J Relig Health (2010) 49:536–546 DOI 10.1007/s10943-010-9347-6 ORIGINAL PAPER
Present at the Creation: The Clinical Pastoral Movement and the Origins of the Dialogue Between Religion and Psychiatry Curtis W. Hart • M. Div
Published online: 19 March 2010 Springer Science+Business Media, LLC 2010
Abstract The contemporary dialogue between religion and psychiatry has its roots in what is called the clinical pastoral movement. The early leaders of the clinical pastoral movement (Anton Boisen, Elwood Worcester, Helen Flanders Dunbar, and Richard Cabot) were individuals of talent, even genius, whose lives and work intersected one another in the early decades of the twentieth century. Their legacy endures in the persons they inspired and continue to inspire and in the professional organizations and academic programs that profit from their pioneering work. To understand them and the era of their greatest productivity is to understand some of what psychiatry and religion have to say to each other. Appreciating their legacy requires attention to the context of historical movements and forces current in America at the end of the nineteenth and the beginning of the twentieth century that shaped religious, psychiatric, and cultural discourse. This essay attempts to provide an introduction to this rich and fascinating material. This material was first presented as a Grand Rounds lecture at The New York Presbyterian Hospital, Payne Whitney Westchester in the Department of Psychiatry, Weill Cornell Medical College. Keywords Clinical pastoral movement Psychosomatic movement Pastoral counseling Pastoral care Theological liberalism Emmanuel movement Anton Boisen Elwood Worcester Helen Flanders Dunbar Richard Cabot
Introduction Personal narrative is a valuable approach for entering the world of those distant in time and history. The following is an excerpt from a letter that introduces two of the individuals under consideration as well as concerns that animate the larger conversation between religion and psychiatry. The letter is written by The Rev. Anton Boisen, widely acknowledged as father to the clinical pastoral movement, somewhere near the end of an extended hospitalization at the Westboro (Massachusetts) State Hospital where his C. W. Hart (&) M. Div Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA e-mail:
[email protected]
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diagnosis was that of schizophrenia of the catatonic type. It is addressed to The Rev. Dr. Elwood Worcester and its date is November 20, 1921. Worcester was then Rector of the Emmanuel Church in Boston’s Back Bay neighborhood which since 1906 had been the scene of a clinic where clergy and physicians had collaborated in the treatment of nervous or mental disorders of all persons who came seeking help. Here, Boisen tells Worcester a part of the story of his hospitalization as well as stating that the suffering he has endured must for him prefigure a new struggle for meaning in life and ministerial vocation. He writes The danger that I may underestimate the gravity of these abnormal conditions [of his experience of illness] and the necessity of avoiding future recurrences. This danger I recognize. The horror of the recent catastrophe is with me still. It has been terrible beyond the power of words to express. And yet I do not regard these experiences as ‘‘breakdowns.’’ If I am right in believing that through them difficult problems have been solved for me and solved right, and if through them help and strength have come to me, am I not justified in such a view? As I have tried to understand my own case and as I have studied the problems of others in the hospital I have come to the conclusion that … They have no physical trouble. They are just sick of soul. Now to the physicians: here anything in the nature of automatisms, any ‘‘voices,’’ visions, even a belief in providence or divine guidance is per se evidence of insanity and justifies commitment… I think there can be little question that such men as Saul of Tarsus [St. Paul] and George Fox [the founder of Quakerism] would fare badly before a present day psychiatric staff. But with them the abnormality was a source of power and strength. I am therefore hoping for the day when cases of mental trouble that are not primarily organic in origin will be recognized as spiritual problems and the church will develop physicians of soul of a type whose work will be based upon sound and systematic study of spiritual pathology… In this purpose, I am guided by my belief in the importance of this task, also by the faith that I can really make some contribution to it. (Boisen, 1960, 139–140). This letter is recorded in Boisen’s autobiography, Out of the Depths, published in 1960 when he was 84. Its text was recorded originally in the 1920s after his initial hospitalization when Boisen enrolled in courses under Dr. Macfie Campbell of the Harvard Medical School to understand his own and others experience of mental illness. There is no published record of Worcester’s response to the ideas put forth here. Indeed, Boisen’s Out of the Depths may be seen as both his own case history as well as an example of the genre of confessional literature and more particularly as part of the category of personal narrative involving stories of suffering and recovery from psychiatric illness. As such, it belongs to such works as Clifford Beers’ A Mind That Found Itself, Joanne Greenberg’s I Never Promised You A Rose Garden, Kay Redfield Jamison’s An Unquiet Mind, and most recently Ellyn Saks’ The Center Cannot Hold. Speculation, both psychiatric and theological, is in order regarding the state of mind of anyone who makes claims that sound patently messianic, if not downright delusional. On the other hand, Boisen’s poignantly expressed desire to discover meaning in the face of suffering and his heartfelt interest to ‘‘make some contribution’’ to a renewal of the church’s ministry of the care of souls based in ‘‘sound and systematic study’’ are both laudable and provocative. They are also powerful ideas that animate and continue to sustain the dialogue between religion and psychiatry. They suggest common ground, a
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place for a meeting of the minds. It is to the context for the discovery of that common ground that we now turn our attention.
Historical Context Religious values had already by the middle of the nineteenth century made an impact on the care of the mentally ill. The philosophy and technique of ‘‘moral treatment’’ emphasized with great earnestness the removal of physical restraints, humane and kindly care in general, attention to religious and moral uplift, and encouragement for performance of useful tasks in the hospital community. Moral treatment predated what later became known as the ‘‘mental hygiene movement’’ with which the name of the reformer and former patient, Clifford Beers, is often identified. Moral treatment and the mental hygiene movement, concerned as they were with social welfare and humane values, were both precursors and contributors to the progressive and hopeful outlook of the milieu in which the clinical pastoral movement arose. What historian Richard Hofstader calls the ‘‘Age of Reform’’, otherwise known as Progressivism, of the later nineteenth and early twentieth centuries, informed the temper of the time during the coming of age and most productive work of those individuals (Boisen, Worcester, Richard Cabot, Helen Flanders Dunbar) instrumental in the foundation of the clinical pastoral movement and in the dialogue between psychiatry and religion. The Progressive Era was marked by such major social and political events as women’s suffrage, the promulgation of child welfare statutes, monetary reform, the growth of the labor movement, and efforts to provide universal public education. In the religious sphere, progressivism was embodied in the principles and personalities identified as the Social Gospel whose liberal Protestant spokespersons such as Washington Gladden and Walter Rauschenbusch supported from a theological perspective these social movements and activities. It is clear that Boisen and others of his era were shaped directly or indirectly by what has come to be called liberal Protestantism. Liberal Protestantism came into vogue in the latter part of the nineteenth century and its impact continued on well into the mid and late twentieth century in American religion. A historian of this phenomenon (Alison Stokes) identifies liberalism’s major characteristics as ‘‘cultural accommodation, a focus on God’s immanence, and progressivism.’’ (Stokes 1985, 149–150) Together these characteristics stress the indivisibility of the sacred and the secular, the need for a pluralistic outlook in the search for ultimate truth, a belief in the primacy of the human experience of God as formative and a prerequisite for any viable, mature religious self-understanding, and an implicit faith in modern modes of inquiry which include science, social science, and psychoanalysis as bases for the improvement of the world and the pursuit of truth. Indeed, Boisen, Worcester, Dunbar, Cabot and their contemporary followers embodied a liberal world view which allowed theology to become a clinical as much as an academic enterprise and thus provided the intellectual framework for the ensuing dialogue between psychiatry and religion. Liberalism’s spirit, moreover, made certain that a positive spirit would exist for the reception of the work of Freud and his followers as it crossed the Atlantic beginning with his visit to America in 1909 that then found its way into academic and popular circles. It is surprising to some in the mental health field to discover the historical and current openness to embracing psychological ideas existing within liberal Protestantism and, in fact, within the liberal or progressive wings of virtually all major religious groups and denominations.
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It is worthwhile noting that the officially acknowledged beginning of the clinical pastoral movement’s training for seminarians and religious workers, known now as Clinical Pastoral Education, was at Worcester (Massachusetts) State Hospital in the summer of 1925. There were actually two other antecedent pastoral training experiments before that time, one of which was inspired in part by Elwood Worcester. By 1925, however, Anton Boisen had been the chaplain at Worcester for one year. He organized and conducted the training. He had obtained this position with the active intercession and support of Richard Cabot who was at that time a mentor figure for him. Among those who were part of that first pastoral training group at Worcester State Hospital was Helen Flanders Dunbar. Boisen was appointed chaplain by Worcester’s Superintendent, William D. Bryan, M.D., an enlightened, dedicated administrator of a hospital with a lively tradition of social awareness, educational and therapeutic innovation, and academic training in all disciplines including psychoanalysis. The year 1925 was also the same summer as the Scopes Trial in Dayton, Tennessee. This event marked a watershed in the confrontation between fundamentalism and modernism in American religion and culture. Boisen himself published a piece on the trial in that year entitled ‘‘In Defense of Mr. Bryan: A Personal Confession by a Liberal Clergyman.’’ The date is significant in that it brings into focus how the clinical pastoral movement represents a significant break with conventional religion and traditional theological education while at the same claiming continuity with an older tradition, the care of souls. Relying directly and indirectly on philosophical pragmatism as articulated by John Dewey and others in clinical and educational matters, on an examination of the psychology of religion and religious experience in the manner of William James, on the values of empiricism and skepticism of the scientific method, and on the ideas generated by Freud and psychoanalysis, it is no wonder that the clinical pastoral movement would come to be seen as suspect and ‘‘too psychological’’ by fundamentalists and others representing the conservative wings of organized religion and by those invested in traditional theological education. The persons now to be discussed (Boisen, Worcester, Dunbar, and Cabot) may be seen to be part of what psychiatrist and historian, Robert Powell, has called the ‘‘extra medical origin of the American psychosomatic movement.’’ (Powell 1974, p. 1) Powell in his work does not place Cabot within this designation but his person and achievements in relation to the clinical pastoral movement and these other figures identify him for inclusion in their company. It may appear inappropriate to place two distinguished physicians, Cabot and Dunbar, under the heading ‘‘extra medical.’’ Both of them, however, addressed issues not only from their point of view as physicians but also from the perspectives of theological and medieval studies (Dunbar) and from social ethics (Cabot). They, Boisen, and Worcester were committed to finding points of dialogue and meaningful connection between science and religion and cooperation among the healing professions. Each made contributions to seeing human beings in dynamic, holistic ways that integrated clinical knowledge and experience in a pluralistic manner, that is, from a variety of points of view. They were dedicated, as Dunbar articulated in the ‘‘Introductory Statement’’ in the initial publication of Psychosomatic Medicine, a journal she founded, to ‘‘the necessity of studying systematically… the therapeutic utilization of the psychic component of the disease process, and in the emotional relationship between physician and patient.’’ (Brown 2000, 2–3) Their identities and contributions are sometimes better known in the medical and psychiatric fields than from within theological schools and religious institutions. Two of the three best histories of the origins of the clinical pastoral movement have been written by psychiatrists Robert Powell and Sanford Gifford. This inattention on the part of the theological community is a topic that of itself merits exploration.
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Why have these four individuals been chosen? First, they could be judged from some standards as being geniuses and all had the egotistical temperament often identified with persons of great talent and achievement. Second, they are all representatives of liberal Protestant traditions. Boisen was a Presbyterian. Worcester and Dunbar were Episcopalians. Cabot was a Boston Brahmin and New England Unitarian. His father was the executor of the estate of Ralph Waldo Emerson and Cabot himself was a distinguished physician who was, among other things in his rich and varied career, the head of medicine at the Massachusetts General Hospital. Third, as previously noted, they were all pluralists who integrated theory and practice from more than one discipline. Fourth, they were all public intellectuals that had broad reputations and constituencies. Fifth, they were all known to one another personally as well as by reputation. This closeness sometimes led to conflict and estrangement even as they shared common values and outlooks. Let us now briefly examine their contributions to the clinical pastoral movement and to the dialogue between psychiatry and religion.
The Patriarch: Anton T. Boisen (1876–1965) Anton Boisen was born in Bloomington, Indiana in 1876. His early life was marked by the death of his father at the age of seven. An able scholar and student, he graduated from the University of Indiana in Bloomington and taught romance languages there for a time before entering the Yale School of Forestry. Later he attended Union Theological Seminary where he studied psychology of religion under George Albert Coe, a professor steeped in the approach of William James’ Varieties of Religious Experience. After a lackluster career of some 10 years attempting unsuccessfully to be a parish minister, he experienced in 1920 the first of three psychiatric hospitalizations. The second was in 1930 after the death of his mother and third in 1935 on the occasion of the death of the love of his life, Alice Batchelder, whom he courted and actively pursued for years even as she refused his continued proposals of marriage. He became convinced that his first hand encounter with mental illness was, as he said, a ‘‘problem solving experience’’ that permitted him to find a new lease on life and vocation well into middle age. He set about the task of educating seminarians and clergy about mental illness in the hospital setting and doing research in the area of the psychology of religious experience that he felt in some striking ways resembled psychiatric illness. He held positions first at Worcester State Hospital and later at Elgin (Illinois) State Hospital where he died in 1965. Boisen made invaluable contributions to the dialogue between religion and psychiatry. His pioneering work included, first, his efforts at establishing pastoral care in psychiatric institutions and, second, his passionate interest in the education of seminarians and clergy through use of what he called the ‘‘living human documents’’, individuals making their way through crises, in clinical pastoral training. He inspired other talented individuals to follow him into this new field even as he tirelessly promoted his ideas in publication of books and articles that reached a wide audience in the psychiatric and religious communities. Besides his autobiography, Out of the Depths, he also wrote The Exploration of the Inner World: A Study of Mental Illness and Religious Experience in 1936, a work that is still studied and referred to in studies related to the psychology of religion. Boisen also spoke convincingly to the mental health community through appearances in the literature of that field. His work appeared regularly in Psychiatry, a publication edited by his friend and colleague, Harry Stack Sullivan, and The American Journal of Psychiatry. His article of 1926, ‘‘Personality Changes and Upheaval Arising Out of A Sense of Personal Failure’’
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drew heavily on his own journey though illness as well as from what he observed and chronicled in patients at Worcester. This piece was selected for inclusion in the Sesquicentennial Anniversary Supplement, 1844–1994 of The American Journal of Psychiatry in the section entitled ‘‘Clinical Description’’ and appears alongside pieces by Sullivan, Erich Lindemann, and Leo Kanner. Its editor, David Spiegel, remarks upon Boisen’s ‘‘understanding of psychodynamic thinking and that his orientation is remarkably existential, focusing on themes of meaning, death, and isolation that are the core issues in existential philosophy and psychotherapy.’’ (Spiegel 1995, 93). Spiegel further credits him with an ‘‘astute’’ understanding of how hypnosis and hypnotic states resemble ‘‘those which arise in shamanism, religious trance, or severe life stress.’’ (Spiegel 1995, 93). Boisen’s success in this dialogic realm was based in part on his ability to listen to those in crisis, his intellect, and to the creative energy shown in the models and approaches to recording case histories he used with patients himself and then shared with his students. He was also a dedicated researcher in both the signs and behaviors involved in mental health issues and in the application of research methods to the sociology of religion in general and church life in particular. Among his shortcomings is what critics have pointed out as his all too clear separation between organic and functional aspects of causality in mental disturbance. He developed something of a brusque, authoritarian manner in dealing with students and colleagues as his life went on. He also lacked in organizational skills as the clinical pastoral movement developed past its early formative stages.
The Empire Builder: The Rev. Dr. Elwood Worcester (1862–1940) The Reverend Dr. Elwood Worcester was the prime mover and inspirational force behind the Emmanuel Movement located at the Emmanuel Church in Boston where he was Rector from 1904 to 1929. Worcester was born in Massillon, Ohio and was the child of a clerical family in the Swedenborgian tradition that moved around frequently during his early years. He attended Columbia College followed by the General Theological Seminary where he completed the 3-year course of study for ordination in 1 year in the Episcopal priesthood. Beyond his theological training he received a Ph.D. in psychology and studied under the great experimentalists and theorists, Wilhelm Wundt and Gustav Fechner, at the University of Leipzig in Germany. After returning to the United States, he taught for a time and then took up a post at St. Stephen’s Church in Philadelphia where one of his parishioners was the eminent neurologist, S. Weir Mitchell. It was from conversations with Mitchell that Worcester describes in his autobiography, Life’s Adventure, that he began to think intentionally about the church’s role in the treatment and care for the mentally ill or sick of soul. Upon coming to the Emmanuel Church, he began conversations with Richard Cabot and psychiatrist, Isador Coriat, who along with his clerical colleague, The Reverend Samuel McComb, supported the idea of a clinic for treatment. The doors opened in November 1906 with one hundred ninety-eight persons waiting for consultations. The Emmanuel Movement grew in public awareness and its program was replicated in several places. Its prestige and success were such that it drew heavy criticism from the psychiatric establishment in the person of James Jackson Putnam who questioned its use of non-medical persons in treatment. The Emmanuel Movement continued until the time of Worcester’s retirement form the church in 1929. He then spent time in New York where among other things he collaborated in a study designed and headed by Helen Flanders Dunbar at
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Columbia Presbyterian Hospital. Its topic was an evaluation of the effectiveness of clergy involvement in the pastoral treatment of the physically ill and its results were inconclusive. Worcester’s contributions were also wide and varied. His success may be measured by the threat he posed to the psychiatric establishment and by the several efforts made to replicate the Emmanuel Movement in other cities, something he heartily approved of. He was ahead of his time by at least a generation in the area of pastoral counseling where he employed a variety of therapeutic approaches which demonstrated his personal skill, resourcefulness, and familiarity with psychoanalysis. As Sanford Gifford notes The present day reader will still be impressed by Worcester’s responsiveness to Freudian theory, and his tact and sensitivity as a clinician, as in treating severely depressed patients and evaluating suicidal risk. Though Worcester valued free association and dream interpretation, he also understood when such uncovering techniques were inappropriate, as in acute grief reactions. (Gifford, 1997, 98). The Emmanuel Movement was also effective in utilizing group psychotherapy techniques of the sort pioneered by Joseph Hersey Pratt, M. D. Group techniques with an educational or cognitive component were also specifically employed at Emmanuel in the treatment of alcoholics. These efforts were headed up by layman Courtenay Baylor and may be seen as a precursor of the group techniques used in Alcoholics Anonymous that came into being in the wake of that group’s founding in 1935. The Emmanuel Movement and Worcester in particular also took a dynamic interest in public health matters such as the prevention and treatment of tuberculosis and in understanding non-Western religions and what they might have to say about religion and health. It should be noted that no less an authority than the renowned physician William Osler recognized Worcester and the Emmanuel Movement for its efforts in bringing science and religion together in an integrated, scientifically responsible way in an article entitled ‘‘The Faith That Heals’’ that appeared in the British Medical Journal in 1910. Worcester’s contributions are remarkable, though largely unrecognized today. He wrote effectively for both a professional and lay audience in articles and books that he coauthored with Samuel McComb and Isador Coriat. It is unfortunate that the Emmanuel Movement could not survive without Worcester’s charismatic leadership as well as endure the assault of the medical establishment of that era. It may be that Worcester’s and the Emmanuel Movement’s enduring legacy belongs to the numerous pastoral counseling centers and twelve step groups whose activities routinely take place within the walls of churches and other religious institutions.
The Practical Theoretician: Helen Flanders Dunbar (1902–1959) Helen Flanders Dunbar was the youngest and most controversial of the founders of the clinical pastoral movement. She was born into a well-to-do family in Chicago in May of 1902. She suffered from a variety of illnesses as child of unclear origin that caused her to spend a great deal of time alone. Because of setbacks in her father’s business and in response to her own health problems, the family moved around a great deal settling finally by her high school years in New York. Raised by three ardent women—her mother, aunt, and grandmother—all of whom invested a great deal in her, she went on to attend Bryn Mawr where she studied mathematics and psychology and psychology of religion in particular. Dunbar then undertook studies in Comparative Literature at Columbia and attended Union Theological Seminary at the same time. While at Union she met Anton
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Boisen who engaged her interest in the training program at Worcester where she worked tirelessly with those in the department of social work studying symbols and symbolization in schizophrenia. Her initial interest in the clinical pastoral movement grew into a commitment leading her to become its first Medical Director even as she completed her medical studies at Yale. Throughout her life she showed herself to be an adept institutional politician who played a central role in the founding of the American Psychosomatic Society. She also was awarded one of the first major grants ever given by the Josiah Macy Foundation for the study of psychosomatics which when completed was entitled Emotions and Bodily Changes. It was first published in 1935 and went through several subsequent editions. She also held the prestigious position of Director of the Joint Commission on Religion and Medicine of the National Council of Churches and the New York Academy of Medicine which oversaw her work and itself showed a strong interest in furthering the formal, scientific study of the relationship between religious faith and health. Her allegiance to Anton Boisen took a variety of forms including helping him through his second psychiatric hospitalization and in being instrumental in supporting his interests in the formal structuring of the movement into the Council for Clinical Training which for a time with her assistance had its headquarters at the New York Academy of Medicine. Never one to avoid controversy, she had confrontations with Richard Cabot and another significant male figure with a stake in the clinical pastoral movement, Austin Philip Guiles. These sorts of confrontations also became common in relation to male peers in medicine. Dunbar was not actively involved with the clinical pastoral movement much after the late 1930s, but her interests became rekindled just prior to her untimely death in 1959 from drowning following a heart attack in a pool in the backyard of her Connecticut home. Dunbar’s legacy is complex in both medicine and the clinical pastoral movement. As for the latter, the power of her intellect and personality were invaluable to Boisen as was her personal loyalty. Her writing expresses a sophisticated and erudite appreciation for the interplay between mind and body. She believed fervently in the importance of clinical training for clergy and the role of symbols in understanding illness. Her own study of medieval literature and Dante in particular informed her medical practice and her therapeutic approaches. The book she wrote arising out of her dissertation at Columbia, Symbolization in Medieval Though and Its Consummation in the Divine Comedy, was published in 1927, republished at the time of her death in 1959, and is considered a classic in its field. Dunbar is described by Robert Powell as a ‘‘practical theoretician’’ and a ‘‘woman with a mission.’’ Nowhere is this more clearly demonstrated than in the delineation of what she called the ‘‘insight symbol’’ which, like symbols in medieval and renaissance literature, in psychosomatic medicine and psychiatry gather, shed light upon, or refer to a multiplicity of meanings, events, and conditions. Symbols in medicine for Dunbar function in the way Paul Tillich describes them in his classic study of symbols that appears in Dynamics of Faith. For her they ‘‘unlock dimensions and elements of our soul which correspond to the dimensions of reality… and participate in the reality to which they point.’’ (Tillich 1957, 42–43) Dunbar may be seen as anticipating Tillich in this regard. For Dunbar, symbols call attention to the whole that is always greater than the sum of its parts—a person with a family, a history, a place in the world who develops or displays signs of dysfunction at a specific time in life. If this is a fair reading of Dunbar’s method and approach, then in her conceptual framework there is permeability between the boundaries of psyche and soma, inner and outer worlds, self and society. Hers is a view that is best described as organic, holistic, where the parts are interdependent on one another. It is a view that has overtones
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of what is called the ‘‘organic functional ideal’’ as that is a property of a medieval world view and at the same time a reflection of other thinkers that influenced her such as John Dewey and Alfred North Whitehead. Indeed, Dunbar was a challenge to her peers intellectually and personally, given her highly individualistic, provocative views as well as her capacities to persuade, confront, and charm others. She may well have been misunderstood in her own time certainly for her personal style. But the depth and breadth of her ideas, formed and molded as they were by her medieval studies, her theological studies, and confirmed through her involvement in the clinical pastoral movement caused her to be out of step in the professional medical and psychiatric world in which she was destined to function.
The Brahmin: Richard Cabot (1868–1939) If America has an aristocracy, then Richard Clarke Cabot was part of it. Born and raised in the midst of privilege to one of the oldest and most prominent of Boston families, he was educated at Harvard College and the Harvard Medical School. He was destined to be a leader and caretaker in his family, his city, and his chosen profession. The first chaplain at the Massachusetts General Hospital, Russell Dicks, once noted that ‘‘the Cabots were reputed to have a direct line of communication with God. I always suspected that Richard Cabot really believed that.’’ (Thornton 1970, 46) But Richard Cabot was also his own man. He worked long and hard to become chief of medicine at Massachusetts General Hospital where he was an authority in hematology, his chosen specialty. He later headed up the extensive outpatient services at the hospital and was an active force in the development of medical social work as a discreet profession. Cabot was engaged in providing medical care for American soldiers in France in World War One, a service for which he characteristically volunteered. He was filled with a deep, moral sense that defined meaning in life as service to others. Because of that grounding and a natural sense of entitlement, he took seriously the roles of leadership that continued to be extended to him. Cabot believed also that a person should have at least two careers and so he later on in life became the first chairman of the newly formed Social Ethics (now Social Relations) Department at Harvard. He regularly taught both undergraduates as well as seminarians at Andover Newton Theological Seminary. He is known to have written early on in the bioethics literature on the topic of the doctor–patient relationship where he emphasized the importance of mentoring medical students and residents by experienced physicians as being crucial in the formation of professional identity. He also appeared to at least some of his peers in his own social circles as an oddball and an eccentric to the degree that his own brother, Godfrey Cabot, an eminent State Street banker in Boston, is reputed to have remarked that there were three kinds of fools in this world: fools, damn fools, and his brother Richard. Cabot made a number of significant contributions to the clinical pastoral movement. He was among the first to encourage Anton Bosien to utilize the case method in the study of persons with disorders as well as in teaching. He helped make possible Boisen’s original appointment at the Worcester State Hospital. He inspired Rusell Dicks, chaplain at Massachusetts General, to start recording and analyzing his prayers and conversations with patients. Because Cabot had been instrumental at starting the clinical pathological case conferences for physicians and students at the hospital where difficult cases were intensively reviewed, he felt Boisen, Dicks, and others might profit from developing similar strategies for assessing the effectiveness of pastoral visits. His considerable prestige was offered to the clinical pastoral movement as the charter for the Council for Clinical
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Training was formally signed and adopted in Cabot’s own home in Cambridge in 1930. He also published in 1926 as part of a book, Adventures in the Borderland of Ethics, an essay entitled ‘‘A Plea for a Clinical Year in the Course of Theological Study’’ that outlined why a year of practical study in a clinical setting should be a requirement of a formal theological curriculum. He collaborated with Russell Dicks on a book, The Art of Ministering to the Sick, a book that discussed at length the inner needs of a patient undergoing surgery or being treated for chronic or acute illness. They stressed the collaborative relationship between doctor and clergyperson. And Cabot was, as noted, an early, active supporter of the Emmanuel Movement. Cabot had his own authoritarian streak and did not take kindly to criticism or confrontation. He was taken aback when seeing Boisen as he was overtaken by symptoms prior to his second hospitalization and lost some faith in him subsequent to that event. Cabot did not agree with Boisen’s psychological and religious ideas regarding mental illness and came to believe that clinical pastoral training would best be carried out in general hospital settings as opposed to psychiatric facilities. It may be, however, as Alison Stokes has noted, ‘‘that his discomfort with Boisen’s ideas stemmed from the fact that he (Cabot) had a sibling who was a chronic manic depressive and he tired or remained thoroughly unconvinced of psychological explanations of this and other psychiatric conditions.’’ (Stokes 1985, 49) Thus, with Cabot and Boisen, as was the case with all of the individuals engaged in the origins of the clinical pastoral movement, there were pronounced differences of opinion that at times strained cooperation. Here, as elsewhere in the complicated interrelationship among them, there remained a common ground of shared values and points of view held in common.
The Legacy The contributions of those most responsible for the clinical pastoral movement that initially made possible the dialogue between religion and psychiatry are wide ranging and clearly relevant to the contemporary world. They provided a framework for future intellectual endeavors and institutional growth in the form of pastoral care and counseling organizations and seminary courses that attempt to integrate psychiatry and religion. They are the following: 1. A sustaining belief in the cooperation of clergy and others in medicine and psychiatry in the treatment of the sick and a view that patients are psychosomatic wholes. 2. A generalized belief in the necessity and mutually beneficial dialogue between religion and science. Epistemologically, this meant advocacy for a pluralistic outlook in the seeking after truth. 3. An interest in research into the efficacy of pastoral care and counseling. 4. A commitment to therapeutic issues that have social implications and overtones, i.e., grief, alcoholism, public health, and the responsibility of religious institutions to the larger world. 5. A commonly held belief in the foundational importance of human experience as critical to the theological enterprise. There is a concurrent concern here in understanding how illness affects the inner life and may be the occasion for the transformation of the self. 6. An abiding interest in the psychology of religion following William James, James Starbuck, George Albert Coe, and James Henry Leuba.
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7. An interest in progressive approaches to education of an inductive, pragmatic, process oriented sort such as those advocated by John Dewey and others. Here, knowledge is seen more as an instrument or a set of tools rather than in terms of absolutes. 8. A concern and support for the ongoing conversation between religion and psychoanalysis. The legacy of the clinical pastoral movement is summed up in these contributions to the dialogue between psychiatry and religion. They are challenging and open ended and, one imagines, Boisen, Worcester, Dunbar, and Cabot would have had it no other way. These contributions are at the same time generative in the way Erik Erikson defines that term to denote in adulthood the special responsibility to care for others who follow in families, society, and professions. Like all truly important ideas, they endure because they are at once rooted in time and history and yet possess a capacity to attract and fascinate even as they stimulate debate, enliven learning, and encourage service to others. They are altogether alive and in our midst.
References Boisen, A. T. (1960). Out of the depths. New York: Harper. Brown, T. M. (2000). The rise and fall of American psychosomatic medicine. Lecture at the New York Academy of Medicine. Gifford, S. (1997). The emmanuel movement: The origins of group treatment and the assault on lay psychoanalysis. Boston: Countway Library of Medicine and Harvard University Press. Powell, R. C. (1974). Healing and wholeness: Helen flanders dunbar (190–1959): An extra-medical origin of the American psychosomatic movement. Durham, North Carolina, unpublished Duke University doctoral dissertation. Spiegel, D. (1995). Clinical description introduction. American Journal of Psychiatry Sesquicentennial Anniversary Supplement, 151(6), 1844–1994. Stokes, A. (1985). Ministry after freud. New York: Pilgrim. Thornton, E. (1970). Professional education for ministry: A history of clinical pastoral education. Nashville: Abingdon. Tillich, P. (1957). Dynamics of faith. New York: Harper.
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