‘Listening Closely to Wisdom,
Guide Your Heart to Understanding’:
Change has to be Weighed 1
Robert Charles Powell, MD, PhD
First, let me provide some context. This year is
– the 130th anniversary (1892) of the first drafts of Sigmund Freud’s writings about
subconscious emotions & subconscious thoughts –
two essential elements of the psychoanalytic theories about human nature – and of the birth of
Harry Stack Sullivan – who acknowledged such un-manifest emotions & thoughts, but focused on those
observable interpersonal processes that might be become manifest through sincere curiosity & careful listening;
– the 120th anniversary (1902) of the birth of Helen Flanders Dunbar, BD, PhD, MD, MedScD – and of the publication of
William James’ The Varieties of Religious Experience – another study of human nature;
– the 95th anniversary (1927) of Dunbar’s graduation from Union Theological Seminary (NY),
her completion of her first of three doctoral dissertations, and
her completion of her first year of medical school;
– the 90th anniversary (1932) of Anton Boisen’s “The Church and Sick Souls”; 2
– the 70th anniversary (1942) of Carroll A. Wise’s Religion in Illness and Health,
a quiet companion volume to Dunbar’s Emotions and Bodily Changes …; 3
– the 75th anniversary (1947) of Dunbar’s best-seller, Mind and Body: Psychosomatic Medicine,
a popular, down-to-earth book about the meaning of the medical movement she founded –
when she wasn’t busy shepherding Boisen’s clinical pastoral chaplaincy movement;
some of you may not realize that Dunbar ran both movements side-by-side, out of one office;
– the 45th anniversary (1977) of my study on Boisen’s “… Attempt to Grasp the Meaning of Mental Disorder” –
a study published in the journal founded by Sullivan; 4
– the 30th anniversary (1992) of The Harry Stack Sullivan Centennial Conference – chaired by our guest speaker; and
– the 20th anniversary (2002) of the Helen Flanders Dunbar Award for Significant Contributions to the Clinical Pastoral Field.
At last year’s plenary, we discussed, “Challenge: Being Well is Being Free to Accept It or Not;
Being Well is Making the Conscious Choice to Keep on Keepin’ On.”
This year also is
– the 10th anniversary (2012) of a CPSP pre-plenary workshop where we discussed,
“The Challenges of Change and Upheavals” –
as had been written about by Boisen, over seven decades before (1936).
My notes from that session record the propositions that
one challenge is to maintain
perpetual revolution in an established institution,
another challenge is to maintain
very high membership standards while being very humane.
That pre-plenary workshop also concluded, in Boisenesque fashion, that,
in order for us to be frank and honest with one another
we have to be functioning within trusting, supportive relationships,
where we can be accepted and valued for our honest efforts
despite our inevitable failures. 5
The actual plenary ten years ago is when, for CPSP, “the dam broke”. It became crystal clear to most all that this covenant collection of small chapters – spread nationwide – had best be reconceptualized – revitalized – in order to accommodate growth – while retaining the “grass roots,” “bottom up” nature of the organization.
CPSP got started in 1990 because Raymond Lawrence and friends heard and thought deeply about discontents within the clinical pastoral ranks. CPSP stumbled and slogged through the revitalization process of the last ten years by
listening closely – then listening closely again – then listening closely yet again.
“Listening closely” in order to “guide your heart”
seems to suggest NOT running with
a first impression –
a first take on what you think is going on –
a first take on what you think needs to be done.
Notice we are not talking about mere “listening” – but about “listening closely”.
Listening closely – without jumping to conclusions.
Listening closely is not something to be done once – and then you move on.
Listening closely has to be done over and over again.
We must listen closely over and over again.
This year also is
– the 5th anniversary (2017) of an essay published in the CPSP Pastoral Report:
“Tolerance and Encouragement: Is ‘Reverence toward Otherness’ Possible?” 6
Is consideration of alternative views possible?
Listening closely to wisdom –
the wisdom of normal, everyday humans – as well as
the wisdom of the sages.
Guide your heart to understanding –
your inner weighings of what is true or false – while considering
others’ inner weighings of what is true or false.
I am not going to focus on the hard work of the last ten years –
and the continuing hard work in
reconceptualizing and revitalizing this community.
I do wish to honor the many well-thought changes that have been made.
Helen Flanders Dunbar, Anton Theophilus Boisen, and Harry Stack Sullivan – among others –
listened closely – and
observed closely – in
a very engaged way.
Yes, we will be discussing Harry Stack Sullivan.
Many of you may know that Raymond Lawrence has a monograph coming out titled,
Harry Stack Sullivan and Anton T. Boisen:
Comrades and Revolutionaries in Psychotherapy.
Harry Stack Sullivan.
Anton T. Boisen.
Dunbar, Boisen, and Sullivan asked provocative questions –
what I have called “mind-boggling questions” – and
they tried to move the troubled persons with whom they were working
away from memorized narratives –
away from narratives that left out little but important details –
away from narratives that did not realize they were confusing.
CPSP had to evaluate itself with “new eyes and ears” – new views.
CPSP still has to evaluate itself with “new eyes and ears” – new views.
Dunbar, Boisen, and Sullivan had to consider that while
past understandings had value,
new understandings, too, might have value.
Sullivan is said to have had the knack of
empathy for the patient’s actual experience –
the knack of a
for and a
deep understanding of a person’s actual circumstances. 7
According to our guest speaker, F. Barton Evans, PhD,
Sullivan believed that … people’s inner experiences and meanings
– Boisen’s “inner world” –
could be shared … and that carefully drawn, valid inferences
could be made, if … [one] would take pains to listen carefully. 8
Both Boisen and Sullivan focused on the person as embedded – or not – in his or her society –
first, in the “society” of the childhood home – and,
then, in the society of the adult, wider world.
Remember, Boisen, as
one of the earliest university-trained foresters,
studied how each individual tree interacted with its larger forest. Then, as
a budding, somewhat accidental sociologist, he
surveyed religious communities in a similar way –
trying to ascertain how each individual parishioner –
or unchurched resident –
interacted with –
was enmeshed with – or not –
his or her larger neighborhood.
Boisen looked at both
how religious thinking –
thinking about “the things that matter most” –
developed from childhood into adolescence into adulthood – and
how emotional conflicts were resolved –
for the better or for the worst – from childhood into adolescence into adulthood.
His study of 173 patients who had tenuous contact with reality –
research formally started 95 years ago –
after earlier assistance by Dunbar – was
one of the first to collect data in an organized manner about disturbed thought content.
Five years later, Dunbar herself was
one of the first to collect almost ten times as much data about slanted thought content. 9
Our guest speaker has tried to clarify that through
detailed inquiry – and – participant observation – through
uncovering and validating – slowly but surely – the
somewhat lost and/ or obscured interpersonal experiences
behind the story each of us tends to tell about ourself and our work –
unless we are prodded to deeper insight.
Sounding himself somewhat like both Sullivan and Boisen, our guest speaker
admonished colleagues to
focus on the meaning of an individual’s experience,
fitting into an a priori set of concepts, but rather
starting with an individual’s experience as
something to be discovered and not assumed. 10
Sullivan, we are told, emphasized the importance of
establishing and maintaining
an atmosphere of interpersonal security
– that could be achieved through
respectful, empathic listening to the
details and specifics of the client’s experience, informed by the psychotherapist’s
knowledge of human development and interpersonal processes and the client’s
expectation of benefit. 11
Sullivan called this a stance of
respectful seriousness. 12
Sullivan, we are told,
believed strongly that it was more important to understand
what an individual’s actions and thoughts were actually intended for, rather than
what the observer speculated them to mean. 13
the process of interpretation was
an investigation toward mutual discovery. 14
That sounds a bit like Boisen’s
“cooperative inquiry” – a process by which two people
discover a mutual language, so to speak.
tried to lead the suffering, bewildered, or vulnerable person into a
self-questioning process – to lead the person into
becoming a co-investigator, increasingly
curious about his or her own life.
There are many overlaps between Boisen’s work and Sullivan’s work –
but today I am going to focus on only their studies about
loneliness and isolation.
Above, I noted the plenary workshop on “The Challenges of Change and Upheavals” in organizations.
That session was, of course, a take-off from Boisen’s classic 1926 study on
“Personality Changes and Upheavals Arising Out of the Sense of Personal Failure.”
I say “classic” as that was the only article by a non-psychiatrist reprinted in
the American Psychiatric Association’s 1994 review of research during the previous 150 years. 15
On page 3 of that classic article, Boisen commented as follows about a full-page chart summarizing his data:
the central proposition embodied in this scheme finds striking support in
a ‘preliminary communication’ by Dr. Harry Stack Sullivan on
‘The Conservative and Malignant Features of Schizophrenia’ …
July, 1924, which appeared after the chart had been worked out. 16
Of the main predisposing factors contributing to
significant psychic disorganization, Boisen emphasized
a sense of isolation
– associated with experiences of personal failure and traumatic upheaval.
He went on to explain,
The sense of isolation is probably characteristic of
the mentally disordered as a group. They are for the most part
those who have been regarded as … different from their fellows.
The individual who succeeds in becoming
an integral part of some group even though that group be small and peculiar
does not as a rule find his way into our hospitals.
On page 13 of his study, Boisen notes Sullivan’s comments about such patients being
excessively sensitive and extremely self-conscious
– in which case their seeking – if not enjoying – isolation makes some sense.
There is much, much more in Boisen’s article.
In his Exploration of the Inner World … , Boisen also emphasized the
sense of isolation … which acts as a barrier between the individual and his fellows.
He spoke of
individuals of the retiring sort with few friends and few social contacts.
He found that roughly one-third of those he studied were
ignored by their associates. 17
Sullivan spoke about “the lonely ones” – and, as our guest speaker has phrased it,
“the extraordinarily disorganizing power of loneliness in personal development”.
“Sullivan believed that anxiety and loneliness lay at the heart of all mental disorder.” 18
Personally, I have found this focus by Boisen and Sullivan on
the isolated – “the lonely ones” – to be quite valuable.
While the average clinical pastoral chaplain might not encounter that often those with schizophrenia per se,
he or she very likely is called upon to minister to
those who have schizotypal personality disorder – a condition which includes
significant difficulties with social relationships.
Let me add at this point – as I discussed almost two decades ago –
Boisen suggested that all of us needed to cut ourselves some slack.
“we need to allow ourselves … some room for
misunderstanding the true nature of things and for
losing the intended path.
To not allow this is to set up ourselves … for
a potentially devastating sense of failure
if the choices made later turn out to need some correction.
Boisen was concerned that even the healthiest of us might experience
disintegration in response to self-perceived failure and threatened isolation. 19
Remember, Sullivan’s article in 1924 and Boisen’s in 1926 are both early in the respective men’s careers.
That early Sullivan article being cited also comments, on its next to last page,
Far more than any single action of the physician, it is his
general attitude toward the patient that determines his value.
Boisen, both as patient and as chaplain/ therapist, could not have agreed more. He emphasized the importance of
genuine interest in the patient and his [or her] problems
as well as
the discovery and solving of the patient’s actual difficulties.
Boisen believed that clinicians should
discover for themselves the meaning of the different forms of illness and that psychotherapy
depended less on technique than on caring relationships between people. 20
In his Exploration of the Inner World … , Boisen discussed Sullivan’s 1931 paper on treatment, and suggested that
transference be viewed as
a special case of interpersonal adaptation, distinguished chiefly by the role of subordination to
an enlightened … [psychotherapist]
skilled in penetrating the self-deceptions to which man is uniquely susceptible,
with the mutually accepted purpose of securing to the patient
an increased skill in living.
In this discussion, Boisen reiterated that
transference in psychotherapy serves to enhance its
social significance … [as well as]
release from isolation (estrangement) and the
attainment of autonomy (maturity) …. 21
We have been led … to the conclusion that only in so far as it is accompanied by
the sense of isolation and estrangement does the sense of personal failure and shortcoming lead to mental illness.
Thus, in Boisen’s view,
the basis of all psychotherapy is
the removal of the sense of isolation. 22
the real evil in mental disorder is not to be found in the conflict but in
the sense of isolation and estrangement. 23
To various extents, life during the COVID-19 era has included a lot of
loneliness, isolation, and estrangement.
CPSP itself has desperately needed to get back to the plenary “small groups” –
that crossed chapter boundaries –
allowing each of us to meet more deeply four or five more colleagues.
Our guest speaker, Dr. Evans, is with us today for many reasons – but
primarily for his ability to
make accessible to all of us Sullivan’s stance toward psychotherapy. 24
Let me make one final comment focusing on Boisen before I turn my attention more to Dunbar.
On the dustcover of Boisen’s autobiography, Out of the Depths …,
the very last words, down at the bottom, are by Sullivan:
We are struck by the power,
the depth and tenderness of feeling,
the clear insight and intelligence.
Boisen and Sullivan had admired each other and each other’s work for over three decades.
Fifty-some years ago, I wrote about Dunbar’s and Boisen’s ground-breaking work between 1924 and 1939.
By the time I wrote another study in 1979, it had become clear that
the psychiatry and psychology of Dunbar and Boisen that rather disappeared around 1949 had
begun to resurface 20 years later –
without acknowledging either Dunbar or Boisen.
Apparently, something similar happened with Harry Stack Sullivan ground-breaking work.
His “interpersonal psychotherapy” that sunk toward obscurity around 1959
began to resurface 20 years later –
without acknowledging Sullivan.
In both cases, what was re-found – what was re-discovered – was the fact that
many problems that, at first glance,
seemed to exist within individuals
actually existed between individuals – both
externally in the outside world and
internally between images inside individuals’ minds.
The separate works of Dunbar and of Sullivan
object-relations theory and self-psychology theory.
One can argue that much of psychosomatic healing and clinical pastoral care –
the life-works of Dunbar and Boisen –
make more sense if we toss Sullivan’s life-work into the mixture.
I feel a certain kinship with our guest speaker, Dr Evans. We both
“plowed ground” that needed to be explored.
Our research, in both cases, was lost – then found.
We both un-interred those whose work had been buried.
Just as Dunbar was
“the wrong kind of psychoanalyst,”
“the wrong kind of psychoanalyst”.
Note that “wrong kind” – in both cases – related to their admiration of William Alanson White’s work on
symbolism and on
the organism as a whole in its environments – outer and inner.
Note that “wrong kind” – in both cases – related to their
curiosity about what goes on
between mother and young child –
between mother and young adolescent. 25
Just as Dunbar had “another life” – mostly ignored – as
a non-ordained theologian,
Sullivan had “another life” – mostly ignored – as
a non-PhD social scientist.
Boisen – as a forester/ social ecologist, theologian, psychologist, sociologist, –
“lived” right in the midst of it all.
It took quite a while for the world to catch up the discoveries made by Boisen, Dunbar, and Sullivan.
They listened closely –
our understandings of how human beings, relationships, and communities work.
As our guest speaker, Dr. Evans phrased it,
“the theme that runs throughout … Sullivan’s work” is
“the relationship between the problems of the person and the problems of society”. 26
Please join me in welcoming our guest speaker –
F. Barton Evans, III, PhD.
1. Proverbs 2:2, CSB [Christian Standard Bible] – more like internal admonitions. KJV [King James Version] “incline thine ear unto wisdom, and apply thine heart to understanding”– more like external commands. Chaplain Robert A. Preston tossed this verse at me in 1975. It is amazing how some things get stuck in the mind.
2. Chicago Theol. Sem. Reg., Jan., 22:12-15, 1932.
3. In the “Author’s Comments” at the end of my main study on the history of clinical pastoral chaplaincy, I note the following: “As I commented in 1999: ‘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 [at Worcester (MA) State Hospital], if the first of his books, Religion in Illness and Health (1942) was perhaps the missing text [the planned companion to Dunbar’s Emotions and Bodily Changes …]. 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.” The mentioned “missing text” was connected to a Macy [Foundation] funded project. See. Robert Charles Powell, “Whatever Happened to ‘CPE’ – Clinical Pastoral Education?” in Robert Charles Powell, Anton T. Boisen (1876-1965): “Cooperative Inquiry”: “Amid the Complex Entanglements of Actual Life”, revised and updated essays, NY: CPSP Press, 2021.
4. Robert Charles Powell, “Psychiatric Examination: Content of Thought” (c.1925-31): An Attempt to Grasp the Meaning of Mental Disorder.” Psychiatry, Nov., 40(4):369-375, 1977; republished in in Robert Charles Powell, Anton T. Boisen (1876-1965): Clinician: A Guide to Clinical Pastoral Assessment & Therapy, revised and updated essays, New York, NY: CPSP Press, 2021.
5. The Rev. Dr. William H. Deadwyler.
7. F. Barton Evans, III: Harry Stack Sullivan: Interpersonal Theory and Psychotherapy. NY: Routledge, 1996; p.47.
8. Evans, HSS:ITP, p.63; boldings added.
9. During1927-1931, Boisen studied from the psychological and religious standpoints 173 patients who were part of a “neuro-endocrine study of dementia praecox” (schizophrenia) directed by Roy G. Hoskins, MD. Both Hoskins and Sullivan publicly respected Boisen’s work.
Anton T. Boisen, “Form and Content of Schizophrenic Thinking,” Psychiatry 5:23-33, 1942.
Powell, “Anton T. Boisen's ‘Psychiatric Examination: Content of Thought’ (c.1925-31).
10. F. Barton Evans, “An Interpersonal Approach to Rorschach Interpretation,” Rorschachiana 38(1), 33–48, 2017; p.35; bolding added.
11. Evans, HSS-ITP, p.166; boldings added.
12. Evans, HSS-ITP, p.167; Sullivan, The Psychiatric Interview, p.56.
13. Evans, HSS-ITP, p.167, boldings added.
14. Evans, HSS-ITP, p.174; boldings added.
15. Anton T. Boisen, “Personality Changes and Upheavals Arising Out of the Sense of Personal Failure,” Amer. J. Psychiat. 5:531-551, 1926; reprinted in the following: The American Psychiatric Association: Sesquicentennial Anniversary, 1844-1994, Washington, D.C.: American Psychiatric Association, 1994, pp.125-133. In this commemorative volume, Boisen’s was the only reprinted article not written by a psychiatrist.
16. Harry Stack Sullivan, “Schizophrenia: Its Conservative and Malignant Features,” Amer. J. Psychiat. 81:77-91, 1924.
17. Anton T. Boisen, The Exploration of the Inner World …, p.36; boldings added.
18. Evans, HSS-ITP, pp.111, 143; boldings added.
19. Robert Charles Powell, “Religion in Crisis and Custom: Discovery and Recovery of Spirit and Soul,” 2005; republished in Robert Charles Powell, Anton T. Boisen (1876-1965). Studying Empirically “the Complex Entanglements of Actual Life”, revised and updated essays, New York, NY: CPSP Press, 2021.
20. Boisen, EIW, p.245; 239-240; boldings added.
21. Boisen, EIW, p. 172; Harry Stack Sullivan, “The Modified Psychoanalytic Treatment of Schizophrenia,” Amer. J. Psychiat. 88:519-540, 1931; boldings added.
22. Boisen, EIW, p.221; boldings added.
23. Boisen, EIW, p.279; boldings added.
24. [Evans, HSS-ITP, starting especially at p.165.
25. Flanders Dunbar, Your Child’s Mind and Body; A Practical Guide for Parents. NY: Random House,1949.
Flanders Dunbar, Your Preteenager’s Mind and Body. Edited by Benjamin Linder. NY: Hawthorn Books,1962.
Flanders Dunbar, Your Teenager’s Mind and Body. Edited by Benjamin Linder. NY: Hawthorn Books,1962.
26. Evans, HSS-ITP, p.201.
Extra Endnote #1: For those of you who read endnotes or footnotes, also take a look at the following – about “the talking cure::
Raymond J. Lawrence, “Reflections on Attending the 2012 National Meeting of the American Psychoanalytic Association”;
Extra Endnote #2: “Both Dunbar and Boisen actually SAW the obvious that others could not see, and they actually HEARD the obvious that others could not hear. They also had a way of allowing others to display their real selves and to convey their real views. Much of the Dunbaresque/ Boisenesque diagnostic approach begins in ‘being with’ – until one finally sees and hears and understands what specifically is bothersome in a specific person’s mind, body, world, or world-view.” That is an excerpt from one of my favorite essays: “Shedding Light on the Unknown – Without Presuming to Exhaust Its Meaning [a Dunbar Award introduction of Donald E. Capps (1939-2015)]” – republished in Robert Charles Powell, Psychosomatic Healing and Clinical Pastoral Care: A Holistic, Organismic, Dantean Approach: Focusing on the Life & Work of Helen Flanders Dunbar. New York: CPSP Press, 2021.
Extra Endnote #3: “The image was of two sincerely curious investigators – the one with specialized clinical pastoral training – sitting side by side, struggling to comprehend … their ‘beliefs ... amid the complex entanglements of actual life’…. This was [Boisen’s] ‘cooperative inquiry’ – neither ‘too personal’ nor ‘too impersonal’ – as firmly embedded in the social milieu as one could imagine.” This is an excerpt from: “ ‘Cooperative Inquiry’ in Pastoral Care” – republished in Robert Charles Powell, Anton T. Boisen (1876-1965): Cooperative Inquiry: Amid the Complex Entanglements of Actual Life. New York: CPSP Press, 2021.
Extra Endnote #4: Raymond J. Lawrence: Harry Stack Sullivan and Anton T. Boisen: Comrades and Revolutionaries in Psychotherapy. Lanham, MD: International Psychoanalytic Books (Rowman), 2022. “coming soon”.