Psychiatry & Being

When I consider the brief span of my life, swallowed up in the eternity before and behind it, the small space that I fill, or even see, engulfed in the infinite immensity of spaces which I know not, and which know not me, I am afraid, and wonder to see myself here rather than there; for there is no reason why I should be here rather than there, now rather than then.

--Pascal: Pensees (circa 1656)

It was a regular quarterly meeting of the Connecticut Society for Psychiatry and Neurology, which usually attracts an attendance of about 60. But the 220 seats in Fitkin Amphitheater at Grace-New Haven Community Hospital were nothing like enough: eager auditors overflowed onto the floor and sat literally at the speaker's feet; standees jammed the back of the hall, an anteroom and stairways. The word they had come to hear was entitled "Contributions of Existential Psychoanalysis." The speaker: Manhattan's Psychoanalyst Rollo May. His audience included, besides the association's hard core of psychiatrists, many members of Yale's faculties of psychiatry, psychology, philosophy and divinity, and enough students to make up the overflow.

What happened in New Haven was typical of what has been happening in several U.S. academic centers since June, when a massive (445 pp.) tome appeared under the title Existence: A New Dimension in Psychiatry and Psychology (Basic Books; $7.50). Rollo May is chief editor, and sums up the origins and distinctive features of existential psychotherapy. Sales are now around the 12,000 mark and continuing briskly. In September came Irrational Man: A Study in Existential Philosophy (Doubleday; $5), by New York University's Professor William Barrett--the most lucid exposition of the subject yet to appear in English. Between them, these books have sharply increased U.S. interest in existentialism, and especially its use in psychotherapy.

Oedipus Recapped. Dr. May explained to his skeptical audience why he--and growing numbers of analysts in Europe and the U.S.--feel that a new approach, but not a new school, is needed. Trouble with previous analytic or "depth psychology" schools, he argued, is that they fail to get to the root of the problems that send patients to analysts nowadays. Thus both scientific progress and improvements in treatment are blocked. May & Co. are convinced that when conventional analytic treatment appears to effect a cure, in all probability something has been going on inside the patient that was different from what the analyst believed.

For sharpest illustration of the difference between the existential and earlier approaches, Dr. May took the well-worn Oedipus situation and recapped it. To Freud, Oedipus meant that a child has a sexual attraction to the parent of the opposite sex; as a result, the child experiences guilt, fear of the other parent, and (in boys) castration anxiety. In Freudian and descendent schools in the U.S., the patient is helped to accept the idea that such transitory feelings are normal and natural, so he is relieved of his guilt and anxiety.

Although the prevailing U.S. attitude to Oedipal situations is superficially true to Freud, Dr. May noted an important subsurface difference: it lacks the tragic element that Freud saw in father-son hostility and rivalry.

But while granting that Freud preserved the classical tragic element, Dr. May argued that his explanation of the Greek legend was wrong. In existential analysis, Sophocles' drama is construed as not primarily concerned with Oedipus' sexual problems--having killed his father and married his mother. The real issue is whether Oedipus will recognize what he has done--face the unbearable truth about himself. Dr. May quoted Tiresias: "How terrible it is to know . . ." And Jocasta: "Don't seek it! ... Wretch, what thou art O might'st thou never know." But Oedipus insists: "Break out what will, I shall not hesitate ... I must hear, no less." And when he learns the awful truth, the significant thing to Dr. May is that Oedipus cuts out his eyes, the organ of seeing, not of sex: "The drama is the tragedy of seeing truth . . . the tragedy of self-knowledge, self-consciousness."

Strong Undercurrent. Most of Dr. May's eager listeners had attended more out of curiosity than conviction. Said an expert afterward: "For the most part they didn't agree and weren't converted." To May this was neither surprise nor disappointment. Many therapists of traditional schools, if they do not dismiss existential analysis as incomprehensible, maintain that it is nothing new and that they are already practicing it. Some are, May concedes, but it is their individual "added value." So far, to the great satisfaction of its proponents, the trend toward existential analysis in the U.S. is only a strong undercurrent among the serious-minded. There is no sign that it will become a frothy success like Freudian analysis or hula hoops. Most emphatically, such men as May and Barrett distinguish it from the so-called existentialist craze that swept the Left Bank beatniques under the inspiration of Jean-Paul Sartre a decade ago. To them Sartre is an embarrassment. The existential analysis advocated by Sartre is not the father of today's movement and has little kinship with it.

One good reason why existentialism, properly defined, is unlikely ever to become a popular fad is that any understanding of it requires the most rigorous intellectual exercise. While it sets great store by reality, it is built of necessity upon the intangible concept of being. Although there has long been a science of being (ontology), there is no definition of being or existence that conveys any added information about it. Most pillars of existentialism therefore content themselves with saying that being or existence is such a fundamental concept that it cannot be defined--but is universally recognized.

Believers & Atheists. Existentialists find themselves in head-on collision with the most widely accepted tenets of many great philosophers--Plato, Descartes, Kant, Spinoza and Hegel. Their particular enemy is Hegel, for his insistence that all reality can be encompassed in a rational structure. It was this that inspired the melancholy Dane, Soeren Kierkegaard (1813-55), to raise the flag of philosophic revolt against all purely rationalist and positivist systems, and to declare that reality and truth are within man himself and his actions, whether they be rational or no. Kierkegaard argued that the central, all-important fact about man is the simplest one: his existence. But because man is the only creature who is self-conscious (in the literal sense, "conscious of himself"), he is the only one who can be consciously aware of his existence. From this flows the corollary: he thus becomes aware of the possibility of nonexistence. And from this comes anxiety.

Ironically, the second of existentialism's classical heroes is an antithesis of passionately Christian Kierkegaard--the prophet Friedrich Nietzsche, who proclaimed that "God is dead." It is characteristic of the lack of crystallized structure in modern existentialism that its adherents include both Christians and atheists. Also, that although its practitioners in psychotherapy readily admit their debt to recent and contemporary philosophers (notably, Henri Bergson and the phenomenologists Edmund Husserl and Martin Heidegger), most of the pioneers began working out an existential approach independently of one another and while still ignorant of its philosophic bases.

The "Here & Now." Spontaneously and almost simultaneously, Psychiatrists Eugene Minkowski in Paris, Erwin W. Straus (now settled in Lexington. Ky.), Baron Viktor von Gebsattel and Karl Jaspers in Germany and Ludwig Binswanger in Switzerland began applying what are now rated as phenomenological and existential principles to psychiatry. The influence spread from these elders to young psychiatrists in training. Binswanger and others named their method Daseinsanalyse, from Heidegger's term for existence, Dasein (translated as "being here and now"). The new approach was not formalized in a new school, designed to supplant earlier "depth psychology" methods, but permeated many of them. Though its greatest acceptance came among eclectics (no particular school), it has been taken up by many Freudians and some Jungians and Adlerians, and recently in the U.S. by followers of Karen Horney, Harry Stack Sullivan and Erich Fromm.

So subtle was the spread of existential thinking in psychotherapy that for a quarter-century it made no mark in the English-speaking world. The most eminent Freudians in Britain today still haughtily deny that they ever heard of it--a pose difficult to maintain in view of the fact that the International Congress of Psychotherapy at Barcelona in September was centered on existential analysis. At this meeting Dr. May explained why its influence in the U.S. has so far been negligible. A pragmatic tradition tracing back to frontier days, he contended, has made Americans a nation of doers, suspicious of theorizing or abstract speculation. But just beneath the conscious surface. Dr. May saw in the American character a rich subsoil of concern for "knowing by doing." This brought him around to Kierkegaard, who proclaimed: "Truth exists for the individual only as he himself produces it in action."

The U.S., said Dr. May, has fallen particular prey to "Western man's preoccupation with mechanistic methods, his apotheosis of technique." For technique, worshiped as a way of controlling nature, has led to "the corollary need to see human personality as an object of control like the rest of nature." And the availability of techniques for an infinite variety of purposes has resulted in neurotic activity, "keeping busy" for its own sake, because "to do is often easier, and may allay anxiety more quickly, than to be."

New Dimension. Ohio-born Dr. May, 49, a fellow of Manhattan's cumbrously named William Alanson White Institute of Psychiatry, Psychoanalysis and Psychology, got his Ph.D. from Columbia with a now classic thesis, The Meaning of Anxiety. He followed it with the more popular Man's Search for Himself, published in 1953. Already applying existential principles in his practice, he then learned what European analysts were doing, began working on Existence. Meanwhile, the confluence of German and Swiss Daseinsanalyse with a more literally existential school developed in Spain, France and Vienna led to the omnibus Barcelona Congress.

Existentialism is not used directly as a philosophy in helping patients, says May, but serves as a foundation for psychologists to construct a broader base for their science and thus to understand man more intimately. In his theoretical view, this means introducing a new dimension--ontology. But to the patient undergoing treatment, one of the biggest differences is in the therapist's attitude to anxiety and guilt. In older, conventional psychology and psychiatry, says May, there was no place for really fundamental anxiety--about such basic issues as being and non-being--and there was no way to treat it. Most anxiety was assumed to be neurotic and the result of emotional injury or repression of instincts, which led to a blockage of the patient's capacities for fulfillment in work or in life generally. This was most obviously true in the case of unconscious repression of sexual urges, such as Freud described, and could be effectively treated by uncovering the unconscious through analysis.

But by the 1930s, May holds, there was not so much of this sex-based anxiety, especially in the U.S., and neurotic anxiety then seemed to stem mainly from repressed hostility. Since World War II, Dr. May contends, there has been another change: most of the anxiety that he sees in practice comes not from repression of instinctual drives, but from the fact that too many people feel that life has lost its meaning for them. This, he argued, brings normal, "existential" anxiety to the surface. Nowadays, when people first sense this normal anxiety, they may still repress it, and consequently develop an ultramodern form of neurotic anxiety with symptoms of depression, blocking in regard to work, despair and melancholy summed up in the cry, "What I do isn't worth anything." The trouble lies, says May, in dammed-up potentialities rather than repressed instincts.

Drama v. Diffusion. In the U.S. the symptoms are less dramatic and more diffuse than in Europe. In Dr. May's practice with Manhattan professional workers and exurbanite brokers and industrialists, the symptoms may be nothing more pronounced than an exaggeration of the normal routine. Wall Street and Madison Avenue, he believes, require compulsive characteristics for success. The man who succeeds in these fields, becoming a slave to routine and conformity, gets nervous when the daily cycle is broken--which explains why he drinks so much on Sundays and holidays.

A typical patient in May's practice is a businessman who has risen rapidly to success, made much money, is intelligent and works hard but is running on an accelerating treadmill. The first sign of his illness is increasing anxiety when the compulsive routine is disturbed, and he soon feels guilty because he is "not working well enough," starts to worry inordinately about details, stuffs his pockets with memos. He cannot take a real vacation. He is a perfectionist--and rigid perfectionism is viewed as a symptom of unconscious guilt. By now, the businessman has something to feel guilty about: he has neglected his family, he feels isolated from his fellow men (especially subordinates), and he gets in a panic because he feels unable to love.

At this point, says May, the U.S. tycoon is likely to crack up with a psychosomatic heart attack. In fact, psychosomaticists contend that practically any part of the body can be a target for the psyche's anxiety and despair.

Man in His Entirety. Americans, says May, use perpetual work as a defense against existential anxiety. They cannot face life itself because life as such has lost its meaning. In the U.S. this despondency has been sharply intensified by the realization that a hydrogen-bomb war could wipe out all life; so the threat of it brings every man abruptly face to face with Kierkegaard's nonexistence and Sartre's nothingness.

To May and like-minded therapists, Freud's view of "natural man," moved by instinctual forces, is an essential element of the truth, but still inadequate. The view of man as a social creature, advanced by Sullivan and Karen Horney, adds a second dimension--but still not enough. For a full understanding, and hence for successful psychotherapy, they hold that man must be seen in his entirety, in the light of his self-consciousness, his imagination, his creativity, and his unique ability to see himself as a finite creature, poised on the brink of nothingness--as Pascal put it, "here rather than there, now rather than then."

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