Sin, Guilt and Mental Health: Confession and Restitution as Means of Therapy

by Paul Martin

Sister Jane Marie Luecke is professor  of English at Oklahoma State University, Stillwater.

This article appeared in The Christian Century, May 21, 1975, pp. 525-527. Copyright by The Christian Century Foundation; used by permission. Current articles and subscription information can be found at This material was prepared for Religion Online by Ted and Winnie Brock.


Mentally disturbed persons need a simple, step-by-step method to move from where they are toward health, community and usefulness: first, to tell others the truth about themselves, and second, to list the people they have harmed and make amends wherever possible. Then they have an obligation to work with others seeking the same help, insuring their own recovery.

"God may forgive your sins, but your nervous system won’t." -- Alfred Korzybski.

One definition of psychiatry is, significantly, "treatment of souls." A growing measure of responsible opinion argues convincingly that had religion been doing the job it should have done, psychiatry would never have arisen as a profession. Proponents of this view say that the problem is generally not a guilt complex. The problem is guilt. Depression, anxiety, hostility, fear, tension and, in more serious cases, psychosis are really ailments of the conscience -- symptoms that result from violating the conscience’s promptings and refusing to live honestly and responsibly. On this basis, the only way to have the good life is to live a life that is good.

Certainly a thoughtful look at psychiatry’s record would increase the depression of many a person seeking help with mental or emotional problems. Studies of the effectiveness of psychotherapy which offer persuasive evidence that this is not where it’s at include one made in 1952 in which H. J. Eyesenck, an English psychiatrist, divided thousands of World War II veterans hospitalized for mental illness into three groups. One group was treated by psychoanalysis, another was given other kinds of therapy, and the third received no treatment at all. The men were then measured on an "improvement scale" with these stunning results: 44 per cent improved with psychoanalysis, 64 per cent improved with other therapies, and 72 per cent got better with no treatment at all.

More recently, Werner Mendel, professor of psychiatry at the University of Southern California, directed a similar study. Trained psychoanalysts treated the patients in the first group, less highly trained psychologists and psychotherapists treated the second group, and the third group was under the care of employees with no formal training. The improvement ratings showed the following remarkable results: the third group, treated by staff members without formal training in therapy, showed the most improvement, whereas the first group, treated by staff members with the most extensive training in psychotherapy, showed the least improvement. Understandably, Dr. Mendel was startled by the results and repeated the experiment, with the same outcome.


There’s always something new flashing across the horizon. The February 1974 issue of Psychology Today includes 2 classified advertisements for Primal Therapy under the heading of "Growth Centers." A few years ago the popular listing was Transactional Analysis, and five years from now it will be something else. All of these fads flourish for awhile and then fade into richly deserved obscurity.

In the past few years, many have been enthusiastically hailing encounter groups and sensitivity groups as bringing about the new utopia. Those who are "with it," along with men and women earnestly seeking release from agonizing inner pain, have been "getting in touch with their feelings." Beating pillows, crying, sobbing, shouting, swearing, screaming, embracing, they embarked upon what purported to be a great voyage of discovery, from which they received a finely tuned method enabling them to reach their human potential. The movement spawned beautiful thoughts and eloquent phrases aplenty, but, after the shouting began to subside, serious studies of the effectiveness of these groups revealed little permanent improvement in the members and sometimes substantial damage. The learning that is supposed to come from what the late Abraham Maslow immortalized as the "peak experience" proves to be an elusive commodity for the person trying to translate it into a better life 365 days a year.

In view of such a record, it’s understandable that some behavioral scientists became disillusioned with their trade. One of them, Hobart Mowrer, research professor of psychology at the University of Illinois, has had a profound effect on the field. Some years ago he became thoroughly disenchanted with the poor clinical results from treating mental and emotional breakdowns according to the traditional Freudian approach. When neurosis is viewed as the product of the impossible demands made on the individual by an overdeveloped conscience, therapy may be directed not toward helping the patient live up to his or her conscience, but rather toward bringing down the conscience to the level of behavior. The goal would seem to be to enable individuals to do whatever they want without being bothered by it.


After following this direction for a number of years, Dr. Mowrer finally rejected it because he found that it did very little to make people well. Influenced by the work of Harry Stack Sullivan, Dr. Mowrer began helping people to improve their performances and live up to their consciences. The results have been dramatic. Again and again, honest, responsible living has improved mental and emotional health. As Dr. Mowrer has pointed out, integration and integrity come from the same root word. There can be no integration within a human being unless he or she aims for a life of integrity.

Honesty, openness, restitution and willingness to help others are keystones in Dr. Mowrer’s approach. Openness means letting "significant others" know us as we really are. It means taking literally the injunction in James 5: 16: "Confess your faults one to another." On the same subject, in Proverbs 28: 13: "He that covereth his sins shall not prosper; but whoso confesseth and forsaketh them shall have mercy. This is a powerfully simple prescription found in both Judaism and Christianity -- but how often is it used? To the inevitable question "Is there really help in telling others the entire truth about ourselves, including those things we’re most ashamed of?" the Integrity Therapy advocates reply, ‘Absolutely.’ Explains Dr. Mowrer:

If secret confession, to priests and psychiatrists, had a really good record of accomplishment, we should be glad enough to be spared the embarrassment of having the "ordinary" people in our lives know who we are. But that record is not good; and, reluctantly, many people are today experimenting with open confession of one kind or another. When you stop to think of it, secret confession is a contradiction in term’s -- secrecy is what makes confession necessary. And it is not surprising that the attempt to cope with unresolved personal guilt by means of continued furtiveness does not work out very well.

Another point heavily stressed in the Integrity Therapy approach is restitution for harm done to others. Christianity all along has had, but mislaid, these specific tools which Dr. Mowrer and others have shown to be potent methods for restoring wholeness to a troubled human being. For example, Matthew 5:23-24 outlines with precise clarity what is to be done: "Therefore if thou bring thy gift to the altar and there rememberest that thy brother hath ought against thee; leave there thy gift before the altar and go thy way; first be reconciled to thy brother, and then come and offer thy gift." As these verses illustrate, one’s relationship with other human beings provides an accurate measuring stick for the state of one’s relationship with God. The Jewish Day of Atonement, too, gives a time to make amends to those who have been harmed.

Sin, kept secret, thrusts the sinner out of community. Alone, alienated, afraid, he can find his answer in letting others know him as he really is and making amends for harm he has caused. The success of this approach lies in its rejection of deterministic theories that make a person a victim of heredity or environment. Rather, it places responsibility for one s own life on the individual.

Christianity’s goal, which is wholeness, remains. The way toward it, which seems to have been lost, has been rediscovered by the Integrity Therapy groups, by the therapeutic communities for drug addicts and by Alcoholics Anonymous, among others. In the final analysis, alcoholism and drug addiction are not about alcohol or other drugs; they come down to dishonesty, self-centeredness, irresponsibility. Here, recovery for desperately sick people hinges on a willingness to be honest and responsible and to employ the techniques of confession and restitution as a basis for character change. Further, the individual is expected to pass this method on to others as part of his or her own recovery.


How well do these techniques work? Responsible opinion agrees that AA and the therapeutic communities are the most effective agencies around for enabling alcoholics and drug abusers to live their lives without chemical support. The Twelve Steps practiced in AA employ principles fundamental in the Christian gospel. Commitment to God as the individual understands him is followed by a searching moral inventory and then an admission of one’s defects to God, to oneself, and to another human being. In addition, the AA member compiles a list of persons he or she has harmed and makes amends to these individuals whenever possible. Meditation is an integral aspect of the recovery program, and each member is enjoined to "carry the message" to other alcoholics. AA helps alcoholics far more effectively than anything else on the scene today, and it does so with tools that have been largely abandoned by organized religion.

Many thousands of alcoholics the world over are staying sober by energetic application of AA’s Twelve Steps. Listen to the persuasive evidence of one man, showing how this process can move one’s life toward a new, positive direction:

My continuing recovery from alcoholism is based on the program of rigorous honesty outlined in Alcoholics Anonymous. I found it absolutely brutal to look at the truth about myself shown in a written moral inventory. When I admitted these things, the results were unbelievable. It was one of the most diflicult things I’ve ever done in my life, but it brought rue a freedom and release I never thought possible...

The sell-knowledge and spiritual awakening allowed me to be completely open with others, and I became privileged to watch the miracle that happened to me repeated in others. I became a channel for God’s grace by continuing to admit my shortcomings and working with others as they did the same. However, to admit that I was a thief was not enough. I was compelled to meet with people I had stolen from and harmed in other ways and make amends. Where stealing was involved, I had to repay them.

My parents, wife, family, fellow workers -- all of whom had been affected by my drinking -- were now being affected by my amends. Once again, waves of release and freedom swept over me and my life continued to change steadily and sometimes dramatically. This entire process has given me a closeness to God and to other people. It’s as if I had been dead and were brought back to life.

There may be extensive arguments over precisely what constitutes a cure in many areas of mental and emotional breakdown, but with an alcoholic or drug addict the first measure is complete abstinence from alcohol or drugs. This is not the whole story; the alcoholic may be sober, the drug user "clean" -- and still be in poor condition as a human being. Without abstinence, however, there is no hope of recovery.

Therapeutic communities such as Synanon, Daytop Village and Gateway House provide one of the few hopeful vistas in the nation’s bleak drug picture. Openness in the therapeutic communities, as with AA and Integrity Groups, involves honest sharing with each other at depth. They, too, take literally the injunction to "Confess your faults one to another."

Gateway House in Chicago opened its doors in 1968 and boasts a glowing record in restructuring its residents into men and women with the moral stamina to live without drugs. A visitor is immediately struck by the vigor and strength of the recovering addicts. Often harshly demanding in its emphasis on truth and integrity, the recovery program at Gateway is designed so that each resident (1) gets a clear look at himself, (2) feels a continuing pressure to change harmful attitudes, and (3) begins to practice honesty and learns to trust others.

Gateway provides persuasive proof of the powerful need for continuing honesty, openness and responsibility for a life of mental, emotional and physical health. Its residents are taught consistently that anything less than this spells return to drugs and destruction.

The strength of honesty, which plays the primary role in enabling desperately sick drug addicts to break free from their destructive habits, is reflected in ever-widening circles in the lives of others. Extensive experience shows with compelling clarity that these principles of honesty, openness, responsibility and integrity are equally effective with men and women whose mental and emotional symptoms have not taken the form of addiction to alcohol and hard drugs.

Too often the advice of the professional counselor is to take a pill and keep still. Prescription drugs are used routinely to mask symptoms; then the conditions causing them are not faced. Some 10 million housewives regularly use a stimulant or calming agent legally prescribed by their physicians. Very possibly these women are dependent on these drugs. Out of every 1,000 persons admitted to a U.S. hospital this year, 50 will be entering for a bad reaction to a legal drug, legally prescribed.


While there are substantial indications that some people do have a biochemical disorder that manifests itself in mental abnormalities, the record offers persuasive evidence that much mental illness stems from the old-fashioned toxins of sin and guilt.

As far back as 1961 Dr. Mowrer outlined the case against conventional psychotherapy and carefully described the powerful healing legacy that Christianity had lost. Recently Karl Menninger, the dean of the U.S. psychiatric establishment, wrote a book called Whatever Became of Sin? (Hawthorn, 1973) that echoes those precise thoughts. Calling attention to a point that Dr. Mowrer raised years ago, Dr. Menninger writes:

The early Christian church cells were comprised of small groups of people who met regularly -- often secretly. The order of worship was, first of all, self-disclosure and confession of sin, called exomologesis. This was followed by appropriate announcement of penance, pleas for forgiveness, and plans for making restitution. A final period of friendly fellowship (Koinonia) closed the meeting. This general formula continued until the Council of Nicaea, AD. 325 when Constantine took over the church for all Roman citizens. To make it acceptable, however, he replaced the requirement of open personal disclosure with private confession to a priest. Private confession to a priest at least once a year was made obligatory in the thirteenth century. Luther dispensed with closed confession for Protestants; the Catholics continued it, but are now discussing open or public confession, while some Protestants are considering the reintroduction of closed confession!

It’s refreshing, indeed, to see a man of Menninger’s reputation conclude that mental health and moral health are inseparable -- thus embracing principles which will bring recovery.

Reality is never ethically neutral. Kick at the universe and it kicks back. If a man jumps out of a tenth-story window, he doesn’t break the law of gravity; he just proves that it exists. Guilt is the tangible result of sin. Lying, stealing, cheating and other forms of irresponsible behavior exact their inevitable price. Mentally disturbed persons need a simple, step-by-step method to move from where they are toward health, community and usefulness: first, to tell others the truth about themselves, and second, to list the people they have harmed and make amends wherever possible. Then, with growing health and increasing vitality replacing the crushing burden of guilt, they have an obligation to work with others seeking the same help. This will help ensure their own recovery.

The spiritual message, which is the method of change, is reiterated in every age and culture, and its validity does not stand or fall on the basis of some historical event. Obsessions with place and time are the cancers of those who are unaware that eternal truth is timeless and not limited to any particular location or specially chosen group.

In his book Life Together, Dietrich Bonhoeffer wrote:

In confession the break-through to community takes place. Sin demands to have a man by himself. It withdraws him from the community. The more isolated a person is, the more destructive will be the power of sin over him, and the more deeply he becomes involved in it, the more disastrous is his isolation. Sin wants to remain unknown. It shuns the light. In the darkness of the unexpressed it poisons the whole being of a person. This can happen even in the midst of a pious community. In confession the light of the Gospel breaks into the darkness and seclusion of the heart. The sin must be brought into the light. The unexpressed must be openly spoken and acknowledged. All that is secret and hidden is made manifest. It is a hard struggle until the sin is openly admitted. But God breaks gates of brass and bars of iron.

While confession initially may be made to just one person, it should move out as personal transparency and sincerity increase. Through confession, the individual takes responsibility for the state of his life, concentrating on what he has done, not what has been done to him.

As more and more persons know all of our secrets and transgressions, we achieve freedom from the constant fear of being found out. We can change the past by dealing with it consciously and positively in the present. As the process continues, we will gradually know growing sanity, stepped-up vitality, greater health and vastly expanded usefulness. With the present no longer a hostage of the past, we begin to live effectively and joyously in the moment. The method is there, waiting to be rediscovered.