Psychiatry and Pastoral Counseling
by Don Browning
Don Browning is professor of religion and psychological studies at the University of Chicago Divinity School. This article appeared in the Christian Century, February 6, 1974, pp. 158-161. Copyright by The Christian Century Foundation; used by permission. Current articles and subscription information can be found at www.christiancentury.org. This material was prepared for Religion Online by Ted and Winnie Brock.
Book Review: Home From the War. By Robert Jay Lifton. Simon & Schuster. $8.95.
Some months ago we spotted Robert Jay Lifton’s Home from the War as a logical choice for special attention. But Don Browning, to whom we commended it for review, saw in it more than an intelligent examination of Vietnam, veterans’ subsequent experiences. He has used it as a trigger for discussion of potential trends in pastoral care and religious counseling. For that reason, we scheduled his argument for this special issue on theological education and pastoral training. Browning’s comment is significant because he shows that pastoral care people are trying to forget what psychiatrists like Lifton are trying to remember. He plunges the readers into the specialist-technical vs. wholistic-organic models. The consequences of the debate will be felt by all who are subjects of or practitioners of pastoral counseling.
The American people have been told by their leaders that the war in Vietnam is over -- though in fact it is not. Our own men have been removed from battle, but the shooting, bombing, maiming and killing continue. Robert Lifton’s new book, Home from the War, tells us with startling vividness something else that we know but, sometimes manage to push from consciousness: that the war is not over even for Americans. Echoes of it rumble on in our minds and emotions. And especially is this true for the returning veteran.
Lifton writes about the Vietnam veterans -- their guilt, their anger, their confusion, their struggles for wholeness. In this account of his experience as a counselor to a rap group of veterans affiliated with Vietnam Veterans Against the War, Lifton has given us a remarkably penetrating and sensitive psychohistorical study of these young men’s inner experience of the tenor and purposelessness of that war.
The book is painful to read: the war is behind us and we do not want to be confronted further by its horrible reality. Some readers will call the book highly biased; the author sees only one side of the Vietnam conflict -- its brutality and moral bankruptcy. Others will find the account unscientific; it deals with the experiences of only a few men.
But in my opinion Home from the War is of considerable importance. First, it provides Americans with, a primary document that portrays the inner psychological and moral landscape of this most "modern" of modern wars. Lifton has dedicated his career in psychiatric research to investigating a variety of uniquely modern confrontations with death and man’s perennial struggle to overcome it. In Life in Death, Revolutionary Immortality, and Thought Reform and the Psychology of Totalism,, he has probed the theme of death in relation to the survivors of Hiroshima, Marxist revolutionary action, and Communist China’s practices of political reeducation.
In Home from the War he investigates the themes of death, and rebirth in the context of a war that was widely experienced as being totally without moral justification and redeeming purpose. What is it like to fight such a war? What is it like to survive it? Lifton does a remarkable job of forcing us to confront these questions, and he does it before the memories of our own direct involvement in the war have become blunted by the mechanisms of denial and the passage of time.
But there is second and more specific reason why the book is important. Home from the War raises profound questions about the meaning of mental health and psychotherapy in our time. In addition, it raises questions about the self-definitions and purposes of the major helping professions of contemporary society -- psychiatry, psychology, social work and pastoral counseling. Lifton himself is a psychiatrist. But the psychiatry that he practices with these rap groups is vastly different from the conventional practice of psychiatry in American society. Psychiatry and its associated disciplines have taken on the aura of scientific detachment and ethical neutrality in dealing with patients and their problems. As a counselor to Vietnam veterans who opposed the war, Lifton drops all pretense of ethical neutrality.
In fact., from one perspective, Home from the War constitutes nothing less than a direct attack upon the medical model as the organizing center of the psychiatric profession. Lifton does not characterize the problems of these returning veterans as sickness, emotional disturbance or battle fatigue. Rather, he approaches their problems and the war itself from a moral standpoint. The veterans’ emotional problems -- fear, anxiety, inertia, confusion, depression, guilt -- are seen as consequences of profound moral conflicts. Lifton is not so much interested in ‘cure’ as he is in a moral and spiritual rebirth. Such a self-definition moves Lifton the psychiatrist much closer to the pastoral counselor, the ethicist and the spiritual director, and away from the "technicist" view of psychiatry so dominant at the moment.
In addition to its testimony to the mental suffering produced by the Vietnam conflict, Home from the War is a call for the renewal of the helping professions in Western society. At a time when both the pastoral counselor and the spiritual director are borrowing profusely from the psychiatrist, the social worker and the psychologist, Lifton is going in another direction and challenging the secular therapist to reclaim some of the wisdom of these more ancient traditions of the cure of souls. At least, this is what his program amounts to, although he has a sophisticated and refreshing way of building his case.
Lifton wants the helping professions to retrieve the fundamental meaning of "profession." He reminds us that the word ‘profess" is made up of the Latin prefix pro, which means "forward," "toward the front." or "into a public position," and fess, which derives from the Latin fateri or fass and means "to confess, own, acknowledge." Lifton believes that originally a profession was "a personal form of outfront public acknowledgment." In addition, "That which was acknowledged or confessed always (until the sixteenth century) had to do with religion."
But gradually the concept of profession took on a more limited meaning and came to be used primarily to refer to the knowledge and skills possessed by practitioners of specialized traditions such as law, medicine and divinity. "Thus," Lifton writes, "the poles of meaning around the image of profession shifted from the proclamation of personal dedication to transcendent principles to membership in and mastery of a specialized form of socially applicable knowledge and skill." And this, Lifton believes, is what has happened to psychiatry and other helping professions.
One might suspect that it is also happening to the pastoral counselor and the spiritual director. As pastoral counseling in both the Protestant and Catholic churches becomes more specialized, it becomes more and more divorced from the moral and ethical context that the church should provide. In the process. the work of the pastoral counselor tends more and more to function in a moral vacuum. Even if the pastoral counselor has some ethical convictions that touch on the issues that come up in counseling, the counselor is most likely to "bracket" these convictions and conceal them as long as he is in the counseling situation.
A good number of our highly trained pastoral counseling specialists refer to themselves as "pastoral psychotherapists." By this they mean that they do psychotherapy (as other professionals do psychotherapy) and that they also "happen to be" ministers. There seems to be no intrinsic relationship between the therapy one does and the minister or pastor that one is. Most of these specialists maintain their relationship to the church even though they may be functioning in specialized counseling centers or in private practice. Most of them say that the church is important, though fewer and fewer are able to articulate why -- especially for their own professional activity as pastoral psychotherapists. It is my judgment that this specialized model of pastoral care is becoming more and more influential on the practices of the local pastor. If this is true, then at the very moment Lifton is holding up the tradition of pastoral counseling as a model for psychiatry, pastoral care and counseling are gradually being stripped of their own ethical contexts and more and more functioning in the technicist framework which Lifton is repudiating.
Lifton gives considerable attention to describing the structure and function of the "rap group" in which he participated with members of Vietnam Veterans Against the War. We quickly learn that these were not "traditional therapy groups," even though individual psychological problems, hurts and fears were very much a part of the agenda. But Lifton believes that from the inception of the groups, it was clear to most of those who participated that the "political-ethical and psychological-therapeutic components were inseparable." Lifton called himself a "professional" rather than a "therapist." The rap groups operated within an explicit moral context. Professionals and veterans alike shared a common, opposition to the Vietnam war and the values and assumptions that made it possible. Thus Lifton indicates that one characteristic distinguishing the rap groups from traditional therapy was "that of affinity, the coming together of people who share a particular . . . historical and personal experience, along with a basic perspective on that experience, in order to make some sense of it."
Another distinguishing characteristic was presence, which Lifton defines as a "kind of being-there or full engagement and openness to mutual impact -- no one ever being simply a therapist against whom things are rebounding." This principle is related to the third unique dimension of these groups -- self -generation: the "need on the part of those seeking help, change, or insight of any kind, to initiate their own process and conduct it largely on their own terms so that, even when calling in others with expert knowledge, they retain major responsibility for the shape and direction of the enterprise."
Lifton was not the only professional who met with the rap groups. There were others, some of whom differed with Lifton on the question of how explicit to make the political-ethical commitments of the groups. Some feared that such a view could result in the prescription of "correct" political opinions as a prerequisite for admission into the groups. Lifton argued that the shared antiwar position of the professionals was inseparable from their capacity to contribute to the psychological health of the veterans, "and that, since political and ethical views inevitably affect and to some extent define therapeutic encounters, we would do better to examine these relationships openly." This open acknowledgment of the moral context of the therapeutic group enabled the group to function in relationship to the individual somewhat like a small congregation or Methodist class meeting. Value commitments were made explicit; clarification of these commitments was pursued; deepening of one’s appropriation of these commitments was sought after; and emotional conflicts, hurts and guilts were dealt with in the context of this value-explicit situation.
From these rap groups, Lifton learned a great deal about raw human reactions to participation in the Vietnam war. He brings some new perspectives to the interpretation of this material which, once again, carry him beyond the customary explanations of psychiatry.
Lifton defines the Vietnam war as an "atrocity-producing situation." It is this kind of situation that can produce the My Lais and the Captain Medinas and the Lieutenant Calleys of this world. In a war that has no clear moral purpose, where it is difficult to distinguish friend from foe or soldier from civilian and where it is forbidden by one’s superiors either to win or to lose -- such a war impels even fairly decent people to commit atrocities. To lower one’s anxiety level, to gain a sense that something is happening, to take revenge for the senseless death of a buddy, one is tempted to kill -- anyone or everyone in sight. And if you are not a killer yourself, you know who the killers are. But you protect them. You enter into the grand conspiracy of silence and numb yourself to the cool efficiencies of mechanized and bureaucratized extermination.
Lifton believes, however, that most veterans did not walk away from this atrocity-producing situation without paying a high price. Many veterans bear the great burden of "survivor guilt"; they condemn themselves "for having killed or helped to kill, and for having remained alive." Lifton tells us that
Much of these early meetings were taken up with the men testing one another -- and finding themselves wanting -- by virtually impossible moral choices: "If you had to kill someone again in order to survive, would you do it? If you had to kill an innocent person in order to survive, would you do that?" "It you had to kill a child in order to survive, would you do that?"
Survivor guilt is the kind of self-torture wherein these questions are asked over and over again. But this is the point at which Lifton turns the tables on traditional psychiatry, which might tend to minimize this kind of guilt. Lifton contends that it has a constructive and exquisitely human value. In fact, it is through confronting this kind of guilt directly that the surviving veteran can be restored to wholeness.
Hence, the antidote to survivor guilt is "animating guilt," which Lifton contrasts with "static guilt." "Static guilt is characterized by a dosed universe of transgression and expected punishment, in which one is unable to extricate oneself from a deathlike individual condition." This is the guilt that traditional psychiatry has rightly preached against. But in campaigning against this kind of debilitating guilt, psychiatry has often overlooked the constructive aspects of genuine guilt -- what Lifton calls "animating guilt" "Animating guilt, in contrast, is characterized by bringing oneself to life around one’s guilt":
This requires . . . active imagery of possibility beyond the guilt itself. Animating guilt and image beyond the guilt are in a continuous dialectical relationship, the one requiring the other. Thus, animating guilt propels one toward connections, integrity, and movement. But for this self-propulsion to occur, one requires prior internal images of at least the possibility of these life-affirming patterns, imagery that can in turn relate no something in the external environment. In this sense the imagery of possibility antedates the animating guilt, but it is also true that animating guilt can activate the individual to the point of virtually creating such imagery.
One can hardly find anywhere a more accurate description of the renewing function of religious symbols than that which, Lifton provides in this passage. Guilt can be a stimulus to renewal and restoration when it is counterbalanced with images of hope and rebirth. But the ideologies of our time, which have made us unmindful of the constructive functions of animating guilt, have also made us oblivious of the importance of countervailing religious symbols, which hold forth the possibility of a renewed life beyond the oppressions of guilt. In ways atypical of the profession which he represents, Lifton is calling for a new appreciation of both -- animating guilt and religious symbols of hope and rebirth.
Lifton has a unique perspective upon the nature of religious symbols. His approach to religion is dictated by some rather unusual metapsychological assumptions. Lifton seems to believe that man has a need for immortality. The theme of immortality and man’s quest for rebirth has been notably persistent in his writings. His understanding of this immortalizing impulse is fundamental to his own perspective on the tragedies of the Vietnam war. Lifton describes this principle of "symbolic immortality as the need to maintain, an inner sense of continuity with what has gone on before and will go on after one’s own individual existence." It is more than the denial of death; it is a "part of compelling, life-enhancing imagery, through which each of us perceives his connection with all of human history." This thrust toward immortality can be expressed in, a variety of ways -- biologically by living on through one’s sons or daughters or one’s community or nation, theologically through resurrection or eternal life, or culturally through works and contributions which persist beyond ones death.
Lifton makes the unusual argument (unusual for a psychiatrist) that the psychological trauma of the Vietnam war can be found in the fact that it frustrated this immortalizing impulse of our soldiers. It is one thing to kill and be killed if one believes he is making a lasting contribution to the welfare of one’s community, succeeding generations, and the future of the human species. It is another thing to kill or be killed when one is convinced that one is making no contribution at all except perhaps a negative one. This latter conviction is at the foundation of the psychological problems of the returning veterans whom Lifton studied.
Hence, for Lifton’s veterans, there were no meaningful sacrifices in the Vietnam war. From the perspective of Lifton’s psychiatric anthropology, man cannot live -- in either war or peace -- without meaningful sacrifices. Man’s immortalizing impulse leads him to the need to believe that beyond the sacrifice of his own death he will in some way enjoy a connection with succeeding generations. For Lifton, religious symbols have to do with this urge for a rebirth and reunion with a larger human matrix beyond the sacrifice of one’s own death. But certain events can lead man to lose faith in this possibility. Lifton holds that the Hiroshima holocaust led many of its survivors to lose faith in the continuation of the very basis for human life. For the survivors of Hiroshima, the immortalizing impulse was threatened because humanity itself was in jeopardy. The experience of the survivors of Vietnam was not as radical; humankind may not have been in question, but the meaning of one’s own possible death and the actual death of one’s friends and enemies was in question.
In positing as part of his psychological theory of man an immortalizing impulse, Lifton comes close to the concepts of "generativity" and "care" as developed by his former teacher in the psychohistorical method, Erik Erikson. Both men believe that man has a tendency or need to contribute to the cycle of the generations beyond the confines of his own individual existence. This vision gives their theories an ethical dimension that is almost completely absent in the rest of psychiatric and psychoanalytic literature.
Against the background of such an anthropology, values and norms suddenly become relevant again to the counseling situation. The therapist is inspired to function in his professional capacity out of a moral stance. The therapy group deals with psychological problems and conflicts within an explicitly ethical context. Health becomes a footnote to the struggle to know and to do the good.
I recommend Home from the War to the religious community and especially to its pastors, rabbis, priests and counseling specialists. Its message should be taken to heart: no matter how tolerant, accepting and nonjudgmental our counseling must necessarily be, it must finally take place in a moral context. It would be a great shame for the church to forget this at the very moment when the secular counseling professions may be once again discovering that it should never be otherwise.