Everyone has to believe in something.” “What you believe and what you know are different things, and it’s important to keep them separated for your orientation.” These two statements about belief are attributed to Dr. Elvin Semrad, the late Boston psychoanalyst who taught generations of psychiatry residents and psychology interns how to listen and enter into the experience of their patients. What he was saying forty years ago is just as relevant today.
Today, like so many days at the hospital where I work, we are discharging people for whom belief is the central issue. One man, now stable on his medications, calmer, in better control of his behavior, and more logical in his thinking, leaves with the belief that the police are watching and waiting for him to slip up so they can arrest him again. Another, also stable on his medications, prepares to return to the community convinced that he has unlocked the key to the universe, replacing traditional beliefs about God with his own edifice of theological propositions. Neither of them knows but they both believe.
They have heard therapists tell them ad nauseam that their mental illnesses make it necessary for them to test their assumptions about the world against the facts and the judgment of others whom they trust. Some take this advice and adjust their beliefs according to this new information. Others persist in their convictions, either too certain even to ask the opinion of others or too committed to their own points of view to take those opinions seriously. It is easy for us mental health professionals, who think we know better, to pass judgment on the foolishness of someone else’s belief. What we lack is not an intellectual understanding of how these beliefs originate or what consequences are likely to flow from clinging to or letting go of an entrenched perspective. They still teach those things in graduate school. What we miss all too easily is how it feels to be sure of something that most people think is wrong.
When we ask where the sense of conviction comes from, we get different answers. As empirically guided psychologists, we are convinced of the truth of a proposition when we see the data supporting its claims. We strive for a standard that will tell us that a particular treatment, carefully described and consistently applied, will produce a certain result with individuals showing specific symptoms, again with the caveat that both the result and the symptoms are specified in behavioral terms. As practical therapists, our laboratory is the office and our research is our interaction with the person who is there seeking our help. When to listen, when to keep silent, when to speak, what to say – this is what we learn by observing the effects of our actions on the way our partner in this grand enterprise tells his story, learns to understand his own role in his troubles, and changes his behavior to effect a more satisfying outcome. The practical therapist gains his sense of conviction from experience. If you do this work long enough, you get a feel for it. I know that sounds terribly old-fashioned and unscientific but it is an intuitive way of knowing that also brings a powerful sense of conviction.
Ideally we need both empirical validation and intuitive grace to be an effective therapist. If the only choice consumers of therapy have is to tell their stories to clumsy empiricists or graceful magicians, then our profession is in deep trouble. I write these words with my head filled with a biography I am reading of Pierre Teilhard de Chardin, the Jesuit priest, mystic, and paleontologist who was part of the team that discovered Peking man, the missing link in the chain of evolution from ape to human. Like Galileo before him, he was a man of science and a man of faith. Teilhard’s ability to live with the tension of these radically different ways of knowing led him to a new vision of the universe governed by the laws of biology, geology, and physics but extending beyond the world of matter to the world of spirit where he believed humanity is being drawn into union with the divine. Teilhard’s steadfast empiricism led him to public support for Darwin’s theory of evolution and earned him the censure of his church and exile in far off China. In a magnificent stroke of cosmic justice, it was in China that Teilhard made his most important scientific discoveries.
If therapists and the great scientist-mystics gain their sense of conviction from some combination of empiricism and intuition, then the same must be said for people with mental illness, no matter how strange their ideas may seem. Perhaps one of the most helpful things we can do as psychologists is to suggest new, different, and more satisfying perspectives to the people who seek our help. For some these new perspectives will come about only with more information, for others, with more understanding of why they so desperately needed their old ways of seeing. Then there are those people who will never think conventionally but may learn to recognize their vision as one among many points of view equally deserving of respect and tolerance. When we look hard enough and listen closely enough, we see and hear the truth buried in the strangest of tales. It is only when we begin by honoring that truth that we can expect to help people move on to something new.
Alan Bodnar, Ph.D. is a psychologist at Worcester State Hospital and a consultant in the field of leadership development.