COMPARISON OF CLERGYMEN I
PSYCHIAIRESI’S IN THEIR REACTION
TO NINE- PROBLEM CASES

Thesis Ior IIw Degree OI M. A.
MICHIGAN STATE UNIVERSITY

Garry J. Geeflings
19 63

 

LIBRARY

Michigan State
University '

 

COMPARISON OF CLERGYMEN & PSYCHIATRISTS
IN THEIR REACTION TO NINE PROBLEM CASES

BY

fi‘)

,1; 3
GARRY JE GEERLINGS

AN ABSTRACT OF A THESIS
Submitted to the College of Social Science
Michigan State University of Agriculture and
Applied Science in partial fulfillment of
the requirements for the degree of

MASTER OF ARTS
Department of Psychology

1963

AN ABSTRACT

This study was designed to compare clergymen,
including a group of senior seminarians, and psychiatrists
in their reaction to nine problem cases.

The impetus for the study was the conviction that
ministers eXperiences difficulty in diagnosing mental
illness because their training has been primarily a
theological one. At the same time, clergymen are the most
numerous among therapeutic agents; they see more peOple
with personal problems than other practicioners and should
be able to recognize when a troubled person is to be
referred to a mental health Specialist.

It was hypothesized that 1) ministers without
psychological training, when confronted with a problem,
do not recognize mental illness which should be referred
to a psychiatrist for proper evaluation and possible
treatment. It was further hypothesized that 2) senior
seminarians with psychological training received in the
seminary also eXperience difficulty recognizing mental
illness. Finally, it was hypothesized that 3) senior
seminarians because of the benefit received from courses
in pastoral psychology will respond better in recognizing
mental illness than ministers who have not benefited from
this training.

Nine case studies were prepared with the intent of
including several clear-cut pathological cases, some

borderline cases, and some cases dealing with problems

whose symptoms were not necessarily an indication of
pathology, and could, therefore, be helped with the eXpert
counseling of a well-trained minister.

The nine case studies were mailed to ten psychiatrists,
requesting the recipient to indicate his professional
judgment as to whether or not a problem could be handled by
a minister or should be referred to a psychiatrist for
proper diagnosis and possible treatment. Thirty ministers
of the Reformed Church in America, located in Grand Rapids,
were given a set of copies of the case studies. Afterwards,
in a personal interview, each minister was asked to answer
questions on each case study, including the question whether
they felt the person should be referred to a psychiatrist
for proper diagnosis and possible treatment. The third
group of subjects were thirty senior seminarians who were
within one month of graduation. They constituted the entire
senior class at Western Theological Seminary in Holland,
Michigan.

The first two hypothesis were confirmed in line with
the predictions that psychiatrists differ significantly
from ministers and senior seminarians in their judgment as
to when a problem should be handled by a psychiatrist.

The third hypothesis was not confirmed and in only four
cases did the seminarians show a better judgment than the

ministers.

These findings seem to indicate also that the ministers,
even though they have not benefited from courses Specifically
designed to aid the clergy in recognizing mental illness,
were able to make a judgment which agreed with the judgment
of the psychiatrists more than were the seminarians.

A tentative conclusion seems to be that ministers draw
from eXperience rather than theoretical knowledge when dealing

with problems in their congregations.

 

/) a f' _ _
Approved diC/fTQ‘J/fi' Z/u’é/‘c
U

/
Alfred G. Dietze

Date: June 4, 1963

TO MY PARENTS

Who in raising a son, shaped a
personality which allows me to
approach people as unique
individuals without regard to
their race, color, or creed.

ACKNOHLEDGMENTS

The author wishes to express his
sincere appreciation to those who have
assisted in the design and execution of
this thesis. He wishes especially to
thank Dr. Alfred A. Dietze for his
stimulating and constructive advice as
well as for his patience and generous
assistance in the preparation of this
manuscript.

He would also like to thank Dr.
Terrence M. Allen for designing the
statistical method used; Dr. Albert I.
Rabin and Dr. Donald M. Johnson for
their time and constructive criticism

which they offered.

GOJOG.

COMPARISON OF CLERGYMEN & PSYCHIATRISTS
IN THEIR REACTION TO NINE PROBLEM CASES

By
GARRY J. GEERLINGS

A THESIS
Submitted to the College of Social Science
Michigan State University of Agriculture and
Applied Science in partial fulfillment of
the requirements for the degree of

MASTER OF ARTS

Department of Psychology

1963

TABLE OF

CHAPTER
I. INTRODUCTION . . . . .
Purpose. . . . . . .
Hypothesis . . . . .
II. EXPERIMENTAL DESIGN .
Subjects . . . . . .
Test Materials . . .
Procedure . . . . .

III.RESULTS AND DISCUSSION

CONTENTS

PAGE

0 o o o o o o o o o o o 1
o o o o o o o o o o o o 9
o o o o o o o o o o o o lo

I. INTRODUCTION

Throughout history, societies have set up institutions
to comfort and help their troubled members. In the past,
such help was usually a function of religious authorities:
oracles, witch doctors, or priests. These people were set
apart in their community and were invested with the
responsibility for the care of the sick, physically as well
as mentally. Their methods of therapy differed greatly and
evolved from their religious beliefs and practices.

Those seeking help, regardless of culture, religious
beliefs, or powers in which they trusted, had in common the
faith that the counsel and help received from their religious
leaders would be effective in curing them from their ills.

Modern society, in contrast with the above, has many
resources that perform therapeutic functions, each becoming
more and more professionalized. Also, the functions of the
traditional professions have been eXpanded to also include
psychological counseling. As a result, contemporary
professional counselors include clergyman, psychiatrists,
psychologists, lawyers, marriage counselors, physicians,
vocational guidance workers, social workers, and many others.

When people have problems they must decide where to seek
help. Some turn to their doctor or minister. Others turn
to Specialists in the handling of personal problems:
psychiatrists, marriage counselors, social agencies, or

clinics.

-2-

Of particular interest are the circumstances under
which people turn to psychiatrists. Many seek help as a
last resort, often as a last attempt to forestall despair.
Others, of course, may consult counselors for far less
drastic reasons. In either case seeking help is not a
icasual choice. A person seeking help for a personal problem
has, in one way or another, come to at least two realizations
about his situation: first, that he has a personal problem
which causes him discomfort; and second, that he cannot find
a solution for it by himself or with only the help his friends
and family can provide.

Once having recognized his trouble as due to problems
which he cannot solve on his own, a person can choose from the
available resources providing help. At this point many peeple
are not aware that there are clinics, agencies, etc., which
provide professional help for those who need it. Gurin, et
al, (1960) found that people under these circumstances most
frequently consult clergymen, with doctors coming second, and
mental health professionals last. His percentages were:
clergy 42%, medical doctors 30%, mental health practitioners,
including psychiatrists, psychologists, marriage counselors,
etc., 28%. In summary, they found that most peOple seeking
help in times of personal distress choose a resource that

does not offer psychological guidance as its primary function.

-3-

It is indeed interesting to note that professionals
in psychological services, e.g., psychiatrists, clinical
psychologists, and social workers, are less often consulted
than others whose major function is not psychological
guidance, such as clergyman and physicians. In commenting
on this, Gurin observed that while clergymen are more
readily available and more numerous than mental health
specialists, it might well be that the greater use of non-
psychiatric specialists indicates a lack of readiness of
people to consult mental health professionals in time of
crisis, or a lack of knowledge about the availability or
effectiveness of such services.

Often neglected in accounting for these facts is the
consideration that people who find themselves in trouble go
to see their clergyman because of an already existing
relationship with him. The path to the clergyman is a direct .
one, almost never mediated by any formal or even informal
referral source. Psychiatrists, however, are usually reached
through some referral agent. Although the referral source
may be a friend or family member, the clergyman is in a
unique position to act as a referral agent for individuals
who require expert treatment for he is the one most people
turn to first with their personal problems. Thus ministers

are the important "gatekeepers" in the path from patient to

-4-

Specialist. They may deal with the patient themselves or
send him on to a professional therapist.

Gurin's (1960) findings, however, indicate that
clergymen rarely act as referral agents, but perceive
themselves as the prOper therapeutic agents even more often
than other sources, such as physicians, do. Whether or not
they do the treatment themselves, or act as referral agents,
such findings emphasize the crucial importance of ministers
in helping people with psychological problems. They
underscore the need for clergymen to receive some
psychiatric training, not only to enable them more
effectively to offer help, but also for them to know when
to refer a troubled soul to an appropriate therapist.
Clergymen must often act in a diagnostic capacity. They
should know how to discriminate between psychological
problems which they may be able to help and those which
should be referred to psychiatric specialists. Furthermore,
they should be able to handle the resistances of those they
refer since many of the peOple with problems do not see
that their difficulties are psychological; and even when
they do, they are unable to see that the cause of such
problems lies within themselves.

Gurin, et al., (1960) also found in their examination

of peoples' perception of their need for help that in most

-5-

cases the search for help does not seem to represent any
real motivation for therapeutic change. Only a minority
of the people who sought help (one in four) eXplicitly
traced the source of their difficulty to some defect in
themselves. This eXplains the choice of the majority of a
clergyman or non-psychiatric physician instead of a mental
health specialist. People who went to a psychiatrist also
tended to be less satisfied with the help they received than
people who saw their clergymen. They tended to describe the
ways in which they were helped in terms of comfort,
reassurance and advice rather than in terms of changes in
themselves. Although motivation for change is not always
essential for the type of problem that is presented, these
data do suggest that where the problem does lie within the
person seeking help, any attempt to direct him toward
therapy involving change is likely to be met with resistance.
Thus the clergyman has an important role in the treatment
process. Clergymen are the most numerous among therapeutic
agents: they see more people with personal problems than
other practitioners and tend to handle such problems
themselves, instead of referring them to specialists. In the
capacity of counselor they are most appreciated for their
offer of comfort, or, more vaguely, of advice. This
substantiates the frequently expressed assertions that
clergymen serve as emotional supporters, while psychiatrists

are seen as demanding change in the person himself. However,

-6-

the first step in the therapeutic process from a
psychological standpoint is readiness for self-examination
and a desire to change. i

People who do not have this point of view are the
very ones who are likely to resist the suggestion that they
seek help from psychiatric sources. Peeple who seek out
ministers are especially likely to have such views and the
competent minister must recognize and be prepared to handle
their resistance to therapy (Gurin, et al., 1960).

Mental illness has always been a mystery. It is
enormously prevalent - more abundant than all other forms
of illness put together. It exists in many forms. Every
priest, pastor, and rabbi spends a considerable amount of
his time listening to parishioners who are in distress
because of recognized or unrecognized mental illness.
Clergymen, therefore, more than most people, are more aware
of the vast extent of misery and suffering in the world. They
and psychiatrists share this sharp awareness (B. H. Hall,
1959). Like the psychiatrist, the minister feels impelled
to do something to diminish this suffering, not only by
advice to the individual, but by the proclamation of
principles of living. In their sermons too, they endeavor
to offer hope, comfort, encouragement, and reassurance to

peOple in their congregations who need help.

-7-

Meanwhile, the psychiatrists are spending their days
listening, comforting, correcting, and reassuring. For
the mystery of mental illness has begun to yield to science.
It began with Freud's discovery that most psychological
processes are not conscious ones - that there is a vast
organization of mental functioning of which our conscious
experiences are only a small part (Henninger, 1954). As
Dr. Menninger states it, "we now have methods for looking
behind the surface of conScious thinking and overt behavior,
there to see formerly unknown intricacies, forces, functions,
and processes." "And these methods of looking have provided
us with methods of changing the patterns." "The inclusive
study of personality is the basic content of modern
psychoanalysis and modern psychiatry."

The entrance of the psychiatrist in the field of help
for the troubled alarms some clergymen, for it seems to put
too much responsibility for personality-molding in secular
hands. Many clergymen feel that psychoanalysts have taken
upon themselves the responsibility for absolving people from
a sense of guilt and that this attempt is contrary to
theological precept and moral principles in general. It is
the prerogative of the Church to do something about guilt and
not the function of the physician. However, they fail to
distinguish between.g3;l§ and a sense of_guilt, and between

a sense of guilt related to actual offenses and a guilt

-8-

related to imaginary offenses.

From a clinical standpoint, every psychiatrist sees
patients every day who feel extremely guilty about something
they have not done. If such an individual were to go to a
priest or minister, he would be assured that he had never
done anything, and, therefore, had no guilt and should not
have any sense of guilt. But if he insists on having a sense
of guilt even when he has no actual guilt, there is nothing
the priest can do about it except to send him to a
psychiatrist. A psychiatrist can, with the scientific tools
now at his disposal, ascertain the unconscious, invisible
reason for a false sense of guilt, attached to a nonexistent
sinful or criminal act. It is a common clinical symptom with
which every psychiatrist is constantly faced. It might be
said that in almost every mental illness there is a very
strong component of guilt feeling. For such a symptom
psychiatry offers relief and the Church does not (Doniger,
1955).

According to Dr. Karl Menninger (1959), the conflict
between psychiatry and religion is a kind of personal
conflict related to fears of impaired authority. Both are
actually dedicated to the same purpose and, to a considerable
extent, attempt to combat trouble in the individual. The

approach may be different, but both endeavor to c0pe with

-9-

ssomething which gives those about them pain. "Comparable
'to sibling rivalry, hostility between children of nearly
the same age in one family, it is natural to see psychiatry

and religion a little bit suspicious of each other.

Purpose:

We have attempted above to show how crucial the role
of the clergyman is in the field of mental health. It is,
therefore, the clergy who first of all should have a
knowledge about the availability and effectiveness of
psychiatric help. They should be able to dispose help
themselves, but at the same time should serve as diagnostic
agents so that they can properly refer cases which fall
outside of their own comptencies. They are the ones who
often have to motivate people towards personal change rather
than receiving comfort and support. Finally, they must be
able to handle the resistances of those whom they refer.
Needless to say, this is quite a task for a man who in his
seminary training sought mainly the knowledge and skills
required of a theologian.

The impetus for the present study was the conviction
that ministers are for the most part not adequately trained
to serve as diagnosticians when confronted with mental
illness in their parishes. They aren't trained to work

within a framework necessary to recognize psychOpathology.

-10..

”While most seminaries do offer courses in pastoral
counseling, it has been our finding that often such
courses attempt to teach future pastors various methods
of counseling without providing them with a thorough
knowledge of psychological theory on which modern
psychiatry is based. Insufficient knowledge of
unconscious processes involved in various types of
pathology may often result in a minister proceeding with
counseling, only to find the situation develOping into a
very serious one in which he is helpless, or the
parishioner breaking off his contact while what at first
appeared as a minor symptom develops into full-blown

pathology.

Hypothesis:
In the light of the above discussion we wish to test

three hypothesis in the present study.

It is hypothesized that ministers, when confronted with
a problem, do not recognize mental illness which should be
referred to a psychiatrist for proper evaluation and

possible treatment. In the form of the null hypothesis for

-11-

the type of data we have collected it may be stated as

follows:

Hypothesis I:

When ministers and psychiatrists are required to

respond to briefly described problem cases, the

former will not differ from the latter in the

proportion responding "refer to psychiatrist"

or 'can be handled by a minister." -

It is hypothesized secondly that senior seminarians,
who have had the benefit of courses in pastoral counseling
and psychology as part of their curriculum, when confronted
with a problem, do not recognize mental illness which
should be referred to a psychiatrist for proper evaluation

and possible treatment. In the form of the null hypothesis

this may be stated as follows:

Hypothesis II:

When senior seminarians and psychiatrists are
required to respond to briefly described problem
cases, the former will not differ from the latter
in the proportion responding "refer to psychiatrist"
or "can be handled by a minister." -

Finally, it is hypothesized that senior seminarians,
because of the benefit received from courses in pastoral

counseling and psychology as part of their curriculum will

-12-

respond better in recognizing mental illness than ministers.

In terms of the null hypothesis this may be stated as:

Hypothesis III:

When ministers and senior seminarians are required
to respond to briefly described problem cases, the

former will not differ from the latter in the

prOportion responding' 'refer to psychiatrist" or
"can be handled by a minister."

II. EXPERIMENTAL DESIGN

Subjects:

Three groups of subjects were used for the study.

The subjects for the first group were ten psychiatrists,
members of the Michigan Chapter of the American Psychiatric
and Neurological Association. While a larger sample of
psychiatrists would have been desirable, the amount of time
required by them to respond to our instrument made this
impractical. An attempt to obtain a random sample of
Michigan psychiatrists would very likely fail for similar
reasons and it was necessary to rely on informants that
could be contacted upon the recommendation of their
colleagues.

The second group of subjects were thirty ordained
ministers of the Reformed Church in America. The Church
includes 222,500 adult communicant members in 891 churches,
mostly in New York, New Jersey, the Middle hest and
California. According to the teachings of the Church, the
only infallible authority for their theology and doctrines
is the Word of God, and nothing can be taught or done
contrary to it. For additional guidance, it accepts the
teachings of John Calvin, the Reformer of the 16th century.
Again, because of the amount of time required to respond to
our instrument, it was not possible to obtain a random

sample of ministers and our sample consists of thirty

-13-

-14-

Reformed ministers who are presently located in Grand
Rapids, Michigan.

The third group of subjects were thirty senior
seminarians who were within one month of graduation.
They constituted the entire senior class at Western
Theological Seminary in Holland, Michigan, one of the two
seminaries of the Reformed Church.

Western Theological Seminary has recently instituted
a three-credit course in Pastoral Counseling which is now
a required course for all students. The seminary also
offers as an elective course an orientation to clinical
pastoral training. This course is conducted at Pine Rest
Christian Hospital in Grand Rapids, Michigan, a hospital
for the mentally ill maintained by the Church. This course
gives the prospective pastor an orientation to the work of
the hospital, and the pastoral ministry in relation to
persons suffering from mental and emotional disorders. The
course includes lectures by psychiatrists, psychologists,
and social workers. Students attend conferences with the
resident chaplain, and engage in weekly visitation with
patients, the writing of reports, and the reading and
recording of interviews. Another elective course offered is
designed to enhance the pastor's ministry to families, and

considers Biblical teaching on marriage and sex, premarital

-15-

counseling, Christian parenthood, and counseling problems
in divorce and remarriage. Because of the limited
facilities at the hospital, only a small percentage of

all seniors can participate in the orientation to clinical
pastoral training and in our sample of 30, only eight had
the Opportunity to take this course.

A Bachelor of Arts degree is the basic requirement
for admission to the seminary, with an emphasis on a broad
and comprehensive "liberal arts" preparation in college.
For the guidance of pre-theological students the seminary
recommends courses in English, philosophy, history, foreign
language, natural science and social science, while only
one half year of psychology is urged to be included in the
student's college curriculum. The theological course is

three years in length.

Test Matergglg:

Because the purpose of this study was to see whether
or not clergymen and seminarians could recognize
psychOpathology when confronted with problems, nine case
studies were prepared with the intent of including several
clear-cut pathological cases, some borderline cases, and
some cases dealing with problems whose symptoms were not

necessarily an indication of pathology and could, therefore,

-15-

be helped with the expert counseling of a well-trained
minister.

Alexander R. Leighton (1959) feels that case studies
are very adequate for diagnosing mental illness. According
to him, ”a case study takes a given person for attention,
and, viewing him as a system, attempts to explain a
selected aspect of that system in terms of other aspects,
in terms of the functioning whole, and in terms of the
history of both. Cross-sections of the moment and life-
story are thus taken into account together with such
components as cagnition, affect, basic urges, and sentiments.
Analysis of the whole is, of course, conducted in terms of
both conscious and unconscious processes. Case studies
are, in short, personality studies conducted for the particu-
lar purpose of diagnosis and treatment." In writing up the
case studies, we attempted to describe the interview as if
it took place between a clergymen and a person seeking help.
We did not strictly adhere to the more conventional method
of writing up case studies since we felt that the situations
presented to the clergy should simulate actual interview
situations a minister might have encountered in his ministery.
Some of the cases are actual publications, or are from the
files of psychiatrists and ministers, while some were made
up based on theoretical knowledge of symptomatolcgy indicative
of psychopathology.

-17-

Case A! deals with a compulsive personality who is
experiencing a crisis in his marriage. Especially from
Mr. P's standpoint, there had been a smoldering marital
discord which burst suddenly into flame. This was caused
by an accident which had heightened his awareness of
mortality. He feared death might overtake him before he
had been compensated for a lifetime of self-denial. His
demand for remuneration, supported by a self-righteousness
built up by years of self-imposed exploitation, was a
masochistic one designed to punish his wife and demand her
pity. In conscious behavior, and in every wish and thought
acceptable to his ego-ideal,.Hr. P is a thoroughly humble
and virtuous man. But his virtue is serving the function
of a reaction-formation against the hostility, the egocentric
ambition, and the grandiosity which he expresses only through
fantasy. Mr. P does not recognize that the present marital
crisis came as an inevitable result of his neurotic

personality. (Burton & Harris, 1955)

ste 3* deals with the problem of obesity, and concerns
a 17-year old girl who is healthy and bright in every way

except for one bad habit - she cannot get rid of her over-

*See Appendix A.fcr the case material as prepared for this
-investigation.

**See Appendix B for the case material as prepared for this
. investigation.

-18-

eating problem. Her physician, who had made numerous
diagnostic studies and found :11 physical and endocrine-
logical studies completely negative, could not understand
why a very intelligent normal girl could not stick to a
reasonable diet when she is so ashamed of her obesity that
at times she goes into the deepest depression and secludes
herself to the point of not being willing to go to school.
Any effective way of dealing with this girl would involve
an interest in her whole personality rather than in one
outstanding weakness of her character. the fact of obesity,
when no organic causal factor can be found, is enough to
diagnose the presence of serious emotional disturbance in
which oral fixation and a conflictual mother-child relation-
ship are of essential causal importance. (Burton e Harris,
1955)

.g;§g_gs is concerned with the presence of a defective
child within the family setting. According to lreud, the
course of‘motherhood, a developmental process, is influenced
by the characteristics of the baby, first by its appearance
and later by its responses. Significant deviations, such
as gross retardation or obvious congenital defects, may limit
or interrupt the mother's developing capacity to accept the
new child who is totally dependent upon her. (Ireud, 1923)

*See Appendix 0 for the case material as prepared for this
-investigation.

-19-

In a recent article, "Is Grief a Disease?”, George L. Engel
(1961) draws the attention to theOimportance of them
pzocegg in human development. Borrowing from Freud's and
Lindemann's work, Engel describes mourning in terms that are
useful for the understanding of the mother's reaction when

a defective child is born. In the mother’s mourning reaction
to the loss of the healthy child, her wishes for and expectations
of the desired child are crushed by the birth of the defective
child. The mourning process enables her to progress from

the initial shock to an awareness of the feeling of disap-
pointment and feeling of loss with the affective symptoms

to the final phase of the grief reaction in which intense re-
experiencing of the memories and expectations gradually
reduce the hypercathexis of the wish for the idealised child.
In this case study we see a mother experiencing one of the
two extreme reactions that are considered pathological,
namely extreme guilt feelings which lead to the mother's
conscious dedication of herself to the welfare of the child.
She wards off her feelings of grief by establishing a guilty,
depressed attachment to the child and as a result fails to
relate adequately to the other members of the family.

The lack of opportunity to discuss the child's diagnosis
can create a situation in which the parents feel overwhelmed
and unable to gauge the reality of their child's retarded
development. Denial then serves to ward off the anxiety and

depressions. .Aocording to Solnit and Start (1959) many
physicians feel that once they have conveyed the initial
diagnosis to the parents there is a tendency to think the
interpretation of‘mental retardation is completed when it
has only begun. the reason for this is that he has not
understood the aspect of the mourning process in the mother's
reaction. Interpretation is a continuing process which
utilises interviews with the professional person to establish
a sense of confidence and trust that will promote the
parents' gradual understanding of the child's defect. In
this atmosphere of trust and confidence the parents are
enabled to express their critical and fearful questions to
the therapist. these interviews then, if successful, are to
serve two purposes: first, the comprehension of the child's
condition, and secondly, enable the parents to realise their
inner reactions of disappointment, resentment, humiliation,

and loneliness. (Solnit and Stark, 1961)

‘gggg;gi deals with the problem of homosexuality.
throughout the history of human development, the fundamental
question.has always been whether or'not.homosexuality is a
disease or simply a.natural form of human behavior which
becomes categorised as a disease only in specific cultures.

*See Appendix D for the case material as prepared for this
-investigation.

-21-

!reud assumed that at least the majority of cases were caused
exclusively by experiental factors. (Brill, 1938) He regarded
homosexuality as related to the three basic phases in the
development of object relations, and he correlated the
development of object relationships with libidinal phases

of development. He saw the child as evolving from autoerotic
and narcissistic phases to object love, which he termed the
autoerotic phase, the phallic phase, and the Oedipus phase.
The particular quality of the libido which is cathected
determines the nature of the object relationship; and, in
turn, once cathected the object then directs the development,
expression, and vicissitudes of that particular phase of
libidinal development. He also believed that the sexual
practices in the homosexual relationship symbolise regression
to the developmental fixation points. (Freud, 1905)

Freud also had some reservations about successful
treatment, even though he was always willing to accept a
homosexual patient for treatment because he felt analysis
might bring the patient harmony, peace of mind, fuller
efficiency, whether he remains a homosexual or gets changed.
(1935)

Other investigators have held even less Optimistic
views. The recent report of the Holfenden Committee (1957),
which surveyed the problem of homosexuality in Great Britain,

asserted: "We were struck by the fact that none of our

-22-

medical witnesses were able, when we saw them, to provide
any reference in medical literature to a complete change.
Our evidence leads us to the conclusion that a total
reorientation from complete homosexuality to complete
hetrosexuality is very unlikely indeed.“ However, Irving
Bieber, et a1, (1962) is more optimistic. "The therapeutic
results of our study provide reason for an optimistic
outlook. Many homosexuals became exclusively hetrosexual
in psychoanalytic treatment. Although this change may be
more easily accomplished by some than by others, in our
Judgment a hetrosexual shift is a.possibility for all
homosexuals who are strongly motivated to change. Our
findings are optimistic guideposts not only for homosexuals,
but for the psychiatrists who treat them. we are firmly
convinced that psychoanalysts may well orient themselves

to a hetrosexual objective in treating homosexual patients
rather than "adjust“ even the more recalcitrant patient to

a homosexual destiny.“

Gag: E* deals with.a.marital conflict which at first
sight appears to center around infidelity. However, it
soon becomes clear that several factors are involved.

from all outside appearances it seems that the young man

*See Appendix E for the case material as prepared for this
-investigation.

-23-

is putting all his energies into his career which, because
of present-day competitive conditions in the business world,
might very well be demanded of him. Because of Hrs. E's
teaching position the husband has to do an excessive amount
of driving and often finds it necessary to work at home,
preventing the couple from spending time together in a
relaxed atmosphere. While it is obvious that this couple
does not seem able to sit down together to discuss their
difficulties, but rather let things drift, the symptoms

do not necessarily point to a pathological condition in
either wife or husband. It is, of course, very possible
that the symptoms are indicative of a more serious problem,
but it must be considered that the culture of which these
two young people are a.part:makes this particular phase

of their life an extremely difficult one. A frank discussion
with someone who is not emotionally involved and an appeal
to their intellect might be all that is needed to save this
marriage.

03s: 3* deals with a problem which is known to every
person whois asked to help people, namely loneliness.
Fundamentally, Just people are never enough. Activities

are not sufficient. A.busy social life can be a barren,

*See Appendix I for the case material as prepared for this
.investigation.

-24-

isolated, bitter one. In order to avoid more than that
degree of loneliness occasioned by the fact that people are
discreet individuals living within their own depths and are
unable ever to communicate fully with one another, there
must be a fengp; relationships which persist and out below
the level of social exchange to become part of a living,
growing, emotional life. In order for contact to become

a relationship there must be continuity of exchange, freedom
of communication, repetition of meeting. The ability to be
a friend must be learned and the feelings must be gained by
example and by experience. There are people occasionally
who have been deprived the opportunity to copy ways of
behaving in order to get closer to people or who have been
hurt so often by death, disillusionment, or removal that
they have forgotten how to open up and invite friendship and
love. They have become fearful of further hurt and have
retreated behind a safe wall. The primary point of Jane's
story is that one can go through the‘lgtigng of friendliness
without the‘glggiggg, can make the gestures which go with
belongingness and remain an alien. It might well be that
this feeling of no value, no real existence, is the beginning
phase of a real psychopathological condition, namely
schizophrenia. However, it might also be that because of
the advancement of age in this woman and the loss of close

relatives, loneliness has become something of which she is

-25-

realistically aware and wants changed, not being afraid to
ask for help. Enabling this woman to form a relationship
which has continuity, repetitiveness, frequency of contact,
and meaningfullness, might be the beginning of a.more
adequate life which involves real emotion and meaningful
relationships. (Greer)

.gggg_§! deals with a 52-year old married man who
experiences a psychotic breakdown and uses religion as a
part of his symptom formation. Very often we hear the
question ”Is religion a.help or a hinderance in the search
for the meaning of life and the direction of a person's work?”
In a case like this, the Judgment is often a negative one. "
However, it must be remembered that the religious patient
often ”uses“ his religion to express his unconscious conflict.
Close examination of’ur. G's case study reveals many conflicts,
such as his daughter's approaching marriage and his impending
retirement, to which he hardly desires to pay any attention.
However, a psychiatrist might well ask if the feeling of
eenitting the unpardonable sin has any possible connection
with his daughter's marriage in the near future. The answer
to the question whether or not there is any relation between
the conscious feeling of being beyond the forgiveness of God

*See Appendix G for the case material as prepared for this
»investigation.

and the possibility of guilt feelings because of unconscious
wishes and desires, as well as hostility, in connection with
his daughter's approaching marriage, might be a revealing one.
Drugs, rightly administered, can bring health and renew'
life, but ineptly administered, may bring disaster. Religion
is Just like that, equally as dangerous as it is useful.
Therefore, the psychiatrist is wise in recognising that
religion‘ggg be dangerous to his patients; he calls the
attention of the teachers of religion to that which he tends
to forget: the dynamic character of the religion he professes
and teaches. Religious educators, being reminded of the
power of religion to hurt as well as to heal, have begun
to re-examine not only the theological nature of the gospel
proclaimed, but the ways in which that gospel is communicated
and administered to the growing lives of children and adults.
(Oates, 1957)

9.9.22.3? is a more complicated case because Hrs. z has
already had two years of supportive psychotherapy. According
to the philosophy of therapeutic intervention, she has
received no advice, and only explored her capacity for growth.
Irom the fact that the psychiatrist has terminated therapy,

we may assume that he felt she had gone as far as possible in

*See Appendix H for the case material as prepared for this
—investigation.

-27-

working through her difficulties which are primarily related
to a disturbed father-daughter relationship. The psychiatrist
might well be very satisfied with the results obtained in
that Mrs. Z is now able to live with her’husband without
much difficulty and hold down a Job in the businessworld.
we do not know the condition as it existed when Hrs. z first
sought help, but the fact that she has not conformed to the
image of an American housewife, as it exists in our culture,
does not.mean that the therapy was not successful. However,
as often is the case, people turn to their minister when
they have to make a decision. This happens frequently after
therapy has been completed because of the unwillingness of
the therapist to make concrete recommendations.

It must be realised that it is possible that.urs. 2
will always remain what is termed an "inadequate personality“
who cannot be expected to accept the role her culture describes
for her. Therapy, however, has allowed her to explore the
possibilities of living a life which gives her the fullest
measure of satisfaction possible in her condition.

when therapy has done all it can for a person with this
type of a disorder, it would seem that the help of a well-
trained minister might be of great help and assistance to
a person like Hrs. 2. However, if a.minister is to handle
this he should be well aware of the implications. If he
has only the desire to make her conform to the duties of a

-23-

mother as he knows it, he must accept the possibility that
Mrs. 2 might regress to a point where she will be completely
useless to her husband and children and instead become a
burden. On the other hand, the minister has a wonderful
opportunity to counsel a person like this if he is able to
deal with.Mrs. Z‘s guilt feelings as she undoubtedly
experiences them because she knows she is not facing up to
her responsibilities as no doubt many people have made her
aware of. Positive advice to pull her family together and
build a family life which might be somewhat different from
the established pattern, would allow this young woman to
continue to live a.meaningful life. This may well mean
obtaining somebody to take care of the children and do the
housework while Hrs. Z works in the business world. If the
minister's attitude is one of understanding about the real
limitations of this person, rather than excercising controls
over her in an effort to make her*sec her ”duty“ as a
Christian mother and wife, this marriage might well continue
without.mental illness disrupting the life of this family.

Cgse 1* is a well-known story to most ministers. They
are often asked to mediate in what appears to be an intolerable

relationship between a parent and adolescent child. These

*See Appendix I for the case material as prepared for this
-investigation.

-29-

are the trying years for every parent and parents often feel
they are at the end of their rope and cannot continue in the
manner in which they are, all of a sudden to find their
children grown up and accepting that which they have rebelled
against these growing years. In this case, however, we are
dealing with a very intelligent woman who seems to have

fought a good fight against her feelings of hostility (and

not without some success), but she apparently has gone as

far as she can in the direction of sheer willpower and self
control without any idea of what she is fighting. Yet for her
own sake, as well as for her daughter, it would appear to be
desirable for her to be freed from this hostility and her
attendant guilt about it. It might be that this hostility

is a true one springing from some as yet unknown cause. Or

it may be that the hostility represents some sort of unconscious
defense against other feelings which she cannot tolerate. Her
occasional feelings of sexual repulsion toward her husband,
with whom she has had a satisfying and happy marriage for

many years according to her own statement, might well be

related to this problem of hostility towards her daughter.

21223229.
A copy of each case study, along with a letter

explaining the nature and purpose of the study* was mailed

*See Appendix J for a copy of the letter mailed to each
psychiatrist.

-30-

to the ten psychiatrists we planned to include in our sample.
Attached to each case was a questionnaire* which requested
the recipient to indicate his professional Judgment as to
whether or not a problem could be handled by a minister or
should be referred to a psychiatrist for preper diagnoses
and possible treatment. To provide as natural a situation
as possible for our professional respondents, provision was
made on each questionnaire for comments which the recipients
might feel desirable.

At an official meeting of the Reformed ministers in
Grand Rapids, Michigan, the writer was given an opportunity
to request the cooperation of the clergy in providing data
for this study. The group voted unanimously to cooperate.
Thirty ministers accepted a set of copies of the case studies,
while four declined because of urgent commitments which would
take them out of town for a number of weeks. The ministers
were requested not to discuss these cases with anyone and
appointments were made for personal interviews with each
minister. This was done to avoid the chance that our
questions would be answered with the help of professional
experts, books, Journals, etc. Each visit took place in the
minister's study and allowed for the utmost of privacy. During

the visit the minister was asked to answer the questions

*See Appendix H for a capy of the questionnaire.

-31-

listed on the questionnaire* especially prepared for this
study. They were given one questionnaire for each of the
nine case studies. This questionnaire was more elaborate
than the one prepared for the psychiatrists and contains

gdditional guestigns which.might supply information about
attitude toward mental illness, experience with.mental

illness, knowledge of community resources, and typical

manner of dealing with problem cases they feel adequate to

handle themselves.

*See Appendix L for a copy of the questionnaire.

III. RESULTS AND DISCUSSION

To test Hypotheses I and II proposed in this research,
eighteen Chi Squares were computed, including a procedure
commonly known as Iates' correction. (Walker and Lev,

1953) This “correction" was used to offset the possibility
of obtaining too large a value which would lead to the
reJection of the hypotheses too often than if the direct
computation of probability by factorials were used. This
was necessary because of the relatively small sample, the
low'number of observations in one cell, and because there
is only one degree of freedom.

Table I and II give the results of the chi-square test
of significance of the difference between psychiatrists,
ministers, and senior seminarians when asked to Judge
whether a case should be handled by a psychiatrist or a
clergyman.

gypgthegis I: It was predicted that when ministers
and psychiatrists are required to respond to briefly
described problem cases, the former will not differ from
the latter in the proportion responding "refer to psychiatrist"
or "can be handled by a.minister.' Table I shows that the '
ministers differed significantly from the psychiatrists for
Cases ”A”, ”B", ”C”, ”B“, and "P", while the statistical
analysis showed that they did not differ significantly on
Cases ”D", ”G”, "H”, and ”I". Thus, the ministers were able

'-32-

Psychiatrists,

Comparison Between
{inisters and Senior Seminarians

TABLE I

in their Responses to Nine Problem Cases

 

fl

 

 

 

 

F... .___ . ..

, T
gages ! Psycfiiigrists E difiisters i Seminarians
: : :1 :30 . N=30 __1
: Refer Handle ' Refer Handle 1 Refer Handle
i to by to by to oy
E Psych. Min. Psych. Min. ; Psych. min.
A i 1 9 21 9 j 16 14
B i 10 o 14 16 Q 21 9
c g 9 1 i 11 19 g 12 18
D | 10 o i 20 10 j 10 20
E i 10 o E 11 19 E 6 24
F l 9 1 g 5 25 k 11 19
G E 10 o ; 25 5 i 18 12
H 2 8 g 18 12 3 21 9
I 9 1 E 17 15 i 15 15

TABLE II

Chi—Square Test Results
of Significance of the Difference Between
Ministers and Psychiatrists, and Senior Seminarians
and Psychiatrists in Their Responses
to Nine Problem Cases

 

 

Ministers Seminarians
Psychigtrists Psychiztrists
Problem Case "A" 8.702% 4.102*
Problem Case "B" 6.805% 2.341
Problem Case "C" 6.533* 5.647*
Problem Case "D" 2.844 18.000*
Problem Case "E" 7.026* 16.802*
Problem Case "F" 7.026% 6.533*
Problem Case "G" 0.685 3.968*
Problem Case “H” 3.333 5.762*

Problem Case "I" 2.344 3.472

 

* Significant at the .05 level of confidence. df l

-33-

to judge correctly (considering the professional judgment
of the psychiatrists as a valid and proper diagnosis) only
four cases out of a total of nine cases.

Hypothesis II: It was predicted that when senior
seminarians and psychiatrists are required to respond to
briefly described problem cases, the former will not differ
from the latter in the proportion responding ”refer to
psychiatrist" or "can be handled by a minister." Table I
shows that the seminarians differed significantly from the
psychiatrists for Cases "A", "C", "D", "E", "F", "G", and
"H", while the statistical analysis showed that they did
not differ significantly on Cases "B" and "I". Thus, the
seminarians were able to judge correctly only two cases out
of a total of nine cases.

The statistical analysis of the differences between the
psychiatrists and the ministers, as well as the differences
between the psychiatrists and the seminarians are significant
at the .05 level of confidence with one degree of freedom.

Hypothesis III: It was predicted that when ministers and
senior seminarians are required to respond to briefly described
problem cases, the former will not differ from the latter in
the proportion responding "refer to psychiatrist" or "can be
handled by a minister." To test Hypothesis III, the sign
test was chosen for the comparison of the two groups (Siegel,
1956). fihile the study does not provide quantitative data,

it was possible to use plus and minus signs to show

-34.

differences in Judgment. Table III shows that it was decided
in each of the nine cases whether the seminarians or ministers
numerically differed in their Judgment with the psychiatrists'
Judgment. If more seminarians than ministers agreed, this
was expressed by a plus sign, while if more ministers than
seminarians agreed, this was expressed by a minus sign.

While the null hypothesis stated simply that the frequencies
with which the two signs occur will not be significantly
different, the prediction was that the seminarians because

of different training would be better Judges than the
ministers. For this reason, a one-tailed test was used,
predicting that seminarians will be better Judges than the
ministers, or, the plus sign will occur more frequently.

In all nine cases there was a difference in Judgment,
but in only bur cases did the seminarians show a better
Judgment than the ministers and thus received a plus sign.
For the data in Table III, I = the number of fewer signs =
4, and N, the number of cases showing a difference in
Judgment, is 9. For N = 9, an x - 4 has a one-tailed
probability of occurence under Ho of p = .500. This value
is in the region of acceptance, thus the null hypothesis
cannot be reJected. We tentatively conclude that
seminarians and ministers when required to respond to
briefly described problem cases, the former will not differ

from the latter in the preportion responding "refer to

TABLE III

MINISTERS AND SEIIHARIAHS JUDGMENTS
OF NIHE PROBLEK CASES

 

 

Agreed with Psych. Direction of
Cases Min. Sem. Difference Sign
Case "A" 9 l4 Xm<XS 4-
Case "B" 14 21 Xm<Xs 4-
Case “C“ ll 12 Xm<Xs +
Case “D" 20 10 Xm>Xs -
Case “E“ 11 6 Xm>Xs -
Case "’F'} 5 11 Xm< Xs +
Case “G" 25 18 Xm> Xs -
Case "H'l' 12 9 Km) Xs -
Case "I“ 17 15 X111) Ks '- -

 

Xm : number of ministers agreeing with psychiatrists

Xs : number of seminarians agreeing with psychiatrists

-35-

psychiatrist" or "can be handled by a.minister."

In examining the comparison between the ministers and
the seminarians, it is found that they agree in their
Judgment on five out of nine cases, namely Cases “A",

"C“, “E“, "P”, and "I". It should be noted that these five
cases on which the ministers and seminarians are agreed in
, their Judgment, all disagree with the Judgment of the
psychiatrists.

It is suggested that these findings indicate that
the psychiatrists, ministers, and senior seminarians differ
in their responses to briefly described problem cases, and
that only for Case "I" a significant agreement was reached
by all three groups. '

These findings also suggest that the ministers, even
though they have not benefited from courses specifically
designed to aid the clergy in recognizing mental illness,
were able to make a Judgment which agreed with the Judgment
of the psychiatrists more than were the seminarians.

It should especially be noted that the psychiatrists
Judged that four of the nine problem cases could be adequately
handled by a clergyman, while the ministers only felt
capable of handling one of these cases, namely Case “E“.

On the other hand, the seminarians Judged themselves incapable
of handling any of the four cases the psychiatrists suggested
clergymen could handle. It is suggested that this might be

-35-

indicative of the fact that the additional training these
students received in the area of psychopathology has made
them too cautious with the result that they tend to over-
refer.

Oase "B" deals with the problem of Obesity which the
ministers were unable to recognize as a severe emotional
problem, while the seminarians were able to diagnose this
condition as a severe mental problem. Case "D" is clearly
a Homosexual problem and the ministers recognise it as one
they should not deal with, while the seminarians feel they
are capable of‘handling this particular problem. Case “G“
indicates that the patient is experiencing a psychotic break,
and the psychiatrists reach a 100% agreement in their diagnosis,
while the ministers are in almost perfect agreement with this,
but the seminarians do not recognize this as such and attempt
to deal with it as if it represents a religious problem.

These last findings seem to suggest that ministers may
tend to draw'on their experience to a greater extent than
on a theoretical knowledge in their counseling situations,
while seminarians who have not had adequate parish
experience and are able to recognise clear-cut pathology
without.much difficulty, are unable to recognize it when
disguised in religious as well as day-to-day rationalisations
and/or symptoms.

The results of this exploratory study call for caution
in interpreting because of certain methodological limitations

-37-

present. If we grant adequate reliability and validity for
our findings, our results suggest the conclusion that
ministers of the Reformed Church differ significantly from
psychiatrists in their responses to briefly described problem
cases as to whether they should be referred to a psychiatrist
or handled by a minister, while senior seminarians of the
Reformed Church differ even more in their Judgments even
though this difference is not statistically significant.

A tentative conclusion also seems to be that ministers
draw from eXperience rather than theoretical knowledge, while
the seminarians can recognize clearly defined pathology, but
are unable to do so when "religious" symptoms are used to
eXpress the illness, probably because they have not been
confronted with this aspect of mental illness in the
community.

Some additional questions asked supply some additional
information which, though not statistically analyzed, is of
interest.

Both ministers and seminarians obviously show a knowl-
edge of the fact that some problems indicate mental illness
which is outside of the realm of their capabilities and
training. However, as soon as the symptomatology includes
a moral problem, they show their inability to clearly under-
stand and accept this as a part of the illness and show a

strong desire to bring the patient in a "right relationship

-33-

with God,’' fully expecting the symptoms to be alleviated.
They do not seem to grasp that for many mental patients,
their reach for religion is nothing else than the desire

to limit their own being and to strengthen this limitation
through the power of religion. Even if religion does not
lead to or does not directly support pathological self
reduction, it can reduce the openness of man to reality,
above all to the reality which is himself. In this way
religion can protect and feed a potentially neurotic state.
(Tillich, 1952)

Both ministers and seminarians showed a complete lack
of knowledge of the community resources available for mental
patients. All respondents mentioned their church supported
mental hospital, while a.maJority also preferred to refer
to a "Christian" psychiatrist, while five showed open hostility
to the whole area of psychiatry by stating they never
referred to psychiatrists for the simple reason that they
"didn't believe in them." Patients and their families often
seek the advice of their ministers in the approaching
necessity of seeking psychiatric treatment for nervous and
mental diseases. With a monotonous repetition they ask
about the religious attitudes and convictions of the
psychiatrist. This is most important from the patient's
point of view. The questions may reflect religious
insecurity, but the patient who is sick enough to need

-39-

psychiatric help cannot be expected to be so secure
religiously as to warrant complete reJection of the validity
of his questions. He has no right, however, to expect his
psychiatrist to be a trained theologian any more than he
has to think of his pastor as a diagnostician of nervous

and mental diseases. If the patient can be reassured that
his doctor will take a clinically reverent attitude toward
his religion as having relaity and meaning to the patient
himself, then he has the security he needs. However, the
presupposition of the question, "Is the psychiatrist a
Christian?" on the part of the clergy, often hmply this

kind of expectation as clearly observed in their responses.
But, more subtle than this, such a referral might well reflect
a ”passing of the buck” for the pastoral care, religious
instruction, and theological guidance of the patient from
the minister to the psychiatrist. Therefore, at the point
of the psychiatric referral, an essentially religious issue
at stake is this: Is this a subtle abandonment of the
patient to psychiatry, referring him‘gygy from the Church?
To the contrary, it should be the Church calling in '
specialised help in its ministry to the person as a whole.
It naturally follows that in the process of therapy,
therefore, the role of religion as a positive force becomes
intensely relevant as the minister and the Church take their
place in vital relation to the psychiatrist and the hospital,

-40-

respectively. Competent referral ability is a most
important ministerial asset. However, at the same time,
while referring a parishioner to another person for more
specialized treatment, the minister does not wash his hands
of the parishioner, but maintains a continuing ministry to
him. (Oates, 1957) Besides insisting on a ”Christian
Psychiatrist,” only four ministers ever indicated their
desire to work as a team with the psychiatrist on a given
case, while the seminarians' responses seemed to indicate
they wanted nothing at all to do with a parishioner who is
mentally disturbed but rather wanted him in a hospital where
his religious needs would also be taken care of by a
chaplain.

From their descriptions of how they would handle a
particular case, it is clear that a maJority of ministers
tend to deal with the presented problems in a clear-cut
very definite authoritative manner, where as the seminarians
seemed to favor the non-directive but supportive approach.

This study is limited to the Grand Rapids ministers
of the Reformed Church in America and statistical inference
should be considered in that light. However, it should be
noted that the average stay of a minister in any one town
is approximately four to six years which.means that even
though we do not have a truly random sample of the ministers

in the Reformed Church, our findings and inference is some-

-41-

what more valid because of this. Also, the training of
these ministers does not vary greatly from the training
most ministers receive at other theological seminaries of
different denominations. This is especially true if only
"fundamentalists" are being considered. However, as already
pointed out, this must be considered an exploratory study
calling for cautious interpretations of the results. If
this study but stimulates further research on this topic

it will be considered successful.

..A N "a ,.
L's}: ‘

{DIX A

1
J.

APPE

 
 

 

 

 
 

 
 

 

 

 

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APPENDIX B

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APPENDIX E

to

Hro mid Hrs: B0 are a young couple who have
the confinim ty and they are recer;t eolleg} ‘
been the PI‘GSLQGDI'G Git-.10 SISLIU. {ILLS 1332;? .t'filcpl
as Jre Executive with IZHo Hrso C? nag:
was very active in schoolo 319 now to me e. n a local grade s.choolo
It is fOl' Lhis rea:3en that H10 Co has to tra tel 80 miles a day to on"
fi-om worl, as this \as the only t ching position open at the t inso
Hro Gas job is h:ighly corpstitive and he often is f01°ced to take rm
home at Big hi; which gives him very little time to spend with LiS‘V1i.o
They do very little together and she is the only one presently
attending church as Hrc Co claims to be "Leo tired to get up on Sunday

morningo "

c tly moved 1m

u es° Hro Co had
S-lior, and new'works
in Education and also

In all her loneliness and feelings of being a burden to her husband,
she had Jory recently drifted into an affair with another teacher at
the school who Izas single and able to give her a lot of undivided
attent ionO Hewever she had now'cut off this relation voluntarily
becaise of her feelings of guilto She had confessed to her husband
and even though he was very bitter and disappointed, he had forgiven
her and been willing to give their marriage another tryo

She goes on to tell you how things were alright again for a while and
their sexual relations were very satisfying to hora but too 5.nfrequeat
because of her husbandis fatigue and business worries She had hoped
to become preaaant, but so far had not been successful even though the
doctor had told them there was no reason why they should not have
childreno

Last'wee1:, however, her whole world had crashedo They had attended a

party and completely unexpectedly her husband had spent the entire

evening in blatant and overt sttention.toward another woman“ She had

:eef them both got upstairs and when she followed then found the bedroom
oc'ed0

The next morning Ih 8. Co had left her husband and moved in'witZI a girl
friend with the firm conviction that she wanted to divorce her hixsband
immediatelyo

She has come to you because she has been Mt'el iding your church and

she and Hank were married in the churcho Sh e wants to know'what your
feelings on the whole deal are as she hates to admit failure9 but
recognizes that she and her husband are not psychologically strong
enough to hold their marriage togetherQ She also worries whether she
is capable of holding a husband at all or if she is unable to love him
in such a way that he would be completely happy with hero

APPENDIX F

1?
.Lo

Jane, who is a middle-a ged single Immanj, drifted into your office one
day, and before she had removed her coat, C. Laim : I3m nothing has

a toolg People 3 st use me mien they want 60L atria”? done and in be»
tween they never think of no any more than they would of a pal ing knife;
They l-I'Ciilq’fi let me he TOE-2.0” I want to be a j(.~-e:L=sm:9 not just someone to
do chores or hold ofxicos

All this is smurismg ..for nous a very ws rm, attzLa Letivo, Lutgoii-,,
and fr: er dly parser al’: aye full on qui ps9 arming stoiies9 (.1315. oaths: i:
eccmmts of what she has bees doi go While she li ms ale: to and has he
relatives9 she w .;.L in a store9 is secretary of her club9 tLCasuror oz?
astudy groop at your church9 president of the Sr day School, ands Il” ya
deeply involved in all area .3 90f the life of the c'lmrch.9 She seems to
get along well w th her fellow LL'orh'ers; the customers like her and a: 7‘:
for here You also know that she has many friends and often goes 0122.9
she attends many concerts, usually wi‘h somebody from church or wi ch a
friend or her lo Ldlac’ya She has a very pleasant apartment, and dri vos
herotm car. She certainly has a good Job and you remember, her telling
you Just recently thats soe had been granted a eonsi derable increase in
salary, and how happy she appeared about her employer being so open in

his praise for her

OutMardly there is nothing to account for such bitterness or for her
feeling that she means nothing to amrhody. As she goes on talking

about her resents. ent and feeling of being negated and dehumanised 15"
her environment, it becomes clear that size is isolated in th.e midst of
a crowd. She is rarely alone and always on the go9 but no companion
holds over from one activity to anothero All her contacts are fortuitos
ones, shifting as rapidly as two rivulets oL water on a windowpaneo She
always eats lunch with one of her emaworlzers, but" the choice depends
upon who is in the cloaimmom when she goes for her coat... It is usually
she who buys the tickets for the concert and suggests going and after
it is ever she and the friend separate with promises to "call each othc;

up some time"o

Jane's mother died ten years ago and you remember well what a great
less this was for Janice Her mother had been a wide I and an invalid
for 20~years and Jane has spend most of her life talci ng care of her
mother often foresaking friends and opporttzni:1e3 for dating because
she felt her mother needed here At the time so. the Lot hor"s death

you had suggested that she become active in caurchwork, to get rid of
the house in the couni my and obtain a lovely apartm .nt within the c:.'i.ty9
hoping that this would fill the camp" ciness and loneliness in this girlgs
lifeo She had done all these things and been one ac: tive in chzrch and
joined a mmber of organist tions, developed a host of new interests,

and made many social contacts

can-r»

Jane had always seemed so happy and adjusted and never complained, alt .....-
early to take on added resoom :ibi lities in the church whenever you res-a
quested it, You now realize9 however9 that all of her contacts were

surface contacts? cerri 0:7 on in the frmgerrerl: e1? token relation-m
ships on the level of pelite social memrageo m2: group was organic?
Feed, lamina All were teneoue clusters of individuals 1.77m met
melamine-rim for a comm-22:1 pun-Jose and then diggersedg to meet with “no
cluster for another-11111313030 and another goal» She had. as an @1115;
child, no relatives,;, 11:) one with when she meeiz- ' ,3 of Image life she
was an integral part, emcee role could not be well i‘illed'by anotherg
If she lunchcd with a {511115 it was vita a can—711033310319 and they talked
over the affairs of the storee As secrebery of her club she often
met with the president, but it was a. eeeretergr and a president Hakim:
plans; not Jane and another 711.23.23.11 beng making friendeo She went to~
a concert but she was paying back a seciel debt or "making a gesture"
tom-lard friendship.)

In other wards, all he;- yela‘cionships x-rere swims: relations-17.13.1330 All
her 739713111011 was rage geeavioro‘ $3 the Fragment of the Stanley Seizc::‘:l
she fem—41107427 certam cmbies am was respended to in a certain 1mg
r- »v"'. - q—‘v ' . _ ., uv 3 e

mtg-ms forgoiwn 17317111 the geezt'meel: "oxlecl aromatic, See mm a gem-7
elem-7:5? a {seer-10101111103 e :3e-::::'=:evary“g an eceurate tremurers a :Z'ai‘thful
$313915? :5. me}. teaclzaero but them-1e was 21:; (me to time. she mezmt 8115M

3 hr?

. .29.)

gene he? begun to rea 12:3 all this and was in yer-r office fer her.
“me fag: see has came 11:) the end of he: rope and feefie she cemm‘
go on like thiso

APPENDIX G

e. .

Mr r'2 ears old and he oily married with four children we
sonsmmarrieg, one be, in col ego and a girl in High School, 3 a
deacon .is your churc . ..One..night at 10 o’clock at night he calls and
asks if he can come and .see you because there is something which he
is unable to discuss over the phone, but which disturbes him to the

point that he feels he must see you immediately.

Mien he arrives he is obviously in a state of excitement, He finds it
difficult to sit down and keeps pacing the floor, continually scattering
to himself that he is lost, damned for eternity, and very likely will go
to hell when he dies. . .

You finally succeed in calming him down so that he is able to converse
with you, even though he remains very excited and hardly can keep his
voice down. Ito-starts by saying that this is not a problem which has
started tonight, but it is something that has been bothering him for a
long tine, at least six to eight months. He has been unable to discuss
this with his wife because he didn't want to "involve" her in this.
After another ten minutes of talking in the same manner, Mrs K. is
finally able to tell you that he is convinced that he has committed the
"unpardonable sin". He immediately quotes the Bible teeth from Mark 3 .
229,30, ”But whoever blasphmcs against the Holy Spirit never has-
forgivencss, but is guilty of an eternal sin «- for they had said, "He

has an unclean spirit."

Mr. K. goes on to say that he has had a feeling for a number of months
now that he is unable to get through to God. He finds it impossible to
pray in private and can only participate in the family prayers and even
then with the greatest difficulty. Every time he tries to pray it

. seems as if "cursing thoughts” toward God run through his mind. He
folly recognizes he is beyond the forgiveness of God and he feels that
he is not able to get saved.

You point out that the interpretation of @ripture quoted by him is
quite different from what Mr. K. has been telling him and that these
words are not directed against sins of'unbeliei’ but against the
malignant noral'blindness which deliberately affirms that that which
is good is evil. _ -

You soon realize that this doesnot comfort Mr. K0 as he still "feels”
lost and wants to resign from his office as a deacon- in the church be»
cause he is not mrthy to serve a God he curses daily. He must await
his final fearful Judgment and he relates how he often thinks of the
fire which will consume him. When he attempts to go to sleep at night
heimagines that the flames are'leaking around his bed, ready to get
at him as a punishment from God. __

 

 

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APPENDIX H

Ho

Mrs. 20 wants to tell: to you about the feasibility of continuing her
marriages She is a very attractive 25 year old woman who crosses H
extremely well and is very relaxed and easngoiilg. she9 however;9 has
lived with a problem in that she has been 33.54.2318. to tone care OJ. her
two children asshe 6.13.; eriences deep feelings of being an fuzscequate
mothers Theyoungest child. has been living with her lessens? in a.
distant city? and she gets to see him only occasronallyo ‘ her clues
son, 1&- year-s olda lives with his parents!) but 17:13:39 no worse. and has
a babysitter for the childo She feels this t-rorks out very -
satisfactorily as she loves working dormtswn and is unable to stay
home because she becomes so upset and nervous that her husband and

children suffero

She has been rmrking for two years and feels much better since that
time, She has also had two years of psychcatherspy from a local
competent psychiatrist and feels that this has been verv helpful in
understanding hemroblem which is related to her father and it also
has helped her to control sonar-mat her feelings of inadecpiacy in
coping with being a wife and mothers Therapy had now come to an end
as the psychiatrist felt he had done as much for her as he could,
telling her that many people with a neurotic conflict are unable to
ever cope with the task of a wife and mother as society demands ito

Her husband has now been promoted and as a result they will be moving
to the east coast where her husband is‘to start a. training program in
an executive school of a large companya He has told her teat if she
cannot be a mother to both their children they should be divorced so
that he can be ferried again and have his children with him He has
long been very angry for not having his youngest child at house.D He
also feels very bitter because the psychiatrist has never consulted
with him and told bobs first to do or expect in the futures He has
wanted to help her but Just doean Inner-r hot-r9

the. Z. is now faced t-rith the decision of 1311311118 her family together
and move into a new home and start living a more normal fend y life
with her two children and the possibility oi" {nevi-1g additional children
in the futures 0n the other hand she faces the possibility of divorce
which will relieve her of the responsibilities she feels she cannot
hamdleo

She states how guilty she x'rould feel if her mrririge broke up as she has
always believed a Christian marriage is 'for keeps.» She is willing to try
and with Sodas help make the best of it, She feels that if her husbaml
will let her work she has a much better chance because the sexes of
achievement in her work helps her tremendously at homes Era-terror, people
fig-1m on \‘rorhing women with children and her husband does not like it

63‘ erg

APPENDIX I

Io
' ° - ‘ . on, «has t»: ‘
Mrso B0 is a highly intelligentg willeeartatec tense in her late
for-tiesC Ker husband is tie AdministratO' of the local hospital?
rchg he a Snncay School teacher

They are both very active in the Chm ‘ . m y
and a deacona while she'is the organist and President of one or the
Guildso fira'and Ursa Do have three children; a girl thirteen? s

boy ten? and another girl sevens fire and Ursa B9 5?0 both regarded
as leaders in the civic affairs of their comlznity and load a very
active social-lifeo They have an intimate and seemsgcing relatione

ship with ref-'15, their 21. ..2i1ister9 and they have Ernst-'11 you ever since
their fias' child was borne

hrs0 BO comes to see you to express her strong concern for new
controllable feelings of hostility towards her eldest childG She

is avers of her being overndeeanding with the girlg always insecting
adult maturity and behaviors However“ despite this awareness? she
finds that very frequently she is unable to change her high expectatiof-
of the danghtero The girl is very bright and highmspirited.ond fizhts
back with her mothers She gets very angry with her mother'when the new“
is expected of her and of late has ran away to her girlsfrienst house
on sneerons occasi.nso All this has created an atmosphere of tension
and resentment between mother and daughter'MQich makes for unpleasohtne:
in the honeo

All this has become increasingly more intolerable to {rec Ba and she
would like you to help hero She has prayed about these angry feelingsE
but still feels that she is losing the battle every tine she loses
control of herself and gets angrys At timesa willrpower and selfm

co trol seems to work for a while, bnt'in the end her excessive demands
and anger get the better of her anywayo

After listening to N sq Bo talk for a while and cfferixr s
comfort she suddenly blurts out that there is something elo 1
doesnst understand within herselfo However, she finds it 3 l
discuss this with anyoneo fifter reassuring her and waiting r t
speak up she finally states that she is very much tethered by oases
feelings of sexual repulsion toward her husbando She the: ex:r 3
her opinion that she feels tint somehow this is costributary £0 ,3
problem with her daughtero She is at a less to undo stand these tee

4 ~15",
of repulsion as she considers herself happily married and her husband
is a very goodulooh.ng nan.who is always very well groomed, very
attentive toward her and does anything to make her happyo She cantiatc
to say that she worries a great deal slicer. her daughter as she wonders
how she will turn out having a mother like her who so frequently gets
angry with her and continual v hogs her about matters that really are
of no importance9 and being unable to show very mach her feelings of

love for this girls

 

APPENDIX J

109 Owen 3311, NOS Uo
La “at IanSing, ,HIiC 1138.11
lay lCLJ 1962

You might wel he aware of recent research findings (Gm "in, et al,
"Americans View Their Ii'ent: l Health"q 1960) whi3h indicate the
crucial role of the ALerican Clergy as one of tle helping res 3ources
for peoole in dzlstress Of persons sannpled who sought "mental
health h3lp", h2fl turned to their clergyn3n.

These fi :dings nzke it 3} :tra lely important that ministers are
capab'le of Logan” proper rexerrals to psychiatristswhen confronted
with mental 5.llness.

I an presently involved in a research project dealing with Just~
this problem. J3 are att 33.nting to find out whether ministers are
able to .~ecogiize pathology, especially when moral issues are in»
volved, or whether they Jould attempt to go ahead and treat these
people themsc veso.

Enclosed you oil 1 find nine case histories, each one presenting a

definite plea. for help from the minister. It is felt that some of

those can ross ihly be dealt with bye clergymen, while others how

cause of tce nature of the pathology, should be_referred_to a
ycxietrist. , v

I would very much appreciate your cooperation by please reading
these cases 3.3d check one of the two questions on each questionaire
ace)nhqnyw:~ each case. As you will noteq space has been provided
in zase you care to make any comments on '33 case, even though this
13:10t a ?”QULr3nonu.

'Please ret‘: rn themguevizonnires only in the enclosed stanoed self«

“I! L' lax-3.3m

addres :sed envelogae at your earliest conveniences

I deeply aopreciate your kind cooperation in this matter and trust
that this type of a study might be of some value to the field of
mental Healtho

Sincerely yours,

Corny J. Geerlings
Graduate Student Clinical Psychology
Michigan State University

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APPENDIX L

Now that you have finished reading this case, please answer the
following questions:

lo

20

30

State briefly your own reaction and feelings about this
particular problemO

to you feel this problem is:

a) somewhat similar to a problem you have counseled
in the pest

b) the case history of a mental patient

c) a problem involving difficulties which might be
overcome by faith, prayers and counseling with
a minister (

would you:

a; Handle this case yourself (

b See: the advice of a psychiatrist in regards (
to further steps

c) Refer this person to a psychiatrist (

If you decided to handle this yourself, please state briefly
hmv'y u would plan to go about this:

UV

VV

BIBLIOGRAPHY

A. BOOKS

Bieber, Irving (ed. ). Homosexuality - A Psychoanalytic Study.
New York: Basic Books, Inc., 1962.

Brill, A. A. (ed.). Sigmund Freud. New York: Modern Library,
19380

Burton, Arthur and Robert E. Harris (eds.). Clinical Studies
2;.Personality. New York: Harper Brothers, 1915.

Doniger, Simon (ed. ). Counselingpwith Neurotics in the
Minister' 8 Consultation Clinic. New York: Channel Press,
1955.

Freud, Sigmund. Three Essays 2_. he Theories g; Sexuality.
London: Imago, 1905.

Freud, Sigmund. The Ego and the IQ. London: Hogarth Press,
1923.

Gurin, Gerald, Joseph Veroff and Sheila Feld. Americans
View Their Mental Health. New York: Basic Books, Inc.,
1950.

Hall, B. H. (ed.). Psychiatry Looks 2;,Religion. New York:
Viking Press, 1959.

 

Leighton, Alexander H. Ey_Name‘;§ Legion: Foundation for n3
Theory 2£_Man in Culture. New York: Basic Books, Inc.

1959.

Menninger, Karl. The Contribution of Psychoanalysis‘gg

American Psychiatry. Bulletin: Menninger Clinic,
18:65-91, 195 o

Menninger, Karl. A_Psychiatrist's World: The Selected Papers
2£.Karl Menninger, M.D. New York: the Viking Press,
1959.

Oates, Wayne E. Religious Dimensions g£_§ersonality.
New York: Allociation Press, 1957.

Siegel, Sidney. Nonparametric Statistics for the Behavioral
Sciences. New York: McGraw-Hill, Inc.

Tillich, Paul. The Courage 23.32, New Haven: Yale University
Press, 1952.

Walker, Helen M. and Joseph Lev. Statistical Inference.
New York: Henry Holt and Company, Inc., 1953.

B. PERIODICALS

Engel, G. L. "Is Grief a Disease?" Psychosomatic Medicine,
XXII, 1961. -

Freud, Sigmund. "Letter (1955)," American Journal 2;
Psychiatry 107; 786, 1951.

Solmit and Stark, "Mourning and the Birth of a Defective
Child," The Psychoanalytic Study 23 the Child, Volume

XVI. New York: International Universities Press, Inc.,
1961.

C. PAHPHLET

Greer, Ina Hay. "Loneliness." The Episcopal Press.

D. REPORT

Holfenden Report. Report 2;.the Committee gngHomosexual
Offenses and Prostitution. London: H. M. S. 0., 1957.

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