OBJECT RELAnONS AND THE PSYCHOTHERAPY OF SIN* JAMES HENDERSON,
M.D.!
. a person who has harboured frequent evil wishes against others, but has been brought up to be good and has therefore repressed such wishes into the unconscious, will be especially ready to expect punishment for his unconscious wickedness in the form of trouble threatening him from without" (3)
situation" (7). "Sin is failure to realize in conduct and character the moral ideal; sin is ruthlessness the willful disregard or sacrifice of the welfare of others for the gratification of self" (9, pp. 18-19) or, from Toynbee, "man's ... human egocentricity" (9, p. 227). In discarding the concept of sin, we risk losing sight of individual human accountability for the human situation.
Freud emphasizes in this quotation the relation between wickedness within and expected trouble from without. Introduction Psychotherapists are beginning to rediscover the importance of man's unconscious wickedness or sinfulness. This paper states the following thesis: there is important but "forgotten" psychological truth in the theological concept of sin, and our potency as psychotherapists will be augmented if we trouble ourselves to examine "sin" in relation to our work. Most of us have never subscribed to' the idea that illness reflects sin. We regard the notion of sin as passe and certainly unscientific. I therefore propose to describe the disappearance of sin as a manifest concept in human psychology, describe its ubiquitous latent presence in modem psychological theory, and connect a theoretical restatement of sin with some practical implications for psychotherapy practice. Why did we abandon the notion of sin and what does sin really mean? "Sin is the word for that which produces mankind's basic problem or predicament . . . by declaring human responsibility for the actual human • Presented at the annual meeting of the Ontario Psychiatric Association, Toronto, January 1976; and by invitation at the annual meeting of the Canadian Psychiatric Association, Quebec City, October 1976. Manuscript received October 1976; revised August 1977. 'Director of Psychiatric Services, The Royal Victoria Hospital of Barrie, Barrie, Ont.; Associate, Dept. of Psychiatry, University of Toronto, Toronto, Ont.; Consultant, Mental Health Centre, Penetanguishene, ant.
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The Disappearance of Sin The very word "sin", once a strong, proud, and even ominous word that described a central point in every civilized human being's life plan and life style, has disappeared, or been relegated to the status of whimsical spoof. The disappearance of sin is multidetermined, and I shall borrow heavily from Karl Menninger in offering some hypotheses (9). Why did we lose the concept of sin? First, punitive practices to counter sinfulness became too severe. The demise of sin was in part a demise of harsh reprisal, but instead of just reducing the penalty, we negated the sin and that seems sometimes to have been regrettable. Second, we grew smarter, and the growth of science undoubtedly helped. There was a time, for example, when authorities of no lesser stature than Benjamin Rush and Esquirol ascribed such mental ailments as mania, stupidity, melancholy and suicide to the sin of masturbation. When this ancient taboo against masturbation simply dissolved, unfortunately most other sins appeared to disappear along with it.
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A third factor in the disappearance of sin of guilt can turn people into criminals" in has been the ascendancy of the notion of whom "a very powerful sense of guilt . . . crime. What once was a personal offence of existed before the crime, and is . . . its conscience before God has become a secular motive. It is as if it was a relief to be able to offence before the state. As more and more fasten this unconscious sense of guilt on to sins get new status as crimes, the breadth of something real and immediate" (4, p. 52). secular group control extends and the Freud here is describing the unconscious accountability of the individual to his feeling of guilt, or of sinfulness, as the origin personal conscience is further eroded. and cause, not the result, of crime. Freud's paper: "A Seventeenth Century Numerous written laws are a sign of a degenerate community, and are frequently Demonological Neurosis" sheds further light not the consequences of vicious morals in a on the psychology of sin (2). In this paper state, but the cause. We live in a society Freud analyzes Haizmann's redemption from characterized by an ever-increasing prolifera- a self-willed possession by Satan. The death of Haizmann' s father precipition of "crimes" prosecuted by increasingly clumsy bureaucracies in an atmosphere of tated a severe melancholia, and Satan real doubt that we are getting to bedrock at appeared to Haizmann and promised him all in the matter of resolving man's basic assistance if he would sign a bond with Satan "to be his bounden son and . . . belong to problem and predicament. Another factor in the demise of sin has him body and soul" (2, p. 82). Haizmann been the growth of so-called rational and attempted to regain his lost father by scientific psychology, whereby a traditional acquiring Satan as a father-substitute as punitive attitude toward badness gave way to suggested in the first description of Satan as a studied scientific neutrality. Freud's dis- "an honest elderly citizen with a brown coveries were used by some to displace the beard, dressed in a red cloak and leaning concepts of guilt, atonement, and restitution with his right hand on a stick, with a black with a fatuous notion that to understand dog beside him" (2, p. 85). The ambivalence Freud describes in everything is to be cured of everything, and Haizmann's relation to his father parallels personal moral accountability is irrelevant. The last factor I shall mention in the that of mankind in relation to its split deity. demise of sin has been the rise of syndromes Satan is regarded as the antithesis of God and symptoms. Aggressive acts, far from and yet on examination is very close to him being sinful, are now often viewed as in nature. The hostile attitude to the father is symptoms of illness. We create a diagnostic externalized into the character of Satan, and entity such as antisocial personality, describe Satan becomes a kind of cop-out receptacle aggression as symptomatic of the illness, and for human aggression and wickedness. state that here is an illness very refractory Freud helps us further here in the indeed to treatment. increasingly female appearance which Haizmann imputes into Satan. In his second Freud and a Concept of Evil and more grotesque appearance to HaizIf we are to resurrect the concept of sin, mann, Satan is "naked and misshapen ... and link it to human aggression, we shall (with) ... two pairs of female breasts" (2, p. have to restate its psychology. Freud never 89). Clearly, there is metamorphosis in embarked on a moral evaluation of man, but Haizmann's Satan toward growing female he helps us with the psychology of sin in morphology, albeit grotesque and terrifying. noting the paradox that man is both far more immoral than he believes and far more moral Melanie Klein and the Origin of Sin than he knows, in that (to quote Freud) "a Haizmann's Satan takes on additional great part of the sense of guilt must normally female characteristics in its successive apremain unconscious" because of its associa- pearances to the painter as though the more tion with the normally unconscious Oedipus aggression is required to be projected out the complex. " ... An increase in this Ucs. sense closer we get to its origin in the relation with
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the mother. Inasmuch as Melanie Klein was the first to undertake a systematic psychology of the infant-mother relationship, her elucidation of object splitting sheds further light on ambivalence, and as the negative pole of ambivalence, hatred. Klein invokes Freud's dual instincts (life instinct and death instinct) to account for ego splitting. Under the influence of these two instincts, the ego splits itself into two parts, and the immature infantile ego comes to be in relationship with two mothers - a loving and loved good Mother, and a hateful and hated bad Mother (10). This early ego splitting becomes the early infantile prototype of a lifelong series of attempts by the human ego to manage conflict and diminish primitive terror. Object Relations and a Concept of Origi-
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love and creativity. This idea bears remarkable similarity to the ancient Gnostic belief in knowledge as the means of achieving redemption and liberation (5, 6). In effect Winnicott has rediscovered the idea of a sinfulness somewhere inside the self which can be neutralized or rendered impotent through self-awareness and selfunderstanding. Perhaps, as psychotherapists, we are also about to rediscover the psychological truths in the traditional pastoral approach of confession of guilt, atonement before the personal deity of one's choice, and restitution (8). The theological view is that the individual is somehow born with a certain quantum of inherent evil and it is his life task to search out, confess, and thereby neutralize that evil in himself in order to grow into a more healthy, creative and loving individual (5,6). Does this differ in any fundamental way from the task of intensive psychotherapy?
Klein's emphasis on instinct, however, leaves us with the view that aggression, like the death instinct, is biologically innate, and Narcissism, Or Social Concern Narcissism is a psychological word for original sin becomes an inescapable curse. Object relations theory gives us a more human egocentricity. Arnold Toynbee, writoptimistic view. Winnicott, in his discussion ing in advance of the current surge of of counter-transference hatred urges that we psychiatric interest in narcissism, comments search for, discover, and know our inherent as follows on human egocentricity, and the quantum of hatred in the view that a hatred capacity of formal science to alter it. which is well-known and familiar is thereby "Science has shown no signs that it is going rendered impotent. The destructiveness of . to be able to cope with man's most serious hatred is not so much in its merely being problems. It has not been able to do anything there, but rather in its being unconscious and to cure man of his sinfulness and his sense of insecurity ... above all, it has not helped partly inaccessible (13). To quote Winnicott, "However much ... him to break out of his prison of his inborn [the therapist] . . . loves his patients he self-centredness . . . All the great historic cannot avoid hating them . . . and the better philosophies and religions have been conhe knows this the less will hate and fear be cerned, first and foremost, with the overcomthe motives determining what he does to his ing of egocentricity . . . all of them are patients" (13). Winnicott observes that it is addressing themselves ... to the individual not so much our hatred of our patients which human psyche . . . to persuade it to injures them, but rather unconscious hatred overcome its own self-centredness and ... acted out in the counter-transference in the They all teach that egocentricity can be form of cruel and sadistic employment of conquered by love" (12, 9, p. 227). As certain therapies which lend themselves to psychotherapists we concur with that, with sadistic misapplication, an observation as some ideas of our own about technique. If narcissism, egocentricity, and sin have relevant now as it was 25 years ago. The psychotherapist searches out man's hatred as an antithesis, it must lie in the capacity for it is manifested in the client-therapist situa- social concern, a term that designates in a tion (both his own and that of his patient) in positive way the phenomenon that is desigthe hope of thus freeing up the capacity for nated in a negative way by guilt. Concern
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and guilt are quite opposite: concern is a positive thing implying other-relatedness, carrying a thrust toward creativity, and deriving from the two person infant-mother relationship (15). Failing the proper relationship with a mother in infancy, a kind of healing by second intent can sometimes occur in the therapist-client psychotherapeutic situation. Aggression Or Frustration If man's sinfulness and egocentricity are so closely linked to aggression and guilt arising in the infant-mother relationship, and if we accept that healing by second intent is what occurs when we are fortunate in the client-therapist situation, our theory of the origin of aggression becomes important. Do our patients and our infants sometimes hate us because they are inherently hateful (with Klein, aggression is innate, attendant on the death instinct) or, do they hate us because we frustrate, provoke and traumatize them? Winnicott's view is that frustration engendered in the almost inevitable lack of perfect fit between what the infant demands and what the mother is able to supply releases a prototypic aggression which inaugurates the negative pole of ambivalence. Although it may please us to call that aggression inherent, even inevitable, we cannot in fairness call it innate, for it is not so much aggression which is innate, but rather the ego weakness of an infant who cannot grasp that 'mother' is an imperfect being who can never fully gratify him ( 13, 14). This is the original sin into which man is born. As psychotherapists, we want to get at the basic problem or predicament of the person identified as our patient, and still retain our status as scientists. Many of us find a concept of sin unscientific, at the same time as we uneasily concur with Toynbee when he says that ". . . science has shown no signs that it is going to be able to cope with man's most serious problems." (9, p. 227) Basic Problem and "Basic Fault" If "original sin" sounds too unscientific, what about Michael Balint's concept of "basic fault" - fault in the geological (not moral) sense - a fault or flaw or defect or
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rift which lays the groundwork for man's basic problem or predicament? (1) We have wanted a concept like that from the beginning. Sin sounded unscientific. With Freud we tried ambivalence toward the father, and failed to find it enough like bedrock; with Klein we tried "splitting" and "death instinct" in relation to the mother and found her too pessimistic; with Winnicott We tried "frustration" and felt he rather begged the question. What about "basic fault" as a word that carries an impact equivalent to that of "sin" but strikes us as being more conducive to research, rational objective study and perhaps even treatment? Balint is getting at man's basic predicament in his clinical concept of "the basic fault" when he says, "The patient ... feels there is a fault within him, a fault that must be put right" (? original sin) ... "there is a feeling that the cause of this fault is that someone has either failed the patient or defaulted on him" and a desperate sense that this time the therapist" should not - in fact must not - fail him." The basic fault "creates a state of deficiency whose consequences and after-effects appear to be only partly reversible" hence, one could add, the pastoral concept of the need for saving 'Grace' . Implications For Psychotherapy Practice What can be drawn from this essentially academic discussion which will help us in our work with patients? A few principles stand to be re-emphasized in a discussion of the psychotherapy of sin. The old notion that psychotherapists should be neutral, ungiving, passive 'blank screen' figures needs to be relinquished. It is true that Freud stated or implied some such attributes, but he was speaking metaphorically to emphasize the importance of rational understanding in analytic work. That was what was primarily missing in the early 1900's and the defect had to be corrected, but the pendulum later swung too far in the direction of detached objectivity as an attribute of the psychotherapist. We need to rediscover the importance of disciplined therapeutic zeal! Incidentally, there is evi-
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dence that Freud as a therapist displayed that quality far more than his writings would imply - it is fair to wonder if indeed Freud was the first of a succession of analytic psychotherapists who privately confess themselves to be much more active clinically than the classical Freudian tradition would warrant that they be! Why cannot this be stated publicly and taught? We can re-examine the goals of psychotherapy. Intensive psychotherapy aimed at promoting insight, ego synthesis and growth offers little assurance of cure in the narrowly medical sense. Concepts such as self-discovery, personal rebirth and personal growth, even salvation have a place alongside concepts of symptom alleviation and cure. Psychotherapeutic treatment, unlike most other forms of treatment, offers not so much a return to the status quo ante but rather a movement toward something that ought to have been but was not. We need to rethink and restate our notions of who can benefit from psychotherapy, and do what we can to lessen the familiar psychotherapeutic paradox of the most skilled and experienced therapists treating the healthiest patients while difficult patients are forced to do the best they can with floundering but well-intentioned novices. We need to solicit the cooperation of government in this aim sometimes government moves ahead in ways that constrict and dehumanize the health care system. Universal mediocrity is no advance from unequal levels of service, and it is a common type of self-deception to take on a danger to combat or diminish danger. For our own part, rigid diagnostic guidelines should be questioned, and formidable lists of prerequisite ego strengths and off-putting if not downright insulting requirements and preconditions of treatment must be viewed with suspicion. In fairness we can ask only that the patients we treat be at some level committed to growing and to ,'getting better. " Summary Psychotherapists are rediscovering concepts previously stated by poets, philosophers, and theologians, and elevating
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them to the status of science sometimes surprisingly little altered from their traditional form (II). The notion of man's sinfulness is such a concept, though it remains latent in modern psychological theory. What were the factors in the disappearance of the concept of sin? Perhaps punishments became too severe, and we "threw out the baby along with the bathwater." Perhaps we grew wiser, and stopped imputing a variety of evils to man's sinfulness in a way that reflected mainly guilt. Partly, however, we elevated many sins to the status of crimes and deluded ourselves that unwieldy bureaucracies could achieve what the individual conscience could not. Finally, the emergence of so-called rational psychology and of so-called scientific medicine dealt a death-blow to sin by enabling us to believe that human behaviour was there to be described, categorized and labelled, rather than morally evaluated and judged for its effect on fellow-man. Freud helps us understand sinful behaviour. He shows how it is often the result, rather than the cause, of feelings of guilt. He traces man's sinfulness to ambivalence in his relationship to a worldly father. Melanie Klein, in her mother-centred psychology, connects ambivalence to ego splitting, attendant on the death instinct, and implies that man's aggression is biologically innate and his sinfulness inevitable. Winnicott pays special attention to a therapist's hatred of his patient, implying that knowing and understanding one's hatred defuses it in part, and frees up an individual to a more positive and creative life style, There is a parallel here with the theological notion of confession of sins with atonement and restitution. Narcissism is the psychological word for human egocentricity and we, as psychotherapists, are beginning to discover its importance, as did the philosophers and theologians in centuries past. Winnicott's discussion of social concern is a useful polarity to human narcissism, and mindful of his analysis of its etiology we can add social concern to the list of objectives for intensive psychotherapy practice. Is aggression innate and instinctual, or
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attendant on frustration in the infant-mother relationship? To view it as attendant on frustration is more acceptable, but tends to get us off the hook of moral culpability. Balint's concept of a basic fault is helpful here in that it has a bedrock quality analogous to the older concept of original sin, but somehow seems more scientific and more subject to rational inquiry and study. The basic fault is a pervasive and recurring sense of having been failed by someone sometime, in a way that is only partially reversible in its damaging effects. Psychotherapists should bring a concept of sin back into their work and emphasize personal moral culpability and accountability as vital to mental health. Technical modifications in line with this theoretical revision would be a more active, warm and empathic therapeutic manner, more attention to personal growth as a therapeutic aim, and relaxed criteria for determining who may benefit from psychotherapy. Perhaps in time we can bring ourselves to say with Menninger, "If the concept of personal responsibility and answerability of ourselves and for others were to return to common acceptance, hope would return to the world with it. " References 1. Balint, M.: The Basic Fault-Therapeutic Aspects of Regression. London: Tavistock, 1968. 2. Freud, S.: "A Seventeenth Century Demonological Neurosis" in Standard Edition, Vol. XIX, Hogarth Press. 3. Freud, S.: "Determinism, Belief in Chance and Superstition - Some Points of View" in Standard Edition, Vol. VI, Hogarth Press. 4. Freud, S.: "The Ego and the Id" in Standard Edition, Vol. XIX, Hogarth Press. 5. Henderson, J.: Object relations and a new social psychiatry (The illusion of primary prevention). Bull Menn Clin, 39: 233-245, 1975. 6. Henderson, J.: Object relations and the doctrine of original sin. Int Rev Psychoanal, 2: 107-120, 1975. 7. Hiltner, S.: Christian understanding of sin and the light of medicine and psychiatry. Pastoral Psychology, 19: 45-55, 1968. 8. Hiltner, S.: Theological Dynamics. Nashville: Abingdon Press, 1972.
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9. Menninger, K.: Whatever Became of Sin. New York: Hawthorn Books Inc., 1973. 10. Segal, H.: Introduction to the Works of Melanie Klein. London: William Heinemann, 1964. 11. Toynbee, A. J.: Poetical truth and scientific truth in the light of history. Int J Psychoanal, 30: 143-152, 1949. 12. Toynbee, A. J.: Surviving the Future. Oxford University Press, 1971. 13. Winnicott, D. W.: Hate in the countertransference. Int J Psychoanal, 30: 69-74, 1949. 14. Winnicott, D. W.: Transitional objects and transitional phenomena. Int J Psychoanal, 34: 89-97, 1953. 15. Winnicott, D. W.: The development of the capacity for concern. Bull Menn Clin, 27: 167-176,1963.
Resume Les psychotherapeutes redecouvrent des concepts deja enonces par les poetes, les philosophes et les theologiens. lIs leur donnent un statut scientifique les modifiant quelquefois etonnarnment peu par rapport it leur formulation traditionnelle. La notion de peche, de faute, chez l'homme en est un exemple, merne si dans la theorie psychologique modeme elle est derneuree latente. Quels sont les facteurs qui ont conduit ala disparition du concept de faute? Les punitions ont peut-etre ete trop severes et nous avons "jete le bebe avec l' eau de son bain' . Peut-etre que nous sommes devenus plus sages et que nous avons cesse d'imputer une variete de maux ala faute de I'homme d'une facon qui refletait surtout la culpabilite. Cependant, nous avons en partie eleve au statut de crimes plusieurs fautes et nous nous sommes crees I'illusion que des bureaucraties peu maniables pourraient accomplir ce que la conscience individuelle ne pouvait pas faire. Finalement, la survenue d'une psychologie dite rationnelle et d'une rnedecine dite scientifique a donne le coup de grace au peche, a la faute, en nous permettant de croire qu'on pouvait decrire, classer et etiqueter le comportement humain, plutot que de l'evaluer moralement et le juger sur ses repercussions sur les hommes. Freud nous aide a comprendre ce comportement de faute. II nous montre que ce
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demier est souvent le resultat plutot que la cause de la sensation de culpabilite. II retrace l'etat de faute chez l'homme a son ambivalence face a sa relation avec un pere existant en ce monde. Melanie Klein dans sa psychologie centree sur la mere, relie l'ambivalence aune scission du moi accompagnant l'instinct de mort et implique que chez l'homme l'agression est biologiquement innee et son etat de faute inevitable. Winnicott porte une attention speciale a la haine du therapeute pour son patient, impliquant par Ia que connaitre et comprendre sa propre haine la desamorce en partie et libere l'individu pour une forme de vie plus creative et positive. On peut etablir ici un parallele entre la notion theologique de la confession des fautes avec expiation et reparation. La narcissisme est le terme qui, en psychologie, decrit l'egocentrisme humain et nous, en tant que psychotherapeutes, commencons a decouvrir son importance, comme l' on fait au cours des siecles demiers les philosophes et les theologiens. La discussion de Winnicott sur la preoccupation sociale constitue une polarite commode pour Ie narcissisme humain et, nous rappelant l'analyse de son etiologic, nous pouvons ajouter la preoccupation sociale a la liste d'objectifs en vue d'une pratique de psychotherapie intensive. Est-ce que I' agression est innee et in-
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stinctuelle, ou bien la resultante de la frustration dans la relation enfant-mere? II est plus acceptable de la voir comme reliee a la frustration, mais ceci tend a enlever toute culpabilite morale. Le concept de Balint d'une faute fondamentale nous aide ici parce qu'il est tres analogue au vieux concept du peche originel, tout en apparaissant plus scientifique et plus propice a une recherche et a une etude rationnelle. La faute fondamentale est la sensation dominante et recurrente que quelqu'un nous a d'une certaine maniere jadis abandonne avec des consequences dommageables qui sont seulement partiellement reversibles. On devrait retrouver dans le travail des psychotherapeutes le concept de faute. Ceux-ci devraient insister sur le fait que la culpabilite morale personnelle avec prise de sa responsabilite est vitale pour la sante mentale. Les modifications techniques en rapport avec cette revision theorique consisteraient en une therapie plus active, plus chaleureuse et plus empathique, en plus d'attention a la maturation individuelle en tant que but therapeutique et en des criteres plus souples pour determiner qui pourrait beneficier d'une psychotherapie. Peut-etre pourra-t-on dire un jour comme Menninger: "Si le concept de responsabilite personnelle, de meme que de reponse de soi-meme et des autres, etait accepte de tous, l'espoir reviendrait alors dans le monde. "
CALL FOR SCIENTIFIC PRESENTATIONS FOR 1978
Dr. Peter Hays, Chairman, Scientific Program Committee ABSTRACTS In view of the ever increasing number of abstracts being submitted, the Scientific Program Committee requests that the following instructions be strictly adhered to in submitting abstracts for consideration for presentation at the 28th Annual Meeting of the Canadian Psychiatric Association in Halifax, Nova Scotia, October 18,19 and 20,1978. i) Five copies are to be mailed to:-
DR. PETER HAYS, CHAIRMAN, SCIENTIFIC PROGRAM COMMITTEE, CANADIAN PSYCHIATRIC ASSOCIATION, DEPARTMENT OF PSYCHIATRY, UNIVERSITY OF ALBERTA, 1 - 134 CLINICAL SCIENCES BUILDING, EDMONTON, ALBERTA. T6G 2G3
ii) Deadline for submission of abstracts is March 31, 1978. iii) First page of abstract should contain: a) Title b) All authors' names along with the one discipline (e.g. M.D., R.N., M.S.W., etc.) that they would wish listed in the program c) Time required for presentation - i.e. 10, 15 or 20 min. (longer presentations are not ruled out but would have to be individually negotiated). d) Requirement for 35 mm. slide projector, if any. Provision of any other audio visual aids will be the responsibility of the speaker. iv) Abstracts should contain 300-600 words. Completed papers which are submitted will not be reviewed. v) As all future correspondence will be carried on with the individual who makes the submission, it would be advisable for the presenting author to submit the abstract. Unless otherwise indicated, it will be presumed that the first listed author will present the paper. It should be noted that it may be necessary to limit the number of presentations by anyone individual.
PANELS, SYMPOSIA, DEBATES, FORUMS Any individual or group who has a suggestion for a "special" presentation of a current, topical, controversial subject, be it political, economic, academic or scientific, is requested to send as much detail as possible - e.g. overall outline, abstracts, speakers, chairman, time required, etc. - for assessment by the Scientific Program Committee for possible inclusion in the program. Deadline for submission of these is March 31, 1978, and five copies are required.
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. a person who has harboured frequent evil wishes against others, but has been brought up to be good and has therefore repressed such wishes into the unconscious, will be especially ready to expect punishment for his unconscious wickedness in the form of trouble threatening him from without" (3)
situation" (7). "Sin is failure to realize in conduct and character the moral ideal; sin is ruthlessness the willful disregard or sacrifice of the welfare of others for the gratification of self" (9, pp. 18-19) or, from Toynbee, "man's ... human egocentricity" (9, p. 227). In discarding the concept of sin, we risk losing sight of individual human accountability for the human situation.
Freud emphasizes in this quotation the relation between wickedness within and expected trouble from without. Introduction Psychotherapists are beginning to rediscover the importance of man's unconscious wickedness or sinfulness. This paper states the following thesis: there is important but "forgotten" psychological truth in the theological concept of sin, and our potency as psychotherapists will be augmented if we trouble ourselves to examine "sin" in relation to our work. Most of us have never subscribed to' the idea that illness reflects sin. We regard the notion of sin as passe and certainly unscientific. I therefore propose to describe the disappearance of sin as a manifest concept in human psychology, describe its ubiquitous latent presence in modem psychological theory, and connect a theoretical restatement of sin with some practical implications for psychotherapy practice. Why did we abandon the notion of sin and what does sin really mean? "Sin is the word for that which produces mankind's basic problem or predicament . . . by declaring human responsibility for the actual human • Presented at the annual meeting of the Ontario Psychiatric Association, Toronto, January 1976; and by invitation at the annual meeting of the Canadian Psychiatric Association, Quebec City, October 1976. Manuscript received October 1976; revised August 1977. 'Director of Psychiatric Services, The Royal Victoria Hospital of Barrie, Barrie, Ont.; Associate, Dept. of Psychiatry, University of Toronto, Toronto, Ont.; Consultant, Mental Health Centre, Penetanguishene, ant.
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The Disappearance of Sin The very word "sin", once a strong, proud, and even ominous word that described a central point in every civilized human being's life plan and life style, has disappeared, or been relegated to the status of whimsical spoof. The disappearance of sin is multidetermined, and I shall borrow heavily from Karl Menninger in offering some hypotheses (9). Why did we lose the concept of sin? First, punitive practices to counter sinfulness became too severe. The demise of sin was in part a demise of harsh reprisal, but instead of just reducing the penalty, we negated the sin and that seems sometimes to have been regrettable. Second, we grew smarter, and the growth of science undoubtedly helped. There was a time, for example, when authorities of no lesser stature than Benjamin Rush and Esquirol ascribed such mental ailments as mania, stupidity, melancholy and suicide to the sin of masturbation. When this ancient taboo against masturbation simply dissolved, unfortunately most other sins appeared to disappear along with it.
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A third factor in the disappearance of sin of guilt can turn people into criminals" in has been the ascendancy of the notion of whom "a very powerful sense of guilt . . . crime. What once was a personal offence of existed before the crime, and is . . . its conscience before God has become a secular motive. It is as if it was a relief to be able to offence before the state. As more and more fasten this unconscious sense of guilt on to sins get new status as crimes, the breadth of something real and immediate" (4, p. 52). secular group control extends and the Freud here is describing the unconscious accountability of the individual to his feeling of guilt, or of sinfulness, as the origin personal conscience is further eroded. and cause, not the result, of crime. Freud's paper: "A Seventeenth Century Numerous written laws are a sign of a degenerate community, and are frequently Demonological Neurosis" sheds further light not the consequences of vicious morals in a on the psychology of sin (2). In this paper state, but the cause. We live in a society Freud analyzes Haizmann's redemption from characterized by an ever-increasing prolifera- a self-willed possession by Satan. The death of Haizmann' s father precipition of "crimes" prosecuted by increasingly clumsy bureaucracies in an atmosphere of tated a severe melancholia, and Satan real doubt that we are getting to bedrock at appeared to Haizmann and promised him all in the matter of resolving man's basic assistance if he would sign a bond with Satan "to be his bounden son and . . . belong to problem and predicament. Another factor in the demise of sin has him body and soul" (2, p. 82). Haizmann been the growth of so-called rational and attempted to regain his lost father by scientific psychology, whereby a traditional acquiring Satan as a father-substitute as punitive attitude toward badness gave way to suggested in the first description of Satan as a studied scientific neutrality. Freud's dis- "an honest elderly citizen with a brown coveries were used by some to displace the beard, dressed in a red cloak and leaning concepts of guilt, atonement, and restitution with his right hand on a stick, with a black with a fatuous notion that to understand dog beside him" (2, p. 85). The ambivalence Freud describes in everything is to be cured of everything, and Haizmann's relation to his father parallels personal moral accountability is irrelevant. The last factor I shall mention in the that of mankind in relation to its split deity. demise of sin has been the rise of syndromes Satan is regarded as the antithesis of God and symptoms. Aggressive acts, far from and yet on examination is very close to him being sinful, are now often viewed as in nature. The hostile attitude to the father is symptoms of illness. We create a diagnostic externalized into the character of Satan, and entity such as antisocial personality, describe Satan becomes a kind of cop-out receptacle aggression as symptomatic of the illness, and for human aggression and wickedness. state that here is an illness very refractory Freud helps us further here in the indeed to treatment. increasingly female appearance which Haizmann imputes into Satan. In his second Freud and a Concept of Evil and more grotesque appearance to HaizIf we are to resurrect the concept of sin, mann, Satan is "naked and misshapen ... and link it to human aggression, we shall (with) ... two pairs of female breasts" (2, p. have to restate its psychology. Freud never 89). Clearly, there is metamorphosis in embarked on a moral evaluation of man, but Haizmann's Satan toward growing female he helps us with the psychology of sin in morphology, albeit grotesque and terrifying. noting the paradox that man is both far more immoral than he believes and far more moral Melanie Klein and the Origin of Sin than he knows, in that (to quote Freud) "a Haizmann's Satan takes on additional great part of the sense of guilt must normally female characteristics in its successive apremain unconscious" because of its associa- pearances to the painter as though the more tion with the normally unconscious Oedipus aggression is required to be projected out the complex. " ... An increase in this Ucs. sense closer we get to its origin in the relation with
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the mother. Inasmuch as Melanie Klein was the first to undertake a systematic psychology of the infant-mother relationship, her elucidation of object splitting sheds further light on ambivalence, and as the negative pole of ambivalence, hatred. Klein invokes Freud's dual instincts (life instinct and death instinct) to account for ego splitting. Under the influence of these two instincts, the ego splits itself into two parts, and the immature infantile ego comes to be in relationship with two mothers - a loving and loved good Mother, and a hateful and hated bad Mother (10). This early ego splitting becomes the early infantile prototype of a lifelong series of attempts by the human ego to manage conflict and diminish primitive terror. Object Relations and a Concept of Origi-
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love and creativity. This idea bears remarkable similarity to the ancient Gnostic belief in knowledge as the means of achieving redemption and liberation (5, 6). In effect Winnicott has rediscovered the idea of a sinfulness somewhere inside the self which can be neutralized or rendered impotent through self-awareness and selfunderstanding. Perhaps, as psychotherapists, we are also about to rediscover the psychological truths in the traditional pastoral approach of confession of guilt, atonement before the personal deity of one's choice, and restitution (8). The theological view is that the individual is somehow born with a certain quantum of inherent evil and it is his life task to search out, confess, and thereby neutralize that evil in himself in order to grow into a more healthy, creative and loving individual (5,6). Does this differ in any fundamental way from the task of intensive psychotherapy?
Klein's emphasis on instinct, however, leaves us with the view that aggression, like the death instinct, is biologically innate, and Narcissism, Or Social Concern Narcissism is a psychological word for original sin becomes an inescapable curse. Object relations theory gives us a more human egocentricity. Arnold Toynbee, writoptimistic view. Winnicott, in his discussion ing in advance of the current surge of of counter-transference hatred urges that we psychiatric interest in narcissism, comments search for, discover, and know our inherent as follows on human egocentricity, and the quantum of hatred in the view that a hatred capacity of formal science to alter it. which is well-known and familiar is thereby "Science has shown no signs that it is going rendered impotent. The destructiveness of . to be able to cope with man's most serious hatred is not so much in its merely being problems. It has not been able to do anything there, but rather in its being unconscious and to cure man of his sinfulness and his sense of insecurity ... above all, it has not helped partly inaccessible (13). To quote Winnicott, "However much ... him to break out of his prison of his inborn [the therapist] . . . loves his patients he self-centredness . . . All the great historic cannot avoid hating them . . . and the better philosophies and religions have been conhe knows this the less will hate and fear be cerned, first and foremost, with the overcomthe motives determining what he does to his ing of egocentricity . . . all of them are patients" (13). Winnicott observes that it is addressing themselves ... to the individual not so much our hatred of our patients which human psyche . . . to persuade it to injures them, but rather unconscious hatred overcome its own self-centredness and ... acted out in the counter-transference in the They all teach that egocentricity can be form of cruel and sadistic employment of conquered by love" (12, 9, p. 227). As certain therapies which lend themselves to psychotherapists we concur with that, with sadistic misapplication, an observation as some ideas of our own about technique. If narcissism, egocentricity, and sin have relevant now as it was 25 years ago. The psychotherapist searches out man's hatred as an antithesis, it must lie in the capacity for it is manifested in the client-therapist situa- social concern, a term that designates in a tion (both his own and that of his patient) in positive way the phenomenon that is desigthe hope of thus freeing up the capacity for nated in a negative way by guilt. Concern
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and guilt are quite opposite: concern is a positive thing implying other-relatedness, carrying a thrust toward creativity, and deriving from the two person infant-mother relationship (15). Failing the proper relationship with a mother in infancy, a kind of healing by second intent can sometimes occur in the therapist-client psychotherapeutic situation. Aggression Or Frustration If man's sinfulness and egocentricity are so closely linked to aggression and guilt arising in the infant-mother relationship, and if we accept that healing by second intent is what occurs when we are fortunate in the client-therapist situation, our theory of the origin of aggression becomes important. Do our patients and our infants sometimes hate us because they are inherently hateful (with Klein, aggression is innate, attendant on the death instinct) or, do they hate us because we frustrate, provoke and traumatize them? Winnicott's view is that frustration engendered in the almost inevitable lack of perfect fit between what the infant demands and what the mother is able to supply releases a prototypic aggression which inaugurates the negative pole of ambivalence. Although it may please us to call that aggression inherent, even inevitable, we cannot in fairness call it innate, for it is not so much aggression which is innate, but rather the ego weakness of an infant who cannot grasp that 'mother' is an imperfect being who can never fully gratify him ( 13, 14). This is the original sin into which man is born. As psychotherapists, we want to get at the basic problem or predicament of the person identified as our patient, and still retain our status as scientists. Many of us find a concept of sin unscientific, at the same time as we uneasily concur with Toynbee when he says that ". . . science has shown no signs that it is going to be able to cope with man's most serious problems." (9, p. 227) Basic Problem and "Basic Fault" If "original sin" sounds too unscientific, what about Michael Balint's concept of "basic fault" - fault in the geological (not moral) sense - a fault or flaw or defect or
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rift which lays the groundwork for man's basic problem or predicament? (1) We have wanted a concept like that from the beginning. Sin sounded unscientific. With Freud we tried ambivalence toward the father, and failed to find it enough like bedrock; with Klein we tried "splitting" and "death instinct" in relation to the mother and found her too pessimistic; with Winnicott We tried "frustration" and felt he rather begged the question. What about "basic fault" as a word that carries an impact equivalent to that of "sin" but strikes us as being more conducive to research, rational objective study and perhaps even treatment? Balint is getting at man's basic predicament in his clinical concept of "the basic fault" when he says, "The patient ... feels there is a fault within him, a fault that must be put right" (? original sin) ... "there is a feeling that the cause of this fault is that someone has either failed the patient or defaulted on him" and a desperate sense that this time the therapist" should not - in fact must not - fail him." The basic fault "creates a state of deficiency whose consequences and after-effects appear to be only partly reversible" hence, one could add, the pastoral concept of the need for saving 'Grace' . Implications For Psychotherapy Practice What can be drawn from this essentially academic discussion which will help us in our work with patients? A few principles stand to be re-emphasized in a discussion of the psychotherapy of sin. The old notion that psychotherapists should be neutral, ungiving, passive 'blank screen' figures needs to be relinquished. It is true that Freud stated or implied some such attributes, but he was speaking metaphorically to emphasize the importance of rational understanding in analytic work. That was what was primarily missing in the early 1900's and the defect had to be corrected, but the pendulum later swung too far in the direction of detached objectivity as an attribute of the psychotherapist. We need to rediscover the importance of disciplined therapeutic zeal! Incidentally, there is evi-
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dence that Freud as a therapist displayed that quality far more than his writings would imply - it is fair to wonder if indeed Freud was the first of a succession of analytic psychotherapists who privately confess themselves to be much more active clinically than the classical Freudian tradition would warrant that they be! Why cannot this be stated publicly and taught? We can re-examine the goals of psychotherapy. Intensive psychotherapy aimed at promoting insight, ego synthesis and growth offers little assurance of cure in the narrowly medical sense. Concepts such as self-discovery, personal rebirth and personal growth, even salvation have a place alongside concepts of symptom alleviation and cure. Psychotherapeutic treatment, unlike most other forms of treatment, offers not so much a return to the status quo ante but rather a movement toward something that ought to have been but was not. We need to rethink and restate our notions of who can benefit from psychotherapy, and do what we can to lessen the familiar psychotherapeutic paradox of the most skilled and experienced therapists treating the healthiest patients while difficult patients are forced to do the best they can with floundering but well-intentioned novices. We need to solicit the cooperation of government in this aim sometimes government moves ahead in ways that constrict and dehumanize the health care system. Universal mediocrity is no advance from unequal levels of service, and it is a common type of self-deception to take on a danger to combat or diminish danger. For our own part, rigid diagnostic guidelines should be questioned, and formidable lists of prerequisite ego strengths and off-putting if not downright insulting requirements and preconditions of treatment must be viewed with suspicion. In fairness we can ask only that the patients we treat be at some level committed to growing and to ,'getting better. " Summary Psychotherapists are rediscovering concepts previously stated by poets, philosophers, and theologians, and elevating
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them to the status of science sometimes surprisingly little altered from their traditional form (II). The notion of man's sinfulness is such a concept, though it remains latent in modern psychological theory. What were the factors in the disappearance of the concept of sin? Perhaps punishments became too severe, and we "threw out the baby along with the bathwater." Perhaps we grew wiser, and stopped imputing a variety of evils to man's sinfulness in a way that reflected mainly guilt. Partly, however, we elevated many sins to the status of crimes and deluded ourselves that unwieldy bureaucracies could achieve what the individual conscience could not. Finally, the emergence of so-called rational psychology and of so-called scientific medicine dealt a death-blow to sin by enabling us to believe that human behaviour was there to be described, categorized and labelled, rather than morally evaluated and judged for its effect on fellow-man. Freud helps us understand sinful behaviour. He shows how it is often the result, rather than the cause, of feelings of guilt. He traces man's sinfulness to ambivalence in his relationship to a worldly father. Melanie Klein, in her mother-centred psychology, connects ambivalence to ego splitting, attendant on the death instinct, and implies that man's aggression is biologically innate and his sinfulness inevitable. Winnicott pays special attention to a therapist's hatred of his patient, implying that knowing and understanding one's hatred defuses it in part, and frees up an individual to a more positive and creative life style, There is a parallel here with the theological notion of confession of sins with atonement and restitution. Narcissism is the psychological word for human egocentricity and we, as psychotherapists, are beginning to discover its importance, as did the philosophers and theologians in centuries past. Winnicott's discussion of social concern is a useful polarity to human narcissism, and mindful of his analysis of its etiology we can add social concern to the list of objectives for intensive psychotherapy practice. Is aggression innate and instinctual, or
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attendant on frustration in the infant-mother relationship? To view it as attendant on frustration is more acceptable, but tends to get us off the hook of moral culpability. Balint's concept of a basic fault is helpful here in that it has a bedrock quality analogous to the older concept of original sin, but somehow seems more scientific and more subject to rational inquiry and study. The basic fault is a pervasive and recurring sense of having been failed by someone sometime, in a way that is only partially reversible in its damaging effects. Psychotherapists should bring a concept of sin back into their work and emphasize personal moral culpability and accountability as vital to mental health. Technical modifications in line with this theoretical revision would be a more active, warm and empathic therapeutic manner, more attention to personal growth as a therapeutic aim, and relaxed criteria for determining who may benefit from psychotherapy. Perhaps in time we can bring ourselves to say with Menninger, "If the concept of personal responsibility and answerability of ourselves and for others were to return to common acceptance, hope would return to the world with it. " References 1. Balint, M.: The Basic Fault-Therapeutic Aspects of Regression. London: Tavistock, 1968. 2. Freud, S.: "A Seventeenth Century Demonological Neurosis" in Standard Edition, Vol. XIX, Hogarth Press. 3. Freud, S.: "Determinism, Belief in Chance and Superstition - Some Points of View" in Standard Edition, Vol. VI, Hogarth Press. 4. Freud, S.: "The Ego and the Id" in Standard Edition, Vol. XIX, Hogarth Press. 5. Henderson, J.: Object relations and a new social psychiatry (The illusion of primary prevention). Bull Menn Clin, 39: 233-245, 1975. 6. Henderson, J.: Object relations and the doctrine of original sin. Int Rev Psychoanal, 2: 107-120, 1975. 7. Hiltner, S.: Christian understanding of sin and the light of medicine and psychiatry. Pastoral Psychology, 19: 45-55, 1968. 8. Hiltner, S.: Theological Dynamics. Nashville: Abingdon Press, 1972.
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9. Menninger, K.: Whatever Became of Sin. New York: Hawthorn Books Inc., 1973. 10. Segal, H.: Introduction to the Works of Melanie Klein. London: William Heinemann, 1964. 11. Toynbee, A. J.: Poetical truth and scientific truth in the light of history. Int J Psychoanal, 30: 143-152, 1949. 12. Toynbee, A. J.: Surviving the Future. Oxford University Press, 1971. 13. Winnicott, D. W.: Hate in the countertransference. Int J Psychoanal, 30: 69-74, 1949. 14. Winnicott, D. W.: Transitional objects and transitional phenomena. Int J Psychoanal, 34: 89-97, 1953. 15. Winnicott, D. W.: The development of the capacity for concern. Bull Menn Clin, 27: 167-176,1963.
Resume Les psychotherapeutes redecouvrent des concepts deja enonces par les poetes, les philosophes et les theologiens. lIs leur donnent un statut scientifique les modifiant quelquefois etonnarnment peu par rapport it leur formulation traditionnelle. La notion de peche, de faute, chez l'homme en est un exemple, merne si dans la theorie psychologique modeme elle est derneuree latente. Quels sont les facteurs qui ont conduit ala disparition du concept de faute? Les punitions ont peut-etre ete trop severes et nous avons "jete le bebe avec l' eau de son bain' . Peut-etre que nous sommes devenus plus sages et que nous avons cesse d'imputer une variete de maux ala faute de I'homme d'une facon qui refletait surtout la culpabilite. Cependant, nous avons en partie eleve au statut de crimes plusieurs fautes et nous nous sommes crees I'illusion que des bureaucraties peu maniables pourraient accomplir ce que la conscience individuelle ne pouvait pas faire. Finalement, la survenue d'une psychologie dite rationnelle et d'une rnedecine dite scientifique a donne le coup de grace au peche, a la faute, en nous permettant de croire qu'on pouvait decrire, classer et etiqueter le comportement humain, plutot que de l'evaluer moralement et le juger sur ses repercussions sur les hommes. Freud nous aide a comprendre ce comportement de faute. II nous montre que ce
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demier est souvent le resultat plutot que la cause de la sensation de culpabilite. II retrace l'etat de faute chez l'homme a son ambivalence face a sa relation avec un pere existant en ce monde. Melanie Klein dans sa psychologie centree sur la mere, relie l'ambivalence aune scission du moi accompagnant l'instinct de mort et implique que chez l'homme l'agression est biologiquement innee et son etat de faute inevitable. Winnicott porte une attention speciale a la haine du therapeute pour son patient, impliquant par Ia que connaitre et comprendre sa propre haine la desamorce en partie et libere l'individu pour une forme de vie plus creative et positive. On peut etablir ici un parallele entre la notion theologique de la confession des fautes avec expiation et reparation. La narcissisme est le terme qui, en psychologie, decrit l'egocentrisme humain et nous, en tant que psychotherapeutes, commencons a decouvrir son importance, comme l' on fait au cours des siecles demiers les philosophes et les theologiens. La discussion de Winnicott sur la preoccupation sociale constitue une polarite commode pour Ie narcissisme humain et, nous rappelant l'analyse de son etiologic, nous pouvons ajouter la preoccupation sociale a la liste d'objectifs en vue d'une pratique de psychotherapie intensive. Est-ce que I' agression est innee et in-
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stinctuelle, ou bien la resultante de la frustration dans la relation enfant-mere? II est plus acceptable de la voir comme reliee a la frustration, mais ceci tend a enlever toute culpabilite morale. Le concept de Balint d'une faute fondamentale nous aide ici parce qu'il est tres analogue au vieux concept du peche originel, tout en apparaissant plus scientifique et plus propice a une recherche et a une etude rationnelle. La faute fondamentale est la sensation dominante et recurrente que quelqu'un nous a d'une certaine maniere jadis abandonne avec des consequences dommageables qui sont seulement partiellement reversibles. On devrait retrouver dans le travail des psychotherapeutes le concept de faute. Ceux-ci devraient insister sur le fait que la culpabilite morale personnelle avec prise de sa responsabilite est vitale pour la sante mentale. Les modifications techniques en rapport avec cette revision theorique consisteraient en une therapie plus active, plus chaleureuse et plus empathique, en plus d'attention a la maturation individuelle en tant que but therapeutique et en des criteres plus souples pour determiner qui pourrait beneficier d'une psychotherapie. Peut-etre pourra-t-on dire un jour comme Menninger: "Si le concept de responsabilite personnelle, de meme que de reponse de soi-meme et des autres, etait accepte de tous, l'espoir reviendrait alors dans le monde. "
CALL FOR SCIENTIFIC PRESENTATIONS FOR 1978
Dr. Peter Hays, Chairman, Scientific Program Committee ABSTRACTS In view of the ever increasing number of abstracts being submitted, the Scientific Program Committee requests that the following instructions be strictly adhered to in submitting abstracts for consideration for presentation at the 28th Annual Meeting of the Canadian Psychiatric Association in Halifax, Nova Scotia, October 18,19 and 20,1978. i) Five copies are to be mailed to:-
DR. PETER HAYS, CHAIRMAN, SCIENTIFIC PROGRAM COMMITTEE, CANADIAN PSYCHIATRIC ASSOCIATION, DEPARTMENT OF PSYCHIATRY, UNIVERSITY OF ALBERTA, 1 - 134 CLINICAL SCIENCES BUILDING, EDMONTON, ALBERTA. T6G 2G3
ii) Deadline for submission of abstracts is March 31, 1978. iii) First page of abstract should contain: a) Title b) All authors' names along with the one discipline (e.g. M.D., R.N., M.S.W., etc.) that they would wish listed in the program c) Time required for presentation - i.e. 10, 15 or 20 min. (longer presentations are not ruled out but would have to be individually negotiated). d) Requirement for 35 mm. slide projector, if any. Provision of any other audio visual aids will be the responsibility of the speaker. iv) Abstracts should contain 300-600 words. Completed papers which are submitted will not be reviewed. v) As all future correspondence will be carried on with the individual who makes the submission, it would be advisable for the presenting author to submit the abstract. Unless otherwise indicated, it will be presumed that the first listed author will present the paper. It should be noted that it may be necessary to limit the number of presentations by anyone individual.
PANELS, SYMPOSIA, DEBATES, FORUMS Any individual or group who has a suggestion for a "special" presentation of a current, topical, controversial subject, be it political, economic, academic or scientific, is requested to send as much detail as possible - e.g. overall outline, abstracts, speakers, chairman, time required, etc. - for assessment by the Scientific Program Committee for possible inclusion in the program. Deadline for submission of these is March 31, 1978, and five copies are required.
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