Kathy was the most frightened person I have even seen. When I came into her room that first time she was sitting on the floor in the comer(拐角) muttering what sounded like a chant. She looked up at me standing in the doorway and her eyes grew wide with terror. She wailed(恸哭) and pushed herself back into the comer and kept straining(竭力) against the walls as if she wished she could push herself through them. I said, “Kathy, I’m a psychiatrist. I’m not going to hurt you.” I took a chair, sat down at some distance from her and waited. For another minute she continued to push herself into the comer. Then she began to relax, but only enough to start weeping inconsolably(无法安慰地). After a while her weeping stopped and she began to chant to herself again. I asked her what was wrong. “I’m going to die,” she blurted(未加思索地冲口说出) out hardly pausing to interrupt the cadence(节律) of her chant. There was nothing more she could tell rile. She continued to chant. Every five minutes or so she would stop, seemingly exhausted, whimper(啜泣) for a few moments, and, then resume her chanting. To whatever question I asked she would respond only with “I’m going to die,” never breaking the rhythm of the chant. It seemed that she felt she might be able to prevent her death by this chanting and could not allow herself to rest or sleep.
From her husband, Howard, a young policeman, I obtained the minimal facts. Kathy was twenty years old. They had been married for two years. There were no problems with the marriage. Kathy was close to her parents. She had never had any psychiatric difficulty before. This was a complete surprise. She had been perfectly fine that morning. She had driven him to work. Two hours later his sister called him. She had gone to visit Kathy and had found her in this condition. They had brought her to the hospital. No, she had not been acting strange lately. Except maybe for on thing. For about four months she had seemed quite fearful of going into public places. To help her Howard had been doing all the shopping in the supermarket while she waited in the car. She also seemed to be afraid of being left: alone. She prayed a lot-but, then, she had done that ever since he had known her. Her family was quite religious. Her mother went to mass at least twice a week. Funny thing-Kathy had stopped going to mass as soon as they were married. Which was just fine with him. But she still prayed a lot. Her physical health? Oh, that was excellent. She’d never been hospitalized. Fainted once at a wedding several years ago. Contraception(避孕)? She too the pill. Wait a minute. About a month ago she told him she was stopping the pill. She’d read about how it was dangerous or something. He hadn’t thought much about it.
I gave Kathy massive amounts of tranquilizers(镇定剂) and sedatives(镇静剂) so that she was able to sleep at night, but during the next two days her behavior remained unchanged: incessant chanting, inability to communicate anything except the conviction(定罪) of her imminent(即将发生的) death, and unremitting(不停的) terror. Finally, on the fourth day, I gave her an intravenous(静脉内的) injection of sodium amytal(阿米妥钠). “This injection is going to make you sleepy Kathy,” I said, “but you will not fall asleep. No will you die. It will make you able to stop chanting. You will feel very relaxed. You will be able to talk with me. I want you to tell me what happened the morning you came to hospital.”
“Nothing happened,” Kathy answered.
“You drove your husband to work?”
“Yes. Then I drove home. Then I knew I was going to die.”
“You drove home just as you do every morning after you drop your husband at work?”
Kathy began to chant again.
“Stop chanting, Kathy,” I ordered. “You’re completely safe. You’re feeling very relaxed. Something was different about the way you drove home that morning. You are going to tell me what was different.”
“I took a different road.”
“Why did you do that?”
“I took the road past Bill’s hours.”
“Who’s Bill?” I asked.
Kathy started chanting once more.
“Is Bill a boyfriend of yours?”
“He was. Before I got married.”
“You miss Bill a lot, don’t you?”
Kathy wailed, “Oh, God, I’m going to die.”
“Did you see Bill that day?”
“No.”
“But you wanted to see him?”
“I’m going to die,” Kathy replied.
“Do you feel that God is going to punish you for wanting to see Bill again?” “Yes.”
“That’s why you believe you’re going to die?”
“Yes.” Once more Kathy started chanting. I let her chant for ten minutes while I collected my thoughts.
Finally I said to her, “Kathy, you believe you are going to die because you believe you know the mind of God. But you are wrong. Because you do not know the mind of God. All you know is what you have been told about God. Much of what you have been told about God is wrong. I do not know everything about God, but I know more than you do and more than the people who have told you about God. For instance, every day I see men and women, like yourself, who want to unfaithful, and some are, and they are not punished by God. I know, because they keeping coming back to see me. And talk with me. And they become happier. Just as you will become happier. Because we are going to work together. And you are going to learn that you’re not a bad person. And you’re going to learn the truth about yourself and about God. And you will become happier, about yourself and about life. But now you’re going to sleep. And when you awake you will no longer be afraid that you’re going to die. And when you see me tomorrow morning again, you will be able to talk with me, and we will talk about God and we will talk about yourself.”
In the morning Kathy was improved. She was still frightened and unconvinced(怀疑的) that she would not die, but no longer certain that she would. Slowly, on that day and for many, many days thereafter, her story emerged, piece by piece. During her senior year in high school she had had sexual intercourse with Howard. He wanted to marry her and she had agreed. Tow weeks later while at the wedding of a friend, the idea suddenly came to her that she did not want to get married. She fainted. Afterward she was confused as to whether she loved Howard. But she felt that she had to go through with the marriage because she knew she had already sinned by having premarital relation with him and this sin would be magnified if she did not consecrate(献身于) their relationship in marriage. Still, she did not want children, at least not until she felt more certain that she loved Howard. So she started on the pill-another sin. She could not bear to confess(坦白) these sins and was relieved(如释重负) to stop going to mass after they were married. She enjoyed sex with Howard. Almost from the day of their wedding, however, he lost interest in her sexually. He remained an ideal provider, buying her gifts, treating her deferentially(谦恭地), working a great deal of overtime, not allowing her to have a job. But she almost had to beg him for sex, and the sex they had every two weeks was about all there was to relieve her unremitting boredom(厌烦). Divorce was out; that was a sin, unthinkable.
Despite herself Kathy began to have fantasies of sextual infidelity(不忠行为). She thought perhaps she might rid(摆脱) herself of these if she prayed more, so she started to pray ritualistically(仪式地) five minutes every hour. Then Howard noticed and teased her about it. So she decided to hide her praying by doing it more in the daytime when Howard was not home, to make up for not doing it in the evening when he was. This meant she had to pray either more frequently or faster. She decided to do both. She prayed now every half hour, and in her five minutes of praying time she doubled her speed. The fantasies of infidelity continued, however, and gradually became even more frequent and insistent. Whenever she went outside she looked at men. That made things worse. She became fearful or going outside with Howard, and even when she was with him, she became frightened of public places where she might see men. She thought perhaps she ought to return to church. But then she realized that if she returned to church she would be sinning if she did not go to confession and confess her fantasies of infidelity to the priest. This she could not do. She again doubled the speed of her praying. To facilitate(使便利) this she began to develop an elaborate(精心制作的) system in which a single chanted syllable stood for an entire particular prayer. This was the genesis(起源) of her chanting. In a while, perfecting her system, she was able to chant a thousand prayers in a five-minute period. Initially, while she was so busy perfecting her chanting, the fantasies of infidelity seemed to abate(减轻), but once she had the system down pat they returned full force. She began to consider how she might actually carry them out. She thought of calling Bill, her old boyfriend. She thought of bars she might go to in the afternoon. Terrified that she might really do this, she stopped taking the pill, hoping that the fear of getting pregnant would help her in resisting such acts. But the desire kept growing stronger. One afternoon she found herself starting to masturbate. She was horrified. That was perhaps the worst sin of all. She’d heard of cold showers and took one as cold as she could stand. I helped her until Howard came home. But the next day it was all back again.
Finally, that last morning, she gave in. After dropping Howard off at work she drove directly to Bill’s house. She packed right in front. She waited. Nothing happened. No one seemed to be home. She got out of the car and stood leaning against it, in a seductive pose. “Please,” she pleaded silently, “please let Bill see me, please let him notice me.” Still nothing happened. “Please let someone see me, anyone. I’ve got to fuck someone. Oh, God, I’m a whore. I’m the Whore of Babylon. O God, kill me, I’ve got to die.” She jumped in the car and raced back to the apartment. She got a razor blade and went to cut her wrist. She could not do it. But God could. God would. God would give her what she deserved. He would put an end to it, and end to her. Let the vigil(不眠) begin. “O God, I’m so scared, I’m so scared, please hurry, I’m so scared.” She began to chant, waiting. And that was how her sister-in-law found her.
This story was elicited(引出) in its entirely only after months of painstaking work. Much of this work centered around the concept of sin. Where did she learned that masturbation is a sin? Who had told her it was a sin? How did her informant(息提供者) know it was a sin? What made masturbation a sin? Why is infidelity a sin? What makes a sin? And so on, and so on. I know of no profession more exciting and more privileged(荣幸的) than the practice of psychotherapy, but at times it may be almost tedious as the attitudes of a lifetime are methodically(系统地) challenged one by one in all their particulars(细节). Often such challenge is at least partly successful even before the whole story emerges. For instance, Kathy was able to tell me about many of these details, such as her fantasies and her temptation(诱惑) to masturbation, only after she herself had begun to question the validity of her guilt and her conception of these acts as sins. In raising these questions it was also necessary that she question the validity of the authority and wisdom of the whole Catholic Church, or at least the church as she had experienced it. One does not take on the Catholic Church easily. She could do so only because she had the strength of an ally in me, because she had gradually come to feel that I was truly on her side, truly had her best interests at heart and would not lead her into evil. This “therapeutic alliance,” such as she and I had slowly constructed is a prerequisite for all successful major psychotherapy.
Much of this work was conducted on an outpatient basis. Kathy had been able to be discharged from the hospital a week following her sodium amytal(阿米妥钠) interview. But it was only after four months of intensive therapy that she was able to say in regard to her notions of sin, “I guess the Catholic Church sold me a bill of goods.” At this point a new phase of therapy was begun, for we began to ask the question: How was it that this had happened? Why had she allowed herself to buy this bill of goods, lock, stock and barrel? How was it that she had not been able to think more for herself and had not until now challenged the church in any way? “But Mother told me I should not question the church,” Kathy said. And so we began to work on Kathy’s relationship with her parents. With her father there was no relationship. There was no one to relate to. Father worked; that was all he did. He worked and he worked, and when he came home it was to sleep in his chair with his beer. Except on Friday nights. Then he went out for his beer. Mother ran the family. Alone, unchallenged, uncontradicted(未遭否认的), unopposed(不受反对的), she ran it. She was kind bur firm. She was giving but never gave in. Peaceful and implacable(能安抚的). “You mustn’t do that, dear. Good girls don’t do that.” “You don’t wear those kind of shoes.” “It isn’t a question of whether you want to go to mass, dear. The Lord wants us to go to mass.” Gradually Kathy came to see that behind the power of the Catholic Church lay the enormous power of her mother, a person so softly yet so totally domineering that it seemed unthinkable to defy(违抗) her.
But psychotherapy seldom goes smoothly. Six months after she had left the hospital Howard called one Sunday morning to say that Kathy was locked in the bathroom of their apartment chanting once again. Upon my instructions he persuaded her to return to the hospital, where I met them. Kathy was almost as frightened as the first day I saw her. Once again Howard had no clue as to what had set if off. I took Kathy into her room. “Stop chanting,” I ordered, “and tell me what’s the matter.”
“I can’t.”
“Yes, you can, Kathy.”
Hardly catching her breath in between her chanting, she suggested, “Maybe I can if you give me the truth drug again.”
“No, Kathy,” I replied. “This time you’re strong enough to do It yourself.”
She wailed. Then she looked at me and resumed her chanting. But in her lock I thought I detected(识别) anger, almost fury, at me.
“You’re angry at me,” I stated.
She shook her head as she chanted.
“Kathy,” I said, “I can think of a dozen reasons why you might be angry at me. But I don’t know unless you tell me. You can tell me. I will be all right.”
“I’m going to die,” she moaned.
“No, you’re not, Kathy. You’re not going to die because you’re angry at me. I’m not going to kill you because you’re angry at me. It’s all right for you to be angry at me.”
“My days are not long,” Kathy moaned. “My days are not long.”
Something about these words sounded strange to me. They were not the words I would have expected. Somehow they seemed unnatural. But I was not sure what to say except to repeat myself on way or another.
“Kathy, I love you,” I said. “I love you even if you hate me. That’s what love is. How could I punish you for hating me, since I love you, hating and all?”
“It’s not you I hate,” she sobbed.
Suddenly it clicked. “Your days are not long. Not long on this earth. That’s it, isn’t it, Kathy? Honor your mother and your father that your days may be long on this earth. The Fifth Commandment. Honor them or die. That’s what’s happening, isn’t it?”
“I hate her,” Kathy muttered(嘀咕). Then louder, as if emboldened by the sound of her own voice saying the dreaded words, “I hate her. I hate my mother. I hate her. She never gave me… She never give me… She never gave me me . She never let me be me. She made me in her image. She made me, made me, made me. She never let any of me be me.”
Actually, Kathy’s therapy was still in its early stages. The real day-to-day terror(恐惧) still lay ahead, the terror of begin truly herself in a thousand little ways. Recognizing the fact that her mother had totally dominated her, Kathy then had to deal with why she had allowed this to happen. Rejecting her mother’s domination, she had to face the process of establishing her own values and making her own decisions, and she was very frightened. It was much safer to let her mother make the decisions, much simpler to adopt her mother’s values and those of the church. It took much more work to direct her own existence. Later Kathy was to say, “You know, I wouldn’t really trade places for anything with the person I used to be, yet sometimes I still long for those days. My life used to be easier then. At least in a way.”
Beginning to function more independently, Kathy confronted Howard with his failure as a lover. Howard promised he would change. But nothing happened. Kathy pressed him. He began to get anxiety attacks. On my urging(催促), when he came to me about these, he went to another psychotherapist for treatment. He started to deal with deep-seated homosexual feelings, against which he had defended himself by his marriage to Kathy. Because she was very physically attractive he had regarded her as a “real catch,” a prize the winning of which would prove to himself and the world his masculine competence. In a meaningful way he had never loved her. Having come to accept this, he and Kathy most amicably(友善地) agreed to a divorce. Kathy went to work as a saleswoman in a large clothing store. With me she agonized(苦恼) over the innumerable small but independent decisions she was required to make in connection with her job. Gradually she became more assertive(果断的) and confident. She dated many men, intending eventual remarriage and motherhood, but for the time being enjoying her career. She became an assistant buyer for the store. After terminating therapy she was promoted to buyer, and most recently I heard from her that she had moved to another larger firm in the same capacity, and was quite pleased with herself at the age of twenty-seven. She does not go to church and no longer considers herself a Catholic. She doesn’t know whether she believes in God or not, but will tell you frankly that the issue of God just doesn’t seem a very important one at this point in her life.
I have described Kathy’s case at such length precisely because if is so typical of the relationship between religious upbringing(养育) and psychopathology. There are millions of Kathys. I used to tell people only somewhat facetiously that the Catholic Church provided me with my living as a psychiatrist. I could equally well have said the Baptist(浸信会教友) Church, Lutheran(路德教会) Church, Presbyterian(长老会) Church, or any other. The church was not, of course, the sole(唯一的) cause of Kathy’s neurosis. In a sense the church was only a tool used by Kathy’s mother to cement(巩固) and augment(加强) her excessive parental authority. One could justifiably(无可非议地) say that the mother’s domineering nature, abetted(煽动) by an absentee father, was the more basic cause of the neurosis, and in this respect too Kathy’s case was typical. Nonetheless, the church must share the blame. No nun(修女) in her parochial(教区的) school and no priest in her catechism class ever encouraged Kathy to reasonably question religious doctrine or in any way whatever to think for herself. There was never any evidence of concern on the part of the church that its doctrine might be overtaught, unrealistically rigid or subject to misuse and misapplication(误用). One way of analyzing Kathy’s problem would be to state that while she believed wholeheartedly in God, the commandments and the concept of sin, her religion and understanding of the world was of the hand-me-down variety and badly suited to her needs. She had failed to question, to challenge, to think for herself. yet Kathy’s church-and this also is typical-made not the slightest effort to assist her in working out a more appropriate and original personal religion. It would appear that churches generally, if anything, favor the hand-me-down variety(多样化).
Because Kathy’s case is so typical and others like it are so common in their practice, many psychiatrists and psychotherapists perceive religion as the enemy. They may even think of religion as begin itself a neurosis-a collection of inherently irrational ideas that serve to enchain people’s mind and oppress their instincts toward mental growth. Freud, a rationalist and scientist par excellence, seemed to see things in roughly this light, and since he is the most influential figure in modern psychiatry(for many good reasons), his attitudes have contributed to the concept of religion as neurosis. It is indeed tempting for psychiatrists to view themselves as knights of modern science locked in noble combat(战斗) with destructive forces of ancient religious superstition and irrational but authoritarian(威权体制) dogma. And the fact of the matter is that psychotherapists must spend enormous amounts of time and effort in the struggle to liberate their patients’ minds from outdated religious ideas and concepts that are clearly destructive.