The Whole Patient: Observation Without Judgment

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PORTRAIT OF A PSYCHIATRIST

Series Editor, H. Steven Moffic, MD

Psychiatry plays a central role in exploring and treating the depths of human experience captured by the word “soul.” During psychiatric residency, I read Bruno Bettelheim’s Freud and Man’s Soul.¹ At that moment, I began to see how my life experience came together to direct the rest of my life. My father was a protestant minister in a small town of 1200 people with 5 different churches. There, St Elizabeth Ann Seton, the first American-born Saint of the Catholic Church, started her Order of the Sisters of Charity.

As a teenager, my thrill of science clashed with religious beliefs starting an unforeseen life journey. In college, pursuing my exciting engineering major changed to psychology when I realized I needed more personal connections in my future career. And the Kuder Preference Test led me to choose psychiatry as a professional goal, when medicine had never before entered my imagination. My experience of a “doctor” was the man four houses down the street who I would go to with a $2 payment and return home with a packet of pills and handwritten instructions.

In college, I stumbled upon “Ethical Culture,” a small American religion that placed ethics and a commitment to the “worth and dignity of every person” as its central purpose. That mediated my religious and science struggles and supported me throughout medical school, pediatric residency, psychiatric residency, and a child and adolescent psychiatry fellowship.

Freud and Man’s Soul¹ opened my awareness to my real quest-the experience of soul-or “psyche” (Greek for “soul” or “spirit”) as a “psyche-atrist.” My first job could not have been a better opportunity as it was with teenagers with mental disorders and addictions during the “crack” epidemic. At the time, we worked within a 12-Step (Alcoholics Anonymous) framework where spirituality was a major part of recovery.

Working with teens who were violent, homicidal, self-destructive, suicidal, and often filled with hatred and hopelessness tested my limits. Still, my commitment to give every patient dignity and respect fed my desire to treat substance use disorders with a spiritual bent, especially because addiction affects the soul mightily.

Outside my professional work, I received support by meeting with people to explore faith from a non-theistic perspective. Twice a month for a full year, we identified core characteristics of the spiritual experience-connectedness, wholeness, integrity, vitality, peace, joy, awe, purpose, and meaning. In the middle of this, I realized my father had somehow passed on to me a personal experience of “faith.” I recall at his funeral, a parishioner said, “That Rev. Chatlos-when he would shake your hand, you just knew that everything would be alright.”

Unexpectedly, as our group explored faith, we discovered that the personal experiences of self-worth (self-confidence/self-esteem/self-competence) and the expression of dignity (reason/wisdom, empathy/compassion, courage/generosity) were key to opening what William James² described in Varieties of Religious Experience. It was so predictable and dramatic that I knew there must be an evolutionary basis for our capacity to experience self-worth and dignity.

Inspiration after loss>

Inspiration after loss

For over 20 years, I was inspired personally and professionally in this vein. It was only when my wife died suddenly and tragically, and my planned future instantly vanished, did it all come together. We discovered why humans can have spiritual experiences, with an evolutionary explanation. An ancient, pre-human, “hominid” drive for cooperation and survival “wired in” our capacity for mystical experiences to provide a sense of meaning. Since then, in working with friends, we have also developed a process to guide people to open the experiential realm that is present in all people. I had finally discovered my life’s mission in an awakening moment as described by Jung:³

Only one who has risked the fight with the dragon and is not overcome by it wins the “treasure hard to attain.” He alone has a genuine claim to self-confidence, for he has faced the dark ground of his self and thereby has gained himself. This experience gives him faith and trust.

I am now exploring and developing the opening to this immanent realm as the “mystical core” that appears to underlie all religious traditions. It is being pursued as the “Human Faith Project” to develop unity among religious, spiritual, and ethical thought traditions with the hope of providing a unity of purpose to address the problems of mental health, addictions, social injustices, and unbridled climate change.

Our goal is to empower the worth and dignity of every person. An honest pursuit to achieve it opens entirely new realms of experience with newfound creativity, compassion, love, and faith in life. Our specialty leads to healing and happiness in ways available to anyone courageous enough to explore honestly their own life experience. In contrast with a focus on material possessions, self-growth and awareness are urgently needed to reconnect with the true “soul” of our country.

The highest spiritual practice is self-observation without judgment. –Swami Kripalu

I have much gratitude for Bruno Bettelheim, Sigmund Freud, and many other spiritual guides in psychiatry.

Dr Chatlos is a Child and Adolescent and Addiction Psychiatrist at Rutgers-Robert Wood Johnson Medical School, in New Brunswick, NJ. He is Medical Director of the Wei Ji Point Ambulatory Withdrawal Management program and the Specialized Addiction Treatment Services outpatient program.

References:

1. Bettelheim B. Freud and Man’s Soul: An Important Re-Interpretation of Freudian Theory. New York: Random House Inc; 1982.

2. James W. The Varieties of Religious Experience: A Study in Human Nature. New York: Longmans, Green, and Co; 1902.

3. Read H, Fordham M, Adler G, Eds. The Collected Works of C. G. Jung. Princeton, NJ: Princeton University Press; 1970.