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  • 04 Apr 2002 9:35 PM | Perry Miller, Editor (Administrator)

    The Helen Flanders Dunbar (1902-59) Memorial Lecture on Psychosomatic Medicine and Pastoral Care
    delivered 11/2/99, at Columbia Presbyterian Center of the
    New York Presbyterian Hospital, New York, New York

    ROBERT CHARLES POWELL, MD, PHD

    ABSTRACT: This essay aims to stimulate rethinking about religious and medical "healing and wholeness." While psychiatrist (Helen) Flanders Dunbar is well known as a psychosomatic investigator and as "Medical Director" of the Council for Clinical Training, the initial home of Anton Boisen's ground-breaking movement for the clinical pastoral education of institutional chaplains and parish ministers, she is less appreciated as a theologically-trained scholar. This essay explores an earlier eras understanding of the "spiritual" and the more "soulful" components of healing and how Dunbar combined these to focus on helping all peoples become "free to think and act."

    "a magnetic, charismatic woman, with . . .

    an almost magical gift

    of insight and intuition."1  

    Now is the time -- no, it is long past time -- to begin honoring Helen Flanders Dunbar, BD, MD, PhD, MedSciD, psychoanalyst and Dantean scholar, for her contributions to religion as well as to medicine.2 As the practical theoretician, loving friend, and guiding force behind the Rev.Mr. Anton Theophilus Boisens ground-breaking movement for the clinical pastoral education of institutional chaplains and parish ministers, she was brilliant, realistic, and sincere. Just as Boisens work focused on breaking "an opening in the wall which separated religion and medicine," Dunbars work focused on that broad area of healing and wholeness, where religion and medicine overlap.3

    This memorial lecture can be seen as honoring the 70th anniversary of Dunbars first treatise, Symbolism in Medieval Thought . . ., which set the tone for all her subsequent work.4 It can be seen as honoring the 65th anniversary of her most beautiful and beguiling article, "What Happens at Lourdes? Psychic Forces in Health and Disease."5 It can be seen as honoring the 60th anniversary of her founding of the journal, Psychosomatic Medicine, and its associated society.6 It can be seen as honoring the 50th anniversary of Your Childs Mind and Body: A Practical Guide for Parents, the sequel to her best-seller, Mind and Body . . . .7 It can be seen as honoring the 45th anniversary of the fourth and final edition of Emotions and Bodily Changes . . . , which launched the mind-body movement.8 It can be seen as honoring the 40th anniversary of Psychiatry in the Medical Specialties, which was accepted for publication on the day of her death.9 From these standpoints and many others, "The Helen Flanders Dunbar Memorial Lecture" can be seen as an occasion well overdue.

    Dunbar considered becoming "free to think and act" -- she underscored the word "free" -- as a basic goal for all those seeking help.10 It was her admonition to physicians and ministers trying to heal as well as to patients and parishioners hoping to be healed. She held that becoming "free to think and act" was an accomplishment open to all -- one that could also be achieved by parents, then taught to children, heading off future problems.11 In various forms, this liberating sentiment -- becoming "free to think and act"  echoed throughout the era between the two world wars. In this essay I will lead you to explore the spiritual and the more soulful components of this admonition, how Columbia Presbyterian Hospital first became a font of knowledge on mind-body interactions, and how Flanders Dunbar became central to this ground-breaking enterprise, on both the religious and the medical sides. As a nonseminarian physician, I can only observe and hypothesize about theological matters, but I hope to stimulate your rethinking of what you thought you knew about religious and medical healing and wholeness.

    While the era opened with much confusion about healing efforts within the church, this quickly evolved into an implied distinction between what I will call

    (a) the "spiritual" [see definition below] and

    (b) the more "soulful" [see definition below] elements involved

    as well as an implied distinction between

    (a) the remedial stance of curing illness and

    (b) the more preventive stance of maintaining health. 12

    As Dunbar saw it, "The priest . . . speaks first of goal" -- the spiritual, that which maintains health and wholeness -- and "brings promise of external assistance." In contrast, without promising any such "reinforcing of strength," the general physician tries to set the soul at ease by removing "objects in the patients path," and the trained psychiatrist focuses on "straightening out . . . disharmony" in the patients path itself.13 Religion alone, she suggested, could add spiritual confidence -- "The Lord is my shepherd!" -- "Shema Israel!" -- to the soulful contentment and quiet that either religion or medicine might achieve. Clergy and physicians both could focus more on the present as it unfolds into the future -- prevention, and less on the past -- the etiology of an illness or disease. Together, the psychiatrist, the physician, and the pastor might guide the person seeking help toward becoming emotionally, soulfully, and spiritually free to think and act.

    Mrs. Ethel Phelps Stokes Hoyt, an intelligent, energetic laywoman, who wrote a remarkable little book called Spirit: A Study in the Relation of Religion to Health, and whose husband, industrialist John Sherman Hoyt, served on the Board of Columbia Presbyterian Medical Center, contributed greatly in the clarification of these issues.14 As early as 1923 she asked, "Will not those Churches which are interested in Spiritual Healing help the Cause more at present by emphasizing the Power of the Spirit in maintaining Health and Abundance of Life, rather than by putting the emphasis on 'Curing disease'?"15 On March 8 of that year she and her husband gathered "a small group of physicians and clergymen"

    (a) to discuss "the possibility of better cooperation between Religion and Medicine in maintaining health and curing disease,"

    (b) "to study the basic factors, physiological, mental, and spiritual, underlying the various healing cults," and

    (c) "to strengthen the work of those groups which were earnestly seeking scientific guidance."16

    As the Rev.Dr. Harry Emerson Fosdick is said to have phrased it at that meeting, "modern ministers are approaching this problem [of healing] in a scientific manner, trying to interpret spiritual laws with the same scientific spirit with which . . . doctors are working to interpret physical laws. We must work scientifically from both sides until the tunnel joins." Just as pastors might be taught a more careful, rigorous, clinical approach, it was suggested that physicians might be taught how to "rekindle latent faith in Patients." Overall, the controversies over religious healing were seen as an unfortunate stumbling block and as "only a small part of the greater problem of [obtaining] 'The Cooperation of the Church & the Medical Profession'."17 Mrs. Hoyt encouraged both sides to see that "the Church can do more in preventive & educational than in curative work" and that putting more emphasis on "religion as an aid in maintaining health" would make it "far easier for doctors and clergy to get together."18

    This "small group of physicians and clergymen," which eventually developed into the "Joint Committee on Religion and Medicine of the Federal Council of Churches of Christ in America and the New York Academy of Medicine," initially focused on the role of "spirit," only later getting around to recognizing the role of "soul." One of Mrs. Hoyt's close friends at the Academy spoke of "a veritable and potent force in these specific emotional states associated with religious experience," and of "the importance that its use in modifying bodily functions be intelligently guided."19 The medical chair of the Joint Committee spoke of "Expectant emotion" as favoring "'the healing power of Nature'."20 Mrs. Hoyt's notes for a presentation quote a Professor Pupin's view of the role of "Purpose" and "Partnership" as "Stimulants" as well as of "Symbols" as "Tonics"; the general thesis asserted that "the symbolism of faith and purpose may arouse latent possibilities of power."21 The Joint Commission on Christian Healing in the Episcopal Church, of which Dunbar became one of the thirteen members, no doubt through the intercession of Mrs. Hoyt, similarly declared that "Effective prayer has the effect of a potent tonic; it vitalizes and energizes the whole personality of man."22 That is, as the Joint Committee was being organized, the original emphasis was upon the more dynamic role of inspiring and inspiriting in the encouragement of health.23

    Once the Federal Council's "Subcommittee on the Relation of Religion to Health" had decided to join forces with the Academy's "Subcommittee on Religious Healing," the Joint Committee then found it hard to find "a clergyman with special interest in this field whose main emphasis in religious therapy was distinctly religious and not some form of amateur psychiatry."24 The irony, of course, is that what they did find was an unordained woman who was trained as a psychiatrist. As their official history tells the story: "In 1929 the [Joint] Committee became interested in Dr. Helen Flanders Dunbar, who had been working in the field of psychosomatic relationships for five years, first as a part of her studies for the degree of Doctor of Philosophy at Columbia University, then in connection with her Bachelor of Divinity degree from Union Theological Seminary and her . . . [Doctor of Medicine degree from] the Yale University School of Medicine."25 Now, it just happens that Dunbar had attended Brearley School and Bryn Mawr College with one of Mrs. Hoyt's daughters, and that both Dunbar's parish priest and one of her seminary professors were members of the Joint Committee.26 Returning now to their own narrative, "While she was continuing her work in Europe [in 1930, as her fourth year of medical school] she undertook to make certain studies at Lourdes and other healing centers for the [Joint] Committee [returning to Lourdes in 1933, again on behalf of the Joint Committee]."27 Let me interrupt again to note that, upon returning from Europe, she promptly became, in September 1930, "Medical Director," and later, "Executive Director," of the "Council for the Clinical Training of Theological Students," the program in pastoral education founded by her teacher, friend, and colleague, the Rev.Mr.Anton Theophilus Boisen. I should add that while Boisen was organizing his pastoral education program in the late 1920s, Mrs. Hoyt was attempting to place "certain Seminary students from Union [Theological]," where Boisen had trained and Dunbar was training, "at Stockbridge," that is, at the Austen Riggs Foundation, a private psychiatric hospital in Massachusetts.28 In addition, she was trying to get "the Human Welfare Group at Yale," where Dunbar was also studying, commuting between New York and New Haven, pulled in with the Academy of Medicine and the Federal Council of Churches as a third constituent of the Joint Committee.29 Returning again to the Joint Committee's own narrative, "In April, 1931, a year after her return, she [, Dunbar,] was appointed Director of the [Joint] Committee's work on a part-time basis."30 Actually she had already, during the opening months of 1931, been supervising the Joint Committee's preliminary "Study Project in Religious Healing" along side her own research on "physiological changes accompanying emotions."31 During the year between her studies in Europe, where she audited lectures at Vienna's Psychiatric-Neurological Hospital while serving as "Assistant" at Zurich's Burgholzli Clinic, meeting with Carl Jung nine times, and her assuming the leadership of both the Council for Clinical Training and the Joint Committee, Dunbar completed an internship in medicine, arranged by Mrs. Hoyt through the help of her husband and others, at Columbia Presbyterian.32

    So who was this amazing "Dr. Helen Flanders Dunbar," who earned two bachelor's degrees and ultimately three doctorates by her mid thirties? To begin with, she was someone who agreed with the Joint Committee's initial assumption about the preeminent role of stimulating the "spirit" in helping to maintain health. An early manuscript of hers speaks of religion as "giving man power for the accomplishment of his ideals," and she certainly managed to accomplish more of her ideals than the average mortal.33 There is no doubt, however, that she understood even this simple sentiment as having more complexity than the average Joint Committee member could have grasped. Every aspect of Dunbar's history thus far touched has turned out to be quite complex, and we await additional insights gleaned from materials gathered by her daughter and the Rev.Dr. Allison Stokes.34

    Thirty years ago I wrote, "Dunbar was a physician. She was also a woman with a mission . . . and with a mask, a persona progressively concealing her person."35 Five years later I wrote, "Who was Dunbar? That is a question even her closest colleagues asked and could not answer. No one knew . . . . [One] close associate has commented that 'after more than a generation of reflection,' Dunbar still remained to him basically an enigma. Some colleagues recall, without being able to account for it, the 'sense of mission' with which she inspired them, while others recall little but enmity toward her for reasons equally obscure."36

    In brief, Dunbar was born in Chicago to an electrical engineer/ mathematician/ patent expert and to an ardent feminist/ translator/ genealogist. Her father withdrew and retired at age forty-six, moving Helen and her younger brother back to the ancestral territory near Manchester, Vermont, where Helen's overprotective mother, her strong-willed maternal maiden aunt, and her deeply religious grandmother, set the tone. Dunbar grew up more at home with books than with people. Following an erratic early education peppered with tutors, she studied at Brearley and Bryn Mawr with mother and brother in tow. During her years at Bryn Mawr, the then shy, unsophisticated Dunbar came under the influence of her maternal uncle's wife, who taught her the basic social graces and made it a point to introduce her to those listed in the New York Social Register, of Professor James Henry Leuba, a psychologist of religion, who proposed systematic "collaboration of religious idealism with science," and of the writings of fourteenth century poet, Dante Aligheri, who argued that religion and science were not antagonistic but complementary.37 Dunbar's first doctoral thesis took Dante's notion of complementarity entirely seriously, seeing his Divine Comedy -- and the world -- as interpretable "at one and the same time on different levels," these interpretations being "so closely interrelated that each is corrected by the other and that all are blended into an harmonious whole."38 This Dantean viewpoint, embracing multiple, simultaneous, complementary interpretations, was to guide Dunbar's intertwined medical/religious approach to the study of emotions and bodily changes.

    So, Dunbar, finally graduating from her simultaneous enrollments at Union, Columbia, and Yale, became Director of the Joint Committee on Religion and Medicine in April 1931, but the committee itself had studied widely, spending eight years refining and expanding its grasp of the "religious healing" problem. The original meeting at the Hoyts' in 1923 had included plans for "Rest and Convalescent Homes," where "tired people" could go for "physical re-creation, mental re-education, and spiritual re-generation."39 While the Joint Committee did not take any such homes under its wing, leaving their private establishment to Mrs.Hoyt and her friends, it did endorse the idea of such so-called "preventoria."40 Similarly, Mrs. Hoyt's above cited notes for a presentation also quote a Professor Pupin's view of the role of "Peace" and "Trust" in providing "Sedative " effects as well as of "Faith" in providing a "Stabilizer" effect.41 The Joint Committee was beginning to recognize that, beyond examining the more dynamic inspiriting, stimulating "motives which will make life worth living," it needed to examine the more holistic, organismic rest, repose, and calming which go toward "modifying the fears" associated as either cause or effect of most illness or disease.42

    The Joint Committee commissioned a research psychologist, Alice E. Paulsen, PhD, to review the principles apparently operant in contemporary religious healing. Her original outline noted, among the "Techniques for making faith more effective," the "reinforcement of rest and relaxation through prayer, meditation, suggestion, and visualization."43 Her final report gave considerable space to the work of the Rev.Dr. William Thomas Walsh, who in early 1931 had worked on the wards under Dunbar's supervision.44 Walsh, Paulsen noted, "states that there is in the Bible abundant evidence of a very definite technic of healing used by Jesus," which was, in essence, creating the conditions that make rapport possible.45 Walsh saw prayer as "the means of getting yourself into the state where you can receive God," and he believed in working hand-in-hand with a patient's physician "in order to get the conditions requisite to the working of divine power."46 In the conclusion of her formal report, endorsed and disseminated widely by the Joint Committee, Dr. Paulsen noted that "Each [healing] system in some way introduces the idea of cure or health after preparing the mind through one means or another [-- generally, "rest and relaxation" --] to accept it . . . ."47 With this study in hand, about one year before Dunbar assumed control, the Joint Committee "proposed that a study shall be made . . . not only of the more specific treatment of disease by spiritual means, but of the therapeutic values of the various forms of worship -- liturgy and hymnody, the exercise of private devotions and the contemplation of religious symbols and architecture."48 The die was set that they would study both spiritual stimulation and soulful repose.

    Once Dunbar was officially in charge, she conducted, with four clergymen, "a preliminary study at Presbyterian Hospital, purely empirical in nature, based on the hypothesis that exposure to religion might prove valuable to the patient. . . ."49 The only restriction the Joint Committee placed upon her work was "that it should be carried on, as hitherto, without publicity of any kind."50 Whereas "isolated cases," primarily patients with cardiac and ulcer problems had been used earlier that year in her observations of the effects of the more soulful, rapport enhancing ministrations by the Rev.Dr. Walsh, Dunbar now proceeded systematically, adding, for what she and others thought would be a control group, "certain types of surgical patients, particularly those who are confined in hospitals for long periods of time, such as [patients with] fractures of the head of the femur."51 The patients were divided "into two groups of a more or less similar type, the one to be treated in the usual [medical] way, and the other with the aid of a clergyman's ministrations."52 Her plan was to determine "what contribution, if any, the stimulation of religious faith might make in . . . . [the] 62 patients treated simultaneously by clergymen and physicians."53 Those assigned to the clergy were seen an average of eight times, and one of the ministers involved suggested that while his inspiriting ministrations produced "no change in the process of getting well," they caused "an extraordinary acceleration of the process."54 Dunbar herself concluded that the clinical investigation of the effects of religious emotion, whether quieting, as in the first study, or invigorating, as in the second study, "was too complex for the present state of our knowledge," and that any further study "should be given background and perspective by a bibliographic survey."55

    In October 1931, Dunbar defined the aim henceforth of the Joint Committee. Whereas a draft forwarded to her suggested that the aim should be to determine "what contribution, if any, religious faith can make in the maintenance of health and the healing of disease" and "under what conditions cooperation between physicians and clergymen may be effectively carried on," she broadened yet focused the scope as follows: "This committee proposes to investigate the border territory between religion and medicine, in other words, to study the problem resulting from the dichotomy of psyche and soma [,] with a view to a better understanding of the integrating forces and of the psycho physiological organism as a whole."56 The original draft supplied to Dunbar suggested that the committee focus on what unique contribution the minister may "contribute as a clergyman," as one "who believes that through religious faith we are brought into contact with cosmic forces . . . , and who uses his contact with the patient to induce in him an attitude which may make the resources of this faith available."57 Dunbar, rephrasing this in her even more poetic language, proposed that they try "to distinguish by careful experiment and observation" the "influence of a personality, of an atmosphere, of a symbol," on "restoring, mobilizing, or accelerating the healing processes as we know them," and specifically the influence of these on "reinforcing . . . that most indispensable and unaccountable of all our therapeutic resources"[:] "rest itself."58 Thus, again, the juxtaposition -- albeit this time, via Dunbar, more of a melding -- of the invigorating and the calming, the spiritual and the soulful.

    "While the primary purpose of our Committee," suggested the draft, "is research, its ultimate purpose is education."59 Dunbar herself further asserted that progress required "both research in the sphere of relationship of psyche and body and actual experiment in cooperation between physicians and clergymen."60 Thus Dunbar's roles, as director of what she now called "psychosomatic research" at Columbia Presbyterian and as medical director of the Council for the Clinical Training of Theological Students, were subsumed under her directorship of the Joint Committee on Religion and Medicine.

    The two divisions of the Joint Committee -- research and education -- were held together by Dunbar's overarching Dantean vision. In the opening pages of her first doctoral thesis, the magisterial Symbolism in Medieval Thought . . . (1929), she suggested that "nothing is more needed by the student of disorders of the human mind" -- that is, the psychiatrist -- "than a thorough study of the development of insight symbolism."61 By "insight symbol" Dunbar meant those special symbols -- almost "alive" -- which invite "continual re-creation and expansion" of meanings, in which "all meanings are true" and "are often all intended at once" -- reaching "out toward the supersensible," toward "a reality . . . greater and truer than the symbol in all its aspects."62 She considered such symbols as mediators between a person's inner and outer worlds, both physical and psychological.63 In a letter dated September 21, 1929, she confirmed that she was, indeed, "writing the thing [, a new version of her dissertation,] in psychiatric terms."64 This, I asserted thirty years ago, essentially became "Part One" of Emotions and Bodily Changes . . . (1935), the book whose publication was arranged by the Joint Committee and that essentially launched the American psychosomatic movement.65 "Part One" can, indeed, be seen as addressing the object of symbolism; in medical/psychiatric terms, Dunbar called this the "working out of the individual's relationship to his [or her] particular environment and personal problems"; in religious terms, invoking Dante, she called this the working out of the individual's "adjustment to the Infinite."66 While "Part One" of her first psychiatric classic thus constitutes a carefully albeit subtly argued treatise on "the organism as a whole" -- the mind-body functioning as a symbol -- and "Part Two" is straightforwardly a bibliography, a ". . . Survey of Literature on Psychosomatic Interrelationships: 1910-1933," as the book's subtitle declared, "Part Three," mentioned frequently in the Joint Committee's minutes as a bibliography on "the relation of religion to health," as "a factor in directing and controlling emotion," did not appear.67

    As early as 1931 and as late as May 1934, two of Dunbar's secretaries were working on "the religious section of the bibliographical survey," and the Joint Committee employed the Rev.Dr. John W. Suter, a board member of the Council for Clinical Training, to produce the final manuscript, but "Part Three" never saw the light of day.68 As I have discussed in greater detail elsewhere, the missing religious, symbolistic part did appear later, in essence, as a volume by Boisen's successor at Worcester State Hospital, the Rev.Dr. Carrol A. Wise.69 When Emotions and Bodily Changes appeared in print in June 1935, hardly one word concerned religion.70 The following November, Dunbar reported to the Joint Committee her conclusion that "Religion itself, no matter how understood, is not a common element" in most "religious healing," and that religion, "So far as we have been able to determine," "is not essential to the healer, to the patient, nor to the setting."71 Nonetheless, she noted that "through the Council [for Clinical Training,] and through our clinical research projects we are accumulating relevant data" concerning "how religion fits into the psychosomatic regime . . . ."72

    Let me emphasize, at this point, that while Mrs. Hoyt, understandably, became as furious as such a genteel woman could upon digesting Dunbar's conclusion that religion was not essential to religious healing, we should not assume that Dunbar meant her conclusion in any negative way. Even the Rev.Dr. Edward E. Thornton, an earlier historian of the clinical pastoral education movement, who, overall, certainly does not idolize Dunbar, nonetheless notes his findings that those working side-by-side with Dunbar "were loyal to her because of her intense commitment to the cause of relating the clergy to physicians in a constructive way and because of her genuine religious interest."73

    Dunbar's religious -- or, perhaps, Dantean -- interest showed itself in a most peculiar way in late 1935. Mrs. Hoyt circulated a letter suggesting that, since "Helen Dunbar has so many extraordinary qualities and so much ability," perhaps "she should be released as far as possible from all the complications of administrative and directing activity and devote her time to the medical side of research . . . for which she is so uniquely well suited."74 Thus damned with praise, Dunbar was removed from her role as Director of the Joint Committee, which was itself dissolved into its original non-joint components. Then, much to Mrs. Hoyt's horror, the possibly infidel Dunbar managed to reconstruct her power base almost exactly as it had been before. Dunbar arranged to have representatives from the Academy of Medicine and the Federal Council of Churches appointed to her executive committee at the Council for Clinical Training, and arranged to have her personal secretaries accepted as representatives to the Academy and the Federal Council. Dunbar herself became "consultant" to the Academy's new "Subcommittee on Emotions, and her "executive secretary" within the Council for Clinical Training organized the Federal Council's new "Subcommittee on Religion and Health." Thus, within the space of only several weeks, Dunbar managed, as Mrs. Hoyt noted with alarm, to "again be virtually head of both Medical and Religious committees. . . ."75 The status quo was thus maintained, with both religious and medical aspects of the original project continuing to be run out of Dunbar's office. The primarily educational arm of her work, The Council for the Clinical Training of Theological Students, later renamed just "The Council for Clinical Training," expanded aggressively into new settings, and the primarily research arm of her work, the psychosomatic medicine division at Columbia, embarked on one of the world's first large scale studies, ultimately involving over 1,600 patients.76

    So, again, who was this amazing "Dr. Helen Flanders Dunbar," who felt driven to maintain complementary religious and medical programs side-by-side as she explored "emotions and bodily changes"? While she agreed, as we have noted, with the Joint Committee's initial assumption about the preeminent role of stimulating the "spirit" in helping maintain health, she came to place equal emphasis on the importance of quieting the "soul." A later manuscript of hers speaks of "creating an atmosphere of quiet concentration and rapport" and she certainly was a master at putting people at ease.77 There is no doubt, again, however, that she understood even this simple skill as having more complexity than the average Joint Committee member could have grasped. Every aspect of Dunbar's history thus far touched has turned out to be quite complex, and her consummate skill with patients, her "magnetic, charismatic" capacity for empathic connection, has been called seductive when its use with foundation heads and department chairs allowed her to get whatever she could want, as she pursued her far-ranging studies of emotional, soulful, spiritual integration.78

    Dunbar made at least three visits to the healing shrine in southern France at Lourdes. It was there that she seems to have had her first inkling of the complementarity of what I am calling the "spiritual" and more "soulful" aspects of religious emotion. Her 1934 article on Lourdes called these aspects "confidence" and "contentment".79 Taking her cue from the nurses and stretcher bearers at Lourdes, Dunbar noted that, of patients visiting the shrine, those overcome by hysterical excitement as well as those merely waiting for a miraculous cure were not the ones to return home feeling well. Patients achieving the most success were those who became able, with "deep confidence and quiet," to go about their day, helping themselves and others.80 That is, both spiritually and soulfully, they had become emotionally "free to think and act."81

    If Dunbar was what I have called a "practical theoretician," "a woman with a mission," her focus regarding illness was on prevention and effective intervention. As you may recall, the era's initial confusion about healing efforts within the church had quickly developed into an implied distinction between

    (a) the remedial stance of curing illness and

    (b) the more preventive stance of maintaining health.

    While Dunbar's early patroness, Mrs. Hoyt, saw a preventive rather than a curative focus as helping physicians feel more comfortable with the clergy, and while a Joint Committee document encouraged "affirmative . . . thinking and praying . . . as a preventive measure" counteracting "early tendencies to disease," it was Dunbar herself who carried this distinction the farthest.82 She saw this "public health" approach of maintaining health in order to prevent disease as one of the major reasons for encouraging cooperation between religion and medicine. She considered her research on mind-body interaction and integration as highly practical, as providing knowledge relevant to physicians' practice albeit disseminated through the clergy. The pastor, she noted, "has the opportunity to spot the first signs of incipient disease, physical or mental, before the parishioner has even realized the need of coming" to anyone for care.83 The pastor "should not forget," she admonished, that he or she "is the one officer of health who is welcome in these homes before illness has developed."84 While acknowledging the glamour of trying to cure, she hoped to impress upon the clergy that "an important part" of their mission is "to prevent disease of body and spirit."85 Clinically trained clergy, she envisioned, could "fill an important part in preventive medicine."86

    Dunbar considered the clergy's "public health function" as extending beyond the mere finding of "cases." She saw belief, perhaps especially religious belief, as "the unifying power in personal life," "mediating relationships of our internal physiological world to the external world at large," and clergy as uniquely qualified to focus upon and clarify beliefs.87 Notice, by the way, her careful combination of words -- "unifying power" -- suggesting the amalgam of soulful and spiritual elements in one concept -- which she had spoken of elsewhere as the almost living, breathing, -- organismic -- "insight symbol." The pastoral task, as she viewed it, was in helping men and women "in their adjustment to their total environment, outer and inner."88 To carry out this role, clergy had to gain an appreciation of scientific method and study firsthand what her colleague, Boisen, called "living human documents," the actual stories of men and women in triumph and in distress.89 She insisted on calling the programs they developed "clinical" rather than "pastoral" training because then existing courses in "pastoral theology" focused on telling the theologue "what to do" rather than "giving the student opportunity for adequate contact with the human being whose problems he [or she] is discussing."90 Dunbar viewed the Council for Clinical Training "not only as a movement in education" but "as a laboratory . . . from which guidance may be expected."91

    Above I spoke of the Council for Clinical Training as primarily the educational arm of Dunbar's work, and of her large scale studies of psychosomatic illness as primarily the research arm of her work. I said "primarily" in each case because each had a second, complementary, function. Just as she saw clinical pastoral education as a research environment exploring how clergy might best interact with their parishioners, she saw psychosomatic research as an educational opportunity for teaching patients and doctors about mind-body interaction. Dunbar, driven by her overarching Dantean vision, can be seen as a major stimulus in the development of the entire combined field. Her focus on "the border territory between religion and medicine," on "the problem resulting from the dichotomy of psyche and soma," led us all to "a better understanding of the integrating forces and of the . . . organism as a whole."92 The evolving, crisscrossing spirals of education/ research/ education/ research and religion/ medicine/ religion/ medicine, which finally led to the current rediscovery of mind-body interaction in medicine, initially had far more impact on religion, creating the clinically-based pastoral disciplines that we know today.

    As author of a history of clinical pastoral education, I am well aware of and have worked with several of the national associations that have developed across the last seventy years. Within the fields of professional chaplaincy, pastoral counseling, and pastoral psychotherapy, however, the College of Pastoral Supervision and Psychotherapy has uniquely chosen specifically to encourage a return to the fields' roots in the work of Anton Boisen and Flanders Dunbar. Trying to retrieve something that once was lost but now is found, the CPSP Diplomates see themselves as "spiritual pilgrims," and the CPSP Covenant speaks of them as specifically dedicated to the "recovery of soul."93 Just as these serious men and women might find it hard to pin down exact definitions of their phrases "spiritual pilgrims" and "recovery of soul" -- which may be why they chose these phrases -- I, too, am perfectly aware that my reification in this essay of an era's and Dunbar's implied distinction between "spiritual" and "soulful" is a bit stretched and certainly not perfect. Nonetheless, there is a distinction to be made. Perhaps it is the distinction between a more active stance and a more passive stance -- a "doing" and a "being" -- without any implication that one is better than the other. If the "spiritual" suggests, at least to me, the more inspiriting, as in "Onward Christian Soldiers!" and most Hanukkah music, then the more "soulful" suggests, at least to me, solitude, rest, and receptivity, as in "Rock of Ages," and most High Holidays' music.

    As I have noted elsewhere, it may be time for the College of Pastoral Supervision and Psychotherapy -- and the broader pastoral fields in general -- to rediscover the inspiriting virtues of remaining "Still Crazy After All These Years," adding these to their ongoing "recovery of soul."94 The true legacy of the Rev.Mr. Anton Theophilus Boisen, I have suggested, may be the courage to espouse beliefs not initially shared by others.95 The founding years of CPSP will most likely be remembered for their insistence that a soul was a terrible thing to waste. A legacy of Dr. Dunbar --BD, MD, PhD, MedSciD -- let me propose, may well be the willingness to tackle the apparently impossible task, of integrating the spiritual and the more soulful. Remembering Dunbar is to remember that much work lies ahead.

    Without being explicit about it, CPSP members seem to have adopted Dunbar's liberating emphasis on becoming "free to think and act," applying it as much to their colleagues as to their patients and parishioners. Dunbar's basic approach was to try to set the person's mind at ease, "to help the patient get into condition to think for him[or her]self," and only then to give the person encouragement in solving his or her own problems.96 A recurrent theme throughout Dunbar's writings is that "few patients need to be given advice as to what to do when once they are emotionally free to think."97 In her master's thesis, seventy-five years ago, she noted that the true reformer must be "like the man in Plato's Allegory of the Cave who knew that his chief task was to turn the prisoners [watching shadows on the back of the cave] around [,] so that they could face in the direction of the sun" and the real-world sources of the shadows.98 We need only, she believed, to show patients or parishioners "the way out"; once they see the path "clearly before them," she believed, "they can be trusted to take it . . . ." "The ideal patient," in her view, was "the one who can proceed down the road to health on his [or her] own two feet -- with guidance but without having to be dragged or carried."99 You do not have to change many words to see this as, in essence, the approach to helping "spiritual pilgrims" in their "recovery of soul" that CPSP has tried to bring to the clinical pastoral fields. There are here, too, however, complementary, potentially crisscrossing spirals of soulful thought and inspiring action as we enter the new century.

    The year 2000 will mark the seventy-fifth anniversary of clinical pastoral education and the tenth anniversary of the College of Pastoral Supervision and Psychotherapy. What began in 1925 with three students -- Boisen always called Dunbar "the first" -- expanded within Dunbar's overarching vision to become an epoch making movement worldwide in theological education and religious practice.100 In closing, let us stop for a moment and try to imagine a world without professional chaplains, pastoral counselors, or pastoral psychotherapists. Let us try to imagine a field of clinical pastoral education without the "return to Boisen and Dunbar" that CPSP has tried to provide. In the fascinating area of healing and wholeness, where religion and medicine overlap, we have now begun honoring Helen Flanders Dunbar, psychoanalyst and Dantean scholar, for her contributions to religion as well as to medicine.

    #

    Robert Charles Powell, M.D., Ph.D., a psychiatrist and historian, gratefully acknowledges that much of the research herein reported was conducted under the tenure of a fellowship from the Josiah Macy, Jr. Foundation and under US-PHS Training Grant TO 2 MH 05972-17. He may be contacted at 847/ 441-8283; 1520 Tower Road, Winnetka, Illinois, 60093-1627.

    ___________________


  • 04 Apr 2002 9:20 PM | Perry Miller, Editor (Administrator)

    References

    1. Marcia Dunbar-Soule Dobson, Dr. Dunbars daughter, quoted in G. Allison Stokes, "Dunbar, Helen Flanders," Notable American Women: The Modern Period, Barbara Sicherman, and Carol Hurd Green, editors, Cambridge, MA: Harvard University Press, 1980, pp.210-212, p.211. Ms. Dobson is Professor of Classics at Colorado College, Colorado Springs, Colorado.

    2. She went by the purposely ambiguous name "H.Flanders Dunbar" between July 1929 and December 1939, and then changed her name legally to "Flanders Dunbar."

    3. Robert Charles Powell, Anton T. Boisen (1876-1965): "Breaking an Opening in the Wall between Religion and Medicine," pp.47, special supplement to the AMHC Forum 29(1), October 1976 (The Association of Mental Health Clergy is now part of the Association of Professional Chaplains since merger in May 1998 with the College of Chaplains.)

    Robert Charles Powell, Healing and Wholeness: Helen Flanders Dunbar (1902-59) and an Extra-Medical Origin of the American Psychosomatic Movement, 1906-36, PhD dissertation, Department of History (Medical Historian Training Program) Durham, North Carolina: Duke University, 1974, [reprint available via University Microfilms, order # 75-2415, on the internet at www.umi.com]

    Robert C. Powell, "Helen Flanders Dunbar (1902-1959) and a Holistic Approach to Psychosomatic Problems. II. The Role of Dunbar's Nonmedical Background," Psychiatric Quarterly, Summer 1978, Vol.50, No.2, pp.144-57.

    4. H. Flanders Dunbar, Symbolism in Medieval Thought and Its Consummation in the Divine Comedy. New Haven: Yale University Press,1929; equals her PhD dissertation, New York: Columbia University,1929; reprinted, New York: Russell and Russell, 1961; reprinted again, Atlanta, GA: SOLINET,1994.

    5. "What Happens at Lourdes? Psychic Forces in Health and Disease." Forum, 1934, Vol.91, pp.226-231. The word "free" is italicized in the title of this essay because Dunbar italicized it in the phrase "free to think and act" on page 1 of this article.

    6. Psychosomatic Medicine was founded by Dunbar in 1939 with the assistance of the Josiah C. Macy, Jr. Foundation and the National Research Council; she remained editor-in-chief until 1947; in 1942 the advisory board of the journal voted to form a sponsoring organization, the "American Society for Research on Psychosomatic Problems," which in 1948 was renamed the "American Psychosomatic Society."

    7. Flanders Dunbar, Your Childs Mind and Body: A Practical Guide for Parents. New York: Random House, 1949.

    Flanders Dunbar, Mind and Body: Psychosomatic Medicine. New York: Random House, 1947; as a "Book-of-the-Month Club" selection, this had numerous printings; a "new, enlarged" edition was issued in 1955.

    8. H. Flanders Dunbar, Emotions and Bodily Changes: A Survey of Literature on Psychosomatic Interrelationships: 1910-1953, 4th edition. New York: Columbia University Press, 1955; reprinted, New York: Arno Press, 1976; the 1st edition, 1935, covered 1910-1933; the 2nd edition, 1938, had some additional editorial material; the 3rd edition, 1946, covered 1910- 1945.

    9. Flanders Dunbar, Psychiatry in the Medical Specialties. New York: The Blakiston Division, McGraw-Hill Book Company, 1959.

    10. Dunbar, "What Happens at Lourdes?," p.226.

    11. Flanders Dunbar, Your Pre-Teenagers Mind and Body, edited by Benjamin Linder. New York: Hawthorn, 1962.

    Flanders Dunbar, Your Teenager's Mind and Body, edited by Benjamin Linder. New York: Hawthorn, 1962.

    12. Definitions:

    Spirit - [Hebrew, "ruach"] - "the animating or lifegiving power of which persons are the recipient"; "Gods dynamic and creative activity."

    Soul - [Greek, "psyche"; compare to the Hebrew, "nephesh"] - "a divine substance within the human construct"; "an intrinsic part of personhood"; "it embraces the whole of [a persons] existence."

    When I first drafted this manuscript I was dealing exclusively with materials from the 1920s and 1930s. Only later did I properly appreciate the need to ensure a correspondence between how these terms were used in that earlier era and how they would be appreciated today. The definitions here quoted are from Raymond J. Lawrence, Jr., The Poisoning of Eros: Sexual Values in Conflict, New York: Augustine Moore Press, 1989, pp.7, 6 (on the internet at www.contramundum.com). Chaplain Lawrence, too, had to deal with the problem of consistency of meanings across many years, and, having checked with three theological dictionaries, I believe his careful definitions would be comfortable with Dunbar and her colleagues as well as current readers.

    After completion of this manuscript, a brochure came in the mail describing a course on "Spirituality & Healing in Medicine," to be given 19-21 March 2000, "Under the Direction of Herbert Benson, MD." The "Course Description" notes research establishing "that when a person engages in repetitive prayer, word, sound or phrase and when intrusive thoughts are passively disregarded, a specific set of physiologic changes ensue. . . . These changes . . . have been labeled the relaxation response." The description then goes on to note later research establishing "that people experience increased spirituality as a result of eliciting this state [-- the relaxation response --] regardless of whether or not they used a religious focus. Spirituality was expressed as experiencing the presence of a power, a force, an energy, or what was perceived of as God and this presence was close to the person. Furthermore, spirituality was associated with fewer medical symptoms." (italics mine)

    As you will note, Benson uses the term "spirituality" much the same as did Dunbar and her colleagues of the 1920s-1930s. However, whereas the earlier group saw soulfulness/ relaxation as enhancing ones receptiveness to the spiritual, Benson and colleagues apparently see it the other way around, with the spiritual enhancing ones potential for achieving soulfulness/ relaxation. Dunbar herself seems to have seen these as going hand-in-hand, with, if anything, the soulful encompassing the spiritual, which, one could argue, comes closest to the more classical theological view.

    13. H.Flanders Dunbar, "Medicine, Religion, and the Infirmities of Mankind," 1934, Mental Hygiene, Vol.18: 16-25, pp.19-20.

    14. Robert C. Powell, "Mrs. Ethel Phelps Stokes Hoyt (1877-1952) and the Joint Committee on Religion and Medicine (1923-1936): A Brief Sketch." Journal of Pastoral Care, 1975, Vol.29, No.2, pp.99-105.

    15. Ethel P.S.Hoyt, letter to Dr. Slattery, 5 September 1922, in folder "Religious Healing, 1923," File A, Drawer 1, Association for Clinical Pastoral Education Archives.

    Since I did my original research in the 1970s, the ACPE Archives have moved at least twice. As best I can tell, the files to which my notes refer are now housed as follows: "Records, 1930-1986 - Series VIII: Related organizations. Record Group No.001 (Formerly Yale Divinity Library MSS 71) F. Miscellaneous Other Organizations, 226 3409 through 226 3416," Archives and Manuscripts Department, Pitt Theology Library, Emory University, Atlanta, GA; these are indexed on the internet at www.pitts.emory.edu/text/rg001s8.html#F.

    16. Helen Van Voast and Ethel P.S. Hoyt, "History of the [Joint] Committee on Religion and Medicine of The Federal Council of Churches of Christ in America and The New York Academy of Medicine, 1923-1936," ?1936, p.1, in folder "Religious Healing, 1923," ACPE Archives.

    17. Van Voast and Hoyt, p.2

    18. Ethel P.S.Hoyt, letter to Dr. E.H. Lewinski Corwin, 23 July 1923, in folder "Religious Healing, 1923," File A, Drawer 1, ACPE Archives, p.2.

    Ethel P.S.Hoyt, letter to Dr. E.H. Lewinski Corwin, 24 October 1924, in folder "Religious Healing, 1923," File A, Drawer 1, ACPE Archives.

    19. E.H. Lewinski Corwin, October, 1923, quoted in Van Voast and Hoyt, p.3.

    20. Frederick Peterson, "Mind, Religion, and Medicine," in Contributions to Psychiatry, Neurology, and Sociology Dedicated to the Late Sir Frederick Mutt, J.R. Lord, editor. London: H.K. Lewis, 1929, pp.37-44, p.38.

    21. Ethel P.S. Hoyt, "Points of Contact: Notes on Religion as a Factor in Maintaining Health and Curing Disease," p.1, 27 December 1925, in folder "Religious Healing, 1923," ACPE Archives.

    22. "Report of the Joint Commission on Christian Healing in the Episcopal Church," Journal of the General Convention of the Episcopal Church, 1931, pp.557-558.

    23. Just before presenting this lecture that I realized that the contrast here proposed between "spiritual" and "soulful" notions in Dunbar's religious thought paralleled the contrast between "dynamic" and "organismic/ wholistic" notions I had documented twenty years earlier in her medical thought.

    Robert C. Powell, "Helen Flanders Dunbar (1902-1959) and a Holistic Approach to Psychosomatic Problems. I. The Rise and Fall of a Medical Philosophy," Psychiatric Quarterly, Summer 1977, Vol.49, No.2, pp.133-52, p.136: "during the 1930s the dynamic mode [of psychosomatic theory] . . . emphasized psychical forces, etiology, specificity, and a focus on the past, e.g., psychogenesis; . . . the organismic, correlational mode . . . emphasized functions, meanings, and wholes -- such as character and constitution -- plus a focus on the future, e.g., purpose, prognosis, and prevention. It might not be too simplistic to say that the . . . [one] focused on the mind, . . . and the . . .[other] on the patient as a whole." Just after finishing my talk, a gentleman from the audience suggested that many disciplines were exploring this kind of contrast during the era between the two world wars.

    24. Van Voast and Hoyt, p.7.

    25. Van Voast and Hoyt, p.7

    26.Powell, Healing and Wholeness, pp.117-118, 88, 114; she majored in mathematics and psychology, but took most of the premedical curriculum; the Rev.Dr. W. Russell Bowie was rector of Grace Church in New York, an outpost of the "Emmanuel Movement" for "medically supervised religious psychotherapy." (See also, Robert Charles Powell, review of Sanford Gifford, The Emmanuel Movement (Boston, 1904-1929): The Origins of Group Treatment and The Assault on Lay Psychotherapy. Boston: Francis A Countway Library of Medicine/ Harvard University Press, 1997. in Bulletin of the History of Medicine, 1999, Vol.73, No.2, pp.345-346.); the Rev.Dr. William Adams Brown had her in at least two courses and one tutorial.

    27. Van Voast and Hoyt, pp.7, 10.

    See, also, Robert Charles Powell, C.P.E.: Fifty Years of Learning, through Supervised Encounter with "Living Human Documents." booklet, 32pp. New York: Association for Clinical Pastoral Education, 1975, reprinted, 1987; reviewed in J.Pastoral Care, 1982, Vol.36, No.4, p.210.

    28.Harrison Elliot [Professor, Union Theological Seminary], letter to Mrs. J.S. Hoyt, 10 March 1925, in folder "Religious Healing, 1923," ACPE Archives.

    29. [?J.A.Hartwell?], letter to Mrs. John Sherman Hoyt, 13 December 1929, in folder "Religious Healing, 1923," ACPE Archives

    30. Van Voast and Hoyt, p.7

    31.[Joint Committee on Religion and Medicine] "Notes on Plan and Procedure of a Study Project in Religious Healing to be Conducted under the Auspices of the Joint Committee on Religion and Medicine" [1930-31], in Seward Hiltner, "Commission on Religion and Health -- Notes from 1923- materials to 1935," 1939, ["Notebook"] in the Federal Council of the Churches of Christ in America Archives, held by the National Council of the Churches of Christ in the U.S.A., New York, New York. H. Flanders Dunbar, "Presentation of the History and Accomplishments of the Committee on Religion and Medicine to the Public Health Relations Committee of the New York Academy of Medicine," 1935, in Hiltner Notebook.

    32. Powell, Healing and Wholeness, pp.100, 102, 118.

    33.Helen F. Dunbar, "The Medieval Mass in the West," typescript, n.d. [?1923-4?], Box 4, Folder 2, Mary Anita Ewer Papers, Cornell University Library, p.13.

    34. Allison Stokes, Ministry After Freud. New York: Pilgrim Press, 1985.

    35.Robert C. Powell, "Emotions, Bodily Changes, and Symbolism: A Study of the Major Influence upon Doctor Helen Flanders Dunbar's Early Medical Writings, 1932-1936," 1969, Trent Prize Essay in the History of Medicine, Duke University, Durham, North Carolina, p.2.

    36. Powell, Healing and Wholeness, p.79.

    37. Robert Charles Powell, "Dunbar, (Helen) Flanders," Dictionary of American Biography, Supplement Six, John A. Garraty, editor, New York: Charles Scribner's Sons, 1980 ,pp.180-181. See also, Powell, Healing and Wholeness, pp.79-105.

    James H. Leuba, The Psychology of Religious Mysticism. New York: Harcourt, Brace & Co., 1926, p.332.

    38. Dunbar, Symbolism in Medieval Thought, p.xi.

    39. Van Voast and Hoyt, p.2.

    40. Powell, Healing and Wholeness, p.217.

    41. Hoyt, "Points of Contact," p.1.

    42. Anton T. Boisen, "A Project for the Study of Certain Types of Mental Disorder from the Religious Standpoint," memo from Boisen to Galen M. Fisher, Executive Secretary, Institute for Social and Religious Research, 1923, in "Dunbar Materials," a box of manuscripts and other items deposited by the Dunbar Estate, Union Theological Seminary Library, New York, New York. While the quotes are from Boisen, they are characteristic of comments by Hoyt and Dunbar during the period.

    43.[?Alice Paulsen? Ethel Phelps Stokes Hoyt?] "A Suggestive Outline of Principles and Techniques to Promote Spiritual Health and Healing," not dated, but internal dating of this revision to at least 1939, catalogued in 1944 and filed under "Paulsen" in the pamphlet files of Union Theological Seminary Library, New York, New York.

    44. Alice E. Paulsen, "Religious Healing: Preliminary Report," Journal of the American Medical Association, 1926, Vol.86, No.20, pp.1519-1524, 1617-1623, 1692-97, p. 1621-1622; while called "preliminary," it was not revised and was distributed as a pamphlet.

    Dunbar, "Presentation," p.7; also the Rev.Drs. Thaddeus A. Cheatham, John A. Gardner, and Lyman R. Hartley.

    45.Paulsen, p.1621. William T. Walsh, Scientific Spiritual Healing. New York: D. Appleton, 1926, Chapter II.

    46. Walsh, pp.71, 105.

    47. Paulsen, p.1693.

    48."Trinity Dean [Percy . Kammerer] Seen as Faith Clinic Head: Academy of Medicine, Federal Church Council Unite in New York Project: Pittsburgh Divine Talked as Leader: Scientific Religious Center to Result from Study of Mind-Body Kinship," The Pittsburgh Press, clipping attached to telegram dated 3 March 1930, in Box 34, Federal Council Archives.

    49. Dunbar, "Presentation," p.7.

    50. [Joint Committee on Religion and Medicine] Minutes, Committee on Religion and Medicine, Medical Section, Committee on Public Health Relations, New York Academy of Medicine, New York, New York, 17 April 1931, p.48.

    51. [Joint Committee on Religion and Medicine], p.47.

    52. [?Committee on Public Health Relations?] Minutes, Executive Committee Meeting, New York Academy of Medicine, 21 November 1932, p.1.

    53. Van Voast and Hoyt, p.8.

    54. Dunbar, "Presentation," p.8.

    Thaddeus A. Cheatham, "Report to the Committee on Religion and Medicine: of the Religious Work at the Presbyterian Hospital and in the Vanderbilt Clinic: from July 3 through Sept.12, 1931," 1931, p.2, in Hiltner Notebook.

    55. Dunbar, "Presentation," pp.8-9.

    56.William Adams Brown, "Statement of Aim of The Committee on Religion and Medicine: prepared for clergymen and laymen," 1 December 1931, p. 1, Union Theological Seminary Library.

    H. Flanders Dunbar, "Prospectus (being a statement of the aim, scope, and work to date): Committee on Religion and Medicine, p.1, in Hiltner Notebook.

    57. Brown, p.1.

    58. Dunbar, "Prospectus," pp.1-2.

    59. Brown, p.2.

    60.H. Flanders Dunbar, "Aim and Scope: Committee on Religion and Medicine," File A, Drawer 1, ACPE Archives, p.2.

    61. Dunbar, Symbolism in Medieval Thought, p.10, fn.19.

    62. Dunbar, Symbolism in Medieval Thought, p.14, 11, 4.

    Helen Flanders Dunbar, "The Sun Symbol in Medieval Thought," Master's Thesis. New York: Columbia University, p.65.

    As an example of how insight symbolism gives "a glimpse of a beyond," Dunbar speaks of a "rock": "A geologist, or navigator charting a channel, will note on the map the conventional sign, thus using an arbitrary[-extrinsic] association symbol as a shorthand representation of the datum. The artist on the other hand may sketch the rock, or write a poem describing it in terms of other sense experience [,i.e., as a simile], which then becomes a descriptive[ intrinsic-comparison] symbol of the rock. Finally, the philosopher or the artist gifted with insight may look through the object to one or more deeper meanings, such as the stability of eternal law, and so use the rock itself as [a symbol proper, that is, as] an [interpretive, semblance or] insight symbol." Later, she adds even more possible deeper meanings: "It [the rock] may stand for Christ, as in the familiar hymn Rock of Ages; or it may exemplify that which each soul should be to its fellows, as Christ himself used the symbol with reference to Peter; or finally, the rock may mean the foundation of the heavenly kingdom." (The italicized and bracketed items are here added so that the passage may serve as a summary statement of Dunbar's comments on symbolism.) Symbolism, pp.8-9, 19-20, 11; "The Sun Symbol," p.4.

    63.H. Flanders Dunbar, "The Faith and the New Psychology," Living Church, 13 January 1934, pp.333-336, p.11.

    64.Helen [Dunbar], 21 September 1929, personal letter to Ted [Theodora Land], from Vienna, in the possession of Mrs. Theodora Land Wilson.

    65. Powell,"Emotions," p.11-22.

    66. Dunbar, Symbolism in Medieval Thought, p.10, fn.19.

    67. Van Voast and Hoyt, p.9. Powell, Healing and Wholeness, pp.239-241.

    Robert Charles Powell, "Whatever Happened to 'CPE' -- Clinical Pastoral Education?" keynote address honoring Anton Theophilus Boisen, delivered 18 March 1999, at the Ninth Plenary Meeting of the College of Pastoral Supervision and Psychotherapy, paragraph 7 (on the internet at www.cpsp.org/powell_address.htm).

    68. H. Flanders Dunbar, "Confidential Report of the Director to the Committee on Religion and Medicine," 1 May 1934, p.5, in Hiltner Notebook.

    69. Powell, "Whatever Happened to 'CPE'," paragraph 7.

    The late Rev.Dr.Seward Hiltner, one-time secretary to Dunbar, later head of the successor to the Joint Committee, before becoming a statesman in pastoral theology, called the late Rev.Dr. Caroll A.Wise's book, Religion in Illness and Health (New York: Harper's Brothers, 1942),"the best and most complete description in print for the non-medical reader about psychosomatic interrelationships." Religion and Health. New York: Macmillan, 1943, p.276. Both books -- both authors -- are recommended to those enjoying the current essay.

    70. The word "religion" does appear three times and the words "religious" and "clergyman" each appear once on page 58, but without any great significance. The Joint Committee is alluded to very inadequately on page xv as "a subcommittee of the Committee on Public Health Relations of the New York Academy of Medicine." A footnote on page xxvi of the "Second Edition," 1938, did provide a little more credit to the Joint Committee, but not much: "'(1930-31) as the Committee on Religion and Medicine assisted in the initiation of this volume . . . . The work of this subcommittee led to the formation of a joint committee representing the Academy of Medicine and the Federal Council of Churches'"

    71. Dunbar, "Presentation," pp.19-20.

    72. Dunbar, "Presentation," p.21.

    73.Edward E. Thornton, Professional Education for Ministry: A History of Clinical Pastoral Education. Nashville: Abingdon Press, 1970, p.77.

    74. Mrs. John Sherman Hoyt, personal letter to Dr. William Adams Brown, 13 December 1935, in Hiltner Notebook.

    75. Powell, Healing and Wholeness, pp.243-244.

    [Mrs, John Sherman Hoyt], "Notes to talk over with Dr. Brown - December 12th, 1935," in Hiltner Notebook.

    76. Dunbar kept control of her whirlwind empire through the end of 1939, at which time complications arose in her personal life -- a divorce from her husband followed by her father's death -- and she was herself ready for a rest. She withdrew to an only slightly quieter, less complicated life. A second marriage brought her the joy of a daughter, and she published seven more books plus twice as many articles between 1939 and 1959. Overall, however, her last twenty years would have tried the patience of a saint.

    77. Dunbar, Psychiatry in the Medical Specialties, p.16.

    78.Stokes, Ministry After Freud, p.84, quoting from my 18 April 1973 interview with yet another of Dunbar's executive secretaries.

    79. Dunbar, "What Happens at Lourdes?" p.228.

    80. Dunbar, "What Happens at Lourdes?" pp.229-230.

    81. Dunbar, "What Happens at Lourdes?" p.226.

    82. [?Paulsen?] "A Suggestive Outline," p.[i].

    83.H. Flanders Dunbar, "The Clinical Training of Theological Students," Religion in Life, 1935, Vol.4, pp.376-383, p.379.

    84. Dunbar, "The Clinical Training," p.380.

    85.H. Flanders Dunbar, "Standards for Clinical Training of Theological Students," Bulletin of the American Association of Theological Schools, 1934, Vol.9, pp.68-80, p.80.

    86. Dunbar, "Confidential Report," p.11.

    87.H. Flanders Dunbar, "Mental Hygiene and Religious Teaching," Mental Hygiene, 1935, Vol.19, pp.353-372, p.370.

    88. Dunbar, "Mental Hygiene," p.370.

    89. For the oft-used phrase "living human documents" see Anton T. Boisen, The Exploration of the Inner World: A Study of Mental Disorder and Religious Experience (Chicago: Willet, Clark & Co., 1936. reprinted, New York: Harper & Brothers, 1952, and Philadelphia: Univ.of Pennsylvania Press, 1971), p.185:

    ". . . I have sought to begin not with the ready-made formulations contained in books, but with the living human documents and with actual social conditions in all their complexity."

    90.H. Flanders Dunbar, "Fifth Annual Report of The Council for the Clinical Training of Theological Students," p.4, in "Dunbar Materials."

    91. H. Flanders Dunbar, "Fourth Annual Report of The Council for the Clinical Training of Theological Students," p.4, in "Dunbar Materials."

    92. Dunbar, "Prospectus," p.7.

    93. On the internet at www.cpsp.org/covenant.htm

    94. Robert C. Powell, "Anton Boisen and Theological Reflection: The Importance of Being 'Still Crazy After All These Years'," delivered at Chicago Theological Seminary, 1987.

    95. Powell, "Whatever Happened to 'CPE'," next to the last paragraph.

    96. Dunbar, Mind and Body, p.49.

    97.Flanders Dunbar, Psychosomatic Diagnosis. New York: Paul B. Hoebner, 1943; reprinted, New York: Johnson Reprint Corporation, 1968, p.116.

    98. Dunbar, "The Sun Symbol," p.72.

    99. Dunbar, Mind and Body, p.73.

    100. Anton T. Boisen, note on the flyleaf of a portfolio of his photographs of the training program at Worcester

    (Massachusetts) State Hospital, "Christmas 1928," in "Dunbar Materials": "To Helen Flanders Dunbar[,] who as the first of my theological students has had much to do with this under taking."

    Robert Charles Powell, M.D., Ph.D., a psychiatrist and historian, gratefully acknowledges that much of the research herein reported was conducted under the tenure of a fellowship from the Josiah Macy, Jr. Foundation and under US-PHS Training Grant TO 2 MH-05972-17. He may be contacted at 847/ 441-8283; 1520 Tower Road, Winnetka, Illinois, 60093-1627.



  • 21 Mar 2002 9:26 PM | Perry Miller, Editor (Administrator)

    Robert Charles Powell, MD, PhD

    The First Annual Helen Flanders Dunbar (1902-1959) Award
    for Significant Contributions to the Field of Clinical Pastoral Training
    3/21/02, Virginia Beach, Virginia, at the Plenary Meeting, of the
    College of Pastoral Supervision and Psychotherapy

    When we've been there ten thousand years.1 Actually, while many have made the collegial, spiritual pilgrimage back to Virginia Beach year after year, this is only the tenth  not the ten thousandth  plenary session of the College of Pastoral Supervision and Psychotherapy. The organizing meeting of what was to become CPSP occurred on St. Patricks Day 1990, with the first plenary session  the first full gathering of the community  occurring from March 12th to the 15th, 1992.

    While ten thousand years may overwhelm contemplation, ten years worth of plenaries has been within our grasp. What about one hundred years  this award being based on a centenary anniversary  can we appreciate that? This group speaks of Anton Theophilus Boisen and of Helen Flanders Dunbar. Can we take a moment to ponder the importance of the year 1902  one hundred years ago  to these two founders of the movement for clinical pastoral transformation? Boisen felt he owed whatever measure of success he was enabled to achieve, exploring the inner world of mental disorder and religious experience, to the compassion, wisdom, courage, and steadfast fidelity of the good woman, Alice Batchelder, whom he met in 1902  one hundred years ago  the year Helen Dunbar was born. Alices death precipitated, as Boisen completed his first book, his final psychotic episode, out of which he was led by Helens rekindling of that Dantean love that moves the sun and  other stars.2 Thus the bedrock of this organization lies in the year 1902  and in love.

    Again, what about one hundred years? This award celebrates the 100th anniversary of the birth of Helen Flanders Dunbar, psychoanalyst, theologian, and Dantean scholar, who herself did not get to see that age, but whose last book, Psychiatry in the Medical Specialties, noted her research on those who did, the so-called centenarians. Dunbar knew she would not be among those who would live that long. While I can not prove it, I suspect that the following words, sent to her in publishers galley proofs the day of her death, describe her own personality cohort, and she knew it:

    These are people who have attained some degree of maturity or at least recognition through achievement. No matter at what point one may find

    them on the ladder, they appear to be live-wires, going somewhere and

    with a tremendous amount of energy to go on. They must go, they must

    grow and sometimes they run head on into a stone wall, a blind alley or

    perhaps a luring adventure that becomes a point of no return. This kind

    of frustration is intolerable,  as it is to [one] who explores  confines 

    and [who] wants to go beyond.  They feel stifled. They feel themselves

    like withering plants growing in the basement without sunshine and they

    [have an]  almost physical pain of having to grow with no space to

    grow in.  In this group one finds  those who have achieved

    everything anyone could hope to achieve in the line of their endeavor

    but  [who] feel there is no further place to go. All of a sudden the walls

    come closing in and they smother.3

    As most of us know, she indeed smothered, drowning in the midst of apparent coronary spasm while briefly alone in the basement swimming pool of her home.

    Could the College of Pastoral Supervision and Psychotherapy have helped her  to live a full one hundred years as brilliantly as she lived her first fifty-seven? As stated in the Covenant, it is essential that members

     guard against becoming

    o invasive,

    o aggressive,

    o predatory toward each other,

     make space for one another and

     stand ready to midwife one another in their respective spiritual journeys.

    It is not by accident that this terse admonition appears in the Covenant. Dunbar could have used a little love. As most of us know, when this titan  all 411 of her  slipped, as all of us must do at some points in our lives, she was attacked and struggled to regain her poise. With more supportive colleagues, perhaps Dunbar could have felt there was some further place to go. Fortunately for the clinical pastoral movement, her best years, even though only part time, belonged to it. Even Dunbars somewhat second-best years, though, provided more than most of us could offer. Just imagine if we had her here today!

    Once again, what about one hundred years? Dunbar knew she could not, would not live that long, but she noted attributes of those who did. Based on her study of a series of about 100 patients followed from 10 to 25 or more years, Dunbar noted that the continued ability to create and invent [her italics] marks potential centenarians. While this continued ability to create and invent is the point to emphasize, a number of Dunbars lesser but unique findings are worth reviewing quite rapidly. She observed that the centenarian appears to have been throughout his lifetime a person different  from the majority of his contemporaries. The pre-centenarian responds creatively to change. She considers this enthusiastic, unfrightened response to change and to the unknown as among the outstanding characteristics of the long-lived. Centenarians have taken catastrophe in their stride and almost automatically mobilized their forces to do quickly whatever could be done to cope with disaster. They seem not to have reacted with shock to personal injury. In brief, these people avoid frustration where possible. When avoidance is impossible, instead of calling themselves failures they make a fresh start. Dunbar also noted that centenarians are honest, giving a straight answer except when they are kidding. She believed this indicated an unusual capacity to be honest with themselves  to observe and face squarely that which is observed. Other noteworthy traits of centenarians, she suggested, are the following: they are religious, but avoid the extremes of orthodoxy; they are disciplined, but are more interested in being creative than in being perfect. They are interested in the development of new ideas, and are never at a loss about what to do with their leisure time. They enjoy conversations with others, increasing their store of information and developing new projects. They express themselves well and keep their lines of communication open. They are more interested in the new than afraid of it. They combat entropy by remaining curious.4

    So, while ten thousand years may overwhelm contemplation, and ten years worth of plenaries has been within our grasp, for the trained chaplaincy to become centenarian, as it soon can become, in only twenty-three more years, certain preventive health measures may have to be in place. If we can apply, perhaps, individual research data to an organization, Dunbars study suggests that, to make it to one hundred years, the clinical pastoral community will have to

     nourish inventiveness,

     embrace change and unknowns,

     take catastrophe in stride,

     avoid frustration in life,

     not avoid making fresh starts, and

     foster self-observation, while

     remaining

    o religious,

    o disciplined,

    o creative,

    o expressive,

    o straightforward, and

    o curious.

    Thats a tall but doable order. The CPSP Covenant already speaks of valuing creativity. That CPSP grasped the need for parish-based programs speaks to inventiveness. CPSP may wish to broaden its view explicitly to include both recovery and discovery of soul, refocusing constantly away from institutions that exist to facilitate and toward the needs of persons trying to maintain serious pastoral relationship.

    While clinical pastoral training implied imparting knowledge with hands-on experience, and clinical pastoral education implied specific exercises for the mind, clinical pastoral creation/invention implies the development of something new. As Edward Thornton pointed out twenty years ago, the best clinical supervisors generally aimed toward neither training nor education but toward transformation  transformation of themselves  and ultimately of their students. Through what Thornton referred to as the central mythic enactment  the so-called mystery of the laying on of CPE hands  the hope was that pastoral theologians, beyond just being trained and educated, would in fact emerge as something new  would be created and invented  re-entering their calling transformed.5

    Again, it is not by accident that clinical pastoral transformation sounds suspiciously like the outcome of intimate hours such as were discussed earlier today. Susan Baur wrote five years ago of psychotherapy as an intense, intimate, and affectionate relationship, one intended  to call two people into existence and revitalize them, as it heightens the relevance of the existential dilemmas they address.6 Is that not akin to what your group refers to as the restoration of soul? Is that not what should occur in supervision, or in local Chapter Meetings? Perhaps similar intimate hours of these plenaries can help ensure that the College of Pastoral Supervision and Psychotherapy will maintain continued ability to re-create and re-invent itself  pastorally transform itself -- into its centenary year and beyond.

    Let me begin to close. Several years ago I proposed that it may be time for the College of Pastoral Supervision and Psychotherapy  to rediscover the inspiriting values of remaining Still Crazy After All These Years, adding these to their ongoing recovery of soul. The true legacy of Boisen, Dunbars colleague, I suggested, may be the courage to espouse beliefs not initially shared by others, with the founding years of CPSP most likely to be remembered for their insistence that a soul was a terrible thing to waste. I further proposed that the true legacy of Dunbar may well be the willingness to tackle the apparently impossible task, integrating the spiritual and the more soulful. Without being explicit about it, CPSP members, it also seemed to me, had already adopted Dunbars liberating emphasis on becoming free to think and act, applying it as much to their colleagues as to their patients and parishioners.7 This time I propose that CPSP take to heart one of Dunbars final observations, that centenarians  perhaps movements as much as people  maintain the continued ability to create and invent. Thus among the challenges facing the College of Pastoral Supervision and Psychotherapy are the following:

     to maintain the courage to espouse beliefs not initially shared by others,

     to maintain the willingness to tackle the apparently impossible task, and

     to maintain the continued ability to create and invent.

    (Each time I speak to you as an historian, I discover and recover one more challenge from your distant past. One of these days you may learn not to invite me!)

    I once was lost, but now am found.8 I am honored to be with you. The phone call from Chaplain Raymond Lawrence, pulling my work out of oblivion, pulling together pieces of my life, has revitalized me as a person. I also hope and trust that benefits accrued to others here tonight. I am thankful to be alive, sustained, and enabled to be with you this day. I value your friendship in coming years.

    Shalom.

    #

    1,868 words

    Endnotes

    1 added stanza, mid 19th c, to Amazing Grace, late 18th c.

    2 Boisen, Anton T., The Exploration of the Inner World: A Study of Mental Disorder and Religious Experience, Chicago: Willett, Clark & Co, 1936. p.v;

    Boisen, Anton T., Out of the Depths: An Autobiographical Study of Mental Disorder and Religious Experience, New York: Harper & Brothers, 1960, pp.47, 52;

    Powell, Robert Charles, Whatever Happened to CPE  Clinical Pastoral Education?1999, published on the web at http://www.cpsp.org/documents/interest/powell_address.htm.

    3 Dunbar, Flanders, Psychiatry in the Medical Specialties, New York: McGraw-Hill, 1959, p.374.

    4 Ibid, pp.465, 461, 464, 153, 459, 460.

    5 Thornton, Edward, "The 'Secret' of Clinical Pastoral Education" [editorial], Journal of Pastoral Care, 36 (3): 145-146, 1982, p.146.

    6 Baur, Susan, The Intimate Hour: Love and Sex in Psychotherapy, Boston: Houghton Mifflin, 1997, p.273.

    7 Powell, Robert Charles, Emotionally, Soulfully, Spiritually Free to Think and Act: The Helen Flanders Dunbar (1902-59) Memorial Lecture on Psychosomatic Medicine and Pastoral Care, Journal of Religion and Health, 40 (1): 97-114, spring 2001, pp.108-109.

    8 Amazing Grace, late 18th c.


  • 04 Apr 2001 9:17 PM | Perry Miller, Editor (Administrator)

    In pastoral care, counseling, and psychotherapy, has there been a paradigm "shift," as suggested by Hunter (Christian Century October 17, 2001), following Patton (1993), following Kuhn (1962)? Or has there been, rather, a "wandering," across the last thirty or more years, of the core working assumption? I would like to suggest the latter. Most authorities  and thoughtful non-authorities  would agree that the movement for specifically clinical pastoral training of the clergy indeed broke new ground between 1925 and 1930, first in the United States, with steady spread to religious communities worldwide. To be sure, "pastoral care," of a generally dry, intellectualized, universalized variety, existed sparsely much earlier, but few would confuse exhortations and visitations with the richness of what is considered the best of pastoral care today.

    After Anton Theophilus Boisen's sudden, creative insight, however initially delusional, about "breaking a hole in the wall separating religion and medicine," pastoral care could never be the same. Boisen's arresting consideration of suffering souls as the "living human documents" of theology forced a true paradigm shift. All roads in clinical pastoral education, no matter how much some may wish to deny it, lead back to Boisen's "Challenge to Our Seminaries" (1926), his Exploration of the Inner World (1936), and his notion of "cooperative inquiry." All else is commentary.

    Boisen knew he was leading a revolution. "What is involved is a thoroughgoing shift of attention and a new method of attack and then, in the end, a new authority [for the clergy], grounded not in tradition but in experience." Boisen called for an "internship" year of supervised field training during which young clergy might deal with "living human documents and with actual social conditions in all their complexity" (1926). That shift  from books to the nitty-gritty world  had something intrinsically compelling about it, sparked by a patient turned clinician on behalf of suffering patients. Subsequent wanderings  however valuable and well intentioned  have had a tone of forced embellishment, prompted more by social maneuvers on behalf of those offering than on behalf of those receiving care. "Applying" family systems theory and narrative theory sounds all well and good, but Boisen simply knew he was working side-by-side with a person, an individual "text." Moving toward "communal-contextural" concerns (Patton, 1993)  eg, of "gender, race, ethnicity [and] aging, together with their associated forms of oppression, abuse and violence" (Hunter, 2001) may have helped clergy broaden their vision toward actually seeing more suffering persons, but it is debatable as to whether it offered anything further for the suffering persons themselves.

    Boisen tossed his students into the fray, the "communal context," asking them to join with another person's nascent curiosity about his or her "beliefs  amid the complex entanglements of actual life" (1936). His later  Outlines for the Co-operative Study of Personal Experience in Social Situations (1946) emphasized that "actual service to human beings in need," getting close enough to view life through their individual eyes, was what held out the hope of "true understanding" that could allow even more specifically "effective service." The image was not of preaching to, ministering to, shepherding, or showing concern. The image was of two sincerely curious investigators  the one with specialized clinical pastoral training  sitting side by side, struggling to comprehend, to repeat, their "beliefs  amid the complex entanglements of actual life" (1936). This was "cooperative inquiry"  neither "too personal" nor "too impersonal"  as firmly embedded in the social milieu as one could imagine. Boisen's colleague, Helen Flanders Dunbar, later spoke of this as avoiding fancy theories of cause or purpose and of simply working closely, intelligently with the person in need, toward discerning "a point of effective intervention" for the problem at hand (1943).

    Remembering Boisen's work helps illuminate Hunter's comments, wherein he calls for an "integrative, praxis-oriented, theological form of inquiry," and for "plumbing the depths of meaning involved in caring, [as well as] in the humanity . . . and in the divinity" "thus disclosed"(2001). Boisen proposed dealing "at first hand with the raw material of some definite segment of human life," so that "we may be able to arrive at some valid generalizations regarding the meaning of the idea of God, the nature and function of religion, and the conditions under which maximum self-realization is likely to be achieved" (1936). Like Hunter, Boisen would grieve that a "generation of pastoral counselors has been theologically educated but not clinically formed in theologically based, pastorally defined programs." He would second the call for "a distinctly pastoral, therapeutically informed art of spiritual and moral counsel" (2001). Hunter's overview of the current confusion allows us to follow the "wandering paradigm" back to its origins: Boisen's vision of "cooperative inquiry."

    ___________________________

    Robert Charles Powell, M.D., Ph.D., a psychiatrist and historian is one of the leading authorities on Anton Boisen, Flanders Dunbar and the early beginnings of the pastoral care movement.


  • 08 Mar 1999 8:50 PM | Perry Miller, Editor (Administrator)

    Entire draft manuscript: copyright, 1999, Robert Charles Powell.
    webpage circulation.

    Whatever Happened to "CPE" -- Clinical Pastoral Education? 

    Robert Charles Powell, MD, PhD 
    keynote address honoring 
    Anton Theophilus Boisen 
    3/18/99, Virginia Beach, Virginia, at the Ninth Plenary Meeting, of the 
    College of Pastoral Supervision and Psychotherapy

    Whatever happened to CPE? Good question. Let me enunciate several other good questions up front. Whatever possessed you, such that the College of Pastoral Supervision and Psychotherapy decided to invite an MD-psychiatrist/PhD-historian to address a room full of theologues? Were you out of your minds? Whatever possessed me, such that I decided to accept? Surely you've handed me an impossible task with which I am doomed to fail. That being the case, in the manner of the Rev.Mr. Anton Theophilus Boisen (1876-1965), the spiritual progenitor of CPE, I have opted to embrace failure, to fail openly with, as he would say, "hope and courage."1 I do not, however, want to fail alone. Nor would he. [Please -- if you will -- please find a pencil or pen and some paper, to jot down notes -- not about what I say, but about what thoughts and associations you have about what I say. The CPSP "Covenant" asks you to "make a space for one another and stand ready to midwife one another. . . ." Please hear me out -- but not passively. Stand ready to expand my presentation.] I accept responsibility for tossing out "half-baked" ideas, but, as I lead you "down the garden path" in this essay, I ask you to commit yourselves to helping me get these ideas "more fully-baked."

    In 1976 I addressed what was then the Association of Mental Health Clergy 2 on Boisen's 100th birthday, exploring in depth his delusion about "breaking a hole in the wall between religion and medicine." 3 As delusions, beliefs not initially shared by others, go, that was an easy one for the chronically sane to absorb, and the AMHC distributed or sold about 2,000 copies of my "Boisen Booklet" on this theme. Just as Boisen exhorted us to attend to the whole of a human being, as a "living human document" of theology, some twenty years ago I challenged those working in pastoral care to take Boisen himself entirely seriously, delusions and all. No one that I know of, however, took the bait when I outlined, in the voluminous footnotes of the "Boisen Booklet," a second of Boisen's key delusions. 4

    Throughout the latter half of his life Boisen puzzled over a delusion about the "family of four." Five days before having the insight about religion and medicine, Boisen sat down to revise his theological "statement of belief." He first alluded to the death of Jesus on the cross, "where he died, . . . the perfect for the imperfect, the strong for the weak," then felt suddenly compelled to conclude that the weak and the imperfect should no longer accept this sacrifice and that they should be willing to give their lives, the imperfect for the perfect and the weak for the strong, that the divine may be freed from its prison house of infirmity and be able to come into the world in beauty and power. . . . He envisioned these types of people, the perfect, the imperfect, the strong, and the weak, as a forever intertwined, unified "family of four." He later added that "the essence of this idea was that of . . . setting the best types free from the appeal of those whose love was based on need." 5

    On the theological level and on the strictly personal level, Boisen considered many interpretations of this idea across time. On the practical level, this delusion determined Boisen's mission within the CPE movement from 1930 until his death in 1965. The "family of four," on one level, included both Helen Flanders Dunbar, BD, PhD, MD, MedSciD, Medical Director of the Council for the Clinical Training of Theological Students, and Austin Philip Guiles, BD, PhD, Field Secretary of the CCTTS and later supervisor in the rival Institute for Pastoral Care. Boisen interpreted the delusion, on one level, as instructing him to "give Dunbar over to Guiles" -- that is, that he, Boisen, was to keep fostering a relationship between the so-called "New York" and "Boston" poles of the movement, despite their natural tendency to mix like water and oil. 6 As outlined in his classic sociology treatise, Religion in Crisis and Custom . . . (1955), Boisen considered the splitting and unifying of groups to be a non accidental significant norm. 7 While he did not want the factions of CPE to be antagonistic or assimilated, he did want them to be productively confronting of each other and engaged in dialogue.

    For those of you who read footnotes, the cryptic footnote number 151 in my "Boisen Booklet" concerns one consequence of this second key delusion alluding to but not mentioning the rumor that Dunbar asked and Boisen told Guiles to accompany her, Dunbar, on a tour of the healing center in southern France at Lourdes -- a research trip that led to one of Dunbar's most poetic, beguiling articles. Whether the rumor was true or false, the point is that Mrs. Guiles believed it and became furious, which added, shall we say, to creative tension within the movement. As much as anything else, this rumor, driven by Boisen's delusion, led to the break between the "New York" and "Boston" camps. At a crucial juncture Mrs. Guiles, backed by the wealth of her father's "Earhart Foundation," encouraged Guiles to seize hold of the training centers he had supervised, while Dunbar literally seized hold of the Council, snatching its charter off the table at a board meeting and whisking it to New York. 8

    You may have noted how I keep using phrases like, "the theological level," "the strictly personal level," "the practical level," etc. Both Boisen and Dunbar had this notion of multiple levels of meaning constantly on their minds. Boisen believed that patients' symptoms "are not merely the results of past causes," but "also attempts at a new synthesis" -- attempts at reconciliation -- attempts at cure. 9 These attempts at synthesis, reconciliation, and cure -- at achieving healing and wholeness -- are, he and Dunbar believed, powerfully mediated through symbols. Dunbar, still world renowned for her first book, Symbolism in Medieval Thought . . . (1929), drew a crucial distinction between three levels of symbolism:

    (1) the association, extrinsic, or arbitrary symbol 
    (this stands for that) -- more properly called "the sign";

    (2) the comparison, intrinsic, or descriptive symbol 
    (this resembles that) -- more properly called "the simile"; and

    (3) the semblance, interpretative, or insight symbol 
    (this reveals many thats) -- the symbol proper, 
    upon which she was to place her attention. 10

    Dunbar spoke of the insight symbol as that which reaches "out toward the supersensible," toward "a Reality . . . greater and truer than the symbol in all its aspects." A "true insight symbol," she believed and you need to understand, "depends on the continual re-creation and expansion of its meanings." Therefore, with an insight symbol, "all meanings are true," and they "are often all intended at once." Dunbar considered insight symbols as mediators between a person's inner and outer worlds, and that much in the realm of healing and wholeness could be achieved through "careful handling of symbolism." 11

    Many know of Dunbar's epoch-making volume in psychosomatic medicine, Emotions and Bodily Changes . . . (1935), whose "Part One" constitutes a subtle philosophic essay on the integrative aspects of the human organism, specifically on the unifying power of emotion. 12 Few realize, however, that another volume was funded to explore these integrative, unifying powers from the religious rather than the medical point of view. The companion volume supposedly never appeared -- yet it did. In 1971, following the money trail, and noting the brilliance with which he had developed his own understanding of the role of religious symbolism, I asked the Rev.Dr. Carroll A. Wise, Boisen's assistant then successor in the original CPE program, if the first of his books, Religion in Illness and Health (1942) was perhaps the missing text. He answered, "Yes." He went on to add that Dunbar, ever aware of political realities, was "reticent in having too much recognition of her influence . . . " upon his work.13

    Let us go back now to Boisen's intriguing notion about the "family of four," made up of forever intertwined weak, strong, imperfect, and perfect people. I emphasize this delusion because it both defines my predicament -- the necessity of sacrificing myself, the theologic weakling, such that you, the stronger ones, may thrive -- and defines what I see as CPE's challenge -- the necessity of speaking with authority and presence from a position of accepted vulnerability. This is also a stance some of us have become increasingly clear about encouraging our patients to consider. I call this notion "acceptance without surrender" -- the acknowledgement of one's imperfection without allowing that as an excuse -- the acknowledgment of one's imperfection while searching there for insights and understandings of potential value to both oneself and those outside. 14 Take, for example again, the crucifixion of Jesus. If there ever was a classic case of someone getting little but lemons yet still managing to make lemonade -- of speaking with authority and presence from a position of accepted vulnerability -- the story of Jesus has got to be it. Not far behind would be the thought-provoking story told by Andre Schwarz-Bart in The Last of the Just (1959)--of doomed Jews conveying redemptive power through their personally unexpected courage in the face of unsought death. 15

    So whatever did happen to CPE? That was the question you posed to me primarily, I suspect, because at the 50th anniversary conference of the Association for Clinical Pastoral Education in 1975 I delivered an address entitled, "Questions from the Past (on the Future of CPE)," in which my narrative explored eight questions I thought Boisen would have asked were he there. 16 These questions, which I encourage you to ponder as I note them, were:

    "Whatever happened to pastoral social work?"
    ". . . to religious diagnosis?"
    ". . . to preventive pastoral care?"
    ". . . to 'everyday,' or 'maintenance,' pastoral care?"
    ". . . to the theology of pastoral care?"
    ". . . to religious rituals and symbolism?"
    ". . . to religious research within CPE?" and
    ". . . to the development of a critical tradition within CPE?"

    Perhaps you quite reasonably hoped for a reprise and update of that presentation. The question, however, "Whatever Happened to CPE?" can still be taken several different ways. Do we mean

    (a) "How has CPE developed since its 50-year mark in 1975?" or

    (b) "Where did it go? To where did CPE disappear?" or

    (c) "Whatever happened to Boisen's vision within CPE?"

    I will spend a minuscule amount of time noting how CPE developed over the last almost twenty-five years, reassuring us in passing that it did not disappear, but I will devote the remainder of my comments to evaluating "Whatever happened to Boisen's vision?" as suggested by the Boisenesque questions above.

    Overall reaction to my presentation in 1975 was polite but defensive. Respondents implied that CPE had moved beyond the "old myths," the original concerns, and that the cutting edge of CPE thought was to be found in full-length books, not in the shorter articles upon which I had focused my review. 17 Others, however, had apparently already keyed into my concerns, as within only several years a number of publications appeared speaking to themes I had raised. Without attempting to be comprehensive, I nonetheless want to draw your attention to the following:

    Paul Pruyser's The Minister as Diagnostician (1976); 18

    Donald Denton's Religious Diagnosis in a Secular Society (1997); 19

    George Fitchett's Spiritual Assessment . . . (1993); 20

    Kenneth Pargament's edited Religion and Prevention in Mental Health (1992); 21

    Thomas Moore's Care of Soul . . . (1992) 22

    Paul Holinger's Pastoral Care of the Severe Emotional Disorders . . . (1985); 23

    Charles Gerkin's The Living Human Document . . . (1984); 24

    John Patton's From Ministry to Theology . . . (1990); 25

    Charles Lopez's dissertation on developments in CPE from 1950 to 1985 (1986); 26

    My own article which serves as a preface to empirical theology (1976); 27;

    I also recommend several recent articles:

    Joanne Greer's "Linkages between Theological Reflection and Empirical Research" (1995) (envisions "empirical research as . . . ongoing self-reflection" and reminds that "after the data has been coded and its impact assessed, the last step is to reflect upon and try to appreciate what God has wrought"); 28

    Robert Duffett's "The Intellectual Foundations of Pastoral Counseling: A Perspective on the Future of the Profession" (1995) (re maintaining integrity in the so-called "managed care" environment); 29 and

    Rodney Hunter's ". . . Postmodernism and the Future of Pastoral Care" (1997) (calling for a "psychologically informed turn to committed religious practice" within a "covenant community"). 30

    One of the main reactions possibly to my presentation was a concerted effort to nourish in-house investigators and historians, an effort that brought scattered success. The annual Abstracts of Research in Pastoral Care and Counseling, begun in 1971, was really flying by 1982. Two award programs arose, in 1982 and 1983, honoring original investigations. The ACPE published a Research Primer . . . 31 in 1988, and launched the ACPE Research Network Newsletter in 1989. Nonetheless, "A Systematic Review of the Quantity and Quality of Empirical Research Published in Four Pastoral Counseling Journals" observed that while pastoral counseling had "integrated the clinical skills of the other mental health disciplines," it had been "far less successful in adopting the scientific method." 32 In stark contrast is the fact, discovered while preparing this paper, that Boisen's now ancient research is cited ubiquitously, with appreciation and serious analysis, in texts on the psychology of religion.

    On the historical side, while Allison Stokes' Ministry After Freud . . . (1985), builds cleanly upon my earlier work, almost as if adding extra chapters, several other attempts at historical commentary stand as detriments to understanding. Without noting the culprits' names, let me bluntly set straight the record:

    (1) Boisen's diagnosis was NOT of manic-depressive disorder; despite the article by a medical student, later psychiatrist, who had suffered psychosis; observations by Wise and Pruyser, among others, make it quite clear that Boisen definitely had schizophrenia. The article cited seemed to want to diminish the magnitude of Boisen's illness and his attempts to overcome it. The wonder is that he lived so long, and through so many episodes, with the mortality rate for acute agitated catatonic states being as high as it is. 33

    (2) Milton Erickson, MD, talented therapist that he later became, was NOT the "grandfather" of CPE as one author alleged, especially if the grounds for this claim are that he, as Boisen's assigned ward psychiatrist supposedly enabled Boisen's recovery and further work; both Boisen and Wise made it clear that Erickson, at that phase of his career, was clueless regarding how to approach psychosis, and that it was Dunbar who, by means not specifically known, popped Boisen out of his 1930 episode of psychosis. The article cited seemed to want to extract some of Boisen's glory as "father" to the CPE movement and place it one step back, somehow allied to magical therapy.

    The far more important point is that it was something about the power of pure and simple love -- "the love that moves the sun and the other stars," he tells us via a cryptic reference to Dante -- that revived and steadied Boisen. While we know that Dunbar flirted, not necessarily on a conscious level, and we know from the apparently ever-truthful Boisen that he got only to the brink of physical intimacy, it adds to the poignancy of his accomplishment that he did not shy away from struggling with the nature of love even from within the essential loneliness of schizophrenia. 34

    (3) Dunbar did NOT commit suicide, despite a reviewer's comments upon Stokes' words and others' suggesting that. Coroners' data support a diagnosis of coronary arterial spasm, leading Dunbar to drown in her private pool; Dunbar's daughter had been with her minutes before and found her minutes after, which underscores the happenstance nature of the death. The article cited seemed to want to suggest some aura of failure at the end of Dunbar's career. On the contrary, while she indeed suffered from others' mischaracterization of her theories in psychosomatic medicine, one of her best-written volumes, Psychiatry in the Medical Specialties (1959), came out on the eve of her death. 35

    Am I the only one who finds it disturbing that a disproportionately large sample of the CPE movement's so-called historical commentary over the last twenty years is not only just plain wrong but also denigratingly biased? As noted in the first issue of the infamous ACPE Underground Report, which arrived in various mailboxes around Christmas week of 1987, "There seems not much more left of Boisen in ACPE than his cane." 36 It was at the 50th anniversary celebration in 1975 that the custom began of handing down "Pappy's" cane to the Association's incoming president. At that very time it had struck me as odd, for, as I had noted in my keynote address earlier that day, Boisen's name appeared nowhere on the program. So, yes, by the time CPSP was getting itself founded some fifteen years later, that cane seemed to have become a spiritless artifact, an empty symbol that, much to what should have been everyone's horror, was whittled down, emasculated in 1991 into, heaven help us, a magical wand! 37

    While reviewing the literature I came across another "smoking gun," displayed without embarrassment or chagrin, as a 1982 editorial in the Journal of Pastoral Care. 38 Revealing, supposedly for the first time publicly and in writing, the "secret" of CPE, the editor noted that the soul of CPE had been in that supervisors' goal was "not education but transformation -- transformation of themselves first of all and ultimately of their students." The editor then went on to opine that the "central mythic enactment," "the mystery of the laying on of CPE hands," the secret soul of traditional CPE was dead -- that the field had matured, moving on toward "objectification, quantification, and verification," a more rigorous albeit soul-less existence! While that editor subsequently rediscovered a personal spiritual life, the editorial stood unchallenged, as far as can be seen, as a most curious proclamation in the movement's flagship publication. Can one do other than cry out in paraphrase, "Father, forgive them, for they know not what they say"?

    While that editor, without sorrow, tried to consign CPE to a soul less existence, he nonetheless provoked at least two important questions about the enterprise. First, how are we actually preparing the next generation in this clinical pastoral field? Second, how does what we call this enterprise shape our vision? Boisen and Dunbar clearly thought in terms of "facts first" -- that the novice needed to gain a knowledge base, needed to learn something, know something, specifically, about a few specific human beings -- that the novice had to do some original "research," so to speak, and be "trained," before he or she could move on to the more interactive processes of education and supervision. 39 During the 1970s and somewhat subsequently, most CPE appeared to have thought it could skip over the "training phase," in which both sacrosanct human documents, real people in crisis, and experts spoke with authority, to an interactive "education and supervision phase" that soon overshadowed the "transformation phase" that should come next, the never ending phase of growth. Beginning with the 1970s, most CPE appeared to have become preoccupied with producing an educated and supervised product. While the literature became overflowing with admonitions about theological reflection, this, too, appeared to be envisioned as an add-on, as in "Oh, yes, this certificate attests that I theologically reflected on January 13, 1983," etc., etc. Although the specter of so-called "managed care" and decimated budgets initially accelerated this focus on "the theologue as product," it eventually encouraged re-focus on "the pastoral service as product," which once again allowed consideration of the unique theologue delivering the service. It is well worth asking the degrees to which we want this pastor to be trained, then educated and supervised, and then transformed. Should we be calling this clinical pastoral training? clinical pastoral education and supervision? or clinical pastoral transformation ? I have argued elsewhere that mature theological reflection does not come early, and that many students are not ready for it. 40 While the seminary student tends to focus on his or her own internal problems and theological identity, the more established pastor or chaplain might be more able to endure the emotional discomfort of working with the distressed, and more free to participate in exploring the theological issues involved. The CPSP seems to grasp this, and perhaps its programs, let me suggest -- especially its latest one for established pastors and chaplains -- might best be characterized as programs supporting ongoing "clinical pastoral transformation." 41

    So, getting back on track, whatever happened to CPE? After an initial fifty years of development, whatever happened to clinical pastoral education? You know the awful answer: By 1980, if not before, clinical pastoral education had lost its soul. That is my conclusion, just as it was yours. Through the Underground Report, however, supervisors called a spade a spade and tried to get that soul back. It is no wonder, then, that the "Covenant" of the College of Pastoral Supervison and Psychotherapy focuses, front and center, on the "recovery of soul."

    Allow me to quote in mere chronological order some of the "cries in the wilderness" recorded in early issues of the Underground Report. A lot of wisdom appeared in those letters to the editor, as the writers called out for

    that something that "feeds and fosters growth"; 42

    "the discernment-of-spirits model of decision-making instead of the majority-rules model . . ., engaging in prophesy instead of strategic planning"; 43

    "a fecund movement. . . . viable, creative, growing, fertile, surrounded by semen or manure and life-giving"; 44

    something "life-giving and energizing"; 45

    the "values of 'chaos and faith' "; 46

    "more of a small group/ tribal atmosphere"; 47

    "a better way to be theologically serious"; 48

    "the awareness that we are a peculiar people, in desperate need of generous professional peers who can be a professional resource for our living and loving in the practice of our ministry"; 49

    "attention to the larger communal issues of value"; 50

    "a redemptive community"; 51

    "a supportive and challenging community of fellow pilgrims." 52

    Out of such sentiments grew the eventual College of Pastoral Supervision and Psychotherapy in March 1990, nine years ago this week. 53

    The CPSP and its members almost immediately had to tackle, even embrace, the necessity of speaking with authority and presence from a position of admitted vulnerability. One could argue that what you had to do as a community powerfully and positively transformed your lives and your pastoral care. The challenge is how to continue the "recovery of soul." I have been leading you "down the garden path" -- a long and winding one through the past -- because I believe that rediscovery of some of the old notions as you revitalize CPE.

    Along with other writings thus far noted, I recommend that you take another look at Wise's magnum opus, Pastoral Psychotherapy . . . (1980). 54 Wise seems to suggest that pastors be firm, yet humble, to listen and to be there. The pastor, he believes, "is called upon not to do but to be." He reminds us that the "religious ideas of a person, if listened to carefully, become a form of symbolic communication" and "are more than ideas in the abtract." In language similar to that used fifty years earlier by Boisen and Dunbar, Wise reminds us that the parishioner's religious ideas "have a vital relationship to the inner life . . . and to his interpersonal experiences," and "are symbolic in form since they express intangibles like meaning, value, and relationships." Without mentioning per se the concept of the insight symbol, that true symbol that reaches "out toward the supersensible," and that "depends on . . . continual re-creation," Wise nonetheless notes that "religious symbols pick up . . . goals from deep, instinctive dimensions . . . and transform them into higher, creative goals." "Growth requires the constant expansion of the meaning of religious symbols. . . ." Through appreciating the depths and potential heights of the "living human document" in front of him or her, the pastoral therapist "faces the experience of learning, unlearning, and relearning theology." 55 That whole thought bears repeating: "religious symbols pick up . . . goals from deep, instinctive dimensions . . . and transform them into higher, creative goals." "Growth requires the constant expansion of the meaning of religious symbols. . . ." Through appreciating the depths and potential heights of the "living human document" in front of him or her, the pastoral therapist "faces the experience of learning, unlearning, and relearning theology." The CPSP, let me suggest, has much to gain from assuming a stance that has authority and presence yet is open and humble, constantly eager for rebirth.

    Ending somewhat as I began, but by now on what I hope you perceive as a more affirmative tone, let me again ask: Whatever did possess you, such that you decided to invite a non-theologian to address a room full of theologues? Were you out of your minds? Maybe you were. Then again, perhaps it is now clear that maybe you should try being out of your minds a bit more often -- as long as you have trusted colleagues to help you find your way back. Boisen would probably argue the importance of being comfortable with madness and open to its potential insights, theological and otherwise. Whatever did possess me, such that I decided to accept this impossible task? Heaven only knows, but I'm glad that I did. Preparing this essay has been an important, reflective experience for me. Possibly I, too, have had some "recovery of soul." Possibly you, too, with "hope and courage," will not shy away from tackling the apparently impossible task. Since I am a physician, let me leave you with two images relating to this theme from "my side of the tracks":

    (1) During medical school, I once at 3am, because I could not get an i.v. into a patient's arm, woke up an intern. With wisdom not anger he sleepily gave me a crucial bit of insight that has served me well. He said, "If the task is impossible, what makes you think I can do it any better than you?" Remember that. I went back to the patient, and somehow he and I got the i.v. into his arm.

    (2) Early in my career, I developed a knack for working with psychotic patients and normal adolescents -- sometimes it's hard to tell the difference -- essentially by entering into the person's system with an open mind, admitting my ignorance, but refusing to entertain unsupported conclusions. This approach irritated one of my colleagues. Not with wisdom but anger he unknowingly gave another bit of insight that has served me well. He said, "Your patients get better because you have the delusional belief that they will!" Think about that one: my patients get better because I'm willing to be considered deluded. I can live with that. Can you? Perhaps CPE will recover its soul precisely because you are willing to tackle the apparently impossible task and not worry about being considered deluded, espousing beliefs not initially shared by others. Is this not the true legacy of the Rev.Mr. Anton Theophilus Boisen? Thank goodness he undertook the exploration of the inner world, leading us out of the depths, insisting that even the weak and the imperfect had a forever intertwined role to play, assisting the strong and the perfect, "breaking a hole in the wall between religion and medicine." 56

    It is now long past time for me to stop talking. I did ask you up front to commit yourselves to helping get some of my "half-baked" ideas "more fully-baked," to "make a space" for me yet to "stand ready to midwife" my nascent thoughts. Now it is your turn to talk, even to argue a bit, about what has become of CPE, and especially about your progress in recovering its soul.

    __________ 

    + See "Afterword" regarding others' valuable contributions to this manuscript after suggestions and comments were solicited at the CPSP webpage. Dr. Powell may be contacted at 847/ 441-8283; 1520 Tower Road, Winnetka, Illinois, 60093-1627. __________ 

    Endnotes

    1
    This is an allusion to Boisen's hymnal for use in mental hospitals. It was initially called Lift Up Your Hearts . . . , Boston: Pilgrim Press,1926, but was reissued in three revised, enlarged editions as Hymns of Hope and Courage, Boston: Pilgrim Press,1932, 1937, and Chicago: Chicago Theological Seminary, 1950. [Back to text]

    2
    Now part of the Association of Professional Chaplains since merger in May 1998 with the College of Chaplains. The address was published as: Robert Charles Powell, Anton T. Boisen (1876-1965): "Breaking an Opening in the Wall between Religion and Medicine" , pp.47, special supplement to the AMHC Forum, 29(1), October 1976 [Back to text]

    3
    Anton T. Boisen, Out of the Depths: An Autobiographical Study of Mental Disorder and Religious Experience, New York: Harper & Brothers, 1960, p. 91. 

    For review of the history of the clinical pastoral training/education movement, see: Robert Charles Powell, C.P.E.: Fifty Years of Learning, through Supervised Encounter with "Living Human Documents." booklet, 32pp. New York: Association for Clinical Pastoral Education, 1975, reprinted, 1987; reviewed in J. Pastoral Care 36(4): 210, 1982. 

    Edward E. Thornton, Professional Education for Ministry: A History of Clinical Pastoral Education. Nashville: Abingdon Press, 1970. Allison Stokes, Ministry After Freud. New York: The Pilgrim Press, 1985. [Back to text]

    4
    See Powell, Anton T. Boisen (1876-1965): "Breaking . . .," pp. 27-28. 

    For the phrase "living human documents" see Anton T. Boisen, The Exploration of the Inner World: A Study of Mental Disorder and Religious Experience, Chicago: Willet, Clark & Co., 1936. reprinted, New York: Harper & Brothers, 1952, and Philadelphia: Univ.of Pennsylvania Press, 1971. p.185: ". . . I have sought to begin not with the ready-made formulations contained in books, but with the living human documents and with actual social conditions in all their complexity." [Back to text]

    5
    Boisen, Out of the Depths . . . , pp. 88, 89,104, 106, 115, 118-119. [Back to text]

    6
    See Powell, Anton T. Boisen . . ., pp. 35- 36. [Back to text]

    7
    Anton T. Boisen, Religion in Crisis and Custom: A Sociological and Psychological Study, New York: Harper & Brothers. 1955. [Back to text]

    8
    See Powell, Anton T. Boisen . . ., p. 36. H. Flanders Dunbar, "What Happens at Lourdes? Psychic Forces in Health and Disease," Forum 91: 226-231, 1934. 

    Robert Charles Powell, Healing and Wholeness: Helen Flanders Dunbar (1902-59) and an Extra-Medical Origin of the American Psychosomatic Movement, 1906-36 , PhD dissertation, Durham, NC: Duke Univ., 1974, [reprint available via University Microfilms, order # 75-2415, on the "web" at www.umi.com] p. 224, fn. 4. The Council's charter was among Dunbar's papers at the time of her death. [Back to text]

    9
    Anton T. Boisen, "Personality Changes and Upheavals Arising Out of the Sense of Personal Failure," Amer.J.Psychiat.5: 531-551, p. 559

    10
    H. Flanders Dunbar, "The Sun Symbol in Medieval Thought," Master's Thesis, New York: Columbia Univ., 1923 

    H. Flanders Dunbar, Symbolism in Medieval Thought and Its Consummation in the Divine Comedy, New Haven: Yale Univ.Press, 1929 [= PhD dissertation, New York: Columbia Univ., 1929] reprinted New York: Russell and Russell, 1961, and again by Atlanta, GA: SOLINET, 1994.

    11
    Dunbar, Symbolism . . . , p.11. Dunbar, "The Sun . . .," p. 4. Dunbar, Symbolism . . . , p.14. H. Flanders Dunbar, "Mental Hygiene and Religious Teaching," Ment.Hyg. 19: 353-372, 362.

    12
    H. Flanders Dunbar, Emotions and Bodily Changes: A Survey of Literature on Psychosomatic Interrelationships: 1910-1933. New York: Columbia Univ. Press, for the Josiah Macy, Jr. Foundation, 1935. revised and enlarged in 1938, 1946, and 1954.

    13
    Powell, Healing and Wholeness . . . ,pp. 240-241, fn. 4; Carroll A. Wise, Religion in Illness and Health. New York: Harper's Brothers, 1942.

    14

    Robert Charles Powell, "Acceptance without Surrender: An Attitude within which We -- the Mentally Ill, the Family, and the Psychiatrist -- Might Work Together." invited address presented before the 3rd Annual Conference on Family Support & Advocacy, Alliance for the Mentally Ill - Northwest Suburban, Arlington Heights, Il., October 1993.

    15

    Andre Schwarz-Bart, The Last of the Just. original French, 1959; translation, New York: Atheneum Publishers, 1960.

    16

    Robert Charles Powell, "Questions from the Past (on the Future of Clinical Pastoral Education). Invited keynote address, presented before the 50th Anniversary Conference, Association for Clinical Pastoral Education, Minneapolis, October 1975. 1975 Conference Proceedings: 1-21, 1976.

    17

    Edward E. Thornton, "The Meaning of History for Today and the Future: A Response to Robert C. Powell," 1975 Conference Proceedings: 22 27, 1976 

    Robert A. Preston, "Watch Out How You Are Listening. Consider What You Are Hearing," 1975 Conference Proceedings: 28-32, 1976

    18

    Paul W. Pruyser, The Minister as Diagnostician. Philadelphia: Westminster Press, 1976. Pruyser's questions concern "communion," "awareness of the holy," "providence," "faith," "repentance of sin," "grace," and "sense of vocation"; they must be compared to Boisen's on "sense of the mysterious and the uncanny," "sense of peril," "sense of personal responsibility," "erotic involvement," "philosophy of life" (about God), " religious concern," and "plans for the future." See Robert Charles Powell, "Anton T. Boisen's 'Psychiatric Examination: Content of Thought' (c.1925-31): An Attempt to Grasp the Meaning of Mental Disorder," Psychiatry 40: 369-375, 1977. Boisen refers to these questions in his The Exploration . . ., but this is the first publication other than by mimeograph of the original full set. See note 19 below.

    19

    Donald Denton, Religious Diagnosis in a Secular Society: A Staff for the Journey. Lantham, MD: Univ. Press of America, 1997. He uses three axes, "the concrete feeling of guilt," "the religious concept of sin," and the cosmic theme of defilement." see note 18 above.

    20

    George Fitchett, Spiritual Assessment in Pastoral Care: A Guide to Selected Resources. Decatur, GA: J. Pastoral Care Publications, 1993.

    21

    Kenneth I. Pargament, Kenneth I. Maton, and Robert E. Hess, eds., Religion and Prevention in Mental Health: Research, Vision, and Action. New York: The Haworth Press, 1992.

    22

    Thomas Moore, Care of Soul: A Guide for Cultivating Depth and Sacredness in Everyday Life. New York: HarperCollins, 1992.

    23

    Paul C. Holinger, Pastoral Care of the Severe Emotional Disorders: Principles of Diagnosis and Treatment. New York: Irvington Press, 1985. This is a revision of two meaty articles; see Pastoral Psychology 27: 136-150, 1979, and J.Pastoral Care 34 (3): 177-189, 1980. Holinger is a psychiatrist with a Master of Divinity degree.

    24

    Charles V. Gerkin, The Living Human Document: Revisioning Pastoral Counseling in a Hermeneutical Mode. Nashville: Abingdon Press, 1984.

    25

    John Patton, From Ministry to Theology: Pastoral Action & Reflection. 

    Nashville: Abingdon Press, 1990.

    26

    Charles J. Lopez, Jr., Pastoral Counseling: Changes and Development, 1950-Present. ??PhD dissertation, Columbia Pacific Univ., ?1986.

    27

    Robert Charles Powell, "Empirical Theology, 1916-1946: A Note on the Contribution of Anton T. Boisen." invited address, presented before the Autumn Convocation, Chicago Theological Seminary, September 1976. Chicago Theological Seminary Register 67: 1-11, 1977.

    28

    Joanne Greer, "Linkages between Theological Reflection and Empirical Research." Abstracts of Research in Pastoral Care and Counseling. Columbia, MD: Congress on Ministry in Specialized Settings, 1995. pp. [xii-xiii]

    29

    Robert Duffett, "The Intellectual Foundations of Pastoral Counseling : A Perspective on the Future of the Profession." J. Pastoral Care 49 (3): 255-263, 1995.

    30

    Rodney Hunter, "Guest Editorial: A Bird's Eye View: Postmodernism and the Future of Pastoral Care." J.Pastoral Care 51(4): 373-375, 1997.

    31

    Larry Vande Creek, A Research Primer for Pastoral Care and Counseling. Decatur, GA: Journal of Pastoral Care Publications. 1988.

    32

    John Gartner, David B. Larson, and Carole D. Vachar-Mayberry, "A Systematic Review of the Quantity and Quality of Empirical Research Published in Four Pastoral Counseling Journals." J. Pastoral Care 44 (2): 115-129, 1990, p.123.

    33

    Carol North and William M. Clements, "The Psychiatric Diagnosis of Anton Boisen: From Schizophrenia to Bipolar Affective Disorder." J.Pastoral Care 35 (4): 265-275, 1981. Dr. North's autobiography, focusing on her successful treatment by dialysis, is of interest even if her diagnosis of Boisen is incorrect. See Carol North, Welcome Silence. New York: Simon & Shuster, 1987. 

    Chaplain L. George Buck, just after my oral presentation of this manuscript told me of, then later supplied copies of, two documents concerning Boisen's admission in late 1935 to the Sheppard-Enoch Pratt Hospital, Maryland: the "Abstract" of his medical record (slightly over two typed pages, single-spaced) and the verbatim minutes of the "Staff Conference" "for Diagnosis" dated 11 November 1935 (slightly over 3 typed pages single-spaced). Let me note that when I sought permission in 1975 to quote from the case records concerning Boisen's hospitalizations in Massachusetts permission was denied because his one remaining relative would not provide consent; that impediment no longer remains.

    From the "Abstract": "His present illness is similar to his previous ones, except that in his relationship this time he believes himself to be on top, whereas formerly he was on the bottom. His ideas center about the family of four  weak accepting from the strong. Time for the weak to do something for the strong -- classifying himself as the weak one. He thought the informant was a Jewess betraying him and then believed he was John the Baptist. . . . He identified himself with Mary Magdalene, referred to Dr. Cabot as being the 'dead Center' of things. . . . He talked about changes going on in the moon, thought the world cold be saved if twins were born every birth because Christ lost his life everytime someone was born."

    From the "Staff Conference": [Boisen:] "I started in despair and began to sing and then felt better. . . . When I began to sing I began to get some hold of myself . . . ." [Physicians:] "Diagnosis -- schizophrenia. Good outlook for this attack. He has recovered from his previous attacks, and this is exactly the same, with the one difference, and that is, when he described the relationship between himself and other people of always putting himself at the bottom and the other people on top, and this time he puts himself on top, which may be a better prognostic significance than the former ones. . . . I try to be optimistic about the outcome, but I am afraid it may not work out that way."

    34

    [Helen Flanders Dunbar] "Certificate of Death [August 21, 1959]." Hartford: Connecticut State Department of Health, August 22, 1959. 

    Flanders Dunbar, Psychiatry in the Medical Specialties. New York: McGraw-Hill, 1959.

    35

    Underground Report 1

    36

    "Male Bashing at Breckenridge [the Association for Clinical Pastoral Education annual conference, 1991]," Underground Report 29 : 1-4, 1992, p.3.

    37

    Edward E. Thornton, "The 'Secret' of Clinical Pastoral Education" [editorial], J. Pastoral Care 36 (3): 145-146, 1982, p.146

    39

    Anton T. Boisen, "Clinical Pastoral Training in Retrospect and Prospect: Remarks at Faculty Luncheon -- Union Theological Seminary. October 30, 1957. 5 pp, lithographed. copy in Boisen's case record at Worcester [Massachusetts] State Hospital; other copies have been seen, and a copy is probably in the ACPE archives.

    40

    Robert C. Powell, "Anton Boisen and Theological Reflection: The Importance of Being 'Still Crazy After All These Years." presentation at Chicago Theological Seminary, 1987

    41

    For more regarding the CPSP program for mature pastors and institutional chaplains, see the "web" at www.cpsp.org

    42

    Underground Report 1 (5): 2, 1988.

    43

    Leonard I. Sweet, Underground Report 1 (6): 4, 1989.

    44

    Robert M. Claytor, Underground Report 1 (6): 4, 1989.

    45

    Lyle Grainer, Underground Report 1 (8): 2, 1989.

    46

    Nick Ristad, Underground Report 1 (8): 3, 1989.

    47

    Carl Brand, Underground Report 1 (9): 4, 1989.

    48

    Raymond Lawrence, Underground Report 1 (17): 2, 1991.

    49

    Perry N. Miller, Underground Report 20: 2, 1991.

    50

    Charles Gerkin's book quoted, Underground Report 23: 3, 1991.

    51

    Raymond Lawrence, Underground Report 22: 2, 1991.

    52

    Perry N. Miller, Underground Report 35: 1, 1992.

    53

    As best I can tell, the meeting that led to the birth of the CPSP opened on March 17, 1990, as the "College of Pastoral Counselors and Supervisors," and closed on March 19, 1990, as the "College of Pastoral Educators and Psychotherapists." Seven months later, on October 19, 1990, it became the "College of Pastoral Supervision and Psychotherapists," later, at some date unclear to me, becoming the "College of Pastoral Supervision and Psychotherapy." The March 1991 issue of ACPE News finally acknowledged the existence of the Underground Report and its offspring. The first plenary meeting of the CPSP occurred March 12-15, 1992.

    54

    Carroll A. Wise, Pastoral Psychotherapy: Theory and Practice. New York: Jason Aronson, 1980.

    55

    Wise, Pastoral Psychotherapy. . . , pp. 27, 16, 17, 276, 57, 62.

    56

    These are allusions, of course, to Boisen, The Exploration of the Inner World. . . and Boisen, Out of the Depths . . . , etc.


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