Presenting a positive, optimistic look at our spiritual potential, author Dr. Gene M. Abroms focuses on how we can transcend the scientific determinism of the empirical mind-set to offer a therapy and lead a life guided by moral values. In Living Right, he shows how taking into account the spiritual reality provides the goals for psychiatric and psychotherapeutic treatment, transforming it from a limited applied science to the expanded scope of a healing art and science.
A philosophical treatise with clinical illustrations, Living Right elaborates on the argument for adding the spiritual dimension to psychotherapy by distinguishing between neutral, objective treatment, and inspirational healing that takes advantage of patients' will to health and meaning. It discusses what spiritual means in a modern context, what is involved in a spiritual therapy, what the role of depression is in paralyzing the will, and how medication and psychotherapy can play roles in freeing the will.
Promoting value change and focusing on the purpose of life-living right-Abroms presents a practical philosophy of the means required to achieve the ends of freedom of will, authenticity of self, strength of character, and compassionate empathy.
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The Ideal of a Moral-Spiritual Therapy
By Gene M. Abroms
iUniverseCopyright © 2014 Gene M. Abroms, MD.
All rights reserved.
Beyond Psychology to Spiritual Knowing
Summary. I describe how a guiding hand in the person of an Air Force colonel led me into the field of psychiatry after a false start in surgery. From the beginning, surprisingly good results accompanied my efforts to practice psychiatry. Patients' strong will to health proved to be an essential prerequisite to these results. But serendipity and synchronicity also appear to play a large role in the would-be spiritual therapist's efforts to relieve patients of their psychiatric maladies. Here I offer a preliminary account of the contrasts between the limited perspective of scientific empiricism and the inclusive scope of spiritual knowing.
In 1960, I reported to an Air Force base in New Mexico to serve a two-year term as a flight surgeon. I had just finished my surgical internship, which proved to be a terrible mismatch of my abilities and true interests and the program's requirements. I was now trying to figure out what kind of medical career I was best suited for. As my wife and I were having lunch at the base officers' club, the hospital commander came in to greet us. After the usual pleasantries, he announced, "Abroms, you are our new base psychiatrist." Surprised, I asked how he had arrived at this decision. Pointing to my folder, he replied, "I see here that you went to Harvard and majored in philosophy." Although for form's sake I challenged his paralogic, the truth was that his conclusion seemed right. I had had a go at psychotherapy during college and had gone to medical school with the intention of becoming a psychiatrist. But my psychiatry rotations had been disappointing, whereas surgery, at the dawn of heart operations, was very seductive. So here I was a failed surgeon about to become base psychiatrist with no training and possibly no talent for the work. But as it turned out, the hospital chief's proposal was a godsend. In no time at all, I found myself intensely engaged with patients and on the way to finding not only a profession but a calling.
The first patient I encountered as base psychiatrist was brought to the emergency room in a comatose state by her jet mechanic husband. I had a hunch that the coma was hysterical, which I tested out by pressing my knuckles forcefully into her sternum. (The surgeon mindset dies a slow death). Confirming my suspicion, she promptly woke up and made an office appointment for the next day. After I reviewed her medical and psychological history and confirmed that her coma was in fact a conversion symptom of thwarted anger, she proceeded to analyze herself with no apparent help from me. Over the next six sessions this high school graduate reviewed her childhood disappointments, her struggles with her mother, her sibling rivalries, her transference of feelings onto her husband, and the frequent psychosomatic crises that resulted from trying to manage her painful feelings. She hardly let me get a word in edgewise during this surprisingly sensitive and self-aware recital, some of which resembled my own past history and the issues of my prior therapy. After the sixth session, she stood up, pronounced herself cured, and thanked me profusely for my help. I protested, "Wait a minute—I haven't even started yet!" She was shocked and not a little hurt by my reaction. As time passed, I came to a better understanding of what had transpired between us.
Some fifteen years later, now a formally trained clinician and teacher of psychiatry in a medical school, I was referred a very attractive college freshman, who was manifesting symptoms of anorexia nervosa. Jane had been a prom queen in her senior year at high school but since starting college had lost twenty pounds to reach the mid-nineties, which at a height of 5'7" made her look rail thin. She subsisted on lettuce, low-calorie dressing, and many cans of diet cola, all in an effort to deal with imagined obesity. By the time she reached eighty-five pounds, Jane felt too weak to carry books to class, and she was showing typical symptoms of depression.
Since she continued to lose weight despite my concerted efforts, I called an emergency family meeting, necessitating a long trip by her parents from western Pennsylvania to Philadelphia. I found out during the conference that Jane's eating disorder symptoms of bulimia and anorexia, followed by cessation of menstruation, had first appeared during puberty. There was also evidence that she had a special place in her handsome father's affections and that her mother played a subsidiary role in the family. There was a strong family history of mood disorders and alcoholism, stretching back at least two generations. When I tried to explore the meaning and impact of these revelations, Jane showed no interest at all in addressing the issues. More importantly, I was unable to convince her to begin eating a caloric diet. In desperation, I called a meeting of Jane's college roommates and enlisted their cooperation in monitoring her diet and urging her to gain weight. After a while they withdrew from the field of battle, overwhelmed by their sense of failure.
Jane, contemptuous of my ineffectiveness, walked into my office one day and presented me with a book by Steven Levenkron on treating anorexic adolescents. She imperiously ordered me to "read it and do what the man says!" My interpretation of the author's viewpoint was that anorexics, far from rebelling against over-controlling mothers, had in fact been permissively indulged so that consistent limits had not been internalized. In consequence, their individual will had become grandiosely and destructively inflated. They needed to be disciplined and corralled, as if one were taming a wild horse. I followed the new paradigm assiduously: I took Jane out of her group because of noncompliance with treatment recommendations, became more stringent about collecting professional fees, and insisted that she sign a waiver relieving me of responsibility in case of an adverse outcome. Soon thereafter, she started eating normally again. Her menstrual periods returned, and she began dating. After graduation from college, she became the manager of a highly regarded restaurant near campus. When last heard from, she was pursuing a career in restaurant management. Although happy about the outcome, I was mystified by how the steps I had taken led to the positive changes in Jane's behavior.
These two case histories illustrate a number of points. One of them, charitably put, is that I am not a conventional therapist. I am directive, prescriptive, and stage manager—all thought to be disqualifying activities for a reputable therapist. I bring in families and roommates to assist in the process, and I am not above trying to outmaneuver the destructive forces that cause symptoms, not just by relying on psychological insight but also by taking certain forms of forceful action. Although I value insight, I think other potentially more powerful therapeutic forces must be summoned. Of these, perhaps the most important is the patient's own will to health. In the first case, the will to health was so strong that once I broke through her hysterical coma, she performed a form of psychodynamic therapy on herself with no obvious prompting from me. In the second case, the patient actually provided me with a guidebook for her successful treatment.
Why do I say such behavior is a manifestation of a strong "will to health"? Why not attribute it to a strong drive or high motivation to succeed in therapy? Why invoke a quasi-mystical force such as "will to health" when more naturalistic, scientific-sounding terms such as "drive" and "motivation" would do? The answer to these questions gets at the heart of the main thesis of this book: that there is a need for a spiritual conception of therapy because the highest forms of physical and mental health can be truly understood and achieved only through adding the spiritual dimension to the usual medical and psychological approaches. By invoking the notion of a will to health, I am introducing a spiritual concept, a purposeful ideal, the first of many that I propose to use in going beyond biological, psychological, and social factors to get at the true complexity and richness of the forces manifested in falling ill and becoming well, in failing to develop maturity and then succeeding at it.
To clarify my purpose here, I want to describe a situation in which the absence or opposite of a will to health—the will to death—was manifest. Gary was a middle-aged man who was diagnosed with diabetes, adult type 2, and prescribed oral hypoglycemic agents. Although the likely long-term effects of uncontrolled diabetes were described to him, he disliked taking anti-diabetes pills and therefore stopped them early in treatment. A few years later he was on kidney dialysis for diabetic kidney disease and was practically blind from diabetic degeneration of the retina. When asked why he had stopped the medication, he replied, "I gambled, and I lost."
Instances of such self-destructive behavior are common in any medical or psychotherapy practice. We see patients who marry known thieves and then are devastated when their money is stolen, or patients who continue ice-climbing after already having suffered many falls and broken bones, or patients who won't stop smoking despite the proven risk of lung cancer. The subsequent funerals, attended by grief-stricken family and friends, are heartbreaking affairs. Less clear-cut is the case of an acquaintance who sought my advice about continuing his medication after recovering from a major depression. I strongly urged him to do so because, as I explained, relapses might start insidiously and be accompanied by accidents or self-destructive behavior rather than overt return of depressed mood. Influenced by another professional's strong bias against psychoactive medications, he stopped his Prozac and was killed in a bicycle accident a few weeks later. Sadly, these kinds of sequences—ending an effective treatment followed by a tenuously connected disaster—are not uncommon in clinical practice.
These are examples of what I consider to be the absence of a will to health, or what the Italian psychoanalyst Edoardo Weiss called destrudo, a death instinct. Since the notion of a destructive instinct or will to death hardly fits into the framework of science—it clearly belongs to the dark side of the spiritual realm—psychiatrists and psychotherapists who value their scientific credentials and reputation do not openly subscribe to this fanciful notion. They tend to have a mind-set that excludes such ideas from serious consideration. I want to trace the origins and underpinnings of the scientific mind-set before elaborating on the properties of the spiritual mind-set. But first, some unfinished business.
I hope that it has not entirely escaped the reader's attention that there are some puzzling coincidences flavoring the clinical vignettes I have recounted. The hospital commander assigned me to the position of base psychiatrist without knowing that, after a bad turn at surgery, I was half-consciously wishing to return to my first love and my main reason for going to medical school in the first place: to become a psychiatrist. This fateful assignment fell right into my lap. It was so right that it proved to be a life-changing event.
Then my first patient as base psychiatrist recapitulated the general outline of my own prior therapy, betraying a knowledge of the process of psychodynamic exploration with neither the past experience nor the education to account for it. No doubt, she was naturally gifted and intuitive. But still, where did her therapeutic expertise come from? As demonstrated by my response, I had no idea and was obviously annoyed by her abrupt declaration of a successful termination. And then another patient, Jane, in whose treatment I was failing miserably, presented me with the guide to therapeutic success. How often does that happen in therapeutic relationships? Perhaps more often than we recognize.
Synchronicity and Serendipity
There are two concepts in general use that help to make some sense of such seemingly unlikely events: serendipity and synchronicity. Serendipity, a notion derived from a Persian fairy tale, concerns the accidental discovery of something of immense value. Fleming's discovery of penicillin by noticing the effects of a contaminating mold on a tissue culture of staphylococci is a classic example of serendipity. Such discoveries are examples not only of valuable coincidences but also of an individual's capitalizing on such seemingly chance occurrences through a readiness to make the best of them. In the examples cited previously, my assignment as base psychiatrist and Jane's gift of a treatment guide are good examples of occurrences that afforded me the chance to use them serendipitously.
Synchronicity is a broader concept of valuable chance occurrences. It is Jung's term for meaningful coincidences—that is, concurrent events whose simultaneity is thought to be improbable or incomprehensible on the basis of scientific causality yet seem to be connected by meaningful purpose, or what Jung called an "acausal connecting principle." This purpose usually involves a great benefit to the one who experiences the coincidence, such as happened to me and my patients in the examples cited previously. Over time, I have had many more such experiences that I have sometimes been able to take advantage of. During the course of my own psychoanalytic therapy, I would often leave my therapist's office after an emotionally intense session to find my own next patient bringing up the same issues that I had been discussing with my therapist, whose responses served as good models for my own. Or I would suggest a somewhat obscure book for a patient to read only to have her produce it from her purse. Not to recognize, at the very least, that we were on the same wavelength surely would qualify as scientific fundamentalism, better known as scientism. By the same token, we should not overlook the possibility that the attribution of meaning to coincidences can be projected wishes that introduce personal bias into the field of observation. Serving heavy soups of such mercurial ingredients without adding large dollops of skepticism is a quick way to join the society of mad hatters. I am counting on my readers, as well as myself, to resist getting carried away by the phenomena alluded to in what follows. A strong will to believe often induces us to cherry-pick the data, ultimately leaving us with none of the weapons of rational analysis that are necessary to maintaining sanity in facing the dangers of the spiritual quest.
Other common synchronistic events are the following kinds of experiences: having memories or concerns about long-lost friends only to have them suddenly materialize or thinking about telephoning someone who has long been out of touch only to have him unexpectedly ring us up. Of course coincidences may be negatively meaningful as well, as in the mode of bad karma or "what goes around comes around." Sometimes schadenfreude, or delighting in the misfortune of another, even a supposed friend, is rewarded by a similar misfortune befalling oneself. If, as a consequence of such an experience, one becomes more empathetic toward others, then the meaning of the coincidence is transformed to a learning opportunity.
The coincidences of serendipity and synchronicity have no special meaning within the current scientific framework. They are mere curiosities. Faced with such occurrences, the contemporary scientist either espouses agnosticism about their purported significance or demonstrates by mathematical and empirical methods that their occurrence by chance is far more likely than has been assumed. At the opposite end of the spectrum, some religious people, especially followers of Alcoholics Anonymous, believe that happy coincidences are instances of "God acting anonymously."
Excerpted from Living Right by Gene M. Abroms. Copyright © 2014 Gene M. Abroms, MD.. Excerpted by permission of iUniverse.
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Table of Contents
ContentsIntroduction: The Purpose, Plan and Spirit of the Book, ix,
Chapter 1: Beyond Psychology to Spiritual Knowing, 1,
Chapter 2: The Spiritual Framework, 12,
Chapter 3: Personal Dimensions of Spiritual Therapy, 35,
Chapter 4: The Will: Its Paralysis and Activation, 59,
Chapter 5: The Divided Will, 82,
Chapter 6: The Spiritual Group and Outpatient Milieu Therapy, 111,
Chapter 7: The Moral Code and the Spiritual Group, 134,
Chapter 8: Character Development, 168,
Chapter 9: Empathy, 190,
Chapter 10: The Calling, 210,
Chapter 11: Blessedness, 227,