ChristiPPaccording to Sigmund Freud
by Dr. Pravin Thevathasan
Pluck from the memory a rooted sorrow,
Raze out the written troubles of the brain,
And with some sweet, oblivious antidote
Cleanse the sniffed bosom of that perilous state
Which weighs upon the heart?
Doctor: Therein the patient must minister to himself
Fortunately, the psychiatrist of today can manage a little better. He has an important, well-defined role in modern medical practice. A psychiatrist is not a secular priest: the "good Christians never see Psychiatrist" notion can hopefully be laid to rest.
However, he must define his role with care and not claim expertise beyond his area of knowledge. As Professor Andrew Sims has written:
Psychiatrists have not increased the credibility of their speciality in the first three-quarters of the twentieth century by posing as the universal experts on the experience of life and how it should be led. Expert knowledge of the abnormal does not preclude ignorance of the normal and the psychiatrist can never generalise from the sample of people selectively referred to him to the whole of mankind." (1) As we shall see, there has historically been an unnecessary conflict between psychiatry and religion.
The Nature of Apparitions
"Bernadette turns away from reality and abandons herself to a fantasy which she experiences with hallucinatory intensity... the "Lady" is the fulfillment of her need to love someone who can replace mother, who is the source of punishment.. the 'Lady" is a product of fantasy." (2)
A tongue in cheek response to this analysis may go as follows:
"Joe Deakes as a little boy, is kicked in the pants by his grandmother for something that his older brother Eustace did. After forty years of repressing his emotions, he begins to denounce the Masonic order and the Knights of Columbus and all other fraternal orders. One day a beggar says to him "Brother, can you spare me a dime?' And he violently attacks the chap." (3)
Other humorous commentators on similar themes are Ronald Knox, Fulton Sheen and, of course, G. K. Chesterton. More seriously, a complete repudiation of the supernatural order is clearly not a basis for dialogue between psychiatry and religion.
The psychiatrist is certainly not in a position to discern the authenticity of apparitions, locutions etc. His contribution in the process of discernment is to differentiate between those who are mentally ill and those who are not. In his differentiation he may consider some of the following points:
1. The mentally ill person may have other symptoms of psychopathology. He may draw unnecessary attention to himself. This contrasts with the behaviour of St. Bernadette and the children of Fatima who went out of their way to avoid publicity.
2. Mental illness is characterised by disordered thinking and loss of goal-directed activity.
3. Extraordinary manifestations are not treated with sensible caution by the mentally ill. In contrast, authentic seers are prepared to await further judgement.
4. The mentally ill person does not have much reticence in talking about his experiences. He is often fascinated by the incredulity of others.
The fascination for the extraordinary and ready acceptance of alleged apparitions can end in disillusionment: there were 200 individuals who claimed to have the stigmata in Belgium last century and not one of them was declared authentic by the church.
It is also worth noting that the number of apparitions of Our Lady that have been accepted is small indeed in comparison to the number of claims made. The teaching of St. John of the Cross is very salutary and may be summed up by saying that "one should take no notice of visions and revelations, but live one's spiritual life on a basis of faith, hope and charity. If the alleged visions are divine, Almighty God will see to it if He wishes that this become abundantly clear." (4)
Psychiatrists have no special expertise in understanding the interior life and if they attempt to arrive at general conclusions from a study of their patients, they are likely to cause confusion. For example, the eminent psychiatrist Kretschmer attempted to interpret self-denial in the following manner:
"Those who practice self-denial develop pleasure from the denial of their appetites... a perversion of instinctive urges." (5)
The pastoral wisdom of centuries is thus dismissed in a sentence.
Similar consequences occur when psychiatrists try to understand mystical states from a purely psychopathological perspective. Professor Frank Fish in his well known textbook of psychopathology described one of St. Teresa of Avila's mystical experiences as: "probably the result of a lack of sleep, of hunger and religious enthusiasm."
In fact, both St. Teresa and St. John of the Cross were extremely prudent in all matters relating to "enthusiasm" and extraordinary phenomena. Far from being an enthusiast, St. Teresa was remarkable for her practical common sense and peace of soul amidst tribulations, features common to the saints. Much the same could be said of St. Catherine of Sienna and St. Joan of Arc, both of whom are described frequently in psychiatric textbooks.
The truth lies in the observation that: "with regard to the phenomena of mysticism in its proper sense, psychopathology has nothing to offer, and for the very good reason that infused contemplation is brought about by grace, which does not destroy, but perfects and elevates the natural capacities." (6)
Freud and his followers
We are grateful for Freud's brilliant analysis of the unconscious and his interpretation of transference. We can be less happy with Freud the anthropologist, the sociologist and the theologian. Why did he dismiss religion as an "obsessional neurosis" after assessing a handful of patients?
According to the Catholic psychiatrist Gregory Zilboorg, Freud had two blind-spots regarding religion. Firstly there is some evidence that he had a largely unconscious attraction towards Catholicism. Thus he encouraged his daughter Anna to gather flowers for Our Lady, he compared himself to a "monk in his cell" and frequently expressed a desire to be in Rome for Easter. His defence against these "threats" appears to be the apparent adoption of an anti-religious stance.
Secondly, Freud believed that faith is always an irrational act, an "illusion." Accordingly, its practice becomes a compulsion neurosis. However, there is some recent research to show that those who suffer such a neurosis are, in fact, less likely to be religious. (7)
A detailed review of recent studies by Lowenthal in her book Mental Health and Religion led her to conclude that, on the whole, religiosity goes along with greater happiness. Her own survey of religious attitudes within the orthodox Jewish Community shows that individuals with religious beliefs are less likely to present with depressive symptoms.
Freud appears to have had a superficial understanding of the nature of ritual in religion. He is correct in believing that rituals are used in order to alleviate guilt and to turn away from sin. But he fails to mention that the underlying purpose of this "metanoia" is typically a joyful affirmation and union with God. Zilboorg concluded that: "religion was for Freud a field of which he knew very little and which moreover seems to have been the very centre of his inner conflicts, conflicts that were never resolved." (8)
Carl Jung is the best known psychotherapist after Freud and on the surface, appeared more sympathetic to man's religious quest. However, as the famous Catholic psychiatrist Dr. Rudolph Allers summed it up: "for Jung, God is not a transcendent reality of whom man may achieve some knowledge by natural reason but, rather, an "archetype"... of a basic tendency in human nature... the idea of God and of a future life are not seen as expressing reality but as a corresponding subjective need." (9)
In fact, Jung was far more interested in Gnosticism, Alchemy and the occult - an interest which led him to take part regularly in seances - than with orthodox Christianity.
Dr. Gregory Zilboorg observed: "that which Jung calls religion is not a religion at all. Even from an empirical point of view it appears to be only a very incidental manifestation." (10)
Religion and Psychiatry: the need for dialogue
"Your activity is capable of achieving precious results for medicine, for the knowledge of the soul in general, for the religious disposition of man and for their development." (Pope Pius XII to Psychiatrists.)
Situations arise frequently when a patient's sufferings can be alleviated by both medical and spiritual means. The following cases will hopefully illustrate this:
1. An eighty year old woman who attended daily Mass developed a psychotic depression. She believed that God had abandoned her and that her sins were too terrible to be forgiven.
Her depression responded well to treatment But it took much longer for her to regain her "faith"in the Church of her childhood.
2. A man developed "terrible thoughts" about his grandchildren. He feared that they were unsafe with him.
These thoughts were obsessional in nature and he suffered with them to the extent that he refused to see members of his family. He went to confession daily regarding these "sins" until the priest insisted on complete submission to his judgement.
The man responded to a course of anti-depressants, although he continued to have obsessional thoughts on occasions. Constant reassurance from both priest and psychiatrist led eventually to peace of mind.
3. A man was assessed for a depressive illness. It was initially believed that he had delusions about swindling the tax man. Later it became apparent that his business ethics in the past had been far from sound. Response to anti-depressant tablets was poor. He said that he felt guilty and wanted to make up for the past.
The possession of guilt is an important feature in the development of a spiritual lift. As Pope Pius XII said:
"No one can deny that there can exist an irrational and even morbid sense of guilt But a person may also be aware of a real fault which has not been wiped away." (11)
The tears of St. Peter and the conversion of St. Augustine are a potent reminder of the importance of guilt and contrition. Psychological problems may result from a pathological response to guilt Fr. Thomas Gilbey O.P. summed it up beautifully: "when regret turns to anxiety there is ill health. When they turn to humility, there is health." (12)
Confession - even though it belongs to the supernatural order- helps to "dissipate neurosis by taking away the guilt of sin and consequently the sense of guilt-so potent a factor in many neuroses." (13)
4. The patient said: "It has been four weeks since I saw you concerning my alcohol dependence. I have unfortunately had a relapse on two occasions."
This statement sounds remarkably like a confession. It is a reminder that addictions may be moral disorders with physical and psychological consequences.
The saintly Matt Talbot responded to his alcoholism by living the act of contrition: being sorry for his sins, detesting them above all things, resolving never to offend again and carefully avoiding the occasion of sin. To a significant extent, this is a summary of the modern management of alcohol dependence. Strong motivation leads to a good outcome. Matt Talbot was very strongly motivated: he fell in love with God.
The above examples will hopefully illustrate the fact that, not infrequently, the patient needs both psychological and spiritual help in order to alleviate his suffering Psychiatry alone cannot heal a wounded heart or cleanse a sinful one:
"When speaking of the priest's contribution to mental health, one's thoughts turn first to his function as a confessor. Now confession in the Catholic sense has a therapeutic value all its own, but it cannot be compared with any other therapeutic device since confession is a sacrament and therefore belongs to the supernatural order. Those who look upon sacramental confession as just another psychotherapeutic device miss its meaning completely... although confession belongs to the supernatural order, it has psychotherapeutic after-effects, for it not only rids the penitent of his sins but greatly contributes in most cases to his feelings of security by ridding him of his feelings of guilt... many a person tortured by guilt feelings due to perfectly conscious sins confide to the priest: 'if this had gone on much longer, I believe it would have driven me crazy.' Hence confession may help to prevent the occurrence of mental disease." (14)
Religion and Psychiatry are not in conflict: the cure of the psyche is helpful to, but no substitute for, the cure of the soul.
When Psychiatry and Religion agree
There is a good deal of recent research to confirm - from a psychological perspective - the pastoral teachings of the Church. For example, on marriage:
'There is almost universal agreement among therapists that conflict is inevitable in a marriage ... when following the honeymoon, couples have to make unromantic decisions (when to visit in-laws, how to budget money, etc.). Authorities agree that it is how couples deal with such inherent conflicts that determine the quality and duration of their relationship." (15)
Research to date suggests that the psychological factors most directly implicated in the development of a satisfactory relationship include:
1. A perception of being loved.
2. Agreement over central issues.
3. Procedures for resolving disagreements.
4. Emotional stability.
Kelly and Conley's 1987 study of 300 couples concluded that marital satisfaction correlates with lower neuroticism and good impulse control in men and lower neuroticism and limited pre-marital sexual experience in women. Unhappy couples are more likely to reciprocate negative behaviour, to disagree often and to use sarcasm as a means of communication, Among the "myths" which lead to marital disharmony are:
1. The idea that spouses are not capable of adapting to new circumstances.
2. The idea that, one's spouse should know one's feelings and thoughts and it is unimportant to communicate them.
3. The idea that a perfect sex life can guarantee stability. (16)
On family life:
"In the field of delinquency, especially in girls, the view that a broken home plays an important role is strong and consistent" (17)
The role that separation and divorce play in fostering conduct disorder (aggression, lying, destructiveness, vandalism, theft and truancy) was demonstrated by Sir Michael Rutter in his classic study in 1971 and has been confirmed by subsequent studies:
"Families broken by divorce and separation produce antisocial children rather than those broken by parental death ... stealing and unsocialized aggression relate to a failure to discover a secure relationship with an adult." (18)
Shaffer's 1974 study of suicide in children concluded that risk factors include parental divorce, antisocial behaviour, depression and feelings of being abandoned.
Parents can be reassured that clinical research supports the pastoral teaching of the Church on bringing up children. In his book Adolescence, Michael Jaffe quotes from a 1992 study which concluded that: "many teenagers are not psychologically, emotionally or socially ready for sexual intercourse" and - rather paradoxically - argues for greater availability of contraception in this group.
He also recommends greater freedom for homosexually active teenagers, while at the same time writing that "it is important for teenagers to know that sexual feelings do not necessarily predict their final sexual orientation." (19) Adolescence is a time of natural risk taking and experimentation parents have obligations to guide and support their children through this crucial phase of development. As Bishop Fabian Bruskewitz has written:
"I believe it is wicked to counsel parents not to intervene, but rather to adopt a 'wait and see' attitude when they find their adolescent children 'experimenting' with homosexual acts. Parents have a grave moral duty to prevent their children from committing mortal sins when they can." (20)
In conclusion, it is increasingly apparent that, in a number of cases, it is not the Church which opposes the findings of psychological studies but it is the spirit of the age, affecting everyone including psychiatrists.
Note: The cases described in this article are approximations of actual cases. This is to maintain confidentiality.
1. Symptoms in the Mind, by Andrew Sims (Balliere-Tindall).
2. The Psychology of Women, by Helene Deutsch.
3. Psychiatry and Asceticism, by Felix Duffey.
4. Quoted in . Religion and Personality Problems, edited by E. F. O'Doherty (Clonmore and Reynolds)
5. The Psychology of Men of Genius, by Kretschmer.
6. Quoted in Religion and Personality Problems.
7. Journal of Anxiety Disorder 5:359-67
8. Quoted in Faith, Reason and Psychiatry, edited by Braceland.
9. Quoted in Faith, Reason and Psychiatry.
10 Quoted in Faith, Reason and Psychiatry.
11. The Mind of Pius XII, edited by Robert Pollock (Fireside press).
12. Quoted in Faith, Reason and Psychiatry.
13. The Catholic Doctor, by Fr. A Bonnar (P.J. Kenedy).
14. Psychiatry and Catholicism, by Vander Veldt and Odennald.
15. Abnormal Psychology, by Davison and Neale (John Wiley and Sons).
16. Adapted from Seminars in Psychology and Social Sciences, edited by Tantum (Gaskell).
17. Clinical Psychiatry, by Slater and Roth (Balliere-Tindall).
18. Essentials of postgraduate psychiatry, by Hill, Murray and Thorley (Academic Press).
19. Adolescence, by Michael Jaffe (John Wiley and Sons).
20. Quoted in The Wanderer, (March 26, 1998).
Theotokos Catholic Books - Church/Psychology Section - www.theotokos.org.uks