In a particular sense the psychiatrist and 1 ancillary psychiatric workers are in need of something beyond their own powers. The conniving and cunning manipulations of the sociopath far exceed those of the average psychotic or neurotic, and their litigious proclivities with endless related enmeshments often tap the resources of the most trained therapist to the limit. The time demanded by these individuals —especially during their mood swings and when they take recourse to the bottle or to drugs or to some of the other devious excesses or ravages—is incalculable. Their lack of consideration for others and of consequences often makes for a special pull on those willing to extend a helping hand.
Therapists Need Christian Faith
Therapists not grounded in Christian faith often succumb both mentally and morally to the pressures brought on largely by this group. Dr. Walter Freeman's recent study into the causes of death among psychiatrists tends to show a preponderant number of suicides as compared with members of other branches in the medical profession.' Daily contact with the depressed or the frankly demented patient rarely leads to the same degree of frustration as does the case of the "emotional imbecile," who is often clothed in a garb of neurotic or psychotic overlay, with persistent and unreasonable demands. Whereas formerly psychiatrists and their helpers were often shot or physically mutilated by some of their paranoid patients, today they are apt to be sued for fabulous amounts, which suits unscrupulous lawyers manage to get settled out of court with little publicity but with much pressure and chagrin to the victim. One seldom hears of the details from the victimized individuals, but from personal experience the author can vouch for an intense inner sense of frustration that only a Christ-centered philosophy of life can surmount. A popular lady psychiatrist, an author of several well-known books in psychosomatic medicine, was found dead in her swimming pool shortly after a settlement of a million-dollar lawsuit.
These are only a few of the professional hazards psychiatrists and the related professions have to contend with. Many wear out with cardiovascular and related disorders long before their time. Some of these were conscientious healers who had learned that some degree of personal involvement was necessary in order to get results with individual patients. As the therapist's practice grows, his time becomes less and less his own, and it is not always possible to put up safeguards. On the other hand, there is a temptation to develop a callous and more or less indifferent attitude toward one's work in order to withstand the strain. Many of those who have survived the gamut of pressure have done so by finding their way to God.
Dr. Alphonse Maeder is such a psychiatrist, a Swiss therapist of vast experience and the author of a number of books on mental and spiritual health. A few passages from one of them, Ways to Psychic Health, may be pertinent to Adventist mental health. Adventist mental health workers would do well to take to heart and thoughtfully ponder the wisdom of this man's observations:
"We know that a physician who has fallen victim to morphine cannot treat a morphine addict; this applies to a certain extent to all forms of undisciplined and confused behavior, such as excesses in drinking, smoking, eating, in sexualibus, et cetera, as well as to all other types of weakness. It is clear that the profession of psychiatry makes heavy demands upon us. Perhaps I am stirring up a hornet's nest when I broach this delicate question. . . . It has been said that the physician can take his patients only as far as he himself has gone. (Only a healthy physician can be of assistance. Psychic health is even more important than physical health.'—Erwin Liek.)
Developing Blind Spots
"We must be more than mere technicians and should seek at all times to lead a natural, orderly and inwardly serene life. Should we be maladjusted to our family and work, to human society, the state, and religion we would then develop blind spots in our psychic field of vision, fall victim to subjective distortions, become emotionally tied up with our work and instead of being of assistance add to the confusion.
"Have not the one-sided approach of the natural sciences for the past hundred years, the increasingly positivist WELTANSCHAUUNG and the prevailing materialism, affected us adversely in our relations to our patients and to our practice? We are all angered when we observe the effect upon public life of the complexes of politicians, statesmen, industrialists and school teachers. But the same sort of thing happens among us!
"We psychiatrists have to undergo strict self-scrutiny. Just as it is a medical error to use unsterilized instruments during an operation, so must our personal behavior be condemned if we, with a confused attitude, weighed down with complexes, undisciplined and at odds with ourselves, practice psychotherapy. Our lot is without doubt more difficult than that of the surgeon because our person itself is one of our instruments; our situation resembles that of the singer whose instrument is his own voice. Our self-knowledge must be checked, and let me immediately add, a spiritual purification must constantly be fostered."
"There is something intrinsically shattering in hearing certain life stories. The physician is overcome by these impressions [sympathy, disgust, or alarm], and by his own reactions. . . . And yet the times demand that one be strong and inwardly unified. Without the certainty and support of faith I cannot carry on. I learn over and over again that what is necessary is granted if I sincerely request it and faithfully follow His guidance. That is why the 'quiet hour' is so necessary.
A Specific Religious Belief
"It is necessary that our spirit be oriented and developed. . . . Some adhere to a specific philosophic, metaphysical, ethical system, to a suitable Weltanschauung, others, in turn, to a general religiousness, or to a specific religious belief. I belong to the latter group, after having for years on end sought light and support from the wise men of the East (Laotse, Confucius, Buddha). Only by means of this detour have I found again that which is nearest at hand, the Christian faith of the Westerner. I now feel that it is right for me. I know through experience that science and religion can be combined in private life whereas during my youth they seemed to be irreconcilable contradictions. . . . In the Bible I find the consolation, the stimulating and direction-giving source of strength I had long sought. The gospels and the psalms, the epistles and the prophets offer an inexhaustible fountain of living waters. The attentive reading and meditation of such a 'message' (a kind of spiritual 'mastication') provides one with new inner experiences not vouchsafed to the purely intellectually oriented person. The age-old passage (Deut. 8:3) expresses it in the following simple fashion: 'Man doth not live by bread alone, but by every word that proceedeth out of the mouth of the Lord doth man live.' "3
The above so-called countertransferences make up only a small part of the total need in psychiatry. Thinking individuals who have observed sparsity of results in numerous patients who for years have been exposed to modern psychiatric theory and practice, with little motivation for life after perhaps hundreds of hours of insight therapy, are asking in all sincerity how this greater need can be met. It is one problem to solve adolescent delinquency, but adult delinquency is also becoming more and more a problem, both in politics and in homes. Approximately three years ago Dr. Emory F. Hodges, an Alexandria, Virginia, psychiatrist, presented at the Ohio Psychiatric Association meeting the findings of a nine-year study of 179 Washington school children. He showed that while it is possible to predict which child is likely to become delinquent, social casework does not usually help in setting him on a straight path. The program ended in 1958 after four years, but the youngsters' progress was followed. At the end of 1962, Dr. Hodges reported, 69 per cent of 72 youngsters who received intensive treatment had become delinquent. Of 34 in an untreated control group, 63 per cent were delinquent. The rest of the children could not be traced. It was suggested that these figures did not mean that treatment did the children any harm, but they did show that it did not seem to do much good, according to Dr. Hodges. The executive director of the Commissioners' Youth Council, Nina Trevett, concluded that the weakness in the present "casework" approach is that it is not able to change the home.'
Christ's Humility
Typical of many a patient in time of need, one recent patient declared: "When I am well I don't mind associating with my scientist friends, but when I realize I am getting ill, I want to come to you, for know you are a Christian and believe in God."
Many others have expressed similar thoughts either in word, insinuation, or looks. Perhaps more than any other professional persons, psychiatrists, psychologists, counselors, and other psychiatric workers need Christ's humility because of the ever-present danger of the familiar "Jehovah complex." The attitude of being like God to the patient is even more developed in this group than in specialties such as surgery, where the matter of life or death often rests in human hands. There is something about the potential control of another person's mind that seems to benumb the finest sensitivities of some therapists even if they do not use direct hypnotic methods. The subtleties of utilizing the knowledge of unconscious motivating forces as well as other hidden weaknesses of a person can take on proportions that may in time endanger the therapist's own mental health if not his reputation. More than once the writer has had to intervene therapeutically or to seek to salvage unfortunate situations derived from abuse of intimate knowledge, especially in the hands of undedicated "healers." "We have our weaknesses, you know," was the frank statement of a university professor.
Dr. Karl Bowman once uttered these words in a class attended by the writer: "Of all people, young psychiatrists must learn humility before the unsolved problems of the universe." True humility is occasionally lacking in the ones whose professed Christianity should have its source in the lowly Galilean. It is sad to see the lack of compassion and warmth of heart, which so many patients need. The impersonal attitude so often taught in psychiatric courses has undoubtedly done more harm than good among young therapists. Even empathy needs to be warm, and there has to be some involvement with the individual. This need does not excuse overemotional and unrestrained approaches, however, and a working relationship both among fellow healers and healers and patients needs to be Christ-centered in orientation. Emotional control and restraint, linked with Christ's spirit of humility, are the only safeguards against threatening countertransferences and improper patient involvements.
Not Exclusive
Psychiatry, as practiced by a Christian physician, will not seek to be exclusive. Christ never turned away a single soul in His ministry. The demoniacs received His services and loving ministry as well as the ordinary cases. He showed the greatest means of effectual work when He displayed His selfless involvement with humanity and its sufferings, identifying Himself with its needs even to the extent of giving His life. When the hostile throngs that had previously extolled Him and His services showed utter ingratitude, He simply prayed, "Father, forgive them; for they know not what they do." Perhaps the psychiatrist who is exposed to hostile assaults or ill-advised charges of patients or relatives also needs to give expression to this spirit of forgiveness.
"For they know not what they do" could be his answer to many a puzzling situation. This forgiving spirit should never condone lack of forthrightness, however. Permissiveness has a place among those who are irresponsible, but even Christ's forgiving spirit, as tactful as it was, never gave support for a single sinful act. When He came to the rescue of the young women caught in open sin, He left no question as to His attitude toward the sin itself. "Neither do I condemn thee: go, and sin no more." His consistency needs to be emulated by every true follower and His ethics should ever be studied, especially in relationship to the personality problems we have discussed above. His supportive, helpful approach, when repeated mistakes are made by an individual irresponsible patient, is surely in order, but it does not seem right that a therapist should become a kind of promulgator of acts of immorality on a continuing basis. Permissiveness can prove a serious stumbling block if not seen from a Christ-oriented perspective. Only from this approach can there be true joy in Christian labor.
(To be continued)
Notes:
1 Walter Freeman, M.D.. The Psychiatrist, Grune and Stratton, Inc., N.Y.C., 1968.
2 Alphonse Maeder, M.D., Ways to Psychic Health, Scribner, 1953, N.Y.C., pp. 187-190.
3 /bid., pp. 193. 196-198.
4 Washington Post, Sept. 29, 1963.
5 Ellen G. White, Testimonies, vol. 9, p. 22, or Guidelines to Mental Health, p. 358.
