Abstract
The following is a discussion of the issue of religious faith on the part of the analyst, in terms of how it comes to bear on the psychological treatment of patients who have faith and some who do not. A consideration, and refutation, of Freud’s position on religion and his belief in a supreme being as an illusion will be conducted, along with subsequent analytic thinking on this matter. The author’s personal experience will be described, and how he is affirmed and sometimes challenged by the various clinical situations in which he finds himself. There will be an application of psychological theory, clinical practice, and theological guide-points.
For the analyst who chooses to remain open to a belief in God, the work of analysis can at times be affirming, and at other times challenging. The following are reflections on that dilemma.
In my experience there has been very little discussion in analytic settings regarding the importance of God in the lives of our patients and analysands. In my nearly 35 years as an active member of the faculty of my analytic graduate school, with the exception of an occasional disparaging remark, I can think of no substantive discussion of this issue. The only laudable exception was an extracurricular event conducted by a colleague in the autumn of 2017 (Goldwater, 2017). Under his able guidance, the pros and cons of God’s relevance in clinical work was considered by an animated audience of mostly non-analysts.
The apparent indifference of my fellow analysts may in some instances simply be the result of a well-thought-out atheism. Or for some it may be the consequence of agnosticism that affords no place for a traditional Judeo, Christian, or Muslim God of personal dimension. Perhaps for those who do maintain traditional leanings it is the casualness of their beliefs, along with the distracting press of personal and professional life that overrides considerations of this sort. However, I do know colleagues who practice their religious beliefs more ardently—who light the Menorah, or attend Mass, or kneel to Mecca. However, their voices are seldom heard. Regrettably, I have been among these.
It is no doubt the lingering influence of psychoanalysis’s founding father and the homage that is required to be paid during the analytic training of candidates, and after, to Freud’s epic notions of the unconscious instinctual forces that drive human mental life and behavior. As Rizzuto (1979) opined, Intentionally or unintentionally (Freud) gave the world several generations of psychoanalysts, who coming from all walks of life, dropped whatever religion they had at the doors of their institutes. If they refused to do so, they managed to dissociate their beliefs from their analytic training and practice, with the sad effect of having an important area of their own lives untouched by their training. If they dealt with religion during their own analyses, that was the beginning and end of it (Rizzuto, 1979, p. 4). Certain religious patients might be especially difficult for some analysts to treat, due not so much to these patients’ inherent ‘unanalizability’ as to their perceptions of the analyst’s fears of being intimately known along what is often highly personal terrain — the analyst’s own relations to mystery and transcendence (Sorenson, 2004, p. 81). Freud simply had little experience with the broad spectrum of religious involvement. His own experience was highly colored by dynamic inputs from his own childhood, and his attempts to educate himself about religious phenomena tended to emphasize the occult, superstitious, or relatively primitive forms of religious experience (Meissner, 1984, p. 137).
Given what Freud concluded to be the exclusively defensive nature of religious beliefs, weak man’s need for succor, he was able to dismiss such human aspirations as ethereal. Although science moves slowly, it was for Freud “the only road which can lead us to a knowledge of reality outside ourselves” (Freud, p. 31). He asserts: It is once again merely an illusion to expect anything from intuition and introspection; they can give us nothing but the particulars about our own mental life which are hard to interpret, never any information about the questions which religious doctrine finds so easy to answer (Freud, 1927, pp. 31–32).
Although Freud’s arguments are compelling, the conclusion that science and its method can give us better answers than those of religion to achieve a more benign civilization, in my opinion falls short. Certainly, since his writing of a “Future of an Illusion” in 1927, the world is considerably more advanced technologically. Momentous gains have been made in education, transportation, communication, and the diagnosis and treatment of illness and injury. However, man’s modern technological capacity has also resulted in two devastating World Wars, numerous regional wars, and racial and genocidal cleansing, all aided by advanced weaponry, including nuclear and chemical, with more sophisticated delivery systems. Indeed, science has enabled the dark instinctual forces within us to attain a level of brutal and predatory expression not previously seen in man’s history. Some would argue that we are closer now to the annihilation of civilization than we have ever been before. And in our everyday lives, as wonderfully enlightening as information technology can be, its capacity to enable unfettered access to dehumanizing content has warped the minds of many including our most vulnerable, the children. Martin Luther King (1964) summarized well this dilemma over 50 years ago: Something basic is missing. There is a sort of poverty of the spirit which stands in glaring contrast to our scientific and technological abundance. The richer we have become materially, the poorer we have become morally and spiritually. We have learned to fly the air like birds and swim the sea like fish, but we have not learned the simple art of living together like brothers (King, 1964).
So, although I believe in science, contrary to Freud, I do not think that science above all else is the answer. Such thinking is extreme and shortsighted and reflects intellectual conceit. Science alone is an illusion that will fail as it always has in the absence of a moral-ethical ethos that encourages and enables altruistic recognition of the other and the belief that true benefit comes only with love, kindness, and cooperative effort. Without this, advances in science will always run the risk of being used against others, with religion, dogmatically espoused, providing justifications.
For Eiseley (1978), in a broader sense Freud’s reductionist impulses allow for no sense of “awe before natural phenomena,” the expansive “great mystery of life,” that feeling of “something inexpressible… felt to be behind nature” (Eiseley, 1978, p. 188), which is perhaps where God dwells. Eiseley’s conclusions seem apt: In the end[,] science as we know it has two basic types of practitioners. One is the educated man who still has a controlled sense of wonder before the universal mystery, whether it hides in a snail’s eye or within the light that impinges on that delicate organ. The second kind of observer is the extreme reductionist who is so busy stripping things apart that the tremendous mystery has been reduced to a trifle, to intangibles not worth troubling one’s head about. The world of secondary qualities — color, sound[,] thought — is reduced to an illusion. The only true reality becomes the chill void of ever[-]streaming particles (Eiseley, 1978, p. 190).
Although to the end he insisted he was a “Godless Jew,” Meissner’s discussion (1984) about Freud’s deep ambivalence concerning the existence of God is compelling. So too, Freud’s friend, the Lutheran pastor Pfister (1928), was unrelenting in his belief that Freud’s quest for truth toward the aim of alleviating human suffering was both mystical and ministerial. Nor was Freud quite able to let the discussion with Pfister go, suggesting that, despite many motives including his friendship with Pfister, he may have been enthralled by the possibilities beyond his own thinking.
But this paper is not primarily to argue God’s existence, only to recognize the importance of allowing the discussion when it has relevance and salience for those with whom we work analytically, as well as to delineate somewhat the challenges that must be endured by analysts who are not themselves godless. For myself, although I question and certainly have doubt, I choose to remain open to the possibility of God. And I choose to lean toward, albeit imperfectly and in a very personal way, the Biblical Jesus in my life and work. Infused with a “doubt of desire” (Cutting, 2015), I have I believe made “a decision, a judgement that is fully and deliberatively taken in the light of a truth that cannot be proven…” (Merton, T., 2003). So, certainly without proselytizing I attempt to be open to God in the analytic session in whatever way entry is made.
That said, I think I must be the least of the true believers. Although I turn my mind to God each day, hoping always to find Him, I am also afraid to do so. I am afraid to face the Hound of Heaven. Perhaps it is that I do not wish to have my everyday reality broken, my hold on life diminished by a presence I cannot fathom. I actually like to think of God the way I think of my long ago departed Italian grandfather: inscrutable, yet benign, mustached, smelling of wine, garlic, and tobacco. And short, very short. Always sitting in his garden of plum tomatoes, basil, and figs. Waiting for me. Silent but approachable. Smiling and tolerant, “as the small boy I was” twists the hairs of his thick mustache into sharp lateral points. But I know that God must be more than that.
The scientist in me keeps doubt alive, like an ache that will not subside. I sometimes wish it were not so. Nevertheless, I am left with my feelings, not always sufficient, of the compelling theology of Jesus of Nazareth, which reaches deep within me for its resonance. Then, too, there are the distant memories of my mother’s mother praying the rosary on her knees, and meting out kindnesses to me. There were the visits to my grandmother’s sister, a missionary nun who prayed for us all and gave the small child I was St. Christopher medals and scapulars to guide me on my journey through life. Prominent among these recollections is that of my uncle Anthony hoisting me onto his shoulders safely above the enthusiastically pushy throngs of people celebrating the Feast of the Virgin in Manhattan’s Little Italy in 1949. He and they and I awash in the surging flood of religious belief. Nor can I forget my father and I walking through swirling breaths or warm glistening January snow in an alien city far away from the family he loved. To the Lithuanian church on a hill where we understood nothing of what was said, save for the rhythm and intonations of the Mass—and the unspoken love of a father and son. My parents were dedicated, my father more so perhaps, in their simple and abiding belief.
I had Irish nuns too, who taught me in high school. They mixed real interest in the students with an austere passion for God that we mocked and respected alternately. I did feel regarded by them. They made me determined to strive. They are all gone now to the glory they told us about.
Add to all of this a feeling, quite subjective of course, that pierces my doubt in thin yet discernible streams, that many of my prayers have been answered. This does stand in contrast to my keen awareness of the laws of coincidence and repetition, as well as the too-often random brutalities of life, manifested in so many ways both as natural and enacted by men. The list is a long one and includes the large-scale injustices, the horrors of war, the local tragedies, unexpected losses, unkind ordinary diminishments of the other, inevitable aging, sickness, and death. Yet I attempt to remain in search, and open.
In my professional work, in addition to my receptivity to the patient’s introduction of God, my personal turning to God occurs when I feel alone or afraid in sessions. For example, in my treatment of intensely paranoid people, I often feel a deep sense of apprehension. Perhaps it is because I sense the capacity in such people to hate and to act on it in ways that are not only injurious to themselves and others, but at times potentially fatal. I am reminded of Mr Z, who accused me often of conspiring with his enemies. He was a robust older man in his early 70s who frightened and alienated everyone around him. This lonely person frequented bars and clubs challenging men much younger than himself, posturing himself in ways that could have resulted in violence towards others, or in his becoming a victim of precipitated attack. He was the same individual who showed up at his girlfriend’s house armed with a crowbar, suspecting that she was there with another man who would attack him. In anticipation of his challenging me, I would at times prepare for sessions by centering and calming myself in prayer.
The juxtaposition of an intact, even affable, personality with the pulsing thread of paranoia can be unnerving. Such presentations have an unravelling effect on our sense of logic and reality. The intractability of the paranoid person’s belief system is both beguiling and humbling. The inclination is to be drawn to and emphasize the rational aspect of the personality and avoid or downplay the irrational, to not engage the person where he is the most fearful. When Mr Z insisted that I must have been talking to his brother with a plan to compromise him, I could only abjectly deny his assertion and question him vigorously: “What would I get out of that?” Or, “Now you’re lumping me in with everybody else.” Having the ability to be appropriately assertive in the face of this man’s visceral accusations and the fear that they induced, was possible as a result of the awareness of the dynamics of the paranoid personality afforded me by my training, and a level of sensitivity to the suffering of the man. It was also facilitated, in the face of the awesome and insidious power of this pathology, by the spiritually driven belief, that although there was darkness in the room, there could be light. This enabled me to endure.
There are other cases in which we are brought into psychic realms where the potential to loose ourselves is great. I recall one profoundly isolated man in the grips of a schizoid defense. I spent many months with this person who made little, if any, contact with me. Pale and gaunt, he engaged in self-denigrating descriptions that induced a sense of disgust in me. He spoke of family members from 30 years ago and the wounds he suffered in that faraway time, particularly as administered by his father. There also were the emotional injuries by former employers, father substitutes. This repetitious communication was bland, emotionless, save for an occasional outburst. At such times, it was as though he was actually still living in the memory, and not in the present with me, in the reality of the moment. In the midst of this, this man presented fascinating fantasy images, daydreams of a vampire society of which he was master of a harem engaged in erotica. These florid images contrasted markedly with the mesmerized and paralytic psychic state that I had been induced into in the absence of any contact from him. For a long time, I was unable to extricate myself.
In this vacuous emotional and sensory chrysalis I was, I admit, aware of no God, so tightly was I bound. Nor do I now remember praying. That I was able, however, to ultimately free myself with a desperate surge of voiced anger may have been providential, but I don’t know for sure. More than likely it was intolerable frustration at the felt helplessness of the position I was in. I simply joined this man by asserting with some vigor and perhaps irritated sarcasm, his commitment to doing nothing with his life. I said to him that he had in fact been quite successful in getting out of the rat race, something that so many men wished to do but were unable. I encouraged him to accept and to enjoy what he had achieved. He didn’t like my saying this and he left in a rage, the first authentic emotional contact he had had with me. After a number of calls to him, he returned and we had the opportunity to talk about what had happened. Although his character is not changed, he seems not to suffer so much. We are still together after three decades. In our relationship, he has become more object-related. We sometimes joke, laugh, and consider in more immediate and sometimes emotionally felt ways, the hurts of his past and current life.
This result was I think due to my accepting my limitations, abandoning my ambitions, and living in the unfolding moments of the session. I had tried much over the years, without success, to impact this individual, perhaps in the beginning for my own reasons (i.e., to advance in my candidacy and graduate, to demonstrate brilliance, to assuage my sense of existential helplessness, to assert meaning in the face of insecurity, and so on). My early attempts were not incorrect, just futile. I have not for a long time sought to cure this man, to confront resistance, administer understanding. I simply try to be with him with neither memory nor desire. I leave the final outcome to God.
With such difficult cases, I have come to hold Merton’s (1993) caution close to my heart as a guiding principle: Do not depend on the hope of results. You may have to face the fact that your work will be apparently worthless and even achieve no results at all, if not perhaps results opposite to what you expect. As you get used to this idea, you start more and more to concentrate not on the results, but on the value, the rightness, the truth of the work itself. You gradually struggle less and less for an idea and more and more for specific people. In the end it is the reality of the personal relationship that saves everything (Merton, 1993: 294).
Early in my career, I did not refer to “God” out loud during sessions. If patients did so, I simply observed or acknowledged and supported their statements without getting much into it. As time has gone by, and as I have become older, and I hope wiser, I have allowed myself to go deeper with people in their belief. In doing so, I have at times found my own belief inspired, as in the following case.
There was a woman, Anna, who suffered many defeats. Intelligent and once capable, she as a single parent to several children founded a school dedicated to a famous saint. For well over 20 years she provided services to many children and their families. Early on, a serious accident had left her in a coma and cognitively impaired for a while. She navigated through a long and arduous period of recovery. She came back from that. Several abusive relationships with men ensued, in which she sustained further physical and emotional trauma. Contention provoked by a daughter-in-law led to alienation from her son, and separation from her grandchildren, with whom she had been very close. Despite her efforts to reconcile, she was met with intransigence. Her heart was broken, and her grief unmitigated. Her own siblings sided with her son and his wife, and turned away from her. Her school began to experience financial distress. That, along with the contrariness and insubordinate behavior of some of her staff, resulted in its collapse. Health problems emerged. Her situation had become truly Job-like.
Through it all, this woman remained faithful to her Catholic beliefs. And although she faltered, she never wavered from her course; she remained faithful. Although desperate in asking for my help, she was tenacious in her resistance to my suggestions, voiced understandings and interpretations, as well as my encouragements. Anna would simply courteously reject them as not applicable, and would ask if I really understood. I was, in fact, often induced with the feeling that I did not understand her. She so often seemed like someone who earnestly wanted my help but would reject it in lieu of complaining. This obstinacy in all likelihood played a part in her difficulty with others, although she seemed unable to consider this.
Out of intense frustration I found myself at times, as others may well have, wishing to be at an end with her. Bludgeoned by the intractableness of her suffering and her resistance, I sometimes turned to God. I prayed for her and myself. Accepting my defeat, I would say to her that it seemed to me that the only thing for her to do was pray. And I agreed to pray for her when she asked me to do so. She seemed comforted by my willingness. Despite my apparent helplessness to provide her with the answers and direction she sought, she stayed with me for many years and is with me now. In this case too, a kind of humility takes place, a surrender that leaves one open to the other as that person is, not as our theory and methodology, our desire, would have that person become. In such a state it is possible to be subject to the wonder and the surprise that is consequent to a more unfettered and deeper human encounter—a communion that sometimes feels spiritual in nature.
With regard to this, an interesting phenomena occurred in this case. It had to do with a story this woman told me recently. It was the first time in all the many years we had been meeting that she had recounted what had happened to her when she was a very young single woman with a small child. She had been vacationing in Italy with her parents and sister. While her parents were baby-sitting, Anna and her sister decided to go off sight-seeing. They boarded a bus with other tourists to go to a port to cross to the island of Capri. On the bus, my patient, who even as a young woman, was strong in her religious sentiments, focused on biblical readings. Occasionally, she would look up and gaze out the window at the beautiful Italian countryside. In one such moment she noticed a statue of Saint Michael in the parapet of a Church, to which she called her sister’s attention. The scene passed and eventually the two young women arrived at the port and boarded a boat for an hour’s journey to this fabled isle. They spent, she said, a pleasant day together exploring. Late in the afternoon near to sunset, they again boarded the boat for their return.
About a half-hour into the boat trip back, my patient noticed smoke seeping into the cabin where they were seated. Crew members began rushing into the cabin shouting for the passengers to exit that area. Soon the craft was enveloped in smoke and fire. People began jumping overboard without the lifejackets, which had become lodged in their storage compartments. Anna, seeing the precariousness of the situation, urged a crew member who was close to her to cut free the floatation devices so that those people in the sea would have something to grab onto. Finally, that was done, and desperate travelers had some recourse.
Despite the smoke and fire, my patient re-entered the cabin and managed, with great effort, to unfasten a single lifejacket, which she brought to her sister, who was in a high state of panic, fearing she would drown. The young woman was placed into the lifejacket and sent into the water, with Anna behind her reassuring her sister, despite the water’s turbulence. Night had fallen and the burning vessel lit the dark sea, casting shadows on frightened and despairing people who were clinging to floating objects in order to keep from going under. Not all were successful. Anna and her sister, who was still frantic, made their way to a large square buoy, and grabbed on. There they found a woman and her husband, holding on tenuously. The husband, somewhat intoxicated, kept slipping under. Anna and the wife struggled to pull him up each time. They were in this state for a long time, and although my patient kept reassuring those around her, she felt herself tiring and the beginning of doubt took hold. Then she said a strange thing happened. In the exhausted quiet that ensued, she heard a clear, man’s voice saying her own young child’s name several times. She said she felt a sense of astonishment, as the voice didn’t appear to becoming from inside her head. It gave her resolve.
They were finally rescued by the Italian Navy and cared for overnight. Late in the morning of the next day, shaken by their ordeal but relieved, they were put on a bus and were on their way back to their parents and my patient’s child. As they passed the church they had seen the previous day, the statue of Saint Michael was no longer there. Anna did not know what to make of this, but her faith was strong and she took it as a sign that this saint, renowned among believers as a protector, had left his place atop the church to utter my patient’s child’s name as an encouragement to the young woman helplessly treading water.
When she first told me this story I found myself somewhat surprised at her fortitude as she struggled with the crisis she was in at the time, and curious why this was the first I was hearing this story. However, I thought no more of it. Six months later she was again in the midst of despair about the perilous state of her financial situation, her loneliness as a result of the loss of her son and grandchildren, mixed with many other complaints and wondering why God was not listening to her. She was frantic about what was going to become of her. I found myself saying “remember who you are. You are the woman who survived in the Tyrrhenian Sea and saved peoples’ lives.” And I asked her to recount the story to me again listening even more intently this time. Strangely, as she did so I found myself now deeply impressed with her heroism. I became aware of a warm feeling of admiration. She did not seem to me to be the helpless, hopeless aggrieved person whom I had striven to endure. I experienced her in that moment as faithful, courageous, and selfless. It was as though her name was spoken to me for the first time. And for the first time I heard it, and I knew the better aspects of the person, and I was changed. What difference this will ultimately make, I wonder.
Sometimes, it is necessary to vigorously wrestle with a patient’s religious beliefs, beliefs that are used to add to the mental anguish that is suffered. I recall a young man crippled by obsessive–compulsive disorder. He was Catholic, Irish, and affable. Tim was first beset with classic obsessional symptoms at 19 years old. Frequently troubled that he may have run over people while driving, he needed to constantly check and recheck the route he had travelled to assure himself, by the absence of bodies, that he had not done so. Also, while working at a data entry position, he often feared that he had added racial or ethnic epithets to the names of the company’s clients. He felt compelled to relentlessly check his work for the appearance of such.
The emergence of this young man’s symptoms coincided with his bragging about the intimate encounters he had had with his girlfriend at the age of 19. He became almost immediately overcome with guilt, believing he had committed a mortal sin, which multiple trips to the confessional did not diminish. He was unable then, and for a long time after, to credit himself with just being a kid flush with success and, as so many boys do, needing to proclaim it. From that time forward into his late 20s he not only refrained from any dating activities, but severely chastised himself if he even had impure thoughts. His overall social life remained restricted, only occasionally getting together with male friends. His time for many years was devoted to solitary tasks of fiction writing and playing music. These were areas in which he, indeed, demonstrated talent as well as served his need for isolation. Simultaneously, he played well the role of the good son.
What was eventually discovered was that what lay beneath was a highly developed conscience operating defensively in an effort to contain the rageful feelings he had towards his alcoholic and maritally discontented parents. His need to be a good boy was strongly reinforced by his Catholic beliefs and served to assuage his anxiety. With treatment he came to recognize his hostility for having to bear witness to, and at times be victim of, his parent’s dysfunction. Often he was induced to support one or the other as each suffered the wounds of marital warfare.
Before his symptoms began to abate, this young man often used God as an excuse, a resistance to moving forward. For example, he would self-attack and in true obsessional style, attempt to undo expressions of legitimate anger for injustices he sustained in the family drama. Sometimes he persecuted himself simply for having “bad thoughts.”
In response, I often challenged him by saying such things as “You know you’re a controlling son of a bitch. You say you are a Catholic, but you refuse to forgive yourself, even though God would forgive you. You must believe that you’re bigger and better than God.” He tolerated this and even more assertive interventions of this sort, even arguing with me at times, in that his positive transference towards me had become strong. And this sort of mild brawling between us provided some expression for his pent up anger; he came to understand that he did not have to be a good boy with me. He also knew of my own Catholic background and this gave me some acceptable leverage with him. He would frequently laugh with these comments. These exchanges were, I believe, instrumental in contributing to his eventually relinquishing the oppressive stance he took with himself.
Tim was ultimately able to leave home and the parents whom he loved, but felt in bondage to. He was able to obtain employment in keeping with his talents. He was able to emerge from his self-imposed isolation and meet a young woman whom he eventually married. Together they bought a home of their own and had a child. He was able to do all of this while recognizing and appropriately exorcising the transformed aggression that had formerly been directed at himself.
Although much happened in the way of therapeutic effort, I do not think that the gains made in this case could have been possible without engaging Tim’s spiritual, religious orientation, neurotically twisted as it was. It was important that he knew that I was familiar with and accepting of the doctrine to which he so often referred, that I could listen respectfully resonant, but also at times challenging. And in my role as a Catholic psychoanalyst it was, I think, helpful to him that I was able to model the acceptance of thoughts and behavior that he considered sinful. And by wrestling the way we did with his notion of God, Tim was able to eventually diminish the harshness of the divine being he had created to perpetuate his suffering.
A severe and punishing God also dominated the life of another person with whom I worked. Mrs A came to my office preoccupied with fears of contamination. She was meticulous in her concern with cleanliness. She spent inordinate amounts of time inspecting the food she purchased, and washed and rewashed the counters and floors in her home. She was, in true obsessional style (Saltzman, 1973), hyper-attentive about her own personal hygiene, repetitively washing and bleaching her hands. Occasionally she bathed in bleach. Her skin became parched, and cracked and bled.
This educated and sociable woman worried constantly that she was not good enough. Always feeling expendable, Mrs A presented a demeanor of affability, humorous self-deprecation, and deference. Beneath this lay a seething hatred that she kept rigidly focused on herself. So it was, at least initially, in our work together.
This woman had much to be enraged about. Born into a troubled old-world marriage, her mother after many pregnancies did not want yet another child. When feeling overwrought, she often made this known to Mrs A throughout her childhood and later. Sometimes she added, in misguided confidence, that she had in moments of desperation thought about putting her child, my patient, into a bag and throwing her into the lake near their home. Mrs A said that the only time she felt loved growing up was when she was being overfed by a mother seeking atonement for her tirades. Needless to say, Mrs A struggled all through her life with the issue of excessive weight, which further damaged her self-esteem. Nor did she have the compensation of children.
The relationship with her father further disturbed her peace of mind and psychological development. He was the minister of a fundamentalist church that preached strict and punitive practices of self-repudiation and denial. Deviation from this was met with condemnation by him and the promise of unforgiving punishment by the God he represented. Though she did not practice this religion in her adulthood, the servitude and fear inspired early in her development infused her obsessional self-attacks and helped keep her life narrow in its pleasures. The parents fought vigorously over this religion, the mother being of a more traditional orientation. My patient was caught in the middle and used by both parents for leverage and succor.
The desperate sense of deprivation and containment experienced by Mrs A as a child resulted in what Spotnitz (1969/2004) referred to as “frustration aggression.” When as a result of treatment her repressed rage began to come out, it came out in a torrent. That torrent was directed towards her family, God, and me: All that hatred came out. I hate! I hate! I hated the silent treatment. I hated the box they put me in…The box. ‘You are in a box now. You’re going to live in this box! And there is an avenging destructive God that is going to whack you the second you are human. You are not going to be human! And if you are human, you are the devil.’ I hated my father and I hated my mother. I hated myself. And I took all that hatred out on me. All that hatred. As you know I put shit away. It’s sad to say, but you were that person I could show hatred to. I just did not know how much I had, have in me. It is all right with me that I know I hate; I know the hate I felt. I know the anger. I knew the rotten things I could do. I knew how I would get you with my messages. The things I knew which would infuriate you. I could murder someone with these hands. Do you know how strong these hands are? (Madonna, 2017, p. 104).
There were occasions in this case too when I chose to challenge the imposition of the grim, oppressive deity of her childhood whom she used to justify her attacks upon herself. I did this only after we had been working together for some time and her positive transference to me was firmly established. For example, on one occasion she had been talking about her fear of punishment for some good fortune and her intense worry that something would be taken from her as a result. I said to her, “You know, your God is a harsh, unforgiving bastard. He’s not my God. My God is a father who forgives.” She seemed shocked, but laughed, obviously relieved by my irreverence, as well perhaps by her own desire for a more moderate view reinforced.
Interestingly, sometime later when she was struggling with a sense of fear and futility over her lack of a belief in a God, and an inability to believe in an afterlife, she asked me: “So you go to Church?” “Yes,” I replied knowing that she knew that I did. “And you get ashes?” “Yes,” I again replied. “Why?” she asked. “Well, it’s not that I need to be reminded that I’m going to die. I know that. It’s that I need practice in humility.” She laughed, having accused me so often of being full of myself. She then said with some genuine pathos in her voice, “I have nothing. So you believe in heaven?” “It’s a nice idea,” I replied. With profoundly sad tone she said, “Where am I going to go? If there’s a heaven, they won’t let me in.” I told her not to worry. If I died before her I’d be at the gate waiting for her. And if she died before me, she should wait for me and I would tell the gate keeper to let her in. That she was with me. She laughed. I received the following text from her later that day: I feel comfort today about your comment: ‘She’s with me,’ when you get to the Pearly Gates. One of the hardest things to realize was that my father just cared about what his reward was going to be, to the exclusion of the rest of us. He wanted to be with his Maker exclusively. I truly believe you will make sure I end up in paradise with you and not cast me adrift into oblivion. That means a lot to me (Madonna, unpublished case notes).
I think of other ways people bring God into the hour with them, with the only intention perhaps being that of bearing witness. There was the police officer, who suffering in the midst of a terrible divorce, put his service revolver to his head and pulled the trigger. The gun did not fire. “It was a perfectly fine gun with a factory-fresh bullet,” he said. “All of the other bullets fired later, but not that one.” When asked why he thought that one hadn’t, he smiled and said, “The man upstairs didn’t want me to leave. It wasn’t time.” Thoughtfully reflecting, he said: I realized how selfish I was being, the damage I could have caused my children, my family. I was just caught up in my own suffering. I wasn’t thinking of them. People say suicide is cowardly. I can see that. But I think it’s selfish. After that happened, I began to think of others. I went back to playing basketball, being with other guys. Went back to worship. Began getting together with men of my church. We had an accountability group to help one another. And I threw myself into work…I’ve kept that bullet for 20 years to remind myself. I never want to be in that place again (Madonna, unpublished case notes).
There are times when we can be emotionally taxed by the despair of those patients of whom we are particularly fond. When we are young, strong, and healthy with many years before us, we can work with those who are old, ill, and close to death without being too impacted. Their struggle is far away from us. We may have some compassion. We may strive to be present. However, it is difficult at best to have the felt knowledge of the elder person’s experience. The young are enthralled by their youth, quick to be distracted from the grim aspects of the aging process.
As we get older we inevitably suffer losses, instances of injury and ill health, sometimes serious enough that our awareness of mortality comes more sharply into focus. We begin to see more clearly where we are on life’s journey and we know that there are more days behind us than ahead. We may not want to dwell on this, or even be casually reminded. When we are confronted with an older patient whose fear is palpable, one instinctive reaction can be to turn away; we understand all too well and feel quickly that our patient’s dread reflects our own destiny. As a consequence, we may be inclined to lend too much support, emphasize too much of the positive in order to divert or assuage the patient’s misery, and our own. Turning to God for acceptance and for stillness at such moments can be the difference between staying or fleeing from the difficult feelings and the patient who evokes them.
Mr B was seven years my senior. An intelligent, pleasant and friendly man, he was sent by his primary care physician because he was depressed about aging, declining memory, and locomotion. He was raised Catholic and attended Catholic schools from early childhood through college, but he no longer espoused that belief. Mr B’s suffering was intense at times. He was terrified about the loss of function and what he experienced as a “downward spiral.” He wondered how it would end for him, and feared the worst. There was no comfort sought in the religion of his boyhood, nor could any be given. I simply listened with as much patience as I could, commiserated with him regarding the vagaries of old age that troubled him (i.e., the noticeable impairment in memory, loss of a sense of relevance, interest, confidence and stamina, inclination to isolate, the anxiety and depression). I supported his efforts to connect with others as well as to do things that brought pleasure. On occasion, I exchanged poetry with him to inspire and reinforce his defiance in the face of the predicament he was in. He particularly liked Tennyson’s “Ulysses” (1833), which I read to him one day, which had the following lines: Though we are not now that strength which in old days moved earth and heaven, that which we are, we are, — one equal temper of heroic hearts, made weak by time and fate, but strong in will to strive, to seek, to find, and not to yield (Tennyson, 1833, p. 396).
In such a circumstance I am reminded of Thomas Merton’s prayer (1999); then my own despair abates a bit and I am able to be somewhat more present to the person I am with, open to all of the dimensions of that person’s experience. And that may be God’s miracle in all of this. My Lord God, I have no idea where I am going. I do not see the road ahead of me. I cannot know for certain where it will end. Nor do I really know myself…I know that you will lead me by the right road though I may know nothing about it. Therefore, I will trust you though I may seem to be lost and in the shadow of death. I will not fear, for you are ever with me, and you will never leave me to face my perils alone (Merton, 1999).
Whether the analyst is religious or not, the capacity to be open and present to the patient’s religious sentiments, or lack thereof, is important. Analysts who have the ability and the fortitude to do so make the vital intersect with the patient that can lead to transcendence and healing. For the analyst who maintains belief, being still, accepting and steadfast, in the face of the patient’s nihilism, can be difficult. For the analyst without belief, being presented with the patient’s faith can be challenging but requires the same response. Nathan Field (2005) may have had this dilemma in mind when he said, “in therapy we are frequently faced with paradoxical situations that the mind cannot grasp, any more than we can grasp water. What we can do is let it grasp us…surrender to it” (Field, 2005, p. 78). Particularly when working with those who have religious belief we enter the realm of the ineffable where we may be affirmed, or where we may see what we do not expect or desire.