conversion and conversion

In his Jesus: The Village Psychiatrist, Donald Capps makes the to-me plausible case that several of Jesus's healings were of conversion disorders - or of what today we tend to call functional neurological disorders (FND). The New Testament, let's recall, tells various tales of Jesus's healing ministry (Mark 2, 5, 8, 9, 10; Matthew 8, 9, 12; Luke 4, 5, 6, 8, 17, 18; John 5, 9). And various of the troubles with which people then presented - paralyses, possession states, fits, skin ailments (which are all misleadingly called "leprosy" in the biblical translations) and blindness - do indeed sometimes have a psychogenic origin. That they responded to a non-medical intervention would itself ordinarily be taken as further evidence of their possible FND character. But Capps doesn't offer us an understanding of the method of cure; he offers us only the idea of Jesus as having charisma and an unspecified psychiatric nous and as having taught some of this to his disciples who went on to cure others in his name. In this post I'd like to fill out Capps' claim by offering something of an explanation - one I've drawn from Habib Davanloo's Intensive Short Term Dynamic Psychotherapy (ISTDP) as applied to FND by Allan Abbass. But first let's consider a handful of these healing tales.

Mark 2 tells the story of the paralyzed man lowered down through the roof by his friends at Capernaum. "When Jesus saw their faith, he said to the paralyzed man "Son, your sins are forgiven"... He got up, took up his mat, and walked out in full view of them all". John 5 gives us the story of a paralyzed man at the Bethesda pool. An invalid of 38 years was lying there. Jesus asked him "Do you want to get well?" Once again Jesus says "Get up! Pick up your mat and walk." The man is cured. Later, Jesus found him at the temple and said to him "See, you are well again. Stop sinning or something worse may happen to you." Mark 9 tells of a boy who is possessed by an impure spirit that renders him mute. Whenever it seizes him, it throws him to the ground. He foams at the mouth, gnashes his teeth and becomes rigid. Jesus asks for the boy to be brought to him; the boy immediately started to convulse. After his father professes his faith, Jesus rebukes the impure spirit and commands it to leave; the boy is cured.

In the examples I've selected, the illness in question is related in some way to sinfulness, and the cure from the illness is described as involving the forgiveness of sins. (Capps, it should be said, mentions neither of these in his book. I find myself wondering if the absence of sin and forgiveness there is because he felt it would take us away from the psychiatric and into the religious domain. The point of what follows will be to argue that, were this the case, it would be deeply misguided.) Sin has in some manner allowed an evil spirit to possess the person, and for some or other reason this spirit then provokes the disorder in question.

To this selection of Gospel healing narratives I'd like to add a further two examples, this time not from holy scripture but from the writings of notable early 20th century French psychologist Pierre Janet, and 21st century neurologist Suzanne O'Sullivan. Janet's study concerns his patient 'Achille'. (For other compelling examples see William Sargant's The Mind Possessed.) Achille was a fairly ordinary 19th century chap. As a youth he was impressionable. His grandfather suffered fugues. His family was superstitious. He married at 22. At the age of 33 he came back from a business trip very taciturn - and soon became mute, and finally completely motionless. Then 'Satanic' laughter came out of him along with complaints of being tortured by demons. He started running out to hide in the woods at night. He tried but failed to kill himself. Involuntary blasphemies (cursing God, the Trinity, the Virgin, etc) poured from his mouth in a deep voice, and he would then speak in his own higher voice, disavowing these. He had visual hallucinations of demons, and engaged in 'devil writing'. Janet found that, when his arms were writhing, Achille was insensible to being pricked (sticking with pins to test for pain insensitivity was an old test beloved of medieval exorcists). Janet struggled to hypnotise Achille directly, but when he acted as an exorcist addressing himself to the devil, he found that the devil would write back using Achille's right hand (Achille was then producing what we call 'automatic writing'), and in this way Janet could get control over him. What Janet found was that Achille had, when away on his business trip, been unfaithful to his wife. He had then had a 'dream' which became increasingly conscious in which he was damned and possessed; the dream then became hallucinatorily fulfilled. Janet next managed to effect a striking - and in a way perhaps rather troubling - cure: He helped Achille recover the memory of his affair consciously, and then encouraged in him a compelling hallucination of his wife forgiving him. Three years later he'd suffered no relapse.

The example from O'Sullivan concerns Camilla, a family lawyer with 2 children aged 9 and 11, married to Hugh. After a work meeting, Camilla suffered profound nausea and a trembling hand. Shaking then overtook all her limbs, her back started arching, and her breathing either ceased or she took huge gasps. Examination found no brain tumour, and epilepsy was diagnosed. However after telemetric investigations found no epileptiform activity, she was rediagnosed as suffering pseudo-seizures; her epilepsy drugs were accordingly withdrawn. Neither Camilla nor O'Sullivan had any idea what had brought on her seizure. But then towards the end of a follow-up meeting, Hugh recalled that Camilla had in fact experienced a similar seizure experience over a decade before. At that time Camilla had been pushing her 18 month old baby Henry in his buggy, and whilst she waited by the road, the buggy rolled off the pavement into the path of a passing car; Henry was killed. Because they had lots of pictures up of little Henry in the landing, and they had had other children, the couple had felt that the loss was now behind them. And what had triggered her latest attack? Well, the work meeting Camilla had been at was one in which she was able to save someone else's child in the family law courts - which tacitly evoked the poignant contrast with what she hadn't been able to do for her own child.

Now, how are we to understand such travails? One putative route is already suggested by labels such as 'psychosomatic illness', 'conversion disorder', and 'spirit possession'. Something which is really a spiritual or a psychological problem somehow gets transmuted into a physical problem by 'conversion' or 'possession'. Now I don't think for one moment that such ideas are helpfully described as simply wrong, nor do I have any knee-jerk animus against terms like 'psychosomatics' or 'conversion'. To be honest I don't really think we know enough about what they mean to say that they're right or wrong. But then: that is my complaint. They're too obscure in meaning to count as explanatory accounts. At best they're just evocative re-descriptions of the phenomena, placeholders for a time when we really do understand just how and why, say, a spirit or repressed anger would cause paralysis or fits.

I won't now go into the nature of the unconscious emotion met with in FND other than to say: such emotion is best understood as a partial res potentia: as a disturbed somatic state whose psychological character is underwritten by the meaning-replete context of its initial arising and recurrence, and the way it dissipates when a particular true ('conscious') emotion or set of emotions instead takes shape. What I do however want to focus on now is that perhaps the most powerful of the contemporary psychotherapies for FND, namely ISTDP as taught and practiced today by Allan Abbass, has an explicit focus on the patient's guilt. 

What first Habib Davanloo and now his student Abbass found in patients with FND is that the pathogenic nucleus underlying their symptoms was a powerfully repressed powerful rage at an abandoning or maltreating attachment figure and/or deep guilt at their actual or imagined actions toward this figure, perhaps along with a suppressed love for them and grief at the loss of them too. The emotions of anger and/or guilt and grief could not form because the patient couldn't cope both with their intensity and moreover with the intensity of the anxiety they provoke. In treatment the therapist, through his demeanour, offers a non-judgemental receptive encouragement to the patient to allow themselves their actual feelings toward the attachment figure. He actively pushes for the expression of emotion in the context of the patient's involved, imagination-rich, portrayal of what they would like to do and say to this figure. When they get overwhelmed by anxiety and symptoms start reappearing, the therapist then pulls back into a more intellectualising recap mode to provide stabilisation. The patient's guilt at, say, their murderous rage toward those they love is not rationalised or chased away. Instead it's welcomed, understood, and allowed (as it were) to breathe - as is their anger, their grief, and their love. In this way the patient learns that their guilt is survivable; now they no longer crumple under the shame and wretchedness it previously provoked.

poor piggies

Let's return now to the scripture. In the gospel stories Jesus releases the sufferers from their disturbance by, at least in part - and we don't know what he actually said and did; all we have here is the gospel writers' pithy summaries - by forgiving them their sins. In the presence of powerful goodness their FND-esque symptoms (convulsions etc) can at first increase. We might think of this as their unconscious guilt being more stimulated. But in the presence of this same powerful goodness, their guilt is now also radically relieved: the Son of Man proclaims them forgiven. This, in fact, is the classic one-two move that's so famously essential to the Christian faith: acknowledge your guilt but know your belovedness even so. Become able to feel your feelings, to mentalise, because you've been offered a chance to feel them in the maximal safety of a loving, fully accepting, relationship. A relationship which, in its conjoint loving acceptance and moral seriousness, in fact makes possible the derepression and mentalisation of otherwise pathogenic guilt. So often will someone remain on the run from their warranted or neurotic guilt or shame for fear that acknowledging it will be too inwardly unbearable, too provocative of scorn and ostracism from others. But when they're invited to confess their guilt, not in a punitive severe manner that heaps further shame on their head, but lovingly and with the promise of consequent liberation, now they can finally return to psychological health. 

My claim in short: Jesus was an effective village psychiatrist not despite, but precisely because of, his emphasis on the repentance and forgiveness of sins. What most matters religiously of course is that one experience repentance, metanoia, conversion: that a soul or psyche which hasn't owned its guilt now do that and return to an integrated life of love. But the upshot of this for those whose repression of guilt leads to FND is psychologically powerful: the restoration of mentalisation and psychological wholeness, and the cessation of such autonomic dysfunction as results in paralysis, fitting, blindness, and psychogenic skin complaints. If I'm right, it's not perhaps exactly what we ordinarily imagine by talk of sins' forgiveness that's the therapeutic moment here. Instead it's the related issue of finding one's human voice in the midst of one's guilt, the diminishment of the self-shattering shame that attends the guilt, and the shrinking of that guilt down to size as it now takes its stage as one of several emotional moments populating the conscious scene.