This paper was presented June 14, 2007 at the Psychiatry and Spirituality Forum of the University of California, Irvine, a part of the Local Societies Initiative of Metanexus Institute.

It may seem strange that a Catholic priest and theologian would be invited into a state medical center to deliver a paper relating to psychiatry. But it is not so odd when we consider things more deeply. We are both committed to the healing of the human person. It is the conviction of the Forum, and I wholeheartedly agree, that we can forge better ways of healing the human person through closer collaboration between medicine, philosophy and theology, that is, human reason thinking about the human body (the science of medicine); human reason thinking about the world (the science of philosophy), and human reason thinking about faith (the science of theology). I am also asserting in the dialogue between these three sciences that we are speaking about three different orders of knowledge. Yet these three sciences are related because they share a common denominator: the human person. Each order of knowledge can inform the others, especially about the human person. This brief paper aims to contribute a theological perspective to this deeper collaboration between medicine, philosophy and theology by contrasting two perspectives of the human person in psychiatric healing.

I assert that our presuppositions about the human person matter in the work of healing. Each of us brings to the work of healing our often unexamined assumption about who or what the human person is. Perhaps you can see already that this question, “Who is the human person?,” is a question that extends beyond the scope of medical science. It is one of the big questions of human existence and thus pertains to philosophy and theology. Our philosophical and theological orientation to life will inform and shape our approach to the specifics of our healing specialties. If I think that the human person is only a complex, albeit beautiful, system of physiology (materialist), or if I think that the human person is basically a ghost in the machine (dualist), or if I think that the human person is made in the image of God, or more specifically in the image of Jesus Christ (incarnational/sacramental)—these will affect the way I go about healing the person. This point may seem more obvious for the work of the psychiatrist and psychologist, but I would suggest that it also is true for the cardiologist and nurse. For instance, I will regard the human body differently if I follow Plato, Michel Foucault, Martin Buber or John Paul II.

One may notice a potentially fruitful play on the word “lies” in the title of this paper. We could take “lies” as a noun which would indicate that something is located here underneath, or we could understand “lies” as a verb indicating that whatever is located beneath is not telling the truth or the full truth. I am suggesting the noun in that our philosophical and theological presuppositions will shape the work of healing, and perhaps I will also suggest toward the end that certain presuppositions do not tell the full truth about the human person, and may be inadequate to hold in the work of healing.

Thus the point is simple: how one understands the human person influences his or her approach in healing the human person. To demonstrate this point, I will compare two perspectives on the human person and show how each perspective influences the basic approach to both the origins and the treatment of anxiety. The first perspective is that of the father of psychiatry and psychoanalysis, Sigmund Freud; the second is one of the great Catholic thinkers of the twentieth century, Hans Urs von Balthasar.

One may object to the choice of these thinkers, especially that of Freud. Those who object to the choice of Freud are not without grounds for psychiatry itself is in disagreement about Freud’s ultimate significance. Freudian techniques have been greatly modified in their contemporary forms, and some aspects of his approach have been abandoned altogether. The choice of Freud, however, is not only warranted but in fact crucial to the present discussion for two reasons. First, as a physician specialized in neurology and the father of the new medical specialty of psychiatry, Freud has exerted tremendous influence on the theory and practice of psychiatry and psychology. Second, even if his approaches have been modified or abandoned, it may be argued that his perspective of the human person still carries weight among many contemporary theorists and practitioners of psychiatry.¹ Hans Urs von Balthasar is chosen because he is one of the outstanding Catholic theologians of recent times, and he worked diligently to engage his thinking with many systems of thought.² In fact, he explicitly engages Freud’s thought regarding the human person in one of his books.³ Given the breadth and scope of the writing of each author, the following presentation of these two perspectives is made in summary fashion keeping in the mind the aim of our present inquiry. 

Sigmund Freud’s Perspective on the Human Person: the Monadic “I”

In reading Freud’s work, it seems that Freud’s understanding of the human person arose from his sincere attempt to interpret his clinical experience. In other words, he was not first a philosopher and then a therapist. He was a therapist whose work pushed him to search for what he eventually called his “metapsychology” (Metapsychologie),⁴ that is, a philosophical perspective of the human person that could account for what he observed in his patients. It is his metapsychology wherein we catch a glimpse at his view of the human person. His metapsychology is based upon his theory of the instincts which he terms “our mythology”;⁵ yet he contends that this foundation also has a biological foundation.⁶ He writes, “Instincts are mythical entities, magnificent in their indefiniteness. In our work we cannot for a moment disregard them, yet we are never sure that we are seeing them clearly.”⁷ The fundamental assumption for Freud’s metapsychology is that the human person is originally a self-enclosed monad.⁸ Now let me explain what I mean by this term. Freud understands the human person as self-sufficient in its original unity, that is, the human person does not necessarily need the outside world and relationships.⁹ By “monad” I mean the “self” but understood as essentially closed in on itself and solitary. This original state is a “(timelessly) self-contained and complacent bliss” and an “absolute, self-satisfied narcissism”.¹⁰ Freud’s monadic starting point is reinforced moreover by his assertion that the human person is “fundamentally bisexual”.¹¹ This primal state, according to Freud, is comprised of the two primary instincts of eros and thanatos. Eros is the creative instinct toward the preservation of the species; thanatos is the destructive instinct toward self-annihilation.¹² The life instinct of eros is formulated from Freud’s own attentiveness to the emerging science of cellular biology in which he observed the constant effort in organisms toward development.¹³ The death instinct, thanatos, is a regressive drive toward the past repose of one’s original state as a self-enclosed, primal monad. Thus eros, which is eventually slightly broadened to include more than the sexual drive, is the creative instinct while thanatos is the destructive instinct.

These two instincts emerge with great prominence after birth and in coming to self-consciousness. According to Freud, the act of birth brings about the irrevocable fissuring of the person as self-enclosed, self-satisfied monad, and this fissuring continues as the person comes to self-consciousness through interaction with the outside world. This coming to self-consciousness happens first with the trauma of birth, and the subsequent trauma of relationships. For example, the fissuring occurs during nursing with the withdrawal of the mother’s nipple. According to Freud, initially the infant (a monad) views the mother’s nipple (its source of survival) as part of his own system, and the infant is content in “the bliss of sucking”. At some point, however, the n