by Carol R. Murphy
Originally published in 1955 as Pendle Hill Pamphlet 82
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The summer morning is sweet and calm; but ahead, behind the stone wall and barred windows of the mental hospital, you hear the shouts and curses of those who live in private worlds of mental confusion. This is the worst moment, when you put the key into the lock of the door leading into the wards. Then you are inside, quickly adjusting to familiar sounds and smells, remembering the daily routine of the ward, and the round of events, dull or absurd. Then come greetings from individuals who are no longer anonymous patients, but real personalities, pathetically eager for your companionship, and you feel a great compassion for them, for they are as sheep without a shepherd.
This daily progress recapitulates what are perhaps the three stages of feeling a hospital worker has toward mental patients. First is the initial shock, and what to the insecure in soul may be fear, felt on encountering the “queer,” the uncontrolled, and occasionally violent inhabitants of the hospital. Then comes the stage, which some never outgrow, of self-protective frivolity and indifference. There are many funny stories that can be told, of the man who says he is “President of the Navy,” the woman who thinks she owns the hospital and distributes vast sums of imaginary wealth to all comers, or the patient who is sure that enemies are sending bad thoughts into his head by radio. In many respects, mental patients behave like fractious nursery school children, and in many respects their attendants behave like over-tired nursery-school teachers. But, in the end, those with sufficiently secure inner foundations can take upon themselves an awareness of the fears, frustrations and hungers that these patients have, and shock and hardness alike give way to compassion.
Why should we follow the hospital worker into this discordant world of private worlds? Of what concern is this world to the sane and secure? For the reason that here, as under a magnifying glass, one can see the fears and hostilities that trouble mankind as a whole; here is a challenge to the redemptive power of religion that will make us look to the resources Christianity has to offer. In particular, the Society of Friends has long tried to meet this challenge by the concern to bring its testimony of peace and love to the mentally ill, leading to the founding of hospitals such as the York Retreat in England in 1796, and continuing today in the work of conscientious objectors and other young Friends as mental hospital aides. Let us now see what the challenge is.
The psychiatrist H. S. Sullivan used frequently to say that we are all much more simply human than otherwise. He who digs down to the common humanity underlying us all sees that the troubles of the mentally ill differ only in degree from those of the so-called “normal.” We are all at times wounded by life, and we all respond with defenses that enable us to carry on, though we may be scarred and distorted. But whereas the symptoms of the “normal” are small, the symptoms of the psychotic (the mentally ill) are conspicuous and disabling; and whereas the average person’s disquiet may be hidden beneath a trivial or conventional surface, the psychotic’s soul is bare and vulnerable. The psychotic is captive to his past; I have seen normal people re-enact a half-forgotten childhood incident in group therapy and relive the emotion as if the incident had occurred yesterday. The psychotic is a prey to irrational guilt; most of us, in extremity, ask: “What have I done to deserve this?” The psychotic may feel that everyone conspires against him; who has not in adolescence felt at times different, conspicuous, and secretly laughed at? The psychotic denies frightening reality and lives in a world of fantasy: most of us have had our mental blindspots, or lived at times the secret life of Walter Mitty. A wise counselor has said that the therapist must feel to the bottom of his boots that “there but for the grace of God go I.” This sense of kinship rather than of distance is a necessity in understanding the psychotic mind.
There are several avenues of approach in understanding psychosis. One may think in terms of a controlling, rational function called the ego, which disciplines impulses in the light of reality. A healthy person has a healthy ego, which needs few inner defenses and attacks problems constructively. He may be likened to a secure and democratic government, which has order without repression. A neurotic person has a defensive ego, which represses what it cannot handle, and becomes rigid. This corresponds to a dictatorship, where freedoms are repressed, often in the name of a tyrannous conscience, and the populace is rigidly controlled by secret police, able to express discontent only by factory “slowdowns” or disguised subversive jokes. The psychotic person has such a weak ego that untamed impulses and childish thinking terrorize or overwhelm him. He is like a country in revolt, where armed mobs surge through the cities and internal communications are disrupted. Under stress, all of us, like governments at war, tend to adopt certain defenses, censoring what we fear to publish, telling ourselves hopeful lies when weakness threatens, rationalizing our defeats, blaming our failures on a scapegoat, succumbing to a strong man when native resource fails, or finally retreating and reorganizing on a primitive basis.
Another avenue of understanding psychosis is through the self-concept, a person’s perception of and attitude toward his own feelings, abilities and appearance. The healthy person recognizes his own feelings and can measure his own successes and failures. He knows his own boundaries. A disturbance in the self-concept means a failure in self awareness, and an exaggeratedly high or low self-appraisal. Such a person may feel deeply threatened by the appraisals that others make of him, when he is unable to estimate himself. The psychotic has lost the sense of his own boundaries. He may disown those feelings of which he is afraid, so that he sees them as alien intruders injected into his mind by enemies. Or his own self may seem to fill the world and influence everybody else. He may think of his own body as loathsome, and assert that his hair has fallen out, or that he smells of decay. He may consider himself guilty of the sins of the world, or he may believe he is the “Light of the World,” sent to redeem it.
Another way of understanding psychotics, as I suggested before, is to see them as people who are dominated by their own past. To the psychotic of the schizophrenic type everyone in the world is his father and mother, and he repeats with them the intense drama of love and hate which began in his first unsatisfactory relationship with his real parents. He is afraid to admit his hatred, for fear he would finally lose the love he feels he never received. He could, if he dared, say with the Roman poet Catullus: “I hate and I love. Perchance you ask me why. I do not know, but I feel it and I suffer.”
Or one can think of mental illness as involving a semantic confusion between symbol and thing symbolized. When a normal person says, “My head is splitting,” he does not mean it literally; but a psychotic may have the delusion that his head is actually cleft in two, when basically his trouble is a mental conflict. Similarly, delusions about physical appearance can really symbolize self-disgust. This sort of thinking is part of the undeveloped thinking-process with private meanings and fantasies that begins in childhood. Later, in the normal mind, it is gradually replaced by thinking with concepts that have a meaning common to other minds, thus making communication—the sharing of minds—possible with others.
Still more light is thrown on the nature of psychosis by thinking of it as a process of inward isolation. In the schizophrenic patient, thinking becomes isolated from feeling, and one thought becomes disconnected from another, so that logical coherence is lost. In repression, certain experience becomes isolated from awareness. In deluded persons, the delusion is isolated from the critical reason. The psychiatrist Dr. Andras Angyal has suggested that human beings have two basic spiritual needs: to assert themselves as individuals, and to participate in a larger whole. The mentally ill have lost their wholeness; they are alienated from others and from themselves, and in the end find it hard even to become individuals.
All these suggested ways of looking at psychosis are one lay person’s attempt to make test borings, as it were, into its nature, in an attempt to understand the mentally ill. Each view has its contribution to make. An element of alienation may be seen in the loss of control over self, the confusion of thought, the loss of contact with reality, the breakdown of the self-concept, and the mingling of hate with love in personal relationships.
What causes such illnesses? There has been much discussion of whether the causes lie in mind or body. This may best be resolved by remembering that a person is a whole wherein mind and body echo each other. We must never forget the person as a whole in a search for a particular “cause” which only turns out to be another symptom. This whole person is also partaker in an interacting environment. Those who have studied the lives of the mentally ill find that illness often arises from the failure of the first and most formative relationship of parent and child. The mental patient may never have learned to love and be loved at the time when the foundations of human personality are laid down. (Of course, I do not here discuss organic brain disease, which is another matter.)
At this point it may be helpful to focus our thinking on the life and mind of one particular patient, who suffers from paranoid ideas of persecution, and to try to understand her as compassionately as we may.
“An Enemy hath done This”
Mary Brown, as we will call her, is a grey-haired woman, who grew up in a humble, hard-working home. She has herself worked from childhood, both helping in the house and working outside. She was also a bright pupil in school. Though she enjoyed some simple country pleasures, what left a deeper impression on Mary was the drudgery of work, and a critical illness of her father, through which he was nursed by her mother. Mary married a man much older than herself, in order to get away from home, she says—a marriage that proved unsatisfactory. At present neither her husband nor her only child will live with her. She has suffered from ill health, some of it genuine, the rest largely complaints. Some years ago she began to claim that certain people were trying to inject diseases into her. This began a series of admissions to mental hospitals. Unable since to adjust to living outside, she is now in a state hospital with a diagnosis of paranoid condition. She is bitter about her position, and disillusioned in religious faith.
In understanding Mrs. Brown’s private world, we must bear in mind the guiding principle that behavior has its springs in perception. As we see, so we act, and our acting in turn molds our seeing. We are affected by circumstances as we see them, we treat other people as what we see them to be, and we evaluate ourselves according to our perception of ourselves. Our ability to learn from life lies in this sphere of “feedback” or interaction between encounter with reality and our perception of reality. Our learning can lead either to self-limitation or self-correction, to a vicious circle or to a transformation by the renewal of the mind. We must therefore try to feel what life looks like to Mrs. Brown, how she must seem to herself, and we must try to understand the nature of that crippling, closed-circle form of “learning” called paranoid thinking.
We may surmise that, when she was young, Mary Brown felt somewhat left out of the circle of family affection. She complains of having worked hard with little thanks as return, a common complaint of lonely persons who feel exploited without enough appreciation. Doubtless, she tried to work all the harder to obtain affection, while, paradoxically, resentment at exploitation mounted. But there was another way open of getting attention, if not affection, and this way she learned when watching her father being nursed. If she could not be a beloved nurse, she herself could be nursed. Through illness, she could transform her needs into claims. As a bedridden invalid herself, she did get some attention, but when the family became impatient, she crawled out of bed to return to work. Marriage was a frustration that only increased her loneliness and hostility. She married a man old enough to be a father-figure to her, to find him sexually unresponsive, and found continuing demands for work, including the care of a child. To look at herself would be to look at someone possibly unlovable, and certainly hostile.
What does a paranoid do with such a threatening perception of life’s experience? A paranoid is not, to start with, strong enough in the ability to accept his real self. His own hostility frightens him, and one may say that he denies the awareness of it in himself and projects it upon others, or that he has lost track of the boundaries between self and not-self, so that his own reactions appear to him as poisonous injections or insidious diseases. Having thus denied and dismembered his original awareness, he must rationalize his interpretation into a delusional system. He does this by means of closed-circle thinking, reaching conclusions that seem always to prove themselves by evidence already interpreted by the conclusions. There is no way out of such a system into the creative inconsistency of new discoveries. The psychiatrist Paul Federn remarks that paranoids ignore degrees of possibility or probability. T o them all ideas and conclusions are felt as certain. Federn says: “False certainty is to the paranoiac what false reality is to the schizophrenic.” (Ego Psychology and The Psychoses) And this false certainty builds a false reality of its own, a tottering structure which grows farther and farther away from the common agreement of human minds, and must be frantically and fantastically bolstered, propped and glued. One might apply to such a closed, delusional system the late Dean Inge’s unkind comment on dogmatic theology: that its foundations are supported by its superstructure. And not only theological systems are in danger of becoming this sort of delusion. There are, for instance, orthodox Freudian psychoanalysts who dogmatize in similar manner. When on the verge of dogmatizing, it is salutary to recall the paranoid patient who indignantly exclaimed: “They call me paranoid, but I’ve always been a realist. I always see things exactly as they are!”
In contrast to paranoid thinking, healthy thinking is open ended, ready to balance conflicting interpretations, to listen to an internal conversation—dialectic is the philosophical word—between the perception of likenesses in situations past and present, and the perception of differences between them. The healthy mind may be compared to a psychiatric staff conference where the doctors gather to discuss a patient’s condition, and reach a differential diagnosis after interviewing the patient and discussing all possibilities. The healthy mind can do this because it is secure enough to see a growing awareness or a new perception as a challenge rather than as a catastrophic threat.
We can begin to understand, then, what it means to say that Mrs. Brown is paranoid. We may suppose (without leaping to a paranoid certainty!) that her feelings of hostility mounted to the point where she had to disown these, and that they then appeared as plots against her and injections of cancer. Her concern with her health may have suggested the form of the “persecution,” but her hypochondria is perhaps an alternative rather than a part of her paranoid state. Mrs. Brown may be in a state of wavering between pleading ill-health as a reason for claiming protection and care, and imputing her ill-health to persecution. The change may take place at the point where she is afraid to admit to her dependent needs and her hostility. It is then she says, in effect: “I don’t want to be a baby, I’m not angry enough to kill; it is the others who are out to get me.” There is also possibly an element in her illness of self-depreciation, of the feeling, “I am unclean.” Her present high blood pressure may be the result of suppressed anger finding a physical outlet.
Here, then, we have the picture of a woman in the later years of her life, living in a private hell where she loves no one and no one loves her. No one wants to live with her, and she finds it hard to live with anyone. And so, as jetsam, she has floated to the shores of a locked ward in a mental hospital. Nor is she the only one of her kind.
The Relevance of Religion
What is the answer of religion to such private infernos? What can pastoral care do to bring “the grace of Our Lord Jesus Christ, the love of God and the fellowship of the Holy Spirit” into such lives? Religion of the usual kind seems to have brought little healing into Mrs. Brown’s life, though there were stages when pastoral counseling and Christian fellowship could have helped her. Now it is the hospital chaplain who must pick up the pieces as best he may. The Mrs. Browns in the hospital receive some satisfaction for their claims for dependency and protection, but the atmosphere is necessarily impersonal. How can his religion help the chaplain to convey to her a deep respect for the individual soul, a love which can pierce below the unlovable claimfulness to the true need for love?
When we reflect on the importance of relationship and the experience of love in mental development, we see at once that mental health flows from the same reality that religion envisages in its cosmic context. The Christian religion sees agape—Christ-like love—as the structure of the universe, to be actualized among men in the Church. It must dare to assert that men become fully human only through love—that is, by the grace of God; here nature and supernature become one. As psychiatry sees the root of mental illness in failure of love, so religion must join with psychotherapy in supplying remedial love. In particular, a healing religion will support sane thinking with a sense of transcendence, it will heal with the gospel of love, and it will be wise in the ways of applying love.
No one can spend time with the mentally ill without concluding that a vital religion must somehow help the isolated mind out of its closed squirrel-cage of thought. There are people who regard religion as a symptom relieving structure of belief which gives security without truth. Not only cynics think this; many religious people seem to agree that religion is a watertight system of thought. But a religion that is only a system of thought is not a mature faith; it is in danger of losing contact with reality because it refuses to grow. To approve of such a system because of its symptomatic relief is to come close to saying that religion is the psychosis to end all psychoses. Religion is indeed a search for an Absolute, not a human absolute which is the center of a closed system, but an uncaptured and transcendent truth which breaks open our human systems and makes them all seem relative. The truth must set us free. We shall know such a growing religion by its creative tension with the transcendent, and by its reach for the ever more inclusive truth. Growth can be shown by a sense of humor that can laugh charitably at religious pretensions in the light of what sets them at naught; more deeply, growth makes religion live by what von Hügel called “that perpetual conversion, that unification and peace in and through a continuous inner self-estrangement and conflict, which is the very breath and joy of the religious life.” (The Mystical Element of Religion, v. i) Its reach for the inclusive will be shown by its ability to embrace both joy and suffering unafraid. We must suspect any belief that sees all light and no darkness, or all darkness and no light. That is what the manic-depressive patients do: they swing from extreme despair to a mood of false and fevered elation which only denies despair without conquering it. A sane religion must find reconciliation in the heart of tragedy; it must bear both the Cross and the Crown.
It does no good, however, to preach a mature religion to those who are afraid to grow. Without love religion is as sounding brass or a tinkling cymbal. Religion must bring salvation, and the salvation of sick minds and souls comes through an experience of relationship that becomes symbolic of man’s relationship to the Ground of being, wherein he accepts himself as accepted by God and gains the courage to face his anxieties and grow toward a goal not rigidly defined. The minister of this sacramental relationship is, in Luther’s words, being Christ to his neighbor. This is the ministry of reconciliation, entrusted to us. The fellowship of love called the Church was founded to nurture every member in an atmosphere of Christian love, the love one does not have to deserve, so as to present every man mature in Christ. After working closely with the mentally ill, trying to meet their great need for love, one revalues all the traditional paraphernalia of religion. There is just one relevant question to be asked of all rituals, theologies, and church activities: how does this help Mrs. Brown in her bitter loneliness? or any other person in spiritual isolation? Much that was considered sacred gets thrown out of the window in such a reassessment; but once the essential element of Christian love is set at the heart of religion, many things can be used in its service. For instance, the powerful nonverbal symbolism of the Lord’s Supper can be used to convey the divine love to those who cannot be reached by words. The Communion service in a mental hospital can be a very moving experience. Theological language can be used, if we make sure that we are offering men Christ, not merely Christology. Silence is good only if it is the silence of communication, not the silence of refusal to communicate.
When we have set religion upon its true foundation, we find ourselves in contact with a real power, not a moral code or vague aspiration. “For the kingdom of God does not consist in talk but in power.” (1 Cor. 4:20. RSV) The power of love does not mean coercion, but ability to perform the work of love in transforming soul and society. By its fruits we shall know it. The injunction to have no regard for the consequences of acting on principle is often used to evade our responsibility to learn to apply God’s love effectively by experiment and self-correction. Acting on principle should mean, not obeying a fiat, but finding the working-principle of things. When a scientist finds the working-principle of nature, he is enabled to understand and co-operate with nature. So we must learn to understand and co-operate with the workings of God. As engineering is the study of how to apply physical power, so religious psychotherapy and pastoral care is the study of how to apply the power of loving and understanding relationship. The difference is that we ourselves must be controlled by the power we channel.
The Healing Relationship
What is the nature of the healing relationship? What are its signs and its effects? It is not a spectacular thing, and its transformation comes less by sudden conversion than by the slow growth of insight through pain made bearable by forgiveness. It relies on understanding rather than judging, and participation rather than withdrawal; a thinking with the person to be helped, rather than for him or about him. A person must be lovingly understood from the inside. The religious therapist feels justified in his calling, when he hears his patient say, as one mentally ill person remarked after pouring out her troubles to a listening ear: “You seem able to tell me what I am really feeling.” The eye of love sees behind the behavior to the heart of the person, seeing all that he thinks and does in the light of his own individual whole, and judging him not by an external standard, but by the secret identity that God has prepared for him. Love tries to root out of our unconscious minds the grim morality of retribution and self-punishment that lives there. It bears the hostility of sick minds without becoming alienated, for the therapist loves in the name of Jesus, who remains the symbol of God’s love even after humanity did its worst to him. “Father, forgive them, for they know not what they do.” (Luke 23:34)
This love, it should be emphasized, is not confined to those who literally know not what to do. We tend to set the mentally ill apart in a special category of the “insane,” not because of any sharp difference between them and the rest of us, but so that society may take a different attitude toward them. Society has two attitudes toward those who get into trouble—a punishing, blaming attitude, and a healing, cherishing attitude. Society has linked blame with responsibility, so that only those declared irresponsible are entitled to healing. Doubtless, Mrs. Brown was considered just a selfish and disagreeable woman until she became too sick for ordinary methods to help her. It is easy to be shocked at the criminal, impatient at the neurotic, and merely indulgent with the “insane”; but the Christian, who sees that all men have their measure of both destiny and freedom, is not interested either in blame or in excuse. “It was not that this man sinned, or his parents, but that the works of God might be made manifest in him.” (John 9:3. RSV) In short, the Christian’s business is to heal.
But there is another side to this healing relationship. Too much participation can mean such an involvement that the therapist is caught in his patient’s closed thinking. Hence the therapeutic relationship has been called one of detached involvement. It is particularly important in dealing with paranoid patients to sympathize with their feelings while being skeptical of their reasoning. It is not easy thus to stand half in and half out of someone’s mental outlook. It is especially hard for some religious people to learn to disagree and yet to love. The spirit of odium theologicum dies hard, yet it is contrary to the mind of Christ.
The problem can be illustrated by giving part of a pastoral interview:
Patient. Come, I want to speak to you. I wrote to ask why I haven’t heard a thing from my family. It’s horrible.
Counselor. That really worries you, doesn’t it?
P. It’s horrible, that’s the word for it.
C. Horrible.
P. I haven’t heard a thing. I’m afraid something has happened, that my daughter’s in the hospital. She was going to send some things I need, but not a word from her.
C. You’re really anxious.
P. Oh, yes. I’m afraid. Other people get visitors and letters, but my daughter doesn’t seem to think how I feel. But here I am and nobody cares.
C. You really feel abandoned, don’t you.
P. Oh, it’s mental torture of the worst kind to be here. They locked me up here because of old age. If it weren’t for doing work I’d go crazy.
C. It really gets you down.
P. It’s mental torture. They’re trying to drive me crazy, and I don’t know how much longer I can take it. And this worry about my daughter. If only they would tell me. I can stand anything except not knowing.
C. That’s something you can’t take.
P. The suspense. Yes. It’s mental torture. I’d like to think somebody hasn’t forgotten me.
C. Of course, you’re not forgotten.
P. Nobody takes me out, and I’ve never had any therapy—no shock treatments, or insulin, or anything!
C. Haven’t you had interviews with the doctors?
P. No, they won’t talk to me. I write letters to them, but they won’t answer.
C. I’m sure you could get to talk with one.
P. The doctor admitted me without ever seeing me and hearing my side of the story. He took others’ word for it.
C. That would be strange.
Here, mingled with feelings of resentment and helplessness, are overwrought speculations about the daughter’s silence, accusations against the doctors and what surely must be untruth about the procedure on admission. The counselor tried to reflect the patient’s emotional tone, without commenting on her conclusions. If the relationship had been deeper, the counselor might have ventured to question gently; for example: “What makes you think they are trying to drive you crazy?” But the groundwork of sympathy must first be laid. The therapist must somehow stay clear of the patient’s paranoid thinking but without arguing, judging, or making an absolute of his own system of thought. Both must venture forth into the larger truth together. A situation like this reminds one of Maurice Samuel’s disturbing little novel, The Devil that Failed, the story of a man who was told that he was suffering from a diseased giantism and had grown to an inhuman size. The question grew in the man’s mind: was he really the victim of a monstrous deformity, or was he the prisoner of a malicious dwarf who scaled the environing room and furnishings down to give a false impression of size? The story then tells of the man’s search for some principle of physics independent of the scale of his surroundings that would be a common measure of his own size and others’ too. Here, in these situations, God as Truth must give a frame of reference larger than that of either the counselor or patient, by which the minds of both are measured. Here, also, we need God as Love to show the way to Truth.
To make the patient relinquish his false world, he must realize his own sickness. Most mental patients appear vague and evasive when asked why they were hospitalized. Those who do not claim to be “railroaded” will reply that they were “tired” or maybe a little “nervous,” or evade the intent of the question by answering, “I was brought here in a car.” Coupled with this lack of insight is the continual complaint about confinement in the hospital, which seems to them like punishment or illegal confinement. It is easy for the pastoral counselor, aware of the ugly, confined, and unsympathetic aspects of life in state hospital wards, to come to pity the patients solely for their surroundings. It must always be remembered that mental patients, like the rest of us, blame circumstances for what is really an internal state of suffering. “This is the excellent foppery of the world, that, when we are sick in fortune—often the surfeit of our own behavior—we make guilty of our disasters the sun, the moon, and the stars…. “ (King Lear, Act I, sc. 2) Granted the uncheerful aspects of hospitalization, it yet remains true that the real trouble is inward isolation and emotional confinement, of which the outward conditions become symbols. Patients yearn nostalgically to get home; once home on a visit they may feel that home is harder to endure than the hospital. When patients know enough to be dissatisfied with their own inner condition, there is hope they can change, and even in time leave the hospital. H. S. Sullivan has said: “The problem of the psychiatrist is more or less to spread a larger context before the patient; insofar as that succeeds, the patient realizes that, anxiety or not, the present way of life is unsatisfactory….” (The Interpersonal Theory of Psychiatry) But this means the ability to face and endure the pervasive, formless anxiety which the symptoms tried to relieve, and, in the therapist’s company, to find a better way of life.
This necessity of admitting the falseness of one’s previous attempts to solve life’s problems has been long recognized. It is true repentance, without shallowly moralistic overtones. Hebrew prophets called for repentance, and the best of Greek philosophy called for a similar turning from darkness to light. One of the early practitioners of the art of leading people to a healing admission of ignorance and helplessness was Socrates. Whereas the usual teacher professes knowledge and presumably leaves his pupils more knowing than before, Socrates claimed to be ignorant, and left pupils who had been sure of their knowledge of good and evil in a state of bewildered but conscious ignorance. Like all great teachers of the spirit, he urged the supreme importance of therapy of the soul. His strategy in argument was not undertaken to demonstrate logical prowess, but to clear his pupils’ minds of unexamined opinions so that truth could enter. He knew that a state of aporia or helplessness is the precondition of new insight. When helping an ignorant slave boy to work out a geometry problem for himself, Socrates asked, “Now do you imagine he would have attempted to inquire or learn what he thought he knew, when he did not know it, until he had been reduced to the perplexity of realizing that he did not know, and had felt a craving to know?” (Meno, W.R.M. Lamb, tr.) After the work of destruction, comes the work of enlightenment. Like the modern psychotherapist, Socrates knew that wisdom cannot be poured from one mind to another. The power and capacity to learn exist in the soul already. About the slave boy, Socrates said, “Now you should know how, as a result of this perplexity, he will go on to discover something by joint inquiry with me, while I merely ask questions and do not teach him…. ” (ibid.) Helplessness need not lead to despair; it can lead to a turning around to face the light, as the prisoners in Plato’s myth of the cave had to turn around from the false world of shadows to go out into the world of real objects and sunlight. A deep transformation, of course, comes from something more than intellectual bewilderment; there must be a recognition of psychological and spiritual perplexity. Jesus knew this when he blessed the poor in spirit. He found the field white for his harvest, not among the satisfied Pharisees who always kept the Law, nor among the Gentiles, who gave no heed to the Law; but among the “sinners”—that is, those who were rejected by the Jewish society to which they normally belonged, and who might be willing to pay the great price—abandonment of their old outlook and way of life—and be born again. For the new insight Jesus brought could only be taught by parables, whose truth could be heard only by those who had ears to hear.
The mental patient, then, must recognize his poverty of spirit. But how can the patient admit his illness if the idea of mental illness comes to him as a threatening judgment or the stigma of disease? How can the counselor help if he is afraid to acknowledge his own distance from the Truth, or also unconsciously feels that mental illness is shameful? When we are humbly willing to accept ourselves as erring mortals, we shall be better able to make psychotics feel that they are accepted even when acknowledged to be mentally ill. The therapist must act in the spirit of Jesus saying to the woman taken in adultery: “Neither do I condemn thee; go, and sin no more.” (John 8:11) This was both recognition of her state of soul and absolution from it. The patient’s acknowledgment of his condition comes in the light of the therapist’s acceptance of the patient as he is, and faith that release from this condition is possible; then the patient begins to see his mental symptoms as a series of defenses which can be dropped as his isolation is overcome.
Nevertheless, let no one suppose that the path of enlightenment through love is easy, especially for psychotics. The therapist has to work with a patient’s ego, which is both friend and enemy to healing; for it both seeks reality and erects stubborn defenses against realizations that would threaten the integrity of the self. The reality-seeking must be strengthened; the defenses must be finally overcome, but respected as long as they are needed. Like the young William Penn, the ego must wear its sword as long as it can. A psychotic person, in contrast to those not so ill, has such a weak ego development that it is hard for him either to protect himself, or to recognize reality from dream: Often the therapist has to supply self-control and a sense of reality by gently bringing an over-excited or fantasying patient back to routine matters of everyday fact. In reacting toward mental health, a stronger person is able to let his reality-perceiving take precedence over self protection; as he matures, he is able to handle anxiety rather than flee from it. But it may be victory enough for many psychotics if they can become strong enough to protect themselves from what they cannot yet acknowledge or control. Further deepening of the therapeutic relationship should be able to strengthen them more, and toward this end religion and therapy must work together.
A final word on the actual point of contact between religious concern and the mentally ill: there are chaplains in many mental hospitals, and some of these chaplains instruct ministers and theological students in clinical pastoral training courses. One of the pioneers in the clinical training movement was Anton Boisen, a minister who became mentally ill himself, and realized from his experience the religious significance of mental crises. The training program which he and others developed beginning in 1925 includes direct contact with patients, supplemented by lectures on mental illness and discussions of the pastor’s role. Beside the programs offered by theological schools, two agencies supervise training in both general and mental hospitals: the Council for Clinical Training (in New York), and the Institute of Pastoral Care (in Boston). Those who have had this training are greatly helped in understanding the reactions of people in times of illness, stress and grief, and in learning how to use a therapeutic relationship. In the task of pastoral counseling, the religious worker does not, of course, rival the physician who tends the body, the psychiatrist who tends serious disorders of the person in the body, or the social worker who sees the person in his social situation; but he collaborates with them, each performing his complementary function, each knowing when to ask the other’s help. The religious counselor, be he called pastor or overseer, committee-member or just concerned Christian, has the opportunity to see a person in the ultimate context of his relationship to God, to bring that relationship to him, and to be sensitive to the need for more skilled help if it should arise.
The Ultimate Reward
We have seen how religion and mental illness are deeply relevant to each other. The mentally ill are human beings who show us in the large the blind-alley defenses, the confusion, the alienation from self, society and God from which we all suffer in some measure. In learning how to meet the tremendous need of these people, we discover both our own weakness and also the underlying structure of relationship which can use us as its binding and healing agents. We come to see that this work is basically religious, being the reconciliation of the world to God as Truth by God as Love. “Rather, speaking the truth in love, we are to grow up in every way into him who is the head, into Christ, from whom the whole body, joined and knit together… makes bodily growth and upbuilds itself in love.” (Eph. 4:15-16. RSV) All that we call “religious” must be tested by its relevance to this ministry of reconciliation. The mentally ill, then, can lead us back to a truer and deeper service to all mankind. In contact with them we can learn the sensitive serenity, the disciplined compassion, which are essential to the task. Thus it can be said that with their stripes we are healed, and in so saying we realize the true reward for being Christ to our neighbors: when we give Christ, we receive him again in those we minister to; for “Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.” (Matt. 25:45)
For Further Reading
The National Association for Mental Health puts out useful literature, especially two pamphlets: Edith Stern’s Mental Illness: A Guide for the Family, and Handbook for Psychiatric Aides. Anton Boisen’s pioneering book on religion and mental illness is The Exploration of the Inner World. His pupil, Carroll A. Wise, has written Religion in Illness and Health; another valuable book along these lines is David E. Roberts, Psychotherapy and a Christian View of Man. For more theological background, see Paul Tillich, The Courage to Be. On the pastor’s role, see Wise’s Pastoral Counseling. On human emotions, the Overstreet’s The Mind Alive is both wise and easy to read, as is Bonaro Overstreet’s Understanding Fear. Leon Saul’s Emotional Maturity may be also mentioned.
For more advanced reading, Edward A. Strecker, Fundamentals of Psychiatry is not too difficult. Maslow and Mittelmann, Principles of Abnormal Psychology is a detailed reference text. An excellent study of the lives of normal people is Robert W. White, Lives in Progress. In The Leaven of Love, Izette deForest describes a loving form of psychotherapy. Frieda Fromm-Reichmann, Principles of Intensive Psychotherapy, helps toward a deeper understanding of psychotics. On the theoretical side, Patrick Mullahy, in Oedipus, brings together psychoanalytic theories with Sophocles’ trilogy. Mullahy has also edited The Contributions of Harry Stack Sullivan, a survey of Sullivan’s thought and practice.
The periodicals Pastoral Psychology, Journal of Pastoral Care, and Psychiatry carry articles that will be of interest.
About the Author
Carol Rozier Murphy (1916-1994) was a Quaker writer and longtime editor and contributor to publications produced at Pendle Hill Quaker Study Center in Wallingford, Pennsylvania.
Her father, Charles Rozier Murphy, was a Harvard graduate and poet and her mother, Mildred Johnston Knight, an amateur artist and musician; according to her autobiography, they had married contrary to the wishes of their families who were well-to-do Philadelphians. After a childhood of home schooling and little contact with children and outsiders in rural Massachusetts, the family moved to the Philadelphia area so that Carol might attend Quaker schools. Her father had become interested in the tenets of Quakerism and began a compilation of Quaker poetry, working at Friends Historical Library. In 1928 the family became convinced Friends, joining the Swarthmore Monthly Meeting. The little family was tight-knit, reading aloud together nightly until Mildred’s death in 1974.
Carol Murphy attended Westtown School 1929-33, and the family moved to Swarthmore when she began her studies at Swarthmore College. She graduated Swarthmore Class of 1937 and earned an M.A. in International Affairs at American University in 1941. In 1947, she began her long association with Pendle Hill, where she found her true vocation in writing, editing, and contemplation. She wrote more than seventeen pamphlets for Pendle Hill as well as for other Quaker publications on topics such as pastoral care, comparative religion, religious psychology, and meditation. In 1951, she took a course on pastoral counseling at the Garrett Biblical Institute, and in 1952 she joined the Pendle Hill Publications Committee. In her later years, Carol Murphy also was active on various Quaker library boards and in the Swarthmore Monthly Meeting. [Adapted from the Friends Historical Library at Swarthmore College]
© 1952 by Pendle Hill (now in public domain)
This piece was originally published as Pendle Hill Pamphlet #82 in 1955, ISBN 978-0-87574-8948. You can purchase a physical copy of this pamphlet from the Pendle Hill Bookstore.
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