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Psychiatry and Religion: A Proposal
KEITH H. J O H A N S E N
Introduction Before the beginning of this century Friedrich Nietzsche had written: "God is dead. God remains dead. And we have killed him. How shall we, the murderers of all murderers, comfort ourselves?''1 Today, "God is dead" is not a phrase only for the consideration of philosophers or theologians. Altizer and Hamilton have sparked a God-is-dead controversy that has found voice in frequent conversations and in diverse publications. Numerous books and papers have appeared describing the changing morals or the so-called sexual revolution of our contemporary culture. Those of us who are students of man and his behavior cannot ignore these ethical and religious controversies. Nor would we expect to find that the forces involved are related entirely to the field of theology. Religion has been an integral part of man and of the society that is our subject of study. It cannot be separated from man, and therefore can be considered by psychiatry. In fact, to understand a man's religious aspirations and convictions helps to understand that man. Draper et al., in I965 reported a double blind study of fifty patients. 2 From a set of questions and answers directed entirely at religious content, they could formulate dynamic and genetic aspects of these patients' personalities. These formulations correlated highly with separate psychiatric interview This paper, presented to the Texas NeuropsychiatricAssociation in Dallas, May, x967, for the zooth Annual Session of the Texas MedicalAssociation, receivedthe Guy Witt Memorial Award presented by the Texas Branch of the American PsychiatricAssociation in ~967. The author is indebted to Judith Johansen for her great help with the biblical portions of the paper.
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studies of the same patients. The authors concluded that "symptomatic, characterological, and psychodynamic diagnostic conclusions could be correctly drawn from the religious history and ideation without benefit of dinical data." This may be a bit strong, but the thesis of this paper is that a man's religion parallels his psychosocial development. This relationship is part of the structure that bridges the gap between a man's intrapsychic mechanisms and the values, ethics, and morals by which he relates to his fellow-man. However, it also raises some very perplexing and complex questions such as: What is the religion of a mature man? To illustrate the relation of a man's religion to his psychosocial development, I will present a case history, in effect, from a classic work of poetry. The author is unknown. The man's name is Job. The account of his illness and recovery and of his attitude toward the object of his religious concern is found in the Old Testament of the Bible.8 I will use the eight stages as described by Erik Erikson in Childhood and Society* to delineate Job's psychosocial development. So that the manner in which I use them may be dear, I will briefly review them here. I. A sense of Basic Trust versus Basic Mistrust. The child learns to rely on outer providers as well as to trust himself. Related to the institution of religion. II. A sense of Autonomy versus Shame and Doubt. A sense of self-control is learned that allows self-esteem. Without this the child has doubt, shame, and an over-manipulative superego. Related to the principle of law and order. III. A Sense of Initiative versus Guilt. "The child indulges in fantasies of being a giant and a tiger, but in his dreams he runs in terror for dear life." The child wishes to take over the activities and prerogatives of the adult, but is fearful of the retaliation that may meet his strivings toward rivalry. In the adult this will be reflected in his relation and attitude toward authorities. Related institution: economic ethos in the form of idealized adults recognized by their uniforms or functions. IV. A sense of Industry versus Inferiority. If the sense of initiative has been adequately developed, the child will de-
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velop the type of industry that leads to a sense of mastery. Related institution: technical ethos. V. A sense of Identity versus Role Confusion. Childhood ends and youth begins. In the face of physiologic upheaval, the adolescent refights old battles of previous years. Ego identity is sought. The youth attempts to reconcile the way he sees himself, and the way others see him. Related institution: ideology and aristocracy. VI. A sense of Intimacy versus Isolation. The emerging adult must now risk this new-found identity in increasing closeness to others. He will commit himself to affiliations and make the sacrifices and compromises necessary to maintain them. Fear of losing himself in such an encounter leads to isolation. He must "become subject to that ethical sense which is the mark of an adult." Related institution: the specific culture's style of "loving and working." (Freud: "'Lieben und Arbeiten") VII. A sense of Generativity versus Stagnation. Generativity is primarily the concern in establishing and guiding the next generation. This is much more than just wanting or having children. It is an "investment in that which is being generated." Related institution: "All institutions codify the ethics of generative succession." VIII. A sense of Ego Integrity versus Despair. The integration of the previous seven stages leads to the final stage of ego integrity. "It is the acceptance of one's one and only life cycle as something that had to be without substitutions." Such a man is ready to defend the dignity of his own life style against all physical and economic threats. It is a "new and different love of one's parents.'" In any one individual the progression from one stage to the next will not be as tidy and complete as it appears in this summary. Some stages will be more nearly complete than others. There will be degrees of attainment. For example, there is a thin but decisive line between relying on others and the distorted belief that the world or one's god is really fair. There is a thin line between a sense of selfcontrol without loss of self-esteem and a need to manipulate one's environment
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or god by sacrifice or ritualistic magic. There is a thin line between being an adult with all its prerogatives and having the prerogatives of one's parent or God. But if the foundation of each preceding stage is well laid and accomplished, and if thereby some major degree of ego integrity is reached, what might be the religious orientation or attitude of such a man through these stages? As Job searches his own faith or hears the counsel of his well-intentioned visitors or considers the voice of his God, we can apply these stages to his circumstances. It is proposed that the poetic author of Job confronts the reader with this progression and the religious attitudes related to it. In the prologue, Satan is given power and permission to take anything from Job except his life. Job loses his possessions, his children, and finally his health. All this happens without warning and Job knows of no reason for it. He is given no meaning to assign to these catastrophic events. Surely Job was not aware of the conversation that the poet related between God and Satan. Bugental likens existence to being shipwrecked on an island; having to erect one's own defenses; and having no way of knowing whether a tidal wave may be approaching the shore or rains coming down from the mountains. 5 This is the way it must have been for Job.
Part i (Erikson's stages of psychosocial development will be designated by Roman numerals. References to the Book of Job will be designated as chapter and verse thus, X :XX.)
Job has lost his possessions, his children, and his social position in the community. He regresses to the protection of infancy (Stage I). Naked I came from my mother's womb, naked shall I return. The Lord gave, and the Lord has taken away. Blessed be the name of the Lord.
9 :2I
Thus in a completely passive position Job seeks security. But this requires the denial of his anger toward the Lord who is said to give and take away. So it is turned upon himself. He indulges in self-effacement, depression, and longing for death.
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Why is light given to the sufferer... Who would exult in great joy and be happy to find a grave?
3:20-22
At this point we can note briefly the attitude and developmental level of Job's friends who come to counsel and console him. They appear to be the poet's representation of the common, religious thinking of the community at the time. Throughout the poem their speeches are rich in the imagery of a fixation at an anal level (Stage II) and of fearful thoughts about the aggression of the phallic stage (Stage III). The world and God are seen according to the talon law of eye-for-an-eye and tooth-for-a-tooth. If a man suffers, it must be divine retaliation for his improper acts or thoughts. For these improprieties man must repent to regain God's good will (Stage II). Thus the friends say: The Almighty--whom we cannot find out-is great both in power and in justice; the man abounding in goodness He does not torment. Therefore do men fear Him, Yes, all the wise-hearted stand in awe.
37:23-24
The fears and castrating expectations of the phallic (Stage III) are vividly shown. He will not escape from the darkness; his shoots will shrivel up in the flame, and his branch in the breath of God's mouth. Let no man believe in empty deceit, for emptiness will be his reward! Before his time he will be cut off, while his branch is not yet green.
"r5:3o-32
Here we will leave the friends, for they do not appear to change. After his friends attack him under the assumption that suffering presupposes guilt, and after seven days of silence, Job begins his struggle toward maturity. Maybe because he feels things can get no worse, or maybe because he feels the pain has expiated some of his guilt, he begins to express his anger. But, he is not yet overtly attacking his tormentor. He is whining and complaining. Having reviewed his own belief of innocence (Stage II), he speaks.
Psychiatry and Religion: A Proposal
I will complain in the bitterness of my soul.
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From this point the poet describes, in a manner consistent with actual case histories, Job's regressions and progressions, his fear of the unknown and his assertions, and his momentary regressions again as he drives toward his own identity. From the legalistic anally-oriented defenses of Stage II, he launches his attack against his protagonist (Stage III). The phallic stage is being tested. He imagines a court in which the guilty will be exposed and his own innocence will be apparent. God will judge. Yet Job realizes that this does not really make sense: the good guys don't always win. I am blameless... The blameless and the wicked He destroys alike. If not He, who then is guilty? 9
9 :zz,22,24
This is too frightening an assertion, and Job regresses momentarily to Stage I. Why did You take me out of the womb? Would I were as though I had never b e e n . . ,
xo:x8
Still, a stage once experienced is more easily won again, and once again Job decides to stand up to God. As he moves forward into Stage III of self-assertion, the anal traces of Stage II are evident in the desire for legalistic justification. Yes, He may slay me; I have no hope, but I will justify my ways to His face! Indeed, this may be my salvation for it is no flatterer coming before Him.
x3 :~3 -x6
Some of the magical rituals are left behind, and Job struggles into the Stage of Industry and Learning versus Inferiority (Stage IV). Teach me, and I shall be silent, and where I have erred, make me understand.
6:a 4
The progression of Job as a maturing man and the changes in his religious thinking can be seen in the alternatives he considers: if God would let me die
6:8
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if God were human like me, whom I could answer when we come to t r i a l . . . if there were an intercessor if God would judge between a man and God as between one man and his fellow if I could see God.
9:32 I6:2o ~6:2x-22 ~9:26
Progressively Job is moving from the passive position of early stages to the idea of two adults speaking together. He is gradually more involved in the adolescent task of defining his identity as a man among men. He is also struggling with the adolescent task of reworking accomplishments-through-action into accomplishments-through-words: Oh that I knew where to find H i m . . . I would lay my case before Him, and my mouth would not lack for arguments. I would learn what He would answer me, and understand what He would say to me. Would He contend with me merely through His great power? No, He would surely pay heed to me, For it would be an upright man arguing with Him, and I would be acquitted by my Judge for all time. 23 :~-7 In his adolescent-like struggle he invokes the defense of aestheticism. He forms his ideals of ethics more dearly. I will not lie or be deceitful... I will be righteous and never blasphemous,
paraphrase 27:2-6
He looks back at the childhood he is leaving with longing. Oh that I were as in the months of old as in the days when God watched over me.
29:2
Still he asks something of his God and finally decides that since God does not answer him He must not love him. If I cry out to You, You do not answer me;
Psychiatry and Religion: A Proposal
if I remain silent, You pay me no heed, You have turned cruel toward me, with all Your might You hate me.
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Job still clings to his infantile desires, but less strongly. At least he sees he must stand alone in relation to his God. He begins to realize he is worth while, even if he does not have prosperity to prove it. Finally the poet tells us that Job speaks with his God. In this encounter the identity of the man is finally completed. But it is completed as a man, not as a god; finite, not infinite; as a grown son, not as the father. God says to Job: Gird up your loins like a man; I will question you, and you may inform Me.
38:5- 3
And more, God says in effect, that Job may do and create as the father does, but not what the father does. Where were you when I laid the foundations of the earth ? 38:4 You surely know it, for you were born then. 38:25 As God goes on, He begins to delineate the fact that Job is not omnipotent. He cannot assure justice. A new image of one's God or Father begins to facilitate a new image of one's self. God says to Job: As you look on each arrogant one---bring him low, and tread down the wicked in their place. Bury them all in the dust, press their faces into the grave. Then I too will render you homage. 4o:52-54 And God asks Job if he would be any more if he made God any less. Will you deny My justice, put Me in the wrong so that you may be in the right? 4o:8 Lastly, God describes to Job the immensity and power of the universe through the metaphor of mythical creatures. Job begins to see himself in relation to himself, his community, his Father-God, and the universe.
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In the epilogue, the poet tells us of Job's gaining the Stage of Intimacy (Stage VI) with wife and friends, Generativity (Stage VII) in his new family and his concern for the community, and Ego Integrity (Stage VIII) by defending his own life style as worth while. Job has grown, and there has been a concomitant change in his attitude toward his God.
Part 2 What, then, are the religious aspects of a mature man or what is the attitude of this hypothetical man to religion? To consider this we must be more specific about the definition and the context in which the word "religion" is used here. If we limit ourselves to connotations of supernatural beings or forces, we are excluding large groups of ideas and convictions that would appear to be very much related in other ways. I will, therefore, use part of Fromm's definition of religion: "any system of thought and action.., which gives the individual a flame of orientation and an object of devotion. ''6 If we accept this definition, it is apparent that more than supernatural beings are included, though these objects of devotion are not ignored. A polarity becomes apparent along the continuum between "supernatural-authoritarian" and "humanistic" religions. Supernatural-authoritarian religion is recognition on the part of man of some higher, unseen power as having control of his destiny and as being entitled to obedience, reverence, and worship. The word in this definition that cannot be overlooked is "entitled." The unseen power is "entitled" to the obedience, etc., which then becomes the never-ending effort of the dependent man. Humanistic religion is centered around man and his strength, his relation to fellow-man, and his position in the universe. It requires that he recognize both his limitations and potentialities. He must develop the power of love for others. It is very necessary to emphasize the continuum aspect of the bipolarity. At one end is the purely supernatural being. Here the dogma and doctrine are allimportant. To gain God's help, man must prove how weak he is. And thus the dilemma is formed: the more man praises this god, the more empty he feels. The more empty he becomes, the more sinful he feels. The more sinful he feels, the more he praises God, etc.
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The other pole of this continuum is the humanistic response of man to his fellow-man. It is the ethic of love--toward himself, his fellow, and his universe. It necessitates man knowing his own limitations and potentials as realistically as possible. Between these two poles and along the continuum are infinite variations and combinations. Materialism, for example, will find its place along here in many forms. Thus, accumulation of wealth could be a statement and sign of one's acceptance in the sight of a rewarding god. Or accumulation of wealth could be a statement of man's fear before his fellow-man and an attempt to maintain security. Most of Freud's studies of religion refer to a supernatural, authoritarian religiond (However, in both Civilization and Its Discontents and in Moses and Monotheism, he speaks of principles and forces of socialization springing from religious basis that could be humanistic as well as authoritarian.) He describes a "three fold task" the gods must perform. This task consists of diminishing the terrors of nature; bringing man into harmony with the cruelty of Fate, especially as seen in death; and compensating man for the suffering he undergoes to be part of civilized life. He shows how this is all accomplished in the Christian religion by creating a benevolent deity who can ignore the reality of death by the promise of an afterlife. In The Future of an Illusion, Freud explores the childlike fears and projections involved in the creation of this type of god. He links the child's need for an omnipotent father who will protect, guide, reward, and punish to the creation of a just and benevolent god who will accomplish the threefold task outlined above. In Civilization and Its Discontents he enlarges upon the way that the controlling and repressing aspects of religion are useful in the civilization of man's instincts into communal living. He describes this in terms of the conflict between man's urge toward individual happiness and the "urge toward union with others in the community...,,8 At the same time that religious practices seem to aid repression, they also allow some mutual, vicarious participation in the forbidden acts derived from instinctual wishes? This occurs through worship and ritual. For example, the cannibalistic, incorporative aspects of the eucharist are quite thinly veiled. Freud called religion a collective neurosis. Fromm reverses this to say that "we can interpret neurosis as a private form of religion. ''1~ He goes on to express the idea that if man does not become totally mature he will, by necessity, develop neurotic illusions to fill in his
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failure to achieve maturity, and will cling to them with tenacity. For as Rilke asks, "Is it possible that there are people who say 'God' and suppose that this is something one can have in common?" and " . . . is it possible to believe that one can have a god without using Him? ''11 Man, then, has only the choice of what form of religion or philosophy he will develop. William James, in his classic The Varieties of Religious Experience, supports the same thought when he says "Religion, whatever it is, is a man's total reaction upon life...,,1~ Even psychoanalytic theory could be used as a religion when viewed in this manner. It would appear that if we could be honest with ourselves, contemporary man is really very polytheistic and has all varieties of objects for his religious devotion. At the supernatural end of the continuum, the so-called monotheistic religions are very polytheistic. Note, for example, the prayers and worship rendered to God, The Son, Mother Mary, and saints too numerous to name. The same people who hold to these religious standards share with so-called atheists the devotion to such gods as a profession, a spouse, or social prestige, to name a few. None of these systems of thoughts or objects of devotion is without its own religious symbols. For example, when, in z92o, Eitengan joined the private "Committee" formed by Freud to protect the purity of the analytic movement, Jones says: "the necessary insignia of a ring followed...,,13 Social prestige has its numerous insignia, ranging from the right car to the right address. Interestingly enough, some of the secular symbols are no less instinctual in origin than are those of supernatural religions. Compare the circumcision of Judaic heritage to the colored cloth phallic symbols hanging from the necks of men who adhere to the tenets of fashion more than to the common sense of simple comfort. Let us also pause at this point to note that these so-called secular religions also fulfill the task of aiding civilization as outlined by Freud in his study on this subject. It is not difficult to see, for example, how the three-fold task of the gods could be filled by the gods of social prestige. A man with such a religion could find in this orientation some protection from the elements through the limitation of activities it requires, protection from fear of death in the immortality of family names, and compensation for his suffering in the homage paid by his fellow-men. As we leave the middle ground of materialism with its gods of fashion, social prestige, etc., and move on past viewing psychoanalysis as a religion rather than
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the superb tool and theory that it is, let us speculate about the other extreme end of the continuum: humanistic religion. Here let us examine humanistic psychology. The basic postulates set forth by BugentaP 4 are as follows: z) "'Man, as man, supersedes the sum of his parts." That is, man is more than id, ego, and superego. 2) The unique nature of man is seen in his always being seen in relation with his fellows. 3) Man's awareness is continuous and is the central fact of human experience. He "does not move from discrete episode to discrete episode..." 4) By simple observation we know that man has choice. 5) Man is intentional. That is, he has purpose, valuing, creating, and reorganizing. It is on this basis that he builds his identity. 6) The orientation of humanistic psychology states that man is concemed about man; that only validation by human experience is valid; that all knowledge is relative; that the humanistic view does not void or replace other valid views, but instead tries to supplement them. I think humanistic psychology leads us toward the attitude described as existential thinking with man as the "object of devotion." What, then, are the aspects of this much contested orientation that we need to consider here? Let us look at man's limitations as described in this system. On a philosophical plane, this is really no different from noting the constitutional, inherited factors of an individual organism on a biological plane. First, collective man is faced with contingencies outside his control, such as the tidal waves or the mountain rains in Bugental's metaphors of man on an island. To the extent that he knows these contingencies, he can be confident. Existential anxiety is the realization that he cannot know all that is necessary to assure his own safety. Still, in the midst of his uncertainty man has the freedom of choice. To return to the metaphor, he can build his hut on the shore or in a cave. But even though his knowledge is limited, man must take the responsibility for his acts. And if he does nothing, that is an act, too. And he is responsible for that. Despite man's most careful decisions, tragedy may follow his action in the face of the given contingencies. Tragedy is part of living. But to no less an extent the choice and the act may be followed by joy. That is part of living, too. In this situation it is not difficult to understand man's need for other men. But his situation is a paradox. Although each man is ultimately in relation to other men, in his freedom of choice and action he is also ultimately alone. Man in his limitations may not be willing to face this existential anxiety. And so, he may
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create illusions and distortions of the reality of his life. They may take many forms. But common to the core of all of them is a desire to recapture the infantile feeling of omnipotence--or at least to project this omnipotence onto an object with whom one may then align oneself for protection and power. "Neurotic anxiety is the distress occasioned by our yielding u p . . . to illusory hopes of being secure, of avoiding tragedy. ''15 The primary value of the existential viewpoint is in the extent to which a man's style of living and his motivations realistically take into account his limitations and abilities. It is the extent to which all possible potentialities are realized rather than having large amounts of energy bound up in limiting defenses. It is the willingness to face existential anxiety and tragedy as well as freedom of choice or joy. This primary value is called authenticity. It is not simply an effort to adjust or adapt to the world. Nor is it a mystical leaving of the world. Obviously, authenticity can be approached only by full recognition and acceptance of the familiar world. Fundamental to this is awareness, both of events and of emotions. Authenticity, like total maturity, is an ideal condition always somewhat more than any man will attain. Once again, what criterion will discriminate between the religion of a mature man and the religion of a man with less nearly complete psychosocial development? I propose that the criterion we are seeking will have the orientation of humanistic psychology and the value of authentic existence. The religion to which it applies will give "the individual a flame of orientation and object of devotion" that will be authentic. It will be in accord with the fullest possible awareness of man's existence in, and relation to, himself and the world. Man will not be a robot, but will take full part in whatever he means by his concept of God. And this concept of God will not conflict with his fullest possible awareness of reality. Did Job achieve this goal? I doubt we can really say from the material available in the epilogue. But I think the poet has shown us a striving in this direction. For, as we saw, Job began to see himself in relation to himself, his community, his Father-God, and the universe. Of what importance is this to us? Why should we, as therapists, have more than an intellectual interest in such matters? This may be made more clear by comparing the criteria of the religion of a mature man with the criteria for appraising psycho-
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therapy. What is the main concern and effort of psychotherapy? Bugental, a psychoanalyst, cites two parts: (a) to discard the distortions of awareness which arose to forestall existential anxiety and (b) to accept the responsibilities and opportunities of authentic being in the world36 The concern in therapy as in the proposed religion of a mature man is with authenticity. I propose a man's religion and his maturity are both parts of the same process and cannot be viewed separately.
References I. Nietzsche, F., in Kanfmarm, W., ed., Existentialism from Dostoevsky to Sartre. Cleveland, Meridian Books by World Publishing Co., I956, p. Io5. z. Draper, E., "On the Diagnostic Value of Religious Ideation," Arch. Gen. Psy., 1965, I 3 , 202.
3. Gordis, Robert, The Book of God and Man, A Study of lob. Chicago, Univ. of Chicago Press, I965 . 4. Erikson, E., Childhood and Society, 2nd ed. New York, W. W. Norton & Co., I963. 5. Bugental, J. F. T., The Search for Authenticity. New York, I-Iolt, Rinehart and Winston, I965. 6. Fromm, E., Psychoanalysis and Religion. New Haven, Yale Univ. Press, I95o. 7. Freud, S., "Totem and Taboo." In The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. XIII. London, Hogarth Press, I955. , "The Future of an Illusion." In Complete Works, op. cit., Vol. XXI, 196I. ~ , "'Civilization and Its Discontents." In Complete Works, op. cit., Vol. XXI, I96I. , "Moses and Monotheism." In Complete Works, op. cir., Vol. XXIII, I964. 8. , "Civilization and Its Discontents," op. cit., p. 123. 9. Gordis, op. cit. 5o. Fromm, op. cit. II. Rilke, R., in Kaufman, W., ed., Existentialism from Dostoevsky to Sartre, op. cit. 52. James, William, The Varieties of Religious Experience. New York, Mentor Books by the New American Library, ~958. 23. Jones, Ernest, The Life and Works of Sigmund Freud, Vol. III. New York, Basic Books, I957. 54. Bugental, op. cit.
I5. Ibid. I6. Ibid. See also: Allport, G. W., The Individual and His Religion. New York, Macmillan, I95o.
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Arlow, J. A., "Ego Psychology and the Study of Mythology," J. Amer. Psychoanal., 296I, 9, 37I. Bunker, H. A., Psychoanalysis and the Study of Religion, Psychoanalysis and the Social Sciences, Vol. III. New York, Inter. Univ. Press, I95I, p. 7. Cox, H., The Secular City. New York, Macmillan, ~965. Money-Kyrle, R., "Psychoanalysis and Ethics," Int. ]. Psychoanal. Assn., 1952, 3, 225. Niebuhr, R., Radical Monotheism and Western Culture. New York, Harper & Bros., I947. Racker, H., "Ethics and Psychoanalysis and the Psychoanalysis of Ethics," Int. J. Psychoanal. Assn., i966, 47, 63. Reik, T., Ritual, Psychoanalytic Studies. New York, Farrar, Straus, 2946. , Dogma and Compulsion, Psychoanalytic Studies of Religion and Myth. New York, Inter. Univ. Press, I95I. Schlassman, H., "Circumcision as a Defense: A Study on Psychoanalysis and Religion," Psychoanal. Quarterly, 1966, 3Y, 34~ Tarachow, S., St. Paul and Early Christianity, Psychoanalysis and the Social Sciences, VoI. IV. New York, Inter. Univ. Press, 1955, pp- 223-281. Thompson, C., "Identification with the Enemy and Loss of Sense of Self," Psychoanal. Quarterly, I940, 9, 37. Tillich, P., Theology and Culture. New York, Oxford Univ. Press, 2959.
Journal of Religion and Health
Psychiatry and Religion: A Proposal
KEITH H. J O H A N S E N
Introduction Before the beginning of this century Friedrich Nietzsche had written: "God is dead. God remains dead. And we have killed him. How shall we, the murderers of all murderers, comfort ourselves?''1 Today, "God is dead" is not a phrase only for the consideration of philosophers or theologians. Altizer and Hamilton have sparked a God-is-dead controversy that has found voice in frequent conversations and in diverse publications. Numerous books and papers have appeared describing the changing morals or the so-called sexual revolution of our contemporary culture. Those of us who are students of man and his behavior cannot ignore these ethical and religious controversies. Nor would we expect to find that the forces involved are related entirely to the field of theology. Religion has been an integral part of man and of the society that is our subject of study. It cannot be separated from man, and therefore can be considered by psychiatry. In fact, to understand a man's religious aspirations and convictions helps to understand that man. Draper et al., in I965 reported a double blind study of fifty patients. 2 From a set of questions and answers directed entirely at religious content, they could formulate dynamic and genetic aspects of these patients' personalities. These formulations correlated highly with separate psychiatric interview This paper, presented to the Texas NeuropsychiatricAssociation in Dallas, May, x967, for the zooth Annual Session of the Texas MedicalAssociation, receivedthe Guy Witt Memorial Award presented by the Texas Branch of the American PsychiatricAssociation in ~967. The author is indebted to Judith Johansen for her great help with the biblical portions of the paper.
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studies of the same patients. The authors concluded that "symptomatic, characterological, and psychodynamic diagnostic conclusions could be correctly drawn from the religious history and ideation without benefit of dinical data." This may be a bit strong, but the thesis of this paper is that a man's religion parallels his psychosocial development. This relationship is part of the structure that bridges the gap between a man's intrapsychic mechanisms and the values, ethics, and morals by which he relates to his fellow-man. However, it also raises some very perplexing and complex questions such as: What is the religion of a mature man? To illustrate the relation of a man's religion to his psychosocial development, I will present a case history, in effect, from a classic work of poetry. The author is unknown. The man's name is Job. The account of his illness and recovery and of his attitude toward the object of his religious concern is found in the Old Testament of the Bible.8 I will use the eight stages as described by Erik Erikson in Childhood and Society* to delineate Job's psychosocial development. So that the manner in which I use them may be dear, I will briefly review them here. I. A sense of Basic Trust versus Basic Mistrust. The child learns to rely on outer providers as well as to trust himself. Related to the institution of religion. II. A sense of Autonomy versus Shame and Doubt. A sense of self-control is learned that allows self-esteem. Without this the child has doubt, shame, and an over-manipulative superego. Related to the principle of law and order. III. A Sense of Initiative versus Guilt. "The child indulges in fantasies of being a giant and a tiger, but in his dreams he runs in terror for dear life." The child wishes to take over the activities and prerogatives of the adult, but is fearful of the retaliation that may meet his strivings toward rivalry. In the adult this will be reflected in his relation and attitude toward authorities. Related institution: economic ethos in the form of idealized adults recognized by their uniforms or functions. IV. A sense of Industry versus Inferiority. If the sense of initiative has been adequately developed, the child will de-
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velop the type of industry that leads to a sense of mastery. Related institution: technical ethos. V. A sense of Identity versus Role Confusion. Childhood ends and youth begins. In the face of physiologic upheaval, the adolescent refights old battles of previous years. Ego identity is sought. The youth attempts to reconcile the way he sees himself, and the way others see him. Related institution: ideology and aristocracy. VI. A sense of Intimacy versus Isolation. The emerging adult must now risk this new-found identity in increasing closeness to others. He will commit himself to affiliations and make the sacrifices and compromises necessary to maintain them. Fear of losing himself in such an encounter leads to isolation. He must "become subject to that ethical sense which is the mark of an adult." Related institution: the specific culture's style of "loving and working." (Freud: "'Lieben und Arbeiten") VII. A sense of Generativity versus Stagnation. Generativity is primarily the concern in establishing and guiding the next generation. This is much more than just wanting or having children. It is an "investment in that which is being generated." Related institution: "All institutions codify the ethics of generative succession." VIII. A sense of Ego Integrity versus Despair. The integration of the previous seven stages leads to the final stage of ego integrity. "It is the acceptance of one's one and only life cycle as something that had to be without substitutions." Such a man is ready to defend the dignity of his own life style against all physical and economic threats. It is a "new and different love of one's parents.'" In any one individual the progression from one stage to the next will not be as tidy and complete as it appears in this summary. Some stages will be more nearly complete than others. There will be degrees of attainment. For example, there is a thin but decisive line between relying on others and the distorted belief that the world or one's god is really fair. There is a thin line between a sense of selfcontrol without loss of self-esteem and a need to manipulate one's environment
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or god by sacrifice or ritualistic magic. There is a thin line between being an adult with all its prerogatives and having the prerogatives of one's parent or God. But if the foundation of each preceding stage is well laid and accomplished, and if thereby some major degree of ego integrity is reached, what might be the religious orientation or attitude of such a man through these stages? As Job searches his own faith or hears the counsel of his well-intentioned visitors or considers the voice of his God, we can apply these stages to his circumstances. It is proposed that the poetic author of Job confronts the reader with this progression and the religious attitudes related to it. In the prologue, Satan is given power and permission to take anything from Job except his life. Job loses his possessions, his children, and finally his health. All this happens without warning and Job knows of no reason for it. He is given no meaning to assign to these catastrophic events. Surely Job was not aware of the conversation that the poet related between God and Satan. Bugental likens existence to being shipwrecked on an island; having to erect one's own defenses; and having no way of knowing whether a tidal wave may be approaching the shore or rains coming down from the mountains. 5 This is the way it must have been for Job.
Part i (Erikson's stages of psychosocial development will be designated by Roman numerals. References to the Book of Job will be designated as chapter and verse thus, X :XX.)
Job has lost his possessions, his children, and his social position in the community. He regresses to the protection of infancy (Stage I). Naked I came from my mother's womb, naked shall I return. The Lord gave, and the Lord has taken away. Blessed be the name of the Lord.
9 :2I
Thus in a completely passive position Job seeks security. But this requires the denial of his anger toward the Lord who is said to give and take away. So it is turned upon himself. He indulges in self-effacement, depression, and longing for death.
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Why is light given to the sufferer... Who would exult in great joy and be happy to find a grave?
3:20-22
At this point we can note briefly the attitude and developmental level of Job's friends who come to counsel and console him. They appear to be the poet's representation of the common, religious thinking of the community at the time. Throughout the poem their speeches are rich in the imagery of a fixation at an anal level (Stage II) and of fearful thoughts about the aggression of the phallic stage (Stage III). The world and God are seen according to the talon law of eye-for-an-eye and tooth-for-a-tooth. If a man suffers, it must be divine retaliation for his improper acts or thoughts. For these improprieties man must repent to regain God's good will (Stage II). Thus the friends say: The Almighty--whom we cannot find out-is great both in power and in justice; the man abounding in goodness He does not torment. Therefore do men fear Him, Yes, all the wise-hearted stand in awe.
37:23-24
The fears and castrating expectations of the phallic (Stage III) are vividly shown. He will not escape from the darkness; his shoots will shrivel up in the flame, and his branch in the breath of God's mouth. Let no man believe in empty deceit, for emptiness will be his reward! Before his time he will be cut off, while his branch is not yet green.
"r5:3o-32
Here we will leave the friends, for they do not appear to change. After his friends attack him under the assumption that suffering presupposes guilt, and after seven days of silence, Job begins his struggle toward maturity. Maybe because he feels things can get no worse, or maybe because he feels the pain has expiated some of his guilt, he begins to express his anger. But, he is not yet overtly attacking his tormentor. He is whining and complaining. Having reviewed his own belief of innocence (Stage II), he speaks.
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I will complain in the bitterness of my soul.
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From this point the poet describes, in a manner consistent with actual case histories, Job's regressions and progressions, his fear of the unknown and his assertions, and his momentary regressions again as he drives toward his own identity. From the legalistic anally-oriented defenses of Stage II, he launches his attack against his protagonist (Stage III). The phallic stage is being tested. He imagines a court in which the guilty will be exposed and his own innocence will be apparent. God will judge. Yet Job realizes that this does not really make sense: the good guys don't always win. I am blameless... The blameless and the wicked He destroys alike. If not He, who then is guilty? 9
9 :zz,22,24
This is too frightening an assertion, and Job regresses momentarily to Stage I. Why did You take me out of the womb? Would I were as though I had never b e e n . . ,
xo:x8
Still, a stage once experienced is more easily won again, and once again Job decides to stand up to God. As he moves forward into Stage III of self-assertion, the anal traces of Stage II are evident in the desire for legalistic justification. Yes, He may slay me; I have no hope, but I will justify my ways to His face! Indeed, this may be my salvation for it is no flatterer coming before Him.
x3 :~3 -x6
Some of the magical rituals are left behind, and Job struggles into the Stage of Industry and Learning versus Inferiority (Stage IV). Teach me, and I shall be silent, and where I have erred, make me understand.
6:a 4
The progression of Job as a maturing man and the changes in his religious thinking can be seen in the alternatives he considers: if God would let me die
6:8
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if God were human like me, whom I could answer when we come to t r i a l . . . if there were an intercessor if God would judge between a man and God as between one man and his fellow if I could see God.
9:32 I6:2o ~6:2x-22 ~9:26
Progressively Job is moving from the passive position of early stages to the idea of two adults speaking together. He is gradually more involved in the adolescent task of defining his identity as a man among men. He is also struggling with the adolescent task of reworking accomplishments-through-action into accomplishments-through-words: Oh that I knew where to find H i m . . . I would lay my case before Him, and my mouth would not lack for arguments. I would learn what He would answer me, and understand what He would say to me. Would He contend with me merely through His great power? No, He would surely pay heed to me, For it would be an upright man arguing with Him, and I would be acquitted by my Judge for all time. 23 :~-7 In his adolescent-like struggle he invokes the defense of aestheticism. He forms his ideals of ethics more dearly. I will not lie or be deceitful... I will be righteous and never blasphemous,
paraphrase 27:2-6
He looks back at the childhood he is leaving with longing. Oh that I were as in the months of old as in the days when God watched over me.
29:2
Still he asks something of his God and finally decides that since God does not answer him He must not love him. If I cry out to You, You do not answer me;
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if I remain silent, You pay me no heed, You have turned cruel toward me, with all Your might You hate me.
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Job still clings to his infantile desires, but less strongly. At least he sees he must stand alone in relation to his God. He begins to realize he is worth while, even if he does not have prosperity to prove it. Finally the poet tells us that Job speaks with his God. In this encounter the identity of the man is finally completed. But it is completed as a man, not as a god; finite, not infinite; as a grown son, not as the father. God says to Job: Gird up your loins like a man; I will question you, and you may inform Me.
38:5- 3
And more, God says in effect, that Job may do and create as the father does, but not what the father does. Where were you when I laid the foundations of the earth ? 38:4 You surely know it, for you were born then. 38:25 As God goes on, He begins to delineate the fact that Job is not omnipotent. He cannot assure justice. A new image of one's God or Father begins to facilitate a new image of one's self. God says to Job: As you look on each arrogant one---bring him low, and tread down the wicked in their place. Bury them all in the dust, press their faces into the grave. Then I too will render you homage. 4o:52-54 And God asks Job if he would be any more if he made God any less. Will you deny My justice, put Me in the wrong so that you may be in the right? 4o:8 Lastly, God describes to Job the immensity and power of the universe through the metaphor of mythical creatures. Job begins to see himself in relation to himself, his community, his Father-God, and the universe.
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In the epilogue, the poet tells us of Job's gaining the Stage of Intimacy (Stage VI) with wife and friends, Generativity (Stage VII) in his new family and his concern for the community, and Ego Integrity (Stage VIII) by defending his own life style as worth while. Job has grown, and there has been a concomitant change in his attitude toward his God.
Part 2 What, then, are the religious aspects of a mature man or what is the attitude of this hypothetical man to religion? To consider this we must be more specific about the definition and the context in which the word "religion" is used here. If we limit ourselves to connotations of supernatural beings or forces, we are excluding large groups of ideas and convictions that would appear to be very much related in other ways. I will, therefore, use part of Fromm's definition of religion: "any system of thought and action.., which gives the individual a flame of orientation and an object of devotion. ''6 If we accept this definition, it is apparent that more than supernatural beings are included, though these objects of devotion are not ignored. A polarity becomes apparent along the continuum between "supernatural-authoritarian" and "humanistic" religions. Supernatural-authoritarian religion is recognition on the part of man of some higher, unseen power as having control of his destiny and as being entitled to obedience, reverence, and worship. The word in this definition that cannot be overlooked is "entitled." The unseen power is "entitled" to the obedience, etc., which then becomes the never-ending effort of the dependent man. Humanistic religion is centered around man and his strength, his relation to fellow-man, and his position in the universe. It requires that he recognize both his limitations and potentialities. He must develop the power of love for others. It is very necessary to emphasize the continuum aspect of the bipolarity. At one end is the purely supernatural being. Here the dogma and doctrine are allimportant. To gain God's help, man must prove how weak he is. And thus the dilemma is formed: the more man praises this god, the more empty he feels. The more empty he becomes, the more sinful he feels. The more sinful he feels, the more he praises God, etc.
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The other pole of this continuum is the humanistic response of man to his fellow-man. It is the ethic of love--toward himself, his fellow, and his universe. It necessitates man knowing his own limitations and potentials as realistically as possible. Between these two poles and along the continuum are infinite variations and combinations. Materialism, for example, will find its place along here in many forms. Thus, accumulation of wealth could be a statement and sign of one's acceptance in the sight of a rewarding god. Or accumulation of wealth could be a statement of man's fear before his fellow-man and an attempt to maintain security. Most of Freud's studies of religion refer to a supernatural, authoritarian religiond (However, in both Civilization and Its Discontents and in Moses and Monotheism, he speaks of principles and forces of socialization springing from religious basis that could be humanistic as well as authoritarian.) He describes a "three fold task" the gods must perform. This task consists of diminishing the terrors of nature; bringing man into harmony with the cruelty of Fate, especially as seen in death; and compensating man for the suffering he undergoes to be part of civilized life. He shows how this is all accomplished in the Christian religion by creating a benevolent deity who can ignore the reality of death by the promise of an afterlife. In The Future of an Illusion, Freud explores the childlike fears and projections involved in the creation of this type of god. He links the child's need for an omnipotent father who will protect, guide, reward, and punish to the creation of a just and benevolent god who will accomplish the threefold task outlined above. In Civilization and Its Discontents he enlarges upon the way that the controlling and repressing aspects of religion are useful in the civilization of man's instincts into communal living. He describes this in terms of the conflict between man's urge toward individual happiness and the "urge toward union with others in the community...,,8 At the same time that religious practices seem to aid repression, they also allow some mutual, vicarious participation in the forbidden acts derived from instinctual wishes? This occurs through worship and ritual. For example, the cannibalistic, incorporative aspects of the eucharist are quite thinly veiled. Freud called religion a collective neurosis. Fromm reverses this to say that "we can interpret neurosis as a private form of religion. ''1~ He goes on to express the idea that if man does not become totally mature he will, by necessity, develop neurotic illusions to fill in his
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failure to achieve maturity, and will cling to them with tenacity. For as Rilke asks, "Is it possible that there are people who say 'God' and suppose that this is something one can have in common?" and " . . . is it possible to believe that one can have a god without using Him? ''11 Man, then, has only the choice of what form of religion or philosophy he will develop. William James, in his classic The Varieties of Religious Experience, supports the same thought when he says "Religion, whatever it is, is a man's total reaction upon life...,,1~ Even psychoanalytic theory could be used as a religion when viewed in this manner. It would appear that if we could be honest with ourselves, contemporary man is really very polytheistic and has all varieties of objects for his religious devotion. At the supernatural end of the continuum, the so-called monotheistic religions are very polytheistic. Note, for example, the prayers and worship rendered to God, The Son, Mother Mary, and saints too numerous to name. The same people who hold to these religious standards share with so-called atheists the devotion to such gods as a profession, a spouse, or social prestige, to name a few. None of these systems of thoughts or objects of devotion is without its own religious symbols. For example, when, in z92o, Eitengan joined the private "Committee" formed by Freud to protect the purity of the analytic movement, Jones says: "the necessary insignia of a ring followed...,,13 Social prestige has its numerous insignia, ranging from the right car to the right address. Interestingly enough, some of the secular symbols are no less instinctual in origin than are those of supernatural religions. Compare the circumcision of Judaic heritage to the colored cloth phallic symbols hanging from the necks of men who adhere to the tenets of fashion more than to the common sense of simple comfort. Let us also pause at this point to note that these so-called secular religions also fulfill the task of aiding civilization as outlined by Freud in his study on this subject. It is not difficult to see, for example, how the three-fold task of the gods could be filled by the gods of social prestige. A man with such a religion could find in this orientation some protection from the elements through the limitation of activities it requires, protection from fear of death in the immortality of family names, and compensation for his suffering in the homage paid by his fellow-men. As we leave the middle ground of materialism with its gods of fashion, social prestige, etc., and move on past viewing psychoanalysis as a religion rather than
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the superb tool and theory that it is, let us speculate about the other extreme end of the continuum: humanistic religion. Here let us examine humanistic psychology. The basic postulates set forth by BugentaP 4 are as follows: z) "'Man, as man, supersedes the sum of his parts." That is, man is more than id, ego, and superego. 2) The unique nature of man is seen in his always being seen in relation with his fellows. 3) Man's awareness is continuous and is the central fact of human experience. He "does not move from discrete episode to discrete episode..." 4) By simple observation we know that man has choice. 5) Man is intentional. That is, he has purpose, valuing, creating, and reorganizing. It is on this basis that he builds his identity. 6) The orientation of humanistic psychology states that man is concemed about man; that only validation by human experience is valid; that all knowledge is relative; that the humanistic view does not void or replace other valid views, but instead tries to supplement them. I think humanistic psychology leads us toward the attitude described as existential thinking with man as the "object of devotion." What, then, are the aspects of this much contested orientation that we need to consider here? Let us look at man's limitations as described in this system. On a philosophical plane, this is really no different from noting the constitutional, inherited factors of an individual organism on a biological plane. First, collective man is faced with contingencies outside his control, such as the tidal waves or the mountain rains in Bugental's metaphors of man on an island. To the extent that he knows these contingencies, he can be confident. Existential anxiety is the realization that he cannot know all that is necessary to assure his own safety. Still, in the midst of his uncertainty man has the freedom of choice. To return to the metaphor, he can build his hut on the shore or in a cave. But even though his knowledge is limited, man must take the responsibility for his acts. And if he does nothing, that is an act, too. And he is responsible for that. Despite man's most careful decisions, tragedy may follow his action in the face of the given contingencies. Tragedy is part of living. But to no less an extent the choice and the act may be followed by joy. That is part of living, too. In this situation it is not difficult to understand man's need for other men. But his situation is a paradox. Although each man is ultimately in relation to other men, in his freedom of choice and action he is also ultimately alone. Man in his limitations may not be willing to face this existential anxiety. And so, he may
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create illusions and distortions of the reality of his life. They may take many forms. But common to the core of all of them is a desire to recapture the infantile feeling of omnipotence--or at least to project this omnipotence onto an object with whom one may then align oneself for protection and power. "Neurotic anxiety is the distress occasioned by our yielding u p . . . to illusory hopes of being secure, of avoiding tragedy. ''15 The primary value of the existential viewpoint is in the extent to which a man's style of living and his motivations realistically take into account his limitations and abilities. It is the extent to which all possible potentialities are realized rather than having large amounts of energy bound up in limiting defenses. It is the willingness to face existential anxiety and tragedy as well as freedom of choice or joy. This primary value is called authenticity. It is not simply an effort to adjust or adapt to the world. Nor is it a mystical leaving of the world. Obviously, authenticity can be approached only by full recognition and acceptance of the familiar world. Fundamental to this is awareness, both of events and of emotions. Authenticity, like total maturity, is an ideal condition always somewhat more than any man will attain. Once again, what criterion will discriminate between the religion of a mature man and the religion of a man with less nearly complete psychosocial development? I propose that the criterion we are seeking will have the orientation of humanistic psychology and the value of authentic existence. The religion to which it applies will give "the individual a flame of orientation and object of devotion" that will be authentic. It will be in accord with the fullest possible awareness of man's existence in, and relation to, himself and the world. Man will not be a robot, but will take full part in whatever he means by his concept of God. And this concept of God will not conflict with his fullest possible awareness of reality. Did Job achieve this goal? I doubt we can really say from the material available in the epilogue. But I think the poet has shown us a striving in this direction. For, as we saw, Job began to see himself in relation to himself, his community, his Father-God, and the universe. Of what importance is this to us? Why should we, as therapists, have more than an intellectual interest in such matters? This may be made more clear by comparing the criteria of the religion of a mature man with the criteria for appraising psycho-
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therapy. What is the main concern and effort of psychotherapy? Bugental, a psychoanalyst, cites two parts: (a) to discard the distortions of awareness which arose to forestall existential anxiety and (b) to accept the responsibilities and opportunities of authentic being in the world36 The concern in therapy as in the proposed religion of a mature man is with authenticity. I propose a man's religion and his maturity are both parts of the same process and cannot be viewed separately.
References I. Nietzsche, F., in Kanfmarm, W., ed., Existentialism from Dostoevsky to Sartre. Cleveland, Meridian Books by World Publishing Co., I956, p. Io5. z. Draper, E., "On the Diagnostic Value of Religious Ideation," Arch. Gen. Psy., 1965, I 3 , 202.
3. Gordis, Robert, The Book of God and Man, A Study of lob. Chicago, Univ. of Chicago Press, I965 . 4. Erikson, E., Childhood and Society, 2nd ed. New York, W. W. Norton & Co., I963. 5. Bugental, J. F. T., The Search for Authenticity. New York, I-Iolt, Rinehart and Winston, I965. 6. Fromm, E., Psychoanalysis and Religion. New Haven, Yale Univ. Press, I95o. 7. Freud, S., "Totem and Taboo." In The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. XIII. London, Hogarth Press, I955. , "The Future of an Illusion." In Complete Works, op. cit., Vol. XXI, 196I. ~ , "'Civilization and Its Discontents." In Complete Works, op. cit., Vol. XXI, I96I. , "Moses and Monotheism." In Complete Works, op. cir., Vol. XXIII, I964. 8. , "Civilization and Its Discontents," op. cit., p. 123. 9. Gordis, op. cit. 5o. Fromm, op. cit. II. Rilke, R., in Kaufman, W., ed., Existentialism from Dostoevsky to Sartre, op. cit. 52. James, William, The Varieties of Religious Experience. New York, Mentor Books by the New American Library, ~958. 23. Jones, Ernest, The Life and Works of Sigmund Freud, Vol. III. New York, Basic Books, I957. 54. Bugental, op. cit.
I5. Ibid. I6. Ibid. See also: Allport, G. W., The Individual and His Religion. New York, Macmillan, I95o.
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Arlow, J. A., "Ego Psychology and the Study of Mythology," J. Amer. Psychoanal., 296I, 9, 37I. Bunker, H. A., Psychoanalysis and the Study of Religion, Psychoanalysis and the Social Sciences, Vol. III. New York, Inter. Univ. Press, I95I, p. 7. Cox, H., The Secular City. New York, Macmillan, ~965. Money-Kyrle, R., "Psychoanalysis and Ethics," Int. ]. Psychoanal. Assn., 1952, 3, 225. Niebuhr, R., Radical Monotheism and Western Culture. New York, Harper & Bros., I947. Racker, H., "Ethics and Psychoanalysis and the Psychoanalysis of Ethics," Int. J. Psychoanal. Assn., i966, 47, 63. Reik, T., Ritual, Psychoanalytic Studies. New York, Farrar, Straus, 2946. , Dogma and Compulsion, Psychoanalytic Studies of Religion and Myth. New York, Inter. Univ. Press, I95I. Schlassman, H., "Circumcision as a Defense: A Study on Psychoanalysis and Religion," Psychoanal. Quarterly, 1966, 3Y, 34~ Tarachow, S., St. Paul and Early Christianity, Psychoanalysis and the Social Sciences, VoI. IV. New York, Inter. Univ. Press, 1955, pp- 223-281. Thompson, C., "Identification with the Enemy and Loss of Sense of Self," Psychoanal. Quarterly, I940, 9, 37. Tillich, P., Theology and Culture. New York, Oxford Univ. Press, 2959.
