Adding a Spiritual Dimension to the Biopsychosocial Model: Psychoanalysis, Kohut, Schleiermacher, Buber, and Marcel

Adding a Spiritual Dimension to the Biopsychosocial Model: Psychoanalysis, Kohut, Schleiermacher, Buber, and Marcel

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All Men Have Need of the Gods (Homer)

In Lapsed Agnostic1, the Irish writer John Walters describes how his increasingly obvious alcoholism made him realize that rock and roll, modernity, and agnosticism actually had not given him the good life he sought. As the certain truths he thought he had found faded, he realized that “the primary difficulty with the alleged rationality of our age is not that it denies God the belief and loyalty of humanity, but that it denies humanity the knowledge and protection of God.”2

It would be the very definition of understatement to say that throughout much of recorded history, many people claim to have found great comfort, strength and protection through an experience with the sacred. Nevertheless, the fields of psychoanalysis, psychology and psychiatry have acted as though this is not salient, or if it is, it should and can be understood in a reductive way that dismisses an actual relationship between humanity and the divine.

Dawkins,3 Hitchens,4 Harris,5 and the rest of the new atheists believe that reductive and dismissive approaches to religion are appropriate because they are certain that god simply does not exist, so there can be no encounter that could have an effect. They are equally convinced that no responsible, reflective person could think otherwise.

Psychoanalysis has a history of disregarding the knowledge and protection of God, and even of understanding religion as merely a defense mechanism. It seems to us that, at least in the United States, there may be an increasing openness amongst psychotherapists to a quest for spiritual development, but this would be hard to measure adequately. Nevertheless, we think that many members of the profession continue to dismiss religion in a way that is far too facile, thereby shortchanging both their patients and themselves.

Certainly, Freud resoundingly dismissed religion as both intellectually indefensible and emotionally unhealthy. He declared that religion was comparable to a childhood neurosis and being freed from it would give people a better chance to have a normal and wholesome life.6

Our concern is this: there are ways to experience god that can be understood through a theological framework that is rigorous and entirely different than what Freud, Dawkins, et al, denounce. The tragedy is that many (including much of the general public and the psychotherapy community) reject belief as if it were defined by only the most conservative dogma. This can lead to dismissing religion with little careful thought (since none seems merited) and with almost no awareness that other theologies exist. We think efforts to address this problem have not succeeded.

Our effort here will describe some of the ideas of Friedrich Schleiermacher, Martin Buber and Gabriel Marcel in relationship to psychoanalytic self psychology. We do not contend that the work of these men provides the only theology to support our effort to show a way to integrate psychoanalytic and religious thinking. Moreover, we do not agree with them completely. Rather, they offer a point of departure that has some therapeutic value; and we have found aspects of their thinking useful in our personal spiritual journeys.

As this subject is open to misunderstanding, we wish to be clear. We are Christians, and one of us (Jones) is an ordained, practicing minister working on his doctorate in theology. Our perspective, however, is not that of “Christian psychotherapists” such as Nick J. Watson, who understands that one goal of the therapist is to help the client “choose to invite Christ into their wounded past (the cross), [so that]…finally the client experiences healing, regeneration and to varying degrees ‘…the glorious freedom of the children of God’ (Rom. 8:21).” With the right clients (whom Dr. Baker rarely if ever encounters), this may be appropriate; but we think that a specifically religious stance may provide an impediment for many psychologists, psychiatrists, psychoanalysts, and patients. We will try to present a theological perspective that is rooted in a broad and generous understanding of the Judeo-Christian tradition, but that does not require subscription to narrowly conceived confessional commitments. Of course, we consider it entirely inappropriate to use the consulting room as a place for religious proselytizing.

We will begin with a brief outline of salient elements of self psychology, and follow with a discussion of Schleiermacher, Buber and Marcel that integrates them into the psychoanalytic perspective. We conclude with some clinical material that illustrates some points of contact between the two disciplines.

Self Psychology

The founder of psychoanalytic self psychology, Heinz Kohut (1913-1981), held a quite positive attitude toward religion. He was an active member of the First Unitarian Church of Chicago. Although he was born into an extremely assimilated Jewish family in Vienna and fled to Chicago in 1939, his son, Tom, believes Kohut came to think of himself as a Christian.7 In his professional writing, Kohut has offered a more nuanced perspective on religion than most of his predecessors.

Because we necessarily offer a brief summary of a great deal of literature, what follows is largely referenced in Baker and Baker8; but the reader is also referred to Kohut’s 3 books9,10,11, Kohut and Wolf’s earlier overview paper12, and Siegel’s more recent text.13

Kohut was a pivotal person in the revolution in psychoanalysis that began in the late 1960’s and has increasingly recognized the relational dimension of mental life. Whereas it had been assumed that the analyst must remain a blank screen so as not to disrupt the unfolding of the patient’s conflicts and defenses, it became obvious to Kohut that, in principle, this was not possible. So-called neutrality was not neutral; and he came to think that it often was not therapeutic. If Kohut failed to understand his patient’s experience from their unique perspective, that is when he failed to be sufficiently empathic, they became more withdrawn or chaotic. For example, a woman he called Miss F. would shriek, “You’re ruining my analysis with your interpretations;” and her symptoms would increase. Unlike many of his colleagues who heard similar complaints, Kohut thought it was possible that this was not resistance and that she was right and he might be wrong. When he was able to grasp her experience as she knew it to be, she reconstituted. In general, when his patients felt he really understood them, they became calmer, more alive, less agitated, etc. Better yet, they seemed to begin to understand that they might be inaccurate about meaning they habitually attributed to their and other’s emotions and behavior. Moreover, they realized that how they understood things sometimes affected how they and others felt and behaved. In other words, patients’ self-states often changed as a consequence of the relational matrix in the transference and in their outside lives. The extent to which this happened varied from patient to patient, and it clearly happened in relationship to important others in their current lives. Very vulnerable patients were exquisitely sensitive to the responses of many people, sometimes falling into frightening states of depression and anxiety, and recovering only with great difficulty.

In psychoanalytic terms, the other is called an “object” (thus one may speak of object relations). Since the object affects the self, Kohut coined the term selfobject. Someone else (the object) provides self-regulating functions. The usage of the term became increasingly confusing, and current parlance is that selfobject experiences enable the maintenance, restoration or reorganization of the self. As humans, we use selfobject experiences to regulate self-esteem (called mirroring, since the response of the other reflects worth back much like a mirror reflects an image) and affect regulation (idealizing, since the idealized parent calms, soothes, delights, and invigorates). An intensely critical parent might be compared to a fun-house mirror, since the image they reflect cannot be positive or realistic. An intensely anxious parent may become more anxious if their child is hurt. The child grasps this so that the parent’s responses compound anxiety rather than soothing it. As well, depression may prevent a parent from being able to respond appropriately to their child; and the child must find a way to understand this and is likely to come to beliefs that will be structured by their cognitive capacities and is likely to place herself at fault. All of these problems are subject to revision as the child matures and gains in cognitive capacities.

The nature of the parent-child relationship must be understood as an emergent property of the interactions. There may be mismatches in temperament between them that accounts for the relational failure and that make it impossible for either child or parent to generate selfobject experiences (parents do have legitimate needs that their children meet, albeit the parent is the adult). There are always empathic failures, and these are part of the motivation for developing internal self-regulatory capabilities.

There is a developmental thrust to appropriate selfobject experiences. For example, a very young child “violinist” might be praised for merely making screeching sounds, but older children get praise only when the music sounds pretty good, and eventually real applause is reserved for the genuinely skilled. The developing child begins to internalize these self-regulatory functions, becoming less dependent on others to actually provide them.

Selfobject experiences usually are generated in interpersonal relationships, but they may occur when a person enjoys playing or listening to music, playing a sport and getting into “the zone,” or engaging in a variety of activities. Van Gogh’s letters reveal that the act of painting provided him selfobject experiences as did his relationships with his brother, and disruptions in the relationship with Theo precipitated Vincent’s psychotic episodes and caused the quality of his brushwork to deteriorate.14

We may also encounter people who seem to assault our being: and, depending on the intensity and importance of the insult, the availability of other selfobject experiences, and our intrapsychic strengths and vulnerabilities, the internal experience of self may become depleted, disorganized, disintegrated or depressed to some variable extent. In those circumstances people do what they need to do to restore the self. Often, those efforts are symptomatic thinking or behaviors, which are understood as the self’s best efforts to restore their self-integrity (albeit ones that may be very short-sighted, limiting, or even lead to worse circumstances).

Everyone, Kohut realized, needs selfobject experiences. Health does not consist in outgrowing that need any more than respiratory health means outgrowing the need for oxygen. Healthy people usually tolerate all but the most egregious misunderstanding, rarely become seriously hurt, and usually recover without too much difficulty. Whether an interaction allows a selfobject experience depends both on quality of the interaction and whether or not the participants are able actually to experience empathic responsiveness. Someone might be so pessimistic about others that they cannot recognize even the most sensitive efforts as sufficient.

Although self psychologists do interpret conflicts and defenses related to sexual and aggressive feelings, there is a crucial recognition that nothing happens in a vacuum. There is always a matrix of interpersonal relationships that contextualize everything we think and feel. No self psychologist questions that children have sexual and aggressive feelings directed toward their parents. These Oedipal feelings probably are universal; but whether they become problematic, i.e. an Oedipus complex that is a part of psychopathology, will depend on the way that parents respond to the child. Kohut thought that the complex usually does not develop in healthy families, where the parents greet the child’s Oedipal amours and competitions appropriately, and where the parents’ relationship facilitates healthy parent-child interactions.

There are parameters that limit how easily we experience hurt and how profoundly we respond to the perceived insult. These include how important the other person is, our basic level of emotional health, and our biological vulnerabilities. If we are stressed by something at work, most of us benefit from the reassurance of a spouse or partner. If they are also stressed or exhausted, they may be in greater need than we are. When multiple stressors gang up, even minor slights can unravel most of us, and we can become quite demanding and difficult. Someone like Miss F would undergo severe decompensation as a consequence of what most people would ignore as a trivial slight. It often took weeks of empathic effort on Kohut’s part for her to again be able to use him to generate a selfobject experience in the transference.

What is crucial is not the objective intensity of the hurt, but the experience of it that a person has. Although he was certainly a sensitive and caring man, Freud believed he could usually assess his patients objectively. A 19th Century scientist, he lived in world in which realist epistemology made sense. He believed he could understand others as they were; that is, unless his own emotions misled him, his mental representation of his patients corresponded quite accurately to how they actually were. At least in theory, it was only in egregious circumstances that his personal behavior would affect his patient’s self-experience. Of course, he thought that he could offer interpretations that would enable his patients to rethink matters and change. I should note, however, that it likely that, in practice, he was often far more human with his patients than his theory implied, and that the practice of that theory seemed to become particularly severe in some schools of American psychoanalysis.

Kohut did not live in a world so dominated by realist epistemology. Developments in philosophy and small particle physics made clear 1) that the way that we interact with something alters that thing (or person) itself; and 2) that our mental representations do not correspond to the thing itself, but are limited by the unique perspective that we can not avoid bringing into any observation or interaction. This is, of course, an extension of the Kant’s Copernican revolution and has antecedents in long-standing nominalist/realist controversies. Constructivist and perspectivalist epistemology has become a given for most self psychologically oriented practitioners, and it makes for a world-view that is very different that our more traditional forbearers.15

One might think of an infant as a constructivist epistemologist who is working hard to make sense of her world. She is learning the interactions patterns that are her life. She and mother affect each other, as do she and father, mother and father, and so on. She develops a web of constructed interaction patterns that shapes self-experience and the way she interacts with others. Soon enough, she develops organizing principles that become the template that she uses to guide how she understands and interacts with others and her entire world. (We will show below how Buber independently came to a virtually identical belief.)

Our infant is constructing a subjective rather than a realist perspective of her world, and the same is true of the others around her. She exists in an intersubjective world where interactions occur and the intersections of the subjective fields that she and all the others around her construct.16 Although we live as if we know reality as it is, and although we may resolutely insist that we know what someone else really thinks, we don’t. What counts is whether or not organizing principles serve us well in the present and whether they will work later in life; and it helps if we hold our beliefs open to change.

If the child’s early life is good enough, she is likely to create a self that is resilient and not unduly prone to states of severe depletion and fragmentation, and she will be able to find relationships that offer the sorts of selfobject experiences she will inevitably need. On the other hand, if (for example) her mother is severely depressed, or if she is subjected to emotional chaos or even violence, it may difficult or even impossible for her to develop a healthy psychological organization.

This developmental process begins very early in life. In fact, there are data suggesting that this interaction may begin in surprising ways in utero.17 There are strong data showing that mothers and their 4-month-old infants track each other’s vocal rhythms and facial expressions at 0.1-second intervals. Importantly, it is not possible to tell who initiates the behavior. Moreover, when these interactions are precise enough, but not too exact, they predict healthy attachment at 2 years, which then predicts healthy relationships into adulthood.18 Since this process begins so early, the initial representations are necessarily limited by the child’s cognitive capability and will need to be revised again and again on the basis of further learning.19 However, clinical experience shows that very early representations may not be forgotten, even if they are not accessible to verbal representation, and they may be recruited in later life as part of the way that lived experiences are constructed.

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Figure 1—The Biopsychosocial Construction of Self-Experience

Self psychology focuses on this intrapsychic experience of self, recognizing that it is not static, that it changes, sometimes substantially, that symptoms are an effort to restore it to a better level, and that the relational matrix is a critical part of this process.

We use the diagram (Figure 1) above to explain how people actively generate their intrapsychic, lived experience through a biopsychosocial process.

This meaning making process is constant; and to do this, we must, of course (at least while alive) use our brain, specifically the working memory function (as used in the broad definition of the term 20). Sensory data from the environment and from inside our bodies are held briefly while the learned organizing principles represented in long-term memory are recruited to create the lived experience in our short-term memory. This, in turn, leads both to new learning (that may alter long-term memory) and to our behavior, which affects what will happen next. As well, short-term memory feeds back into working memory. We use this function of our brain to continuously join 1) what happens to us, 2) what we have learned, and 3) whatever meaning we just made a moment ago. (There are specific, essentially instinctual circumstances when the working memory function is bypassed in the service of rapid self-protective reactions, such as when we hike in the woods and startle at something might be a bear.) Perhaps amazingly, there is no single anatomical locus for this function. Instead working memory is rather widely distributed in the brain.

The biopsychosocial model is at least the putative standard for American psychiatry, meaning that a theoretical recognition that psychopathology can result when 1) our biology, especially our brain is not working properly, 2) our psychology is ineffective (when the organizing principles we use to understand our relationships and affects are dysfunctional), or 3) our socialcircumstance can not meet our needs. What is particularly crucial is that there is a continual interaction between these three elements, so that they each affect each other. For example, medication may help relieve a person’s depression because it alters the brain, which in turn affects cognition and affect, which affects interpersonal relationships. Experienced clinicians have all dealt with situations in which Prozac taken by a husband relieves a wife’s depression. Interventions should consider the ramifications throughout in all three systems and usually should focus on what is thought to be the most salient or malleable element.

In self psychological terminology, the self-experience that is biopsychosocially constructed may be coherent, vigorous, cohesive, and appropriately emotional; or it may be poorly integrated, depleted, agitated, fragmented, or chaotically emotional; or it may be somewhere in between. While there are parameters that limit the variability, it is obvious that our self state changes and that it is powerfully impacted by our relationships—not merely in childhood, but also on a day to day (sometimes moment by moment) basis throughout the life cycle. Whether significant others are empathic, partially empathic or non-empathic plays a role in our ongoing self-experience. It is also limited by the organizing patterns (i.e. transferences) that we have come to learn, and by whether or not our brain is fully functional.

The goals of self psychologically oriented treatment are to clarify the ways that people habitually and problematically organize their environment, facilitate changes in those patterns, and enable patient to modify relationships so that they avoid interactions that inevitably result in self disintegration and find ones that yield at least the opportunity for selfobject experiences. We understand treatment should happen in the context of the analyst’s consistent empathic immersion in the patient’s experience. There will be inevitable failures on part of the analyst, often generated by the analyst’s own personal limitations. If these are recognized and dealt with appropriately, which is to say with empathic recognition of the impasse, this creates a form of corrective emotional experience that the patient may genuinely understand and apply not only to the treatment situation but also relationships in general.

We presume that, in this context, as you read this abbreviated account of self psychology, you have been wondering about the affect of our relationship with god. The consequence of how we construct this relationship will vary, and that effect may be irrelevant, salutary or debilitating for the analyst, the patient, and the relationship between them. Will a god of wrath and punishment or a god of compassion and grace enter the consulting room? Will the therapist even know?

We argue that the biopsychosocial model is incomplete: there is a ground in which the entire process embedded. For Tillich21, of course, this ground of our being is God. Consciously acknowledged or not, Risutto22 believes that essentially all people have a god representation. Perhaps there are those who have lived in such a secularized world that there is virtually no god representation, but most people do have some sort of personal theology that may be a source of great strength and growth—or the cause of the sort of deep, destructive terror that the younger Luther described when he was locked into a hateful relationship with a judgmental, wrathful God.23

We argue that there is not only a place, but a requirement to recognize that theology is present whether it recognized or not. Indeed, “Freud’s god” can be understood as a projection of childhood wishes and fears and an unrealistic, even symptomatic defense mechanism to protect us from the terrifying recognition of death. Not only is there no valid argument that this perspective is wrong, but many of us know people for whom this adequately describes their religious experience—and some whose lives have been ruined by it. Still, despite his denials, Freud was preoccupied with religion. Nicholi argues that “throughout Freud’s letters [to the Swiss pastor and analyst, Oskar Phister] are statements such as, ‘if someday we meet above,’ ‘[my] one, quite secret prayer,’ and statements about God’s grace.”24

Certainly not all analysts hold reductionistic or dismissive attitudes toward religion. Marie Hoffmann convincingly shows that both W. R. D. Fairbarin and Donald W. Winnicott were influenced by their religious backgrounds, and the differences in their theory are consistent with the differences in their religious perspectives.25

It is not certain whether Kohut’s religion importantly shaped his theory; but his biographer, Charles Strozier, is unambiguous that Kohut was interested in and valued religion, and that he thought that Freud had a “profound misperception of the true purpose of religion, which is simply in another realm from science. [In fact, Kohut thought that] for many in the twentieth century psychoanalysis robbed religion of [its legitimate functions] and became a substitute religion.”26

Kohut’s theory, of course, lends itself to a very different concept of God than Freud posited. Holliman27 has argued that a person’s relationship with God can be understood partly as a selfobject experience. In this construction of God, we find an empathic and understanding god who seeks to be with us as we live our lives. The function of a relationship with this sort of god is to “shore up, to hold together, sustain, to make harmonious, to strengthen, man’s self…. [Kohut does not offer a] simplistic causal relation between God and mother. We do not merely seek uplift from God because our mothers once picked us up to hold and feel and sooth us. Religion is not, as it was basically for Freud, a rather mundane human institution but rather a complex interplay of human psychological needs and the deeper workings of the Divine. Unlike Freud, one might say, Kohut grants a God and then tries to understand our psychological relationship to her.”28

We think it may be helpful to continue the effort to describe a theology of the self-in-relationship to God that can be useful within the professions of psychoanalysis, psychology and psychiatry. It must be intellectually defensible and applicable beyond a particular religious confession. We have chosen to start with an exploration of the work of Friedrich Schleiermacher, Martin Buber, and Gabriel Marcel. Certainly we will not complete this task, and we neither specifically endorse what they believe nor claim that the thoughts of others will not prove to be equally (or more) valuable.

Because we are not aware of any specific references by Kohut to them, and because Kohut was notoriously careless in referencing the work of others, we have asked Tom Kohut if he knew whether his father has read Schleiermacher, Buber, or Marcel. He did not know, but he but assumed his father read Buber and well might have read the others. He could certainly see the connection between their thinking and his father’s.

Friedrich Schleiermacher

Friedrich Daniel Ernst Schleiermacher (1768-1834) was a German theologianand philosopher known for his impressive attempt to reconcile the criticisms of the Enlightenment with traditional Protestant orthodoxy. Because of his profound influence on subsequent Christian thought he is often called the “Father of Modern Protestant Theology.” He has also made important contributions to hermeneutics (i.e. theory of interpretation) and was an accomplished translator. He and Friedrich Schlegel began a project of translating Plato’s dialogues between 1799 and 1804, but Schlegel eventually left this work to Schleiermacher, who published them between 1804 and 1828. Although not all the dialogues were translated, they still widely used and admired today.29

Schleiermacher ranks among the most prolific Christian thinkers in any period, let alone his own. He published numerous works in philosophy, hermeneutics, ethics, biblical criticism, and of course in theology, which in his day was often referred to as dogmatics. He also delivered sermons at least weekly for most of his life and was highly regarded as a preacher. His magnum opus, The Christian Faith (Der christliche Glaube)30 is by any standard one of the finest and most important works in systematic theology, that is the branch of Christian thought that seeks to “offer a vision of the whole, a sense of how to bring together all the elements of Christian involvement into unity around an organizing center or centers.”31

Schleiermacher’s is rightly regarded as a modern, if not the modern, theologian. The term modern of course goes beyond chronological description. In the shadow of modernity, modern theology has tended to see itself as offering symbol systems and language to clarify the meaning of human existence as opposed to offering infallible metaphysical propositions about the natural and historical world. Likewise the influence of historical criticism and the awareness of cultural relativism has undercut the notion that one could do theology that would be “once for all”, pronouncing the final word or words on any given topic that concerns Christians and the Church. Theology must be done again and again for each age and era. It must always be ready to begin again at the beginning so to speak.32

We contend that Schleiermacher’s deep involvement with translating Plato profoundly influenced his thinking in a way that is relevant to this essay. The way he approached translation bears a close parallel to how Kohut came to think the analyst must meet his patient, that is through as complete an empathic emersion into the analysand’s or author’s experience as possible. Quoting Schleiermacher, Richard Neibuhr underscores this: the translator must come “to understand the text just as well as and then better than the author himself understood it.”33 Neibuhr continues that “Schleiermacher preferred to define hermeneutics as an art rather than a science, because ultimately its success rests upon the ability of the interpreter to re-construct the individuality of the author, a process for which no technical rules can suffice…it rests upon the personal talents, specifically, the talent for the understanding language from within, as a living reality, and the talent for knowing individual men.”34 Schleiermacher did not, and could not use the word “empathy”, since no form of it entered the modern lexicon until 1858, when Rudolf Lotze used the word einfuhlung in relationship to architectural theory. It 1903 the American psychologist Edward Titchener translated einfuhlung into English as “empathy.” Empathize was coined in 1924.35

We focus on this for two reasons: 1) because it may be related to Schleiermacher’s modernity, since translating demanded an awareness of historical criticism and cultural relevance, and 2) because it is so close to Kohut’s thinking. The parallel comes closer. Neibuhr continues that, for Schleiermacher, hermeneutics “is nothing but the special application of the dialectic that is the hall-mark of self-hood…in which each member of the dialogue is called upon to construct the self-hood of the other member(s)…and in so doing to become himself….”36 Thus Neibuhr contends that it is necessary to understand the roots of Schleiermacher’s theology “in his vision of man as a being who is essentially determined by his living relationship to others* as well as to the Other.”37 As we will see, it is but as small step between this and Martin Buber’s I-Thou.

Although Schleiermacher is indeed modern, he is also deeply traditional. He doesn’t seek to overturn every stone of the Christian tradition in light of modern thought and culture, eviscerating it of any and all connections with its premodern past. He is constantly referencing the Bible, the Apostle’s Creed and various 16th and 17th century confessions as he offers his own constructive and coherent vision of the Christian faith. Schleiermacher seeks to offer an understanding of the Christian tradition that can make its way meaningfully and coherently in the modern situation. These two characteristics, namely Schleiermacher’s modernity and his traditionalism, make him a fitting example of a theologian salient for our purpose. His modernity ought to make him at least intellectually credible to any thoughtful clinician. His traditionalism roots him enough in the generally accepted piety in which most of the faithful are raised, so that he can deepen their own understanding of God, themselves and their world without forcing them to jettison all or most of their core convictions.

Schleiermacher was influenced by Kant, who showed that the constants of what we can know are not in the phenomena, but in our a priori categories of experiencing the phenomena. God, however, is not a “phenomenon”, so we are in principle incapable of direct experience of god. However, Schleiermacher insists that “god-consciousness” is possible, and he believes that this happens in community.

Schleiermacher’s Christian Faith begins with his own philosophical anthropology. According to Schleiermacher all human being is spent in alteration between a state of abiding-in-self (Insichleiben), which involves knowing, and a state of passing-beyond-self (Aussichheraustren), which involves doing. Knowing, or thinking, is verbal and can be communicated on that basis. To knowing and doing, Schleiermacher adds a third category, feeling (Gef¸l). Unlike knowing or doing, feeling is a form of immediate self-consciousness, and it is to be distinguished from the sort of self-awareness that is mediated by contemplation and self-reflection. These result in my defining what I am like according to various categories and descriptors and my preoccupation with my lived concerns. The process of knowing involves some objectification of self. It is done using language, and can be communicated through typical verbal expression. Feeling is how we experience the immediate consciousness of self, and it induces in us an awareness that we all share in kind-consciousness (that is an awareness that we are all much more human that otherwise). It is possible precisely because it is free from objectifying influences, but it is not to be confused with irrationality. It cannot be articulated, but this does not mean that it cannot be communicated. Sometimes we can complete the thoughts of someone we are close to, but it is not possible to similarly share the feelings of another. If my hand hurts, it is not sensible to extend it toward you and say, “Here, feel how this hurts.” This does not, however, mean that we cannot participate in the feelings of another, but doing this requires that we disclose or reveal feeling through gesture, though non-verbal communication on the basis of our own immediate self-consciousness, often through a mutual sharing of self-consciousness. It will become clear that the distinction between whether we join together on the basis of knowing/thinking or feeling is related to Buber’s I-It and I-Thou. Both men have similar struggles conveying “I-Thou” and “feeling.”

What is critical for our purposes is that “Schleiermacher places the individual in the community of uttered thought not as a monad that stands in either an external or predetermined relationship to all other individuals but as a particular rational life in which consciousness of self and of community or kind nourish each other organically.”38 In contrast to many subsequent existentialists, Schleiermacher seems optimistic about the possibility for genuine human communication. He thinks of hermeneutics as correctly understanding the speech of another—and he is well aware of the difficulties that are imposed by the fact that our language spiritually modifies us. As our internal language is, to some extent, unique, particularly if we are trying to communicate across era, culture or class, the interaction is genuine, but destined to be incomplete.

The subject matter of dogmatics is piety, which belongs to the realm of feeling, not to the realm of knowing or doing. The subject matter of dogmatics, while involving a kind of knowledge, is not essentially knowledge. If it were, the most knowledgeable theologians would be the most pious Christians, which patently was not the case in Schleiermacher’s day, nor is it in our own. Likewise the essence of faith, and thus the subject of dogmatics, cannot be doing or morality. To evaluate the morality of an action religiously is not the same as evaluating it ethically. Ethical evaluation requires that one look at its telos (the intended consequence or ultimate goal). Rather, dogmatics is concerned with the motive and starting point, which is the feeling Schleiermacher calls piety. He notes “not only the most admirable but also the most abominable, not only the most useful but also the most inane and meaningless things, are done as pious and out of piety.”39 While there is both a knowing and a doing which pertain to piety, “neither of these constitutes the essence of piety itself: they only pertain to it inasmuch as the stirred-up feeling sometimes comes to rest in a thinking which fixes it, sometimes discharges itself in an action which expresses it.”40

A detailed exposition of Kant’s relationship to the Enlightenment is beyond the scope of our essay, but a momentary reflection is certainly in order. Schleiermacher once described himself as a Moravian (a form of Pietism) of a higher order. Schleiermacher was able to accept Kant’s thesis that knowledge is limited to our perception of phenomena, that we can intuit and then organize utilizing our categories of understanding. He thus concluded that theology cannot offer a description of God in himself, since God is not an object we can intuit in the phenomenal realm of reality.41 Nevertheless, Schleiermacher was convinced that we can have an immediate feeling within our consciousness of the infinite and eternal within the finite and temporal. He described this feeling as absolute dependence, over against the feelings of relative dependence and relative freedom that co-exist in our consciousness all the time as we interact with the world. The “whence” from which our feeling of absolute dependence flows is our God-consciousness, the essence of piety. Schleiermacher concedes to the Kantians the point that theology cannot provide metaphysical knowledge about God. But he will not trod the path of Enlightenment reductionism that would transform religion into ethics. Theology is a proper science in the Enlightenment sense of the word. It has a phenomenal object of study, namely the feeling of absolute dependence, or piety. Theology is a discipline in its own right with its own unique subject matter and its own unique methodology. It is also a particular and confessional exercise. There is no form of piety or absolute dependence in the abstract. One can only speak of piety as it is found in particular instantiations within particular communities. Thus one can speak of and study Buddhist piety, or Islamic piety, or Jewish piety, but never piety in general, because piety is always mediated through historical expressions that constitute it not formally but materially.

As a Christian theologian, Schleiermacher’s conception of piety is rooted in the consciousness of blessedness and redemption that comes from the Redeemer, Jesus of Nazareth. It is only in the consciousness of Jesus that the feeling of absolute dependence exists in reality in its pure form. “In every other individual it only exists in modified form; i.e. in combination with modifications that have been introduced into it through stimuli that have come to the individual from without, entering by way of the ‘sensible self-consciousness.’”42 It is important to note that for Schleiermacher the “essence” of any religion “consists in the modifications which take place in the feeling of absolute dependence and not in that feeling per se, which means that various religions cannot be regarded as “just so many species of a common genus.” Although all genuine religions have feelings of piety, each religion has an “irreducible uniqueness that is not set aside by formal similarities on the level of doctrines or ethics.”43

Schleiermacher is rightly described as a theologian with little tolerance for the “speculative.” While some may hold that all theology is speculation and be perplexed by the aforementioned description, we hold it to be defensible. In §30 of The Christian Faith Schleiermacher describes three sorts of propositions with which Christian doctrine deals. The first sort are descriptions of human states, or states of mind or consciousness. The second are conceptions of divine attributes or modes of action. The third has to do with the constitution of the world. The priority for Schleiermacher clearly rests with propositions of the first sort, for “it is clear that descriptions of the human states of mind with this content can only be taken from the realm of inner experience, and that therefore in this form nothing alien can creep into the system of Christian doctrine.”44 This is not the case with the other two sorts of propositions, “whereas…utterances regarding the constitution of the world may belong to natural science, and conceptions of divine modes of action may be purely metaphysical; in which case both are engendered on the soil of science, and so belong to the objective consciousness and its conditions, and are independent of the inner experience and the facts of the higher-self consciousness.”45 What Schleiermacher is in effect saying is that theology deals with realm of immediate feeling wherein God-consciousness resides. It must stay concretely related to that subject matter or run the risk of a theology that has nothing to do with the piety that is religion’s essence. For example, Schleiermacher thinks that the doctrine of providence is important. No Christian could live without the idea that God sustains the world that is absolutely dependent on him. But whether or not creation eternally existed or was brought into existence ex nihlio, as Christian orthodoxy has insisted, is simply not a theological question for Schleiermacher because it affects no one’s sense of piety. The question may be an interesting one intellectually, but it doesn’t concern the theologian as such. It is a metaphysical issue best left to philosophers and now perhaps to cosmologists.

Likewise, while the divinity of Jesus is essential for Schleiermacher, the doctrine of the Trinity is not, at least not in its classic form. Ultimately, the telos of the Christian project is that the powerful God-consciousness as revealed through the person and teaching of Jesus is to be implanted as a vital principle within us and between us within our community, which is to say within all of creation. This is because without the concept of Christ’s divinity, which flows from the realization that his God-consciousness is perfectly potent, the Christian feeling of redemption falls apart. Not so with the doctrine of the Trinity. It is for Schleiermacher classic speculation. Not so with the confession that the God on whom we absolutely depend meets us in (and perhaps as) Jesus of Nazareth, or with the belief that Christ’s Holy Spirit is still present with us in the fellowship of the Redeemed. These are all concrete statements flowing from the realm of immediate self-consciousness. But no one “feels” the doctrine of the Trinity. It is an abstraction and thus speculative, coming solely from the realm of objective self-consciousness. It’s important to remember that the feeling of absolute dependence as immediate feeling lies beyond the grasp of the theologian. All theologians have to work with is a representation of that feeling, constructed by the objective consciousness through words, symbols, stories and the like.46 Thus theology is always a provisional and fragmented exercise. It is “systematic” in that its contents ought to be organically related and logically coherent. But given that the theologian’s subject matter, i.e. an immediate feeling, cannot be communicated directly, accessible to her only in mediated forms, an emphasis on the limits of human knowing in this realm is always in order.47

Schleiermacher is reticent to speak of divine attributes as “realistically” referring to God in some sort of propositional fashion. Traditional talk of divine attributes really describes modifications of our God-consciousness as it interacts with sensible stimuli. To speak of God as omnipotent is simply to express the feeling we have of a power that is the source of the web of causes that we experience as the world. To speak of God as eternal is to speak of our feeling that God is the source of the nature-system which we interact with temporally. But Schleiermacher is not so reticent when he describes the being of God as love. Nowhere in Scripture do we find a proposition asserting that God is omnipotence or eternity. Not so with love. First John 4:16 clearly states that “God is love.” Love alone and “no other attribute can be equated thus with God .”48

For Schleiermacher the sense of divine love is present “directly in the consciousness of redemption, and as this is the basis on which all our God-consciousness is built up, it of course represents to us the essence of God.”49

At the heart of the divine love is God’s desire to unite with the other, namely the human race. All of creation is bound up with actualizing the divine love in the world. All things, says Schleiermacher, “were created for the Redeemer…disposed with a view to the revelation of God in the flesh, and so as to secure the completest possible impartation to the whole of the human nature, and thus to form the Kingdom of God.”50 Everything in the world would be “disposed otherwise, and the entire course of human and natural events, therefore, would have been different, if the divine purpose had not been set on the union of the Divine Essence with human nature in the Person of Christ, and, as a result therefore, the union of the Divine Essence with the fellowship of believers through the Holy Spirit.”51 Deeply related to the divine love is the divine wisdom that orders all things in accordance with the elective purposes of the divine love. “The divine wisdom, as the unfolding of the divine love…[confronts us] with the task of more and more securing recognition for the world as a good world, as also of forming things into an organ of the divine Spirit in harmony with the divine idea originally underlying the world-order, thus bringing all into unity with the system of redemption.”52 When an individual experiences “salvation”, they come into communion with the God-consciousness of the Redeemer through the fellowship that shares His Spirit.

The sinner who was once caught up in the web of God-forgetfulness now comes more and more to see the world as the theater of God’s redemptive love, and comes more and more to see in every time, every place and every relationship the manifestation of that love. The world is to the redeemed almost literally a divine love letter attesting to God’s desire for union with his children through Christ, in whom and for whom all things were made.53

The essence of sin is not moral failure or transgressing rules, it is relational in character. Sin is literally God forgetfulness, which leads to the sense of God forsakenness. It is not that God forsakes the sinner, but the sinner in succumbing to the most base form of the sensible self-consciousness, forsakes God. In so doing, he comes to experience a world where there is alienation and brokenness between God, self, others and environment. To be a sinner is literally to forget the most important thing one could ever know—that one is the object of the divine love.

Schleiermacher retains a sense of original sin, but not as some metaphysical transaction based on inherited guilt over the primeval transgression of Adam in the Garden. Rather, our metaphorical first parents entered into primeval act of God forgetfulness, succumbing to the lie that the more base drives of the lower self-consciousness could yield greater happiness and wholeness than that of the higher self-consciousness that finds its rest in God and God alone. If the family that prays together stays together, all the more the family that sins together will be shaped by the alienation and brokenness that comes with God-forgetfulness. To use a baseball metaphor, we come to the plate behind in the count. Because we are raised by God forgetters in a society of God forgetters, we will have an inevitable tendency to forget and forsake the divine in lieu of lesser things. We will be taught to value the banal, to often place it above the genuine, and to deny that we are alienated in these futile pursuits. To quote Schleiermacher: “All activities of the flesh are good when subservient to the Spirit, and all are evil when severed from it.”54 Essentially sin is to want the gifts without the Giver. Sin’s tragic effect is that the sinner loses both the ultimate source of good, i.e. God who gives us the good, and also to lose the relative good that comes in and through the gifts, which become lifeless idols. Wanton sexuality, relentless materialism and other “lusts of the flesh” are sinful not because of their ontological baseness or because of their relationship to a puritanical moral code, but because such pursuits ultimately make the world that the God of heaven fashioned for our good into a living hell that isolates us from God, others and even ourselves. There is a fine line between Schleiermacher’s “sinner” and Kohut’s patient who has become a depleted self. The lives of both are characterized by a frantic and isolated pursuit of sensual things in a quest for wholeness that is destined to fail.

Martin Buber

For Martin Buber (1897-1965), life is essentially and always relational: we really can only think of ourselves in relationship, whether to others, nature, our work, ideas, and so forth. I must relate to another in one of two broad ways. One (I-Thou) is direct, engaged, mutual, present and open to the other. The second (I-It) is detached, objective, not mutual, objective, and sometimes even marked by using the other to meet some personal need (which the other may well agree to meet, such as a surgeon I might consult). Both are a part of healthy life. While the most vicious, dehumanizing behavior can only be done in the I-It relationship, it is also in those relationships that we get the vast majority of the business of life done, including buying groceries, doing research or learning in class. But it is in the I-Thou relationship that life attains its full meaning—in fact, for Buber, the presence of god may be encountered in the most complete I-Thou moments, as it were emerging in the space between and embracing the participants. What is also crucial is that the “I” participating in I-Thou is different in essence than the “I” engaged in the I-It.55 This perception is so critical that “Karl Heim has been moved to describe it as a ‘Copernican Revolution’ in philosophy.”56

Buber was concerned that we participate in relation in a stance of I-Thou as consistently as possible our daily life, right here, right now, with the persons right next to us. To the extent that we can do this in all aspects of life, we “emerge from [our] entanglement in busy-ness.”57 Through everything that becomes present to us in this way, “we gaze toward the train [hem or edge] of the eternal You.”58 (Kaufmann translates Du as You rather than Thou.)

Empathy is a part of I-Thou encounters; but, for Kohut, empathy is only the ability to accurately enter into the affective and cognitive experience of someone else. Buber used the term somewhat differently, “to glide with one’s own feeling into the dynamic structure of an object…it means to ‘transpose’ oneself over there and in there.”59 For Buber empathy seems closer to what I would feel in the other’s shoes, whereas for Kohut it is my be awareness of what they feel in their shoes. Using Kohut’s understanding, empathy is a critical, value-neutral technique to gather information. What we do with the empathically gathered information is up to us. Clearly, there is an empathic resonance between two people engaged in an I-Thou relationship—whether lovers, friends, or members of a meaningful community. If understood as Kohut does, it is a sine qua non of I-Thou, a part of knowing and being known. However, empathy is a tool that can be used to motivate others, perhaps to sensible ends, or to manipulate them, sometimes (as we will see), to genuinely evil ends. Thus, empathy can be part of both I-Thou and I-It relationships.

It seems to us that, despite all of his genuine concern for his patient, the dialogue between Kohut and Miss F was confined to I-It until he finally heard the legitimacy of her complaints. She knew he treated her as an object, someone whom he studied carefully but mechanically, that is in a way that meant that he did not actually listen to or relate to her. Rather, he was relating to his mental construct of her; and that construct was more determined by his pre-existing theory than by her personhood. Moreover, he was locked into a role that was determined by psychoanalytic “correctness.” Eventually, Kohut realized that what she demanded was legitimate and necessary; and he had to reconsider their interaction. At this point, there was a shift into the realm of I-Thou. Indeed, this enabled both of them to change and for healthier selves to emerge, although it is the patient whose self is entitled to primary attention in the psychoanalytic situation.

Anyone who provides psychotherapy knows that the process is not an unbroken chain of I-Thou moments. Indeed there are times when we must disengage from our patients to some extent, to think about what they are doing, their interactions, and even whether they are suffering from a biological process such as depression that would benefit from medication. In the treatment hour as in life in general, there is a vacillation between I-Thou and I-It in the very best of relationships.

Buber understood God to be the ultimate Thou, entirely other, yet deeply engaged in relationship with us, both transcendent and immanent throughout his creation. He was aware that there may be very special moments when god emerges in the I-Thou encounter between man and man. (He used the gendered term, but we do not think that he implied that this did not happen between man and woman or woman and woman.)

While he did acknowledge that these invaluable moments of god’s immanence are related to what Schleiermacher called “god consciousness,” Buber was unwilling to limit this to the intuition or feeling of absolute dependence. He believed that “[w]hile the insistence on this element [the feeling of absolute dependence] and its definition are right, the onesided emphasis on this factor leads to a misunderstanding of the character of the perfect relationship…. [F]eelings merely accompany the fact of the relationship which after all is established not in the soul but between an I and a [Thou].”60 Since Schleiermacher (deeply influenced by Kant) thought God was in principle ineffable, it would not be possible to experience a relationship with Him/Her. By contrast, “it is one of Buber’s central insights that, though inexpressible, the I-Thou relation…is possible in the context of life with others, life with nature, and life with God, [and] can be fully revealed and therefore ‘known’ in the actual experience of the relation by the human subject.”61 Here the internal experience is a part of the relationship and cannot be decontextualized from the relationship in which it occurs. In fact, Buber seems to argue that the absolute dependence and the other intuitions that are a part of god consciousness are the consequence, i.e., secondary to our awareness of the relationship between God and God’s creation, including us.

This becomes particularly clear when Buber considers the childhood origins of I-Thou. His thoughts here are entirely consistent with child development research. “It is not as if a child first saw an object and then entered into some relationship with that. Rather, the longing for relation is primary, the cupped hand into which the being that confronts us nestles; and the relation to that, which a wordless anticipation of saying You, comes second…. In the beginning is the relation—as the category of being, as readiness, as a form that reaches out to be filled, as a model of the soul: the a priori of relation; the innate You.62

For Kohut, the core of most psychopathology is a failure in the relationship between infant/child and caretakers to succeed in the longing for relation in which the partners can find selfobject experiences, that is in I-Thou. The reasons that the primary relationships fail are legion and beyond the scope of this paper, but for Kohut repair of the consequences requires creation in the transference of what we think is I-Thou. We cannot help but notice when writing this the different quality of “selfobject relationship” and “I-Thou.” The latter seems so much more complete, but the former has a place as well.

Sweetman discusses difference between I-Thou and I-It, and argues that Buber thinks that the “information” derived in both I-Thou and I-It are “objectively real.” The latter are subject to objective verification, while the former are not. Objective verification, however, does not necessarily determine the truth-value of what we know. Rather, “Buber cannot describe fully what the I-Thou relation involves because this realm must ultimately be experienced to be truly known. Nevertheless, he can to some extent describe the structure of human experience philosophically so as to reveal that I-Thou relations are possible, valuable, and ontologically superior to I-It relations. It is then up to us to recover or retrieve, this experience for ourselves….It is possible, that is, to describe or to conceptualize certain experiences (albeit inadequately) which must ultimately be experienced in order to be fully known” 63 even though they cannot be abstracted into objectively verifiable data.

Still, as therapists, we are required to struggle with the difficult task of moving back and forth between these two perspectives in order to meet the complex needs of our patients. Failure can come in many forms, but biological reductionism is one. The claims of Nobel laureate Francis Crick show us where this leads: “[Y]ou, your joys, your sorrows, your memories, and your ambitions, your sense of personal free will, are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules.”64

Crick certainly would have no place for Schleiermacher’s concept of “sin” (that which removes us from the possibility of god consciousness), but we think it is useful. When we act in a way that annihilates the potential for the I-Thou, might that appropriately be considered “sin”? We do not refer here to that normal, inevitable, even necessary and useful vacillation between I-Thou and I-It that daily life requires. Rather, we refer to deliberate (as opposed to unintended) treatment of the other in such a way that we descend into a pit of “I-It-ness” in which we and others become mere objects and when there is no potential to experience god’s immanence. At its most extreme, we might think of the moment in Sophie’s Choice65 in which the Nazi officer exercises extraordinary empathic skills to deeply sinful ends. He demands that Sophie choose which of her two children will live and which will be exterminated, her son or daughter. The incalculable evil of the officer destroys the potential for Sophie to be a Thou as she looked into the eyes of the daughter she chose to sacrifice. Here we see the officer misuse of his impressive empathic skills to commit soul-murder. Buber’s central insight that the I of I-It is different than the I of I-Thou reminds us that the officer also destroyed his own soul as well. Whether redemption of their souls could occur is a matter for another discussion.

Let us make a rather dramatic shift back to Kohut and Miss F. Certainly nothing like Sophie’s choice was involved. However, did Kohut needlessly do things early on that prevented the potential for an I-Thou encounter? Eventually, he came to believe something like this—and he considered this shift from what we think can be understood as movement from I-It to I-Thou to be important enough that he devoted the rest of his professional life to understanding 1) how this happened in particular analytic situations, and 2) how he and others might undertake their psychoanalytic work in a way that was more consistent with the I-Thou stance. He did not use Buber’s terminology, however.

Gabriel Marcel

Gabriel Marcel (1889-1973) is generally labeled a Christian existentialist philosopher. He built upon Buber’s thinking; but to us his language sometimes seems more accessible than Buber’s, and some of his ideas offer specific value for psychotherapists.

Marcel emphasizes two general ways of comporting ourselves towards others: disponibiltÈ and indisponibiltÈ. These are related to I-Thou and I-It, are generally translated as “availability” and “unavailability.” DisponibiltÈ means that I am available to someone, that my resources are at hand to offer; and indisponibiltÈ means that I am not available, that there is some measure of alienation—the other is not a Thou but a He, She or even It.66

Marcel could not have known Kohut’s work, but he describes the two ways that Kohut interacted with Miss F: “The other, in so far as he is other, only exists for me in so far as I am open to him, in so far as he is a Thou. But I am only open to him in so far as I cease to form a circle with myself, inside which I somehow place the other, or rather his idea; for inside this circle, the other becomes the idea of the other, and the idea of the other is no longer the other qua other, but the other qua related to me.”67

Treanor68 even states, “If I treat the other person as purely external to me, as a ‘Her’, a generic Ms. X [rather than F], I encounter her ‘in fragments’ as it were.” He continues:

The person who is disponible, who is available or disposable to others, has an entirely different experience of her place in the world: she acknowledges her interdependence with other people. Relationships of disponibiltÈ are characterized by presence and communication between persons qua other, qua freedom—a communication and communication between persons who transcend their separation without merging into a unity, that is, while remaining separate to some degree. “It should be obvious at once that a being of this sort is not an autonomous whole, is not in [the] expressive English phrase, self-contained; on the contrary such a being is open and exposed, as unlike as can be to a compact impenetrable mass.” [quote from Marcel]

Here Marcel underscores the futility of pride (hubris), an illusion that it is possible to exist drawing one’s strength and capabilities solely from oneself. This parallels Schleiermacher’s concept of sin, in that isolation is not only separating from others, but also from god. We regularly hear our patients tell us that they grew up with the admonition and continue to believe that they are not to rely on others, that they are to be independent and manage for themselves. Of course, it doesn’t work, because it really means to try to live without selfobject experiences, which (as Kohut has shown) is as possible as living without relying on oxygen. Again, this is similar to Schleiermacher’s concept of the community setting the stage for sin, that is that “God-forgetters” cannot help but raise “God-forgetters.”

Borderline patients frantically seek to possess the other, like someone gasping for air, to control the other’s behavior much as they expect to control the movement of their hand. They cannot tolerate setting the other at a distance, recognizing their autonomy and freedom as Buber tells us is required for an I-Thou relationship. At least when these patients are in states of self-fragmentation, no reciprocity is possible, because it cannot be demanded. Reciprocity of disponibiltÈ is analogous to “a being awaiting a gift or favor from another being but only on the grounds of his liberality, and that he is the first to protest that the favor he is asking is a grace, that is to say that the exact opposite of an obligation.”69

Of course, patients will endeavor to extract responsiveness from their therapists, and we have an obligation to them. Anyone who has treated a Borderline patient is well aware of the dehumanizing misery sometimes inflicted upon us by these patients—and the rage that it can evoke in us. According to Treanor, Marcel does not shy away from the affective elements that accompany being “with” the other in a relationship of reciprocal disponibiltÈ, in particular love, hope and fidelity. He recognizes that we are bound to one another though “fraternity,” which is shared sense of sharing the joys and sorrows common to the human family, through what we suggest is an empathic grasp that we all struggle through the human condition together.

While those affects enhance and deepen our core self experience, the ones that are problematic come when interactions leave us aware that the other has totally denied our personhood and successfully left us feeling that we are nothing other than an “It.” There are times when our patients attack us without mercy, completely failing to realize that we too struggle to understand—although sometimes without success. We know that somehow our empathy has been insufficient, that we have failed in some way, and we feel completely reduced to objects. They can push us to the point where we wish to be free of them; and it can get so bad that, when they threaten suicide, we can think, “Go ahead.” We have been turned into someone filled with hurt and rage, and we may wish to isolate ourselves within a protective cocoon. This, however, is a moment of greatest opportunity. Our task is to recenter, to regain our disponibiltÈ, and find a way back into recreating I-Thou in the transference. If we can do this, the patient has been offered a genuine corrective emotional experience, a moment of grace.

It seems to us that Marcel and Buber do not emphasize the horrendous affects that we can feel when we are thrown from any sense of I-Thou. These affects can create a barrier to recapturing our humanity. They are dark moments that happen to all of us in all manner of relationships, and they can be most intense with those we love most dearly. Then we are in particular need of “the person who is at my disposal…who is capable of being with me with the whole of himself when I am in need; [and I do not merely need] the one who is not at my disposal [and] seems merely to offer me a temporary loan raised on his resources. For the one I am a presence; for the other I am an object.” If I find that, when the memory of a loved one, a friend, a supervisor, my hard-won training, or even an awareness that God is disponsible to me in the therapeutic moment and if I open myself to that possibility, I become restored enough that I can again become disponible to the other and myself. Again I am able to do what Buber recommends in his comments about psychotherapy.70 The therapist “sets the other at a distance,” recognizing the integrity of the other, while opening himself to the I-Thou/disponible encounter. In Kohut’s terms this enables the patient to find a selfobject experience in the transference that contains their self so that it they may reorganize it to be more flexible, coherent, and vital.

We may find in the best encounters with others such complete, mutual recognition that we may be aware of god’s presence; and we may also find such complete denial of this that our experience is that our self has been annihilated, precipitating the worst of human emotions. It is at these horrible moments that we in the greatest need of grace. If we have recognized god consciousness in the best I-Thou moments, it can give us an awareness that in the darkest moments God’s grace is present for us to recognize and accept that we are located within a ground of being that can hold, restore and redirect us.

This recognition is not a part of usual psychoanalytic discussion and dialogue.

Clinical Implications and Illustrations

We have tried to show that the thinking of Schleiermacher, Buber and Marcel, integrates with and adds to Kohut’s self psychology. The implication is that there is a central guiding principle for all human interaction, of which psychotherapy is but one example: how shall this particular relationship be conducted so that there is a possibility of an I-Thou encounter, perhaps even a moment of god consciousness? When this idea guides our way of listening, a great deal changes. What we are likely to understand from the same material will be different, and then our interpretations and other interventions will change, with the inevitable result that treatment will follow a different path. Of course, there are times when disponibiltÈ is sufficient if I interact in the realm of I-Itwhile not precluding the potential for deeper interaction. The etiology of psychopathology that Kohut describes using the concepts and intersubjectivity are entirely consistent with what we have just outlined, but the language offered by Schleiermacher, Buber and Marcel can enrich how we understand the same data. It is beyond the scope of this essay to discuss therapeutic technique in detail.

The clinical material that follows briefly considers what is required for disponibiltÈ, some thoughts on etiology, how what is heard and said changes, and whether actual god-consciousness can ever become an overt part of treatment.

One of us (HB) treats many adults with Attention Deficit/Hyperactivity Disorder. Throughout their lives, these patients have had periods of inattention at inopportune times. Throughout their life cycles, this has stressed their interpersonal relationships and academic and vocational success. Some of them have had understanding and effectively supportive families and social networks, so they have been able to find ways to navigate quite effectively through how their biology affected them. Some have even turned their scattered thought process to very creative ends. Those around them have been disponsible, have made selfobject experiences possible, and enabled them to develop healthy self structures, though they still may need medication. In this case, disponibiltÈ requires only careful evaluation, prescribing medication and appropriate follow-up monitoring.

More commonly, many of the interactions these patients have had were not successful. Teachers did not understand why Johnny didn’t listen or why he got an A on one test and a D on another. An explanation was required, and it might have been that he was lazy or perversely rebellious, and that is the way Johnny was treated. This mirror provided by the teacher can begin a pattern of poor self-esteem and anger at authorities. Some parents may be capable of dealing with this and helping Johnny to alter these interactions, but others complicate the problem with comments like, “Can’t you ever do anything right?” The result may be a pattern in which others, because they do not understand that Johnny is inattentive because his brain does not filter information in the usual way, will create a concept of Johnny that is not accurate. Their idea of Johnny is placed in the circle that Marcel describes, but Johnny himself remains outside it; and Kohut has shown us that this makes it impossible for Johnny to find selfobject experiences, and his core self can be damaged. Then medication is only part of the psychiatrist’s job. Disponsibilite requires a struggle to find ways to open the circle of the therapeutic relationship so that he can find selfobject experiences, and this means that I-Thou must remain a central focus and be sufficiently understood and explained that he can carry this into other aspects of his life.

Not infrequently, people like Johnny have been so damaged that they do not even conceive of the possibility of I-Thou. It is not the therapist’s right to determine the goals for Johnny’s treatment, but it is also not possible to operate without our own values being a part of the calculus as to where the treatment will go. Even the most troubled patients usually have a longing to be welcomed into I-Thou, even when this is deeply defended against. It is all too easy for therapists to disregard this and focus merely on what can be accomplished purely within the realm of I-It. Sometimes practicality and the limits of available resources and time cause this. However, many times it is unwillingness to risk entering I-Thou, particularly when it will be rebuffed again and again until the right path is found.

The following case vignettes illustrate 1) how awareness of the above may shift what is heard and said, 2) that moments of profound and therapeutic god consciousness may happen in the therapy hour, 3) some form of god consciousness may contain the therapist in a useful way.

Ms. V is a senior executive at a major manufacturing corporation. She returned to treatment because of turmoil she felt in relationship to her sister, Dr. L, who is a successful academic at a prestigious small college. Dr. L had been having difficulty completing a book and had started to drink so heavily that it came to the attention of her colleagues. Despite tenure, her job was in jeopardy. Ms. V, her brother, and Dr. L’s son intervened, and Dr. L was admitted to an alcohol treatment center. She did well following discharge, completed her book, and then started to drink again. Ms. V was distraught and her efforts to help were met with fury. Dr. L had even refused to speak to their brother when he tried to intervene again.

Alanon wisdom was that nothing Ms. V could do would stop her sister’s drinking, that she did not cause her sister’s drinking, could not change it and could not cure it. Here it might be possible to think about “appropriate boundaries” and that these would require separating oneself from the alcoholic. Nevertheless, thinking about her wish to be available (disponible) to her sister and that this was humanly appropriate. I suggested that she was being excluded from the circle of her sister’s being, and only a misrepresentation of her as an interfering younger sister was admitted. This left Dr. L isolated and alienated, which was the state that she seemed to be trying to self-medicate with alcohol. We realized that what was troubling Ms. V was that she was an It in her interactions with her sister, meaning that there was no possibility for her to be the I of I-Thou, only the I of I-It. We realized that while she certainly could not stop her sister’s drinking, it was fair to point out the alienation that her sister was provoking for both of them, for the others in her sister’s life, and even for the important work that her sister was doing. We also thought about how she might deal with the pain of the “It-ness” she felt and the anger that it provoked. I quite literally used Buber’s and Marcel’s language with Ms. V; and she thought these actual words would be useful as she again tried to approach her sister, particularly since the nature of her sister’s work meant she almost certainly had some familiarity with both Buber and Marcel.

The importance of responding with disponibiltÈ remains a part of the human condition, even if it is rebuffed. The hurt and anger that occurs because the “I” cannot be fulfilled is inevitable, and it can provoke one to abandon the other. Determining how one proceeds in the circumstance that Ms. V faces is secondary.

Mr. L is a 40 year old single man who has been preoccupied with and masturbates to sadomasochistic sexual fantasies. In these a woman, dressed entirely in black rubber and wearing a gas mask strangles him; and he ejaculates at the point in the fantasy when he is about to expire.

His father taught at a college with a very strong religious outlook, and the family was active in an evangelical church. He described how sin was a major focus. I asked him what that meant; and he said, “Disobeying the rules.” He was taught that these were rules given by God. Currently he realizes that the rules in fact were actually interpretations of Biblical text determined by his parents, his minister, and church elders; and he thinks that the point of the rules was to control his behavior so that he would bend to their will. He sees this as different than being a part of how parents guide children so that they develop into healthy people. Accomplishing endless tasks took precedent over any shared fun, and sensuality seemed entirely off limits. For his family, fun was not fun. Instead it was frightening over-stimulation.

As we talked about this, I said, “Is it possible that some things are actually wrong, not because they break an abstract rule, but because they interfere with developing happy and wholesome relationships?” He was stunned at this idea, but soon began to think about how the “sinfulness” of his sexuality was actually “sinful” since it was the epitome of denying relationship in what should be a loving act that, at least in some circumstances, actually could even be sacred.

I cannot imagine that I would have offered either patient the interpretations without grounding it in the understanding described in this paper. There can be no question that these ideas were helpful for them.

I will describe an extraordinary treatment hour when a patient and I had a profound, entirely unanticipated experience of god’s presence with us. This was a shared experience that was overwhelming in its intensity. We discussed it many times, agreed about what happened, explored its ramifications, and realized that it had valuable, lasting effects on us both. This has been followed by further experiences of god-consciousness in treating other people. Some were nearly as intense, shared and discussed in treatment hours. Most were merely my awareness of the immanence of god’s presence as a quiet, settling, guiding force during some of the inevitable difficult moments and impasses that all therapists encounter; and they were not shared with the patients. I was alarmed by the first experience, initially wondering if I was having some sort of psychotic episode, but that has proved to an unwarranted fear.

Shared mystical experiences are supposed to be rare, and this one has stayed with me in a way that has required me to explore it again and again. One way I did this was to attend a continued education conference on Spirituality and Healing at Harvard. There was a point when it was appropriate to share it with the group, and (at my request) the course director asked the approximately 300 other participants if any of them had similar experiences. Over one hundred of them raised their hands! This furthered a developing conclusion that I was forming that, as the Delphic is alleged to have said to the Spartans, “Bidden or not bidden, god is present.” Perhaps it is up to us to open ourselves to guidance, protection and strength offered to us.

Rev. B was a 30-year-old minister in a liberal, protestant denomination. He had graduated from a college and a divinity school that are both rigorous and undeniably respected. He had begun his first job as assistant pastor at an important church. Although his family was responsible, warmth and empathy often were lacking. He had expected to marry a classmate from divinity school, but her dedication to her career and other factors related to their individual psychodynamics led them to end those plans.

He sought treatment because he was feeling depressed and overburdened, even to the point of questioning his vocation, or at least wondering whether working in his particular parish was adequately serving the needs of the poor and disenfranchised. Exploring these issues and their psychodynamics had been the major focus of our work together.

In the session I will describe, Rev. B came in feeling quite upset. His grandfather had died, and the family had asked him to preside at the funeral. He was not close to that grandfather, who had a lingering and painful illness that made his passing a blessing. His upset was not about his loss. Rather, it was because he realized how his family had remained aloof from the funeral service. His parents regularly attended religious services, but Sam felt that religion had little daily impact on their lives. Sometimes they would trivialize theology, and Sam thought they neither really participated in the community spirit of their religion nor considered that their interactions with others there had any spiritual import. He was angry at their disengagement and the way that they trivialized the funeral service. He was upset that, even at this time of grief, he was unable to reach them.

I said, “You mean that, even during the service, when God could have been experienced as a real presence, you could not help that to happen within your own family?”

“Yes.”

I thought of a passage in Anne LaMont’s Traveling Mercies.71 She was in the throws of a horrendous addiction, and writes about one very low point in which she felt that Jesus was in the corner of the room, saying nothing, just being there. I think that what she described was a mystical, not psychotic experience. I referred to that, suggesting that he hoped to achieve that sort of divine presence within his family, at least from time to time. I added that you hoped that you could help your family have an experience “as if Jesus was sitting in that chair (pointing to one in my office).”

At that point, neither of us spoke, or even could speak. Eventually I said, “You know, Jesus is in the room now.” He shook his head in agreement. We tried to talk about what was happening, but we could say very little.

It is very difficult to describe just what this was like. It was not visual, but certainly powerful and remains so as I write this. It did not feel merely like extreme, mutual empathy—although this may have set the condition for what happened. It was highly charged, and there was an intense reality of a divine, transcendent presence that made it difficult to breathe, and left the hair on my arms standing on end. I wondered if I was I was having a psychotic episode, since nothing like this had ever happened to me before, but I was pretty sure that something valuable happened—that together we had tapped into a profound source of comfort and power that we both believed was God.

The next session, I asked him if he thought that it was metaphorical that Jesus was in the room. “No. He was here,” was the reply.

It is important to insert here that although we used specifically Christian imagery, we did so because of his vocation and our shared background. We (and Rev. B) are convinced that the sacred is available to persons of all religious persuasions. It certainly is not confined to people who share a Christian faith.

Shortly after the session I just described, Rev. B encountered an extremely difficult interpersonal situation that he handled beautifully. Initially, he felt overwhelmed and could barely work that day. During the afternoon he prayed that he could not deal with this alone, and asked God to be with him and the other person when they met that evening. He described this to me at length the next day. I pointed out how well they had dealt with this, and we thought about what made him so effective. Again, we stopped talking. Jesus was back in the room.

He has concluded what can only be considered a successful treatment, and he was convinced that it was greatly facilitated by these encounters.

Similar, although not quite as intense shared experiences have happened in treatment hours with two other patients. One was a married Jewish physician, and the other a Roman Catholic student. In both cases they were shared and had extremely salutary effects.

Conclusion

We have shown that, despite some real differences, there is a basic consistency in the thinking of Schleiermacher, Buber, Marcel and Kohut. This offers a philosophical and theological ground for psychoanalysis. It is becoming a given that psychoanalytic theory consistently considers relationships and their consequences. We suggest that all human relationships are embedded in a greater relationship to the transcendent, and mindfulness of this possibility may change they way we encounter others, including our patients, and how we think about their clinical material.

Although few would argue that the existence of god could be proved, god consciousness is something that is available and very real to those who experience it. It has been attested to for millennia, and we have described this in clinical practice.

We are concerned that, because religion is so widely understood according to ancient theologies, it seems absurd to many in our era. Certainly there is no shortage of preachers who define faith in terms that many find impossible, even repulsive. The consequence is that people with a more modernist world-view reject religion without considering the sorts of theological perspectives we have outlined. As a result, in Walter’s terms, they are denied “the knowledge and protection of God.” They may do this a way that can only be considered intellectually careless. Homer’s admonition that “All men have need of the gods” may be treated as though uttered by someone who should be dismissed as a thinker of little merit.

Consistent with the goals of Metanexus, it is our hope this outline can help the process of recapturing an intellectually respectable theological/philosophical perspective that we believe is essential if psychoanalysis, psychology and psychiatry are ever to ground their theory and practice in an awareness of the transcendent. Should this happen, it will not only be helpful to patients, but to practitioners in their professional and personal lives.

Perhaps we will broaden our understanding and will come to share Paul Tillich’s tragic understanding that “neurosis is way of avoiding non-being by avoiding being.”72

 

 


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