Science in Christian Perspective



Psychotherapy and the Patients Ethical System

From: JASA 14 (September 1962): 82-83.

What is the good life? Where does it lead? What is the good, the true, the beautiful? I shall share with you some of the thoughts concerning these questions which have been meaningful to me both as one who is a professed believer in the claims of Jesus Christ and as one who engages in the practice of clinical psychiatry.

The questions that I listed above are often on people's minds and hearts. Strangely enough, classical psychiatry has not dealt with them directly. Gordon Allport, a Harvard professor and former president of the American Psychological Association, notes that "psychologists write with the frankness of Freud or Kinsey on the sexual practice of mankind, but blush and grow silent when die religious passions come in view."IL Allport goes on to argue that the psychologist has no right to retire from the field, since two-thirds of this nation's adults regard themselves as religious people, and ninetenths affirm belief in some sort of god.

Paul Meehl, present A.P.A. President, says,

I suppose the viewpoint of the major psychotherapeutic schools in this country on the question of religious factors in counseling is essentially that of classical psychoanalytic tradition. It is pointed out that the therapist's business is not to convert or unconvert people with regard to religion, or more broadly "philosophy of life," and that a therapist who is unconsciously carrying out a missionary activity will be ineffective .... Religious material is like other material which is brought up by the patient: If it comes up, one has to deal with it on the same basis as anything else, that is by reflection, clarification, ventilation and interpretation. For example, some patients may bring up religious material as a form of resistance in order to avoid talking about something else. Others may bring  it up as part of their intellectualized defense system, or in the effort to seduce the therapist into cognitive combat. This point of view would tend to depreciate the therapist engaging in discussion about value problems or religious questions as such; and if he permitted this to happen, he would be criticized for falling into the patient's defenses.

Shall ethical belief be considered as only "symptomatic"? What shall be grist for the psychotherapeutic mill? What shall be valid material for die psychotherapist and his patient to consider during their hours together? I shall share with you some thoughts expressed by Dr. Orville Walters, Director of Student Health Services, University of Illinois. I shall lean heavily on Dr. Walters' remarks.3 He makes a strong plea that the psychiatrist himself should become conversant with the claims of Christianity.

The psychiatrist who is asked to make an evaluation of purpose is likely to cite his status as a scientist, in which role he professes to deal solely with facts, refraining from value judgements and maintaining ethical neutrality in his relationship with patients. I suppose the same psychiatrist would say that the Christian is a proponent of a system of metaphysical constructs. The psychiatrist, by identifying himself this way, seeks to enjoy the vast prestige of science and places the Christian on the defensive in a supposedly new variation of the science versus religion conflict.

Actually, the psychiatrist's identification of himself as a scientist deserves scrutiny. As a physician, he has much in common with his medical colleagues in other branches of medicine. In one respect, however, the psychiatrist is unique. Whether the sufferer is saint or sinner, the surgeon remains the scientist and removes the inflamed appendix. Whether his patient is priest or gangster, the orthopedist reduces and splints the fracture. The psychiatrist, on the other hand, must frequently relinquish the role of scientist and may even have to make a value judgement before he can decide whether he has a patient. He must decide whether the complaint of the patient is in fact a cause for treatment.

The psychiatrist may draw upon the full armamentarium of the scientific method, but he cannot be only a scientist. His patient has, let us say, a strong sense of guilt. The psychiatrist must ask himself many questions. Was the deed proportionate to the guilt that followed) Was the act good or bad? Does the patient need psychotherapy for neurosis, or forgiveness for sin, or both? Does he need a psychiatrist or a spiritual counselor? Making such discriminations obviously requires value judgements on the part of the therapist. What code of ethics is to be applied in arriving at such judgements? Shall he apply his own ethical code or some other? Shall he discard the patient's scale of values or abide by it? As long as he functions as a scientist, the psychiatrist can claim with validity to be ethically neutral, for science has no concern with values. When he begins to make value judgements, as I maintain he must when dealing with live human beings in conflict, the therapist forfeits a neutral status.

Ethical neutrality is an abstraction that does not exist in fact for any man. Every man has his own hierarchy of values and in the interaction of psychotherapy where understanding of deep motivation is sought and where issues of ultimate consequences are faced, the value systems of both therapist and patient are inevitably implicated. When the psychiatrist offers to use his professional knowledge and skill in intimate contact with a person in conflict, his activity is no longer only observational, but actively interventional. The psychiatrist may try to preserve the objectivity of the scientist, but

*Revision of a paper presented at the Sth regional meeting of the North Central Section of the ASA, April 7, 1962, as part of a symposium on "Critical Ethical Decisions in Science."

**Dr. Larson is practicing psychiatrist in Minneapolis and a residence child psychiatrist at the Wilder Child Guidance Clinic in St. Paul, Minnesota.

now he has an active interest in the outcome.

The psychotherapist is thus an involved participant who has elected to follow a certain sectarian procedure of his choice with an interest in the outcome. There are many schools of psychology and psychiatry, each of which makes its own assumptions about the nature of man. Both the choice of the method and its application are tinctured by the therapist's own philosophy of life. In the process of psychotherapy, a relationship is established in which, either by spoken word or by nonverbal cue, the psychiatrist's value system is soon discerned and may even be appropriated by the patient to serve his own needs. This direct or subtle communication of his own world to the patient soon compromises the psychiatrist's imagined neutrality.

When the psychiatrist is seen in this light, the tension between psychiatry and religion may be more clearly recognized. It is not a science-versus-religion conflict but rather an extension of the older naturalism-versus-theism tension.

I think the point is sufficiently made that the psychiatrist himself, either as a professional therapist or as a person, cannot be ethically neutral. I would assert that such neutrality is only a sham and does not in fact exist.

The psychiatrist himself, I feel, should also actively consider the Christian faith. For one thing, he is a seeker after truth. Christian theology claims to have knowledge of truth and to be an important aspect of reality. The psychiatrist should acquaint himself with the claims of Christ, for when he deals with patients who are committed in their personal lives to this Person, he must be able to distinguish between devotion and "resistance." If he does not distinguish between specious rationalization and moral conviction, he may do his patient a serious disservice.

The psychiatrist should examine the Christian faith because he is a healer. There is, of course, profound evidence that Christian experience is often extremely therapeutic.

The psychiatrist should examine the Christian faith because he is a philosopher. Everyone has his world view, and Christianity presents a satisfying and logical world view.

The psychiatrist should examine the Christian faith because he is a person. He too has guilt, anxiety, and conflict.

When the therapist leaves science behind, his philosophy must compete with a Christian philosophy on an equal basis. Among the diverse and conflicting doctrines of man, none explains as much as the Christian view. In contrast to Freud, who saw man as primarily instinctual and biological, and the neo-Freudians, who see man as primarily social, the Christian approach offers a synoptic view of man, presenting him as a spiritual being with elements in his nature that respond to transcendental reality. The unifocal view of Freud that sees primarily the evil in man and the humanistic views that emphasize primarily the good are exceeded in the broader, more realistic Christian doctrine that sees, beyond man's basic evil, unlimited potential for good through divine redemption and grace. In contrast to the freshly minted theories of human nature, the Christian doctrine of man enjoys a coherence and maturity that has withstood centuries of the severest attack and criticism without essential change.

In closing, let me quote several others on the importance of considering the patient's ethical system in the process of psychotherapy.

David Reisman in Individualism Reconsidered says 

increasingly today the new type of analytic work is with people who are not obviously ill-whose "symptom" is their malaise, their whole way of life-people who are troubled about moral issues or ought to be troubled about them. This forces analysts to be concerned with problems of values as part of every task of therapy.4

Gregory Zilborg, a well-known convert to Christianity and an eminent psychiatrist, wrote

suffuse with anxiety, man again is forced to contemplate what it is that he is, what it is that he wants, what it is that he wants to want, and what is his place in relation to his fellow man individually, to society, to himself. These are ontological, metaphysical, and fundamentally religious questions. A psychoanalyst, more than any other professional man, must cultivate a philosophy of values.5

  0. Hobart Mowrer, who is a research professor of psychology at the University of Illinois, quotes the following young man who had the diagnosis of schizophrenia. The origin of the illness was 

motivated in the first place by fear. A schizophrenic psychosis originates in a break with sincerity and not in the classical assumption of a "break with reality." The patient's ocial appetite including love and respect for persons in s ociety is consciously anticathected or forsaken, and ultimately repressed with the passage of time, since full satisfaction with society entails more or less communicative honesty, faith, and intimacy.6

I feel the epitaph on the tombstone of an infant in a London cemetery reflects the most burning question before the human race today:

This may be, this must be, a concern in psychotherapy.

1.i. Allport, G., The Individual and His Religion (New York: Macmillan, 1950).

2. Meehl, P., "Some Technical and Axiological Problems in the Therapeutic Handling of Religious and Valuational Material," journal of Counseling Psychology, V1, No. 4, 1959. 3. Walters, 0., personal communication.

4. Reisman, D., Individualism Reconsidered (Garden City, New York: Doubleday and Co., 1954).

5. Zilborg, G., "Some Denials and Affirmations of Religious Faith," in F. J. Braceland (Ed.), Faith, Reason and Modern Psychiatry (New York: P. J. Kenedy & Sons, 1955).

6. Mowrer, 0. H., 1960 Convention Proceedings, Christian Association for Psychological Studies.