Every now and then I do get a question about my future as a psychotherapist, and I am in fact as of this writing cramming my updating courses to renew my medical license in March. After some time away from daily office hours, and some intense work in the areas of religious education and catechesis (which includes brewing up some daily thoughts for our Catechist Café), I may go back into volunteer and/or contract work. I did close the practice at the “average” retirement age of 66 and the day before the new DSM-V diagnostic codes went into place, but in truth I suspect that I was coming to a fork in the road on the issues of the theory, goals, and interventions of the mental health profession.
Two points I wish to emphasize before I continue. I was not “tired” of my patients. I still enjoyed the prospect of meeting a nervous new client right up until I stopped admitting patients altogether. Some of you, I’m sure, have sought therapy at some juncture in your life. You know how hard it is to make that phone call—which is why my receptionists always put through new inquiries even when I was in session. No established patient ever complained about that, because as they told me over and over, “I only had the courage to do it once.” I myself have been on the other side of the desk, so to speak, once for a year during my own training, and again when my stepson was killed by a drunk driver.
Second, there are many reasons people develop mental health symptoms. Chemical imbalance, crisis or trauma, upbringing, physical illness, substance abuse, side effects of medication, and chronic pain can produce clinical symptoms of depression or anxiety, for example. Life stages such as those enumerated by Erik Erikson each bring an age appropriate but significant strain. Individual circumstances of grief, broken relationships, stagnation, business failure, economic strain can trigger physiological changes in the body, including the brain. In truth, science does not fully understand the causes of most of those intimidating mental health diagnoses we write on our insurance claims.
In my own work what I came to perceive in so many patients—and this is my own subjective observation—was the loss of a North Star, so to speak. People came to therapy to find the right answer, to solve problems, a calm a troubling restlessness. Very few demanded the old Freudian couch psychoanalysis, and hardly any were pill seekers. (Therapists in Florida are not prescribers unless they are physicians.) A number asked me to teach them “techniques” to change behavior, and while I am not a behaviorist, I respected the willingness to undertake that work. Most seemed frightened that they were pushing what they thought were the right buttons but nothing was working. This was particularly true among parents.
There is a very important point of connection between mental health and religious formation. The great Catholic/Christian theologians of the twentieth century (Karl Rahner, S.J., comes immediately to mind) sought to recover the philosophical/theological richness of the entire Judaeo-Christian era in defining the nature of God’s communication with human life. As a man forgets or never receives a formation of his divine participation, he is prone to a basic identity crisis that produces an inherent anxiety. The absence of a sense of Providence, a code of living, a purpose of behaving, leaves a person in a constant need to reinvent one’s self. Little wonder that there is so much stress.
Religious formation, catechesis, adult faith formation—all must begin with that most critical question of human identity. If you look at a catalogue of any Catholic seminary, college or university, you will see that the first courses are in fact philosophical—Plato, Aristotle, Philo, Augustine, Aquinas—in order to explore the identity of the divine and the human. The next courses fall under the title of Christian anthropology: how the God of revelation meets the human in the mind and in the flesh. No religious training is possible, no catechism understandable—until these issues are resolved.
The wise catechist understands the needs of the human spirit and implants or restores that North Star that guided Moses and David …and a contemporary society in a state of identity crisis. In my own professional life, the move from psychotherapy to theology was almost imperceptible.