Reflections for Clinical Pastoral Education Students in Psychiatric Settings

This article focuses on Donald Capps’s books on mental illness. In doing so I highlight three key insights from Capps that I have applied in my own ministry with persons with mental illness in various psychiatric hospitals. These insights, together with my own experience as a chaplain, lead to three practical lessons for clinical pastoral education students in psychiatric settings. I provide some context for my interest in mental illness and my friendship with Capps, as well as some background regarding how Capps’s writings on mental illness fit with certain broader themes in his own work as a pastoral theologian. This essay is personal throughout.     

Deep, dark…or transparent? Knowing our desires

The idea that introspection is transparent—that we know our minds by looking out to the world, not inwards towards some mental item—seems quite appealing when we think about belief. It seems that we know our beliefs by attending to their content; I know that I believe there is a café nearby by thinking about the streets near me, and not by thinking directly about my mind. Such an account is thought to have several advantages—for example, it is thought to avoid the need to posit any extra mental faculties peculiar to introspection. In this paper I discuss recent attempts to extend this kind of outwards-looking account to our introspective knowledge of desire. According to these accounts, we know our desires by attending to what in the world we judge to be valuable. This, however, does not deal satisfactorily with cases where my value judgments and introspective knowledge of my desires come apart. I propose a better alternative for the proponent of transparency, but one that requires giving up on the supposed metaphysical advantages.     

Moving on From the Suburbs

This is an account of my development as a psychoanalyst beginning in a safe but very unquestioning culture of a London suburb. Some unusual features of my childhood, as well as a natural curiosity, made me need to question the apparent certainties of my surroundings. I describe how a number of events—the death of my father, my illness as an adolescent, and an unlikely encounter with psychoanalysis shortly after, set me onto a rather slow road toward becoming a psychoanalyst several years later. I describe the influences that were important to me. I have always been most inspired by those who could explain complex ideas in a simple and straightforward way, and this has become important objective for me.     

Fighting With Spoons: On Caretaking Rivalry Between Mothers and Daughters

I present an aspect of my version of modern drive theory with a preservative and a sexual drive as basic motivating factors in mental life. To consider self-preservation and object preservation as primal drive activities allows me to focus on the many issues of caretaking as they play a major role between mother and daughter. I discuss three different ways that mothers deal with object-preservative concerns in the interaction with the child with regard to competition and rivalry. An extended psychoanalytic example demonstrates how I use these concepts in my clinical work. The article ends with some reflections on specific countertransference difficulties in the context of self-preservative and object-preservative urges and needs.     

Man on Wire: Walking the Therapeutically Transformative Tightrope of the Analyst’s Cancer

Almost nothing was clear to me when I was diagnosed with pancreatic cancer. I knew that I intended to inform all of my patients about my illness. But how could the focus remain on their needs when my mortality was so at risk? Unexpectedly, I discovered that I coped with my fears most effectively in my office. It was the one place where I could maintain a grasp on a holistic sense of myself and hold conflicting intense emotions. Additionally striking was the corresponding capacity of my patients to remain in treatment while addressing the unpredictable dyadic changes generated by my sickness. In this paper, I address this point of intersubjective transformation—the interactive contributions that generated each treatment’s unique rhythm. I also discuss the temporality of illness and how my continuing reconfigurations of self-experience impacted my ability to maintain authenticity and analytic balance both during and after treatment.     

Concrete Tornadoes

I present the case of a Hispanic woman whose physical illness parallels the massive destruction that she witnessed at the World Trade Center. I talk about my own feelings of terror and how I try to deal with my private ghosts as I sit afraid and wanting to help. I mention the longings we all have for powerful parents who can protect us and keep us safe.     

Surviving the bombing of pan am flight 103: The loss of innocence and a dear friend in an international tragedy

Abstract

On December 21, 1988, a terrorist bomb blew Pan Am Flight 103 out of the sky over Lockerbie, Scotland, 54 minutes after it took off from London's Heathrow Airport. The explosion sent 259 passengers and crew members tumbling 6 miles to their deaths, killed 11 people on the ground, and created waves of shock and grief that continue to reverberate across the globe. My friend Miriam Wolfe, one of 35 students returning from a semester in London under the auspices of Syracuse University, was on that flight. Her death was the final, jarring event in a traumatic year that had brought me the accidental deaths of four other friends in an Easter plane crash and the breast cancer that would force my mother to endure a mastecotomy and painful years of chemotherapy and drug treatments. While it is tempting to canonize the victims of violent disaster, Miriam was different–and inarguably deserving of such hagiography. A tribute written for one of three memorial scholarships established in her honor calls her a rare and gifted young woman who lived life to the fullest; actively worked to change the world for the better; and gave a great deal of love, joy and wisdom to all who knew her!' Her death yanked me from the comfortable naivete of my youth and forced me to confront the pain and confusion of the adult world. It destroyed my faith in the inherent good of mankind but showed me how disaster can bring out the best in people. It gave me a nihilistic view of life but forced me to make the most of every moment I have. It made me appreciate the people around me but gave me little tolerance for anyone who wastes my time. And it instilled in me a knee-jerk animus toward religion and nearly all things Middle Eastern. Ultimately, though, Miriam's life and death taught me how to live and love and survive in ways I never thought necessary—or possible.     

Doubts about One’s Own Existence

The aim of this paper is to show that it is not irrational to doubt one’s own existence, even in the face of introspective evidence to the effect that one is currently in a certain mental state. For this purpose, I will outline a situation in which I do not exist, but which cannot be ruled out on the basis of any evidence available to me—including introspective evidence about my current mental states. I use this ‘superskeptical scenario,’ as I will call it, to formulate an argument to the conclusion that I do not know that I exist. In order to substantiate my argument, I draw upon Terence Parsons’ theory of non-existent objects. I conclude that, inasmuch as Parsons’ theory is reasonable, doubts about one’s own existence are reasonable as well.     

Inner Communications Following the Near-Death Experience

Inner communications following the near-death experience (NDE) have been reported by a number of authors. Although such communications are similar in some ways to the hallucinations heard by individuals with mental illness, they differ in that their effects are predominantly positive, whereas the hallucinations in mental illness exert predominantly negative effects. This article describes three individuals who reported experiencing inner communications subsequent to their NDEs. I suggest that these inner messages may be a form of intuition, and encourage further research into this phenomenon.     

Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Crisis?

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify ending their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons’ mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge.     

The Myth of the Golden Years:

Adjusting to old age requires more than coming to terms with eventual physical decline. It also demands accepting the permanent loss of loved ones. This autobiographical account describes both positive and negative experiences during the seventh decade of life. My coping skills have been enhanced by previous employment as a mental health professional. As an older woman, I have been forced to become my own social worker, acting on my own behalf with medical and other bureaucracies. And, as a retired social worker, I have the ability to evaluate the skills and limitations of those care providers who have been called upon to assist me in coping with the problems of old age.     

Grounding Recognition: A Rejoinder to Critical Questions

It is always great good fortune for an author to have his writings meet with a receptive circle of readers who take them up in their own work and clarify them further. Indeed, it may even be the secret of all theoretical productivity that one reaches an opportune point in one's own creative process when others' queries, suggestions, and criticisms give one no peace, until one has been forced to come up with new answers and solutions. The four essays collected here, in any event, jointly represent an ideal form of such a challenge: I am now compelled to make further theoretical developments and clarifications that lead me to a whole new stage of my own endeavours, well beyond what I initially had in mind in The Struggle for Recognition . For this reason, I will not concentrate here on interpretative issues regarding my earlier work but will instead take up the problems and challenges that have occasioned several revisions on my part. For this reason, it makes sense to begin (in section I) with the points that Carl-Göran Heidegren makes, in terms of a history of social theory, regarding my proposed theory of recognition. The issues that still motivate me today can best be expressed via an engagement with the conscientious interpretations he offers. The core of this rejoinder is based on Heikki Ikäheimo's and Arto Laitinen's suggestions and corrections, which they have used to develop my initial approach further, to the point where the theoretical outlines of a precise and general concept of recognition come into view. It is primarily these two contributions that helped me develop a productive elaboration of my originally vague intuitions (section II). By way of conclusion (in section III), I take up the penetrating questions raised by Antti Kauppinen regarding the use of the concept of recognition in the broader context of social criticism; he has compelled me to take on several extremely helpful clarifications, and they give me the opportunity, in conclusion, to summarize my overarching intentions.     

The Vocation of Depth Psychotherapy

During the last years of my training as an analyst, from 1980 to 1985, I was in analysis with Dr. Edward Edinger. I remember well my first session; I had come to ask him if he would supervise one of my clinical cases. He told me that my father complex was in such an unconscious state, I would probably hear everything he said to me as critical. I asked if he would work with me analytically and he said that was a possibility.     

Computers, criminals, an eccentric billionaire, and APA: a brief autobiography

In this invited autobiographical account, I sum up what life has been like for me personally and professionally. For most of the first 50 years of my life, I lived in Alabama. During my years at the University of Alabama, my professional activities included developing a computer-based system to interpret the MMPI (Hathaway & McKinley, 1943), managing a national and international continuing education program for psychologists, involvement in a class action suit that resulted in the deinstitutionalization of Alabama's mental hospitals, organizing a team of professionals to reclassify all of the inmates of Alabama's prison system, and conducting a psychological autopsy on Howard Hughes. I was the American Psychological Association (APA) president in 1988 and served from 1989 to 2003 as APA Chief Executive Officer. Since my time at APA, I have been engaged in work with international psychological organizations.     

“More Life,Not Less”: Using Narrative Therapy With Older Adults With Bipolar Disorder

Counselors who work with older adults with bipolar disorder are in a unique position to help them navigate their challenges. Older adults with bipolar disorder have lived decades with mental illness and also face the regular aging process. Narrative therapy provides counselors with a framework to deal with these issues.     

JUSTICE AS INHERENT RIGHTS: A RESPONSE TO MY COMMENTATORS

The critical comments by my fellow symposiasts on my book, Justice: Rights and Wrongs , have provided me with the opportunity to clarify parts of my argument and to correct some misunderstandings; they have also helped me see more clearly than I did before the import of some parts of my argument. In his comments, Paul Weithman points out features of the right order conception of justice that I had not noticed. They have also prodded me to clarify in what way rights are trumps; and both his comments and Bernstein's have prodded me to clarify certain aspects of the theistic account of human rights that I offered. Attridge's comments lead me to see that I was perhaps over-zealous in emphasizing the objective aspects of the semantic range of dikaiosunê as used in the New Testament and downplaying the subjective aspects. And O'Donovan's comments have provided me with the opportunity to make clear that my account of rights is not an immunities account that presupposes nominalism, and to emphasize the ways in which it is not an asocial individualistic account.     

SOME UNQUESTIONED ASSUMPTIONS

I In 1848 Frederic Bastiat wrote an article in the Journal des Debats in which he said, Man struggles against pain and suffering. However, he is condemned by nature to suffering and to privation if he does not take upon himself the effort of work. Hence he has only the choice between two evils…. Up to now, however, no remedy has been found for it, except for one man to avail himself of the work of others…so that all work is for the one and all enjoyment is for the other. Hence [we have] slavery and robbery. [Today] the oppressor no longer directly compels the oppressed through his own strength. There is still a tyrant and a victim, but now the state, i.e. the law itself, is placed as a mediator between the two. What could be better for the purpose of stifling our doubts and vanquishing all resistance? We turn to the state and say to it: I find that between my enjoyment and my work there exists no relation that satisfies me. In order to bring about the desired balance, I would like to take away a little from others. However, that would be dangerous were I to do it myself. Can you, state, facilitate matters for me? Can you not assign me to a favorable position, or assign a more unfavorable one to my competitor? Can you not grant me a special “protection” and, not without plausible reason, lend me capital which you have taken from its possessors? Or, can you not educate my children at public expense? or guarantee me a carefree life from age 50 onwards?… In this case the law would be acting for me, and I would have all the advantages of exploitation without its risks and its onus.     

The Interface Between Countertransference and Projective Identification in a Case Presented to Peer Supervision

This case report, presented to a supervision group, is a prenatal genetic counseling casethat caused me a great deal of emotional discomfort as the events unfolded. Thediscomfort originated during my first meeting with the couple for routine preamniocentesiscounseling and continued through later encounters. This case illustrates the process ofworking through countertransference and projective identification issues that may arise ingenetic counseling.