whether or not these events really happened and whether or not they fulfilled predictive prophecy. The Christian man of science can afford to have a hard-nosed look at facts without sacrificing the deep religious yearnings that are such a fundamental part of his being.
In the Judaeo-Christian view of man the physician finds a sure base for the enduring dedication of medicine to the health of his fellow man. Only this seems to provide good reason for his allowing himself both to spend and to be spent, for making of himself the therapeutic tool in psychotherapy, to be used as a whole person in his patients’ search for health. His patient is a being of inestimable worth, as he is himself. The sick patient, who comes to him in trust, is a being created by God in his own image; the type of being that God would incarnate himself in, in Jesus; a being of such ultimate worth that God in Christ would voluntarily offer himself on the Cross for the remissions of sins of the believer. In this high view of man the stern ethic of the psychiatric physician finds a well-grounded raison d’être. Man as an individual abundantly deserves our very best. The frequent evidence to the contrary in both high and low places notwithstanding, man is a being of great dignity and worth, treasured by the living God. I can find no other fully sufficient reason for the traditional reverence in which the physician holds the lives of others.
It is also well to remember that science flourished in the Western world, a world suffused by the underlying assumption that the universe was created and providentially upheld by a God of order, of purpose, and of design, a God whose work could be comprehended and understood. The importance of this Judaeo-Christian world view (along with the important contribution of the antithetical orientation of the Greek philosophers) to the development of science and our capacity to conceptualize man as a rational, responsible being is brilliantly treated by Francis Schaeffer. In Escape From Reason Schaeffer strikes the keynote:
When the Bible says that man is created in the image of God it gives us a starting point. No humanistic system has provided a justification for man to begin with himself. The Bible’s answer is totally unique. At one and the same time it provides the reason why a man may do what he must do, start with himself; and it tells him the adequate reference point, the infinite-personal God. This is in complete contrast to other systems in which man begins with himself, neither knowing why he has a right to begin from himself, nor in what direction to begin inching along [Inter-Varsity, 1968, p. 87].
I would in no way minimize the success and the rich benefits derived from the scientific study of the nature of man. We have learned much that is important for our understanding of man and the treatment of his mental disorders, and if we remain steadfast in our goals we shall learn much more from this study. But let us not think that we have explained all. The question “What then is man?” remains. In Sherrington’s words, “the human mind stubbornly resists all efforts to take its measure, and shrinks forever from the probe of the mechanistic analyst.” Or as Sir Martin Roth stated, “For man is always more than he knows about himself and will perhaps always be.” Nothing in the dictates of reason, of logic, or of science properly applied requires that because man’s behavior is in part determined it must be totally so, or that because man is free his behavior cannot be in part determined by the biological and psychological forces within him, or by the social and cultural forces outside him. Nature’s causes and man’s purposes may complement rather than contradict each other.
This sense of complementarity is in full accord with the position to which science has now been taken by the findings of modern physics. The work of Maxwell, Planck, Bohr, and Einstein has changed the philosophy of science. In the study of sub-atomic particles the act of observation becomes one of participation, the certain eventual predictability of yesteryear has become probability, the laws of the machine have become the laws of chance. Heisenberg’s “principle of uncertainty” and Bohr’s “principle of complementarity” have become more meaningful in the light of these findings than the assumptions of objective predeterminism. The basic datum of science is no longer matter but energy. Sir James Jeans overstated the case only somewhat in saying that “the universe begins to look more like a great thought than like a great machine.” Pascal long since suggested that “the spirit of geometry” could not encompass all of man. With this revolution in science it is no longer scientifically impertinent to think in terms of incalculability, of purpose, of “open systems,” or even of the freedom of living organisms. “Vitalism” lives again!
In the very evocative analogy of Bohr’s “principle of complementarity,” science comes close to terrain long familiar to Christians. Science now wrestles productively with paradoxes not unlike the dual nature of Christ, as both perfect man and perfect God, or the trinitarian concept of God as the three in one. C. S. Lewis put this situation nicely some years ago when he said:
Reality, in fact, is usually something you could not have guessed. That is one of the reasons I believe in Christianity. It is a religion you could not have guessed. If it offered us just the kind of universe we had always expected, I should feel we were making it up. But, in fact, it is not the sort of thing anyone would have made up. It has just that queer twist about it that real things have. So, let us leave behind all these boys’ philosophies, these over-simple answers. The problem is not simple and the answer is not going to be simple either [Mere Christianity, Fontana, 1952],
In all of this, then—from the tradition of medicine, from the historical teaching of the Church, and from the matrix of modern science—we find good and sufficient reason to relate ourselves to our fellow man as beings both wonderful and worthwhile. In this context, we can live comfortably as psychiatrists with the paradoxes that man is pulled by his own purposes as well as pushed by his experiences, bowed in reasonable reverence to his Creator as well as bent by his biology, blessed by his aspirations as well as bewildered by his mechanisms of defense, and that man’s reasons count as well as nature’s causes. Can we, in fact, fully relate to man as he is without accepting that man is as much a product of his personal value system as of his libidinal forces, or vice versa, that he is free as well as bound, determining as well as determined, possessing free choice as well as conditioned, that he is responsible as well as responsive, a maker of history as well as being molded by history, and that he is a being whose moral and religious strivings are as real as his sexual and his aggressive drives?
Jurgen Reusch states the matter this way:
Inner experience must be restored to the position it has held for thousands of years. The outer and inner observer stand in a relationship of complementarity. What one sees the other does not see and vice versa. This acceptance of the limitations of the human observer brings psychiatrists into agreement with the views of modern physicists [in Modern Concepts of Psychoanalysis, Citadel, 1962],
“There is no such thing,” said Kenilworth, “as an unprejudiced man.” In the maturity of a life fully, enjoyably, and satisfactorily lived I see no reason to disagree with him, and I see no good reason to think that psychiatrists are any exception to this maxim. I also agree with Samuel Miller when he says:
Believing is as much an integral factor in man as are eating and sleeping. He neither gains nor loses faith; he merely changes the object of it.… There is little or nothing that man, even modern man in all his supposed sophistication, will not believe. Man is simply an inveterate, incurable, inevitable believer” [Are You Nobody?, John Knox, 1971, p. 74].
As Jung said, “If we do not acknowledge the idea of God consciously, something else is made God.” Man is a being who will persist in distinguishing between good and evil—he has an inherent sense of oughtness in him. He is also a being who demands a solution for the fundamental human problems of individual meaning and worth, of suffering and defeat, of death and destiny.
As such a being, I would share with you some other aspects of the profound areas of agreement I have found between that part of my life dictated to by Jesus Christ and that part of my life spent in the study and practice of psychiatry. I would first acknowledge that I have found much in my Christian faith to sustain me in the many perplexing situations which have arisen in the practice of my profession, and much in psychiatry that has enriched my Christian experience.
Both psychiatry and Christianity soundly affirm the centrality of personhood and of relationship to meaningful human existence. Our profession is insistently aware of the importance of relationship to the growth of personality and to health. The majestic God of the Old Testament, replete with the awesome powers of divinity, always presents himself as personal, a Being who seeks, finds, and communicates with man. This personal God of the Hebrews was fully affirmed by Jesus and made even more personal through his life here on earth.
The judicious use of authority with its positive contribution to the health of patients is familiar to all psychiatrists; the finding of the self in the other and the fundamental importance of the loving authority of the parent to the successful adjustment of the child has become second nature to those of us in child psychiatry. All this resonates very nicely with Christ’s statement that “whosoever loseth his life for my sake shall find it,” and with the wonderful Christian notion that true freedom is found only in total subjection to Christ—“bound yet free,” said Saint Peter. One’s inner being senses a pleasant balm when Saint Paul’s dictum, “Provoke not your child to wrath,” and the more familiar “Bring up a child in the way he should go, and when he is old he shall not depart therefrom,” are placed side by side with a statement like this from Adelaide Johnson:
These parents have been seen to unconsciously encourage the amoral or antisocial behavior of the child [whereas] … the mature mother expects the thing to be done, and later if she finds the child has sidestepped her wishes, she insists without guilt on her part that it be done. The mother must have this undoubting, firm, unconscious assurance that her child will soon make her intention his own in accordance with her own image of him [in Searchlights on Delinquency, ed. by K. R. Eissler, International Universities Press, 1949].
Both my profession and my faith deal with man realistically. Both see and accept man as he is, a far from perfect being of unending contrariness, yet capable of enormous good. If there is any surer prophylaxis to moral shock than the daily practice of psychiatry, it is a sound appreciation of the Christian doctrine of sin and its companion doctrine of the fall of man. Within this realistic approach to man, both my profession and my Lord affirm that man can and does change. My profession reaches out with all its resources—drugs, the physical therapies, and our persons in psychotherapy—toward this end. Jesus reaches down to bring regeneration to man. Both approach man as a rational being possessing freedom of choice; both reach out to man in persuasion and in love; and both refuse to coerce or to manipulate man.
Both psychiatry and Christianity seek to release man from the bonds of guilt. Psychiatry attempts, not always successfully, to distinguish between objective and irrational guilt and to resolve the latter. In his death, Christ freely offers release from the ultimate sting of both.
My faith and my profession are again in accord in regard to genital sexuality. Both the Old and the New Testaments (yes, even that so-called male chauvinist Saint Paul) place the full enjoyment of sex at the core of the marital relationship. They portray the expression of sexuality, on the basis of full equality between the partners, with a warm-hearted openness, and in the Bible anticipated by at least 2,000 years the findings of Masters and Johnson.
But the great historic doctrines of the Church and the scientific findings of psychiatry come together with resounding accord in their mutual emphasis on the overwhelming importance of love in the life of man. This lies at the center of the advances made by the fathers of our profession; it is of the essence in our relationship to our patients in psychotherapy and has been deeply etched into our professional consciences by the careful scientific work of Ribble, Spitz, Bowlby, Mahler, and others. And this is in complete agreement with the out-reaching love of God for man revealed to us in both Testaments. Jesus again and again made it clear that the love of the God of justice for man transcends man’s merit. His death was because of his love for us. The prodigal was loved as much as the deserving older brother. God’s grace is free. In him, the reconciliation of the baptized believer to God is non-conditional. Saint John said, “We love, because he first loved us.” In this response to God’s all-embracing love, and motivated by it, one finds the root of that other cardinal doctrine of the New Testament—the outreach by the Christian in love and in service toward his fellow man.
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