David Avery, M.D., on determining factors in freedom and destiny

Psychiatry and Religion: One Psychiatrist’s Perspective

Note from this Special Issue editor: The following is an edited excerpt from an unpublished paper entitled Psychiatry and Religion: One Psychiatrist’s Perspective, by David Avery, MD. While the full paper also includes commentary on the role of chance and randomness in conditioning and shaping our experience, the selection that follows contains the main points of the discussion. This is a reflection by a thoughtful physician, who is at the same time, an inquiring, contemplative and active person of faith.

Differences between Science and Religion

Science strives for objective truth – truth that can be reproduced by another scientist. Religion concerns itself especially with subjective truth – personal truths that each individual must find. Science is concerned with factors that determine reality and emphasizes causation. Determinism is part of scientific language. Religion on the other hand, emphasizes human freedom, free will. We are not simply a function of factors that have determined our existence. Religion emphasizes the importance of action in spite of the “slings and arrows of outrageous fortune.”[1]

Science is concerned with what is; religion is not only concerned with what is, but with what ought to be.

Science is concerned with how questions, questions of mechanisms – how does the brain work? What are the processes occurring in the synapse by which one brain cell communicates and connects to its neighbors? Religion is concerned with why questions – why do tragedies occur? Why do bad things happen to good people?

Science addresses specific questions, questions of structure, questions of atoms, and questions of molecules and cells. Religion addresses global questions in life, questions of meaning, questions of love, questions of justice and questions of ethics.

These contrasts begin to spell out some of the main differences traditionally emphasized by philosophers who have examined the issue. Science and religion are different disciplines, with their own “languages,” methods and interests. While some argue that discussion between the fields of science and religion is difficult, if not impossible, comparing and contrasting psychiatry and religion can lead to a deeper understanding of the human condition and our journey in terms of freedom and destiny.

Non-scientific Psychiatry and Religion

In the discussion of psychiatry and religion, it is important to recognize that psychiatry is anything but a homogeneous profession. For the sake of simplicity, I will make a distinction between scientific and non-scientific psychiatry. Although a continuum may exist between these two types, much of psychiatry falls within these two categories.

Perhaps the most famous example of non-scientific psychiatry is psychoanalysis. The work of Freud developed in the twentieth century into a wide range of psychotherapies. The psychiatric tradition that includes Jung, Fromm, Frankel, May and Maslow and their successors have increasingly addressed issues that traditionally fall within the province of religion – questions of meaning, questions of values, questions of responsibility, questions of subjective truth and theology, questions that are not scientifically testable.

Religion, particularly at the non-dogmatic end of the spectrum, has developed a growing dialogue and relationship with non-scientific psychiatry and its descendant psychologies and therapeutic approaches. The areas of overlap between Paul Tillich and Rollo May are a case in point. The emergence of pastoral counseling as a specialty blends religion and psychiatry.

Religious concepts have their parallel in non-scientific psychiatry. At the personal level, the religious notion of sin as estrangement from one’s true self has its parallel in psychotherapeutic concepts of repression or unconscious inner conflicts. On a personal level the religious solution to estrangement involves forgiveness, grace, atonement – “at-one-ment,” – “becoming whole,” salvation. Parallel concepts in non-scientific psychiatry include the notions of promoting self acceptance and nurturing self worth, tension reduction and resolution. In psychoanalytic terms gaining insight and gaining a harmonious relationship of the psychological self, the integration of ego, super ego and id, is the goal of therapy.

At the social level, religion offers the notion of sin as estrangement from others; human beings are caught in “trespasses” and “debts,” paralleled by psychiatric concepts such as alienation, or complexes of guilt or inferiority. In religion, our estrangement is overcome with love, through communion and koinonia, in an ever growing I-Thou relationship. In psychiatry, there is an emphasis on overcoming narcissism, the healing of trauma, the restoration of the self and the capacity for intimacy, increasing social interest and participation in community. Psychiatry too shares an understanding of the power of love, the importance of nurture and attachment.

At the ontological level, religion wrestles with our existential alienation, idolatry, the absence of God in our lives, our struggle for meaning and purpose. Psychologies generally avoid the word God, but refer also to our existential challenges, our vulnerability to fixation on the unhealthy and destructive, our confusion, anxiety and isolation. Religion leads us to consider what Tillich calls the “ultimate concern” in our lives, [2] the “ground of our being.”[3] In parallel, psychiatrist Rollo May explores the “communion of consciousness,” [4] and Viktor Frankl shares with us the “search for ultimate meaning,” [5] drawing on his struggle to survive the horrors of a concentration camp.

This comparison of theological concepts and psychological constructs is not meant to be a strict analysis of the relationship between religion and psychiatry; it is only meant to point to some similarities that exist. It is ironic that many of the concepts expressed in these “new” psychologies are frequently restatements of religious beliefs that have been present for centuries. For example the idea of self realization certainly did not begin with Maslow. The emphasis on human choice and responsibility for one’s self did not begin with Fritz Perls’ Gestalt therapy. The emphasis on the here and now did not begin with existential psychologists.

The boundary between religion and non-scientific psychiatry is diffuse. The dialogue between theology and psychology has proceeded at the level of theory and scholarship, to professional training and clinical collaboration, to the front lines where pastors and mental health providers consult in the moment of crisis.

Biological Psychiatry and Religion

One type of scientific psychiatry, biological psychiatry, is characterized by its focus on medical practice informed by an understanding of brain structure and processes, and scientific research that aims at effective treatment for mental disorders.

Non-scientific psychiatry employs constructs which parallel religious concepts. Biological psychiatry may provide symbols that have religious power.

Let me clarify what is meant by religious symbols, as defined by Paul Tillich.[6]

1. Symbols point beyond themselves to something else.
2. Symbols participate in that to which they point.
3. Symbols open up levels of reality which otherwise are closed for us.
4. Symbols open up hidden depths of ones own being.
5. Symbols cannot be produced intentionally.
6. Symbols, like living beings, grow and die.

One’s ultimate concern can only be expressed symbolically. One basic symbol of our ultimate concern is God. Other symbols may point to God. For example, the beauty in nature may do this. For others, the infinity of the universe or the symbiosis in nature is symbolic of God, pointing beyond an immediate experience, concept or concrete reality to something greater.

Biological psychiatry contains “symbols,” in Tillich’s sense, symbols that “point beyond,” symbols that suggest religious importance and theological themes.

Aspects of Biological Psychiatry that Point to Religion

In the process of scientifically exploring psychiatry, one cannot help but be impressed by the limits of our knowledge. Research only takes us to a certain point, beyond which there is mystery. Additionally, one cannot help but be impressed by our own finitude, the smallness of individual human beings in our human situation. A good scientist does not “eat from the tree of knowledge” and feel that he or she has absolute truth. God is ultimately a “mystery.” Biological psychiatry, science and research offer no ultimate explanations, but open us to the infinite, to “being itself, to the mysterium tremendum to use Rudolph Otto’s term for God. [7]

In doing research in biological psychiatry, one cannot help but be impressed by our dependence on nature. Our minds are dependent upon the brain; we are dependent upon thought processes, on cells, molecules, atoms, etc. Research on the specifics of our biological nature points us to a growing appreciation that we are part of creation – “dust.” We are pointed to the notion of creation and Creator. We are pointed to Schleiermacher’s reference to religion as a “feeling of dependence.” [8]

It is difficult to investigate the human brain without being in awe of the power of the mind. Biological psychiatrists often begin their investigations by exploring the normal functioning of the brain before attempting to find out what has gone wrong. In these studies we come face to face with the amazing processes of the human brain, the complex ways the brain coordinates our bodies and behavior.

Researchers are confronted with the realization of the major role biological forces play in our moods, thinking and behavior, Understanding determining characteristics such as genetic factors in alcoholism and depression may increase our empathy and points us to the religious concepts of forgiveness and grace. In Psalm 103, it states that the Lord has compassion for us because he knows that we are made of dust. The psychiatric concept of diminished capacity points those of us who do not have our freedom significantly impaired, toward a deeper understanding both of our own personal responsibility, and our responsibility for our neighbor.

Freedom and Destiny

The determinism implied by biological psychiatry points to its opposite – human freedom. Perhaps this is the main point of contact between religion and biological psychiatry. Perhaps the determinism explored in biological psychiatry is in effect a religious symbol that points to a religious concern. Looking at biological psychiatry from the point of view of Tillich’s method of correlation, one could say that biological psychiatry raises the question of freedom and destiny.[9]

Biological psychiatry poses such questions as these:

In what sense is suicide “free choice?

How do we view a mother with postpartum depression who kills her child and then commits suicide because she feels that there is no hope and the world is an irredeemably awful place to live?

To what extent does one create one’s own hell?

Biological psychiatry helps us understand the nature of depression in its various forms, and offer medication and treatment that enhances healing, recovery and the freedom to live and choose.

The freedom-destiny concern arises also in relationship to schizophrenia. For example it is clear that about 30% of schizophrenic patients probably have atrophied brains as demonstrated by abnormal computerized tomography (CAT) scans. This issue was raised in the John Hinckley trial. To what extent is a man with a significant portion of his brain atrophied responsible for his actions?

Another illness that is at the center of the freedom-destiny debate is alcoholism. Data from many investigators accumulated over the last ten years indicate a genetic factor in the development of alcoholism. Is alcoholism a sin or an illness?

Examining cholera will place this question in a historical perspective. Cholera came in epidemics, usually beginning in Europe and then spreading to the United States. One hundred and fifty years ago Europe was experiencing a cholera epidemic. The Americans made note of this epidemic and pointed to the probability that God in some way was punishing the Europeans for their sin; cholera was a manifestation of that sin. After the epidemic spread to the United States the explanation was revised somewhat. Cholera mainly affected the prostitutes, criminals, and alcoholics (who parenthetically also happened to live in the poor neighborhoods with poor sanitation). Thus, the link of cholera to sin was preserved. It was only with the linking of cholera to an infectious process that cholera became recognized as an illness.

Ongoing research on the biological processes at work in alcoholism and addictions is giving us a clearer understanding of the illness and disease dimension of a person’s struggle for sobriety and recovery. There are no simple answers here. It is not an either/or situation. It is rather more appropriate to view the freedom versus destiny question on a continuum. It is a matter of degree. Furthermore, the degree of responsibility may change over time. Although one can point to genetic factors in alcoholism, it is clear that once a person knows he or she has a problem and is sober, choice and responsibility enter the picture in a real way. On the other hand, if a person struggling with alcoholism is in the middle of delirium tremens, confused, delusional and hyperthermic, the degree of responsibility at that point is very low.

Humans do not consistently maximize their potential. We all underutilize our freedom of choice. We all underutilize our gifts. It is a primary concern of religion to encourage us to maximize our freedom and fulfill our potential.

Factors that determine our existence are probably under-appreciated. It is the job of any science to search out those determining factors. It is clear that science will continue to find more factors that determine our destiny: social, economic, political and biological.

Proof of the importance of determining factors does not necessarily diminish one’s freedom. For example, knowledge that a person has a genetic predisposition to alcoholism increases the importance of freedom of choice. The decision to drink, or not drink, becomes clearer. A person with a biological, alcoholic father can make a better-informed choice about whether to drink socially or become abstinent. Knowledge of determining factors, in this sense, increases freedom for that individual.

Conversely one may exercise one’s freedom in order to learn more about one’s destiny.

It is a goal of humankind to increase its freedom, to develop a greater understanding of the factors determining our existence and to decrease the role of chance and randomness in determining our lives.

Science and religion both contribute to the healing and well being of the patient. By gaining increasing knowledge of the determining factors in mental disorders, we can offer treatment and care that enhances human freedom and choice. Appreciating the limits of science, we seek in religion wisdom and guidance to explore our human existence, to learn ever more about the full range of our freedom and destiny.

Footnotes:

[1] Shakespeare, William, Hamlet, Act 3, scene 1.

[2] Tillich, Paul, Systematic Theology Volume 1, University of Chicago Press, Chicago, 1951, p.14.

[3] Ibid. p, 156.

[4] May, Rollo, Love and Will, WW Norton, New York, 1969 p.307.

[5] Frankl, Viktor, Man’s Search for Ultimate Meaning, Basic Books, New York, 1997.

[6] Tillich, Paul, Dynamics of Faith, Harper and Row, New York, 1957, p.41-43.

[7] Otto, Rudolph, The Idea of the Holy, Oxford University Press, London, 1958, p.12.

[8] Niebuhr, Richard R., Schleiermacher on Christ and Religion: A New Introduction, Charles Scribner’s Sons, New York, 1964, p. 181.

[9] Ibid., Tillich, p.60.

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