Psychiatry and Spiritual
In the first part of this article, published in last week's Spectator, a parallel was drawn between the effects of some of the present-day forms of physical treatment of mental illness and those of the means of attaining spiritual grace practised by religious revivalists, In particular John Wesley. Wesley often produced, consciously or unconsciously, older versions of psychological and physiological shock therapies to religious ends. In many cases of mental depression, in which the patient is completely unamenable to reasoning or spiritual consolation, electrical shock therapy has been strikingly successful. Similar relief of depression sometimes resulted from the preaching methods of John Wesley, and in the sauthern States of America today some revivalist methods also produce-phenomena similar to the results of electrical shock treatment.
INOW come to another physical treatment that has aroused much more controversy, namely the brain operation of leucotomy. Its introduction and use has proved an uphill struggle in England in the last twelve years. It has had to bear with periodic attack both from some religious bodies and philosophical theorists alike. But there has always been the constant encouragement of numerous patients, whose whole life has been altered for the better by it, and from their relatives. Around 10,000 operations have now been performed in this country, and wherever it has been used, either here or abroad, about a third of hitherto incurable patients have been able to leave mental hospitals. Even better results are obtained in less ill patients. It must also be emphasised that the patients who do best are those who are undergoing the greatest mental anxiety and suffering. The presence of what has been called unremitting 'tortured self-concern ' has been picked out by one American writer as the supreme indication for this operation. Self-concern and self-examination are good for the soul, but when this becomes so severe, prolonged and intolerable that the individual is completely incapacitated by it, it ceases to serve any useful purpose except to make him pray for the after-life even if he is very uncertain what it will be like for him.
Some severe criticisms have been made about the results of this operation. It has even been said that the soul can be destroyed. But one can say definitely from experience that normal religious beliefs and attitudes are not usually destroyed, especially with the new modified forms of operations now being increasingly used in such patients.. On the con- trary, many patients have had their religious faith heightened by their cure. The capacity to develop a religious fanaticism is often reduced by leucotomy. More normal attitudes to religion may be adopted, since the individual does tend to 1 -- ., become rather more matter of fact in most things. The operation is certainly never done light-heartedly ,and -, is only used when all other methods hold out little hope and , the patient's suffering has become intolerable and apparently , endless. A price has sometimes to be paid in the adoption I of more practical and concrete attitudes, and in living more ' in the present and less in constant preoccupation with past sins.and future punishments. Religion, however, also sets out to help people to obtain just this sort of relief from their , overwhelming anxieties by 'its - own particular methods. Furthermore, we know that the intellectual faculties of the • average mind Ire not greatly altered especially by the newer : forms of opelition, and the improvements seen mostly occur , in the crippling emotional accompaniments of the patient's . illness. pathological anxiety. These persons are often plagued by habits needing constant useless repetition, or tortured by obsessive thoughts which cannot be cast out of the mind. We all know how some of these patients are absolutely resistant to all psychological and religious methods of healing, which. should help them in theory but actually fail to do so in practice.
I now come to perhaps the most difficult problem of all— an attempt to link such treatments to some provenly effective religious practices in spiritual healing.
The three physical treatments discussed have one interesting common factor. In the mentally ill they can disperse recently acquired or deeply set patterns of thought and behaviour, and either allow old patterns to return, or new ones to be put in their place. Shock treatments and leucotomy, to use Wesley's own words, " suspend vital union, interrupt the circulation. and put nattire out of its course," just as he felt his preaching sometimes did when he could produce a "strong, lively and sudden apprehension of the hideousness of sin and the wrath of God and the bitter pains of eternal death." Leucotomy can more effectively break up very long-standing patterns of abnormal behaviour or thought while insulin coma and elec- trical treatment work better in .niore recently ill patients. They are mostly used in those types of patient whom we know to be so resistant to ordinary psychological methods of healing.
When we understand more about psychiatric illness, we are certain to find that many mentally ill patients have at the time a more rigidly acting brain and nervous system than the normal. Normal people, so-called, in any community are generally those more easily moulded to current beliefs and behaviour without the need to resort to such drastic methods of displacing old patterns of thought and behaviour with new. But I attach considerable importance to Wesley's repeated observation that final changes of heart and belief should generally be sudden and overwhelming to be effective in most instances. Perhaps he had grasped the fact that the nervous system has generally to be put into a highly charged emotional state before old habits of thought can be effectively disrupted, and new conceptions of God are able to flood' in and grip the person concerned. This does not mean that before a sudden .change to new beliefs arid behaviour there may not also have to be a long preliminary period of generalised anxiety, self-questioning and indecision, all producing a soften- ing-up of the patient prior to his sudden acceptance of a new way of life often so foreign to his previous one.
lit is important to notice the similarities seen in the technique of psychoanalysis, where for months the individual may be made to lie on a couch and be subjected to the often unpleasant re-arousal of previously frightening and guilt-laden stimuli in his past life. Tension gradually mounts, the individual is emotionally thrown more and more off his normal balance, and a stage is finally reached when he will start to accept interpretations of his conduct and past life which would have been quite unacceptable to him 'before. He then finally gains what is called insight.' I saw this same basic guilt-creating, anxiety-creating, and softening-up process being streamlined and sometimes used with tremendous effect in American revival meetings, leading at the end to a sudden submission and quite uncritical acceptance of the new beliefs desired by those in charge of such meetings. During the war we also learned how to facilitate this process by means of drugs in treatment, and the Russians have obviously perfected it. It can be used for wrong purposes as well as good. Human beings could never have adjusted to their changing conditions unless the 'normal ' brain had had these powers of final submission under great emotional stress incorporated into its basic mechanisms. Some people, however, are much more difficult to change than others, and many mentally ill persons are among these. It was a comparison between the results of what, we called drug abreactive treatments in the last war, when the so-called truth drugs' were injected and soldiers were often greatlY helped by being made to re-live emotionally their horrifying battle experiences, and sope of the detailed reports by John Wesley himself about the effects of his preaching that made hie specially interested in the relation of modern physical treatments and some older and often most effective types of religious healing procedures. Let me give you two quotations.
Grinker and Spiegel, describing the effects of abreaction under barbiturate drugs in 1943, in the treatment of acute War neuroses, report: "The terror exhibited . . . is electrifying to watch. The body becomes increasingly tense and rigid; the eyes widen and the pupils dilate, while the skin becomes covered with a fine perspiration. The hands move convulsively. . . . Breathing becomes incredibly rapid or shallow. The intensity of the emotion sometimes becomes more than they can bear; and frequently at the height of the reaction there is a collapse and the patient falls back in the bed and remains quiet for a few minutes. . . "
Over two hundred years ago, Wesley, on April 30th, ,1739, also reports:
" We understood that many were offended at the cries of those on whom the power of God came; among whom was a physician, who was much afraid that there might be fraud or imposture in the case. Today one whom he had known many years was the first who broke into strong cries and tears. He could hardly believe his own eyes and ears. He went and stood close to her, and observed every symptom, till great drops of sweat ran down her face and all her bones shook. He then knew not what to think, being clearly convinced it was not fraud nor yet any natural disorder. But when both her soul and body were healed in a moment, he acknowledged the finger of God."
Grinker and Spiegel saw in their results a confirmation of Freud's themes and a freeing of the ego.' Wesley, however, Was equally certain that it was "the Lord's doing, and it is marvellous in our eyes."
In physical treatments, psychotherapy, and religious healing, techniques, which I believe overlap each other to• some extent, can be applied slowly or more speedily, and in greater or lesser amounts as required; while there are other types of person only helped by a calm intellectual approach. The results obtained Will often depend on the selection of the right patient for the right method of handling.
One other point I would specially emphasise is the absolute necessity of carefully reconditioning and supporting an emotionally disturbed and redirected patient till new stability IS gained. Wesley succeeded where so many others have failed using similar methods, because of the great importance he attached to organising and making his recent converts attend small weekly 'class meetings.' Here, if his original instructions are re-read, his converts were re-indoctrinated, their personal problems repeatedly discussed, and unsatisfac- tory persons discovered and weeded out after their initial conversion experience. Physical treatments in psychiatry also need follow-up psychotherapy and environmental support to be most helpful in many instances.
Psychiatry, however, often lacks what spiritual healing may have; this is something that is really positive and satisfying to Put in place of old and faulty patterns of behaviour and thoughts displaced. It is the parable of the seven devils all Over again. I therefore feel I need make no apology for dis- cussing these recent advances in physical methods of treat- ment in psychiatry in the way I have because I believe they may have a most important bearing on current problems in spiritual healing,-and both may overlap at times. Psychiatrists and those interested in spiritual healing have much to learn one from the other, and we must realise that because there are so litany varieties and conditions of mankind, and many varied types of illness, quite different methods, or combinations of hiethods, will always have to be employed in actual practice to provide spiritual peace for the great number of persons needing it today.
(The name of the writer of the above article is withheld for reasons of medical ethics. It cannot be disclosed to enquirers. Nor can any letters or personal questions of a Professional nature be passed on to the author.)
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