Cult books revisited: Frank Lake’s Clinical Theology

Abstract

Frank Lake’s Clinical Theology: A Theological and Psychiatric Basis to Clinical Pastoral Care was published in 1966. It is a truly massive tome, consisting of 1,160 pages, a further 21 pages of appendices, 24 figures in the text, and ten separate charts contained in a folder in the rear cover. To understand its significance, this article considers it in the context of the time of its publication, but also with an awareness of the author’s distinctive personality and powerful sense of mission.

Keywords

Bishop John Robinson Bridge Pastoral Foundation clinical theology Clinical Theology Association Frank Lake psychiatry R. D. Laing

Britain in the 1960s was undergoing massive social changes, particularly in the spheres of sexuality, social hierarchies, and religious belief and observance. Philip Larkin captures the first of these in his poem Annus Mirabilis,¹ where he famously claims that sexual intercourse began in 1963, reflecting what has been described as the sexual revolution of that era.

The contraceptive pill was licensed for use in Britain in 1961, although until 1967 it was (officially) available only for married women. At the same time both homosexuality and abortion were being hotly debated. The Wolfenden Report, published in 1957, recommended radical amendment to the criminalization of homosexual acts between consenting adults. (However, it took ten years for the law to be changed and then only in parts of the UK.) The Abortion Act of 1967 was a response to a widely held view that allowing medically sanctioned terminations of pregnancy was morally preferable to the massive harm caused by back-street abortions. But perhaps the greatest indication of major social change was the defence of lifting a ban on D. H. Lawrence’s Lady Chatterley’s Lover by a Church of England bishop (Bishop John Robinson). While roundly condemned by other religious pundits, Robinson’s stance showed the shift towards a more situational approach to traditional moral norms, described in Robin Gill’s earlier article in this series.²

Another important contextual aspect of Lake’s writing was the lively debate in the fields of psychiatry, psychotherapy and counselling about appropriate methods of dealing with mental illness and with more minor psychological problems. Here, major influences were the non-directive counselling approach advocated by the American psychotherapist Carl Rogers, and the critique of traditional psychiatric methods initiated by the Scottish psychiatrist R. D. Laing. In a series of highly influential books – The Divided Self (1960), The Self and Others (1961) and The Politics of Experience and the Bird of Paradise (1967) – Laing advocated a radical reappraisal of how we understand the experience of mental illness, leading to what became known as the ‘anti-psychiatry movement’.

In the midst of all this social ferment and questioning of traditional attitudes, the pastoral care of the churches began to look seriously out of tune with the times. Increasingly, people were seen to turn to other sources of help for their personal problems and moral uncertainties. Moreover, training in pastoral care and counselling for the priesthood or Christian ministry was patchy at best, and mostly woefully inadequate. Dr Frank Lake, a medical missionary and specialist in parasitology, who later trained in psychiatry, offered an answer to this problem by providing intensive training seminars for clergy and theological students in a multidisciplinary method he called ‘clinical theology’. In 1962, the Clinical Theology Association (CTA) was formed to provide an organizational base for this enterprise. Eventually, the resources of the CTA were used by 41 Church of England dioceses and by the principals of 18 Anglican theological colleges, and later by both ordained and lay members of other churches nationally.³ It was partly from the documents written for these training seminars by Frank Lake that Clinical Theology emerged in 1965, but a massive mount of additional material was added by Lake, who was a compulsive writer, dictating material as he drove hundreds of miles around the country to promote his cause.

What is ‘clinical theology’?

Despite its massive size, one will look in vain in Clinical Theology for a clear definition of its subject matter. The extensive index has 24 entries referring to it, but all of them are about various applications of the concept to other topics. One is left interpreting the central meaning of the term through the way it is applied by Lake. For example, in a chapter on depression and accidie, he writes:

Clinical theology is not a diagnostic exercise. It is an interpersonal encounter of infinite complexity in which God the Holy Spirit is using one ‘dead’ man (glad that God has enabled him to die to any other desire than to be lived in and used by God) to communicate with another ‘dead’ man (who is just beginning to realise how dead, in so many ways he is – and worried about the past and the future).⁴

This quotation may help to convey the quite distinctive approach of Lake to pastoral care and counselling. He uses strongly religious terminology – always from a distinctively evangelical Christian tradition – in juxtaposition with quite technical descriptions of serious psychiatric conditions, such as depression, schizophrenia, paranoia and phobias. He makes this pairing or correspondence quite explicit in the introduction, in which he describes what he regards as his ‘central empirical finding’:

[I]n the severest forms of mental pain, those which underlie the schizoid position, in which depth analysis shows that being-itself is lost, under conditions of trans-marginal stress, and the paranoid position in which all well-being, rights, and sustenance have been similarly lost, there is a close correspondence between the agony of the human spirit as it endures these ultimate injuries, and the agony of Christ in his Crucifixion.⁵

This approach is, at the same time, very radical and profoundly conservative in the way it seeks to connect psychiatric terminology with the language of traditional Christian belief. In some respects it is more than radical – it is revolutionary! The boldness with which Lake makes correlations between central Christian doctrines and the treatment of seriously disabling psychiatric conditions is unprecedented in the pastoral care literature. Of course, there had already been powerful writing reflecting on the experience of mental illness from a religious perspective, notably Anton Boisen’s Out of the Depths (1960), to which Lake refers very briefly when discussing paranoid conditions. But Boisen did not attempt to equate his religious faith with recovery from mental illness in the way that Lake does; and most of the standard works of the time, such as Hiltner’s Pastoral Counseling (1949) and Clinebell’s Basic Types of Pastoral Counseling (1966), make a clear distinction between religious conversion and preaching of the gospel, and the counselling techniques to be used in pastoral care. Even in the more theologically explicit writing – for example, in the Barthian approach of Eduard Thurneysen in A Theology of Pastoral Care (1962) – a distinction is usually drawn between spiritual counselling (‘cure of souls’) and psychological counselling; Lake rejects this and takes Thurneysen to task for it.⁶ For Lake, a distinction between ‘medical psychotherapy and the cure of souls’ is of ‘doubtful validity’.⁷

The radical nature of Lake’s approach is even more startling when we see the methods that he both used himself and advocated in his seminars. At the time of writing Clinical Theology, his main influences seem to have been the neo-Freudian theories of a British group of psychoanalysts, notably Harry Guntrip, Melanie Klein and Donald Winnicott. But he also writes appreciatively of Ronald Laing (who participated in some CTA events), and from quite early on Lake used LSD to take people back to early traumatic birth and neonatal events. There are many striking case studies in the book, with graphic details of personal distress drawn out by this method of LSD-induced ‘abreaction’. Later, Lake was to espouse primal therapy, tracing mental distress back to the trauma of birth and earlier, eventually claiming to access the very earliest intra-uterine experiences of the foetus. This last theory was expounded in one of his final publications, Tight Corners in Pastoral Counselling (1981), to which I shall return later in this article.

Yet, in the midst of all this radicalism, there is also a profound conservatism. This is most obvious in issues relating to sexuality. Masturbation is discussed in 28 separate places in the book, and always in the context of some kind of psychiatric pathology or emotional disturbance. Homosexuality is classed as a psychiatric disorder that requires therapy. While it is true that at that time the internationally accepted classification of the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM) included homosexuality as a mental illness, there was already a lively debate about this, and this classification was to be substantially modified in 1973 and finally abandoned completely in 1987. Moreover, as noted earlier, eight years before the publication of Clinical Theology, the Wolfenden Report had been published. However, such liberalization of views about human sexuality would not have been shared by many in the churches, and it is clear that, for Lake, while compassion and understanding are always required, these aspects of sexual behaviour are aberrations. It is perhaps significant that Lake’s last book, published in the year of his death (With Respect, 1982), was an appreciation of Pope John Paul II, the pope who reiterated and reinforced the Roman Catholic Church’s traditional teaching on contraception, abortion, homosexuality and the ordination of women.

Frank Lake’s conservatism is also evident in his treatment of Christian doctrines. He freely admits in the introduction that he is no academic theologian:

I am a professional psychiatrist, but an amateur theologian. Not even a life-time’s reading of theology nor many years as a preacher and a missionary will disguise from the professional theologian my lack of academic equipment for the theological aspects of my task. Unless I am mistaken, I have been brought to an empirical knowledge of the truth and the power of the central facts of Christian theology … I am a theologian only in the sense that every Christian layman could be a theologian, committed to think about the ultimate meaning of the knowledge and skill he commands.⁸

This frankness (pardon the pun) is admirable, but it does not confront a central problem in the whole enterprise, a problem inherent in the title of both the organization and the volume – the claim to be offering not just a guide to mental illness and on how to minister to psychological distress, but a theological reflection on its nature and on the way pastoral help can provide a remedy. There can be no doubt that Frank Lake, up to his untimely death from cancer at the age of 67, devoted himself to a ‘life-time’s reading of theology’. This is evident throughout the volume, with a myriad of references to both contemporary and historical theologians, as well as to numerous other sources in the psychological and psychiatric literature. However, he uses his sources in a highly selective way, basically to back up his claims about the power of central Christian doctrines, such as the incarnation, the resurrection and the power of the Holy Spirit, and to show their relevance to the dark night of the soul, a central theme in his account of how religion relates to psychiatry. There seems to be no awareness of the critical work of the writers he refers to. For example, he has references to Bultmann and to Tillich, but without any account of their radical reassessments of central Christian teaching in light of both biblical criticism and major philosophical changes in the understanding of the nature of truth and belief. Bishop John Robinson does get one brief mention, but only ‘at his most orthodox’.⁹ It is as though Honest to God (first published in 1963) was simply unmentionable!

It is clear, then, that Clinical Theology has no place for the theological doubt and self-criticism that so characterized the period in which it was written. In this sense it is a highly conservative treatment of Christian belief. Yet, this account of it is perhaps somewhat unfair. Lake is not trying to give a systematic critique of the faith that is clearly so central to all of his work as a psychiatrist and teacher. Instead, he wants his readers to see for themselves how relevant, inspirational and therapeutic Christian faith can be for those in deep distress. His writing is at its most powerful and compelling when he shares with the reader the darkness that his patients have to enter into in therapy, and the light that can dawn when out of depression and despair comes hope and a new confidence in their lives as worthwhile. (Lake would have approved of the birth metaphor in this description.) It is no accident that one of his favourite and most quoted writers is Kierkegaard, for whom the concept of dread was both a personal burden and an ultimate source of hope.

The man and his mission

It is sometimes thought that assessing the impact and significance of a book should be done ‘objectively’, and should not include an account of the personality or life history of the author. This may be true in some instances, but it is certainly not the case with Clinical Theology. Frank Lake was a man with a mission, and, as an issue of Contact commemorating his life plainly shows, he was an extremely driven person, for whom work was all-consuming. His younger brother, Brian, also a psychiatrist, who provided a steadying influence on the CTA over many years, has this to say about his brother’s personality:

People who knew him recognised his immense drive and some outstanding abilities. He was always exploring and trying out new psychotherapeutic approaches. They saw many of his projects blossoming and bearing fruit, although he never quite achieved the harvest he strove for … Perhaps it was a sense of anxious urgency, which interfered with the cultivation of recently imported and un-acclimatized new crops. He excited growth but was unable at times to sustain and maintain it … It was this contradictoriness, sometimes reframed as paradoxicality, which made Frank an outstanding but enigmatic and complex figure.¹⁰

Psychologist Irene Bloomfield writes in less compromising terms in the same issue:

He had some sort of prophetic vision and the drive, determination and conviction to make his vision into a reality, or near-reality. Perhaps it is not always easy to see a clear dividing line between a prophetic vision and a pathological obsession.¹¹

We gain further insight into this driven aspect of Lake’s personality in John Peters’ comprehensive and brutally honest biography, Frank Lake: the man and his work. There are numerous accounts in this book from colleagues, patients and his own family of what a complex, enigmatic and difficult person he was, and how he seemed incapable of accepting any kind of criticism of what he believed to be empirically established truths.¹² Michael Hare Duke, who was Pastoral Director of the CTA in its early days and later became Bishop of St Andrews, describes what it was like to have him as a colleague:

Frank Lake was not an easy colleague to work with because he was always so totally convinced that he was right and endeavoured to deal with argument by inducing guilt. He found it difficult to operate on an adult basis. He either had to be the charismatic leader holding parental authority or else he swung into the role of the child.¹³

The most telling and poignant portrayal of Lake’s unresolved problems with personal relationships comes from his wife, Sylvia, who writes with total candour in the foreword to Peters’ biography:

I struggled to love Frank; sometimes it was very difficult, yet for me it was an unbreakable bond of love; sometimes it seemed as though he deliberately tried to destroy love, as though to prove once and for all that love was a fallacy.¹⁴

These insights into Lake’s personality may partly help to explain why Clinical Theology is such a difficult book to read and to come to terms with. It has been aptly described as ‘a challenging book which throbbed with missionary zeal’.¹⁵ For Lake, everything and everyone had to take second place to his life’s work, which was the culmination of his previous career as a medical missionary, military doctor and superintendent (for a time) of the Christian Medical College in Vellore, South India. His discovery of the power of depth psychology opened up what he saw as a path to ‘the re-integration of the person through the healing and reconciling resources of God in Christ and through the Holy Spirit’.¹⁶ In a telling analogy, he saw his move from parasitology to clinical theology as changing the battle with the pathogens outside the human body to the pathogens within the individual personality. The labyrinthine pages of Clinical Theology, his first attempt to fight this seemingly endless battle, are like an engagement with a many-headed monster, with the reader left to cope somehow with the plethora of technical language, detailed and moving case histories, and affirmations of Christian belief, which are claimed to be effective weapons in this fight.

The legacy of Clinical Theology

What then is the significance of this book? I believe it is correctly described as a ‘cult book’. True, there must have been very few people who were able to read the entire work – a later abridged edition proved to be more accessible and was almost certainly widely read, particularly by the thousands of people who participated in the CTA seminars, before and after Frank Lake’s death. One of the features of a cult is that it centres around a charismatic leader, and this is obviously true in this instance. Lake’s death was a severe blow to the CTA, not least because it was also in dire financial straits, with a costly and somewhat chaotic organization. However, the CTA did survive, in a slimmed-down version, and has subsequently assumed a new identity as the Bridge Pastoral Foundation.¹⁷

A second feature of a cult is that it brings people together who have a shared perception of need. In this respect, Clinical Theology and the organization associated with it had a remarkable and lasting impact on pastoral training in Britain. Delivering the seminars required a very large number of tutors scattered across England and other parts of the UK. The response, both in terms of tutors enlisted and regular attendance at what were very personally challenging seminars, showed how widespread the perception of need was in the 1960s and 1970s. There can be no doubt that Frank Lake performed an enormous service to his own denomination, the Church of England, and more widely to pastoral workers and health professionals of various religious faiths in alerting them to the deep and complex psychological dimensions of their attempt to serve people in distress.

On the other hand, the more dogmatic and extreme aspects of Lake’s venture into the depths of the human psyche, with its emphasis on the schizoid personality and its focus on natal and prenatal psychological traumas, are no longer seen as mainstream in pastoral training – if indeed they ever were. Instead, there is an emphasis on a more generalized set of basic competencies in pastoral counselling, with work at greater depth requiring specialist training and carefully organized supervision and accreditation. The legacy of Clinical Theology is not so much in its wilder advocacy of a succession of psychodynamic theories of mental illness, as in the dedication of its author to bringing the churches’ cure of souls into the modern era.

Footnotes

Author biography

Alastair V. Campbell is a Visiting Professor and Emeritus Director, Centre for Biomedical Ethics, National University of Singapore.