wrgs-book-s When this process takes place within the culture of a religion such as Judaism or Christianity, the forms of these faiths that are most persuasive become the vehicles of the feeling of fate. For example, the following case material is illustrative of what I mean:

     A forty-eight-year-old man was a devout and active member of a Disciples of Christ Church. By occupation he was a public school teacher. His wife was also a public school teacher. Both of them held positions of leadership in their church. They had made a vow when they were married that they would never have children. They did not want to perpetuate their two families' histories because neither of them was proud of the family that produced them. They were both "heredity buffs" and felt that heredity was thecause of much or most of human ills. They chose to devote themselves to teaching and church work rather than to have children of their own. The husband was a very dependent man and the wife was a very motherly person.

      Their adjustment to life enabled them to accomplish much good in their small city community, and they gave of themselves liberally to the needs of other people. This worked quite well until they discovered that the wife was pregnant at the age of forty-seven. She brought the child to full term and delivered a beautiful baby girl.

      They took separate approaches to the coming of the child. The wife and mother spent her full time in caring for the child, having quit her job and lost her interest in the work of the church. She was so absorbed in the care of the child that she more often than not had no meals prepared for her husband when he came home from work. They took separate bedrooms so that she could give full attention to the child at night without disturbing her husband's sleep.

      The husband, in turn, redoubled his efforts in school work and church work. He sought to make up for the difference caused by his wife's loss of interest in the works of the community. He became intensely interested in studying theology with especial interest in the Second Coming of the Lord Jesus Christ. He began to doubt that he was a Christian at all and he sought reassurance from everyone that he had not committed "the unpardonable sin." He began to lose sleep and to refuse to eat until "Jesus comes," It was at this point that his pastor and his family physician sought psychiatric consultation and hospitalization for him.

     This couple's situation represents not only a serious value upheaval occasioned by the advent of the child. As a couple, they represent the difficulty of reorganizing one's values at middle life when those values have already been established on unrealistic and even neurotic bases. The process of treatment took into consideration the necessity of psychotherapeutic reorganization of the goal structure of these persons' lives as well as their support as a family as they adjusted late in life to the radical event of childbearing.

      The symptomatology presented by the husband, however, is illustrative of the magical use of religion to ward off impending doom. Religion became a means of incantation of the sense of impending destruction the man felt. In a real sense, the world which he had constructed had come to an end. The underlying fear that compelled him was the fear that, inasmuch as his world had come to an end, he would kill himself. This was the unpardonable sin he feared committing. Facing this in a protected environment was a part of his recovery.

      Superstitions and the magical use of religion can be valuable in the diagnosis of the disorders of the patient, according to Draper and his associates. They should not be brushed aside as insignificant. Neither should they be taken as an authentic representation of the validity or invalidity of the particular living religion whose symbols they use. Rather, they should be viewed as a sick use of the religion—a time when religion becomes sick. In other words, one of the times religion becomes sick is when the accidents, the uncontrollable events and the inevitable demands of life call for acceptance of changes and re­sponses to growth that the individual cannot maneuver, manage, nor accept. He then resorts to placation of evil spirits, magical incantation of the "powers" that control the "shape of things to come," and develops elaborate explanations of his behavior in terms of the religious symbols he has been trained to use. The end result is what the behavior therapists call "odd behavior."

      

Chance and Accidents in a Religious Person's Mind

     Underneath the patient's behavior is a world view that all behavior is determined totally by God, that there is no such thing as a chance of more than one outcome for any given situation, and that even within the variety of direc­tions a course of events could take, there is no such thing as the fortuitous "break" of events in which accidents change the whole direction of a given history. William Pollard, the executive director of the Oak Ridge Institute of Nuclear Studies, says that "there are two sources of indeterminacy in history. One of these is chance." By this he means "the available alternative responses to a given set of causative influences." "Another source of indeterminism in history ... is accident." He uses "accident" to refer to situations "in which two or more chains of events have no causal connection with each other.... The accidental does not depend on the presence of choice and alternative in natural phenomena." (William Pollard, Chance and Providence, pp. 73-74; Charles Scribner's Sons, 1958.)

      At the core of superstition and its rituals of magic is the assumption of a hidden purpose, which we can determine if we will just perform the right act in the right way at the right time. Thus everything becomes controllable and every outcome is predictable; we can be secure because what is going to happen has been decided by our behavior. We have nothing to worry about now. The risks of the future have been charted, precautions taken, and we are safe.

      As Levy-Bruhl said of the primitive mentality much earlier: "Nothing ever happens by accident. What appears to us Europeans [and Americans] is, in reality, always the manifestation of a mystic power. . . . There is no such thing as chance to a mind like this, nor can there be. Not because it is convinced of the rigid determinism of phenomena ... it remains indifferent to the relation of cause and effect and attributes a mystic origin to every event which makes an impression upon it." (Lucien Levy Bruhl, Primitive Mentality, p. 43; Beacon Press, Inc., 1966.)

      My own basic premise is that among even sophisticated Americans exposed to the popular nuances of Judaism and Christianity, a subterranean flow of this same kind of superstition about mystic origins of events "indifferent to the relation of cause and effect" is at the heart of much sick religion, especially among the mentally ill. The rituals that are cautiously developed are seemingly senseless. But they are calculated to take the risk, the unpredictable, and the unknown out of life.

      Little wonder is it that prudential ethics have been built on cultural mores that are calculated to make us healthy, wealthy, and wise. As Paul Tillich has said, the risk element has been removed from a legalistic morality of safety. A morality of adventure calls for taking risks, the courage to move into the unknown. The prophetic faiths call for this element of risk and the capacity to absorb ambiguity and unpredictableness. Yet the religion of superstition and magic works to control and obliterate the unknown and the risky by the legalisms, the taboos, the rituals of incantation, and the obsessive acts that are developed as magical controls.

      When we see the histories of mental patients from conception to maturity, we see even at the point of conception the variables of heredity. These are not nearly so predictable as we once thought. In the process of prenatal development, chance and accident coexist with predetermined course. In the development process after birth, the great transitions from one era to another are crises of necessity and possibility interacting with each other. Even in later years of maturity, cerebral changes take place that are the end result of chance, accident. They are seen even legally as "acts of God," when in reality they are not.

      My hypothesis is that religion becomes sick when a person loads the whole responsibility for these "thrown situations" entirely upon God and thereby thrusts the whole responsibility for changing the situation upon him. Thus God becomes the ghostly visitant of all the thousand mortal ills the flesh is heir to. Patients' rituals are their efforts to placate the caprice of their god to change the situation. Into the mythology of this set of beliefs flows the flood of religious symptomatology we deal with in the religiously sick. Usually these patterns of religious behavior have been taught the person from infancy. The kind of religion described here was used as positive reinforcement of approved behaviors by parents, grand parents, pastors, and teachers. It was also used as taboo, punishment, and negative reinforcement of disapproved behaviors, ideas, and attitudes. Usually persons suffering from this kind of sick religion have been suffering so for a long time, and the demands of maturity have brought a chronic situation to crisis.

     This forty-three-year-old woman is an assembly-line worker in an electronics company. She has a high school education plus one year of college. She is married to a man who is her own age, an auto mechanic, a veteran of World War II and given to periodic times of drunkenness that interrupt his work and have at times resulted in his losing his job. They have no children, having lost their first and only child fourteen years prior by a premature birth. They live in a house for which they are paying, but the bills are paid from the wife's income. Both husband and wife are Protestant, but belong to different denominations. Hers is very strict concerning attendance at movies, dancing, drinking, and smoking; his is much more flexible about these things.

      Presenting symptoms.In the patient's own words, she says: "I can be in church and get fearful, almost like I'm leaping over something—like I'm thinking or trying to think evil and bad thoughts. The first time it happened most severely was during the Lord's Supper. I was afraid to drink and afraid not to. I remembered what the Bible says about eating and drinking 'damnation' to yourself. I felt I would die before I got out of there if I did the wrong thing. I've felt this way at funerals and in church. I'm so afraid that I'll think a blasphemous thought, I get beside myself. I stay depressed for days, crying much of the time.

      "If it is Satan, I know the Lord will see me through. When I'm tempted, I use affirmations of Scriptures and hymns, but Satan even attacks me through them. I say to myself: 'Do this!' Is this a premonition or mental telepathy or something? I've been doing it for years."

      The longer term history.For three years after her birth the patient lived with her parents. She has one younger sister. The mother divorced the father because of alcoholism when the patient was three. Each parent went to his parental home, taking one of the children for the grandparents to raise. The patient went with the father to the paternal grandparents. The grandmother was in her sixties, a very, very religious woman, and used religious beliefs about the end of the world, the displeasure of God, and the ever presence of the devil as a means of disciplining the patient as a child. As the patient became older, she worked and prepared all year round for excellence in the youth activities of her church. She joined the church when she was nine years of age. She says: "During this time I read my Bible but would be frightened by the thoughts of 'before' and 'after' time. I made myself afraid with the thought that the world would end. I would become afraid when I read the book of Revelation.

      "I lost time in school (nearly two years) for being too nervous to go. Measles, mumps, whooping cough, and bronchitis were all mine. I remember little of this except a sign in the doctor's office that read:

     Go nowhere you wouldn't want to be found when Jesus comes;

      Say nothing you wouldn't want to be saying when Jesus comes;

      Do nothing you wouldn't want to be doing when Jesus comes.

     "I finished high school and married two years later. A year later we lost our little girl because she was premature and because of my unbelief. I always thought the world would end before I had any children. We still don't have any. My sin."

     This patient has made repeated professions of faith in revival meetings she has attended. She struggles with cursing thoughts against God, thoughts like those her husband expresses in his drunken rages.

      She refuses to be critical of her husband, to face the possibility of her marriage breaking up, or to come to grips in face-to-face discussion with him about the painful aspects of their relationship. She denies problems of a causal nature arising out of the habitual patterns of discipline set by her grandmother, or those arising out of her feelings of injustice in relation to her husband. Instead, she seeks more and more religious rituals, reassurances, and ruminations to ward off the fears that beset her.

      The program of treatment.This patient was hospitalized for a period of three months. Chemotherapy, electroconvulsive therapy, and subsequent psychotherapy were used during her hospitalization. She was involved in social group therapy and learned to participate in many recreations she would have refused in her natural habitat—dancing, playing cards, movie attendance, etc. She never expressed negative emotions except through the "nuisance value" of her repetitive religious ideas. To the contrary, she was unusually sweet and protested forcefully that she "loved" all people. Yet she despised and loathed herself as unworthy of man's or God's approval. She was seen regularly by a pastoral counselor during hospitalization,

      The patient was dismissed with a guarded prognosis and a plan for continued contact. She was improved to the extent that she could do her work without difficulty.

      The follow-up history. A plan was established for the patient to see a pastoral counselor in her neighborhood on a regular and formal basis. This relationship became a regular emotional nutriment to this deprived person over a period of five years. The pastoral counselor was in constant contact with her family physician, who supervised medication for the patient.

      In her spare time, the patient started back to college with her husband's full support and consent. She received her college degree and took a job as an apprentice in a social welfare agency. She continued her religious interest but found attendance at most churches a burden to her. She listened to TV religious programs but was made fearful, sleepless, and apprehensive by going to church.

      A second major episode in her illness occurred when the pastoral counselor to whom she had regularly gone left the area. This was concurrent in time with her medical doctor's advice that she have a complete hysterectomy. She was so agitated that she was referred to a nearby psychiatrist for psychotherapy and returned to this author for pastoral guidance and consultation. She successfully underwent the surgery and yet not without a heavy recurrence of her religious preoccupation. This went somewhat as indicated in her own words in the above account. The precise habits of thinking were repeated almost verbatim. The most significant addition was: "You should see how well I can take antidepressants and cry at the same time. If crying could heal, I'd have been well long ago for I've cried a river. Also, I'm still plagued by the idea that not going to church is turning from Christ, which I don't want to do. At the same time, I have the feeling that just going to church is just trying to be 'religious.' . . . I used to use magic to keep things from happening that I didn't think I could cope with. I wouldn't talk of things that scared or upset me for fear they would happen."

     The patterns of treatment that have been used with this patient over a period of six years have been unevenly effective. Her molds of thinking and behaving remain existentially the same—unhappy, inwardly torn, and fearful in relationships. Her basic function as a worker in production lines and in school has been even except during the two periods of hospitalization, one for a depression and the other for the gynecologic surgery. The most recent episode was intimately related to the coincidence of both the menopause and the need for a hysterectomy.

      Yet the religious sickness, consisting of a "ghostly" conception of God, elaborate religious mythologies of the end of the world, and a confessed feeling of need for magical practices to ward off evil, remains essentially unchanged in spite of extensive pastoral counseling by the author and another trained pastoral counselor.

      

End-Setting or Transfusions of Ego Strength

     Gerda E. Allison, M.D., reports the case of a thirty-five-year-old woman who was reared by an extremely demanding, controlling, and perfectionistic mother and a father who submitted to the mother's controls in every way except in his pursuit of a very fundamentalistic religion. The patient's mother died when the patient was twenty-five and she and the father developed a very close dependency upon each other. The patient refused marriage to a young doctor because the suitor would not "go along" with her own and her father's strict religious beliefs. Then, while tile patient was away on a special teaching assignment, the father rather suddenly married without conferring with his daughter about it. He died of tuberculosis about three months later. At this time the patient became anxious and depressed. She sought psychiatric help. As to treatment, Dr. Allison says that lie did not attempt to deal with the underlying dynamic material. Rather he used supportive therapy and encouraged her to express "her negative feelings toward God and her father in a rather oblique manner." He enabled her to build up her defenses and this allowed her to continue functioning in her work as a "conscientious but somewhat rigid head nurse." He says that she has maintained community with her religious group where she attends revivals, "where she obtains regular transfusions of ego strength." (Gerda E. Allison, M.D., "Psychiatric Implications of Religious Conversion," Canadian Psychiatric Association Journal, Vol. 12, 1967, pp. 57-58.)

     There is an indirect evaluation of the revival here as a source of ego strength. I have observed this to be true in some instances and I am glad to have this confirmed by an unbiased observer. However, in the instance of the patient whose case is reported from my files, this was not true. She received her transfusions of ego strength from counseling sessions with a pastor. Yet in both instances, when we speak of this condition of replenishment of the ego that has from early childhood been deprived and rejected through the use of religious symbols, we may be confessing that there is such a thing as permanent emotional handicap that can be offset by such "transfusions of ego strength." We are not involved here in curing a patient, but in making a handicapped person useful to himself and other people.

      A second case, that of a twenty-year-old patient, demonstrates the interaction of superstition, magic, and sick religion in the life of a man and his family.

     For two years the man had been under psychotherapeutic outpatient treatment for phobic behaviors about eating, driving a car alone, and other fears clustering around his master fear of dying. He found that if he did not carry through his magical rituals, God would "zap" him, strike him dead.

      A psychiatrist and a pastoral counselor treated him as cotherapists upon referral to them from a pastoral counselor and a psychiatrist in another state when the man changed his residence. The two professional persons in that state had not seen the patient at the same time. The magical rituals were, in effect, declared off limits for discussion. The superstitious character of the religious ideation was identified as superstition, not true religion. The basic vocational, marital, and realistic religious issues in the man's life situation were then confronted by the patient with psychiatrist and minister together in the same interview situation.

      End-setting procedures were inherent in the time situation itself and the patient was not allowed to adopt "treatment" as a way of life. Rather, decisions were expected of him. His wife was involved in the treatment situation and was cooperative in the process. Life decisions were reviewed at an adult level under supervision. In the course of thirty interviews a new "life space" was discovered that gave both the man and his wife breathing room. The symptoms diminished in their intensity and number. In times of uncertainty they were reassessed by the patient as memories rather than as present events. When a crisis would come, the symptoms would reactivate until the crisis was past and then they would fall into the realm of memory again.

     The value of joint therapy by minister and psychiatrist stands out as a plus feature of this second case. The value of an implosive "breakthrough" of the "odd behaviors" as magical rituals for a basically superstitious person and not as objects for continuous rumination even in psycho-therapeutic interviews was evident in the case, at least. The value of time-limiting of the therapeutic process, lest the "game" of psychiatry or religion—as the case might be—became a substitute for life itself, was more than validated. Possibly, when defenses such as these phobias are needed periodically, they will recur, but, hopefully, the man will have a context for identifying them as magic, superstition, and sick religion—not as bona fide excuses from facing life and developing a life of faith as healthy religion.

      The first case was dealt with through transfusions of ego strength. The second was focused upon an end-setting procedure. The question arises as to the relation between these two therapeutic approaches. One differentiating factor was that the diagnostic picture was different. In the case where end-setting procedures were used, the patient was primarily paranoid when he was emotionally disabled. Transfusions of ego strength were acceptable to the depressed patient, but very threatening to the paranoid patient. Other factors were drawn from the patients' developmental history. The one patient who was depressed had been rejected and deprived in her early life. The other patient had been pampered and overindulged in his earlier life. In the first patient, feelings of helplessness and powerlessness were stimulated by fears, magical feelings, and superstition. In the other, the manipulative cleverness of the patient was stimulated by similar fears, feelings, and superstitions. The one experienced feelings of worthlessness and the other experienced feelings of limitlessness and omnipotence. These were some of the bases of importance in making the decision between end-setting and transfusions of ego strength. A final one was the presence or absence of the suicidal possibility. End-setting procedures would be risky indeed with a person who was potentially suicidal.

      

Case Studies of Magic, Superstition, and Religious Healing

     Records of the "magical response to superstition" expressions of sick religion have been recorded in some of the journal literature. Extensive studies of magic, faith, and healing have been published by psychiatrists who work in cross-cultural contexts and have to relate themselves to primitive attempts at psychotherapy, folk psychiatry, and contemporary American uses of persuasion in healing.

      Most of these studies refer to the inclusion of primitive religious ideas and practices in the life pattern of persons of cultural and/or racial minorities in a technological society. For example, Ari Kiev studied the delusions of ten West Indian schizophrenics in English mental hospitals and found religious and magical themes that were taken from the layers of fundamentalist use of the Bible and ghost cults from their West Indian backgrounds. (Ari Kiev, "Beliefs and Delusions Among West Indian immigrants to London," British Journal of Psychiatry, Vol. 109, 1963, pp. 356-363.)

      With the movement of Southern rural Negroes into industries in Northern cities such as Rochester, New York, and Chicago, patients have been observed to use the "root work" of their primitive, self-help magic to allay the anxiety and despair associated with illness.

      In nine cases of criminally convicted but apparently psychotic Negro patients from the Bedford-Stuyvesant area of New York City, Bromberg and Simon found—with the work of Negro psychiatrists—an overlay of "to be expected" psychotic material: delusions, illusions, grandiosity, mannerisms, etc. But underneath these were somewhat coherent evidences of a thoroughgoing break with the patients' upbringing, with the Caucasian values of their general milieu, etc. These expressed themselves in "identification with the Islamic religion, fragments of voodoo practices, and an outright avowal of the Yaruba religion. What appears to be grandiosity and paranoid coloring of the productions of these patients derives directly from the 'primitive' religions and ideologies which function as a protest against centuries of domination by Caucasian values ... the ego has not undergone sufficient impairment to justify a diagnosis of psychosis." (Walter Bromberg, M.D., and Frank Simon, M.D., "The Protest Psychosis: A Special Type of Reactive Psychosis," Archives of General Psychiatry, Vol. 19, No. 2 Aug., 1968, pp. 155-160.)

      The objectivity required to study magical and superstitious uses of a living religion by exponents of that religion itself is almost if not entirely nonexistent. The following autobiographical account is an example of the way in which superstition can saturate the symbols of a living religion, issue in magical counteractions on the part of the person, and result in a pathological religious orientation to life. This woman spent three months in a mental hospital.

     Being a young, Christian, blood-washed, redeemed, Child of God of nine months, I was not content to grow in the knowledge and grace of the Lord, I had the desire to run headlong down the narrow path and it almost led to my spiritual destruction mentally. Through not relying on the promises of God in His inspired Word, the Bible, I was willingly led (through demon possession of the mind) to an entirely new and different church group, entirely new as of the last fifty or so odd years as a supposed church. I had never doubted my salvation because I was completely delivered from alcohol even as far as the desire, proving that when the Lord Jesus does a thing, He does it right.

      However, Satan, whom I found out I was no match for, knew that Jesus had taken over my heart, and there was no room for the devil, so he tormented me with all kinds of little things in my mind, thus robbing me of the joy of my salvation mentally. Because of my convinced knowledge, based on the promises of God's Word, that once saved always saved, and that God is not slack concerning His promises to a child of God, washed in the blood and covered by the blood, and that eternal life is a GIFT from God, and that God is not an Indian giver, but the Almighty Giver of life everlasting, I became overconfident, using my salvation as a crutch with the idea that I couldn't really do anything that was wrong, because Jesus was my Savior and I knew it.

      It was when I had gotten to that state that I started to walk by feet and not by faith. So these demons convinced me that I still didn't have a full experience with the Lord God. Thus I followed the direction in which these seducing spirits of Satan were pulling me. When inside this so-called church building, the power and friction in the air was terrific. This convinced me only more that I was led to the right place, and by the Holy Spirit yet! Then the call was given for anyone who had a testimony for the Lord. I was nervous and shaking inside; nevertheless, I stood up facing the congregation and said, "Jesus is the way and the truth and the life, and I know He is because I know," and then is when it happened.

      I was filled with an ice cold air and I was froze (as it were) on my feet with my mouth open. This air came from the direction of the altar, and I was so numb that I couldn't sit down for at least three minutes. I just couldn't understand this, because I had so much to testify about my Lord Jesus. When I questioned others after the service they told me that it was an experience with the Lord, and that He was trying to reveal something to me, and that I must search the Scriptures to find out the answer, they couldn't tell me. They also said that this meant that I was close with the Lord and that He more fully wanted to use me as a servant and give me a gift. Now I was really confused, which is exactly what Satan had planned to do.

      Now even though these demons were trying to absolutely convince me of the realness of this thing, Jesus was tugging at my heart because he knew I didn't know exactly what I was doing, yet I still had my own will, and he wasn't going to force me into coming out from among them. What a war was going on inside my mind for the space of two weeks. At home I walked around like I didn't know what I was doing and I was beginning to greatly fear as though I were some kind of criminal or something. It began to be noticeable [sic] to my friends. But do you know that those demons were so powerful, that they convinced them, through my mouth and out of curiosity [sic] to also go there to witness this thing. I almost denied my Lord Jesus, and caused others to do so too. 0h, how I have repented for my lack of faith, through willing ignorance. Satan made a fool out of me for his own sake, but Jesus has lifted me up again with his love through God the Father. He is truly Lord of Lords and King of Kings.

      Satan had almost succeeded in planting a permanent seed of doubt in my mind with on-and-off-again salvation, trying to hold me in the bondage of fear. This type of religion so presents itself as the real thing that it is the perfect counterfeit of the day. I should rather have my feet cut off than to enter under the roof of any such establishment.

      But now that I know this by the Grace of God, and especially that God is not the author of confusion and cannot lie, I will by the grace of God be content to grow.

      These poor souls that are being used by Satan are in reality dedicated and sincere. But they are dedicated to Satan and sincerely wrong. I speak of them as poor souls because the Holy Spirit within me is grieved because of their willingness toward deception because even though they themselves are ignorant of the Truth, God will hold them accountable because there is no excuse.

      These seducing spirits had taken over my mind and my members so much that I no longer even had control over my voice. The Scripture that came out of my mouth was true, but my voice deceived me. Outside I was a lamb, outside of the demon control, but inside I was a raving wolf. The way this was proven to me was by a Scriptural statement I made concerning the body, soul, and spirit, out loud in that demonic voice, which proved to be a WRONG statement. That was, I knew that it was no Holy Spirit voice.

      Besides this evidence, that afternoon at home I became taut and tight inside all over and when I tried to relax, it just got worse. My mouth began to open slowly as by force until it was stretched open so far that I moaned with pain and called on Jesus, still not knowing what was going on. My hands seemed to get numb and rise slowly before me as if by force and I was so afraid that I hardly dared move at all. However, the worst part came when I tried reading the Scriptures aloud and laughed and talked real fast like a 33 1/3 r.p.m. record playing at 78 r.p.m. speed.

      It was then that Satan told me I could heal myself of this fear and that the Lord had given me the gift of healing. I even believed this lie and looked around for some sore or abraised spot on my children. But after trying this I found that it did not work. I cried out to the Lord Jesus Christ in my agony of mind and it was then that He revealed to me that I was possessed with demons.

      I was so blinded by these things (demons) in my mind that I didn't even know that I wasn't serving the only True God, and Savior Jesus Christ.

      So now back to that assembly of people. I stood before the Pastor and his wife and told them these experiences and when I confessed with tears in my eyes that I was demon-possessed they just dropped their eyes and said that they would pray for me right there and then. Now they were under the impression that they were praying for my deliverance and it would happen then. Besides this they knew from all evidence that I had shown that I was that way, but yet I still was invited back all the time there, which would have made me one of those demons too.

      But I thank the Lord Jesus, and I surely do, He knew my heart and when they cried out in prayer for me, it was to get rid of me. The proof was when instead of inviting me back another time, they gave me a calling card.

      Yes, thank the Lord Jesus, He didn't want me back there any more either, but Satan still left his calling card. Now though, I through the Grace of God am reminded that I must call on Jesus and plead the blood by which I am covered when I am disturbed by tormenting thoughts and He alone will dismiss these demons from the mind. The awful lump in my threat was there because I would not cry out in true repentance and until I did it was not removed.

      I say true repentance, never again to do that which I had done or was doing that kept me from close communion with my Savior.

     This extensive autobiographical account calls for some explanatory observations to relate it to the discussion of magic, superstition, and sick religion. The reader will note that the obsessional preoccupation of the patient with "all kinds of little things" in her mind is attributed to the tormenting of the devil and is not seen in any sense as empirical cause and effect. Tactual feelings of power and friction in the air, being filled with ice cold air, the loss of control of the voice, numbness of the hands, etc., are described by the patient. The somatic involvements of religious experience weave themselves into a magical explanation and lead to the demand for a magical solution. Most often, this woman explained these as invasions of the devil into her being. However, one wonders how much effect the biochemical therapies would have on these tactual responses in removing the need for magical explanations and magical solutions. The pastoral counselor would then be in a position to discuss the person's relation to God and Christ without the impediment of at least this portion of the superstitious frame of mind of the patient. Here pastoral counseling and medical treatment have their nexus.

      Another observation is how the patient moved toward the minister and his wife, was apparently appreciative of their prayers, but then began to associate them and their giving her their card with the devil who "left his calling card." The pastoral counselor may as well be prepared to become a part of the evil side of the patient's delusions. He may well be cast into the role of the persecutor or the tempter or even, as in this case, the devil. Staying on the brighter, more benevolent, and friendly side of the patient's delusional structure is difficult indeed, and often impossible. The couple to whom she talked seemed to have been overwhelmed by the patient's strangeness. They may not have had the advantage of the knowledge of the patient's whole religious outlook that her autobiographical account gives the reader here. If they had, they could have built upon the healthier ideas that she presented, such as her struggle to rely upon the grace and love of God without so much personal effort on her part. The act of giving the patient their calling card was interpreted literally by her and apparently served to break the relationship. The Lord Jesus is interpreted by her as not wanting her back there anymore.

      The task of a spiritual director in this person's life would be to establish and maintain a durable relationship to her—in short, to stay by her through thick and thin. Yet the very nature of the illness itself caused her to break relationships. Once established, such a relationship would be the touchstone of reality that she needed. This points to the need for a pastoral strategy based on a good theory and developed into a wise practice for dealing with magic and superstition in religious experience.

Theories of Magic, Superstition, and Religious Healing

     Several theories as to the interaction of magic, superstition, and religious healing have been advanced by research persons in the area of culture and personality.

Personal Response to Acculturative Stress

     David Omar Born has proposed that these sick forms of religion are caused by the individual's effort to respond and grow under the stress caused by the conflict between an older, more established culture into which one is born and in which his habits are formed and a newer, less established culture into which he is moving, by reason of education, generation gap, and technological adjustments being made. He says that in the face of the stress created, a person may go in one of four directions: First, retreatism, a return to or the conscious preservation of traditional patterns, and resistance to new patterns. Second, reconciliation, or attempting to "strike a happy medium" of combining both the traditional and the new. Third, innovation, or the complete acceptance of the new patterns and the conscious rejection of the traditional. Fourth, withdrawal, an overt rejection of both the traditional and the new. This denial of both is the mechanism of defense.

      In all but the first mode of adjustment, the possibilities of the person's becoming sick are present because he takes the risks of change. He can easily become a "marginal" man caught between things old and things new. His religion, when seen as a conserving, maintaining, and continuity-giving force in his life, becomes a symbol of his heritage, with which he must stay in touch. On the other hand, if his religion is at the same time prophetic and bids him have done with the bondage of the past, it may introduce a conflict of "fever-level" proportions that results in his illness as a person. (David Omar Born, "Psychological Adaptation and Development Under Acculturative Stress," unpublished paper, Southern Illinois University Department of Anthropology.)

      The symbolic beliefs that a person brings over from his original culture continue to exert emotional "unreason" over his life despite the intellectual overlay brought by education, technological cause-and-effect training, and the like. The patterns of thought and behavior ingrained as fears into the patients described above tended to operate habitually in spite of attempts to "reason" with the patient. These patterns themselves can be disengaged, isolated, tranquilized, or dissociated in such a way that the persons can work, eat, sleep, and carry on the daily rounds of their lives, but some specific reeducation of the patterns of behavior themselves must take place if they are to be identified as being from the realm of magic and superstition. The findings of the behavioral therapists can be first fully focused upon these phobic personalities' needs.

      

Superstition and Magic as a Conditioned Response

     B. F. Skinner has set forth the theory that superstition is the accidental connection of a given reinforcing stimulus with a given response: "If there is only an accidental connection between the response and the appearance of a reinforcer, the behavior is called 'superstitious.'" (B. F. Skinner, Science and Human Behavior, p. 85; The Macmillan Company, 1953) This raises the issue of what kind of rewards and punishments go with the belief of such religious persons as have been described in this chapter. We know that one of the patients was rewarded with approval for holding faithful to the beliefs. She was punished with the belief if she disobeyed her grandmother. In adult life, holding the beliefs gave her membership in a church group, and rebelling against them denied her fellowship and left her isolated.

 

Persuasion, Illness, and Healing

     A related but distinctly different concept of the power of superstition and magic is that of forced indoctrination, more popularly known as "brainwashing." William Sargant has done the most thorough work on forced indoctrination. He comments that the theological improbability of eternal punishment is less frightening to people today than to those of Charles Finney's day. Yet the threat of hard labor for life in a Communist prison camp can produce results similar to those of Finney in their power to change the mind. (William Sargant, The Battle for the Mind, p. 141; Penguin Books, 1957.) It may be added that the fear of mental illness itself is an even more subtly powerful threat in the culture of America today.

      Jerome Frank has identified the element of persuasion and thought reform in modern psychotherapy as an essential part of the ability of the psychiatrist. He says, "Although the psychotherapist may state his interpretations in neutral terms, many are nevertheless covert exhortations or criticisms based on implicit value judgments." (Jerome D. Frank, in Ari Kiev, ed., Magic, Faith, and Healing, p. xii; The Free Press of Glencoe, 1964.) The religious healer, likewise, must have an ideology that offers the patient "a rationale, however absurd, for making sense of his illness and the treatment procedure." (Jerome D. Frank, Persuasion and Healing, p. 60; The Johns Hopkins Press, 1961.)

      On the one hand, then, the empirically-minded student of sick religion is faced with the reality of persuasive and even magical formulas in the belief-value system of the religiously sick person. On the other hand, he comes up against the rather elaborate value systems and ideologies of the psychotherapists. When the student understands both systems well, he knows that they overlap considerably. If he is a scientifically trained and religiously devout minister or psychiatrist, he must exist with integrity in both the empirical-pragmatic world of causal relations and the persuasive-ideological world of convincing values. How can this be?

      

The Existential Shift

     Jan Ehrenwald says that, in the last analysis, these two conflicting worlds "derive their rationale from two contrasting sets of myths." He describes them both as having long histories, not one as "old and magical" and the other as "new and scientific." They both waver against each other as a magical vs. a pragmatic view of causality, as a sacred vs. a profane view of life, as prayer opposed to personal efforts, as the noumenal vs. the phenomenal. Ehrenwald says that the effective therapist is measured by his capacity to shift from one of these existential modalities to the other. He calls this "the existential shift" and gives the following definition of this "shift." He says:

      The therapist's abrupt transformation into a hypnotist is a graphic illustration of the principle. His dramatic shift from a pragmatic to a magic level of function is predicated upon a self-imposed regression—in this case in the service of treatment....

      The scientifically trained psychiatrist is donning the mantle of the magician and playing the part of the omnipotent hypnotist. It may well be that he himself is satisfied that all that is involved in such a venture is to assume a new, or rather an old-fashioned and traditionally well-defined professional role. Yet, in my experience, such role play is not enough in Order to be effective. The hypnotist must not just pretend to be playing the role of the hypnotist. He must project himself, heart and soul, into the act. (Jan Ehrenwald, Psychotherapy: Myth and Method, An Integrative Approach, pp. 145-146; Grune & Stratton, Inc., 1966.)

     Yet, the clinical application of this existential shift is unresearched insofar as I can learn. Ari Kiev found a near equivalent in the Mexican-American curanderos of San Antonio. The curandero is neither a doctor nor a priest. He is not a shaman in that he does not become possessed, exorcise, or prophesy; nor are special initiations, dream experiences, or ordeals used to qualify him to help people in distress. He is a personally religious person, functioning within the belief system of the Roman Catholic Church and "his religious demeanor, untrammeled by the authority of the Church, is his paramount virtue." (Ari Kiev, Curanderismo: Mexican American Folk Psychiatry, pp. 30-31; The Free Press of Glencoe, 1967.) The curanderodraws upon both the beliefs of the Catholic faith and the folk medicine empirically learned through trial and error and handed down apprentice-style from one generation to the next. He does not look askance at but even recommends medical and/or psychiatric attention if the resources of expense and willingness on the part of the patient will bear it.

      Kiev concludes that many of the elements present in psychotherapy are evident in the work of the curandero. His work is preventive of some psychiatric disorders, ameliorative in others, and supportive though not remedial in others. "Curanderism," says Kiev, "is also important not only as a form of prevention which contributes to lower incidence, but as a form of treatment agency whose presence leads to a reduced flow of people going to hospitals." (Ibid., p. 192.)

      

Pastoral Approaches to Superstition

Magic vs. Sick Religion

     The problem involved in the folk psychiatry of the curanderofor both the educated minister and the psychiatrist is that neither of them can, as Ehrenwald has suggested must be the case, "project himself heart and soul into the act" of using nonrational hypnotic, and/or magical practices. Both are committed to rational interpretations of both theology and human behavior. Both are committed to a "commonsense" approach to faith and health. Both fear quackery to such an extent that they feel more comfortable withdrawing from a patient such as the "victim of seducing spirits" than to "be party to the superstition" or implementer of magical formulas. This leaves the patient with a "calling card" but no help. The rituals of both organized religion and modern clinical psychiatry suffer from a lack of concept and procedure for coping creatively with the habits of thought of patients such as those who have been described here. Yet, implicit in both sets of ritual are tools useful to a patient as defenses against recovery. The patient usually uses one set of compulsive ideas to ward off the psychiatrist and another to fend off the minister. Consequently, the illness has an economy of its own that gratifies needs and becomes a substitute for realistic living in the world as it is. Some clues from the transactional therapists and the behavioral therapists may be helpful in suggesting a new departure, at least, in dealing with these patients.

      Eric Berne, in his transactional analysis, suggests that psychiatry itself can become a distance-making, change-resisting "game." The patient continues for months to recite symptoms, dreams, fears, and obsessive religious ideas. In a demanding mood, the patient then seeks "answers" as to why he or she is this way and how the problems can be fixed. In short, magic answers and solutions are required of the therapist. As Berne says, the patient feels that "if she can only find out who had the button, so to speak, everything will suddenly be all right." (Eric Berne, Games People Play, p. 156; Grove Press, Inc., 1964.) In Berne's system, a game is a transaction that involves deception, maintains the status quo, and keeps others at a distance.

      The "child" dimension of the patient is one of defiance: "You will never cure me . . . ;" it is also one of substitute gratification: "but you will teach me to be a better neurotic (play a better game of 'Psychiatry')." All the while, the adult-to-adult transaction is: "I am coming to be cured." (Ibid., p. 155.) In the face of such confusion, the psychiatrist and/or pastoral counselor find the game doubly employed, in that religion is used against the psychiatrist to maintain the game and psychiatry is used against the pastoral counselor.

      One effective deterrent to this complicated situation, I have found, is to have both psychiatrist and pastoral counselor sit down together in the same therapy session—after taking a careful history of attempts at therapy—interpret this game to the patient and hopefully enter a contract that the game will be called off and specific difficulties in living faced as they are, without too much attention being given to the phobias, religious superstitions, and magical formulas.

      This calls for an implosion—a breaking through the symptom wall—into the underlying problem areas of work, marriage, goals in living, and ways of deceiving other people at a quite conscious level. Wolpe, one of the formulators of what is coming to be called "implosive therapy," sees this as indicated for neurotic behaviors that are associated with intense anxiety but not appropriate for psychotic patients. (Joseph Wolpe, "The Systematic Treatment of Neurosis," Journal of Nervous and Mental Disorders, Vol. 132, 1961, pp. 189-203.) The patients described above are in this category, except for episodes of depression that came at specific crises and times of gross stress. Yet the compulsive-obsessional character of the thought processes persisted after the depression lifted. The differential diagnostic skill required here imperatively indicates the need for medical supervision. Yet the magical-superstitious religion that gives content to the anxiety states cannot be coped with effectively without the presence of a trained minister who can break through the wall of religiosity with more cooperation from the patient than can the psychiatrist.

      In the cases dealt with in this manner by the author and a clinical psychiatrist conjointly, the process of treatment moved forward more rapidly and certainly because the stalemate between the religious and the health defenses of the patient was broken from the outset. Running from religious rationalizations to psychological ones was futile because each could be challenged by the minister or psychiatrist as the instance required.

      The behavioral therapist's use of rewards or denials in reconditioning "odd behaviors" in obsessive patients has produced some possible areas of cooperation between behavioral therapists and ministers. The Catholic system of penance has utilized negative conditioning, and an expansion of this system to include "here-and-now" positive reinforcement is an unexplored area of possible cooperation with behavioral therapists. 0. H. Mowrer's point of view seems to be that the unrealistic guilt of such patients should be refocused on things they really ought to feel guilty about and then dealt with realistically. (For a thorough, detailed analysis of behavioral therapy, read Halmuth H. Schaeffer and Patrick L. Martin, Behavioral Therapy; McGraw-HilI Book Company, Inc., 1969.)

      The crucial issue in all the above suggestions, however, is that of interdisciplinary collaboration between ministers, psychiatrists, and clinical psychologists. The training of each must be thorough enough that cooperative work with patients is more than being superficially courteous to each other. The therapeutic imperialism of any one of the three must be forfeited. The proud insecurities of each, resulting in promising much and delivering little in therapeutic results, must be faced and admitted.

      Apart from this kind of candid collaboration, patients have turned and will continue to turn to mass-produced cultural forms of treatment. Christian Science is one of these forms and appeals directly to the need of persons for positive reassurance, fixed rituals, and a loose-knit group fellowship. The perennial appeal of the affirmations of Norman Vincent Peale is another mass approach to the repetitive need for almost if not wholly magical uses of religion. The repetitive "aisle walker" in evangelistic crusades is another example of the way large numbers of people born and reared in the revival tradition turn to the ritual of the confession of faith or rededication of life again and again in their repeated anxiety states. Catholic priests write of the "scrupulous" person who returns repeatedly to confession for forgiveness for the same set of feelings.

           The psychiatrist, the pastoral counselor, and the clinical psychologist are in much the same position in practice as are the above-mentioned groups. The expectations of magic brought by the suffering person are the same. The repetitive cycle in the treatment—with the exception of medical intervention in the case of periodic depressions and suicidal possibilities—is about the same.

      One more positive way of looking at the compulsive, chronically fear-ridden persons discussed in this chapter is to see them as having been maimed by their superstitious upbringing. This has left them in a state of emotional deprivation and dependency that may well be lifelong. Reconditioning of their behavior will produce obedience to a new source of dependency in order to compensate for their deep deprivation of approval and acceptance. However, the dependency and deprivation remain; the changed element is that the source of dependence rests in the therapist and the approval for changed behavior comes from the therapist. Periodic attention throughout the life-span of this person is provided by the therapist in many instances. "Therapy" becomes a way of life.

      Theologically, the issue at stake is one of the sources of ultimate justification and trustworthiness in the world. Martin Luther's autobiography depicts this as his struggle —between the unmerciful demands of an unrelenting conscience and the need for redemption by faith alone. Yet the rituals of forgiveness themselves become a burden of repetition for patients such as we have described in this chapter. Possibly the words of one of the patients quoted above hold a key to this dilemma also. In speaking to a group of chaplains she said, "Show us that you care about us and maybe we can decide for ourselves that God cares."

      

In Summary

     This chapter has sought to identify the magical and superstitious as a pathological distortion of healthy religious faith. The religion of superstition is at heart a system of manipulation, which seeks to rule out the necessity of faith in the face of the risks of the unknown and uncontrollable. Both magical rituals and obsessive-compulsive neurotic acts are in essence incantations of fear. Specific case history materials show how these magical practices of the emotionally disturbed person are "warding-off" devices and do not yield either to religious reasoning or to psychiatric treatment. The promise of behavioral therapy as a choice of treatment is discussed. The need for combined teamwork of minister and psychiatrist interviewing the patient together and at the same time was explored.

 

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