Psychiatry and Spiritual Healing
In the July Atlantic we published a challenging paper, “A Psychiatrist’s Choice,” written by one of England’s most distinguished psychiatrists, the author of standard works in his field and a man who has won recognition as a teacher. Now, in his second paper, he discusses the relationship between physical methods of psychiatric treatment and some of the valuable techniques of spiritual healing. The name of the writer is withheld for reasons of medical ethics. It cannot be disclosed to inquirers, nor can personal questions of a professional nature be passed on to the author; but we shall be glad to publish the more pertinent comments in the Atlantic Repartee.
ANONYMOUS
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WE HAVE recently seen the emergence of varied forms of physical treatment of the mind which can, among their other uses, change those tortured by feelings of guilt about past actions, the prey of endless moral scruples and preoccupied perhaps day and night with feelings of inadequacy in regard to their social and religious behavior, into happy people again, able to practice their true religion and carry out their everyday social obligations in a much more normal way. Philosophical problems of a tremendous magnitude have been created, and I shall try to avoid most of these. I shall only take it as an assumption that no truly great religion in history has despised physical means to the attainment ol spiritual grace — rather it has generally incorporated such means into its various disciplines. Fasting, exercises in breathing, the deliberate production of states of intense emotional and physiological excitement, and in more primitive religions the use of drugs, have all been put to religious uses to make people more amenable to the reception of better attitudes to life, or to fix more firmly in the mind certain basic truths imported by those in religious authority over them.
I want to examine first of all the physical aspects of some of these religious healing methods. For I believe that the churches have lost much ot their old power to change men’s lives because ol their present neglect of the way in which Wesley, for instance, was able to change the face of a large part of England by the use of what I think were physiological as well as psychological aids to the attainment of spiritual grace. In some of the sudden and abrupt conversion phenomena produced, one may see, perhaps, a vital connecting link between our present physical methods of treatment in psychiatry and some of the really effective methods of mental healing which have been practiced down the centuries by certain men of God.
My main qualification to speak on such matters lies in my own personal awareness of, and interest in, the possibilities of both the religious and the physical approaches to the prevention and cure of psychiatric disorders, and the possible interrelation of some of these. I witnessed in my own father the personal acquirement of a firm spiritual faith which enabled him to rise above business troubles which he would only have surmounted with great, difficulty without this faith. I have seen what amounted to a conversion experience occur in one of my own brothers, which has left him years later perhaps the most levelheaded and socially constructive member of my own family. He is working now as a bishop of one of the churches of our Commonwealth. On my mother’s side, many eminent preachers, and one president of the Methodist Conference, contributed to both my heredity and my early upbringing.
As a child I also met those who had been truly rescued by the old revival services from the depths of alcoholic despair and evil living, and given a new Christian faith that had kept them mentally stable and well for years after. In America, after the last war, 1 was therefore specially interested to study some of the religious revival methods, sometimes carried to that vast country from England and still practiced there, though almost totally neglected now in this country by the very churches which originally became so powerful because of their use. Their obvious power to help some of the mentally and spiritually ill should again make them specially important today to those who feel that their own present preaching methods are often achieving so very little.
My own professional life as a doctor, however, has been spent more in studying those physical and psychological methods of’treatment which can often produce similar mental miracles, if they can he designated as such, while still continuing the search for common physical and psychological factors which 1 believe to be at work in many varied disciplines of mental healing. John Wesley himself speculated on such matters. He certainly often produced, consciously or unconsciously, older versions of psychological and physiological shock therapies to religious ends. He even commented on the part possibly played by physical factors in genuine spiritual conversion experiences. “How easy it is to suppose,” he wrote, “that strong, lively and sudden apprehension of the hidcousness of sin and the wrath of God and the bitter pains of eternal death should affect the body as well as the soul, suspending the present laws of vital union and interrupting or disturbing the ordinary circulation and putting nature out of its course.”
Only one great religious leader has, in fact, discovered the secret of altering the face of England in a generation in the last three centuries, and this was John Wesley. We should therefore study afresh some of the forceful methods he employed. He often brought aboul physical effects by his preaching, which are now laughed at and scorned by his successors, but seem extremely pertinent in view of the recent successes of shock treatments in psychiatry. The eighteenth century has been called the Age of Reason, but paradoxically it needed Wesley, with his special techniques aimed at the emotions, to produce the really dramatic changes in outlook on life of so many of the ordinary people of Great Britain. I venture to predict that in this new era of attempted appeal to man’s religious reason rather than his emotions, it will again be only with a return to somewhat similar methods in modernized form that a true revival of the art of spiritual healing and conversion will occur. The real danger is that such methods can be so overwhelmingly powerful in their effects and that they can be used to assist the forces of evil as well as of good. For modern medical research is showing that alterations in a person’s emotional and physiological state can, in fact, alter the whole functioning of mind and body, and also alter profoundly intellectual judgment and balance.
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WHEN I entered psychiatry, for instance, I was taught, among other theories, that schizophrenia or “split mind” was a subconsciously motivated withdrawal from reality on the individual’s part because he wished to evade life’s problems. This attractive theoretical concept was very rudely shattered for me and many others when, after repeated periods of induced mental confusion and excitement leading on to deep unconsciousness, and brought about by a temporary lowering of the blood sugar with large doses of insulin, the patient might suddenly emerge from his fantasy world of delusion and horror, and seem very much pleased to be well again and to be able to set about the daily task of living. Insulin coma treatment, has now been shown to be perhaps the most effective way of obtaining the maximum number of remissions in early cases of schizophrenia of all of the methods of treatment in use at the present time. The time factor in treatment is also of supreme importance. While up to 70 per cent of patients may be brought into remission In the first few weeks or months of the illness by insulin treatment, combined if necessary with electrical shock treatment, at the end of two years of continued illness the percentage of recoveries sinks to a much lower figure. These facts in regard to insulin are now reasonably well established; therefore, a special burden is placed on all who use spiritual healing methods to recognize such illnesses and to help get them to a hospital for insulin coma therapy as early as possible.
In schizophrenia, one sometimes comes very near to some of the ecstatic states reported by the saints of old. The individual not only may see the outside world through a distorting mirror, but becomes intensely preoccupied with his own internal feelings and thoughts. It is not strange, therefore, that some of the finest poetry, some of the eternal verities, and some of the great contributions to art, science, religion, and philosophy have been contributed by those who have had such illnesses, or in whom a few of the symptoms have been present without the full development of the disease. But to most ordinary sufferers it may mean a life in which they seem finally at the mercy of apparently uncontrollable impulses or sinister influences from without or within themselves. Voices talk to them day or night which may seem to be good or evil. God perhaps seems to be damning them, or the devil has taken them for his own. Much more rarely does a patient experience delusions and hallucinations of a consistently pleasant type, so that happiness is achieved where it was absent before illness. Hell on earth is much too frequently their undeserved fate for up to thirty years or more.
Because of the commonness of symptoms of mental depression — including the sudden or gradual onset of guilt feelings, preoccupation with past sins, exaggerated feelings of unworthiness, mental rumination on worries in the past or possible disasters in the future — electric shock treatment is much more talked about by the public than is the insulin treatment of schizophrenia. I spent some years in psychiatry before the introduction of this treatment. I remember having to watch people whose lives had been spent in helping others, who were the most conscientious of persons, whose good works were obvious to all who knew them, but who, nevertheless, had developed an attach of severe mental depression. “They would start to torture themselves with past remembrances of minor sins, and be filled with the most terrible forebodings about the future. Their suffering was often so unbearable that many attempted to destroy themselves after a time, in full realization that this might mean eternal damnation, which they now often felt they more than fully deserved. The cardinal feature of the illness — and many may have seen its occurrence in friends and relatives — is that it is completely unamenable to intellectual reasoning or spiritual consolation. Whether the environment remains bad or good, the depressive ideas also persist. Now the introduction of electric shock therapy has meant that many such patients can be got well in as 1 ittIf as a month from the commencement of the treatment.
The success of convulsion therapy in selected states of depression has led to its frequent and often unsuccessful use in other states of neurosis and psychosis. Religion, like psychiatry, makes similar mistakes in thinking that a method helpful to one special group can be applied liberally to all and sundry. Why is it that an illness in which ideas of guilt and past sins figure so largely can now be so easily dispersed by a purely physical method of treatment, while proving so resistant to all other treatments provided by religion or psychotherapy; and why does the same treatment so often fail where anxiety rather than depression is more prominent in the total picture, and the sleep rhythm and mood show a different pattern of abnormality, even though some of the thought content may be similar?
We are on very difficult philosophic ground here. We certainly do not yet know all the answers. John Wesley, however, sometimes produced what amounted to shock phenomena for the relief of spiritual depressions that had not reached the stage of melancholia, and 1 can also assure you that in the southern states of America some revivalist methods can even produce physical shock and convulsive phenomena coming fairly near to what is achieved by passing an electrical current through the brain and producing a fit, which is the essence of the modern electric shock treatment of depression. While in the United States, I saw’ a patient who reported cure of two attacks of milder depression by such revival meetings, but who needed electrical shock treatment for a third more severe attack. Her faith was not destroyed, because she knew that God had made this alternative method available to her.
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I NOW come to another physical treatment that has aroused much more controversy; namely, the brain operation of leucotomy. Its introduction and use have proved an uphill struggle in England in the last twelve years. It has had to bear with periodicattack from some religious bodies and philosophical theorists alike. But there has always been the constant encouragement of numerous patients whose whole lives have been altered for the better by it and from their relatives. Around 10,000 operations have now been performed in England, and wherever it has been used, cither here or abroad, about a third of hitherto incurable patients have been able to leave menial hospitals. Even better results are obtained in less ill patients. It must also be emphasized that the patients who do best are those who are undergoing the greatest mental anxiety and suffering. The presence of what has been called unremitting “tortured selfconcern” has been picked out by one American writer as the supreme indication for this operation. Self-concern and self-examination are good for the soul, but when this becomes so severe, prolonged, and intolerable that the individual is completely incapacitated by it. it ceases to serve any useful purpose except to make him pray for the afterlife even if he is very uncertain what it will be like for him.
Some severe criticisms have been made about the results of this operation. It has oven been said thal the soul can be destroyed. But one can say definitely from long experience that normal religious beliefs and attitudes are not usually destroyed, especially with the new modified forms of operations now being increasingly used in such patients. On the contrary, many patients have had t heir religious faith heightened by their cure. The capacity to develop a religious fanaticism is often reduced by leucotomy. More normal attitudes to religion may be adopted, since the individual does lend to become rather more matter-of-fact in most things.
The operation is certainly never done lightheartedly, and is used only when all other methods hold out little hope and the patient’s suffering has become intolerable and apparently endless. A price has sometimes to be paid in the adoption of more practical and concrete attitudes, and in living more in the present and less in constant preoccupation with past sins and future punishments. Religion, however, also sets out to help people to obtain just this sort of relief from their overwhelming anxieties by its own particular methods. Furthermore, we know that the intellectual faculties of the average mind are not altered, especially by the newer forms of operation, and the improvements occur mostly in the crippling emotional accompaniments of the patient’s illness.
Leucotomy helps some patients with schizophrenia resistant to all other methods; it may relieve the tortures of continued depression that has not responded to convulsive therapy; and it is interesting from a religious angle in its effects on patients subject to excessive scruples, obsessional rituals, and chronic pathological anxiety. These persons are often plagued by habits needing constant useless repetition, or tortured by obsessive thoughts which cannot be cast out of the mind. We all know how some of these patients are absolutely resistant to all psychological and religious methods of healing, which should help them in theory but actually fail to do so in practice.
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I NOW come, perhaps, to the most difficult problem of all: an attempt to link such treatments to some provenly effective religious practices in spiritual healing.
The three physical treatments discussed have one interesting common factor. In the mentally ill they can disperse recently acquired or deeply set patterns of thought and behavior, and either allow all patterns to return or new ones to be put in their place. Shock treatments and leucotomy, to use Wesley’s own words, “suspend vital union, interrupt the circulation, and put nature out of its course,” just as he felt his preaching sometimes did when he could produce “a strong, lively and sudden apprehension of the hideousness of sin and wrath of God and the bitter paitis of eternal death.” Leucotomy can more effectively break up very longstanding patterns of abnormal behavior or thought while insulin coma and electrical treatment work better in more recently ill patients. They are mostly used in those types of patient that we know to be resistant to ordinary psychological methods of healing.
When we understand more about psychiatric illness, we are certain to find that many mentally ill patients have at the time a more rigidly acting brain and nervous system than the normal. Normal people, so-called, in any community are generally those more easily molded to current beliefs and behavior without the need to resort to such drastic methods of displacing old patterns of thought and behavior with new. But I should like to call your attention to Wesley’s repeated observation that final changes of heart and belief should generally bo sudden, and overwhelming, to be effective in most instances. Perhaps he had grasped the fact that the nervous system has generally to be put into a highly charged emotional state before old habits of thought can be effectively disrupted and new conceptions of God are able to Hood in and grip the person concerned. This does not mean that before a sudden change to new beliefs and behavior there may not also have to be a long preliminary period of generalized anxiety’, sell-questioning, and indecision, all producing a softening-up of the patient prior to his sudden acceptance of a new way of life very foreign to his previous one.
It is important to notice the similarities seen in the technique of psychoanalysis, where for months the individual may be made to lie on a couch and be subjected to the often unpleasant, rcarousal of previously frightening and guilt-laden stimuli in his past life. Tension gradually mounts, the individual is emotionally thrown more and more off his normal balance, and a stage is finally reached when he will start to accept interpretations of his conduct and past life which would have been quite unacceptable to him before. He then finally gains what is called “insight.” I saw this same basic guilt-creating, anxiety-creating, and softening-up process being streamlined and sometimes used with tremendous effect in American revival meetings, loading at the end to a sudden submission and quite uncritical acceptance of the new beliefs desired by those in charge of such meetings. During the war we also learned how to facilitate this process by means of drugs in treatment, and the Russians have obviously perfected it. Fasting and other debilitating procedures have been used throughout the ages for the purpose of softening up the individual and making him more sensitive to external psychological influences or to his inner spiritual conscience. Fear-provoking techniques are sometimes necessary. They can be used for wrong purposes as well as good. Human beings could never have adjusted to their changing conditions unless the “normal” brain had had these powers of final submission under great emotional stress incorporated into its basic mechanisms. Some people, however, are much more difficult to change than others, and many mentally ill persons are among these.
It was a comparison between the results of what we called drug abreactive treatments in the last war, when the so-called “truth drugs” wore injected and soldiers were often greatly helped by being made to relive emotionally their horrifying battle experiences, and some of the detailed reports by John Wesley himself about the effects of his preaching that made me specially interested in the relation of modem physical treatments and some older and often most effective types of religious healing procedures. Let me give you two quotations.
Grinker and Spiegel, describing the effects of abreaction under barbiturate drugs in 104b, in the treatment of acute war neuroses, report: —
The terror exhibited . . . is electrifying to watch. The body becomes increasingly tense and rigid; the eyes widen and the pupils dilate, while the skin becomes covered with a fine perspiration. The hands move convulsively. . . . Breathing becomes incredibly rapid or shallow. The intensity of the emotion sometimes becomes more than they can bear; and frequently at the height of the reaction there is a collapse and the patient falls back in the bed and remains quiet for a few minutes. . . .
Over two hundred years ago Wesley, on April 30, 1739, reported: —
We understood that many were offended at the Cries of those on whom the power of God came; among whom was a physician, who was much at raid that there might be fraud or imposture in the case. Today one whom lie had known many years was the first who broke into strong cries and tears. He could hardly believe his own eyes and ears. He went and stood close to her, and observed every symptom, till great drops of sweat ran down her face and all her bones shook. He then knew not what to think, being clearly convinced it was not fraud nor yet any natural disorder. But when both her soul and body were healed in a moment, he acknowledged the finger of God.
Grinkcr and Spiegel, reporting their results, stale; —
. . . The stuporous become alert, the mute can talk, the deaf can hear, the paralysed can move, and the terror stricken psychoties become well organised individuals,
Wesley, reporting his, states: —
I will show’ you him that was a lion till then, and is now’ a lamb; him that was a drunkard, and is now’ exemplarily sober; the whoremonger that was, who now abhors the very garment spotted by the flesh.
Grinkcr and Spiegel saw in their results a confirmation of Freud’s theories and a “freeing of the ego.” Wesley, however, was equally certain that it was “the Lord’s doing, and it is marvelous in our eyes. Possible physiological mechanisms, also, should not be ignored.
Provided suitable methods are used, it is often possible to arouse a state of nervous excitement psychologically as well as physically, which may have the effect of temporarily causing states of increased suggestibility and transference, and can also help in the destruction of undesirable patterns of thought and behavior. This seems most easily accomplished if, as in the case of insulin coma therapy, convulsion therapy, and drug abreaction, for instance, brain excitement can be progressively stimulated to a point at which the higher brain centers reach the limit of their capacity to respond and then switch to a state of temporary inhibition. Wesley reports repeatedly that by preaching alone such results could be obtained, so that, prior to final sudden conversion, many persons might drop down as though dead and be temporarily deprived of their senses. He achieved this by not letting the audience forget the stark alternatives facing them there and then of eternal damnation or salvation by faith.
A somewhat similar phenomenon was also reported by Pavlov in his animal experiments. He, too, found that, if an animal could be excited to a point of producing a state of temporary cortical inhibition, previously implanted conditioned behavior patterns in the nervous system might be destroyed and the ground thus more easily prepared for new ones to be put in their place. In America, I found that such states of emotional excitement and collapse were, in fact, being quite deliberately induced at some revival meetings and were even referred to as “wiping the slate clean prior to the acceptance of the new beliefs desired. Brain-washing behind the iron curtain also seems to include these basic physiological mechanisms.
In physical treatments, psychotherapy, and religious healing, techniques, which I believe overlap each other to some extent, can be applied slowly or more speedily, and in greater or lesser amounts as patients require; while there are other types of person only helped by a calm intellectual approach. The results obtained will often depend on the selection of the right patient for the right method of handling.
One other point I would specially emphasize is the absolute necessity of carefully reconditioning and supporting an emotionally disturbed and redirected patient till new stability is gained. Wesley succeeded where so many others have failed, using similar methods, because of the great importance he attached to organizing and making his recent converts attend small weekly “class meetings.” Here, if his original instructions are reread, his converts were reindoctrinated, their personal problems repeatedly discussed, and unsatisfactory persons discovered and weeded out after their initial conversion experience. Physical treatments in psychiatry also need follow-up psychotherapy and environmental support to be most helpful in many instances.
Psychiatry, however, often lacks what spiritual healing may have; this is something that is really positive and satisfying to put in place of old and faulty patterns of behavior and thoughts displaced. It is the parable of the seven devils all over again. I therefore feel I need make no apology for discussing these recent advances in physical methods of treatment in psychiatry in the way I have because I believe they may have a most important, bearing on current problems in spiritual healing, and both may overlap at times. Psychiatrists and those interested in spiritual healing have much to learn from one another, and we must realize that because there are so many varieties and conditions of mankind, and many varied types of illness, quite different methods, or combinations of methods, will always have to be employed in actual practice to provide spiritual peace for the great numbers of persons needing it today.