Amazing grace! How sweet the sound
That saved a wretch(不幸的人) like me!
I once was lost, but now am found,
Was blind, but now I see.
T‘ was grace that taught my heart to fear,
And grace my fears relieved;
How precious(宝贵的) did that grace appear
The hour I first believed!
Through many dangers, toil(苦干) and snares(陷阱),
I have already come;
‘Tis grace hath(有) brought me safe thus far,
And grade will lead me home.
And when we’ve been there ten thousand years,
Bright shining as the sun,
We’ll have no less days to sing God’s praise
Then when we first begin
The first word associated with grace in this famous early American evangelical(福音的) hymn(赞美诗) is “amazing.” Something amazes us when it is not in the ordinary course of things, when it is not predictable by what we know of “natural law.” What follows will demonstrate grace to be a common phenomenon and, to a certain extent, a predictable one. But the reality of grace will remain unexplainable within the conceptual framework of conventional(依照惯例的) science and “natural law” as we understand it. It will remain miraculous(奇迹般的) and amazing(神奇的).
There are a number of aspects of the practice of psychiatry which never cease to amaze me as well as many other psychiatrists. One of these is the fact that our patients are amazingly healthy mentally. It is customary(习惯的) for other medical specialists to accuse(指责) psychiatrists of practicing an inexact and unscientific discipline. The fact of the matter, however, is that more is known about the causes of neurosis than is known about the vast majority of other human disorders. Through psychoanalysis it is possible to trace the etiology(病原学) and development of a neurosis in an individual patient with an exactitude(精确) and precision that is seldom matched elsewhere in medicine. It is possible to come to know exactly and precisely how, when, where and why an individual develops a particular neurotic symptom or behavior pattern. It is also possible to know with equal exactitude and precision just how, when, where and why a particular neurosis can be cured or has been healed. What we do not know, however, is why the neurosis is not more severe—why our mildly(温和地) neurotic patient is not severely neurotic, why our severely neurotic patient is not totally psychotic. Inevitably we find that a patient has suffered a trauma or traumas of a particular quality so as to produce a particular neurosis, but the traumas are of an intensity that in the ordinary course of things should have been expected to produce a neurosis more severe than the one the patient has.
A thirty-five-year-old remarkably successful businessman came to see me because of a neurosis that could only be described as mild(轻微的). He was born illegitimate(私生的), and through infancy and early childhood was raised solely by his mother, who was both deaf and dumb, in the slums(贫民区) of Chicago. When he was five years old the state, believing that no such mother could be competent to raise a child, took him away from her without warning or explanation and placed him in a succession of three foster(寄养的) homes, where he was treated to rather routine indignities(侮辱) and with a total absence of affection(关爱). At the age of fifteen he became partially paralyzed(瘫痪的) as the result of a rupture(疝气) of a congenital(先天的) aneurysm(动脉瘤) of one of the blood vessels in his brain. At sixteen he left his final set of foster parents and began living by himself. Predictably, at the age of seventeen he was jailed for a particularly vicious and meaningless assault(人身攻击). He received no psychiatric treatment in jail.
Upon his release, after six months of boring confinement(监禁), the authorities got him a job as a menial(卑微的) stock-room clerk in a rather ordinary company. No psychiatrist or social worker in the world would have foreseen his future as anything but grim(凄凉). Within three years, however, he had become the youngest department head in the history of the company. In five years, after marrying another executive, he left the company and eventually succeeded in his own business, becoming a relatively wealthy man. By the time he entered treatment with me he had in addition become a loving and effective father, a self-educated intellectual, a community leader and an accomplished artist. How, when, why, where did this all come about? Within the ordinary concepts of causality(因果关系), I do not know. Together we were able to trace with exactitude, within the usual framework of cause and effect, the determinants of his mild neurosis and heal him. We were not able in the slightest degree to determine the origins of his unpredictable success.
This case is quoted precisely because the observable traumas were so dramatic and the circumstances of his success so obvious. In the vast majority of cases the traumas of childhood are considerably more subtle (although usually equally devastating(毁灭性的)) and the evidence of health less simple, but the pattern is basically the same. One seldom sees patients, for instance, who are not basically healthier mentally than their parents. We know very well why people become mentally ill. What we don’t understand is why people survive the traumas of their lives as well as they do. We know exactly why certain people commit suicide. We don’t know, within the ordinary concepts of causality, why certain others don’t commit suicide. All we can say is that there is a force, the mechanics of which we do not fully understand, that seems to operate routinely in most people to protect and to foster their mental health even under the most adverse(有害的) conditions.
Although the processes involved in mental disorders frequently do not correspond to the processes of physical disorders, in this respect they apparently do. We know a great deal more about the causes of physical disease than we do about the causes of physical health. Ask any physician, for instance, what causes meningococcal(脑膜炎球菌的) meningitis(脑膜炎) and the instant response will be, “Why, the meningococcus, of course.” There is a problem here, however. If this winter I were to make daily cultures of this bacterium from the throats of the inhabitants of the small village in which I make my home, I would discover it living there at some point in approximately nine out of ten people. Yet no one in my little village has suffered from meningococcal meningitis for many years, nor is likely to do so this winter. What is happening here? Meningococcal meningitis is a relatively rare disease, yet the causative agent is extremely common. Physicians use the concept of resistance to explain this phenomenon, postulating(假定) that the body possesses a set of defenses that resist invasion of the body cavities(腔) by meningococcus as well as a whole host of other ubiquitous disease-producing organisms. There is no question that this is true; we actually know a good deal about these defenses and how they operate. But enormous questions remain. While some of the people in the nation who will die from meningococcal meningitis this winter will be debilitated(操劳过度的) or otherwise known to have a defective resistance, the majority will be previously healthy individuals with no known defects in their resistance systems. On a certain level, we will be able to say with confidence that meningococcus was the cause of their death, but this level is clearly superficial. On a deeper level, we will not know why they died. The most we will be able to say is that the forces that normally protect our lives somehow failed to operate in them.
Although the concept of resistance is most commonly applied to the infectious(传染的) diseases, such as meningitis, it can also be applied to all physical disease in one way or another, except that in the instance of noninfectious disease we have almost no knowledge of how resistance works. An individual may suffer a single, relatively mild attack of ulcerative colitis—a disorder generally accepted to be psychosomatic—recover completely, and go on to live through life without ever again experiencing this difficulty. Another may have repeated attacks and become chronically crippled by the disorder. A third may demonstrate a fulminating(暴发性的) course and go on to die rapidly from even the first attack. The disease appears to be the same, but the outcome is totally different. Why? We have no idea except to say that individuals with a certain personality pattern seem to have different types of difficulty in resisting the disorder while the vast majority of us have no difficulty whatsoever. How does this happen? We don’t know. These kinds of questions can be asked about almost all diseases, including the most common ones, such as heart attacks, strokes, cancer, peptic(消化（有关）的) ulcers(溃疡), and 0thers. An increasing number of thinkers are beginning to suggest that almost all disorders are psychosomatic(身心的)—that the psyche is somehow involved in the causation of the various failures that occur in the resistance system. But the amazing thing is not these failures of the resistance system; it is that the resistance system works as well as it does. In the ordinary course of things we should be eaten alive by bacteria, consumed by cancer, clogged(阻塞的) up by fats and clots(血块), eroded(被侵蚀) by acids(酸). It is hardly remarkable that we sicken and die; what is truly remarkable is that we don’t usually sicken very often and we don’t die very quickly. We can therefore say the same thing about physical disorders that we said about mental disorders: There is a force, the mechanism of which we do not fully understand, that seems to operate routinely in most people to protect and encourage their physical health even under the most adverse conditions.
The matter of accidents raises further interesting questions. Many physicians and most psychiatrists have had the experience of coming face to face with the phenomenon of accident proneness. Among the many examples in my career the most dramatic was that of a fourteen-year-old boy whom I was asked to see as part of his admission to a residential treatment center for delinquent youths. His mother had died in the month of November of his eighth year. In November of his ninth year he fell from a ladder and fractured his humerus(肱骨) (upper arm). In November of his tenth year he was in a bike accident and sustained a fractured(断裂的) skull(颅骨) and severe concussion(脑震荡). In November of his eleventh year he fell through a skylight, fracturing his hip(臀部). In November of his twelfth year he fell from his skateboard and fractured his wrist. In November of his thirteenth year he was hit by a car, sustaining a fractured pelvis(骨盆). No one would question that this boy was indeed accident-prone, or the reason why. But how did these accidents occur? The boy did not consciously cause himself to be hurt. Neither was he conscious of his grief(悲伤) over his mother’s death, blandly(温和地) telling me he had “forgotten all about her.” To begin to understand the question of how these accidents occurred, I think we need to apply the concept of resistance to the phenomenon of accidents as well as to the phenomenon of disease, to think in terms of accident-resistance as well as accidentproneness(事故倾向性). It is not simply that certain people at certain times in their lives are accident-prone; it is also that in the ordinary course of things most of us are accidentresistant.
One winter day when I was nine, carrying my books home from school across a snowy street as the light was turning, I slipped and fell. By the time a rapidly approaching car skidded(刹车) to a stop my head was even with the front fender(挡泥板); my legs and torso(躯干) were underneath the middle of the car. I pulled myself out from under the car and, in a panic, ran off home unharmed. By itself this incident does not seem so remarkable; one might simply say I was lucky. But put it together with all the other instances: times I just missed being hit by cars while on foot, on a bicycle or driving; times when I was driving a car and almost struck pedestrians(行人) or barely missed bike riders in the dark; times when I jammed on the brakes, coming to a stop no more than an inch or two from another vehicle; times when I narrowly missed skiing into trees, almost fell out of windows; times when a swinging golf club brushed through my hair, and so on. What is this? Do I lead a charmed existence? If readers examine their own lives at this point, I suspect the majority will find in their own personal experiences similar patterns of repeated narrowly averted disasters, a number of accidents that almost happened that is many times greater than the number of accidents that actually did happen. Furthermore, I believe readers will acknowledge that their personal patterns of survival, of accident-resistance, are not the result of any process of conscious decision-making. Could it be that most of us do lead “charmed lives”? Could it really be that the line in the song is true: “‘Tis grace hath brought me safe thus far”?
Some may think that there is nothing exciting about all this, that all the things we have been talking about are simply manifestations of the survival instinct. But does the naming of something explain it? Does the fact that we have an instinct to survive seem humdrum(无聊的) because we have called it an instinct? Our understanding of the origins and mechanisms of instincts is minuscule at best. Actually, the matter of accidents suggests that our tendency toward survival may be something other than, and even more miraculous than, an instinct, which is a phenomenon miraculous enough in itself. While we understand hardly anything about instincts, we do conceive of them as operating within the boundaries of the individual who possesses them. Resistance to mental disorders or physical disease we can imagine being localized within the unconscious mind or bodily processes of the individual. Accidents, however, involve interactions between individuals or between individuals and inanimate things. Did the wheels of the man’s car fail to run over me when I was nine because of my survival instinct or because the driver possessed an instinctual resistance to killing me? Perhaps we have an instinct not only to preserve our own lives but also to preserve the lives of others.
While I have personally not experienced this, I have several friends who have witnessed automobile accidents in which “victims” have crawled virtually intact(完好无损的) out of vehicles smashed(破碎的) beyond recognition. Their reaction has been one of pure amazement. “I don’t see how anyone could have survived such a wreck at all, much less without serious injury!” is the pronouncement. How do we explain this? Pure chance? These friends, who are not religious people, were amazed precisely because chance did not seem to be involved in these incidents. “No one could have survived,” they say. Although not religious, and without even thinking deeply about what they were saying, in attempting to digest these experiences my friends made such remarks as “Well, I guess God loves drunks” or “I guess his number wasn’t up yet.” The reader may choose to assign the mystery of such incidents to “pure chance,” an unexplainable “quirk” or a “twist of fate” and be satisfied thus to close the door on further exploration. If we are to examine such incidents further, however, our concept of an instinct to explain them is not terribly satisfactory. Does the inanimate machinery of a motor vehicle possess an instinct to collapse itself in just such a manner as to preserve the contours(轮廓) of the human body within? Or does the human being possess an instinct at the moment of impact to conform his contours to the pattern of the collapsing machinery? Such questions seem inherently absurd. While I choose to explore further the possibility that such incidents have an explanation, it is clear that our traditional concept of instinct will not be of help. Of more assistance perhaps will be the concept of synchronicity. Before considering the concept of synchronicity(同步性), however, it will be helpful to first examine some aspects of the functioning of that part of the human mind which we call the unconscious.