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domingo, 25 de abril de 2010

Dan Blazer Freud vs. God: How Psychiatry Lost Its Soul and Christianity Lost Its Mind

Freud vs. God: How Psychiatry Lost Its Soul and Christianity Lost Its Mind by Dan Blazer. Downers Grove, Ill., InterVarsity Press, 1998, 249 pp., $22.99. GEORGE E. VAILLANT, M.D. Boston, Mass. Dan Blazer has written an important and an interesting book. The subtitle (How Psychiatry Lost Its Soul and Christianity Lost Its Mind) sums up his thesis. For the first half of the twentieth century there was controversy, argument, and struggle between theologians and psychiatrists. For the last few decades, devout Christian pastoral counselors and devout dynamic psychotherapists have behaved toward each other like 2-year-olds engaged in "make nice" parallel play. In seeking to renew a spirited conversation between psychiatry and Christianity, Blazer notes that their previous conversation "soured and then disappeared" because of too much ideology and not enough courage. Productive debate involves inviting frontal assault on one's cherished beliefs, be they neuroscientific positivism or Biblical inerrancy. Freud vs. God aims to rekindle such debate and so restore to psychiatry its soul and to Christianity its mind. Blazer writes in the first person and provides enough biographical information so the reader can appreciate the dialectical struggle between religion and psychiatry that has gone on in his own mind. As an elder of the Brooks Avenue Church of Christ, he refers to himself as a "fundamentalist, evangelical Christian physician." His deep commitment to the spiritual side of humanity, however, did not prevent Duke University from appointing him Dean of Medical Education. He is also the J.P. Gibbons Professor of Psychiatry and a world-class epidemiologist, a clinician who treats the seriously mentally ill with both drugs and compassion. In short, Blazer has lost neither his mind nor his soul. Blazer grounds his arguments in discussion of real clinical cases. He surrenders nothing that he has learned from psychoanalysis or from neuropsychiatry. But he also helps the reader to appreciate that in order to hear the evangelical Christians who consult them, other principles are also needed: Jesus, the inerrancy of the Bible, participation in the Christian community, and, lastly, the tools of prayer, forgiveness, and the Eucharist. Nevertheless, despite his frank admission that he has been committed to "born again Christianity" from birth, Blazer is in no way intolerant of other "faith traditions." He candidly sums up his own philosophy: "Life is tough (my own childhood wasn't that pleasant) for Christian and non-Christian alike. Yet, learning to tell one's life story seemed central to healing and hearing that story seems central to doctoring." He points out that through most of human history, suffering has been a concern much more of the community than of professionals and that the tendency for medicine to individualize human suffering can be antitherapeutic. Christianity is about people living in relationships with other people and with God. Thus, Blazer reminds us that "Christianity is about care for emotional suffering through perseverance within a community of care." Blazer is even-handed. He deplores that evangelical Christianity cares so much about community that it tries to reshape the larger community politically. Blazer does not suffer fools gladly. Of pop Christian psychology, he notes, "It is easier to write books and hold seminars when the encounter is brief and upbeat than it is to work day in and day out with someone suffering a chronic and serious mental illness." At the same time, he deplores that psychiatric experts have such a one-sided focus on the individual that it sometimes ignores the community altogether. Debate is needed, Blazer suggests. I believe that not since William James's The Varieties of Religious Experience has a psychologically minded physician so evenly played both sides of the street. Readers from other faith traditions, especially psychoanalysis, may wish that Blazer was as dispassionate as James, but James's own lack of religious commitment was a weakness as much as a strength. In contrast, Blazer is steeped in his own faith, and it is precisely because Blazer is so profoundly committed to two disparate worlds that his book is so rewarding. Blazer makes it quite clear that when forced to choose he has always put "doctoring" ahead of his "faith tradition." But he points out that this choice comes at a price. The advantage of his choice is that it has "prevented me from entering into relationships that are not therapeutic and encouraged me to use medication—often with dramatic results—when listening and talking are of no avail." As he points out, however, the price has been steep: "I believe my patients and I have lost as much as we have gained. I don't know them; and they don't know me; and psychiatry is, frankly, just not as rewarding. I have withdrawn my soul in large part from my practice." If forced to choose, there is no question that Blazer would choose Darwin over Genesis, but he does not want to have to choose. He wants there to be dialogue and struggle. Blazer does not want the judge to have to choose between Darrow and Bryan in the Scopes trial; rather, he wants a humane synthesis. Humankind exists in a state of striving for meaning. At present, neuropsychiatry, psychoanalysis, and Christianity are each passionately but autistically engaged in this search. Blazer suggests that the interface between neuropsychiatry and religion may become the most important relationship of all—especially if, in their striving for the meaning of emotional suffering, they need to mix it up a little. Written with admirable scholarship, Freud vs. God is a real contribution to American social and intellectual development. Its bibliography includes seminal work by philosophers, psychoanalysts, anthropologists, neuropsychiatrists, academic theologians, and evangelical pastoral counselors. Blazer integrates these competing Gestalts with grace and intelligence. He is always careful to put what he writes into historical perspective. However, he is not content with just writing cultural history; he also desperately wants psychiatry to regain its soul. Blazer is quite clear that the dialectic must remain on the ecumenical planes of spirituality, soul, mind, and neuroscience and not on the parochial planes of religion, sin, Jesus, and Freud. Thus, devout molecular biologists, neuroscientists, and Kleinians, if they have hearts, can applaud this book. Devout Buddhists, Moslems, and Jews, if they have minds, can do likewise. Finally, directors of psychiatric residencies and of pastoral education should consider assigning Freud vs. God as required reading.

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