In my religious formation as a young person and then in my seminary education, I picked up a reticence about psychiatry and the notion of clergy as therapists. Psychiatry was not dismissed as a false science, as it is in some quarters, but still a sharp distinction was made between pastoral care and psychiatry. In a way this was a reaction to the idea of priest as counselor and psychiatrist that characterized post-World War II models of clerical vocation. Priests are not, as a rule, psychiatrists, and this is a helpful and healthy distinction. The result of forming clergy around this axiom, however, can have unforeseen and undesirable consequences.
At Trinity School For Ministry I was taught effectively by Leander Harding and the late Martha Giltinan to use thoughtful theological reflection in caring for our future congregants, along with a healthy dose of family systems theory as a means to avoid some of the pitfalls of ministry — “Stay out of the triangles!” Nevertheless, there was an implicit bifurcation between the language of theology and the language of psychiatry, and we were firmly rooted in the former.
Obviously, seminarians cannot be educated in every specialized field. Seminarians aren’t given any instruction on medical care! The problem is that while clergy may never have to administer any kind of first aid, many will be confronted with a wide array of psychological challenges in their parishioners. Educating clergy with a minimum competency in the field of psychiatry would at least give them a sense of the complexity of the problem, and hopefully, in their use of a theologically-grounded pastoral care to “do no harm” to those who come to them for counseling or encouragement.
A Lutheran colleague a few years back introduced me to the works of Donald Capps, who was a professor of pastoral theology at Princeton until his untimely death in a car accident in 2015. His many publications touch on an array of subjects relating to pastoral care and psychiatry. Some of the motifs in his writings include the use of humor in ministry and the development of religion in men and boys.
This summer I read his book on clinical narcissism. He says in the introduction that “in the 1950s and early 1960s, psychoanalysts, psychotherapists, and psychiatrists began to sense that a new type of patient was coming to them” (p. 11). The more pervasive borderline personality disorders were eclipsed by what came to be understood as clinical narcissism. The popular idea of narcissism reflects the myth of Narcissus who could not remove his gaze from his reflection in water. Narcissism in this popular conception is a vain and selfish regard for one’s self. What the mental health workers realized was that what might manifest as an excessive regard for one’s self was actually a “weak or fragmentary self-structure.” Hence, the title of the book, The Depleted Self.
A weak sense of self often has its roots a child’s experiences at a very young age. Capps talks about the human need for mirroring, that is, for the gaze and attention of an individual to be reflected by an “other.” Thus, the development of a sense of self begins with the infant gazing into the eyes of its mother. When for this or other reasons a person does not develop a healthy sense of self, then there are number of defensive strategies that effectively prop up the faltering self.
Capps, drawing on the research of Ben Bursten, enumerates four narcissistic types (pp. 20ff):
- the craving narcissist is “emotionally undernourished” and thus is constantly seeking the praise and approval of others, an appetite that is ultimately insatiable;
- the paranoid narcissist is fiercely competitive, easily enraged, and feels there are forces of evil constantly working against him;
- the manipulative narcissist uses “deceit, lies, and deviousness” to try to gain control over others to make them do what one would wish;
- the phallic narcissist “parades his masculinity” with reckless feats in an attempt to gain the attention of others. Each of these types are means for magnifying one’s self-image.
One would think that the way to fix the narcissist would be to deflate and ignore, but the tragic reality is that neither feeding the hungry depleted self by praise, attention, and accommodation, nor refraining from these things will help. The problem lies deeper in the weak sense of self.
This is something that is certainly beyond the ken of most clergy, but on the other hand, Capps acknowledges that everyone is a narcissist in this clinical sense to a greater or lesser degree. Even the best and most nurturing of mothers must turn away her gaze at some point, leaving one with a doubting sense of worth. For the narcissist, living in the narcissistic age, the stain of shame is often more pervasive and arresting than the sense of guilt over sin.
Clergy will, I think, would recognize themselves in this book. They would certainly recognize some of their parishioners. A growing number of younger clergy are looking to reclaim the theological heritage of the church, but we must also recognize that not all personal problems are theological problems. This sort of totalizing approach is very attractive to religious people in general, but in so doing, a profound disservice to the flock would take place. Theological language has a critical message to convey about the value of self and the expansive love of God, but clinical language and expertise needs to hold a place in the overall care of souls. The pastor should appreciate psychiatry as a tool to practice or more likely to commend for the person with a depleted self or other psychiatric problems.
I know the call to add even more to the curriculum of seminary formation is likely to be largely ineffectual. We live in a time in which even the principle of residential theological education is being widely questioned. Perhaps the best that could be done is to encourage a little remedial study for those in holy orders who have a gap of knowledge in psychiatry. Just a small amount of study in this field will give a sense of the complexity of the problems that face some of our parishioners, and how to relate to them with an appropriate degree of pastoral sensitivity and psychiatric competence.
Fr. John Mason Lock is rector of Trinity Episcopal Church in Red Bank, New Jersey.
