THOMAS
B. K I R S C H
Psychiatry and Religion THE RELATIONSHIP between psychiatry and religion can be discussed from a variety of viewpoints. In the larger social context, religious attitudes have undergone profound changes, as witnessed by the Godis-dead movement as well as the enormously increased community involvement of pastoral leaders. This latter movement has brought the newly evolved community psychiatrist and the religious leader into direct contact with one another. I would call this the social or ethical aspect of both disciplines, their common desire to "do good" in the community. On the more personal level, both the psychiatrist and the pastoral counselor see people with family problems and do supportive psychotherapy. Both are deeply involved with the problems of suicide, guilt, conscience, and salvation, and have prepared positions and techniques to deal with them. Each of the above-mentioned areas, and many others, could easily be the subject of a paper. However, I would like to focus this discussion on the mystical or transcendent experience, an area that has received much notoriety of late because of its relationship with LSD. The examination of the transcendent or God experience is open to misunderstanding from the side of religion as well as from that of psychiatry. I must clearly state that I am not a theologian; therefore, it may seem presumptuous of me to approach the highest content of religion--God--from a psychological point of view. However, it must be pointed out that religion is most certainly a phenomenon of the human psyche and, as such, open to psychological study. It would be sacrilegious if, in the course of its study, psychiatry claimed to make any statement about the absolute existence or nonexistence of God, or about any other reality of religious faith. The realities of faith, as such, are not accessible to psychology. What is, however, the legitimate concern of psychology is the phenomenon of religious experience as an activity of the human psyche and as an expression of its inner processes. Psychiatry is not concerned with the reality of God, but with a psychic 74
]ournalof Religion and Health
experience that corresponds to the projected image of God. This experience may or may not correspond to the existence of an absolute deity, but in any case it is a psychic reality of the greatest importance. On the other hand, general psychiatry and psychoanalysis have been antipathetic to the study of religion, either because of its supposed "mystical" or nonscientific nature, or because it has been merely viewed as a symptomatic epiphenomenon. Freud, in his controversial work on religion, The Future o~ an Illusion, states that religious ideas are born of the need to make tolerable man's helplessness in his environment and from man's memories of his helplessness during his own childhood and the childhood of the human race. They owe their vitality to mankind's hostility to culture and the instinctual renunciations that culture demands. Thus, according to Freud, religion is a sublimation of a primary biological or instinctual drive. Religion is, therefore, an "illusion," as the title of the book implies. This way it loses all importance as an experience in itself. This kind of thinking has been responsible for the distance between orthodox psychoanalysis and theology. However, many theologians have been able to accept Freud's clinical formulations and at the same time deny his philosophical or religious attitudes. An early pioneer with this kind of dichotomous attitude was Oskar Pfister, a Protestant theologian and practicing pastor on the one hand, and on the other hand, a psychoanalyst in the strictest Freudian sense. Pfister was one of the early "converts" to psychoanalysis; he practiced both endeavors in Switzerland. Against a psychoanalysis inimical to religion, he defended the rights and values of religion; against Protestant theology largely antipathetic to psychology, he set up Freud's teachings and used them as an auxiliary in the cure of souls. In my opinion, however, he was never able to bridge the gap between the clinical setting and his philosophical or religious attitudes. First, he saw psychoanalysis purely as a method, which it certainly is, but failed to accept its underlying philosophical and scientific implications about human nature. Secondly, he did not call on it to give a deeper interpretation of theological matters, but only used psychoanalysis in the interpretation of psychopathological religious phenomena. One of the early psychologists deeply interested in this subject was William James, whose Varieties o~ Religious Experience, published in 19o2 , remains a classic in the field. He defines the religious attitude as "both a helpless and a sacrificial attitude which the individual finds him-
Psychiatry and Religion
75
self impelled to take up towards what he apprehends to be the divine. In the religious l i f e . . , surrender and sacrifice are positively e s p o u s e d . . . in order that happiness may increase." (p. 5 ~). In the concluding chapter he states: "At the same time the theologian's contention that the religious man is moved by an external power is vindicated, for it is one of the peculiarities of invasions from the subconscious region to take an objective appearance, and to suggest to the subject an external control." In this connection between the unconscious (or in James's terminology, the subconscious) and God, James sees the link between religion and the science of psychology. In recent years, through the influence of existential philosophy on psychiatry, religious faith has again been accepted as a significant psychological problem in some psychoanalytical circles. Although there is a wide divergence of opinion among existential psychotherapists, one group is characterized by its adherence to a definite religious persuasion as well as a positive evaluation of religious faith. Prominent among this group are Karl Stern, in Montreal, Canada, and Igor Caruso, Viktor Frankl, and Wilfried Daim in Austria. Caruso feels that Freud's theory contains two specific errors: ~) the reduction of all values to the subiective sphere of pure immanence; 2) the unquestioning acceptance of certain false imperatives of the social collectives (Freud's superego). Caruso sees every neurosis as a violent struggle between affirmation and negation, good and evil, truth and falsehood. In effect, he states that a neurosis is always simultaneously a flight from the Absolute as well as a longing for the Absolute. He rejects the assertion of the Freudians that wrestling with religious faith is a sign and symptom of neurosis. According to Caruso, when religious problems arise in psychotherapy, each psychology must have as its frame of reference a "realistic" scale of values. If a person suffers emotionally as a consequence of certain "fixations" or false absolutes (that is, in servitude of fictitious values), it becomes the job of the psychotherapist to liberate the individual from his fixations and lead him back to a world of more objective values. It may be at this juncture that questions of great existential or religious significance are being asked and that a primary biological orientation just does not suffice. Existential psychology of every shade acknowledges the reality of the mind or spirit in addition to man's biological side. Existentialism does not view the spirit as an epiphenomenon of man's biological nature.
76
Journalof Religion and Health
The ultimate aim in this kind of therapy is to experience as relative those values which the neurotic fixation had previously idolized as being absolute. An integrated psychotherapy, as proposed by the therapists of the "Vienna Circle," will thus lead the patient to a recognition of an objective scale of values and then aid him in appropriating these values in a free and conscious choice. Caruso goes on to say that "medical psychotherapy is a preliminary to an eventual religious metanoia or conversio," that is, a metaphysical-religious awakening, rebirth, and reorientation. It is at this crucial juncture that the religiously oriented Austrian members (most of whom are Roman Catholic with a strong Aristotelian-Thomistic background) part from the other existential groups. Other existential analytic schools, such as those of Medard Boss and Ludwig Binswanger, are religiously neutral, whereas the one of Jean Paul Sartre is atheistic in its religious and philosophical orientation. The spiritual aspects of the "Vienna Circle" writings have been emphasized, as they have been significant contributions toward deepening our understanding of the connection between depth psychology and religion. To avoid any misunderstanding, it is important to realize that this kind of existential "synthesis" is possible only after a precise scientific "analysis" in the more traditional psychoanalytic sense. There are two areas that concern me as a psychiatrist. First, Caruso strongly emphasizes a "hierarchy of true values" and finding the "True Absolute." I am concerned whether the "Vienna Circle" would not have a prescribed set of true values that the patient becomes indoctrinated to during the course of psychotherapy. My second criticism is related to the first: it is that one obtains a distinct impression of didacticism in Caruso's work. He has the patient write an account of the session and then compares these notes with his own. One of his main therapeutic techniques is to give short summaries of the different psychological theories whenever there is a prolonged silence. He feels that this helps to overcome some of the resistances in psychotherapy. Thus, if there are pauses during the session, the patient is subjected to short lectures. C. G. Jung, one of the pioneers in depth psychology, from the beginning has been extremely concerned with the interconnections between psychiatry and religion, and much of his work in psychology has been in interpretation of religious phenomena. Jung's starting point is very similar to that of William James: namely, that the psyche is the carrier of religious contents. In Jung's book, Psychology and Religion,
Psychiatry and Religion
77
he defines religion as a "careful and scrupulous observation of what Rudolph Otto aptly termed the 'numinosum,' that is, a dynamic existence or effect not caused by an arbitrary act of will. On the contrary, it seizes and controls the human subject, which is always rather its victim than its creator." (p. 4)- The concept of the numinosum as developed by Rudolph Otto in his book, The Idea of the Holy, states that a numinous state of mind is made up of various elements that are basically irreducible to any one, and is experienced with overwhelming intensity as if gripped by something "wholly other." It contains a "tremendum" or sense of "awfulness," a condition that, in the Bible, is referred to as the "fear of God." The experience of numinosity also has an element of fascination. One can see that this definition of religion is something quite different from a religious creed. For Jung, creeds are codified and dogmatized forms of original religious experience, which often have become sanctified and congealed in an elaborate structure. An individual may follow scrupulously the creed and dogma of a church and never come close to anything approaching a religious experience. Now how does the numinous experience enter into the person's life? Jung finds this kind of experience in his patients' dreams, visions, and fantasies. On this basis, he feels that the religious instinct manifests itself spontaneously, and that it is rooted in the unconcious, elemental level of psychic life. Jung sees dreams as spontaneous revelations of the unconscious; he believes that their manifest form and content have meaning in themselves. For Freud, however, dreams and religious manifestations are "nothing but" exaggerated symptoms of primary sexual and aggressive drives. Through Jung's open approach to dreams, several important connections with religion are noted: I) Jung states that the language of dreams is revealed in symbols. He defines a symbol as a term, name, or picture that is familiar to us; but in combination with unknown or unexpected elements, it implies something strange but meaningful to us beyond the ordinary realm of human understanding. Since all religions use symbolic language or images as well, such as the cross, the wheel, or the sun, there is a definite similarity between religion and the images of the unconscious. On the other hand, signs are consciously contrived and stand for something completely known. For Freud, dreams stand for completely known things and are, therefore, signs, not symbols. 2) Jung notes that there is teleological or purposeful movement in which the psyche of an individual works toward integra-
78
Journalof Religion and Health
don and wholeness. The process by which this occurs in maturing people is called individuation. The individuation process is a mysterious, winding path, different for every individual and without rules to follow, except what is brought forth from psychic necessity. Its goal, the Self, as image, manifests itself usually by a circle containing a square or cross and is felt to be quite numinous. It can be expressed by other symbols such as a jewel, or the Divine Child, or the lapis, the miraculous stone that was the goal of alchemy. Whatever the image is, the effect is always to be found in a resolution of a conflict between the opposites. Jung finds the individuation process to be very similar to certain religious disciplines, such as Yoga and Zen. Furthermore, the individuation process demonstrates that religions embody in symbolic form basic truths of the soul. Time does not allow me to present individual case histories, but Jung's books are filled with such examples. Jung's approach to religion, from the point of view of a psychiatrist, has given the broadest meaning to religious phenomena. He has opened up new ways to approach religious contents, i.e., through an understanding of unconscious processes. It is interesting to note that he has been criticized from both sides. From the point of view of traditional psychiatry, he has been seen as a mystic because of his interest in studying religious phenomena qua phenomena. His ideas have been seen as nonscientific, nonempirical, and irrational. From the point of view of theology and Christian existentialist psychiatry, he has been seen as being too rational. From their standpoint, he sees the relative value of different religious experiences and does not provide metaphysical answers. Jung's main contribution to the study of religion, which should be acceptable to any of the groups, is his demonstration of a primary religious attitude arising in the unconscious of modern people, whether they are psychological "patients" or "normal" individuals. This attitude cannot be reduced to any more original form of archetypal image or mode of behavior.
Psychiatry and Religio~
79
B. K I R S C H
Psychiatry and Religion THE RELATIONSHIP between psychiatry and religion can be discussed from a variety of viewpoints. In the larger social context, religious attitudes have undergone profound changes, as witnessed by the Godis-dead movement as well as the enormously increased community involvement of pastoral leaders. This latter movement has brought the newly evolved community psychiatrist and the religious leader into direct contact with one another. I would call this the social or ethical aspect of both disciplines, their common desire to "do good" in the community. On the more personal level, both the psychiatrist and the pastoral counselor see people with family problems and do supportive psychotherapy. Both are deeply involved with the problems of suicide, guilt, conscience, and salvation, and have prepared positions and techniques to deal with them. Each of the above-mentioned areas, and many others, could easily be the subject of a paper. However, I would like to focus this discussion on the mystical or transcendent experience, an area that has received much notoriety of late because of its relationship with LSD. The examination of the transcendent or God experience is open to misunderstanding from the side of religion as well as from that of psychiatry. I must clearly state that I am not a theologian; therefore, it may seem presumptuous of me to approach the highest content of religion--God--from a psychological point of view. However, it must be pointed out that religion is most certainly a phenomenon of the human psyche and, as such, open to psychological study. It would be sacrilegious if, in the course of its study, psychiatry claimed to make any statement about the absolute existence or nonexistence of God, or about any other reality of religious faith. The realities of faith, as such, are not accessible to psychology. What is, however, the legitimate concern of psychology is the phenomenon of religious experience as an activity of the human psyche and as an expression of its inner processes. Psychiatry is not concerned with the reality of God, but with a psychic 74
]ournalof Religion and Health
experience that corresponds to the projected image of God. This experience may or may not correspond to the existence of an absolute deity, but in any case it is a psychic reality of the greatest importance. On the other hand, general psychiatry and psychoanalysis have been antipathetic to the study of religion, either because of its supposed "mystical" or nonscientific nature, or because it has been merely viewed as a symptomatic epiphenomenon. Freud, in his controversial work on religion, The Future o~ an Illusion, states that religious ideas are born of the need to make tolerable man's helplessness in his environment and from man's memories of his helplessness during his own childhood and the childhood of the human race. They owe their vitality to mankind's hostility to culture and the instinctual renunciations that culture demands. Thus, according to Freud, religion is a sublimation of a primary biological or instinctual drive. Religion is, therefore, an "illusion," as the title of the book implies. This way it loses all importance as an experience in itself. This kind of thinking has been responsible for the distance between orthodox psychoanalysis and theology. However, many theologians have been able to accept Freud's clinical formulations and at the same time deny his philosophical or religious attitudes. An early pioneer with this kind of dichotomous attitude was Oskar Pfister, a Protestant theologian and practicing pastor on the one hand, and on the other hand, a psychoanalyst in the strictest Freudian sense. Pfister was one of the early "converts" to psychoanalysis; he practiced both endeavors in Switzerland. Against a psychoanalysis inimical to religion, he defended the rights and values of religion; against Protestant theology largely antipathetic to psychology, he set up Freud's teachings and used them as an auxiliary in the cure of souls. In my opinion, however, he was never able to bridge the gap between the clinical setting and his philosophical or religious attitudes. First, he saw psychoanalysis purely as a method, which it certainly is, but failed to accept its underlying philosophical and scientific implications about human nature. Secondly, he did not call on it to give a deeper interpretation of theological matters, but only used psychoanalysis in the interpretation of psychopathological religious phenomena. One of the early psychologists deeply interested in this subject was William James, whose Varieties o~ Religious Experience, published in 19o2 , remains a classic in the field. He defines the religious attitude as "both a helpless and a sacrificial attitude which the individual finds him-
Psychiatry and Religion
75
self impelled to take up towards what he apprehends to be the divine. In the religious l i f e . . , surrender and sacrifice are positively e s p o u s e d . . . in order that happiness may increase." (p. 5 ~). In the concluding chapter he states: "At the same time the theologian's contention that the religious man is moved by an external power is vindicated, for it is one of the peculiarities of invasions from the subconscious region to take an objective appearance, and to suggest to the subject an external control." In this connection between the unconscious (or in James's terminology, the subconscious) and God, James sees the link between religion and the science of psychology. In recent years, through the influence of existential philosophy on psychiatry, religious faith has again been accepted as a significant psychological problem in some psychoanalytical circles. Although there is a wide divergence of opinion among existential psychotherapists, one group is characterized by its adherence to a definite religious persuasion as well as a positive evaluation of religious faith. Prominent among this group are Karl Stern, in Montreal, Canada, and Igor Caruso, Viktor Frankl, and Wilfried Daim in Austria. Caruso feels that Freud's theory contains two specific errors: ~) the reduction of all values to the subiective sphere of pure immanence; 2) the unquestioning acceptance of certain false imperatives of the social collectives (Freud's superego). Caruso sees every neurosis as a violent struggle between affirmation and negation, good and evil, truth and falsehood. In effect, he states that a neurosis is always simultaneously a flight from the Absolute as well as a longing for the Absolute. He rejects the assertion of the Freudians that wrestling with religious faith is a sign and symptom of neurosis. According to Caruso, when religious problems arise in psychotherapy, each psychology must have as its frame of reference a "realistic" scale of values. If a person suffers emotionally as a consequence of certain "fixations" or false absolutes (that is, in servitude of fictitious values), it becomes the job of the psychotherapist to liberate the individual from his fixations and lead him back to a world of more objective values. It may be at this juncture that questions of great existential or religious significance are being asked and that a primary biological orientation just does not suffice. Existential psychology of every shade acknowledges the reality of the mind or spirit in addition to man's biological side. Existentialism does not view the spirit as an epiphenomenon of man's biological nature.
76
Journalof Religion and Health
The ultimate aim in this kind of therapy is to experience as relative those values which the neurotic fixation had previously idolized as being absolute. An integrated psychotherapy, as proposed by the therapists of the "Vienna Circle," will thus lead the patient to a recognition of an objective scale of values and then aid him in appropriating these values in a free and conscious choice. Caruso goes on to say that "medical psychotherapy is a preliminary to an eventual religious metanoia or conversio," that is, a metaphysical-religious awakening, rebirth, and reorientation. It is at this crucial juncture that the religiously oriented Austrian members (most of whom are Roman Catholic with a strong Aristotelian-Thomistic background) part from the other existential groups. Other existential analytic schools, such as those of Medard Boss and Ludwig Binswanger, are religiously neutral, whereas the one of Jean Paul Sartre is atheistic in its religious and philosophical orientation. The spiritual aspects of the "Vienna Circle" writings have been emphasized, as they have been significant contributions toward deepening our understanding of the connection between depth psychology and religion. To avoid any misunderstanding, it is important to realize that this kind of existential "synthesis" is possible only after a precise scientific "analysis" in the more traditional psychoanalytic sense. There are two areas that concern me as a psychiatrist. First, Caruso strongly emphasizes a "hierarchy of true values" and finding the "True Absolute." I am concerned whether the "Vienna Circle" would not have a prescribed set of true values that the patient becomes indoctrinated to during the course of psychotherapy. My second criticism is related to the first: it is that one obtains a distinct impression of didacticism in Caruso's work. He has the patient write an account of the session and then compares these notes with his own. One of his main therapeutic techniques is to give short summaries of the different psychological theories whenever there is a prolonged silence. He feels that this helps to overcome some of the resistances in psychotherapy. Thus, if there are pauses during the session, the patient is subjected to short lectures. C. G. Jung, one of the pioneers in depth psychology, from the beginning has been extremely concerned with the interconnections between psychiatry and religion, and much of his work in psychology has been in interpretation of religious phenomena. Jung's starting point is very similar to that of William James: namely, that the psyche is the carrier of religious contents. In Jung's book, Psychology and Religion,
Psychiatry and Religion
77
he defines religion as a "careful and scrupulous observation of what Rudolph Otto aptly termed the 'numinosum,' that is, a dynamic existence or effect not caused by an arbitrary act of will. On the contrary, it seizes and controls the human subject, which is always rather its victim than its creator." (p. 4)- The concept of the numinosum as developed by Rudolph Otto in his book, The Idea of the Holy, states that a numinous state of mind is made up of various elements that are basically irreducible to any one, and is experienced with overwhelming intensity as if gripped by something "wholly other." It contains a "tremendum" or sense of "awfulness," a condition that, in the Bible, is referred to as the "fear of God." The experience of numinosity also has an element of fascination. One can see that this definition of religion is something quite different from a religious creed. For Jung, creeds are codified and dogmatized forms of original religious experience, which often have become sanctified and congealed in an elaborate structure. An individual may follow scrupulously the creed and dogma of a church and never come close to anything approaching a religious experience. Now how does the numinous experience enter into the person's life? Jung finds this kind of experience in his patients' dreams, visions, and fantasies. On this basis, he feels that the religious instinct manifests itself spontaneously, and that it is rooted in the unconcious, elemental level of psychic life. Jung sees dreams as spontaneous revelations of the unconscious; he believes that their manifest form and content have meaning in themselves. For Freud, however, dreams and religious manifestations are "nothing but" exaggerated symptoms of primary sexual and aggressive drives. Through Jung's open approach to dreams, several important connections with religion are noted: I) Jung states that the language of dreams is revealed in symbols. He defines a symbol as a term, name, or picture that is familiar to us; but in combination with unknown or unexpected elements, it implies something strange but meaningful to us beyond the ordinary realm of human understanding. Since all religions use symbolic language or images as well, such as the cross, the wheel, or the sun, there is a definite similarity between religion and the images of the unconscious. On the other hand, signs are consciously contrived and stand for something completely known. For Freud, dreams stand for completely known things and are, therefore, signs, not symbols. 2) Jung notes that there is teleological or purposeful movement in which the psyche of an individual works toward integra-
78
Journalof Religion and Health
don and wholeness. The process by which this occurs in maturing people is called individuation. The individuation process is a mysterious, winding path, different for every individual and without rules to follow, except what is brought forth from psychic necessity. Its goal, the Self, as image, manifests itself usually by a circle containing a square or cross and is felt to be quite numinous. It can be expressed by other symbols such as a jewel, or the Divine Child, or the lapis, the miraculous stone that was the goal of alchemy. Whatever the image is, the effect is always to be found in a resolution of a conflict between the opposites. Jung finds the individuation process to be very similar to certain religious disciplines, such as Yoga and Zen. Furthermore, the individuation process demonstrates that religions embody in symbolic form basic truths of the soul. Time does not allow me to present individual case histories, but Jung's books are filled with such examples. Jung's approach to religion, from the point of view of a psychiatrist, has given the broadest meaning to religious phenomena. He has opened up new ways to approach religious contents, i.e., through an understanding of unconscious processes. It is interesting to note that he has been criticized from both sides. From the point of view of traditional psychiatry, he has been seen as a mystic because of his interest in studying religious phenomena qua phenomena. His ideas have been seen as nonscientific, nonempirical, and irrational. From the point of view of theology and Christian existentialist psychiatry, he has been seen as being too rational. From their standpoint, he sees the relative value of different religious experiences and does not provide metaphysical answers. Jung's main contribution to the study of religion, which should be acceptable to any of the groups, is his demonstration of a primary religious attitude arising in the unconscious of modern people, whether they are psychological "patients" or "normal" individuals. This attitude cannot be reduced to any more original form of archetypal image or mode of behavior.
Psychiatry and Religio~
79
