What Lies Beneath: Two Perspectives on the Human Person in Psychiatric Healing
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, â€œWho is the human person?,â€ 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)â€”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 â€œliesâ€ in the title of this paper. We could take â€œliesâ€ as a noun which would indicate that something is located here underneath, or we could understand â€œliesâ€ 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 Freudâ€™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 Freudâ€™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 Freudâ€™s Perspective on the Human Person: the Monadic â€œIâ€
In reading Freudâ€™s work, it seems that Freudâ€™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 â€œmetapsychologyâ€ (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 â€œour mythologyâ€;5 yet he contends that this foundation also has a biological foundation.6 He writes, â€œInstincts 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.â€7 The fundamental assumption for Freudâ€™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 â€œmonadâ€ I mean the â€œselfâ€ but understood as essentially closed in on itself and solitary. This original state is a â€œ(timelessly) self-contained and complacent blissâ€ and an â€œabsolute, self-satisfied narcissismâ€.10 Freudâ€™s monadic starting point is reinforced moreover by his assertion that the human person is â€œfundamentally bisexualâ€.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 Freudâ€™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 oneâ€™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 motherâ€™s nipple. According to Freud, initially the infant (a monad) views the motherâ€™s nipple (its source of survival) as part of his own system, and the infant is content in â€œthe bliss of suckingâ€. At some point, however, the nipple is removed by the mother thereby frustrating the infantâ€™s desire; and this breaks up the monad because it is made to realize that the nipple is not part of him. Thus the infantâ€™s first coming to consciousness as a self is in a threatening situation: â€œMy desire is being frustrated.â€14 The initial clash of having the nipple withdrawn awakens the baby to his own dependence on something outside of himself. This experience of dependency (hunger, self-preservation) is how the ego begins to fix the objects of the external world, and thus distinguish itself from them.
Thus in Freudâ€™s view, the human person comes to consciousness as a self in the midst of, and because of, a threatening situation: a desire which is frustrated by the mother. It seems important to note that in such a perspective the mother is no interpersonal â€œthouâ€, but is perceived by the infant as an â€œobjectâ€ of its own drive. The childâ€™s awareness of himself and the outside world, therefore, comes about through the frustration of the childâ€™s desire to be self-satisfied. The monadic person is initiated into the external world amid threat and frustration.
The primal clash with the mother produces a fissure within the self in Freudâ€™s perspective. The drive for self-preservation and the drive for pleasure clash within the self making the fulfillment of its desire unattainable in â€œrealityâ€, and the monadâ€™s â€œunacceptableâ€ desires are repressed into the unconscious. Freudâ€™s view of the unconscious is comprised of the id, which is the reservoir of drives, repressed material, defense mechanisms and the superego. The ego, the personâ€™s conscious life, thus represents only a fragment of the whole person. The ego, in this view, includes â€œthe restricting and repressing powerâ€ toward self-preservation, and the id, represented by â€œsexual trends as the restricted and repressedâ€, is the power toward propagation.15
The fissuring of the self continues with the emergence of what Freud terms the â€œsuperegoâ€ (Ãœber-Ich), understood as â€œconscienceâ€ or socially-acquired control mechanisms which have been internalized. The superego is outside authority internalized in the person, yet it also represents the unconscious id which opposes the ego, and â€œsadistically and aggressively tyrannizes itâ€.16 The egoâ€™s projection beyond itself toward the superego is the vain attempt to recover the lost narcissism of the personâ€™s original state. According to Freud, the superego does violence to the ego by employing the unconscious energy of the id for its own purposes.
What is important for the purpose of our inquiry is to notice that the self-enclosed, self-satisfied totality of the primal phase, that is, the original totality of the self, can never be regained after its encounter with the world. The primal phase exists after that first clash only in the unconscious. The ego, moreover, is not the â€œprimary phenomenonâ€ of the person, but rather is only the exposed upper and outer surface, while the largely unconscious superego and the id lie underneath.17 Thus the human person in Freudâ€™s system is less the self of the conscious ego and more the id of the irrational and contradictory unconscious, that is, not so much a person (an â€œIâ€) but a drive (the id). In this world, rather than persons, â€œthere are only â€˜objectsâ€™, there is no â€˜thouâ€™ that could form a bridge leading out of the lonely isolationâ€.18 It is interesting to note that this conclusion is developed by adherents to Melanie Kleinâ€™s â€œobject relations theoryâ€ in which persons are referred to as â€œobjectsâ€.19
Freud formulates his perspective of the human person as a self-enclosed primal monad driven by primal instincts in his sincere attempt to interpret his clinical experience. Yet Freud himself admits that this perspective is not empirically proven. Instead, he appeals to a â€œmythologyâ€, understood in its positive sense of an attempt to give an overall explanation of the world. I find an appeal to a mythology as the ultimate justification of his psychiatric theory an unusual causative hypothesis for a neurologist. Yet it does help illustrate the point of this paper. Interestingly, his theory on the contending instincts of eros and thanatos has striking similarities with the philosophy of Schopenhauer, and, in my view, basically constitutes a twentieth century re-proposal of the pre-Socratic philosopher Empedoclesâ€™ (c. 492-432 B.C.) cosmology of Love and Strife.20 To be fair, he thought his mythological causation would be justified through further scientific research. Nevertheless, it is noteworthy that Freud proposes his psychiatric theory based upon philosophical assumptions about the human person. Now this begs the question, has further scientific research supported Freudâ€™s philosophical perspective?
- To summarize this section: Freud views the human person as a narcissistic primal monad, a monadic self, that is, a self-enclosed, self-satisfied self with the dual urges of life and death contending within it. As I understand Freud, he holds that the social instinct is not primary, that is, the human person is not essentially or naturally relational. Furthermore, this perspective is founded upon philosophical assumptions about the human person, a metapsychology, which Freud himself admits. As will be shown below, this fundamental assumption has important consequences in both the origin and treatment of anxiety. But before considering this, let us consider another perspective on the human person, that of Hans Urs von Balthasar.
Hans Urs von Balthasarâ€™s Perspective on the Human Person: the Relational â€œIâ€
Although Balthasarâ€™s writings are basically classified as theological, philosophical and literary, Balthasar himself had considerable contact with psychiatry and psychoanalysis. He pursued his doctoral studies in German literature at the University of Vienna in the 1920s, a hotspot for this new science called psychiatry, and was a very close friend of the psychoanalyst Rudolf Allers who was a critic of Freud and a student of Adler.21 Later in life Balthasar also maintained a close friendship with the psychoanalyst Albert GÃ¶rres. Balthasar admits that Allers had a profound impact on his thinking, especially in seeing the human person as essentially relational with others, particularly God.22
Hans Urs von Balthasar sees the human person as created in the image of the Triune God, three Divine Persons â€“ Father, Son and Holy Spirit â€“ who share one divine nature. The relationships between the Divine Persons within the Godhead, as revealed by Jesus of Nazareth â€“ especially in his suffering and death on the Cross â€“ are characterized by absolute, total, self-giving love of one Person to the Other. In other words, each Personâ€™s self-identity is constituted by His receiving and self-giving in relationship with the other Divine Persons. Self-identity comes from receiving the gift of self from the other and then giving oneself in return. For instance, the Divine Son is â€œSonâ€ because He receives the Fatherâ€™s gift of Himself and then gives Himself completely back to the Father in filial love. The Godhead itself is thus constituted by relationship, and this reality comprises the archetype from which the image â€“ the human person â€“ is patterned. Thus, in this view, the human person is also essentially relational.
The structure of the mother-child relationship for Balthasar is based upon the archetypical relationship of the Trinity, distinct Persons united in the one nature of self-giving love. The relationship of mother and child is also grounded in both unity and distinction. The unity of mother and child begins with conception and the childâ€™s life in utero where mother and child exist together almost as one. Balthasarâ€™s concept, however, is radically different from Freudâ€™s view in which the child perceives the mother as an extension of himself. For Balthasar, the child is completely dependent on the mother, yet nevertheless is ontologically distinct from her since the child exists through the indispensable action of other persons, namely the childâ€™s father and God. The childâ€™s very conception is brought about by the self-giving of other persons within a relationship: father, mother and God. The unity-in-distinction of the mother and child, for Balthasar, reveals itself as an image of the Trinitarian archetype.23
Balthasarâ€™s perspective of the human person as an image of the Divine Person, specifically God the Son, in turn affects Balthasarâ€™s understanding of how the human person comes to consciousness. The unity-in-distinction of mother and infant continue from the womb to the breast. Then, and this is very important for understanding Balthasarâ€™s view, the miraculous moment occurs. For the first time â€œthe child will recognize in its motherâ€™s face her protective love and will reciprocate this love with a first smile.â€24 For Balthasar, the mother is no object of the childâ€™s drive, but a â€œthouâ€, a person. It is in the â€œthouâ€ who first offers herself to the child in love that the child is awakened to his own self. He is the unique recipient of the motherâ€™s love, and thus perceives on some level that he is a unique subject, a unique self, a person. He then offers himself in love back to the â€œthouâ€ by smiling. Thus, in contrast to Freudâ€™s theory, the self-consciousness of the infant comes about not through the frustration of desire, but by being drawn out of himself through the love of his mother indicated by her smile.25 To use Balthasarâ€™s own words, her â€œloving â€˜thouâ€™ summons forth the [infantâ€™s] â€˜Iâ€™.â€26
Her smile in turn awakens her infant to the True, the Good and the Beautiful â€“ the transcendentals of Being.27 Whereas in the Freudian view, the world is shown to be essentially threatening to the infant, in Balthasarâ€™s view, the world is essentially revealed to be good, true, and beautiful. It is precisely through being addressed by the â€œthouâ€ of the mother that the child becomes conscious that he is â€œIâ€ â€“ he is not the mother but the one-loved-by-the-mother.28 The awakening of the childâ€™s â€œIâ€ by the motherâ€™s â€œthouâ€ establishes a relationship of love which has an elliptical shape, two poles of giving and receiving in love. When the â€œIâ€ receives love from the â€œthouâ€ and then moves toward the â€œthouâ€ in love, it becomes aware of itself. Balthasar writes, â€œBy giving itself, [the child] experiences: I give myself. By crossing over from itself into what is other than itself, into the open world that offers it space, it experiences its freedom, its knowledge, its being as spirit.â€29
The ellipse of love constituting the mother-child relationship indicates the inherent relationality of the self. The world itself is at its foundation gift, love and therefore gratitude.30 The very process of biological generation of a child through the spouses, moreover, indicates for our author that, and I quote him, â€œBeing in-the-flesh always means receiving from others.â€31 In Balthasarâ€™s perspective, the mother is essentially a gift, not a threat.32 The child realizes, in the elliptical relationship of love, that he is somehow singular and exclusive, and possesses the capacity to encounter other human subjects in loving relationship.
From the motherâ€™s love and the beginning of the childâ€™s self-awareness, the child is initiated further into the external world. The elliptical structure of the mother-child relationship possesses absolute importance for the child because that love is the key not only for the child to become aware of itself but also to open the child beyond the motherâ€™s love to Godâ€™s love.33 The foundational relationship between mother and child establishes the childâ€™s relationship with the rest of reality, including God. At first the child cannot distinguish the rest of reality from his mother. She is everything, and only later does the child begin to distinguish the mother from God and the rest of the world. If all goes well, Balthasar writes, â€œThe child will see clearly that love is realized only in reciprocity, in an oppositeness that is encounter and not opposition, a relationship that is held together in its very difference by the spirit of love and that, far from being endangered by mutuality, is rather strengthened by it.â€34 In other words, I cannot know myself as an â€œIâ€ without being in relationship with a â€œthouâ€. Self identity comes not from within the self but as a gift from the other. Love enables the child to experience his inferiority and dependence not as a threat but as a way to be loved.
To summarize Balthasarâ€™s view: the human person is made in the image of God, more specifically in the image of the Divine Son in his relationships with the Father and the Holy Spirit. The human person is made for love and thus relationship with other persons who can love. His view of the human person could be termed a â€œtranspsychological anthropologyâ€.35 By this term he means an understanding of the human person that extends beyond (trans) the measurement of the psychiatric and psychological sciences.36 The human person cannot be adequately measured in terms of the self or in comparison with other human beings, but only to the archetype in which he or she was made, that is, God. Only in relationship with God can the human person be fully understood.
The Effect of the Perspective on the Origin of Anxiety
Having sketched these two perspectives of the human person, we can begin to see how each perspective shapes their approach to the origins and treatment of anxiety. Freud seems to locate the origins of anxiety in the act of birth itself37 and in the birth of the ego in self-consciousness.38 Certainly these two core events in human life seem to be rife with anxiety. Freud writes, for example, â€œthe act of birth is the source and prototype of the affect of anxiety,â€ that this primal anxiety was a â€œtoxic oneâ€,39 and that subsequent experiences of anxiety are â€œa signal threatening a repetition of such a momentâ€.40 Moreover, it seems that anxiety is ever present in the conscious life of oneâ€™s ego, which appears helpless and menaced in the hands of the id and superego, and in the struggle between the instincts of eros and thanatos. A personâ€™s arrival at self-awareness, it seems, can be nothing other than self-awareness-in-anxiety. The self-enclosed, monadic perspective can only end in the conclusion that the external world, the other person, and the very structure of the mother-child relationship are threatening, and therefore anxiety-producing.
Balthasar, for his part, agrees with Freud to a point about the origins of anxiety, namely, that anxiety is part of the fabric of life for a human being in a fallen world.41 Much of our conscious and unconscious life contends with anxiety. Both agree that the mother-child relationship is crucial. Balthasar writes, for example, that any damage to that relationship, any lack of love, places the child in anxiety. Although Balthasar agrees with Freud that the ego is a primary locus of anxiety, he nevertheless rejects Freudâ€™s position that the ultimate origin of anxiety lies in the biological event of birth and in the birth of self-consciousness. His critique aims at Freudâ€™s view of the human person and in the construal of the mother-child relationship as essentially threatening.
Balthasar argues for a deeper origin for anxiety in the human person. This deeper origin, I suggest, stems from his understanding of the human person as essentially relational and open to God. According to this view, the mother-child structure and relationships in general are not essentially threatening. In fact, they are the way in which one is able to receive and to give love. However, the relationship is comprised of flawed individuals and so the structure can be flooded with anxiety from any lack of love and especially through sin. Understanding the human person as essentially relational allows him to look beyond the act of birth and ego-consciousness for an origin of anxiety that is located within estranged and damaged relationships.
Balthasar locates the ultimate origin of anxiety in the human raceâ€™s estrangement from God caused by original sin. Man and woman, made in the image of God, alienated themselves from God in their choice to grasp for themselves knowledge of good and evil independent of God. In other words, they sought to possess knowledge without love. The choice for sin set off a chain of devastating consequences whereby human persons were not only estranged from God but from the world, each other and even within themselves. Thus, the world, relationships and self-awareness become places that threaten the human person and make him feel anxious. At the root of all human anxiety, in Balthasarâ€™s view, is this fundamental stance of alienation from God. In other words, self-consciousness is a place for experiencing anxiety, but the ultimate origin of anxiety does not lie in coming to birth or in the mother-child structure itself, but rather from a deficiency of love. The ultimate origin of this deficiency lies in original sin.
What seems to emerge with prominence in considering the origins of anxiety again is the importance of the philosophical and theological presuppositions about the human person. Behind the anxiety about giving lectures, about spiders or about nothing at all is the fear of suffering and death. And the problem of suffering and death has driven philosophical and theological inquiry for millennia. Anxiety leads one to a consideration of the big questions about human existence: why am I here? What does life mean in the face of death? Is there any ultimate security about my fragile life?
The Effect of the Perspective on the Treatment of Anxiety
Even more striking is how each perspective affects the basic approach in the treatment of anxiety. How does oneâ€™s view of the human person play out in dealing with anxiety? Freudâ€™s approach, understandably, follows the logic of his understanding of the human person. Treating anxiety is one of negotiation, compromise and the ultimate reduction of the conscious self. The inner fracture of the human person which occurred through the act of birth and coming to self-consciousness cannot be restored. The ego must reduce itself through repression in order to cope with anxiety amid the internal world of the self and the external world of relationships42. The encounter with the world and the id always involves a compromise in which something is sacrificed, for example, the direct satisfaction of a drive by way of repression or another defense mechanism. I cannot but help register a sense of despair about the human person in Freudâ€™s theory. One cannot be made whole again once the original fissure occurs. No regression can ever regain it. For Freud, there is no ultimate completion or fulfillment of the self. The self is thrown back upon itself and reduced in order to live in the world. Finally, Freudâ€™s view of thanatosâ€™ ultimate ascendancy over eros in his metapsychology solidifies that despair of ever recovering what was lost in the personâ€™s original fissuring. Anxiety remains the order of the day. The father of psychoanalysis seeks to help man overcome anxiety in the ego, but his solution leads him to reduce and fragment the self since it has no other measure than the monadic perspective.
Balthasarâ€™s transpsychological perspective also shapes his approach in dealing with anxiety. Instead of restricting the ego to cope with anxiety, he proposes that the ego must go actually in the opposite direction: outwards, by casting itself forward in relationship with another, especially God. The unity of the person is not found within the personâ€™s self but in that personâ€™s relationship with God â€“ in the â€œThouâ€ of God. Since the human person is made in the image of God, the human person has an ecstatic or eccentric center; the center of his person lies outside himself in self-giving. In other words, one has to let go of himself, to lose himself in order to find himself. Self-consciousness and self-identity flows from self-giving and receiving. The direction of the egoâ€™s movement then consists not in its reduction through repression into the unconscious; rather the movement is one of casting oneself forward in relationship with God. Treatment involves not the reduction of the ego but its expansion via self-giving love.
Now Balthasarâ€™s proposal would not seek to displace the importance of good psychotherapy and pharmacological intervention in treating anxiety, but rather to add the helpful theological dimension to this healing. Anxiety is transformed in the Christian life through casting the self forth into relationship with God and with all those persons who are with God. This happens through the tremendous proximity and intimacy of God achieved through the Incarnation of Jesus Christ, that is, God the Son became man without ceasing to be God. He relates to us as one of us. This intimacy, and the security this intimacy creates, is deepened through the exercise of the theological virtues of faith, hope and love. The very dynamic of faith, hope and love work against anxiety and are a primary way the human person casts himself forth in relationship with God. Intimacy with God is also deepened through the reception of the Sacraments, which are direct encounters with the Incarnate God. I think especially of Confession whereby guilt is absolved, and in Holy Communion where the believer receives the very Body and Blood of God Incarnate into his or her own body and blood. Furthermore, in the relationship with God, the anxiety from role identification is lessened since one receives from God his own particular mission, vocation or role. Thus the meaning of oneâ€™s particular life and oneâ€™s place in the world is given and ensured by God Himself, and is not simply assigned by other flawed human beings such as parents or society as a whole. Furthermore, the attitude of spiritual childhood also figures largely in the Christian life. Jesus said, â€œUnless you turn and become like children, you will never enter the kingdom of heavenâ€ (Mt. 18:3). This attitude is constituted by courageous vulnerability, hope and joy, of surrendering all of oneself to God in trust and seeking every need from Him in confidence. These relational dimensions of the Christian life are designed to bring people out of anxiety.
However, the Christian life also means the possibility of participating in Christâ€™s own sufferings, including his anxiety which he suffered in the Garden of Gethsemane. Balthasar also holds that it is possible for anxiety to be overcome not only through reducing it, but also by transforming it. In a distinctively Christian form of anxiety, one can participate mystically in Christâ€™s anxiety in the Garden of Gethsemane, even to share in a redemptive and salvific anxiety for the world. As St. Paul writes in Colossians, â€œIn my flesh I complete what is lacking in Christâ€™s afflictionsâ€ (Col. 1:24). But a deeper consideration of this type of anxiety extends beyond the scope of this paper.43
To summarize: Balthasarâ€™s solution lies not in reducing the human person to help him cope with anxiety, but rather to open him in vulnerability to the divine Thou. In other words, to quote the French Catholic novelist Georges Bernanos, â€œWe must all â€˜overcomeâ€™ life. But the only way of overcoming life is to love it.â€44
In this brief paper I have argued for the importance of examining oneâ€™s pre-suppositions about the human person, the subject of the healing sciences. Who we think the human person is will shape our approach in healing him or her. Moreover, the question, â€œWho is the Human Person?,â€ is not a question that can be answered completely by medical science. It is also a question to be treated in a deepened tria-logue between medicine, philosophy and theology. Psychotherapy and pharmacology can treat the symptoms, which is necessary and important, but they are not equipped to address completely the questions which drive the symptoms. These questions extend into the domain of philosophy and theology. It does seem helpful to inquire in this tria-logue between medicine, philosophy and theology, do new findings in neuroscience suggest or orient us toward a certain perspective of the human person? Do such discoveries suggest the exclusion of certain perspectives? The recent neurobiological studies on brain development and secure attachment done by such researchers as Ainsworth, Bowlby, Greenspan, Siegel and Stern are suggestive.45 These studies resonate well with the relational perspective of Balthasar and not so well with the monadic perspective of Freud. Is the monadic perspective that lies beneath Freudâ€™s view doing more than informing the surface? Is it also lying to us? Such resonance between these studies and a perspective like Balthasarâ€™s also support the call for greater collaboration between medical science and the philosophical and theological sciences. And indeed, it seems that over time psychotherapy has come to conceive of itself more akin to the human than the hard sciences.46 I can see this occurring, for example, in the work of people like Peterson and Seligman and in the emergence of â€œpositive psychologyâ€.47 Their empirical research on character strengths seems to reduce all character strengths to seven, which not-surprisingly line up remarkably well with the seven virtues which come to us from Greek and Judeo-Christian tradition.
A perspective like Freudâ€™s limits psychiatryâ€™s conversation with main currents of philosophy and theology because Freudâ€™s perspective is basically materialist. Compared the traditional currents of philosophy and theology, materialism is a narrow construal of the human person. Balthasar would argue that the medical sciences in themselves are incapable of obtaining the total picture of the human person by measuring the human person against itself or other human persons. If the human person has a possible open horizon toward God, and in the Judeo-Christian perspective of a being made in the image of God, then only in relation to God can the human person be completely understood. Thus, the ultimate goal would be not self-knowledge but knowledge of God which in turn discloses self-knowledge. Accurate self-knowledge can only occur in relationship with the ultimate origin and end of the human person, namely, God. This approach involves a fundamental turning away from self and turning toward another in relationship. The personâ€™s fractured unity, which Freud and Balthasar acknowledge well, cannot be healed by throwing the person back upon himself, but by moving him outward toward God.48
Hopefully I have been able to show in a small way the need for deeper collaboration between philosophy, theology and the medical sciences. For example, a closer connection with theology might have modified Freudâ€™s theory. Part of the inadequacy of Freudâ€™s theory of love-death dualism is that he views them only in opposition to each other. Christianity offers psychiatry the perspective that does not view love and death solely in terms of opposition. After all, does not love reveal itself precisely in the moment of complete self-giving even unto death? As we find in the Gospel of St. John, love in its deepest sense consists of freely giving oneâ€™s life unto death which in turn bears much fruit (cf. Jn. 15:13-16; 1Jn. 3:16; Jn. 12:24).49
What lies beneath our approach to healing is our view of the human person. Our inquiry explored a fundamental contrast between the concept of the human person as a self-enclosed being threatened by other persons and the world versus an essentially relational being called to develop and flourish through self-giving and receiving in love. Our view will shape our approach to healing the human person. My proposal is that we examine such perspectives and increase the conversation between these sciences of the body, of life and of faith so that we can become better and more effective healers of the human person.
1 Cf. Rieff, Philip. The Triumph of the Therapeutic. Uses of Faith after Freud, Chicago 1987; Freud. The Mind of the Moralist, Chicago 1979. Even Freudâ€™s most trenchant critics agree on his influence. Cf. Allers, Rudolf. The Successful Error. A Critical Study of Freudian Psychoanalysis, New York 1941; Crews, Frederick. â€œThe Making of a Freud Skeptic,â€ Skeptic 7 (1999) 42-49; â€œThe Verdict on Freud,â€ Psychological Science 7 (1996) 63-68; ed., Unauthorized Freud. Doubters Confront a Legend, New York 1998.
2 Another scholar on Balthasar, Thomas Dalzell, also has sought to relate Balthasarâ€™s thought with psychoanalysis. Cf. Dalzell, Thomas. â€œBalthasarâ€™s Theological Aesthetics and Lacanian Psychoanalysis,â€ Irish Theological Quarterly 69 (2004) 3-16.
3 Balthasar, Hans Urs von. Theodramatik. I. Prolegomena, Einsiedeln 1973; English trans., Theodrama. Theological Dramatic Theory. I. Prolegomena, San Francisco 1988. [TDI hereafter]
4 Ernest Jones holds that Freud invented the term himself, and that â€œmetapsychologyâ€ occupied a central place in Freudâ€™s thinking by which â€œhe wished to designate a comprehensive description of any mental processâ€ (Jones, Ernest. The Life and Work of Sigmund Freud. II. Years of Maturity 1901-1919, New York 1955, 185). The term is quoted also by Balthasar (TDI, 480; Eng. 511) and by Jacques Servais as Freudâ€™s own. Cf. Servais, Jacques. â€œIl dualismo Freudiano di vita e morteâ€, CiviltÃ¡ Cattolica (1989) 240.
5 Freud, Sigmund. The Complete Introductory Lectures on Psychoanalysis, New York 1966, 559.
6 Freud writes, â€œHowever jealously we usually defend the independence of psychology from every other science, here we stood in the shadow of the unshakable biological fact that the living organism is at the command of two intentions, self-preservation and the preservation of the speciesâ€ (Freud, The Complete Introductory Lectures, 559). He continues, â€œActually what we are talking now is biological psychology [â€¦] the psychical accompaniments of biological processesâ€ (Freud, The Complete Introductory Lectures, 559-560). He makes another reference to the biological foundation of his instinct theory on p. 567.
7 Freud, The Complete Introductory Lectures, 559.
8 Balthasar uses the term â€œnarcissistic primal monadâ€ [narziÃŸtische Urmonade] (TDI, 478; Eng. 509).
9 A personâ€™s first condition is â€œan original pregenital state in which the developing human being, like a monad, is a closed-in, worldless, â€˜autoeroticâ€™ system governed by the â€˜pleasure principleâ€™â€ (TDI, 477; Eng. 508). In the footnote, Balthasar quotes three passages of Freud which further describe his initial stance toward the ego: â€œThe ego, insofar as it is autoerotic, does not need the external worldâ€; â€œLove arises from the ability of the ego to satisfy a part of its instinctual desires autoerotically, through sensual pleasure. In origin it is narcissistic, and then projects onto the objects which are incorporated in the expanded egoâ€; â€œthe social instinct is not primitive and proof against dissectionâ€.
10 TDI, 477; Eng. 508.
11 TDI, 480; Eng. 510-511. Balthasar quotes Freud in the footnote: â€œThe individual is a fusion of two symmetrical halves, which many researchers consider to be male and female respectively. It is equally possible that each half was originally hermaphroditeâ€. His view that male and female are contained within a single human person reinforces the presupposed anthropology that man is not completed outside himself in a â€œthouâ€, and understandably therapeutic â€œhealingâ€ comes not from relationship but from a return to the self.
12 He writes, â€œIf we recognize in this instinct the self-destructiveness of our hyposthesis, we may regard the self-destructiveness as an expression of a â€˜death instinctâ€™ which cannot fail to be present in every vital processâ€ (Freud, The Complete Introductory Lectures, 571). Freudâ€™s position in this lecture is derived from his Beyond the Pleasure Principle (cf. Freud, The Complete Introductory Lectures, 572, translatorâ€™s footnote). Balthasar quotes Freud: â€œThe rules of logical thought do not apply, particularly that of noncontradiction. Contrary impulses exist side by side without cancelling each other outâ€ (TDI, 479; Eng. 510). This is an account of what Freud called primary process thinking. Primary process thinking which characterizes the operation of the unconscious occurs in a way that is a-temporal, pre-rational and symbolic.
13 Cf. Servais, â€œIl dualismo Freudianoâ€, 245.
14 TDI, 478; Eng. 508.
15 Freud, The Complete Introductory Lectures, 560.
16 TDI, 479; Eng. 510.
17 TDI, 481; Eng. 512. Balthasar quotes Freud, â€œIn our view an individual is a psychic id, unacknowledged and unconscious, on the surface of which sits the ego, developed as a nucleus out of the perception systemâ€. The id is â€œthe nucleus of the egoâ€, merely â€œa particularly differentiated part of the idâ€, performing its business â€œas directed by the idâ€ (TDI, 481; Eng. 512).
18 TDI, 482; Eng. 513.
19 Cf. Bott-Spillius, Elizabeth. Melanie Klein Today. I. Mainly Theory, New York 1988.
20 Cf. Servais, â€œIl dualismo Freudianoâ€, 251. Empedoclesâ€™ cosmology is an eternal cycle of change characterized by growth and decay, in which two personified cosmic forces, Love and Strife, battle eternally for supremacy in the world.
21 Cf. Balthasar, Hans Urs von. PrÃ¼fet alles das Gutet behaltet, Ostfildern 1986, 8; English trans., Test Everything. Hold Fast to What is Good, San Francisco 1989, 10. He writes, â€œTo the student in Vienna, the friendship with Rudolf Allers, doctor, psychiatrist, philosopher and theologian [â€¦] was an almost inexhaustible source of stimulation. An opponent of Freud and a free disciple of Alfred Adler, he possessed and imparted the feeling for interhuman love as the objective medium of human existence; it was in this turning from the â€˜Iâ€™ to the reality full of a â€˜thouâ€™ that he saw philosophical truth and psychotherapeutic methodâ€ (Balthasar, Hans Urs von. Zu Seinem Werk, Einsiedeln-Freiburg 20002, 75-76; English trans., My Work in Retrospect, San Francisco 1993, 88-89 [ZSW hereafter]).
22 Marchesi, Giovanni. La Cristologia Trinitaria di Hans Urs von Balthasar, Brecia 2003, 25. For further treatment on this topic, cf. Balthasar, Hans Urs von. â€œOn the Concept of Person,â€ International Theological Review Communio 13 (1986) 18-26.
23 He writes, â€œThe â€˜archetypical identityâ€™, which we discover in creatures within a clear separation of persons who are held together by love, is a creaturely imago trinitatis, veiled and yet not wholly invisibleâ€ (Balthasar, Hans Urs von. Wenn ihr nicht werdet wie dieses Kind, Einsiedeln-Freiburg 19982, 21-22; English trans., Unless you become like this Child, San Francisco 1992, 19. [WdK hereafter]
24 WdK, 19; Eng. 17. Balthasar adds elsewhere, â€œCreaturely love in all its modes is a distant echo of this primal event, and the love bestowed by grace in the world is, in very diverse modes, participation in this primal eventâ€ (Balthasar, Hans Urs von. Spiritus Creator. Skizzen zur Theologie, III, Einsiedeln 1967, 40; English trans., Explorations in Theology.III. Creator Spirit, San Francisco 1993, 44). [SC, hereafter]
25 SC, 13; Eng. 15.
26 SC, 13; Eng. 15.
27 Balthasar writes, â€œThe infant is brought to consciousness of himself only by love, by the smile of his mother. In that encounter, the horizon of all unlimited being opens itself for him, revealing four things to him: (1) that he is one in love with the mother, even in being other than his mother, therefore all Being is one; (2) that that love is good, therefore all Being is good; (3) that that love is true, therefore all Being is true; (4) that that love evokes joy, therefore all Being is beautifulâ€ (ZSW, 98; Eng. 114).
28 Balthasar observes, â€œThe interpretation of the motherâ€™s smiling and of her whole gift of self is the answer, awakened by her, of love to love, when the â€˜Iâ€™ is addressed by the â€˜thouâ€™; and precisely because it is understood in the very origin that the â€˜thouâ€™ of the mother is not the â€˜Iâ€™ of the childâ€ (SC, 13; Eng. 15).
29 SC, 13-14: Eng. 16. [Italics Balthasarâ€™s]
30 The motherâ€™s smile gives the child â€œthe awareness of a permission to exist that can never be mastered, never taken into oneâ€™s own possession, an awareness of the gracious favor that grants access to the realm of Being as a wholeâ€ (SC, 15; Eng. 18). Our author writes that in the childâ€™s self-awareness, â€œ[l]ove is understood to be the most pristine source of all. This understanding opens up in the child the dormant bud of self-awareness. The love between a â€˜thouâ€™ and â€˜Iâ€™ inaugurates the reality of a world which is deeper than simple being because of its absolute boundlessness and plenitudeâ€ (WdK, 19-20; Eng. 17-18). He continues, â€œAnd, since this opening up occurs on the basis of love, unbounded being is seen to be the reality that makes sense, that is self-evidently right: in short, truth which is identical with the goodâ€ (WdK, 20; Eng. 18).
31 Balthasar, Hans Urs von. Theodramatik. II/2. Die Personen des Spiels. Die Personen in Christus, Einsiedeln 19982, 162; English trans., Theodrama. Theological Dramatic Theory. III. Dramatis Personae. Persons in Christ, San Francisco 1992, 177.
32 Balthasar writes, â€œsince [â€¦] the child in this process replies and responds to a directive that cannot in any way have come from within its own self â€“ it would never occur to the child that it itself had produced the motherâ€™s smile â€“ the entire paradise of reality that unfolds around the â€˜Iâ€™ stands there as an incomprehensible miracleâ€ (SC, 14; Eng. 16).
33 Cf. WdK, 20-21: Eng. 18. Certainly the fatherâ€™s love is important as well, for not only does he contribute to confirming the trinitarian archetype of love through his own love, but also his love reminds the child that the child is distinct from the mother.
34 WdK, 21; Eng. 18. [Italics Cihakâ€™s]
35 Balthasar uses this term in his study on Georges Bernanos to describe Bernanosâ€™ view of the human person. Cf. Balthasar, Hans Urs von. Gelebte Kirche. Bernanos, Einsiedeln-Trier 19883, 263; English trans., Bernanos. An Ecclesial Existence, San Francisco 1996, 289. [B hereafter]
36 Balthasar writes, â€œA subjectâ€™s penetration through knowledge into the openness of anotherâ€™s spiritual being can be defined as an act of truth, in the strict sense, only by being grounded in love â€“ the love of God, which God makes available to his creatures. In the absence of such love, the medium of knowledge can only be loveâ€™s opposite: the concupiscence of hell. Here there can be no neutral middle ground. The knowledge of anotherâ€™s spirit must either be creative through love or destructive through greed: for the otherâ€™s spirit, as spirit, necessarily stands before God and is therefore inaccessible without Godâ€ (B, 385; Eng. 429).
37 Freud, The Complete Introductory Lectures, 397; cf. pp. 396-97, 407, 409. The English translator, J. Strachey, comments, â€œA full history of Freudâ€™s belief in a connection between anxiety and birth was given in the Editorâ€™s Introduction to Inhibitions, Symptoms and Anxietyâ€ (Freud, The Complete Introductory Lectures, 397). He maintains this position in his second theory of anxiety (cf. Freud, The Complete Introductory Lectures, 557-559). He writes in a letter to Oskar Pfister in 1909, â€œIn the matter of anxiety one has to remember that children begin their experience of it in the act of birth itselfâ€ (Jones, The Life and Work of Sigmund Freud, 445). Freudâ€™s location of the primal event of anxiety in the act of birth was opposed by A. Adler who nevertheless thought that the primordial event of anxiety was traceable to childhood.
38 The first lecture on anxiety was given in 1916-1917 (Lecture XXV: â€œAnxietyâ€), the second in 1933 (Lecture XXXII: â€œAnxiety and the Instinctual Lifeâ€) in which he greatly modifies his first theory. His second theory of anxiety modifies his initial theory of the ego. Initially he supposed a weak ego when compared to the id, a position he basically retains in the second theory, but adds that the ego is capable of exerting its own influence over the id. He writes, â€œthis same ego is the better organized part of the id, with its face turned towards realityâ€, and the ego exerts influence â€œby putting into action the almost omnipotent pleasure-unpleasure principle by means of the signal of anxietyâ€ (Freud, The Complete Introductory Lectures, 557). Nevertheless, the act of repression on the part of the ego reveals its weakness vis-Ã -vis the id, â€œfor by the act of repression it renounces a portion of its organization and has to allow the repressed instinctual impulse to remain permanently withdrawn from its influenceâ€ (Freud, The Complete Introductory Lectures, 557). The ego, in other words, must withdraw itself somewhat to cope with the anxiety. From these two theories, it becomes clear that Freud locates the origin of anxiety in the ego, the personâ€™s self-awareness: â€œthe ego is the sole seat of anxietyâ€ and â€œthe ego alone can produce and feel anxietyâ€, a thesis he advanced toward the end of his The Ego and the Id (1923b), and developed in Inhibitions, Symptoms and Anxiety (1926d). Cf. English translatorâ€™s comments, Freud, The Complete Introductory Lectures, 549.
39 Freud, The Complete Introductory Lectures, 396.
40 Freud, The Complete Introductory Lectures, 558-559.
41 It is admittedly difficult to construct Balthasarâ€™s analysis of Freudâ€™s theory on the origins of anxiety. When Balthasar comes to treat Freudâ€™s ideas in the first volume of the Theodramatik, his primary concern is to evaluate Freudâ€™s anthropology as it relates to Balthasarâ€™s own theodramatic theory, and not to investigate directly Freudâ€™s theory of anxiety or its origin. Balthasarâ€™s guiding intention in TDI is glean from the world of theater a grammar from which to construct the dramatic aspect of his theology. From the psychoanalysts specifically he wishes to glean material concerning the relationship between person and role. Balthasar offers no explicit treatment of Freud in his work on anxiety: Balthasar, Hans Urs von. Der Christ und die Angst, Einsiedeln-Trier 1951; English trans., The Balthasar, Hans Urs von. Christian and Anxiety, San Francisco 2000. Balthasar presumes his reader is already familiar with Freudâ€™s theories, and offers a careful reading and short presentation of Freudâ€™s position which is dense with footnotes. His eight page treatment contains over 75 citations of Freudâ€™s works. Cf. TDI, 474-482; Eng. 506-513. All of Balthasarâ€™s citations of Freudâ€™s work are taken from Gesammelte Werke, and Briefe 1873-1939. Instead of proceeding downwards from clinical observations to their ultimate origin in a foundational metapsychology, as Freud does, Balthasar proceeds upwards beginning from Freudâ€™s metapsychology to a consideration of Freudâ€™s second, more developed, theory of anxiety, which emerges in greater clarity toward the end of Balthasarâ€™s presentation. Balthasar indicates in his work four ways in which the ego is a primary locus of anxiety. It should be noted that these four ways are my own construction from Balthasarâ€™s writing. First, anxiety surfaces in the ego through the damaging of the relationship between mother and child, namely, from a lack of love within the structure. Second, it emerges in the difficult and complex task of role identification, that is, the relationship between oneâ€™s â€œIâ€ and his role in life both in knowing and executing it. Third, anxiety comes about in the ego through the relationship between oneâ€™s â€œIâ€ and the horizon of meaning which measures its action from which can come a sense of guilt. Fourth, anxiety can surface in the relationship between oneâ€™s â€œIâ€ and the future. The first way is found in Wenn ihr nicht werdet wie dieses Kind and the other three can be gleaned from Theodramatik I.
42 TDI, 482; Eng. 513. Cf. Riefâ€™s Freudian description of the â€œpsychological manâ€ in The Triumph of the Therapeutic.
43 The reader is referred to the final chapter of my doctoral dissertation: Cihak, John. Salvific Anxiety: the Phenomenon, Origins, Redemption and Transformation of Anxiety according to Hans Urs von Balthasar, Rome 2007.
44 B, 203; Eng. 224.
45 Cf. Ainsworth, Mary et al. Patterns of Attachment. A Psychological Study of the Strange Situation, Mahwah 1978; Bowlby, John. A Secure Base. Parent-Child Attachment and Healthy Human Development, New York 1990; Greenspan, Stanley and Nancy Breslau-Lewis. Building Healthy Minds, New York 2000; Greenspan, Stanley and Beryl Lieff-Benderly. The Growth of the Mind, Reading 1998; Siegel, Daniel. The Developing Mind, New York 1999; Stern, Daniel. The Interpersonal World of the Infant, New York 2000. These newer studies indicate that infants are not motivated by oral, anal and sexual needs as in Freudâ€™s theory, but rather are motivated to be in relationship, to have reciprocal contingent exchange of communication, and to become competent. The Freudian practice of having the patient lie down and freely associate with little comment by the analyst is considered now to be counter intuitive. The human person learns through direct eye-to-eye and contingent and collaborative communication. The patient-psychiatrist relationship, although asymmetrical, that is, focused on the patientâ€™s interior life and not on the doctorâ€™s, is a corrective and healing relationship. It is precisely through the relationship to the therapist, through talking therapy, that neurosis can be healed. It seems as though Freud did not pay close enough attention to his own insight on the value of talking therapy.
46 Paul Vitz observes that while two of the branches of psychology (experimental and test-and-measurement) have developed into hard sciences, psychotherapy on the other hand has â€œgrasped that its founding inspiration is humanistic, and that its founders made a serious category mistake in declaring it to be a [hard] scienceâ€ (Vitz, Paul. â€œPsychology in Recovery,â€ First Things 151  18). The founders of psychotherapy, Vitz observes, used literary, mythical or religious models, for example Freudâ€™s Oedipus theory or Jungâ€™s archetypes, for understanding the mind as much as scientific ones, and psychotherapists in the current day have grasped that psychotherapy works best by making use of concepts and approaches traditionally found in the human sciences. Cf. Vitz, â€œPsychology in Recovery,â€ 18.
47 Cf. Peterson, Christopher and Martin Seligman. Character Strengths and Virtues. A Handbook and Classification, Oxford 2004.
48 Balthasar writes, â€œThe only true self-knowledge occurs in God, and there man does not see himself but, through faith, God. This vision of God is the truth of what man is. To look back upon himself is already untruth, impurityâ€ (B, 210; Eng. 230). He continues, â€œâ€˜Personality developmentâ€™ as an ideal is not only a lie; it is also an enslavement, for freedom is to be found in God alone, in the Infinite One, who delivers us through love from the chains and dungeons of our finitude and hence gives us the only possibility of moving, not toward a permanent end, but toward a new beginningâ€ (B, 211; Eng. 231).
49 Servais, â€œIl dualismo Freudianoâ€, 252.
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 of Metanexus Institute.