CHALLENGE:Robert Charles Powell, MD, PhD
“BEING WELL IS BEING FREE TO ACCEPT IT OR NOT”:
BEING WELL IS MAKING THE CONSCIOUS CHOICE TO KEEP ON KEEPIN’ ON:

[a story about “imagined ‘living human documents’ come alive”] 1, 2

ROBERT CHARLES POWELL, MD, PHD

 

I’ve never opened one of these Dunbar Award introductions –
this is the 20th – my 15th – with a “preface,”
but this time I believe that I must.

Talk about “challenge”!
Raymond Lawrence keeps handing me impossible tasks, and
the best for which I can hope each time is inspiration –
that inspiration finally will come to save the day.

“Bodily Changes and Emotions in the Social Body” was a hard topic.
“Neuropsychoanalysis” was a hard topic.

This year, the task itself demanded that I study 19 books –
19 books about imagined “living human documents” come alive. 

Let me repeat that: 
books about imagined ‘living human documents’ come alive”. 3

The task has been emotionally challenging. 
In practicing this presentation, several times I was brought to tears. 14

That never has happened before.

Bear with me. 

Normally, I need 8 to 15 minutes for one of these introductions. 
This time I will need 20 minutes.

Again, bear with me.

First, let me provide a chronologic context.

115 years ago – in 1906, Elwood Ernest Worcester founded what became 
                              “The Emmanuel Movement” for “medically-supervised religious psychotherapy” – 
                               which, actually,
                               fostered a broader appreciation of psychotherapy in general – &
                               opened the door for what became clinical pastoral psychotherapy. 4

110 years ago – in 1911, Sigmund Freud published
                               “Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia” –
                               for which Anton Theophilus Boisen prepared one of the very first English translations.
                               Boisen focused on Freud’s suggestion that
                               “delusional formation” is “an attempt at recovery, a process of reconstruction”.

100 years ago – in 1921, Boisen began psychotherapy with Worcester &
                               began writing his “My Own Case Record” – 
                               noting the psychosis behind his delusional – but
                               extraordinarily useful –
                               insight about having
                               “broken an opening in the wall which separated religion and medicine”.

100 years ago – in 1921, Helen Flanders Dunbar’s patroness, Ethel Phelps Stokes Hoyt –
                               the driving force behind The Joint Committee on Religion & Medicine,
                               through which Dunbar later supported Boisen’s work –
                               published Spirit: A Study in the Relation of Religion to Health.

95 years ago – in 1926, Boisen published (1) his hymnal for patients: Lift Up Your Hearts
                               (2) his call for clinical pastoral chaplaincy: “A Challenge to Our Seminaries” – and
                               (3) his ground-breaking article –
                               printed & later reprinted by the American Psychiatric Association – on
                               "Personality Changes and Upheavals Arising Out of the Sense of Personal Failure”.
                               Some years later, our Dunbar Awardee spoke of
                               “the malignant and pernicious loneliness that is the ground of mental illness …” 5

95 years ago – in 1926, Dunbar & Boisen became research colleagues at Worcester (MA) State Hospital,
                               studying the differences between
                               beneficent & malignant “Content of Thought” in schizophrenia. 6

95 years ago – in 1926, The Joint Committee sponsored Alice E. Paulsen’s widely disseminated report on
                               “Religious Healing …” – that explored
                               the mechanisms behind the beneficial effects of faith. 7

90 years ago – in 1931, partially on Worcester’s recommendation, Dunbar became
                               Director of the Joint Committee on Religion & Medicine.

                               Dunbar guided the Committee “to
                               investigate the border territory between religion and medicine” – & “to
                               study the problem resulting from the
                               dichotomy of psyche and soma with a view to better
                               understanding of
                               integrating forces and of
                               the psycho-physical organism as a whole”. 8

                               To accomplish these goals, the committee maintained two divisions: the
                               Department of Research, to supervise Dunbar’s
                               work in psychosomatic medicine, & the
                               Department of Education, to administer Boisen’s
                               “Council for the Clinical Training of Theological Students,” of which
                               Dunbar already had been Medical Director for one year.

90 years ago – in 1931, Boisen, as a language teacher, helped Dunbar with her translation of
                               Eugen Kahn’s Psychopathic Personalities, one of the earliest efforts at trying to
                               understand the role of narcissistic libido in symptom formation.

85 years ago – in 1936, Boisen published his classic study:
                               The Exploration of the Inner World:
                               A Study of Mental Disorder and Religious Experience.

                               The book came out soon after Boisen’s
                               5th full-blown psychotic episode, but,
                               as our Dunbar Awardee has phrased it,
                               there are those who have chosen “to
                               cast with the world, to
                               help it,
                               even while sick and estranged.” 9

75 years ago – in 1946, Boisen published his guide on
                               canvasing parish communities:
                               Problems in Religion and Life:
                               A Manuel for Pastors: With
                               Outlines for the Co-operative Study of
                               Personal Experience in
                               Social Settings.

70 years ago – in 1951, Boisen published another disrupting article:
                               “The Therapeutic Significance of Anxiety.”

                               Our Dunbar Awardee has spoken of
                               “a good, healthy sickness”. 10

70 years ago – in 1951, our Dunbar Awardee began a decade-long incognito slog toward freedom – &
                               began drafting a novelized personal case history.

65 years ago – in 1956, Boisen thoroughly reworked his “My Case Record,”
                               begun 35 years earlier.

65 years ago – in 1956, Boisen addressed the question:
                               “Is Psychotherapy a Religious Process?” –
                               expanding upon his discussion of “The
                               Therapeutic Significance of Anxiety”.

As our Dunbar Awardee asked,
                               “What if the brain [, a divine creation,] wants a shot at fixing itself?” 11

45 years ago – in 1976, 2,000 copies of the little green Boisen biography booklet were distributed.

20 years ago – in 2001, CPSP Pastoral Report published thoughts about Boisen’s
                               “Cooperative Inquiry” – as
                               what clinical pastoral chaplains do – as
                               what psychotherapists do.

15 years ago – in 2006, our Dunbar Awardee published at least an 18th study of
                               how people really function –
                               with still more studies to come.

15 years ago – in 2006, a CPSP plenary had us begin exploring the notion of
                               “How to Have Strong Feelings Without Being Self-Righteous”.

10 years ago – in 2011, CPSP Pastoral Report published the 1st of the 6 essays on
                               “Tolerance & Encouragement”.

That’s enough chronology.

I believe that it helps each year to acknowledge
whence we come, and
wither we go. 12 

One literary authority
“criticized” our Dunbar Awardee for providing
extreme “naturalistic” description – which is
interesting, as
the nineteenth century French tradition of “documents on human nature” was
part of the background to William James’ notion of “human documents” – which was
part of the background to Anton Boisen’s further development of
“case histories” as “living human documents”. 3

This is why our Dunbar Awardee’s works might well be described as
“imagined ‘living human documents’ come alive”.

Obviously, challenge – accepting it or not – is
a main theme in our Dunbar Awardee’s work, but
I want to focus, for a moment, on
several related themes in that work.

I am going to label them “Topic # 1” through “Topic #12” –
to make it easier for you to jump in on later discussions. 13

~~~~~

All Greenberg books cited are indicated by their initials; see “References” & “Endnotes” below.

** This is a deliberate decision – to place more emphasis on the words quoted than on the books where they appeared. **

~~~~~

&&&&&
Topic #1
that
being a good and decent person is mandatory – not optional – & is 
without any promise of appreciation. 

Let me share a number of comments from within our Dunbar Awardee’s writings – about 
accepting the challenge – at 
whatever level we are capable – just because 
the challenge demands it:

“There was left to him only to be an example, to be good and helpful. 
                               Where was the thunder in that?” 
                               [JY, p.132]

“They had kept faith with a future which might never sing their praises.”  
                               [INPYRG, p.274]

“ ‘Life isn’t a game.’ ”
                               “ ‘there’s nothing to be won … except the satisfaction of having done a very tough thing.’ ”
                               “ ‘it’s … without guarantees.’ ”
                               [MWC, [p.219; 216; 219]

“ ‘Let people be good without reward, freely.’ ”
                               [JY, p.184]

“ ‘It’s when my design is good, and it works, that no one notices.’ ”
                               [MWC, p.160]

“that they aren’t the center of the universe, that they don’t have to be.”
                               [SD, p.59]

“she seemed to take no special pride in her accomplishment.” [she was too busy]
                               [JY, p.146]

“Heroes are modest, and because they are, often unsung.”
                               [AIDFY, p.47]

“ ‘we’ll die forgotten, the way almost all decent and heroic people do.’ ”
                               [JY, p.390]

&&&&&
Topic #2 

Decades ago, a patient described her problem to me with a phrase I’d never forget.

She said that she had a “suferiority complex” – that 
she felt both superior & inferior at the same time.

Focus on that for a second. 
“suferiority”

Surely many of us feel that way once in a while – both superior & inferior at the same time.

Our Dunbar Awardee recognized that many of those we call “patients” 
feel that way much of the time: 
afraid of their possible power in superiority – 
in knowing too much about how others interact between themselves 

&, at the same time,
afraid of vulnerability in inferiority –
in knowing too little about how to act socially with others.
                               [INPYRG, p.180]

We may at times live within a “suferiority complex,” but
Dunbar insisted that we must struggle through to become
“emotionally free to think and act”.

&&&&&
Topic #3 

Who is the strange one?

The patient – and his or her life – may seem strange to us.

But each of us – and our life – may seem strange to the patient. 

Can we try to become more aware of how much we do not know?
                               [AC, pp.104-5; 119.]

&&&&&

Topic #4

Speaking of how much we do not know,
our Dunbar Awardee drops the hint that, 
as we are talking along to someone,
the other person’s silence does 
NOT mean that he or she agrees with what we are saying.

Silence does not mean “Yes” or “No”.
We have to be honest about what we 
do not know.
                               [FSV, p.238; AC, pp.193-4.]

&&&&&
Topic #5

Years ago, as an almost psychiatrist, I was dating a woman who worked at an adolescent drop-in clinic. 
I’d get there near closing time and sit in the waiting room. 
I guess I seemed like a safe-enough adult, as, after I had been sitting there many times,
a kid here and a kid there would ask my help with this or that pressing problem. 

Officially so or not, I’d become the waiting room psychotherapist.

That’s sort of the way I envision our newest Dunbar Awardee – 
as a sort of unofficial psychotherapist. 

The suffering, bewildered, and vulnerable need thoughtful listeners. 
That can be us – whether we are official or not.

&&&&&
Topic #6       
Years ago, I tried to explain the notion of “Amazing Grace” to one of my sons. 
I told him that, for the most part, Christians assume “grace abounding” – that tomorrow will be a better day. 
In contrast, Jews, for the most part, accept that tomorrow could be better OR could be worse – and 
they truly are amazed when grace abounds.

Our Dunbar Awardee seems to suggest that both good and evil are necessary parts of life – 
that they form a complex, unavoidable mixture in the world. 

“ ‘People keep asking why is there evil in the world, but never why is there good, which is the real miracle ….‘ “
                               [FP, p.72.]

“ ‘Make good out of evil? What the hell else is there to make it out of?’ “
                               [FP, p.22.]

“ ‘He [G-d] gives life, but not peace – joy and suffering, but not peace.’ “
                               [FP, p.53.]

“Nothing on earth is complete – in all the universe, nothing is complete except the Lord, our G-d. 
Neither joy nor sorrow is whole.” [TKP, p.217]

“ ‘The Lord quit early on that sixth day. Quit without finishin’; the job. 
We’re stuck with finishin’ the job ourselves ….’ “
                               [FP, p.104.]

&&&&&
Topic #7
Going back to the question of whether being a hero really is the goal, our Dunbar Awardee notes,

“What we try and fail to do I counted against us …. What we try and succeed to do is not seen …. We are known, then, by the quality of our failures.”
                               [TKP, p.184]

We are counseled not to be too proud – thinking only we can succeed –
“not to be revived by … [our] own righteousness.” 
                               [TKP, p.181]

We are reminded not to be too proud – thinking we can do it all alone –
“When is a hero not a hero? When he can’t be a coward too?”  
                               [TMV, p.258]

&&&&&
Topic #8

“The two ends of a miracle are commonplace, ordinary days” – 
even “ordinary” days in which we have worked very, very hard. 
                               [TMV, p.254]

Many a woman “feels a little let down after she has a baby – 
nine months and a spectacular moment in the delivery room, and then, well, it’s just a baby.” 
                               [TMV, p.256]

Many a patient has struggled hard to overcome severe illness, 
only to find,  well, “It was like Everest. At last, I got to the top. You know what I found there? 
I found the rest of the world, strolling … and littering up the summit … while they looked at the view.” 
                               [TMV, [p.254-5]

&&&&&
Topic #9
Sure, you’re supposed to be the expert, but, when in doubt, ask the patient for guidance.
“At the end of his interviews, he began to say, 
‘What questions should I be asking?’ 
He got strange looks for this …, but occasionally the question yielded surprising and fruitful responses ….” 
                               [WTSQ, pp.272-3]

&&&&&
Topic #10
Don’t assume that everyone can form and use concepts as easily as you do. 
Some folks work primarily with percepts – and 
you must recognize that in order to work well with them. 

This is a complicated topic, but our Dunbar Awardee circles around it in many writings. 
                               [ITS, difficulty with abstraction: pp.164, 204, 211, 224; 
                               OSSD, mastery of abstraction: whole book; 
                               ROP, p.124-5; WTSQ, pp.174, 181, 186, 272-3]

&&&&&
Topic #11
While all of life is a challenge – (and 
2020 certainly presented plenty of extra challenge!) – 

the issue is about us 
making a conscious choice – & about us 
encouraging patients to make a conscious choice – about 

accepting (or not) the need to carry on – to 
keep on keepin’ on!

&&&
There’s more.
&&&

One of our Dunbar Awardee’s books leads us on toward conclusion A-1 – then, 
we get asked to reconsider everything we THOUGHT we knew, to accommodate conclusion B – then, 
we get asked to reconsider everything again, which leads us to conclusion A-2. 

THEN – and this is the part – 
either about me or about our Awardee’s writing – 
that I don't really understand. 

On the very last page of the book, I felt a deep sadness. 

The main character is "moving on" in life, but 
the last words – 
without drama – 
struck me as very, very sad.

I guess that was the message. 

Life goes on – but sometimes it goes on, carrying the sadness nonetheless.
                               [FSV]

&&&&
Topic #12 

Our Dunbar Awardee spoke of folks “wronged by life”– 
adding, “we don’t know enough to put the label ‘hopeless’ on anyone.” 
                               [AC, p.99]
                               [A, p.256]

I believe that it is right, with our Dunbar Awardee’s & others’ help, to acknowledge
before Whom
there will be judgment and reckoning. 12

It will not be before us.

%%%%%%%%%%%%%%%%%%%%

Now, 
let me conclude.

Our Dunbar Awardee – 
for almost 6 decades – 
through 19 books about 
imagined “living human documents” come alive – 
                               has been nudging us to 
                               hang on in there! – to
                               keep ourselves alive! – 
                                                              involved, & useful – 
                                                              according to our capabilities – 
                               without any promise of some reward, 
                                                              some artificial rose garden.

Life goes on.

&&&&&

Please join me in welcoming our 20th recipient of 
The Helen Flanders Dunbar Award for Significant Contributions to the Clinical Pastoral Field!

a good and decent person:

                   Joanne Greenberg.

Robert Charles Powell, MD, PhD; Joanne Greenberg; and Raymond Lawrence

Above: (L to R) Robert Charles Powell, MD, PhD, Joanne Greenberg, and Raymond J. Lawrence

 

Joanne Greenberg
Joanne Greenberg

 

~~~~~
REFERENCES: 


The following are the books studied for this essay:

Greenberg, Joanne. The King's Persons. [TKP]
          New York: Holt, Rinehart, & Winston, 1963.

Green, Hannah [Greenberg, Joanne]. I Never Promised You a Rose Garden.  [INPYRG]
          New York: Holt, Rinehart, & Winston, 1964 [“Book Club Edition” is version cited]

Greenberg, Joanne. The Monday Voices. [TMV]
          New York: Holt, Rinehart, & Winston, 1965.

Greenberg, Joanne. Summering: A Book of Short Stories. [S]
          New York: Holt, Rinehart, & Winston, 1966.

Greenberg, Joanne. In This Sign.  [ITS]
          New York : Holt, Rinehart, and Winston, 1970.

Greenberg, Joanne. Rites of Passage (short stories) [ROP]
          New York: Holt, Rinehart, and Winston, 1972.

Greenberg, Joanne. Founder’s Praise. [FP]
          New York: Holt, Rinehart, & Winston, 1976

Greenberg, Joanne. High Crimes and Misdemeanors (short stories) [HCD]
          New York : Holt, Rinehart, and Winston, 1979.

Greenberg, Joanne. A Season of Delight. [SD]
          Millburn, NJ: Montemayor Press, 1981.

Greenberg, Joanne. The Far Side of Victory. [FSV]
          New York: Holt, Rinehart, & Winston, 1983

Greenberg, Joanne. Age of Consent. [AC]
          New York: Henry Holt & Co., 1987

Greenberg, Joanne. Of Such Small Differences. [OSSD]
          New York: Henry Holt & Co., 1988

Greenberg, Joanne. With the Snow Queen (short stories) [WTSQ]
          New York : Arcade, 1991.

Greenberg, Joanne. No Reck’ning Made. [NRM]
          New York: Henry Holt & Co., 1993

Greenberg, Joanne. Where the Road Goes. [WRG]
          New York: Henry Holt & Co., 1998.

Greenberg, Joanne. Appearances. [A]
          Millburn, NJ: Montemayor Press, 2006.

Greenberg, Joanne. Miri, Who Charms. [MWC]
          Millburn, NJ: Montemayor Press, 2009.

Greenberg, Joanne. All I’ve Done for You. [AIDFY]
          Larkspur, CA: McMania Publishing, 2017.

Greenberg, Joanne. Jubilee Year. [JY]
          Larkspur, CA: McMania Publishing, 2019.

 

~~~~~
ENDNOTES: 


This presentation opened with the first one minute of the Queen song,  “Keep Yourself Alive!” (1972), written by Freddie Mercury.
The key words:

          Now they say your folks are telling you
          “Be a super star!”
          but I tell you “Just be satisfied!”
          “Stay right where you are!”

          Keep yourself alive! Yeah!
          Keep yourself alive! Oh,
          it'll take you all your time and money!
          Honey, you'll survive! …

Part of Greenberg’s message seems to be, you don’t have to be perfect, a hero; just work hard at being a consistently good and decent person! This presentation closed with the first two and a third minutes of Queen’s “Hang On In There!” (1989), written by Freddie Mercury.
The key words:

          Don't let go!
          Don't lose your mystique!
          Wait a little longer!
          Tomorrow brings another feast!

          Don't let go!
          Don't lose your reputation!
          Thank G-d you're still alive! Ha!
          You're still in one piece!

          Hang on in there! Don't lose your appetite!
          Hang on in there! Forget the danger signs!

          Pray for that magical moment
          and it will appear! 
          Wait for the sunrise and every
          thing will seem so clear! …

Part of Greenberg’s message – for both patient and therapist – seems to be, “Hang On In There!” Change comes for those who patiently can work together. 2

  1.   “challenge, and being well is being free to accept it or not at whatever level you are capable.”  [INPYRG, p.128]
              “half the delight in the world comes from challenges.” [AC, p.173]
  2.   Just several days before this presentation, I came across a long article about a research psychologist who had experienced definite episodes of schizophrenia. At the very end of the article, she is asked [by email] whether she has concerns about relapsing into severe emotional disturbance – and she answers in a manner that reflects my intuition about choosing those two songs:
     
    “… when I asked her [Nev Jones, PhD] about relapses, she said she had pretty much stopped worrying about getting sick again. She knew it could happen. But she   had become too busy to worry about relapses, and it was no use worrying anyway. ‘If your experience includes psychosis,' she wrote, ‘that becomes a part of who you are. It's now a core part of my identity. It has given me such a strong sense of purpose.’ 
    She doesn’t mind, for instance, that she still experiences some stretches and wrinkles in reality’s fabric. …
    ‘It's like a heightened form of what they tell you before your first violin recital,’ she told me. 
    ‘If you mess up, keep going. People are only going to notice if you stop playing.’ “

    Dobbs, David. “The Touch of Madness [about Nev Jones, PhD].” Pacific Standard. Nov 26, 2018; underscoring added; https://psmag.com/magazine/the-touch-of-madness-mental-health-schizophrenia 

    When on the edge of becoming overwhelmed by a challenge, “Keep Yourself Alive!” and “Hang On In There!”

  3. Note that Greenberg herself has viewed her characters as somewhat “alive”:

    "I don't believe we create our characters. I think they create themselves. Sure, they live through us, but they live. We can even create circumstances that shape their lives, but how they react to those circumstances is on them. It falls to us simply, to listen." Greenberg, Joanne. Facebook page. January 31, 2018.

    She also wrote at least two short stories about literary characters confronting their author. See “That Bitch” and “Hell Is a City Much Like Seville” – both being chapters in WTSQ.

    An interesting collection of reviews of Greenberg’s books – books that might be considered as more interesting than usual clinical “case histories” – has been published:
    “Joanne Greenberg”. “Critical Essays”. “ [“Last Updated on May 8, 2015, by eNotes Editorial.”]
    https://www.enotes.com/topics/joanne-greenberg/critical-essays/greenberg-joanne-goldenberg 

    It is one of these essayists who “criticizes” the author for her extreme “naturalistic” description – which is exactly how the genre of “human document” writings began in the late nineteenth century.
    For a more detailed discussion of the history behind these notions of  “human documents” and “living human documents” – which, in the early twentieth century, merged into the notion of “case histories,” see

    Powell, Robert Charles. Anton T. Boisen (1876-1965): Clinician: A Guide to Clinical Pastoral Assessment & Therapy. [to be published as a monograph]; “Part One,” section on, “So, What Are These ‘Living Human Documents’?”

  4. Powell, Robert Charles. Elwood Worcester and The Emmanuel Movement: Physician of the Whole Man, of the Soul as Well as of the Body. a 67-page booklet available on Amazon through Kindle e-books & through North Charleston, SC: Kindle Direct Publishing, August 2018.

  5. American Journal of Psychiatry 5:531-551, 1926.
    reprinted in American Journal of Psychiatry 151(6 Supplement):125-33, 1994.
    INPYRG, p.76.

  6. Powell, Robert Charles. “Anton T. Boisen's ‘Psychiatric Examination: Content of Thought’ (c.1925-31): An Attempt to Grasp the Meaning of Mental Disorder,” Psychiatry 40: 369-375, 1977; abstract on the internet at www.pubmed.gov.
    Noll, Richard. “Feeling and Smelling Psychosis: American Alienism, Psychiatry, Prodromes and the Limits of ‘Category Work’ .” History of Human Science 31(2):22-41, 2018, cites Powell and then notes that Boisen created one of the first forms for rating psychotic symptoms – thus helping to transform American psychiatry into a more scientific endeavor. 

  7.  Paulsen, Alice E. “Religious Healing: Preliminary Report,” J. Amer. Med. Ass. 86:1,519-1,524, 1,617-1,623, 1,692-1,697, 1926; also in Ment. Hyg. 10:541-593, 1926.

  8. Dunbar, H. Flanders. “Prospectus (being a statement of aim, scope, and work to date): Committee on Religion and Medicine,” Oct. 1931c, Hiltner Notebook, p.1; cited in Powell, Robert Charles, Healing and Wholeness …, 1974.

  9. INPYRG, p.175.

  10. Journal of Pastoral Care, 5(2), 1-11, 1951; INPYRG, p.277.

  11. Pastoral Psychology, 7(62), 44-46, 1956; JY, p.408.

  12. Akavia ben Mehalalel, Pirkei Avot (“Ethics of the Fathers”) 3:1.

  13. Topics #7, 8, 9, and 10 were inserted into the list after the presentation at the CPSP plenary in Denver – after I had finished reading and studying the 7 of Greenberg’s 19 books to which I had not yet gotten.

  14. Reading Greenberg’s writings can be quite an emotional experience. I recommend all her books. Several, however, did not just “touch” me; they “smacked” me. Those were AC, FSV, MWC, FP, and A.

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