How does this apply to ALL Religions when they go sick?

A GUILT-LADEN MAN gouges his eyes out because he has read literally the Biblical injunction, "If thine eye offend thee, pluck it out ..."

I am walking down the corridor of a mental health center with the superintendent of the institution. We see a young girl with her right hand missing. He tells me that she felt that God had told her to cut her offending hand off and she did so.

My students saw an eleven-year-old boy in a juvenile detention center. He had been placed there by his parents. He is the oldest child of four living at home. He would not stay at home but insisted on running away. He would stay out of school and go to work with a nearby neighbor, who was a contractor building houses. He would work all day installing dry wall under the direction of the man. If the boy ran away from home in the evening, he would be found late at night helping an auto mechanic repair cars. The parents' complaint against him was that he was unmanageable and would not go to the new school where they were sending him. They wanted the public authorities to "make him mind."

When my students investigated the home situation, they found that the school to which the boy had previously gone was a Catholic school and that now he had to go to a public school. When the students inquired as to why the schools had been changed, they discovered it was because the parents had become "gifted with the Holy Spirit," had changed churches from the Catholic Church to a Pentecostal-type church, and were demanding that the boy "get right with God" and have an "experience with the Holy Spirit." They had told him, the father said, that he would never be right with them until he got right with God. The father was angry with the son because he refused to "knuckle under" to God. A sixteen-year-old son had left the home, had a part-time job, and continued his attendance at the Catholic school.

These instances convince us that the term "religious" is very ambiguous, and that, like the word "love," it covers a multitude of sins. Since the apostle Paul stood on Mars' Hill and told the Athenians that they were in all things very religious, the term "religion" has had a double meaning. It can refer to a very positive, "health-giving" doctrine by which men not only survive but live and do well. A healthy faith is the expression of the total personality of an individual in his relationship to the Divine as his ultimate and comprehensive loyalty. At the same time, "religion" can refer to a pantheon of false gods by which men shrivel in the bondage of fear and death. When religion becomes reified--that is, made a thing of as separate and apart from the total expression of the whole life of a person--it becomes an external "it," a thing apart. When this happens, the "it" religion becomes either a segregated, autonomous system in an airtight compartment separated from the rest of life, or it becomes a disturbing factor in the total functioning of the person. In either instance, it is sick. In these latter instances, a person's "religion" becomes "bad news" instead of good news. Such religion is sick and not well. When we use the word "religion," then, we are not necessarily saying that something is good.

Persons come to pastors when their religion has become a burden to them. When they are sick at heart because they are becoming more and more religious but enjoying God less and less, people have a way of turning to their pastor. Their pastor may be in something of the same "fix" himself; nevertheless, he is called upon by people when their religion gets sick. The concern I have in writing this book is to enable both the pastor and the persons who come to him to understand the religiously sick. This book is only secondarily about mental illness. It is primarily about sick religion.

THE INTENTIONS OF THIS BOOK

Basic questions provide the intentions of this book: When does religion get sick? What kinds of experience blight the religious lives of individuals, groups, and their leaders? What can the pastor and his church do about these experiences when they occur? How can they go about predicting when sick religion will occur and preventing this malaise of the spiritual life from setting in? These questions imply that religion may be either sick or well and that it is not always one or the other. Ordinarily, it is sick in some respects and well in others at the same time. This view keeps us from the intellectual "dead ends" of Freud's assumption that religion is a universal neurosis at all times and places. It also avoids the sweet optimism of denominationalism in American religion; that is, that religion, because it is religious, has to be well, good, and healthy by the nature of the case. Both kinds of thinking are unrealistic and do not fit the facts of life.

THE MEANING OF "SICK"

Conclusions are drawn here as to the nature and functioning of "sick" religion. When I use the word "sick," I am not using it in some broad, vague, generalized sense. As Prof. H. Stuart Hughes has said, it becomes very much the "in" thing to do to view society as a whole in terms of emotional illness and as "sick." Yet he says that this is so vague as to be meaningless. (Psychiatric News, Vol. 4, No. 6, June, 1969, p. 4.) Rather, when I use the word "sick" here I am referring to a specific functional breakdown. When religion is sick, it massively hinders the basic functions of life. Malfunction, then, is the criterion of sickness. When a person not only fasts according to shared and spiritually understood "ground rules," but refuses to eat at all because he fears God's punishment for eating, then that person has failed to function in a "well" manner. When a person refuses to rest at all because he must awaken people at every hour of every night of the week to win them to Christ, the people around him ask if he is really well. When a person feels that all contact of any kind between the sexes is of itself evil when practiced by anyone, especially himself, then one asks about the illness or health of the ethical perspective of that person. When a person's work routine is completely hindered by the kind of religious life he leads, he has no adequate way of being a responsible supporter of his family. Then one asks if he does not have need of the physician as well as of the Divine.

In other words, the word "sick" is not used in some global, vague, or moralistic sense here. It does not necessarily refer to "society as the patient" or to the solution of all the world's problems in some sort of cure-all. Rather, it refers to specific situations in which particular people suffer major failures of functioning in the conduct of their lives because of religious preoccupations and stumbling blocks. In other words, when the word "sick" is used, it is employed in a restricted rather than a general or "broadside" sense.

A CLINICAL MANUAL OF RELIGIOUS PATHOLOGY

An underlying hope of this writer is to arrive at a distinctly religious understanding of the problems of disturbed and unhappy people. This is not to put the religious understanding over against the psychiatric interpretation of the ills of humankind. Rather, I hope to develop a set of working hypotheses and concepts concerning human behavior in its direst distresses that will be readily understood and appropriated by any minister who has taken the Judeo-Christian interpretation of human life seriously. At the same time, my objective is to cut across the orthodox psychiatric classifications and to produce a religious classification, interpretation, and pattern of approach. Nevertheless, this pattern of approach will not be contrary to nor ignore the demonstrated findings of contemporary psychiatry and psychotherapy. In other words, this is a religious interpretation of the disturbed person's life. As an interpretation, it is just that: one interpretation. Whether it becomes a pervasive and influential interpretation depends upon its fidelity to the facts of life it represents and upon how seriously the reader takes these categories of and approaches to understanding and counseling the religiously sick.

The following pages are really statements of working hypotheses concerning a pathology of religion. They are stated in the language and mood of hypothesis. Persons who are looking for statistical and quantitative exactitude will find some comfort, but it will be cold. The realm of interpretation does not always lend itself to precise quantification. Rather, the patterns of interpretation set forth seek to provide working themes that can be tested by students and pastors as they see for themselves whether the hypotheses set forth here fit the kinds of empirical experience they are having. Do they make sense?

THE MINISTER AS A PROFESSIONAL INTERPRETER OF RELIGIOUS PATHOLOGY

The role of the minister is that of an interpreter and evaluator. He is called upon to use his specific skills in understanding and counseling with the distinctly religious concerns of the emotionally disturbed. The value systems of a disturbed person are the minister's "territory." He cannot act as if no one else can have free traffic into and out of this territory; neither, if he is doing his job well, can he assume that anyone else should be the guide rather than he in this territory. He cannot ditch his responsibility on social workers, psychiatrists, and psychologists and whine because they are uninformed and unskilled at dealing with the distinctly religious concerns of persons. He cannot be timid or apologetic about occupying his own territory as a professionally trained person who also "knows his stuff." He can neither be an intimidator of nor be intimidated by persons who are uninformed as to his own training and professional "know-how."

The minister takes the religious problems of persons as real. They are clues to and linkages with the rest of the personal concerns and the social situation of the person who has the ideas. They are not just symptoms of something else. They are valid in and of themselves. As such they are ways of interpreting life so that it makes some sort of sense. If these ways of interpretation are sick, then the whole body will be filled with darkness. The minister and the doctor who take these religious ideas and problems of the person seriously will find in them the patient's way of communicating his distress. For many patients, this is their only way to communicate their distress, and to "shut them up" at this point is to consign them to oblivion and ourselves to ineffectiveness. Edgar Draper has said that the patient individualizes his religious communication regardless of what his formal religious background has been. "Details of their interpretations of religion not only fit with their diagnostic picture, but also offered clues to diagnosis at the clinical, developmental, and psychodynamic levels." (Edgar Draper, George Meyer, Zane Parzen, and Gene Samuelson, "On the Diagnostic Value of Religious Ideation," Archives of General Psychiatry, Vol. 13, No. 3, Sept., 1965, p. 202.) The patient's religious ideas are symbolic counterparts of this whole life experience and not mere side effects of his "real" condition. They provide the basis for a symptomatic character diagnosis. They are realizable clues for diagnosis of the psychiatric disorder of the patient.

Therefore, the minister and the psychiatrist who will take seriously the religious culture of the patient will have here one more royal road to the hidden agendas of disturbed people's lives. With both the family physician and the attending psychiatrist taking the religious life of the patient as significant in its own right, the total life of the patient is benefited. The physician can no longer afford to consider the religious concern of the patient as unreal. Nor can the minister ignore that the religious life of the patient can become ill. Neither religion nor illness is a myth and both may be synonymous. A realistic approach brings both together in collaboration.

The person who is suffering is comforted and his trust is established when he knows that his beliefs and cherished values, however inflamed with illness, are taken seriously by both his doctor and his minister. He is not ignored as a religious person by his doctor. He is not treated as "some sort of nut" by his minister as if his religion did not matter at all. Standing together, both the minister and the doctor can more adequately stand by the patient and take him more seriously.

THE MINISTER, by the nature of his calling, is committed to proclaiming the good news of a prophetic faith. In both the Christian and the Jewish heritages, prophetic faith is set over against their own cultural forms, which are by definition idolatrous. In other world religions, a similar obscuring of the ultimate values takes place by excessive preoccupation with the proximate, temporary things that men overvalue. The hypothesis of this chapter is that when the relative values of life take the place of the eternal and ultimate ones, a condition of idolatry exists. The person in this time and place is on the way to becoming off center, disturbed, unbalanced, and sick at the core of his religious life.

The astute reader will readily ask: "Who is to define what is idolatry and what is the true and living God? Is this not a very relative matter?" "Are you taking a hard, party-line position that gives you the right to determine who the true and living God is and requires that everyone be in accord with this or be seen as sick religiously?" These are very legitimate questions. The answer to them is possible but not easy. The questions can be approached confessionally as to who I think is the true and living God. The end result would be that as a Christian I could be heard to take a "hard, party line." Or, I can take the position of a psychologist of religion and ask for an empirical description of the kind of religious sentiment that makes for health and disease in religion. This does not require that I give specific content and character to the kind of religion a person may have. It does require a functional value judgment as to how the value works. I choose to follow the latter procedure. The reason for doing so is that I may speak to people of all religious persuasions and ask whether they are sick or well in their faith. Even so, I have already spoken in other places, especially in my book Christ and Selfhood, from an unequivocally Christian point of view. Readers who wish to "positionize" me, for better or worse, can read that book against the background of what is said here. But, in this book, the distinctly phenomenological and empirical point of view is taken. What, then, are the characteristics of a religious world view that could be characterized as laying hold of the Eternal, and what are the characteristics of an idolatrous religion?

THEOLOGICAL PERSPECTIVES

Paul Tillich has done most to make the concept of the demonic power of idolatry a negotiable concept for the modern, sophisticated reader. He says that the distinctly religious quest is concerned with the power of the New Being in that which takes the empirical form of an ultimate, not a proximate concern. When we invest ultimate concern in that which is ultimate, we have anxiety but it is normal anxiety, which grows out of our realization of our finitude, our mortality in the face of death, and our encounter with meaninglessness in the proximate things of life. When we invest ultimate concern, however, in proximate, finite, temporal, and transitory realities, we "absolutize the finite." We give ourselves over to these proximate concerns, which become idols in our lives. As such, the idol exercises demonic power over us. It has become the ultimate power over us. It possesses us with a frail hand. (Illustrations for these ideas rush to my mind, but these can wait for the empirical histories of patients who have become sick in this way.) Nevertheless, the end result is pathological anxiety. (Paul Tillich, The Courage to Be, pp. 40-63; Yale University Press, 1952.) The person becomes "pathologically fixed to a limited self-affirmation." (Ibid., p. 73.)

Tillich uses the example of the idolatrous character of utopianism, which serves to make his point very concrete in the face of the almost millennialistic social reform movements of today. He says:

For utopianism, taken literally, is idolatrous. It gives the quality of ultimacy to something preliminary. It makes unconditional what is conditioned (a future historical situation) and at the same time disregards the always present existential estrangement and the ambiguities of life and history. (Paul Tillich, Systematic Theology, Vol. III, p. 355; The University of Chicago Press, 1963.)

Again, Tillich identifies religious nationalism as a contemporary idolatry at the same time that he defines what idolatry is:

Idolatry is the elevation of a preliminary concern to ultimacy. Something essentially conditioned is taken as unconditional, something essentially partial is boosted into universality, and something essentially finite is given infinite significance (the best example is the contemporary idolatry of religious nationalism). (Paul Tillich, Systematic Theology, Vol. 1, p. 13; The University of Chicago Press, 1951.)

Emil L. Fackenheim, a Jewish professor of philosophy at the University of Toronto, says that a particular symbol or art object is rarely thought of as a modern possibility of idolatry. However, the idolater of today is concerned with living idols that can literally hear, speak, and act. He defines modern idolatry as follows:

The idol itself is divine. The idolatrous projection of infinite feeling upon finite object is such as to produce not a symbolic, but, rather, a literal and hence total identification of finiteness and infinitude. (Emil L. Fackenheim, "Idolatry as a Modern Religious Possibility," in Donald R. Cutler, ed., The Religious Situation: 1968, p. 275; Beacon Press, Inc., 1968.)

From a psychological point of view, one can readily discern that the mechanism of idolatrous construction is projection of both wish and fear upon an external person who hears, speaks, and acts. From our understanding of primitive religion, this can be either a living or a dead person, depending upon the sick person's attitude toward death. The ghosts of the restless dead, as in Hamlet, can still be operative in the spiritual distemper of the religiously sick. A disturbed and imminently suicidal Saul can consult with the departed spirit of Samuel. Even though he had "cut off the mediums and the wizards from the land" himself, Saul consulted a woman who was a medium and asked her to bring up Samuel for him (I Sam. 28:8 ff.). He did this in disguise, thereby rejecting to a great degree his role as the king. The point, in brief, is that he and Hamlet both were fixed in their loyalty upon a departed and dead hero. Yet, as Fackenheim says, their relationship was not a symbolic one but a literal and total one. They had "bet their whole lives" on what was going on between them and the departed spirits. Insofar as I have been able to find, the Muslim religion, with its heavy emphasis upon monotheism, is more prone to interpret behavior in terms of idolatry than is either Hinduism or Buddhism. The Muslim likens an idolater to "the spider who buildeth her a house: but, verily, frailest of all houses surely is the house of the spider." (Quoted from the Koran by Edward Sell, "Images and Idols (Muslim)," in James Hastings, ed., Encyclopedia of Religion and Ethics, Vol. VII, p. 150; Charles Scribner's Sons, 1928.) To the Muslim, idolatry is the unpardonable sin. Yet Hinduism and Buddhism alike are more syncretistic religions and permit polytheistic worship of nature, veneration of ancestors, etc. This "lower" type of worship for the populace rarely reaches the level of conferring ultimate significance upon the object of worship. The objects of worship do not become matters of total identification of the finite with the infinite.

PSYCHOLOGICAL ESTIMATES OF ULTIMATE AND PROXIMATE RELIGIOUS CONCERN

Several psychologists have been definitive about the mature religious sentiment, as Gordon Allport calls it. By negative reference, the sick religious concern can be pointed out. Allport speaks of religious concern in terms of interest, outlook, or a system of beliefs. This is a system of readiness that we use in coping with life. When thought and feeling are organized and directed toward some highly chosen object of value--a mother, a son, a neighborhood, a nation, or a church--"we call the system a sentiment." Then Allport defines a specifically religious sentiment by saying that it is "a disposition, built up through experience, to respond favorably, and in certain habitual ways to conceptual objects and principles that the individual regards as of ultimate importance in his own life, and as having to do with what he regards as permanent or central in the nature of things" (italics his). This allows for a wide variety of religious expressions, but it gives a good inner view of how the individual with the religious sentiment feels about it.

Then Allport continues to identify the characteristics of a religious sentiment. It has a well-differentiated capacity of self-criticism. As Anton Boisen used to say, the mature prophet has a certain consciousness of "prophesying in part," a genuine humility. Sick religion, correspondingly, is uncritical, self-contained, and lacks any measure of humility and teachableness. In the second place, the dynamic character of a religious sentiment provides the main index to its health or unhealth. Immature religion is shot through with magical thinking, self-justification, and personal comfort. Mature religion is the master in the economy of life, controlling motives rather than being controlled and determined by them. The control is directed toward a goal "that is no longer determined by mere self-interest." In the third place, a mature religious sentiment is characterized by a consistency of moral consequences of the religion itself. The criterion of moral consistency suggests that the mature religious sentiment generates high and consistent standards of action. This speaks to the religious sociopath's situation, wherein religion becomes a means of immoral behavior of various kinds. (Gordon Allport, The Individual and His Religion, pp. 56 ff.; The Macmillan Company, 1950.)

The focus of this chapter on the idolatrous character of sick religion, however, is clarified best by Allport's assertion that a mature religious sentiment is a comprehensive sentiment. A nonidolatrous kind of religion calls for a comprehensive philosophy of life. The Hindus said that "truth is one and men call it by many names." Plato said that sin is the rising up of a part of the soul against the whole. The Hebrew prophets and the Lord Jesus Christ insisted that we cannot serve two masters but that purity of heart calls for a Lord of lords. A comprehensive faith embraces the whole order of Creation. The idol is a "part-process," a restriction and constriction of the life. The negative counterpart of this comprehensive religious sentiment is what Andras Angyal calls the domination of the whole sphere of life by a "part-process," which thrusts the organism into a state of "bionegativity." In the illness, whether it be of a psychotic order or a behavioral disorder, the identity of the person takes on a negative character instead of a positive and constructive nature.

The previous examples of the restriction of life around the spirits of the departed dead make Allport's point of view more concrete. However, we need more precise clinical demonstration of the way in which life is constricted and controlled through the worship of something less than the Eternal. Bereavement, preoccupation with the family inheritance, and preoccupation with one role in life to the exclusion of all others provide three areas where the point of view set forth here can be demonstrated clinically.

THREE AREAS OF CONSTRICTION

Bereavement

Lindemann, Wallis, and others have established through empirical studies the validity of interpreting grief as a process with varying but definable stages. The loss of someone by death moves through the stages of shock, numbness, a struggle with reality as over against fantasy, a time of depression and a flood of tears, a regrouping of the life with sporadic bursts of memory reactivating the previous stages momentarily, and finally a reordering of the whole life around new interests, relationships, and pursuits in life. Pathologically, the person may become arrested in the process of grief at the stage of shock, numbness, or the struggle with fantasy, or at the time of depression. The loss of someone by death can, therefore, be a precipitating factor in severe emotional disorders of various kinds, depending upon the life history and style of life of the person. The religious life of the person quite regularly becomes the first casualty in his life and may take on all of the symptomatology of sick religion. Various sources of data can be consulted here.

Comparative studies between a primitive religion and psychotic episodes among people in a technological society are productive of insights as to how very thin the veneer of our so-called Western civilization really is. J. H. M. Beattie offers a clinical study of the relation between belief-reactions to the spirit of someone who has died and illness among the Bunyoro. He carried out these field studies in Bunyoro, Uganda, for about twenty-two months, during 1951 through 1953 and in 1955. He developed case history details on fifteen individuals whose illnesses were attributed to the ghosts of the departed dead. Of the fifteen cases, three were epilepsy, five were miscarriages, one was a sudden seizure, one was an undiagnosed fatal illness, one was leprosy, one was a painful swelling, one was an allergy to certain foods, one was ulcers on the legs, and one was a man who set fire to some property.

However, the most interesting fact about these involvements with the dead was that "in eight out of the fifteen cases…where ghostly activity was diagnosed, the original offender was not attacked directly but through his children, and in two others he was long since dead and vengeance was wreaked upon his descendants." (J. H. M. Beattie, "The Ghost Cult in Bunyoro," in John Middleton, ed., Gods and Rituals: Readings in Religious Beliefs and Practices, pp. 259-261; The Natural History Press, 1967.) The important thing for the reader to note is that bereavement is ordinarily associated in the Western mind with the death of someone, but the technical distinction I am making is that a person may be alienated from a living person and suffer a more profound grief reaction than if that person had died. Death is definitive and can be identified easily. A hostile separation is not so easy to grasp. For example, the Bunyoros substituted an innocent living person for a deceased individual who had offended someone. In contemporary psychotic behavior, the substitution of an innocent person for one's own offenses, the offenses of other living persons, or the offenses of deceased persons appears as a distortion of moral responsibility. For another example:

Mr. Daily was a twenty-one-year-old man admitted to the hospital with terrible feelings of having committed an awful and unpardonable sin that he could not identify. He was referred to the hospital from a remote rural region by an area missionary. His father was a lay preacher, and his mother a housewife. He had two sisters, one eleven and one seventeen. He felt that his father was always on his back and that he gave preference at all times to the sisters. The patient had had two years of college and had taught in a rural county school for one year. He felt much anxiety over his "call" to be a minister, but daydreamed considerably about other roles in life--being a missionary bachelor, being a policeman, etc.

There had been no previous illnesses of a psychiatric nature. The presenting symptoms at this time were sleeplessness, and a strong feeling that he had sinned against God and that God was going to punish his younger sister for his sins. He was worried deeply about the safety and well-being of this sister. As he underwent treatment, both chemotherapy and electroconvulsive therapy, this fear for his younger sister's safety went away, but it returned in the form of a similar fear about the safety of the older sister. He could express his anger at God for punishing someone like his sisters, who were suffering for things he himself had done.

During the course of treatment, the concerns about his sisters became less compulsive and obsessive. he could think of them in the past tense. As he did so, the focus of his anger shifted from God to a frank acceptance of negative and destructive feelings toward his father. Upon entry into the hospital he had extolled his father's great kindness to him and his perfect instruction of him in salvation from God. Upon outpatient treatment, he was able to express some of his anger toward his father, who had "restricted him too much," to use his own words.

The father himself also felt that he had forced his son to lead too sheltered a life and that he had not wanted to let him be anything except his "little boy."

The conception of God in this account is a "ghostly" one. God is seen as a ghost to be feared. Also, he is seen as one who unjustly punishes someone whom we love and "gets at us" through them. Of course, the anger is really Mr. Daily's in this case, and the vengeful mood is his own toward his favored sisters. The "ghost god" is a vehicle of his own anger toward his sisters and toward his father for treating them with favoritism.

After dialogue with the patient, I met a private psychiatrist who said that within the last twenty-four hours he had met two patients. One of them had lost her mother by death about ten months previously. The other had given birth to a badly malformed child. Each said similar things of God: "God will punish you. He will get at you by hurting the person closest to you.'' Here in these instances cited by the psychiatrist, grief was present in the loss of someone by death as well as alienation from someone by misunderstanding. In both instances, as in the case of the psychotic patient, Mr. Daily, and in the previous references to the Bunyoros, an innocent third party is seen to be the victim.

The overlay of Christian symbols does not remove the basically primitive character of the "ghost cult" within the ranks of somewhat educated people. The patient endows the fear of his own anger toward his parents and siblings with ultimate concern. As such, his own uncontrolled impulses are the source of his "bondage" and distress. Not until he begins to recognize his own feelings and accept limitation upon them can he begin to function effectively and happily.

No specific bereavement caused by death provided the "ghost" in the case of Mr. Daily. The bereavement was due to the breach between the patient and his father. If the father had died, the situation would be synonymous with that of the Bunyoro tribe. The young man's father was not dead. God, instead, became the ghost between father and son, working punishment on the patient by threatening his sisters. The combined erotic and hostile impulses toward the sisters made the overwhelming fear a compound of guilt and anxiety of pathological proportion. A "ghostly" conception of God took the persecutor's role.

The Japanese religions are different from modern Judeo-Christian faiths at the point of the custom of worshiping the dead. At one and the same time, the translation of a loved one into an ancestor lowers the reality of death and makes the separation anxiety less severe than in Western Christian tradition. Yamamato and his associates studied twenty widows who were the bereaved wives of traffic accident victims. Eighteen of the twenty had either Buddhist or Shinto family altars (butsudan) in their homes. Yamamoto compared his and his associates' results with those of a London psychiatrist, C. M. Parkes. They discovered that the Japanese widows suffered significantly less depression, numbness and apathy, sleeplessness, and cultivation of and the actual sense of the presence of the dead than did the London group of widows. In turn, the London widows had significantly more awareness of the presence of the dead, trouble escaping reminders of the dead, and difficulty in accepting the loss of the deceased. One would ask whether or not the encouragement of ancestor reverence does not lower the psychic stress at the expense of a more realistic handling of the harsher reality of death. Yet the cultural affirmations of ancestor reverence among the Japanese might well lower the incidence of mental illness with grief as a precipitating factor. (Joe Yamamato, M.D., Keigo Ogonogi. M.D., Tetsuya Iwasahi, M.D., and Saburo Yoshimura, M.D., "Mourning in Japan," American Journal of Psychiatry, Vol. 125, No. 12, June, 1969, pp. 1660-1665.)

The Inheritance Syndrome

The family inheritance is another common repository of the ultimate concern of a person. In turn, the family inheritance becomes an idol constricting the life of the individual. The form and shape of this constriction often derives its power and community sanction from religious sources. Especially is this true when the life of the sick person has been religious.

The story of the rich fool, found in Luke 12:13-21 of the New Testament, exemplifies this situation. A man came to Jesus asking that he make his brother divide the family inheritance with him. Jesus refused the role of divider and judge over him. Then he told the story of the rich fool who gave himself entirely and solely to the finite task of building a bigger and bigger estate. The man's life was required of him in the process. Jesus asked, "Then whose will those things be?" It was a rhetorical question the answer to which was obvious: These things would be the sons' to argue over, to shape their lives by.

Jesus said to another man (as recorded in Luke 9:59), "Follow me." But he said, "Lord, let me first go and bury my father." The father may or may not have been at the point of death at that time. The family fortune, a mistaken sense of loyalty to a reasonably healthy parent, and an ultimate concern for the inheritance may have bound the son against following the Lord to whom he gave lip service. Preoccupation with the family's future can become an obsession and a sick religion. The following case is significant at this point:

A thirty-two-year-old man was the younger of two sons. The father and mother had become parents of the two sons late in life because they had wanted to become financially secure before they had children. The two sons came within two years of each other and grew to young manhood as part of the family business. The elder of the two sons became a very religious person, contrary to the pattern of the family as a whole. Under the tutelage and with the encouragement of his church, he became a missionary in a rural section of the United States, even though he had been reared in a large city. He stayed with the mission work faithfully and was gradually promoted in his duties until he became an editor of one of his church's publications. He established himself in his own right all the way across the continental United States apart from his father's business.

The younger son tried the same method of breaking away from the family business but failed. Each time he would try to establish himself in the work of the church, he would become emotionally sick and have to return home. His reasoning was that someone had to look after his aging father as long as be lived. But when faced with the realistic job of putting up with his father's eccentricities and the demands of the family business, he would become anxiously depressed and even suicidal. Upon admission to the hospital for treatment he would say: "If I could only be a missionary like my brother, I wouldn't be sick. It is all due to my unfaithfulness to God." But underneath, this, there was his quiet assurance that if he waited long enough, the inheritance would be his and he would not have to worry. As he became less depressed and expressed his hopes about life, this was the way he reassured himself. Realistic plans for him to learn a kind of work of "his own" apart from both his brother and his father ran aground upon his settled assurance that when he buried his father, his troubles would be over because the inheritance would be his. The task of therapy was to challenge and change this settled resolve of the patient at the same time that the symptoms of depression, anxiety, and suicidal indications were managed therapeutically.

The course of treatment involved intensive social-work efforts to devise a fitting kind of meaningful work in which the man could use his skills as a salesman apart from the sales organization of his father. He also needed his own identity apart from the missionary position of his brother. The pastoral counselor was in the position of collaborating with the patient to find the approval and acceptance of God for the work the patient decided he realistically should do "under God." When the clutching fingers of his devotion to the family fortune--little in fact that it was--loosened, the man became less sentimental about his father, less depressed about his own worthlessness, and more confident of his own future in a sales job for which he was both talented and fitted.

In summary, the "part-process" of preoccupation over an inheritance dominated and possessed the total life of the persons described. The inheritance takes on an ultimate significance for the person who permits it to become the total direction of his life. As subtle and somewhat nebulous as this may be, it becomes much clearer when we see the inheritance as an idolatrous construction of the individuals involved. In sentimental concern over the well-being of the father or mother whose path is presupposed if the inheritance is to be received, the person builds a reaction formation to mask his guilt at the wish for the death of the parent.

Self-reflection

The most malignant form of religious sickness probably comes from a perfectionistic expectation of oneself as a self. The classic statement of this is Nietzsche's exclamation: "There is no God! If there were, how could I stand it if I were not he?" Caught between the necessity of his humanity and the possibility of his divinity, a person settles the tension between the two on the side of his infinitude. As Kierkegaard, who set forth this paradox most clearly in his Sickness Unto Death, says, a person becomes "drunk on infinitude." The following case history is illustrative:

An eighteen-year-old girl attempted suicide at the college where she was a freshman. She was sufficiently dangerous to herself for the college authorities to advise her parents to have her hospitalized. During her hospital stay she repeatedly threatened to try suicide again.

Her family history revealed a father who worked as a day laborer, a mother who served as a maid, a brother in the Armed Services, and the patient herself the youngest daughter. She was the only one of her family who went beyond the sixth grade and her church has made her college education possible at a church-related college. Her father was hostile toward her getting so much education. Her mother silently approved it but gave little or no verbal encouragement to the strivings of the girl toward an education.

The minister of the patient had been very influential in her life, convincing her that she could do excellent work and that there was no limit to her possibilities as a student. She despaired at reaching his expectations, but used her assurance from him as a way of "putting down" her father. This patient vacillated between exceptional elation and unremitting despair. When I was introduced to her by a nurse, the girl's first remark to me was an elated, "What can I do for you?" She spoke of her homesickness, but shifted quickly to discussing her service in a teaching project for underprivileged children. She could not get over the betrayal she felt at being shipped by her school to a hospital, and consoled herself by saying that she must now decide alone what she was to do with her life. She talked frankly about killing herself as a way of "hating my parents and the school to death." Suicide was one way of getting out from under the tyranny of her expectations of herself and at the same time of getting back at those she held responsible for her plight.

One conversation pinpoints the crucial issue of her deification of her own self-expectations. In this third conversation, Miss____ talked about what she said was "really wrong" with her. She said:

"I've tried to be God and I've expected other people to be God. When I couldn't make it, nothing was worth anything. If I could not be God, I didn't want to be anything. When I was in high school I won all the honors and did not expect to do so. I was surprised, but when I got to college, I thought there was nothing I couldn't do. Then I turned up with above-average grades but not perfect ones. This destroyed me.

"I also had a minister who I thought was a god. He could do no wrong. He was everything--savior, lover, everything--to me. Then when I didn't do as well as he expected me to, he just cut me off. He led me to believe that my intelligence was so great that I could do anything. When I didn't make it, he just cut me off."

She said: "I didn't want to be human. That is not good enough." We talked about the courage it takes to be neither less than nor more than human. It was a thorough discussion of the "importance of being human."

The crucial issue in this chapter is twofold: the true nature of the Eternal and the acceptance of the limitations of our humanity. The problem is far more than that of accepting ourselves as sinners in the face of forgiveness. This is a problem we shall discuss in a later chapter. The problem of the idolatry of the self is that of accepting ourselves as human--limited in power, in time, in space, in everything. When these limits are denied and rejected, whatever forms of religion we have become sick. Religion becomes a tool of our basic rejection of our human condition.

PASTORAL APPROACHES

The pastoral care of a person bound to a loyalty less than God is not one of harshness. When the finite powers an individual has trusted fail him, he is likely to become religiously sick if he has taken religion at all seriously in the first place. As a result, he is shattered along with the confidence he has placed in the idol that possesses him. A shattered person does not need further shattering. What does he need?

Comfort and Catharsis

The first prerequisite of a pastoral relationship is that of the pastor's taking the role of a comforter in the face of the disillusionment brought about by the collapse of the idol. The twenty-one-year-old young man who feared for the safety of his sisters was suffering from a collapse of his hopes that his father would ever come to his senses and bring some degree of encouragement to him as the firstborn, a son with a birthright that was denied him in the preoccupation of the father with the sisters. The son felt permanently denied a place of his own in the family. The objective of pastoral care of the young man was to establish a relationship in which there would be an absence of competition and to give him individual attention. This provided a comfort that was more than superficial "cheerleader"-type words. The importance of fixed times for visits gave the patient points in time to which he could look forward. The experiences of life had unhinged the patient's orientation to time, work, play, and sleep. Medication and electroconvulsive treatments were employed by the physicians to restore these. Psychotherapy was instituted by the physician after the ECT was concluded. Reeducating the parents and creating the opportunity for completing college were tile tasks of the social workers. The task of the pastoral counselor was that of giving his undivided attention and comfort to the patient as these other therapies took place, plus allowing the patient opportunity to feel free to pour out his complaint to God. The infinite God was portrayed as one who can bear with affection the darkest feelings we have to express.

Thus a catharsis of the patient's feelings of disillusionment, injustice, and disappointment could be expressed. Also, he confessed that the illness itself was pleasant in that this way he could really be "Daddy's little boy" and have first place in Daddy's attention. Such confession and subsequent insight comes only through disciplined listening that enables a person to speak his or her most private thoughts without fear of pastoral probing.

Confrontation of the Constricting Powers of Idols

When patients are convalescing from an acute psychotic episode, they, like surgical patients, tend to want to "sort out" what happened to them, how they feel about the past, their treatment, and the future. At this time, if the pastor has had an effective and faithful relationship with the patient during the episode, he has an opportunity to philosophize with him about the nature of his primary concerns in life. The pastor runs the hazard of just replacing the idols of the past with an idolatry of himself. Both this possibility and previous constrictions on the life of the patient can be challenged and confronted. This the pastor is in a position to do during the rebuilding of the realistic confidence of a patient during convalescence.

For example, the young man who was waiting for his father's inheritance to be his was confronted very frankly with the fact that his aging father would indeed die sooner or later. Decision on the son's part now toward becoming self-sustaining in his own right could not but make for more self-confidence when the father's death did take place. Just to sit and wait for someone to die drains the present of meaning and casts a shadow on the hopes one has for the future. Encouragement of each move toward the patient's effective mastery of his own job was part of the positive reinforcement of a nonidolatrous kind of functioning. As Rudolf Dreikurs has said: "Deficiencies are not eliminated by being emphasized. One cannot build on weaknesses, only on strengths." The process of encouragement is more than kindness; it is constructive reinforcement of the strongest and most positive intentions of the person as a whole. (Rudolf Dreikurs, M.D., Psychology in the Classroom, 2d ed., p. 97; Harper & Row, Publishers, Inc., 1968.) In Judeo-Christian values, encouragement--according to Chaplain Myron Madden--is the power to bless, to invest belief in a person in such a way that the person feels it to be genuine.

Therefore, the pastoral challenge is to discover with the person the real strengths of his life and to concentrate on these, not his deficiencies. Real strengths are an individual's direct contact with his true self and with a nonidolatrous loyalty in life.

Frank Discussion of the Nature of God

The minister's primary responsibility is to know God and to speak frankly and without glibness of him. Working with the religiously sick focuses this responsibility. I recall a seminar with a group of senior psychiatric residents at an Eastern Seaboard hospital. The first question was asked by a young Hindu resident. He said, "What is it that you do in relation to a patient that a psychiatrist does not do?" I replied: "I, when I am introduced to the patient as a pastor or a minister, always represent God. The psychiatrist may occasionally do this by choice, but the minister does so of necessity when he is presented or presents himself as a minister." "But," replied the Hindu doctor, "which God do you represent? There are many." I replied: "The God I represent to the patient is the patient's God, and there are many. My first task is to discover who and of what nature is his God." The Hindu physician pressed further, "But what is your God like?" I replied: "My God is like Jesus of Nazareth, but this does not mean that I can assume that everyone else's God is the same as my own. These differences are the stuff of our conversation. I will learn as well as will the person with whom I converse."

Frank discussion of the nature of God is a part of the later phases of a patient's care by a minister. The beneficent restoration to a reasonable pattern of conversation is the end intention and desired result of intensive psychiatric treatment. The restoration of a rational, realistic perception is one of the healing results of psychiatric treatment. As one doctor said, "The doctor's job is to help people see straight, and the minister's job is to see to it that they are looking at the right God when they seek to be religious."

For example, the suicidal patient mentioned above, when faced with the possibility of leaving the hospital, became apprehensive about whether she would attempt suicide again. She said: "I am trapped. I don't want to return home and I don't want to stay here. Suicide seems the only way out. I wonder if God can forgive me for what I have done and am thinking about doing." When asked, "Which God is that?" she replied, "The Almighty God." I told her that this God could forgive her and enable her to find other alternatives for living. I explained that the god of her own need to be perfect could not be forgiving the way the Almighty God can.

In a letter she wrote after her return home, she said: "I'm finally on the road to recovery. I finally admitted to myself and others why I wanted to die--actually I did not want to die. I wanted someone to care and I needed to change some things in my life and suicide offered 'the easy way out."'

Another patient, in speaking to a group of chaplains, said: "Go easy on how you tell us that God cares. Show us that you care and we'll decide for ourselves whether God cares on the basis of what you do!"

IN SUMMARY

This chapter has emphasized the ways in which the substitution of a limited, finite loyalty for an ultimate, comprehensive concern is for all practical purposes a false center of idolatry. This, in turn, produces a disturbed balance in the whole life. Bereavement, preoccupation over the family inheritance, and deification of the self as perfect were chosen as clinical working models for demonstrating the sickness of religion known as idolatry. Specific pastoral approaches of conflict and catharsis, confrontation, and frank discussion of the nature of the God of reality were described in some detail.

IDOLATROUS CONSTRICTION leaves much of life unattended. The "ghostly" gods of the dead, of the finite hopes of inheritance, and of one's own imagination of his own perfection leave untapped the possibility of an abundant life for an individual. Life is wasted. One negative side effect of such constriction is the development of a life of superstition. The world becomes populated with omens, signs, and other mysterious connections that control life. In order to counter and manage these mysterious forces, magic--incantations, rituals, and superstitious ways of thinking--must be developed as antidotes. These magical formulas, for all practical purposes, become a way of life. When this process takes place within the culture of a religion such as Judaism or Christianity, the forms of these faiths that are most persuasive become the vehicles of the feeling of fate. For example, the following case material is illustrative of what I mean:

A forty-eight-year-old man was a devout and active member of a Disciples of Christ Church. By occupation he was a public school teacher. His wife was also a public school teacher. Both of them held positions of leadership in their church. They had made a vow when they were married that they would never have children. They did not want to perpetuate their two families' histories because neither of them was proud of the family that produced them. They were both "heredity buffs" and felt that heredity was the cause of much or most of human ills. They chose to devote themselves to teaching and church work rather than to have children of their own. The husband was a very dependent man and the wife was a very motherly person.

Their adjustment to life enabled them to accomplish much good in their small city community, and they gave of themselves liberally to the needs of other people. This worked quite well until they discovered that the wife was pregnant at the age of forty-seven. She brought the child to full term and delivered a beautiful baby girl.

They took separate approaches to the coming of the child. The wife and mother spent her full time in caring for the child, having quit her job and lost her interest in the work of the church. She was so absorbed in the care of the child that she more often than not had no meals prepared for her husband when he came home from work. They took separate bedrooms so that she could give full attention to the child at night without disturbing her husband's sleep.

The husband, in turn, redoubled his efforts in school work and church work. He sought to make up for the difference caused by his wife's loss of interest in the works of the community. He became intensely interested in studying theology with especial interest in the Second Coming of the Lord Jesus Christ. He began to doubt that he was a Christian at all and he sought reassurance from everyone that he had not committed "the unpardonable sin." He began to lose sleep and to refuse to eat until "Jesus comes," It was at this point that his pastor and his family physician sought psychiatric consultation and hospitalization for him.

This couple's situation represents not only a serious value upheaval occasioned by the advent of the child. As a couple, they represent the difficulty of reorganizing one's values at middle life when those values have already been established on unrealistic and even neurotic bases. The process of treatment took into consideration the necessity of psychotherapeutic reorganization of the goal structure of these persons' lives as well as their support as a family as they adjusted late in life to the radical event of childbearing.
The symptomatology presented by the husband, however, is illustrative of the magical use of religion to ward off impending doom. Religion became a means of incantation of the sense of impending destruction the man felt. In a real sense, the world which he had constructed had come to an end. The underlying fear that compelled him was the fear that, inasmuch as his world had come to an end, he would kill himself. This was the unpardonable sin he feared committing. Facing this in a protected environment was a part of his recovery.
Superstitions and the magical use of religion can be valuable in the diagnosis of the disorders of the patient, according to Draper and his associates. They should not be brushed aside as insignificant. Neither should they be taken as an authentic representation of the validity or invalidity of the particular living religion whose symbols they use. Rather, they should be viewed as a sick use of the religion-a time when religion becomes sick. In other words, one of the times religion becomes sick is when the accidents, the uncontrollable events and the inevitable demands of life call for acceptance of changes and responses to growth that the individual cannot maneuver, manage, nor accept. He then resorts to placation of evil spirits, magical incantation of the "powers" that control the "shape of things to come," and develops elaborate explanations of his behavior in terms of the religious symbols he has been trained to use. The end result is what the behavior therapists call "odd behavior."

This couple's situation represents not only a serious value upheaval occasioned by the advent of the child. As a couple, they represent the difficulty of reorganizing one's values at middle life when those values have already been established on unrealistic and even neurotic bases. The process of treatment took into consideration the necessity of psychotherapeutic reorganization of the goal structure of these persons' lives as well as their support as a family as they adjusted late in life to the radical event of childbearing.

The symptomatology presented by the husband, however, is illustrative of the magical use of religion to ward off impending doom. Religion became a means of incantation of the sense of impending destruction the man felt. In a real sense, the world which he had constructed had come to an end. The underlying fear that compelled him was the fear that, inasmuch as his world had come to an end, he would kill himself. This was the unpardonable sin he feared committing. Facing this in a protected environment was a part of his recovery.

Superstitions and the magical use of religion can be valuable in the diagnosis of the disorders of the patient, according to Draper and his associates. They should not be brushed aside as insignificant. Neither should they be taken as an authentic representation of the validity or invalidity of the particular living religion whose symbols they use. Rather, they should be viewed as a sick use of the religion--a time when religion becomes sick. In other words, one of the times religion becomes sick is when the accidents, the uncontrollable events and the inevitable demands of life call for acceptance of changes and responses to growth that the individual cannot maneuver, manage, nor accept. He then resorts to placation of evil spirits, magical incantation of the "powers" that control the "shape of things to come," and develops elaborate explanations of his behavior in terms of the religious symbols he has been trained to use. The end result is what the behavior therapists call "odd behavior."

Chance and Accidents in a Religious Person's Mind

Underneath the patient's behavior is a world view that all behavior is determined totally by God, that there is no such thing as a chance of more than one outcome for any given situation, and that even within the variety of directions a course of events could take, there is no such thing as the fortuitous "break" of events in which accidents change the whole direction of a given history. William Pollard, the executive director of the Oak Ridge Institute of Nuclear Studies, says that "there are two sources of indeterminacy in history. One of these is chance." By this he means "the available alternative responses to a given set of causative influences." "Another source of indeterminism in history ... is accident." He uses "accident" to refer to situations "in which two or more chains of events have no causal connection with each other.... The accidental does not depend on the presence of choice and alternative in natural phenomena." (William Pollard, Chance and Providence, pp. 73-74; Charles Scribner's Sons, 1958.)

At the core of superstition and its rituals of magic is the assumption of a hidden purpose, which we can determine if we will just perform the right act in the right way at the right time. Thus everything becomes controllable and every outcome is predictable; we can be secure because what is going to happen has been decided by our behavior. We have nothing to worry about now. The risks of the future have been charted, precautions taken, and we are safe.

As Levy-Bruhl said of the primitive mentality much earlier: "Nothing ever happens by accident. What appears to us Europeans [and Americans] is, in reality, always the manifestation of a mystic power. . . . There is no such thing as chance to a mind like this, nor can there be. Not because it is convinced of the rigid determinism of phenomena ... it remains indifferent to the relation of cause and effect and attributes a mystic origin to every event which makes an impression upon it." (Lucien Levy Bruhl, Primitive Mentality, p. 43; Beacon Press, Inc., 1966.)

My own basic premise is that among even sophisticated Americans exposed to the popular nuances of Judaism and Christianity, a subterranean flow of this same kind of superstition about mystic origins of events "indifferent to the relation of cause and effect" is at the heart of much sick religion, especially among the mentally ill. The rituals that are cautiously developed are seemingly senseless. But they are calculated to take the risk, the unpredictable, and the unknown out of life.

Little wonder is it that prudential ethics have been built on cultural mores that are calculated to make us healthy, wealthy, and wise. As Paul Tillich has said, the risk element has been removed from a legalistic morality of safety. A morality of adventure calls for taking risks, the courage to move into the unknown. The prophetic faiths call for this element of risk and the capacity to absorb ambiguity and unpredictableness. Yet the religion of superstition and magic works to control and obliterate the unknown and the risky by the legalisms, the taboos, the rituals of incantation, and the obsessive acts that are developed as magical controls.

When we see the histories of mental patients from conception to maturity, we see even at the point of conception the variables of heredity. These are not nearly so predictable as we once thought. In the process of prenatal development, chance and accident coexist with predetermined course. In the development process after birth, the great transitions from one era to another are crises of necessity and possibility interacting with each other. Even in later years of maturity, cerebral changes take place that are the end result of chance, accident. They are seen even legally as "acts of God," when in reality they are not.

My hypothesis is that religion becomes sick when a person loads the whole responsibility for these "thrown situations" entirely upon God and thereby thrusts the whole responsibility for changing the situation upon him. Thus God becomes the ghostly visitant of all the thousand mortal ills the flesh is heir to. Patients' rituals are their efforts to placate the caprice of their god to change the situation. Into the mythology of this set of beliefs flows the flood of religious symptomatology we deal with in the religiously sick. Usually these patterns of religious behavior have been taught the person from infancy. The kind of religion described here was used as positive reinforcement of approved behaviors by parents, grand parents, pastors, and teachers. It was also used as taboo, punishment, and negative reinforcement of disapproved behaviors, ideas, and attitudes. Usually persons suffering from this kind of sick religion have been suffering so for a long time, and the demands of maturity have brought a chronic situation to crisis.

This forty-three-year-old woman is an assembly-line worker in an electronics company. She has a high school education plus one year of college. She is married to a man who is her own age, an auto mechanic, a veteran of World War II and given to periodic times of drunkenness that interrupt his work and have at times resulted in his losing his job. They have no children, having lost their first and only child fourteen years prior by a premature birth. They live in a house for which they are paying, but the bills are paid from the wife's income. Both husband and wife are Protestant, but belong to different denominations. Hers is very strict concerning attendance at movies, dancing, drinking, and smoking; his is much more flexible about these things.

Presenting symptoms. In the patient's own words, she says: "I can be in church and get fearful, almost like I'm leaping over something--like I'm thinking or trying to think evil and bad thoughts. The first time it happened most severely was during the Lord's Supper. I was afraid to drink and afraid not to. I remembered what the Bible says about eating and drinking 'damnation' to yourself. I felt I would die before I got out of there if I did the wrong thing. I've felt this way at funerals and in church. I'm so afraid that I'll think a blasphemous thought, I get beside myself. I stay depressed for days, crying much of the time.

"If it is Satan, I know the Lord will see me through. When I'm tempted, I use affirmations of Scriptures and hymns, but Satan even attacks me through them. I say to myself: 'Do this!' Is this a premonition or mental telepathy or something? I've been doing it for years."

The longer term history. For three years after her birth the patient lived with her parents. She has one younger sister. The mother divorced the father because of alcoholism when the patient was three. Each parent went to his parental home, taking one of the children for the grandparents to raise. The patient went with the father to the paternal grandparents. The grandmother was in her sixties, a very, very religious woman, and used religious beliefs about the end of the world, the displeasure of God, and the ever presence of the devil as a means of disciplining the patient as a child. As the patient became older, she worked and prepared all year round for excellence in the youth activities of her church. She joined the church when she was nine years of age. She says: "During this time I read my Bible but would be frightened by the thoughts of 'before' and 'after' time. I made myself afraid with the thought that the world would end. I would become afraid when I read the book of Revelation.

"I lost time in school (nearly two years) for being too nervous to go. Measles, mumps, whooping cough, and bronchitis were all mine. I remember little of this except a sign in the doctor's office that read:

Go nowhere you wouldn't want to be found when Jesus comes;
Say nothing you wouldn't want to be saying when Jesus comes;
Do nothing you wouldn't want to be doing when Jesus comes.
"I finished high school and married two years later. A year later we lost our little girl because she was premature and because of my unbelief. I always thought the world would end before I had any children. We still don't have any. My sin."

This patient has made repeated professions of faith in revival meetings she has attended. She struggles with cursing thoughts against God, thoughts like those her husband expresses in his drunken rages.
She refuses to be critical of her husband, to face the possibility of her marriage breaking up, or to come to grips in face-to-face discussion with him about the painful aspects of their relationship. She denies problems of a causal nature arising out of the habitual patterns of discipline set by her grandmother, or those arising out of her feelings of injustice in relation to her husband. Instead, she seeks more and more religious rituals, reassurances, and ruminations to ward off the fears that beset her.

The program of treatment. This patient was hospitalized for a period of three months. Chemotherapy, electroconvulsive therapy, and subsequent psychotherapy were used during her hospitalization. She was involved in social group therapy and learned to participate in many recreations she would have refused in her natural habitat--dancing, playing cards, movie attendance, etc. She never expressed negative emotions except through the "nuisance value" of her repetitive religious ideas. To the contrary, she was unusually sweet and protested forcefully that she "loved" all people. Yet she despised and loathed herself as unworthy of man's or God's approval. She was seen regularly by a pastoral counselor during hospitalization.

The patient was dismissed with a guarded prognosis and a plan for continued contact. She was improved to the extent that she could do her work without difficulty.

The follow-up history. A plan was established for the patient to see a pastoral counselor in her neighborhood on a regular and formal basis. This relationship became a regular emotional nutriment to this deprived person over a period of five years. The pastoral counselor was in constant contact with her family physician, who supervised medication for the patient.

In her spare time, the patient started back to college with her husband's full support and consent. She received her college degree and took a job as an apprentice in a social welfare agency. She continued her religious interest but found attendance at most churches a burden to her. She listened to TV religious programs but was made fearful, sleepless, and apprehensive by going to church.

A second major episode in her illness occurred when the pastoral counselor to whom she had regularly gone left the area. This was concurrent in time with her medical doctor's advice that she have a complete hysterectomy. She was so agitated that she was referred to a nearby psychiatrist for psychotherapy and returned to this author for pastoral guidance and consultation. She successfully underwent the surgery and yet not without a heavy recurrence of her religious preoccupation. This went somewhat as indicated in her own words in the above account. The precise habits of thinking were repeated almost verbatim. The most significant addition was: "You should see how well I can take antidepressants and cry at the same time. If crying could heal, I'd have been well long ago for I've cried a river. Also, I'm still plagued by the idea that not going to church is turning from Christ, which I don't want to do. At the same time, I have the feeling that just going to church is just trying to be 'religious.' . . . I used to use magic to keep things from happening that I didn't think I could cope with. I wouldn't talk of things that scared or upset me for fear they would happen."

The patterns of treatment that have been used with this patient over a period of six years have been unevenly effective. Her molds of thinking and behaving remain existentially the same--unhappy, inwardly torn, and fearful in relationships. Her basic function as a worker in production lines and in school has been even except during the two periods of hospitalization, one for a depression and the other for the gynecologic surgery. The most recent episode was intimately related to the coincidence of both the menopause and the need for a hysterectomy.

Yet the religious sickness, consisting of a "ghostly" conception of God, elaborate religious mythologies of the end of the world, and a confessed feeling of need for magical practices to ward off evil, remains essentially unchanged in spite of extensive pastoral counseling by the author and another trained pastoral counselor.

End-Setting or Transfusions of Ego-Strength

Gerda E. Allison, M.D., reports the case of a thirty-five-year-old woman who was reared by an extremely demanding, controlling, and perfectionistic mother and a father who submitted to the mother's controls in every way except in his pursuit of a very fundamentalistic religion. The patient's mother died when the patient was twenty-five and she and the father developed a very close dependency upon each other. The patient refused marriage to a young doctor because the suitor would not "go along" with her own and her father's strict religious beliefs. Then, while the patient was away on a special teaching assignment, the father rather suddenly married without conferring with his daughter about it. He died of tuberculosis about three months later. At this time the patient became anxious and depressed. She sought psychiatric help. As to treatment, Dr. Allison says that lie did not attempt to deal with the underlying dynamic material. Rather he used supportive therapy and encouraged her to express "her negative feelings toward God and her father in a rather oblique manner." He enabled her to build up her defenses and this allowed her to continue functioning in her work as a "conscientious but somewhat rigid head nurse." He says that she has maintained community with her religious group where she attends revivals, "where she obtains regular transfusions of ego strength." (Gerda E. Allison, M.D., "Psychiatric Implications of Religious Conversion," Canadian Psychiatric Association Journal, Vol. 12, 1967, pp. 57-58.)

There is an indirect evaluation of the revival here as a source of ego strength. I have observed this to be true in some instances and I am glad to have this confirmed by an unbiased observer. However, in the instance of the patient whose case is reported from my files, this was not true. She received her transfusions of ego strength from counseling sessions with a pastor. Yet in both instances, when we speak of this condition of replenishment of the ego that has from early childhood been deprived and rejected through the use of religious symbols, we may be confessing that there is such a thing as permanent emotional handicap that can be offset by such "transfusions of ego strength." We are not involved here in curing a patient, but in making a handicapped person useful to himself and other people.

A second case, that of a twenty-year-old patient, demonstrates the interaction of superstition, magic, and sick religion in the life of a man and his family.

For two years the man had been under psychotherapeutic outpatient treatment for phobic behaviors about eating, driving a car alone, and other fears clustering around his master fear of dying. He found that if he did not carry through his magical rituals, God would "zap" him, strike him dead.

A psychiatrist and a pastoral counselor treated him as cotherapists upon referral to them from a pastoral counselor and a psychiatrist in another state when the man changed his residence. The two professional persons in that state had not seen the patient at the same time. The magical rituals were, in effect, declared off limits for discussion. The superstitious character of the religious ideation was identified as superstition, not true religion. The basic vocational, marital, and realistic religious issues in the man's life situation were then confronted by the patient with psychiatrist and minister together in the same interview situation.

End-setting procedures were inherent in the time situation itself and the patient was not allowed to adopt "treatment" as a way of life. Rather, decisions were expected of him. His wife was involved in the treatment situation and was cooperative in the process. Life decisions were reviewed at an adult level under supervision. In the course of thirty interviews a new "life space" was discovered that gave both the man and his wife breathing room. The symptoms diminished in their intensity and number. In times of uncertainty they were reassessed by the patient as memories rather than as present events. When a crisis would come, the symptoms would reactivate until the crisis was past and then they would fall into the realm of memory again.

The value of joint therapy by minister and psychiatrist stands out as a plus feature of this second case. The value of an implosive "breakthrough" of the "odd behaviors" as magical rituals for a basically superstitious person and not as objects for continuous rumination even in psycho-therapeutic interviews was evident in the case, at least. The value of time-limiting of the therapeutic process, lest the "game" of psychiatry or religion--as the case might be--became a substitute for life itself, was more than validated. Possibly, when defenses such as these phobias are needed periodically, they will recur, but, hopefully, the man will have a context for identifying them as magic, superstition, and sick religion--not as bona fide excuses from facing life and developing a life of faith as healthy religion.

The first case was dealt with through transfusions of ego strength. The second was focused upon an end-setting procedure. The question arises as to the relation between these two therapeutic approaches. One differentiating factor was that the diagnostic picture was different. In the case where end-setting procedures were used, the patient was primarily paranoid when he was emotionally disabled. Transfusions of ego strength were acceptable to the depressed patient, but very threatening to the paranoid patient. Other factors were drawn from the patients' developmental history. The one patient who was depressed had been rejected and deprived in her early life. The other patient had been pampered and overindulged in his earlier life. In the first patient, feelings of helplessness and powerlessness were stimulated by fears, magical feelings, and superstition. In the other, the manipulative cleverness of the patient was stimulated by similar fears, feelings, and superstitions. The one experienced feelings of worthlessness and the other experienced feelings of limitlessness and omnipotence. These were some of the bases of importance in making the decision between end-setting and transfusions of ego strength. A final one was the presence or absence of the suicidal possibility. End-setting procedures would be risky indeed with a person who was potentially suicidal.

Case Studies of Magic, Superstition, and Religious Healing

Records of the "magical response to superstition" expressions of sick religion have been recorded in some of the journal literature. Extensive studies of magic, faith, and healing have been published by psychiatrists who work in cross-cultural contexts and have to relate themselves to primitive attempts at psychotherapy, folk psychiatry, and contemporary American uses of persuasion in healing.

Most of these studies refer to the inclusion of primitive religious ideas and practices in the life pattern of persons of cultural and/or racial minorities in a technological society. For example, Ari Kiev studied the delusions of ten West Indian schizophrenics in English mental hospitals and found religious and magical themes that were taken from the layers of fundamentalist use of the Bible and ghost cults from their West Indian backgrounds. (Ari Kiev, "Beliefs and Delusions Among West Indian immigrants to London," British Journal of Psychiatry, Vol. 109, 1963, pp. 356-363.)

With the movement of Southern rural Negroes into industries in Northern cities such as Rochester, New York, and Chicago, patients have been observed to use the "root work" of their primitive, self-help magic to allay the anxiety and despair associated with illness. In nine cases of criminally convicted but apparently psychotic Negro patients from the Bedford-Stuyvesant area of New York City, Bromberg and Simon found--with the work of Negro psychiatrists--an overlay of "to be expected" psychotic material: delusions, illusions, grandiosity, mannerisms, etc. But underneath these were somewhat coherent evidences of a thoroughgoing break with the patients' upbringing, with the Caucasian values of their general milieu, etc. These expressed themselves in "identification with the Islamic religion, fragments of voodoo practices, and an outright avowal of the Yaruba religion. What appears to be grandiosity and paranoid coloring of the productions of these patients derives directly from the 'primitive' religions and ideologies which function as a protest against centuries of domination by Caucasian values ... the ego has not undergone sufficient impairment to justify a diagnosis of psychosis." (Walter Bromberg, M.D., and Frank Simon, M.D., "The Protest Psychosis: A Special Type of Reactive Psychosis," Archives of General Psychiatry, Vol. 19, No. 2 Aug., 1968, pp. 155-160.)

The objectivity required to study magical and superstitious uses of a living religion by exponents of that religion itself is almost if not entirely nonexistent. The following autobiographical account is an example of the way in which superstition can saturate the symbols of a living religion, issue in magical counteractions on the part of the person, and result in a pathological religious orientation to life. This woman spent three months in a mental hospital:

Being a young, Christian, blood-washed, redeemed, Child of God of nine months, I was not content to grow in the knowledge and grace of the Lord, I had the desire to run headlong down the narrow path and it almost led to my spiritual destruction mentally. Through not relying on the promises of God in His inspired Word, the Bible, I was willingly led (through demon possession of the mind) to an entirely new and different church group, entirely new as of the last fifty or so odd years as a supposed church. I had never doubted my salvation because I was completely delivered from alcohol even as far as the desire, proving that when the Lord Jesus does a thing, He does it right.

However, Satan, whom I found out I was no match for, knew that Jesus had taken over my heart, and there was no room for the devil, so he tormented me with all kinds of little things in my mind, thus robbing me of the joy of my salvation mentally. Because of my convinced knowledge, based on the promises of God's Word, that once saved always saved, and that God is not slack concerning His promises to a child of God, washed in the blood and covered by the blood, and that eternal life is a GIFT from God, and that God is not an Indian giver, but the Almighty Giver of life everlasting, I became overconfident, using my salvation as a crutch with the idea that I couldn't really do anything that was wrong, because Jesus was my Savior and I knew it.

It was when I had gotten to that state that I started to walk by feet and not by faith. So these demons convinced me that I still didn't have a full experience with the Lord God. Thus I followed the direction in which these seducing spirits of Satan were pulling me. When inside this so-called church building, the power and friction in the air was terrific. This convinced me only more that I was led to the right place, and by the Holy Spirit yet! Then the call was given for anyone who had a testimony for the Lord. I was nervous and shaking inside; nevertheless, I stood up facing the congregation and said, "Jesus is the way and the truth and the life, and I know He is because I know," and then is when it happened.

I was filled with an ice cold air and I was froze (as it were) on my feet with my mouth open. This air came from the direction of the altar, and I was so numb that I couldn't sit down for at least three minutes. I just couldn't understand this, because I had so much to testify about my Lord Jesus. When I questioned others after the service they told me that it was an experience with the Lord, and that He was trying to reveal something to me, and that I must search the Scriptures to find out the answer, they couldn't tell me. They also said that this meant that I was close with the Lord and that He more fully wanted to use me as a servant and give me a gift. Now I was really confused, which is exactly what Satan had planned to do.

Now even though these demons were trying to absolutely convince me of the realness of this thing, Jesus was tugging at my heart because he knew I didn't know exactly what I was doing, yet I still had my own will, and he wasn't going to force me into coming out from among them. What a war was going on inside my mind for the space of two weeks. At home I walked around like I didn't know what I was doing and I was beginning to greatly fear as though I were some kind of criminal or something. It began to be noticeable [sic] to my friends. But do you know that those demons were so powerful, that they convinced them, through my mouth and out of curiosity [sic] to also go there to witness this thing. I almost denied my Lord Jesus, and caused others to do so too. 0h, how I have repented for my lack of faith, through willing ignorance. Satan made a fool out of me for his own sake, but Jesus has lifted me up again with his love through God the Father. He is truly Lord of Lords and King of Kings.

Satan had almost succeeded in planting a permanent seed of doubt in my mind with on-and-off-again salvation, trying to hold me in the bondage of fear. This type of religion so presents itself as the real thing that it is the perfect counterfeit of the day. I should rather have my feet cut off than to enter under the roof of any such establishment.
But now that I know this by the Grace of God, and especially that God is not the author of confusion and cannot lie, I will by the grace of God be content to grow.

These poor souls that are being used by Satan are in reality dedicated and sincere. But they are dedicated to Satan and sincerely wrong. I speak of them as poor souls because the Holy Spirit within me is grieved because of their willingness toward deception because even though they themselves are ignorant of the Truth, God will hold them accountable because there is no excuse. These seducing spirits had taken over my mind and my members so much that I no longer even had control over my voice. The Scripture that came out of my mouth was true, but my voice deceived me. Outside I was a lamb, outside of the demon control, but inside I was a raving wolf. The way this was proven to me was by a Scriptural statement I made concerning the body, soul, and spirit, out loud in that demonic voice, which proved to be a WRONG statement. That was, I knew that it was no Holy Spirit voice. Besides this evidence, that afternoon at home I became taut and tight inside all over and when I tried to relax, it just got worse. My mouth began to open slowly as by force until it was stretched open so far that I moaned with pain and called on Jesus, still not knowing what was going on. My hands seemed to get numb and rise slowly before me as if by force and I was so afraid that I hardly dared move at all. However, the worst part came when I tried reading the Scriptures aloud and laughed and talked real fast like a 33 1/3 r.p.m. record playing at 78 r.p.m. speed. It was then that Satan told me I could heal myself of this fear and that the Lord had given me the gift of healing. I even believed this lie and looked around for some sore or abraised spot on my children. But after trying this I found that it did not work. I cried out to the Lord Jesus Christ in my agony of mind and it was then that He revealed to me that I was possessed with demons. I was so blinded by these things (demons) in my mind that I didn't even know that I wasn't serving the only True God, and Savior Jesus Christ. So now back to that assembly of people. I stood before the Pastor and his wife and told them these experiences and when I confessed with tears in my eyes that I was demon-possessed they just dropped their eyes and said that they would pray for me right there and then. Now they were under the impression that they were praying for my deliverance and it would happen then. Besides this they knew from all evidence that I had shown that I was that way, but yet I still was invited back all the time there, which would have made me one of those demons too.

But I thank the Lord Jesus, and I surely do, He knew my heart and when they cried out in prayer for me, it was to get rid of me. The proof was when instead of inviting me back another time, they gave me a calling card.

Yes, thank the Lord Jesus, He didn't want me back there any more either, but Satan still left his calling card. Now though, I through the Grace of God am reminded that I must call on Jesus and plead the blood by which I am covered when I am disturbed by tormenting thoughts and He alone will dismiss these demons from the mind. The awful lump in my throat was there because I would not cry out in true repentance and until I did it was not removed.

I say true repentance, never again to do that which I had done or was doing that kept me from close communion with my Savior.

This extensive autobiographical account calls for some explanatory observations to relate it to the discussion of magic, superstition, and sick religion. The reader will note that the obsessional preoccupation of the patient with "all kinds of little things" in her mind is attributed to the tormenting of the devil and is not seen in any sense as empirical cause and effect. Tactual feelings of power and friction in the air, being filled with ice cold air, the loss of control of the voice, numbness of the hands, etc., are described by the patient. The somatic involvements of religious experience weave themselves into a magical explanation and lead to the demand for a magical solution. Most often, this woman explained these as invasions of the devil into her being. However, one wonders how much effect the biochemical therapies would have on these tactual responses in removing the need for magical explanations and magical solutions. The pastoral counselor would then be in a position to discuss the person's relation to God and Christ without the impediment of at least this portion of the superstitious frame of mind of the patient. Here pastoral counseling and medical treatment have their nexus.

Another observation is how the patient moved toward the minister and his wife, was apparently appreciative of their prayers, but then began to associate them and their giving her their card with the devil who "left his calling card." The pastoral counselor may as well be prepared to become a part of the evil side of the patient's delusions. He may well be cast into the role of the persecutor or the tempter or even, as in this case, the devil. Staying on the brighter, more benevolent, and friendly side of the patient's delusional structure is difficult indeed, and often impossible. The couple to whom she talked seemed to have been overwhelmed by the patient's strangeness. They may not have had the advantage of the knowledge of the patient's whole religious outlook that her autobiographical account gives the reader here. If they had, they could have built upon the healthier ideas that she presented, such as her struggle to rely upon the grace and love of God without so much personal effort on her part. The act of giving the patient their calling card was interpreted literally by her and apparently served to break the relationship. The Lord Jesus is interpreted by her as not wanting her back there anymore.

The task of a spiritual director in this person's life would be to establish and maintain a durable relationship to her-in short, to stay by her through thick and thin. Yet the very nature of the illness itself caused her to break relationships. Once established, such a relationship would be the touchstone of reality that she needed. This points to the need for a pastoral strategy based on a good theory and developed into a wise practice for dealing with magic and superstition in religious experience.

Theories of Magic, Superstition, and Religious Healing

Several theories as to the interaction of magic, superstition, and religious healing have been advanced by research persons in the area of culture and personality.

Personal Response to Acculturative Stress

David Omar Born has proposed that these sick forms of religion are caused by the individual's effort to respond and grow under the stress caused by the conflict between an older, more established culture into which one is born and in which his habits are formed and a newer, less established culture into which he is moving, by reason of education, generation gap, and technological adjustments being made. He says that in the face of the stress created, a person may go in one of four directions: First, retreatism, a return to or the conscious preservation of traditional patterns, and resistance to new patterns. Second, reconciliation, or attempting to "strike a happy medium" of combining both the traditional and the new. Third, innovation, or the complete acceptance of the new patterns and the conscious rejection of the traditional. Fourth, withdrawal, an overt rejection of both the traditional and the new. This denial of both is the mechanism of defense.

In all but the first mode of adjustment, the possibilities of the person's becoming sick are present because he takes the risks of change. He can easily become a "marginal" man caught between things old and things new. His religion, when seen as a conserving, maintaining, and continuity-giving force in his life, becomes a symbol of his heritage, with which he must stay in touch. On the other hand, if his religion is at the same time prophetic and bids him have done with the bondage of the past, it may introduce a conflict of "fever-level" proportions that results in his illness as a person. (David Omar Born, "Psychological Adaptation and Development Under Acculturative Stress," unpublished paper, Southern Illinois University Department of Anthropology.)

The symbolic beliefs that a person brings over from his original culture continue to exert emotional "unreason" over his life despite the intellectual overlay brought by education, technological cause-and-effect training, and the like. The patterns of thought and behavior ingrained as fears into the patients described above tended to operate habitually in spite of attempts to "reason" with the patient. These patterns themselves can be disengaged, isolated, tranquilized, or dissociated in such a way that the persons can work, eat, sleep, and carry on the daily rounds of their lives, but some specific reeducation of the patterns of behavior themselves must take place if they are to be identified as being from the realm of magic and superstition. The findings of the behavioral therapists can be first fully focused upon these phobic personalities' needs.

Superstition and Magic as a Conditioned Response

B. F. Skinner has set forth the theory that superstition is the accidental connection of a given reinforcing stimulus with a given response: "If there is only an accidental connection between the response and the appearance of a reinforcer, the behavior is called 'superstitious.'" (B. F. Skinner, Science and Human Behavior, p. 85; The Macmillan Company, 1953) This raises the issue of what kind of rewards and punishments go with the belief of such religious persons as have been described in this chapter. We know that one of the patients was rewarded with approval for holding faithful to the beliefs. She was punished with the belief if she disobeyed her grandmother. In adult life, holding the beliefs gave her membership in a church group, and rebelling against them denied her fellowship and left her isolated.

Persuasion, Illness, and Healing

A related but distinctly different concept of the power of superstition and magic is that of forced indoctrination, more popularly known as "brainwashing." William Sargant has done the most thorough work on forced indoctrination. He comments that the theological improbability of eternal punishment is less frightening to people today than to those of Charles Finney's day. Yet the threat of hard labor for life in a Communist prison camp can produce results similar to those of Finney in their power to change the mind. (William Sargant, The Battle for the Mind, p. 141; Penguin Books, 1957.) It may be added that the fear of mental illness itself is an even more subtly powerful threat in the culture of America today.

Jerome Frank has identified the element of persuasion and thought reform in modern psychotherapy as an essential part of the ability of the psychiatrist. He says, "Although the psychotherapist may state his interpretations in neutral terms, many are nevertheless covert exhortations or criticisms based on implicit value judgments." (Jerome D. Frank, in Ari Kiev, ed., Magic, Faith, and Healing, p. xii; The Free Press of Glencoe, 1964.) The religious healer, likewise, must have an ideology that offers the patient "a rationale, however absurd, for making sense of his illness and the treatment procedure." (Jerome D. Frank, Persuasion and Healing, p. 60; The Johns Hopkins Press, 1961.)

On the one hand, then, the empirically-minded student of sick religion is faced with the reality of persuasive and even magical formulas in the belief-value system of the religiously sick person. On the other hand, he comes up against the rather elaborate value systems and ideologies of the psychotherapists. When the student understands both systems well, he knows that they overlap considerably. If he is a scientifically trained and religiously devout minister or psychiatrist, he must exist with integrity in both the empirical-pragmatic world of causal relations and the persuasive-ideological world of convincing values. How can this be?

The Existential Shift

Jan Ehrenwald says that, in the last analysis, these two conflicting worlds "derive their rationale from two contrasting sets of myths." He describes them both as having long histories, not one as "old and magical" and the other as "new and scientific." They both waver against each other as a magical vs. a pragmatic view of causality, as a sacred vs. a profane view of life, as prayer opposed to personal efforts, as the noumenal vs. the phenomenal. Ehrenwald says that the effective therapist is measured by his capacity to shift from one of these existential modalities to the other. He calls this "the existential shift" and gives the following definition of this "shift." He says:

The therapist's abrupt transformation into a hypnotist is a graphic illustration of the principle. His dramatic shift from a pragmatic to a magic level of function is predicated upon a self-imposed regression-in this case in the service of treatment....

The scientifically trained psychiatrist is donning the mantle of the magician and playing the part of the omnipotent hypnotist. It may well be that he himself is satisfied that all that is involved in such a venture is to assume a new, or rather an old-fashioned and traditionally well-defined professional role. Yet, in my experience, such role play is not enough in Order to be effective. The hypnotist must not just pretend to be playing the role of the hypnotist. He must project himself, heart and soul, into the act. (Jan Ehrenwald, Psychotherapy: Myth and Method, An Integrative Approach, pp. 145-146; Grune & Stratton, Inc., 1966.)

Yet, the clinical application of this existential shift is unresearched insofar as I can learn. Ari Kiev found a near equivalent in the Mexican-American curanderos of San Antonio. The curandero is neither a doctor nor a priest. He is not a shaman in that he does not become possessed, exorcise, or prophesy; nor are special initiations, dream experiences, or ordeals used to qualify him to help people in distress. He is a personally religious person, functioning within the belief system of the Roman Catholic Church and "his religious demeanor, untrammeled by the authority of the Church, is his paramount virtue." (Ari Kiev, Curanderismo: Mexican American Folk Psychiatry, pp. 30-31; The Free Press of Glencoe, 1967.) The curandero draws upon both the beliefs of the Catholic faith and the folk medicine empirically learned through trial and error and handed down apprentice-style from one generation to the next. He does not look askance at but even recommends medical and/or psychiatric attention if the resources of expense and willingness on the part of the patient will bear it.

Kiev concludes that many of the elements present in psychotherapy are evident in the work of the curandero. His work is preventive of some psychiatric disorders, ameliorative in others, and supportive though not remedial in others. "Curanderism," says Kiev, "is also important not only as a form of prevention which contributes to lower incidence, but as a form of treatment agency whose presence leads to a reduced flow of people going to hospitals." (Ibid., p. 192.)

Pastoral Approaches to Superstition

Magic vs. Sick Religion

The problem involved in the folk psychiatry of the curandero for both the educated minister and the psychiatrist is that neither of them can, as Ehrenwald has suggested must be the case, "project himself heart and soul into the act" of using nonrational hypnotic, and/or magical practices. Both are committed to rational interpretations of both theology and human behavior. Both are committed to a "commonsense" approach to faith and health. Both fear quackery to such an extent that they feel more comfortable withdrawing from a patient such as the "victim of seducing spirits" than to "be party to the superstition" or implementer of magical formulas. This leaves the patient with a "calling card" but no help. The rituals of both organized religion and modern clinical psychiatry suffer from a lack of concept and procedure for coping creatively with the habits of thought of patients such as those who have been described here. Yet, implicit in both sets of ritual are tools useful to a patient as defenses against recovery. The patient usually uses one set of compulsive ideas to ward off the psychiatrist and another to fend off the minister. Consequently, the illness has an economy of its own that gratifies needs and becomes a substitute for realistic living in the world as it is. Some clues from the transactional therapists and the behavioral therapists may be helpful in suggesting a new departure, at least, in dealing with these patients.

Eric Berne, in his transactional analysis, suggests that psychiatry itself can become a distance-making, change-resisting "game." The patient continues for months to recite symptoms, dreams, fears, and obsessive religious ideas. In a demanding mood, the patient then seeks "answers" as to why he or she is this way and how the problems can be fixed. In short, magic answers and solutions are required of the therapist. As Berne says, the patient feels that "if she can only find out who had the button, so to speak, everything will suddenly be all right." (Eric Berne, Games People Play, p. 156; Grove Press, Inc., 1964.) In Berne's system, a game is a transaction that involves deception, maintains the status quo, and keeps others at a distance.

The "child" dimension of the patient is one of defiance: "You will never cure me . . . ;" it is also one of substitute gratification: "but you will teach me to be a better neurotic (play a better game of 'Psychiatry')." All the while, the adult-to-adult transaction is: "I am coming to be cured." (Ibid., p. 155.) In the face of such confusion, the psychiatrist and/or pastoral counselor find the game doubly employed, in that religion is used against the psychiatrist to maintain the game and psychiatry is used against the pastoral counselor.

One effective deterrent to this complicated situation, I have found, is to have both psychiatrist and pastoral counselor sit down together in the same therapy session--after taking a careful history of attempts at therapy--interpret this game to the patient and hopefully enter a contract that the game will be called off and specific difficulties in living faced as they are, without too much attention being given to the phobias, religious superstitions, and magical formulas.

This calls for an implosion--a breaking through the symptom wall--into the underlying problem areas of work, marriage, goals in living, and ways of deceiving other people at a quite conscious level. Wolpe, one of the formulators of what is coming to be called "implosive therapy," sees this as indicated for neurotic behaviors that are associated with intense anxiety but not appropriate for psychotic patients. (Joseph Wolpe, "The Systematic Treatment of Neurosis," Journal of Nervous and Mental Disorders, Vol. 132, 1961, pp. 189-203.) The patients described above are in this category, except for episodes of depression that came at specific crises and times of gross stress. Yet the compulsive-obsessional character of the thought processes persisted after the depression lifted. The differential diagnostic skill required here imperatively indicates the need for medical supervision. Yet the magical-superstitious religion that gives content to the anxiety states cannot be coped with effectively without the presence of a trained minister who can break through the wall of religiosity with more cooperation from the patient than can the psychiatrist.

In the cases dealt with in this manner by the author and a clinical psychiatrist conjointly, the process of treatment moved forward more rapidly and certainly because the stalemate between the religious and the health defenses of the patient was broken from the outset. Running from religious rationalizations to psychological ones was futile because each could be challenged by the minister or psychiatrist as the instance required.

The behavioral therapist's use of rewards or denials in reconditioning "odd behaviors" in obsessive patients has produced some possible areas of cooperation between behavioral therapists and ministers. The Catholic system of penance has utilized negative conditioning, and an expansion of this system to include "here-and-now" positive reinforcement is an unexplored area of possible cooperation with behavioral therapists. O. H. Mowrer's point of view seems to be that the unrealistic guilt of such patients should be refocused on things they really ought to feel guilty about and then dealt with realistically. (For a thorough, detailed analysis of behavioral therapy, read Halmuth H. Schaeffer and Patrick L. Martin, Behavioral Therapy; McGraw-HilI Book Company, Inc., 1969.)

The crucial issue in all the above suggestions, however, is that of interdisciplinary collaboration between ministers, psychiatrists, and clinical psychologists. The training of each must be thorough enough that cooperative work with patients is more than being superficially courteous to each other. The therapeutic imperialism of any one of the three must be forfeited. The proud insecurities of each, resulting in promising much and delivering little in therapeutic results, must be faced and admitted.

Apart from this kind of candid collaboration, patients have turned and will continue to turn to mass-produced cultural forms of treatment. Christian Science is one of these forms and appeals directly to the need of persons for positive reassurance, fixed rituals, and a loose-knit group fellowship. The perennial appeal of the affirmations of Norman Vincent Peale is another mass approach to the repetitive need for almost if not wholly magical uses of religion. The repetitive "aisle walker" in evangelistic crusades is another example of the way large numbers of people born and reared in the revival tradition turn to the ritual of the confession of faith or rededication of life again and again in their repeated anxiety states. Catholic priests write of the "scrupulous" person who returns repeatedly to confession for forgiveness for the same set of feelings.

The psychiatrist, the pastoral counselor, and the clinical psychologist are in much the same position in practice as are the above-mentioned groups. The expectations of magic brought by the suffering person are the same. The repetitive cycle in the treatment--with the exception of medical intervention in the case of periodic depressions and suicidal possibilities--is about the same.

One more positive way of looking at the compulsive, chronically fear-ridden persons discussed in this chapter is to see them as having been maimed by their superstitious upbringing. This has left them in a state of emotional deprivation and dependency that may well be lifelong. Reconditioning of their behavior will produce obedience to a new source of dependency in order to compensate for their deep deprivation of approval and acceptance. However, the dependency and deprivation remain; the changed element is that the source of dependence rests in the therapist and the approval for changed behavior comes from the therapist. Periodic attention throughout the life-span of this person is provided by the therapist in many instances. "Therapy" becomes a way of life.

Theologically, the issue at stake is one of the sources of ultimate justification and trustworthiness in the world. Martin Luther's autobiography depicts this as his struggle--between the unmerciful demands of an unrelenting conscience and the need for redemption by faith alone. Yet the rituals of forgiveness themselves become a burden of repetition for patients such as we have described in this chapter. Possibly the words of one of the patients quoted above hold a key to this dilemma also. In speaking to a group of chaplains she said, "Show us that you care about us and maybe we can decide for ourselves that God cares."

In Summary

This chapter has sought to identify the magical and superstitious as a pathological distortion of healthy religious faith. The religion of superstition is at heart a system of manipulation, which seeks to rule out the necessity of faith in the face of the risks of the unknown and uncontrollable. Both magical rituals and obsessive-compulsive neurotic acts are in essence incantations of fear. Specific case history materials show how these magical practices of the emotionally disturbed person are "warding-off" devices and do not yield either to religious reasoning or to psychiatric treatment. The promise of behavioral therapy as a choice of treatment is discussed. The need for combined teamwork of minister and psychiatrist interviewing the patient together and at the same time was explored.