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Psychological Integration and the Religious Outlook
by Rama P. Coomaraswamy, M.D.1

(Presented at the 73rd Annual Meeting of The American Orthopsychiatric Association, May 1–4, 1996 Boston, Mass.)

Introduction: Regarding the “self”
By philosophical background and training, the majority of health care professionals are prone to view religion and/or spirituality through the eyes of psychiatry. The question of whether or not a given religious value is “true” is not an issue—our concern tends to center on the issue of whether or not such a value has a positive or negative role in the psychological life of our patient. If one accepts the philosophical premisses of the Freudian corpus—Darwinism, materialism and atheism—such an attitude becomes not only logical, but obligatory. Within the framework of such a weltanschauung, religious beliefs are bound to be seen as delusional. But do not all of us have our pet delusions, and what harm if such delusions help us to navigate the rough seas of life?

There is of course another view—that of looking at psychiatry through religious eyes. Immediately you will raise the issue of “which religious eyes—those of Jews or Christians—those of Hindus or Muslims, to say nothing of the different sects within these categories?” With so many competing religious viewpoints, the health care worker is left with a state of bewilderment. But before we abandon the struggle, let us consider the reverse. The host of different psychological theories can be just as bewildering for the theologian. For example, almost all of us agree that man has a “self”, but virtually no two therapists can come to any agreement about the real nature of this “self,” to say nothing of what can be considered “normal” behaviour for it. Despite this, I believe there is a sufficient consensus in both areas—a consensus that allows us to communicate with each other and provide a real help for our patients.

When one reads texts on the history of psychiatry, one gets the impression that our field of endeavour only got started about 250 years ago. While the psychological ills of man have obviously existed since the Stone Age, and while theologians in all the great religions have written treatises on psychology and the nature of the self (or should I say, man’s many different selves), most of us are unaware or unfamiliar with this material. More importantly, despite the many differences in religious outlooks, there is a surprising consistency among the great religious traditions about the nature of man and his various selves. I would like to examine some of these theological concepts and show how, in selected patients, they can be put to therapeutic use. Before considering these theological applications, however, I would like to raise some other issues for our consideration.

Belief Systems
In order to have an effective therapeutic relationship with a patient, I think it important that there exist a certain commonality in outlook between the therapist and the client. This is well illustrated by a very successful Indian psychiatric colleague of mine who studied for many years in England and Austria, and then returned to India as a fully qualified psychoanalyst. I asked him if he used psychoanalysis in treating Indian patients. He laughed, saying it would be impossible to do that since the average Indian patient he saw didn’t believe in psychoanalysis and would think him crazy to engage in such an endeavour. Now it is important for us to recognize that we all have “belief systems.” I mentioned above that Freud was a Darwinian, a materialist and an atheist. While this may be an oversimplification, it does point to the fact that he had a belief system, which was no more rational or cogent than the belief systems of some of his patients. For years physician colleagues used to refer to me as a “believer,” and to themselves as “non–believers.” The more I have thought about this the more I have become convinced that such a dichotomy is false. We are all believers, it’s just that we believe in different things.

Until fairly recent times, the majority of patients seen by psychologists and psychiatrists in this country could be classified into those that were grossly psychotic and required institutionalization, and those that came from a background quite similar to that of the therapists themselves, namely, middle class Americans who shared the same beliefs and outlooks. Patients with strong religious affiliations, be they orthodox Jews or Catholics, tended to keep away from psychiatrists. This is no longer the case. The psychotics of course still exist, but the breakdown of social and religious structures and the tremendous influx of individuals from cultures foreign to our own had led to our treating many Axis II problems in individuals with whom we have much less in common. It is of course not necessary for us to share the beliefs of our patients and it is inappropriate for us to impose our personal beliefs on them. What is however incumbent upon us is to understand their beliefs and to realize that they can play an important role in our patient’s lives. With these brief comments behind us, let us begin to look at psychology, or more specifically, at the nature of man, from the viewpoint of the some of the great religions, and see whether some of their concepts can be integrated into our therapeutic armamentarium.

“Self” in Religion
Traditional psychologies can be said to base their view of man on the principle that there are two selves in man: (a) an inner Self or “sacred” core related to his very “being,” and (b) an outer psycho–physical “personality”, the Islamic nafs consisting of the body and soul, and which, because of its constantly changing character, is often described as multiple. Still other texts speak of man’s nature as tripartite because they separate the body from the psyche. Let us start by clarifying the terminology used to describe man’s “self”:

	CATHOLIC	GREEK	ISLAMIC
SPIRIT	Spiritus (Animus vel Intellectus)2	Pneuma	Ruh
PSYCHE	Anima3	Psyche	Nafs
BODY	Corpus	Soma	Jism

While the traditional psychologies often speak of a tripartite anthropology, the Psyche and the Body are often classified together as the “lesser self” or “ego.” Thus it is that we have St. Thomas Aquinas teaching “duo sunt in homine,” (“there are two in man”) and St. Paul speaking about the Law of his “members” being opposed to the law of his “mind” (Rom. 7:23). The body and the psyche are conceptually merged for two reasons:

1 The Body in se has no directive force. It needs some higher “power” like the psyche to tell it what to do, or at least to go along with it; and

2 Both the body and the psyche lack permanence or consistency in so far as they are always in flux, or in a state of what the theologians call “becoming.”

Note that I, or rather, traditional psychologies, have equated the “lesser self” with the “ego.” Theologians use the term “ego” in a different sense than Freudian psychologists do. They see self–centredness—which, when excessive, we call “malignant narcissism”—as egoity or pride and thus are prone to speak of such individuals as being “selfish” (i.e. full of “lesser self”). Be this as it may, this “lesser self” or “ego” is never stable. To quote Albert Ellis4, this “‘I’ is an ongoing, everchanging process.” It is its very potential for change which makes this “lesser self” the subject of our endeavours.

Now as opposed to this lesser and inconstant “self”, which is the self we as psychiatrists and psychologists deal with and attempt to help our clients modify, the religious psychologies hold that man also has a higher or inner Self. This inner Self, often distinguished by the use of a capital S, goes by many names. It is seen as “divine,” is often described as the “indwelling of the Holy Spirit,” the scholastic “Synteresis,” the Hindu “Source of the Breaths” or Atman, the Arabic Ruh, Philo’s “Soul of the soul,” and Plato’s “Inner Man”, and so forth. Such a metaphysical outlook further presumes that the average person is “at war with himself” precisely because these two selves are in conflict and that true sanity or wholeness is ultimately to be found only in the saint whose two selves are at one—the essential nature of “at–onement” or “atonement,” a state in which the “lamb and the lion” can be said to lie down together. It is in this sense that we speak of someone being in control of him-self and admonish the distraught to “get hold of your self” or “pull yourself together.”

Allow me to illustrate this weltanschauung from the Bhagavad Gita, a text with which many of you are familiar. The “myth”—I use the word, not as is current, but rather in the sense of revelation of truth in the form of a story—opens on the battlefield of Dharma or “right action.” Arjuna asks Krishna, his Charioteer, to drive his Chariot between the two opposing armies representing the forces of Good and Evil. Arjuna gives many arguments against fighting, and incidentally couches them in pious religious phrases, finishing up by throwing his weapons—the faculties of the soul—to the ground. He leaves the Field of Endeavour in tears. Now it goes without saying that everyone of us gets up each day and must face the Battle—to live with courage and hopefully also to resolve that Inner War in which everyone is engaged, whether we like it or not. This is the essential nature of the Islamic Jihad or what Father Scapoli calls “spiritual warfare.”5 Arjuna eventually returns to the fray, for he is a warrior and his duty is to fight against Evil, both externally and internally. But the symbolism goes even farther, for the Chariot is the psycho–physical vehicle as which or in which—according to our knowledge of “who we are”—we live and move. The Horses are the senses, the reins their controls. If the Horses are allowed to run away with the mind, the Chariot will go astray. If however the Horses are curbed and guided by the mind in accordance with its knowledge of the Self, the Atman represented by the God Krishna, then, and only then, can it travel along its proper course.

“One cannot fight the enemy when the Chariot is out of control.” Such concepts are amazingly universal. I would recall for you a famous poem of St. Patrick of Ireland entitled “Christ in the Chariot seat,” and a passage from the Canticle of Habakkuk in the Old Testament praying: “That you [might] drive the steeds of your victorious chariot.” Even more remarkable is a passage from an exorcism described by the Rabbi Chaim Vital, where the dybbuk confesses:

The soul is like the driver while body is like the wagon, horses, wheels and reins... Most of my life my body commanded my soul, and my emotions guided my intellect. And so when my body was lowered into my grave, I found that my soul had become so enslaved by my body that I could not ascend to heaven.

In our mythical allegory, Krishna, the inner and higher Self, instructs Arjuna, the identified personality, that it is not the mere living and dying of the individual that is important, but rather there is in each individual an inner core, the Atman, which must be “known”. He tells Arjuna that until this Atman is known, the two selves “will continue to be at war with one another.” The Buddhist scriptures speak to the same issue, teaching us of the “rabble that imagines that all possession—what some psychiatrists call a person’s baggage—are its own... those who talk of an “I and mine,” the untaught manyfolk,” who take their own “inconsistent and composite personality to be an essence.” It follows that one of the most explicit injunctions of the Buddha was to “Make the Self thy refuge or resort... Make the Self thy lamp, the Self thy refuge.”

Mystical writers in every tradition speak both of the annihilation and of the transformation of the “lesser self” or nafs interchangeably—for in fact by these two terms they mean essentially the same process, a situation well described in the Hindu text Aitareya Aranyaka: “This Self gives itself to that self, and that self to this Self: they become one another.” Only the one who has achieved this “supreme identity” can say with Al–Hallaj, “an al–Haqq,” “I am the Truth.” In passing, it should be clear that when traditional psychologies speak of the immanence of the Divine in all creation, they by no means deny God’s transcendence. Traditional texts abound with the statement that “He is both within and without.” He is both “Creator” and “Preserver.” We “are” because we participate in His “Being.”

“Self” in Modern Psychology
Given the universality of this traditional concept of the “two selves,” and given the fact that almost every psychoanalytic writer has written about the nature of the self—no two of them defining it in the same terms—one must raise the question as to why modern psychologies say little if anything about the Inner or Higher Self. I think the answer lies in the following:

1 modern psychologists are generally fearful of departing from the strictures established by Freud; and

2 Freud and his followers were limited by their Descartian view of reality and conceived of the human psyche, if not the totality of man, in terms drawn from the discipline of 18th century physics.6

Philosophically speaking, Freud was a “Humean.” To quote Hume:

There are some philosophers who imagine we are at every moment conscious of what we call our self; that we feel its existence and its continuance in existence; and are certain beyond the evidence of a demonstration, of its perfect identity and simplicity.

In his attempts to delineate such a self, Hume found himself involved in “such a labyrinth that I neither know how to correct my former opinions, nor how to render them consistent.” It was a labyrinth for him because he could not “explain the principles that unite our successive perceptions in our thought or consciousness.” On the contrary, he found perceptions, emotions and sensations to always be “in perpetual flux and movement.” Thus, man’s psyche is made up of a “system of different perceptions or different experiences, which are linked together by the relation of cause and effect, and which mutually produce, destroy, influence and modify’ each other.” It follows that for Hume, identity or the “self” is an illusory product of the mind’s capacity to remember and to infer causes, and he concluded that it is “the chain of causes and effects which constitute our self or person.”7

Traditional writers would agree with Hume’s description as applied to the “lesser self.” As one traditional writer put it, “our Ego is nothing but a name for what is really only a sequence of observed behaviours.” Where they disagree however is when Hume and his followers declare that man consists of nothing but this “lesser self,” when they reduce spirit to mind, mind to brain, and brain in turn to anatomical structures. For such individuals, thinking is a “neuro–chemical” process, or as Wilson puts it, “an epiphenomenon of the neuronal machinery of the brain.” As William James pointed out before the turn of the century, “if with the Humeans one deny some transcendental principle of unity and say that the stream of passing thoughts is all, [this] runs against the entire common sense of mankind.”

Freud was, as I said, in essence a Humean. He denied any transcendent principle in the soul and saw the totality of man in the tripartite structure of id, ego and superego. When he used the words “self” or “soul,” he was specifically referring to this tripartite structure. Others who followed in his footsteps, even those who saw the self as a supra–ordinate structure responsible for organizing and directing Freud’s tripartite soul, denied any transcendent principle equivalent to the inner Self of traditional psychologies even when their clinical work pointed to such an entity. At times one suspects that this may have resulted from their fear of being labelled “heretics,” or, even worse, of admitting to the possibility that man had a spiritual nature. Three consequences clearly follow from admitting that man has a higher Self:

1 It is clear that the higher Self incorporates some aspects of what Freud called the superego;

2 Admitting to such a hierarchical view of man’s intrinsic nature clearly points to the primacy of the spiritual; and

3 If man has a higher Self, it becomes incumbent upon him to seek it out, and to bring his lesser self with its innumerable faculties into line with this higher Self. The therapeutic implications are obvious.

Commonalities in Traditional and Modern Psychologies
Freud, like most of us, was not of course, always consistent. While he was an evolutionist, he also believed in the free will, and in assisting the weak—the psychologically blind and lame—to function more effectively. Despite his at times highly ambivalent denial of any higher principles, he by no means believed in giving the passions—the drives of the lesser self—free reign. He stressed the need for an adult to live a life based on love and reason rather than hate and impulse. He spoke of the need for erotic love to become fixed on a love object rather than being a purely non–loving biological animal egotism. Thus, he held that the child’s eroticism should mature into the adult love of others—a love apart from one’s sexual partner, a love that is “de–sexualized.” Freud also felt that a healthy path of sexuality and purely sexual life is the direction of parenthood, of the active healthy wish for children and the psychological capacity of being a parent and not merely the sexual companionship of the oppose sex. At the same time, he pointed out that if the pleasure principle—what he called infantile sexuality—was not controlled but given total freedom, it would lead to maladjustments and mental illness in the adult. This would be primarily manifested in the adult by what Freud called “narcissism.”

Freud is often falsely accused of instructing his patients to give free reign to their unconscious impulses. While it is true he felt that an excessive inhibitory attitude towards the sexual instinct was undesirable, it is oft forgot that he held this view because such a repressive attitude only served to enhance the subjective value of sexual drives. As a matter of fact, he tells us that love in the wider sense suffers when there are but few barriers in the way of sexual gratification. He comments:

In times during which no obstacles to sexual satisfaction existed, such as, maybe, during the decline of the civilization of antiquity, love became worthless, life became empty, and strong reaction–formations were necessary before the indispensable emotional value of love could be recovered.

He has also stated:

Love alone acts as the civilizing factor in the sense that it brings a change from egotism to altruism.

When asked what he considered an ideally normal person, he answered, a person whose life consisted of work and love (arbeiten and lieben)—that the ultimate ideal of human psychological health was the ever–increasing liebenization of the higher human activities such as parental, filial and friendly love, at the expense of purely sensual erotic and aggressive–destructive drives. He also felt that a knowledge of our subconscious drives and motivations would enable us to be in control of them and thus achieve a certain level of freedom. There is nothing in such attitudes that religious individuals can object to.

It should be clear that the traditional psychologies in no way deny the existence of the subconscious or of drives that are potentially pathological but capable of being transformed into virtues. Plato described the subconscious in the following terms. Speaking of desires quickened in sleep, he stated:

When the rest of the soul, the rational and gentle and dominant part, slumbers, but the beastly savage part, replete with food and wine, gambols and endeavours to sally forth and satisfy its own instincts, you are aware then, in such cases, there is nothing it will not venture to undertake as being released from all sense of shame and all reason. It does not shrink from tempting to lie with a mother in fancy or with anyone else, man, god or beast. It is ready for any foul deed of blood; it abstains from no food and in a word falls short of no extreme of folly or shame. (Republic)

We have all, as part of our training, come to recognize the subconscious drives and potential for evil that exits within us. This descent into hell must, if one is not to be “stuck in the mire,” be accompanied by a corresponding assent. Jacob Boehme describes this well:

Now almost every man carrieth a beast in the body which doth plague, molest, and burden the poor captive soul... It must be transmuted again into an angel’s form.8

“Drives”, then, provide another area of compatibility between Freudian theory and the traditional or religious viewpoint. Freud spoke of two basic drives of the id: the libido and what he eventually came to call thanatos. Traditional theologians also speak to these drives, though they use different terms and a different paradigm. For them, the soul is the principle of life. Plants are said to have vegetative souls which enable them to perceive and react, and whose principle functions are nutrition, growth and generation. These functions are independent of any directive will and operate whether the plant wishes it or not. Animals with animal souls, have two additional powers, called the “appetitive” and the “passible,” which also function independent of any higher control such as reason. They constitute:

1 the “concupiscible”, which consists of desires, affections, and the irrational imagination, very much what Freud labelled the libido; and

2 the “irascible”, which include all forms of aggression and combativeness.

This dual nature of instinctive drives can be traced back to the Greek philosopher, Empedocles, for whom the two fundamental forces were “love and hostility.” In mankind, these forces continue to exist, but can be controlled and directed (could we perhaps say, “sublimated”) by still higher powers such as reason and intelligence. In common parlance we say a man acts like an animal, not when he uses his instincts, but when he uses them without restraint, namely, without placing them under the control of his higher powers. We do not submit an animal’s instinctive acts to moral judgements, but a person is condemned when he acts irresponsibly and without constraint.

As Dante said, man is endowed with a triple soul, vegetable, animal and rational, and hence he walks a triple path. Inasmuch as he is a vegetable, he seeks utility; inasmuch as he is an animal, he seeks pleasure (in which he participates with brutes); inasmuch as he is rational, he seeks for honour (in which he is either alone, or is associated with the angels).

In the practice of psychiatry, I think it is impossible for the therapist to be completely neutral. While clearly it would be a violation of our ethics for us to impose our beliefs on our patients—quite apart from the fact that such imposed beliefs rarely convince or stick—yet, our beliefs must to some degree influence our attitudes and our subliminal communications. If a patient were to inform us that he planned to murder someone, quite apart from legal requirements, I am sure our own innate sense of right or wrong would be conveyed to the patient. What if our patient informed us of his intent to steal? Here no legal requirement demands a violation of confidentiality. Yet our value and beliefs would lead us to suggest he or she find some more appropriate means of paying our bill. If we ascribe our moral values to superego formation, and superego formation in turn to oedipal influence, we are led to a reductionism that voids all value of meaning. If however we accept—even theoretically—that there is a higher structure within the person, with directive capacity—the concept that there is a natural law, essentially the Ten Commandments, written in the hearts of men and women—we can help our patients to learn to seek out and listen to this “higher structure” and thereby resolve the conflictual relationship between the lesser self or ego driven by “drives” and influenced by the subconscious, and this “higher structure” which the great religions refer to as the Spirit dwelling within us.

Traditional approaches to Counselling
It has been my experience that patients usually come to us because of some major crisis, a loss or severe trauma in their lives. Once one has dealt with the present problem, many leave, but others stay on and wish to deal with more fundamental problems such as who they are and the purpose and meaning of life. As Viktor Frankl pointed out many years ago9, a cross–sectional, statistical survey of patients and the nursing staff at the Vienna Poliklinik Hospital revealed that “55% of the persons questioned showed a more or less marked degree of existential vacuum. In other words, more than half of them had experienced a loss of the feeling that life was meaningful.” Many therapists avoid dealing with this issue, perhaps because it raises issues they may not themselves have resolved. However, such issues do not go away. To quote Dr. Murphy in a book review: “I was taught primarily by the silence that surrounded them to avoid moral issues in counselling. I quickly discovered in practice however that moral issues are often at the center of the pain that drives patients to seek help.” It is here that the tripartite nature of man as envisioned by the traditional religions can be of help especially, though not exclusively, for those who come to us from a religious background. With such a paradigm we can help them to see that they are responsible for their actions, that many of their problems result from conflicts between their two selves, and that they must seek resolution of their conflicts by learning to listen to their inner Self and ordering their disordered lives accordingly.

How would Freud react to such a statement? I think the answer can be found in his correspondence with pastor Pfister10. Freud stated that

Psychoanalysis is neither religious nor non–religious, but an impartial tool which both priest and layman can use in the service of the sufferer.

He wrote to the pastor:

...you are in the fortunate position of being able to lead them to God...for us this way of disposing of the matter does not exist. Our public, no matter what racial origin, is irreligious, and we are generally thoroughly irreligious ourselves.

It is my conviction that the use of the hierarchical program, whether we personally believe in it or not, can be a valuable clinical tool with some of our patients.

Let me add a few comments on Plato’s familiar admonition: “Know Thyself.” Few are aware of the fact that this admonition was placed over the Sun Door of the Temple of Apollo—the Sun Door being that pathway through which we pass beyond the limitations of this measurable world. The Greeks well knew the distinction between Helios, the material sun, and Apollo the “Sun of God.” Socrates tells us that the injunction to “Know Thyself” is not a “piece of advice,” but “God’s salutation to those who enter,” and that the words are spoken by God to those who are entering His Temple, “otherwise than as men speak” and “very enigmatically” (Charmides 1 64D). Elsewhere, Socrates states that “he who orders: “Know Thyself,” bids us know the soul,” but goes on to say that one who knows only what is of the psyche “knows the things that are his baggage, but not himself.” (Alcibiades 1, 130, OE ff.). Plato then and in fact, all the traditional religions, are much less interested in our getting to know our “lesser selves” than they are in our getting to know the Spirit that dwells within us and whose “Temple” our bodies are, and with which our lesser selves must learn to “harmonize.”

Conclusion
I would like to conclude by quoting an Islamic writer, a graduate of MIT and holding advanced degrees in both philosophy and physics from Harvard University. I have already pointed out that the Islamic term nafs refers to that aspect of the human psyche with which we as psychiatrists and psychologists deal. As Professor Seyyed Hossein Nasr explains: “The Arabic word nafs means at once soul, self and ego. As ordinarily understood, the nafs is the source of limitation, passion and gravity, the source of all that makes man selfish and self–centered. This nafs which is called the al–nafs al ammarah (the soul which inspires evil), following the terminology of the Qu’ran, must be transfigured through death and purgation. It must be controlled by the higher Self. With the help of the Spirit the nafs al–ammarah becomes transformed into the nafs al–lawwarmah (the blaming soul), gaining greater awareness of its own nature, an awareness that is made possible through the transmutation of its substance. In the further stage of inner alchemical transmutation the nafs al–lawwarmah becomes transformed into the nafs al–mutma’innah (the soul at peace), attaining a state in which it can gain knowledge with certainty and repose in peace because it has discovered its own center, which is the Self. Finally, according to certain Sufis, the nafs al–mutma’innah becomes transmuted into the nafs al–radiyah (the satisfied soul), which has attained such perfection that it has now become worthy of being the perfect bride of the Spirit... The process through which man becomes him–Self and attains his true nature does not possess only a cosmic aspect. It is also of the greatest social import. In a society in which the lower self is allowed to fall by its own weight, in which the Ultimate Self and means to attain it are forgotten, in which there is no principle higher than the individual self, there cannot but be the highest degree of conflict between limited egos, which would claim for themselves absolute rights, usually in conflict with the claims of other egos—rights which belong to the Self alone. In such a situation, even the spiritual virtue of charity becomes sheer sentimentality. The traditional science of the soul however, sees only one Self, which shines, no matter how dimly, at the center of oneself and every self. It is based on the love of one–Self which however does not imply selfishness but on the contrary necessitates the love of others, who in the profoundest sense, are also one–self. For, as Meister Eckhart has said: Loving thy Self, thou lovest all men as thy Self.”

 

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