The American Psychiatric Association awarded Irvin Yalom the 2000 Oscar Pfister
prize (for important contributions to religion and psychiatry.) Here is his
acceptance speech delivered at the American Psychiatric Association annual
meeting
in May 2000 at New Orleans. A version of this lecture has been published in the
American Journal of Psychotherapy (number three – 2002)
When Dr. Harding first notified me that
the committee on psychiatry and religion had honored me with this wonderful
award I experienced an onslaught of feelings, primarily great pleasure and also
pride at being in the company of former recipients, all of them thinkers I have
much admired. I was particularly delighted to learn that the first recipient of
the Oscar Pfister prize was one of my mentors, Jerome Frank, whom I am pleased
to inform you is, at the age of 93, as thoughtful, curious, and coherent as
ever.
But there were also other feelings – more
complicated, quirky, dark, difficult to express. “Religion? Me? There must be
some mistake.” Hence, my first words of reply to Dr. Harding were: “Are you
sure. You know I regard myself as a practicing atheist?” His immediate response
to me was: “We believe that you’ve dedicated yourself to religious questions.”
The graciousness of his reply disarmed me and brought to mind many
conversations with my former therapist and, later, my dear friend, Rollo May,
who insisted on regarding my textbook, Existential Psychotherapy, as a
religious book. I remember, too, that Lou Salome referred to Nietzsche as a
religious thinker with an anti-religion perspective.
My talk today will focus on the issues
raised by these dissonant feelings and especially on some of the existential
therapeutic issues that, as Dr. Harding points our , are often considered to be
religious in nature.
I’ll also sketch out some comparisons
between existential psychotherapy and religious consolation. I believe these
two approaches have a complex, strained relationship. In a sense, they are
cousins with the same ancestors and concerns: they share the common mission of
ministering to the intrinsic despair of the human condition. Sometimes they
share common methods – the one to one relationship, the mode of confession, of
inner scrutiny, of forgiveness of others and self. In fact, more and more as
I’ve grown older, I consider psychotherapy as a calling, not as a profession.
And yet, still, it is true that the core beliefs and basic practical approaches
of psychotherapy and religious consolation are often antipodal.
It is true that throughout history, or at
least from the first to the mid 17th century, the thinkers who were most
concerned about issues of existence were rooted in the religious wisdom
traditions – not necessarily that their insights emanated from fundamental
religious beliefs but that the religious institutions provided the sole arena
which promoted and supported such intellectual activity. One can delineate both
positive and negative aspects to this phenomenon: positive in that religious
institutions encouraged and sponsored (indeed, for many centuries, were the
sole sponsors of) philosophical inquiry, negative in that religious
institutions often restricted what could be thought and which problems could be
examined.
Nietzsche once said, (BGE)
“Gradually it has become clear to me what
every great philosophy so far has been: namely, the personal confession of its
author and a kind of involuntary and unconscious memoir.; also that the moral
(or immoral) intentions in every philosophy constituted the real germ of life
from which the whole plant has grown.”
Though such perspectivism runs the risk
(which Nietzsche was delighted to take) of denying the possibility of any fixed
truth, still I take his words seriously and I’ll sketch in the origins of my
own religious point of view and intellectual positions. My early religious
training was a pedagogical disaster – my family’s orthodox Jewish synagogue was
cloaked in rigid unyielding, authoritarianism which I found highly distasteful.
In the long run, that was decisive for me because I lost any possibility of
faith early in life. Schopenhauer reminds us that religious faith, if it is to
thrive, has to be planted and take root in childhood. In his words, “The
capacity for faith is at its strongest in childhood; which is why religions
apply themselves before all else to getting those tender years into their
possession.” Hence, I’ve never been burdened with early planted faith and I’ve
taken the position that faith, like so many other early irrational beliefs and
fears, is a burden.
Again in Schopenhauer’s term, “Religion
is truth expressed in allegory and myth and thus made accessible and digestible
to mankind at large.” But when short-sighted religious teachers either
personally mistake the allegory and the metaphor for historical truth or may
make a deliberate choice to teach in that fashion and substitute biblical
authority for all forms of reason, they run the risk of alienating certain
students, and I was one of those who were alienated early.
Gradually my understanding of existence
led me more and more to a scientific, materialistic world view. I resonate
greatly with the views of Schopenhauer, Voltaire, Nietzsche, Freud. In fact,
recently while preparing these remarks I reread Freud’s writings on religion (The
Future of an Illusion) and was at first surprised to see how closely I agreed
with him until it occurred to me that these very writings had, no doubt, been
instrumental in shaping my own beliefs. I grew to believe that religious and
the scientific world view were incompatible – I felt sympathetic to
Schopenhauer’s metaphor of religion being like a glow worm that was only
visible in the darkness. Schopenhauer predicted, incidentally, that once the
light of scientific insight dispelled the darkness of ignorance, religions
would shrivel. Given the current resurgence of religious belief in the United
States, it’s very curious how far off the mark was this prediction.
I also find myself much in agreement with
the views expressed so well in Francis Crick’s (the DNA Nobel laureate) recent
book (The Astonishing Hypotheses). The first lines of his book are:
“The astonishing hypotheses is that you,
your joys, your sorrows, your memories, and your ambitions, your sense of
personal free will, are in fact no more than the behavior of a vast assembly of
nerve cells and their associated molecules.”
I believe that... extraordinary claims
require extraordinary evidence
I might add to this list of human
experiences that are the result ultimately of electro-chemically powered
neuronal behavior such other experiential phenomena as the sense of the Atman,
the divine spark, the Buddha nature, the soul, the sacred ground, as well as
longings for satori, nirvana, enlightenment, salvation. To my mind, this
materialistic, or let’s refer to it as a naturalistic, view of mind is
lamentable, humbling, and distasteful, yet obvious and inescapable. I can tell
you that I very much want to contain the divine spark, I crave to be part of
the sacred, to exist everlastingly, to rejoin those I’ve lost – I wish these
things very much but I know these wishes do not alter or constitute reality. I
believe that these extraordinary claims require extraordinary evidence – and I
mean by that evidence beyond pure experience which as we therapists know is
fragile, fallible, rapidly shifting, and vastly influenceable .
The current writers on this topic who
seem to express my own position most clearly, who express the scientific
position while retaining the sense of awe and mystery inherent in life (much
like Santayana and Spinoza/s atheism (or pantheism), and which retain a true
piety toward the universe and respect for other’s belief systems) are
individuals such as Carl Sagan in his book The Demon Haunted World and Chet
Raymo, the distinguished physicist (and Catholic) in his book Skeptics and True
Believers.
It’s not easy to acknowledge one’s lack
of belief in this country today – where over 80% of Americans profess on the
Gallup poll to believe in life after death. These figures are, as we know, vastly
higher than reported rates from any other nation. Anywhere from 40 to 70
percent of people in France, Sweden, Denmark, Austria, Great Britain, the
Netherlands, Japan and the Czech Republic believe that there is, alas, no life
after death. Only 3% of Americans will say they don’t believe in God in
contrast to 6-7 times that number in European countries. Though it is difficult
for me not to feel peripheralized when reading these national polls about
religious belief, still I believe that my views differ little from those of the
overwhelming majority of the academics and therapists with whom I associate.
My college education was a science-based,
premedical curriculum permitting only a few electives that I invariably devoted
to courses in literature. I was a voracious reader of fiction, still am, and in
my adolescence was transfixed by those novelists – especially the great Russian
and French existential writers – who explored fundamental questions of death,
meaning, freedom, and relationship.
In my psychiatric training, the
eclecticism of the psychiatric residency curriculum at Johns Hopkins where I
encountered such teachers as John Whitehorn and Jerome Frank suited me well. I
entered into a long personal orthodox analysis but felt dissatisfied with the rigid
and impersonal posture of the analyst. And felt dissatisfied, too, with the
then narrow and reductionistic analytic belief system – at times analytic
doctrine felt to me uncomfortably similar to a religious fundamentalist venue.
In my 2nd year of training Rollo May’s
book “Existence” was published and had an enormous impact upon me, opening up a
whole new perspective on viewing and ameliorating despair. My daily discussions
with my wife who was writing her doctorate dissertation in comparative literature
on Kafka and Camus contributed to my increasing interest in existential writers
and while a third year resident I enrolled in my first course in philosophy.
From that point on I have spent considerable time in independent and guided
philosophical study, concentrating on those philosophers exploring the human
condition – hard to know how to refer to them – no philosopher ever embraced
the term, existentialist – perhaps, the older term lebens -philosoph (life
philosopher) is best. I’ve been particularly drawn to the presocratics , the
stoics, Lucretius, Schopenhauer, Sartre, Camus, Heidegger, Nietzsche, Corlis
Lamont, and Santayana.
But philosophy has always served me more
for confirmation than for inspiration. My major teachers were always my
patients and for decades I fashioned my clinical work to help me explore
relevant philosophic issues. I learned early on that a therapist cannot easily
address raw existential issues: they are so anchored to dread that they appear
evanescently only to be quickly replaced by the distractions of quotidian life.
Consequently I began to search for and concentrate my clinical practice on
those patients who, for one reason or another, were forced to confront
fundamental issues of life and death. One of the great advantages of being a
member of the Stanford University academic faculty was that I had the resources
and freedom to select my patients carefully and without regard to economic
remuneration. These were of course in the halcyon pre-managed care days, the
days before university hospitals, one after the other, began filing for
bankruptcy.
For a number of years I chose to treat
patients who were forced on a daily basis to confront finitude – these were
individuals with metastatic cancer and I worked with them first in individual
therapy and then gradually developed the courage to treat them in a group
setting. Later I concentrated on grief, both spousal and parental, and focused
especially on the ways in which grief confronts us not only with loss but with
our own mortality.
Eventually I grew to believe that I had
something to say about an existential approach to therapy and spent years
writing a text on the subject – a text with the arresting, dramatic title of
Existential Psychotherapy. The term is a vague one and before proceeding
farther allow me to offer a fairly uninformative definition of existential
psychotherapy.
Existential psychotherapy is a dynamic
therapeutic approach which focuses on concerns pertaining to existence.
I warned you the definition would be
uninformative. Let me dilate it by clarifying the phrase “dynamic approach.”
Dynamic has both a lay and a technical definition. The lay meaning of dynamic
(derived from the Greek root, dunasthi – to have power or strength) implying
forcefulness or vitality (to wit, dynamo, a dynamic football runner or
political orator) is obviously not relevant here. But, if that were the meaning
of dynamic, then where is the therapist who would claim to be other than a
dynamic therapist, in other words, a sluggish, or inert therapist?
No, I use “dynamic” in its technical
sense which retains the idea of force but is rooted in Freud’s model of mental
functioning which posits that forces in conflict within the individual generate
the individual’s thought, emotion, and behavior. Furthermore – and this is a
crucial point – these conflicting forces exist at varying levels of awareness;
indeed some are entirely unconscious.
So, existential psychotherapy is a
dynamic therapy which, like the various psychoanalytic therapies, assumes the presence
of unconscious forces which influence conscious functioning. However, it parts
company from the various psychoanalytic ideologies when we ask the next
question: what is the nature of the conflicting internal forces?
The existential psychotherapy approach
posits that the inner conflict bedeviling us issues not only from our struggle
with suppressed instinctual strivings or internalized significant adults or
shards of forgotten traumatic memories, but also from our confrontation with
the “givens” of existence.
And what are these “givens” of existence?
If we permit ourselves to screen out or ‘bracket’ the everyday concerns of life
and reflect deeply upon our situation in the world, we inevitably arrive at the
deep structures of existence (the “ultimate concerns,” to use theologian Paul
Tillich’s salubrious term). Four ultimate concerns, to my view, are highly
germane to psychotherapy: death, isolation, meaning in life, and freedom. These
four themes form the spine of my textbook and I shall elaborate upon them as I
proceed today.
What does Existential therapy look like
in practice? To answer that question one must attend to both “content” and
“process” – the two major aspects of therapy discourse. “Content” of course is
just what it says – the precise words spoken, the substantive issues addressed.
“Process” refers to an entirely different and enormously important dimension:
the interpersonal relationship between the patient and therapist. When we ask
about the ‘process’ of an interaction, we mean: what do the words (and the
nonverbal behavior as well) tell us about the nature of the relationship
between the parties engaged in the interaction?
If my own therapy sessions were observed,
one might often look in vain for lengthy explicit discussions of death,
freedom, meaning, or existential isolation. Such existential content may only
be salient for some patients (but not all patients) at some stages (but not all
stages) of therapy. In fact, the effective therapist should never try to force
discussion of any content area: therapy should not be theory-driven but
relationship-driven.
But observe these same sessions for some
characteristic process deriving from an existential orientation and one will
discover another story entirely. A heightened sensibility to existential issues
deeply influences the nature of the relationship of the therapist and patient
and affects every single therapy session.
Perhaps I can best elaborate upon that
with some comments upon the basic nature of the therapeutic relationship. What’s
the best term for our relationship with those we treat? Patient/therapist,
client/counselor, analysand/analyst, client/facilitator, or the latest – and,
by far, the most repulsive – user/provider? The choice is uncomfortable for me
because none of these phrases accurately conveys my sense of the therapeutic
relationship. Though I, for convenience, refer to the patient/therapist
alliance, inwardly I believe there is something to be said for thinking of
patients and therapists as fellow travelers, a term which abolishes
distinctions between “them” (the afflicted) and “us” (the healers).
Andre Malraux, the French novelist,
described a country priest who had taken confession for many decades and summed
up what he had learned about human nature in this manner: “First of all, people
are much more unhappy than one thinks ... and there is no such thing as a
grown-up person.” Everyone – and that includes therapists as well as patients –
is destined to experience not only the exhilaration of life, but also its inevitable
darkness: disillusionment, aging, illness, isolation, loss, meaninglessness,
painful choices, and death.
No one put things more starkly and more
bleakly than Schopenhauer:
“In early youth” Schopenhauer says, “as we
contemplate our coming life, we are like children in a theater before the
curtain is raised, sitting there in high spirits and eagerly waiting for the
play to begin. It is a blessing that we do not know what is really going to
happen. Could we foresee it, there are times when children might seem like
condemned prisoners, condemned, not to death, but to life, and as yet all
unconscious of what their sentence means.”
Though Schopenhauer’s view is colored
heavily by his own personal unhappiness, still it is difficult to deny the
inbuilt despair in the life of every self-conscious, free-thinking individual.
My wife and I have sometimes amused ourselves by planning imaginary dinner
parties for groups of people sharing similar propensities – for example, a
party for monopolists , or flaming narcissists, or artful passive-aggressives we
have known or, conversely, a “happy” party to which we invite only the truly
happy people we have encountered. Though we’ve encountered no problems filling
all sorts of other whimsical tables, we’ve never been able to populate a full
table for our ‘happy people’ party. Each time we identify a few
characterologically cheerful people and place them on a waiting list while we
continue our search to complete the table, we find that one or another of our
happy guests is eventually stricken by some major life adversity – often a
severe personal illness or that of a child or spouse.
This tragic but realistic view of life
has long influenced my relationship to those who seek my help. During my
training I was often exposed to the idea of the “fully analyzed therapist,” –
remember that fairy tale? But as I have progressed through life, formed
intimate relationships with a good many of my therapist colleagues, met the
senior figures in the field, have been called upon to render help to my former
therapists and teachers, and have, myself, become a teacher and an elder, I
have come to realize the mythic nature of this idea. We are all in this
together and there is no therapist and no person immune to the inherent
tragedies of existence.
When I speak of the ultimate concerns, of
death, meaning, freedom, isolation, I am obviously veering close to the domain
which is the stuff of every religious tradition. It is indisputable that
religious belief and practice has been ubiquitous throughout the ages – has
there ever been a culture discovered without some form of religious
observation? Sometimes it is suggested that the omnipresence of religious
belief constitutes confirmation or validation of an omnipresent divinity.
As many do, I take the reverse position –
in other words, that, throughout history, every being in every culture has had
to deal with the ultimate concerns and has sought some way to escape the
anxiety inbuilt in the human condition. Every human being experiences the anxiety
accompanying thoughts of death, meaninglessness, freedom (that is, the
fundamental lack of structure in existence, das nichts ) and fundamental
isolation – and religion emerges as humankind’s basic attempt to quell
existence anxiety. Hence the reason that religious belief is ubiquitous is that
existence-anxiety is ubiquitous. Rather than being created by Gods, it seems
obvious that we create Gods for our comfort and, as philosophers have pointed
out since the beginning of the written word, we create them in their own image.
As Xenophanes, the Presocratic free-thinker , wrote 2500 years ago, “If Lion
could think, their Gods would have a mane and roar.”
Let me turn now to a consideration of
some psychotherapeutic as well as religious efforts to assuage existence
anxiety. Consider first the ultimate concern of meaninglessness.
We humans appear to be meaning-seeking
creatures that have the misfortune to be thrown into a world devoid of
intrinsic meaning. One of our major life tasks is to invent a purpose in life
sturdy enough to support a life. And then next we have to perform the tricky
maneuver of subsequently denying personal authorship of this purpose so as to
conclude that we “discovered” it – that it was “out there” waiting for us.
Our ongoing search for substantial
purpose in life systems often throws us into a crisis. More individuals seek
therapy because of concerns about purpose in life than therapists often
realize. Jung, for example, estimated that one third of his patients consulted
him for that reason. The complaints take many different forms: for example, “My
life has no coherence,” “I have no passion for anything,” “Why am I living? To
what end? Surely life must have some deeper significance.” “I feel so empty –
watching TV every night makes me feel so pointless, so useless.” “Even now at
the age of fifty I still don’t know what I want to do when I grow up.”
I recently read a beautiful book called
“The Listener,” the memoirs of Alan Wheelis, the San Francisco psychoanalyst
and marvelous lyrical writer. One passage relevant to this discussion has stuck
in mind. The author is walking with his dog, Monty:
If then I bend over and pick up a stick,
he is instantly before me. The great thing has now happened. He has a mission.
It never occurs to him to evaluate the mission. His dedication is solely to its
fulfillment. He runs or swims any distance, over or through any obstacle, to
get that stick.
And, having got it, he brings it back:
for his mission is not simply to get it but to return it. Yet, as he approaches
me, he moves more slowly. He wants to give it to me and give closure to his
task, yet he hates to have done with his mission, to again be in the position
of waiting.
For him as for me, it is necessary to be
in the service of something beyond the self. Until I am ready he must wait. He
is lucky to have me to throw his stick. I am waiting for God to throw mine.
Have been waiting a long time. Who knows when, if ever, he will again turn his
attention to me, and allow me, as I allow Monty, my mood of mission?
Why does that passage stay with me? It’s
so seductive to think of a preordained concrete assignment for life. Who among
us has not had the wish: if only someone would throw me my stick. How
reassuring to know that somewhere there exists a true, a real, an ordained,
pre-assigned purpose-in-life rather than only the incorporeal, gossamer,
invented purpose-in-life which it seems to me inevitably follows from the
ultimate vision of our solar system lying in ruins.
The problem of life meaning plagues all
self-reflective beings. And, of course, religious revelation which communicates
God’s ultimate personal purpose for us is, no matter how difficult, no matter
how lengthy, deliciously welcome. How much more comforting is the religious
solution to the problem of meaning than the more rational but bleak message
sent us by nature, a message that reminds us of our miniscule place in the
cosmos and in the great chain of being? I once saw a memorable and jarring
cartoon containing several panels, each depicting some species, for example, an
earthworm, a fish, a bird, a snake, a cow. In each panel one of these creatures
was depicted as chanting the same refrain: “Eat, survive, reproduce. Eat,
survive, reproduce.” The last panel depicted a man in Rodin’s “thinker” posture
and chanting to himself, “What’s it all about? What’s it all about?” All the
other life forms seem to get the picture but we humans just cannot get our
minds around it and instead demand and then legislate the existence of some
higher purpose or mission.
Most clinical and theoretical
explorations into sturdy and satisfying life-purpose projects point to such
goals as hedonism, altruism, dedication to a cause, generativity , creativity,
self actualization. It seems evident to me that life-purpose projects take on a
deeper, more powerful significance if they are self-transcendent – that is,
directed to something or someone outside themselves – the love of a cause, the
creative process, the love of others or a divine essence.
The precocious success of today’s young
hi-tech millionaires has often generated a life crisis that is instructive
about the limitations of non-self-transcendent life meaning systems. These
individuals begin their careers with clear vision – they are intent on making
it: earning heaps of money, living the good life, receiving the respect of
colleagues, retiring early. And an unprecedented number of young people in
their thirties have done exactly that – until of course the end of the good
times in the recent market collapse. But then the question arises: “What now?
What about the rest of my life – the next forty years?”
Most of the young hi-tech millionaires
that I have seen continue doing much of the same: they start new companies,
they try to repeat their success. Why? They tell themselves it is to prove it
was not a fluke, to prove they can do it alone, without a particular partner or
mentor. They raise the bar. To feel that they and their family are secure, they
no longer need one or two million in the bank – they need five, ten, even
twenty-five million to feel secure. They realize the pointlessness and
irrationality in earning more money when they already have more than they can
possibly spend but they do not stop. They realize they are taking away time
from their families, from things closer to the heart, but they cannot give up
playing the game – “the money is just lying out there” they tell me, “all I
have to do is pick it up.” They have to make deals. One real estate
entrepreneur told me that he felt he would disappear if he stopped. Many fear
boredom – even the faintest whiff of boredom sends them right back to the game.
Unlike my approach to other existential
ultimate concerns (death, isolation, freedom) I find that, in my clinical
practice, purpose-in-life is best approached obliquely – it is best not to
pursue purpose explicitly but to allow it to ensue from meaningful and
authentic engagement, from plunging into an enlarging, fulfilling,
self-transcending endeavor. We therapists do most good by identifying and
helping to remove the obstacles to such engagement. The explicit pursuit of
purpose-in-life is, as the Buddha taught, not edifying: it is best to immerse
oneself into the river of life and let the question drift away. Incidentally,
I’ll point out in passing that one of the great privileges of our profession as
therapists is that it inoculates us against a crisis of purposelessness – that
is a complaint I very rarely hear voiced by experienced therapists.
I’ll turn now from meaninglessness to
another ultimate concerns: Existential Isolation. First we need to discriminate
between the several uses of isolation in our profession.
There is Intra-psychic isolation which
refers to separation from oneself. It’s an old concept – think of Binswanger’s
description of Ellen West where in a discussion of how she no longer knows her
own opinion he says: “This is the loneliest state of all, an almost complete
separation from one’s autonomous organism.” Freud described the defense
mechanism of isolation as the process of stripping off affect from the memory
of some unpleasant event and interrupting its associations so it is isolated
from ordinary processes of thought. Many therapists, for example Fritz Perls,
often described the therapeutic goal of helping patients reintegrate split-off
parts of themselves. Indeed, Perls christened his approach, Gestalt therapy, to
emphasize his dedication to the aim of “wholeness.” (Note the common
etymological root of whole, heal, healthy , hale.)
And there is Interpersonal Isolation
which is commonly experienced as loneliness, a ubiquitous issue in therapy.
Loneliness issues from a variety of sources – social, geographic, cultural
factors, the breakdown of intimacy sponsoring institutions in our society, lack
of social skills, personality styles inimical to intimacy – for example,
schizoid, narcissistic, exploitative, judgmental. We therapists are accustomed
to working with loneliness and are, I am persuaded, particularly effective
treating profound loneliness in a group therapy setting.
Finally, in addition to intra-psychic and
interpersonal isolation, there is Existential Isolation which cuts even deeper;
it is a more basic isolation which is riveted to existence and refers to an
unbridgeable gulf between oneself and others, a separation not only between
oneself and others but between self and world. It is a phenomenon that, in my
experience, is experienced most keenly by patients facing death for it is as
that time that one truly realizes that one was born alone into the world and
must exit from the world alone. We may want others to be with us at death, we
may die for another or for a cause but no one can, in the slightest degree,
have one’s solitary death taken from him or her. Though we may wish that others
accompany us in death (as did rulers in several cultures of antiquity) still
dying remains the loneliest of human experiences. Consider the Everyman drama
still performed after seven centuries. Remember that when Everyman was visited
by the angel of death, he pleaded for respite or delay. When that was refused
he pleaded to be allowed to take company on his trip. The angel of death
agreed, “Sure, if you can find someone.” And for the remainder of the drama
Everyman searched for a travel companion. All his friends and relatives
declined with the flimsiest of excuses. A cousin had a cramp in the toe.
Finally he turned to allegorical figures – beauty, wisdom, wealth – but even
they declined to accompany him. With one exception – the moral of this
Christian morality play – in the final denouement Good Deeds accompanied
Everyman on his final journey.
Religious consolation and psychotherapy
have each developed its methods of quelling the dysphoria of the various forms
of isolation. The Oxford English dictionary informs us that one of the roots of
the word “religion” is re-ligare – to tie or to bind. The Romans used the term
religare to connote a variety of ties – to family, to ancestors, to the state.
That meaning – tying or binding together or let us refer to it as connectivity
– vividly illuminates the similar missions of psychotherapy and religion. In
fact, connectivity is a good common denominator for all the present forms of
the contemporary spiritual search.
In any discussion of religion and
psychiatry that term “connectivity” has great value. Therapists place nothing
above the goal of connecting with patients as deeply and authentically as
possible. The professional literature regarding the therapist-patient
relationship is replete with discussions of encounter, genuineness, accurate
empathy, positive unconditional regard, ‘I-thou encounter.’ And group
therapists place the highest priority on establishing group cohesiveness. Once
the group is cohesive each of the members is more able to examine and
strengthen his/her relationship with each other member. In coping with death
members of my groups for cancer patients often spoke of the great comfort they
experienced from being with others who, by virtue of facing the same situation,
provided a deep connection. One of these patients offered a lovely description
of “connectivity”: “I know we are each ships passing in the dark and each of us
is a lonely ship but still it is mighty comforting to see the bobbing lights of
the other nearby boats.”
In work with the spousally bereaved I’ve
been struck by the despair emanating from the rupture in connectivity which
extends even beyond the experience of loss. Widows and widowers speak of the
pain of living an unobserved life – of having no one who knows what time they
come home, go to bed, or woke up. And who has not seen individuals continue a
highly unsatisfying relationship precisely because they crave a life witness?
And how often do we therapists provide help from becoming our patient’s life
witness?
Religion provides powerful forms of
connectivity. A religious person is offered the consolation of a personal
eternally observing deity, who is not only aware of his/her existence but also
promises ultimate reunion – with lost loved ones, with the Godhead, with the
universal life force. And of course it is readily apparent that organized
religion provides connectivity through community: the church provides a stable
congregation of like-minded individuals, sponsors enormous numbers of small
groups including social groups, special interest groups, bible study, book
groups, marriage encounter groups, singles groups. Large numbers of individuals
undoubtedly join the religious community for reasons of social connectivity
rather than allegiance to the substance of a particular religious doctrine.
Death is the most obvious, intuitively
apparent ultimate concern. Though some therapists, whenever possible, avoid the
subject in therapy following Adolph Meyer’s adage, “Don’t scratch where it
doesn’t itch,” most therapists realize that concerns about death are always
there, percolating under the surface. Death haunts us as nothing else; we’ve
been preoccupied with its dark presence, often just at the rim of
consciousness, since early childhood and we have erected denial-based defenses
against death anxiety that play a major role in character formation. Many
philosophers have discoursed on the interdependence of life and death: to learn
to live well is to learn to die well and conversely to learn to die well is to
learn to live well.
A confrontation with death often creates
a dramatic perspective-altering opportunity. Heidegger spoke of two modes of
being. First, an “everyday” mode in which we marvel at the way things are in
the world. This is a state of forgetfulness of being, of fleeing, of being
tranquilized by the cornucopia of objects surrounding us. And, second, an
“ontological mode,” a state of mindfulness of being in which we live
authentically and marvel that things are, marvel at the very suchness of
things. In this state the individual is primed for life-change.
How do we move from the everyday state to
the ontological state? Jaspers described the major vehicle as the “boundary
experience” – a jolting, irreversible experience which shifts the individual
from the everyday mode to a more authentic mode. Of all the possible boundary
experiences, confrontation with death is by far the most potent.
Time and again, we see individuals who in
a confrontation with death make dramatic life changes. It is a familiar theme
in great literature (for example, Scrooge in The Christmas Carol and Tolstoy’s
Pierre in War and Peace, or Ivan Ilych). Cancer patients have described the
experience of reprioritizing life values and trivializing the trivia in life,
of saying “no” to the things that are unimportant, of turning full attention to
loving ones about them, to the rhythms of the earth, changing seasons, to
concern about the model of dying they set for others. In a macabre manner,
cancer cures psychoneurosis and death bestows an unmistakable bitter-sweet
poignancy to life. Still another way to put it is that though the physicality
of death destroys us, the idea of death can save us.
But I’ve so often heard patients lament,
“What a pity I had to wait for wisdom until now, till my body was riddled with
cancer.” This statement poses a major challenge for therapists: how do we find
the leverage for such change in the absence of imminent death – in our everyday
practice with our everyday patients? Therapists with a sensibility for
existential issues may be able to utilize other less visible, more subtle
boundary experiences- for example, life era markers, retirement, the aging
body, children leaving home, the death of the other. Even such a trivial event
as a birthday may be an important route into deeper ground. We generally
celebrate such days but brief reflection upon the matter raises the question of
what the celebration is about – isn’t its function really to deny and to
neutralize the grim reminder of the inexorable rush of time?
Most religious doctrines, it seems to me,
may make use of some of these therapeutic approaches but for the most part the
believer is offered powerful consolation through the denial of the finality of
death – through the idea of the survival of the soul, through judgment,
redemption, and paradise, through reunion with loved ones, and with God,
through reincarnation, through merging with the universal life force.
Do I try to impose my views on belief
upon my patients? Of course not – my task is to be of help and that means to be
as empathic as possible to patient’s belief system – (look out patient’s window
– elaborate).
But even more than empathy is required:
it is important that the therapist be well-informed about the patient’s
religious views – such edification may flow from the patients themselves or
from the therapists’ independent study. I’ve sometimes worked with priests or
nuns and urged them to look more deeply into their religious beliefs in order
to obtain the comfort that should be provided therefrom. Sometimes part of the
therapist’s task is to lay bare the rationalizations that have permitted
individuals to reprioritize and elevate certain religious practices over other
more central ones – for example when excessive service to the letter of ritual
takes precedence over expression of love, charity, and community.
That’s how I respond outwardly to an
individual’s great reliance on belief in the absence of my own. And my inward,
silent response? What is that like? Often I experience sheer amazement at the
power and persistence of our need to believe. It does not go away: our need to
believe in something beyond biology is so remarkably tenacious that we are
everywhere surrounded by not only a variety of religious beliefs with many of
them insisting upon the uniqueness of one particular set of beliefs, but we are
also surrounded by the presences of less thoughtful and more patently
irrational beliefs: past-life channelers, abduction by extraterrestrials,
clairvoyance, psychic surgery, ghosts, witches, astrology, TM levitation,
astral traveling, dowsers, necromancy, miracles, after-death experiences, I
Ching, Feng Shui, Angels, healing crystals, palm reading, astrology, aura
reading, psychokinesis, poltergeists, exorcism, Tarot cards, precognition,
synchronicity and I’m sure each of you could add to this list. To repeat my
earlier statement, such extraordinary claims demand extraordinary proof and no
such extraordinary proof has ever been posited.
And sometimes I feel a deep sorrow for
the underlying fragility of the human condition which begets our gullibility
and our powerful need to believe that, like nascent oxygen, must and will
instantaneously adhere to something. Sometimes I fear the future because of the
dangers that irrational belief creates for our species. It is supernatural
belief, not absence of belief that may destroy us. We need only look to the
past to trace out the huge swaths of destruction that unyielding conviction has
caused. Or look to contemporary conflicts in the Mideast or the Indian
subcontinent where conflicting and unyielding fundamentalist belief systems
threaten millions. I love Nietzsche’s aphorism that it is not the courage of
one’s convictions that matters but the courage to change one’s convictions.
There are times when I feel (but keep to
myself) sorrow as I consider the amount of an individual’s life that can be
spent in bondage to obsessive-compulsive behavior, and to practices of
prolonged meditation or excessive preoccupation with ritualistic practice. What
is lost is some part of human freedom, creativity and growth.
In his four noble truths the Buddha
taught that life is suffering, that suffering originates from craving and
attachment, and that suffering can be eliminated by detachment from craving
through meditative practice. Schopenhauer took a similar position – that the
will is insatiable and that as soon as one impulse is satisfied we enjoy only a
moment of satiation which is instantly replaced by boredom until another desire
seizes us.
To me, these views feel unnecessarily
pessimistic. I appreciate the suffering in human existence but I never
experience that suffering as so overwhelming that it demands the sacrifice of
life. I much prefer a Nietzschian life-celebratory, life engagement, amor fati
(love your fate) perspective. My work with individuals facing death has taught
me that death anxiety is directly proportional to the amount of each person’s
“unlived life.” Those individuals who feel they have lived their lives richly,
have fulfilled their potential and their destiny, experience less panic in face
of death. Therapists have much to learn from Nikos Kazanzakis, the author of so
many great life-celebratory works of art, for example, Zorba the Greek and The
Greek Passion. Kazanzakis was, like Nietzsche, an anti-religion religious man
whose grave (placed just outside the city walls of Heraklion on Crete, because
of excommunication from the church) bears his chosen epitaph, “I want nothing,
I fear nothing, I am free.” I love the advice he offers in his major work, A
Modern Sequel to the Odyssey. His advice for life is: “Leave nothing for death
but a burned-out castle.” It’s not a bad guideline for our life – and for our
work in therapy.
Copyright © 2000 Irvin D. Yalom, M.D.
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