Wednesday, August 28, 2013

Sufism & Psychiatry (I)

by Arthur J. Deikman, M.D. (1976)

   The questions, "What is the purpose of living?" and "Why do I. exist?" haunt modern Western civilization and the absence of an adequate answer to them has given rise to the "illness" of meaninglessness or anomie. Psychiatrists, themselves, are afflicted with this same illness, partly because the problem of the meaning of life is solved by a special type of perception rather than by logic-psychiatry is trapped by its commitment to rationalism.

   Sufism, on the other hand, is a tradition devoted to the development of the higher intuitive capacity needed to deal with this issue. By taking advantage of the special science of the Sufis, Western civilization may be able to extricate itself from its dilemma and contribute to the development of man's full capacities.

   "I think it not improbable that man, like the grub that prepares a chamber for the winged thing it never has seen but is to be-that man may have cosmic destinies that he does not understand."
    -Justice Oliver Wendell Holmes

   Psychiatry can be defined as the science of reducing mental suffering and enhancing mental health. To date, the field has been primarily concerned with the first part of the definition. For example, in the Index to the Standard Edition of the Complete Psychological Works of Sigmund Freudthe word "neurosis" has over 400 references. In contrast, "health" is not even listed. The imbalance tends to be true of contemporary texts, as well. This situation is understandable because psychiatry originated to deal with disordered function. The question, "What is the function of a healthy person?" which require the further question "What is the purpose of human life?" is not usually asked be cause it is assumed to be answered by simple observation of the everyday active ties of the general population.

   Underlying all of our activities are purposes that give meaning and direction to our efforts. One might go to college to become a lawyer, or save money to buy car, or vote to elect an official; all of these actions are vitalized by purpose and if the purpose is removed, the activities may cease. That being the case, what is the purpose of human life, itself? What answer do we have to the question, "Why am I?” A direct answer is not usually attempted in our culture but an indirect answer is there, implicit in scientific publication and in the world view that permeates from scientific authority to the public-at-large. We are told either that the question lies outside the scope of science or that the question is false because the human rat has developed by chance in a random universe. Erwin Schrodinger, the physicist, commented an this problem:

   "Most painful is the absolute silence of all our scientific investigations towards our questions concerning the meaning and scope of the whole display. The more attentively we watch it, the more aimless and foolish it appears to be. The show that is going on obviously acquires a meaning only with regard to the mind that contemplates it. But what science tells us about this relationship is patently absurd: as if the mind had only been produced by that very display that it is now watching and would pass away with it when the sun finally cools down and the earth has been turned into a desert of ire and snow".

   We pay a price for the nonanswer of science. Psychiatry has recognized the existence of "anomie"  — an "illness" of meaninglessness, of alienation or estrangement from one's fellow men. Anomie stems from the absence of a deeply felt purpose. Our contemporary scientific culture also has had little to say about meaning, itself, except to suggest and assume that man imposes meaning; he does not discover it. That this assumption may be incorrect and productive of pathology is a possibility that needs to be considered. It may be that the greatest problem confronting psychiatry is that it lacks a theoretical framework adequate to provide meaning for its patients, many of whom are badly handicapped in their struggle to overcome neurotic problems because the conceptual context within which they view themselves provides neither meaning, direction, nor hope. That context derives from the modem, scientific world view of an orderly, mechanical, indifferent universe in which human beings exist as an interesting biochemical phenomenon  — barren of purpose. Survival is a purpose, but not enough. Working for the survival of others and to alleviate suffering is a purpose but it loses its meaning against a picture of the human race with no place to go, endlessly repeating the same patterns, or worse.

   The issue of meaning increases in importance as one's own death becomes less theoretical and more probable. Life goals of acquisition become utterly futile, for no achievements of money, fame, sex, power, and security are able to stop the relentless slide toward extinction. Our bodies age and our minds grow increasingly restless seeking a solution to death. As former goals lose their significance, life can easily appear to be a random cycle of trivial events and the search may end in the most profound despair or a dull resignation. The widespread use of sedatives, alcohol, and narcotics is related to the wish to suppress despair and substitute sensation for meaning.

   Such "existential" despair is so culturally accepted that it is often defined as healthy. Consider the following extract from The American Handbook of Psychiatry:

   "To those who have obtained some wisdom in the process of reaching old age, death often assumes meaning as the proper outcome of life. It is nature's way of assuring much life and constant renewal. Time and customs change but the elderly tire of changing; it is time for others to take over, and the elderly person is willing to pass quietly from the scene".

   So we should end, according to the voice of reason, neither with a bang nor a whimper, but in a coma of increasing psychological fatigue.

   The problem is illustrated concretely and poignantly by the dilemma of many psychiatrists, themselves. A recent article in the American Journal of Psychiatry concerned a number of professional therapists, ages 35 to 45, mostly of a psychoanalytic background, who formed a group which at first provided peer supervision and later attempted to function as a leaderless therapy group for its members who, as it turned out, were in a crisis:

   "The original members of the group we have described were remarkably homogeneous in their purposes in joining. The conscious reason was to obtain help in mastering a phase in their own development, the mid-life crisis. We refer to that stage of life in which the individual is aware that half of his time has been used up and the general pattern or trajectory of his work and personal life is clear. At this time, one must give up the normal manic defenses of early life-infinite faith in one's abilities and the belief that anything is possible. The future becomes finite, childhood fantasies have been fulfilled or unrealized, and there is no longer a sense of having enough time for anything. One becomes aware that one's energy and physical and mental abilities will be declining. The individual must think of prolonging and conserving rather than expanding. The reality of one's limited life span comes into sharp focus, and the work of mourning the passing of life begins in earnest".

   The "healthy" attitude recommended here would seem to be a stoical and courageous facing of a reality defined by certain assumptions prevalent in our culture: limited human capacity and limited meaning to life. From this point of view, it can be maintained that the second half of life should be used to adjust oneself to the final termination of individual consciousness. The grimness of such a goal may have resonated in the authors' minds for they go on to brighten up the picture.

   "In Erikson's terms, the individual must at this time struggle to achieve intimacy and creativity and avoid isolation and stagnation. If the work of mourning one's lost youth is carried through and the realities of the human situation are fully accepted, the ensuing years can be a period of increased productivity and gratification" (4, p.1166).

   "Increased productivity" and "gratification" are invoked to suggest that something good is still possible after 40, but the possibilities still would seem to call more for resignation than for vitality and continued growth. This ultimately circumscribed view of human life is widely held by psychiatrists. Even in the relatively affirmative writings of Erikson the Eight Stages of Man have some of the flavor of a survival manual.

   In contrast to our scientific culture and its psychology, Eastern introspective (mystical) disciplines have focused on meaning and purpose but have employed a strategy in which the use of intellect and reason is neither central nor basic to the process of investigation. Procedures such as meditation, fasting, chanting and other unusual practices have been employed as part of an integrated strata whose exact pattern and content depended on the nature and circumstances of the individual and of the culture in which the teaching was taking place.

   Unfortunately, the literature of Eastern psychological disciplines has not been much practical use for contemporary Western readers. Academic study of such texts does not seem to develop wisdom or improve personality functioning, and exotic practices themselves have proven be elusive and tricky instruments. For example, procedures such as meditation that were once part of a unique and individually prescribed pattern of development are now extracted from their original context and offered for consumption as if they were a kind of vitamin that was good for everyone, ridiculously cheap, and devoid of side effects. Those who use these components of a specialized technology may obtain increased calmness, enjoyment, and improvement of efficiency  — but without noticeable gain in wisdom. They answer the question, "Who am I?" by reciting dogma, not by realization, and for all of the "bliss" that may be displayed, the person's essential knowledge appears unchanged. For those who fare less well meditation, schizoid withdrawal, grandiosity, vanity, and dependency flourish under the disguise of spiritual practice. Perhaps the worst effect of indiscriminate and unintegrated use of these techniques is that people come to believe that the effects they experience are the measure of Eastern esoteric science. The end result is that they confirm and strengthen their customary conceptual prison from which they desperately need to escape.

   The crux of the problem is that modern Westerners need technical means specific to their time and culture. Although such a statement makes perfect sense to most people when the subject concerns the training of physicians or physicists, training in the "spiritual" is believed to be a different matter. Programs and techniques 2000 years old are assumed to be adequate to the task: indeed, it seems that that the older and more alien they are, the better they are received.

   Fortunately, some traditional materials have recently been made available in a form suitable for contemporary needs; they offer practical benefits of interest to psychiatry as well as the general public. These materials address themselves to the question, "Who am I?" but they do so in a unique manner:


   "Walking one evening along a deserted road, Mulla Nasrudin saw a troop of horsemen coming towards him.

   His imagination started to work; he saw himself captured and sold as a slave, or impressed into the army.

   Nasrudin bolted, climbed a wall into a graveyard, and lay down in an open tomb.

   Puzzled at his strange behavior, the men  — honest travelers  — followed him.

   They found him stretched out, tense and quivering.

   'What are you doing in that grave? We saw you run away. Can we help you?'

   'Just because you can ask a question does not mean there is a straightforward answer to it,' said the Mulla, who now realized what had happened. 'It all depends upon your viewpoint. If you must know, however: I am here because of you, and you are here because of me'".

   "Why We Are Here" is a teaching story adapted from the classical literature of Sufism. Teaching stories, in a form appropriate to the modern reader, are the means now being made available to prepare Western intellects for learning what they need to know. The stories, such as "Why We Are Here," are built of patterns, depth upon depth, offering resonance at the reader's level, whatever that may be. Teaching stories have more than one function. They provide the means for people to become aware of their patterns of behavior and thinking so as to accomplish a refinement of their perception and the development of an attitude conducive to learning. Some stories are also designed to communicate with what is conceived to be the Innermost part of the human being.

   Speaking metaphorically, Sufis say the stories make contact with a nascent "organ" of superior perception, supplying a type of "nutrition" that assists its development. It is this latter function that is of particular importance to understand; it is the key to the possible role of Sufism in helping to diagnose and cure, eventually, the basic illness that afflicts psychiatrists as well as their patients.

Arthur Deikman.

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