The Rationalization of Suffering
Contrary narratives of emotional discontent interplay in complex ways.
By James Davies
When I was an undergraduate at the School of Oriental and African Studies in London, I was taught the secularization thesis. At the core of this thesis sits the idea that there has been a long-term decline in the power, popularity, and prestige of religious beliefs and rituals, brought about by modernization, or more specifically by individualism, diversity, and egalitarianism in the context of liberal democracy.1 While arresting my interest as an undergraduate, this theory was relegated in my thinking for many years, until recently, when I encountered certain problems during my work as a psychotherapist in the United Kingdom’s National Health Service. These problems returned the theory forcibly to mind. At first I thought they could be explained in terms of the secularization thesis I had earlier studied, but midway into my analysis I realized that the secularization thesis had led my analysis astray. Before I get to that theoretical discussion, let me describe the issues I encountered through two vignettes.
Vignette One. A woman walks into my consulting room for our first appointment. She is disheveled and seems not to have slept properly for days. Although not appearing inebriated, she has obviously been drinking recently, for she emits a powerful alcoholic odor. She shuffles to the chair opposite me, slumps down, and then declares through clenched teeth: “Where is my God now?” There is silence, so I inquire hesitantly, “Your God?” “The God who has forsaken me,” she says in mocking tones. “You feel he has left you in your hour of need?” I ask. “My year of need,” she cuts back. “Nothing can now help me but these pills they give me. The doctors told me I have manic depression, and that my brain is misfiring.” Her head droops for a moment, before snapping back up. “Do you know what that means?” I shake my head. “It means that either God created me to suffer, and that God is therefore cruel; or that there is no God. As I hate the idea of a cruel god, I have decided there is no God. There is just me, my pain, these pills, and now you. What the hell are you going to do to me?”
Two months later, and after eight sessions, my patient leaves therapy a confirmed atheist. I did nothing to aid the conversion. It started before we met, some 12 months previously, with her conversion to psychiatry, to a medicalized vision of her discontent.
Vignette Two. After the death of her husband, a patient suffers a grief so debilitating and protracted that she finally succumbs to her psychiatrist’s insistence that she take a course of antidepressants. After resisting his petitions for two months, she at last concedes and takes the pills. Two months later she no longer pines so deeply, nor weeps so profusely. But neither has her previous joy and vivacity returned. Her days are marked by a metallic emotional monotony. Six months later, and still in this state, she continues attending her local church but now feels that her relationship to God has altered, his presence feels remote, and she needs him less than before. At the same time her need for her psychiatrist increases. She seeks pharmacological rather than religious healing.
These two vignettes highlight a contrast. In the first vignette my patient’s suffering does not deepen her faith but obliterates it. As she believes Christianity failed her in her time of need, psychiatry becomes a replacement, which seems to her to better understand, manage, and respond to her suffering than her religious community could. She leaves, convinced that the Christian vision of suffering was more a consolation than a cure, and that in pills, not piety, resides her salvation.
In the second vignette, on the other hand, the patient’s Christianity lives on, but now with diminished authority in her life. While she still attends her local church, she only does so insipidly, more out of habit than out of conviction and hope. She has latticed her Christian identity with the identity of psychiatric patient, of a person harassed by biological misfortune, which the church is comparatively powerless to treat.
Both patients’ involvement in psychiatry appears to have changed their faith. For the first, religion is destroyed, for the second, it is weakened. These changes could be understood to be a result of the psychiatric understanding and management of their suffering, altering how these patients understood their emotional discontent. And this is how I initially viewed their changes in faith, an interpretation which seemed to me to endorse the secularization thesis: as the psychiatric vision increasingly colonized their outlook, their dependence upon the Christian vision decreased. This conclusion appeared compelling to me at the time, and it set me on a path to explore these visions more closely, focusing in particular upon the different presuppositions about emotional suffering underpinning the psychiatric and Christian responses to emotional distress. I was led to reflect that the psychiatric management of despair is premised upon a very different vision of suffering from that which Christianity traditionally professes. In short, psychiatry appeared largely to advance what I would call a “negative model of suffering,” while Christianity, in its more traditional forms, seemed to advance a “positive model of suffering.”2
The positive model holds that suffering can have a redemptive role to play in human life, that from affliction there can be derived some unexpected gain, new perspective, or beneficial alteration. If this vision of suffering could have its motto, Thomas Hardy captured it well in his poem In Tenebris II: “. . . if way to the Better there be, it exacts a full look at the Worst.” The positive vision, thus considered, sees suffering as a kind of liminal region through which we can pass from a worse to a better place. Or alternatively, suffering is a natural outcome of confronting certain unpleasant facts about the human and natural world, facts we may well need to confront if we are to live more firmly rooted in reality.
The negative model asserts quite the opposite view—namely, that little of value can come of suffering at all. It holds that there is no new vista or perspective to be gleaned at suffering’s end, nor any insights to be retrieved from its depths. Suffering is thus something to be either swiftly anesthetized or, better still, wholly eliminated, for what good is an experience whose most obvious features are pain and inconvenience?
The positive vision of suffering is at the heart of traditional Christianity. This can be illustrated by the Christian idea of spirit, which is traditionally understood in two generally accepted metaphysical senses: first, as describing an element of God which reaches down to the individual through expressions such as the Holy Spirit; and second, as an element of the individual which reaches up to God for the soul’s total purification. In either correspondence (from God to individual or from individual to God), suffering has been regularly acknowledged to play its part, as if very few “summers of divine communion” can be won without a preliminary season of struggle and sorrow. Martin Luther captured this idea well:
God works by contraries . . . a man feels himself to be lost in the very moment when he is on the point of being saved. When God is about to justify a man, he damns him. . . . God’s favor is so communicated in the form of wrath that it seems farthest when it is at hand. Man must first cry out that there is no health in him. He must be consumed with horror. This is the pain of purgatory. . . . In this disturbance salvation begins.3
Luther understands purgatory not as a geographical domain lodged between the earthly and heavenly realms, but as a stage or period of human life during which we become conscious of the flawed portions of our humanity—a stage which is inherently painful, because to overcome our defects we must first see them, and seeing them hurts. This idea also has prominence in the Gospel of John: “Bad men all hate the light and avoid it, for fear their practices should be shown up” (John 3:20). The insight John is offering is that the act of illumination is both a great and a terrible affair: great insofar as it dispels darkness and raises life onto its proper track, but terrible insofar as it asks that we undertake the awful act of apprehending what may be broken within us.
The idea that suffering is implicated in our moral or spiritual advancement—that passing through this inner confrontation, this fiery ordeal, or what Luther called this purgatory, will ultimately deepen our spiritual life—surfaces in Judeo-Christian literature of every sort. Psalm 119:71, for instance, articulates: “It has been very good for me that I was afflicted, that I might be well instructed, and learn thy holy laws.” We also read it in the great religious autobiographies of John Bunyan, Saint Augustine, and Leo Tolstoy, in the letters of Saint Catherine of Siena, and, more recently, in Mother Teresa’s correspondence documenting her extended “dark night of the soul.” It is enshrined in the poetry of William Blake, Saint John of the Cross, Saint Francis of Assisi, and Hildegard of Bingen. It is the primordial material for Dante’s Purgatorio, and finds outlet in Oscar Wilde’s De Profundis, the book heralding his late conversion to Roman Catholicism. It is present in the more religious psychologies of Carl Gustav Jung and William James—in Jung’s writings on the human shadow, and in James’s discussion of the “sick soul.” I offer this list not to impress readers with the authority of well-known names, but as a reminder that a great many Christian thinkers saw suffering either as marking the road to redemption or as a means to redemption itself, and in either case as a necessary and often unavoidable accompaniment of attaining the religious life.
By anesthetizing suffering by chemical means, the message is conveyed that suffering is an encumbering experience from which patients must be liberated.
The psychiatric management of suffering, on the other hand, is premised upon what I have called a negative model of suffering—a model which holds, in contradistinction to the positive model, that emotional suffering does not facilitate, but rather impedes human advancement. Much psychiatric thinking is rooted in the Enlightenment, that revolutionary movement which held that there are “eternal, timeless truths, identical in all the spheres of human activity—moral and political, social and economic, scientific and artistic; and there is only one way of recognizing them: by means of reason.”4 The law of reason—lex rationis—when expressed through observation, experiment, and scientific method, would reveal the world as a single system of interlinked laws that could be manipulated for the reform of human affairs. This vision was communicated by the eighteenth-century Encyclopedists and philosophes; it was expressed through the sociologies of Saint Simon, Auguste Comte, and, later, Émile Durkheim, and through the early psychology of Wilhelm Wundt; and it was given philosophical foundation by the Utilitarians, Jeremy Bentham, and later by the Viennese positivists. Through these and other influences, this vision came to play a decisive role in the legal, social, and technological organization of the modern world.
Although the Enlightenment removed many unnecessary hardships from human life, in its more reactionary determination to cast every kind of suffering in negative terms—even those kinds once seen as purposeful, ennobling, holy, or transformative—human distress began to be culturally imagined in a new way, without much positive association. One of the industries most influenced by the Enlightenment was biological psychiatry. Early in psychiatry’s history, all mental facts were conceptualized as reducible to biological facts, and therefore as amendable to scientific study. This reductive psychiatry was first developed by Emil Kraepelin in the early twentieth century, and remained unchallenged until the rise of psychoanalysis in the 1930s (which, incidentally, took a more positive vision of suffering, as can be seen in Sigmund Freud’s writings on anxiety, mourning, and obsessive behavior). Once the scientific credibility of psychoanalysis began to weaken in the 1970s, and once new developments in neurobiology helped smooth the way for the pharmacological revolution of the 1970s and the neurological revolution of the late 1980s and the 1990s, biogenetic psychiatry returned to prominence by the end of the twentieth century. For many psychiatrists, this was a welcome development, since it helped distance psychiatry from the less scientific discipline of psychoanalysis, while also bringing psychiatry back in line with the strong and respected physicalistic leaning of biomedicine. Suffering was now less a matter for psychoanalytic, moral, or spiritual solutions than it was for decisive diagnosis and pharmacological management.
Psychiatry has not completely ignored a psychosocial model of suffering. Indeed, its theory recognizes that predisposing, precipitating, and perpetuating causes of mental distress stem from a mixture of social, biological, and psychological factors. What I would like to stress is that while such holistic theoretical admissions are readily made, psychiatric treatment, has, in spite of them, increasingly privileged pharmacological treatments, such as antidepressants, in the last 20 years. This has led since the 1980s to a rapid decline in more exploratory treatments, such as psychotherapy.
To illustrate this point, the Medical Expenditure Panel Survey has shown that about 10 percent of Americans—or 27 million people—were taking antidepressants in 2005. Recent estimates now put this number at well over 30 million (about 13 to 15 percent of the U.S. population).5 This means that antidepressant usage has tripled in the United States since 1986, making antidepressants the most prescribed medication in the United States today (and the most prescribed medication in U.S. medical history). In Britain, the situation is comparable. The National Institute for Health and Clinical Excellence, for instance, has shown that antidepressant usage increased by 234 percent in the 10 years up to 2002. Indeed, there were 34 million prescriptions of anti-depressants in Britain in 2007 alone—a figure which may now have increased to about 40 million a year.6
These figures raise the question as to whether this surge in prescriptions is helping to spread the negative vision of suffering. After all, those prescribing chemical remedies are not responding to suffering as though it were a necessary call to change (and therefore as an experience whose message must be heard); nor are they responding to suffering as though it were the organism’s protest against harmful social or psychological conditions (and therefore as requiring a social or psychological rather than a chemical response); nor are they responding to suffering as though it were a natural accompaniment of spiritual preferment (and therefore as something which has vital lessons to teach). Rather, by anesthetizing suffering by chemical means, the message is conveyed that suffering is none of these things, but rather an encumbering experience from which patients must be liberated. Psychiatry may not advance its negative model of suffering as much by way of its theoretical pronouncements as it does by way of its clinical practices.
These reflections are, of course, pertinent to the two case studies with which I opened. I initially interpreted these cases as illustrating how processes of secularization can work on the ground, how a patient’s involvement in psychiatry may actually undermine her religiosity. I was led to ask: Are many other Christians taking these pills, and, if so, is their religiosity being similarly affected? Currently, there is no national statistical data to answer this question, but there is sufficient anecdotal and ethnographic data to convince us that such usage is now widespread. For instance, in a recent article for the Christian Broadcasting Network, titled “Prozac Christians: Has Jesus Been Replaced With a Substitute?” the journalist Jessica Dorian noted anecdotal evidence that nearly half the women in the congregation of the Southern Baptist church of her childhood were taking some form of antidepressant medication. Her further research revealed that such practices are not particular to this one church, but may be more representative. Similar trends have been noted by Christianity Today, which indicated in its cover package, “The Depression Epidemic,” published in March 2009, that antidepressants were being used by increasing numbers of Christians. In my own informal study conducted in a psychotherapy outpatient unit in the United Kingdom, 30 percent of Christians receiving psychological help were taking antidepressants, which actually exceeded usage among nonadherents (27 percent). Furthermore, if you type “depression and Christianity” into Google, of the 10 Christian articles that appear on the first page, eight acknowledge that antidepressants may improve emotional health.
In website after website, across Christian denominations—Roman Catholic, Baptist, Lutheran, and others—I encountered similar deference to the antidepressant revolution. Of course, this evidence is scattered and patchy, and to extrapolate far-reaching conclusions from it would be perilous. Nonetheless, the evidence that does exist forces us to accept that increasing numbers of Christians are taking antidepressants. In his book Seeing With New Eyes, David Powlison from Westminster Theological Seminary echoes this point:
The church typically lags a bit behind the culture’s way of thinking. But the ethos and practice of biopsychiatry are deeply affecting the church already. If it’s broken, or even just not working optimally, it can be fixed from the outside by a drug. . . . In your ministry and in your church you are probably already facing the ethos and the practices. Many people in both pew and pulpit are on mind-, mood-, and behavior-altering drugs. We all increasingly face the ideas and knowledge claims, too. The cover story in Time magazine informs the everyday queries and choices of Christian people.7
Given my discovery that the faith of others might be mitigated by psychiatry, as it had for my patients, it makes sense that I initially interpreted the rise of antidepressant usage as illustrating how abstract secularization forces actually operate on the ground and how a modernizing institution can erode religiosity by the administration of emotional technologies that manage human discontent in nonreligious ways. The equation was neat. This interpretation of the facts gave me a feeling of gratification that pleasantly anesthetized me for some days, until the anesthetic wore off and unease returned, bringing new questions: Had I omitted certain facts unknowingly to reach this neat equation? Or, worse still, had I simply brought to the case studies the secularization theory I had claimed to derive from them? These questions prompted me to revisit the case studies to ascertain whether I had overlooked any inconvenient facts, or whether divergent interpretations were actually possible.
For instance, I wondered whether the first patient’s rejection of religion was really caused by psychiatry, as I had originally supposed. Perhaps she had used psychiatry to complete a renunciation which had been germinating in her for years, long before her psychiatric treatment. Once I allowed this possibility, I was able to recall many other confessions she made during our work together: how her animosity toward religion had been long-standing; how she had been at odds with the rigid Catholicism her father professed; and how, most significantly, her diagnosis had brought her considerable relief because she could now tell her father that her suffering had a biological rather than a religious cause, and therefore the church was powerless to help her. In the light of these new facts, I wondered whether it was psychiatry that had curtailed her religiosity after all, or whether she had simply employed it to legitimate a renunciation she had long wanted to make. If this were so, then psychiatry could no longer be seen as the primary agent of secularization.
Surely it is the way a person lives and practices, or treats his neighbor or those in need, that is more expressive of religious living than the conventional markers of affiliation and action.
Another factor challenging the idea that “psychiatry always advances secularization” is that many of the websites I encountered did not see antidepressants as threatening Christianity (as I originally did), but rather as working in league with it, irrespective of how the psychiatric vision of suffering might be contrary to the Christian vision.9 These websites provide theological justifications, if ad hoc, for antidepressants being a manifestation of God’s love. Many Christian groups, it seems, are adapting to rather than attacking pharmacological remedies by rearticulating their understanding of medicine in terms that enable adherents to reconcile drug consumption with the religious way of life. Pills may mitigate suffering so prayer can be indulged; doctors can be consulted because medicine is part of God’s plan; drugs can enable the severely depressed to quit one’s bed and return to the pew. Many churches, therefore, seem to be transfiguring these pills into tools that keep church attendance alive, and do not see them as agents of secularization.
By removing the lens of the secularization theory, the facts reconfigured before my eyes. While it remained true to me to say that psychiatry and Christianity broadly presuppose different visions of suffering (the negative and positive, respectively), I came to see that the proliferation of psychiatric practices, which implies the negative vision, does not necessarily advance secularization. Since this new conclusion was contrary to the one I had initially made, I reflected upon whether the secularization theory had distorted my vision. I decided that it taught me to see a sacred world and a secular world and a continuum in between, along which people may travel back and forth, toward or away from the religious life, a religious life which is largely measured by these theorists in terms of religious attendance and engagement in regular prayer or meditation: the higher the attendance and prayer, the more religious the community or individual.
But this equation is grossly weakened as soon as we challenge the idea that practice and affiliation are the safest indexes of religious living. Such criteria, after all, cannot account for how a nonadherent may be, psychologically speaking, more religious than the devotee; or how a High Church Anglican may have more in common, spiritually, with an atheist than an evangelical; or how the so-called sacred may dwell in realms far beyond the precincts of traditional religious affiliation. The secularization theory taught me to see the world as far more dichotomous than it is, discouraging me to recall that what we profess no more indicates true religious living than does what we practice. Surely it is the way a person lives and practices, or treats his neighbor or those in need, that is more expressive of religious living than the conventional markers of affiliation and action. Practices and beliefs, after all, are not primary phenomena, but are rooted in social and psychological processes that may or may not have as their central aim the full realization of the religious life.
It seems that this thesis not only blinkered me to nuance and contradiction, but also led me to read the facts in such a way as to support a theory that may similarly mislead others. Such constrictions may not only misguide academic inquiry, but can foster divisiveness by misrepresenting social relations. The economist and philosopher Amartya Sen has spoken eloquently about the dangers of grand theoretical classifications—how by partitioning life into neat groupings (such as the West and the rest, the black and the white, the sacred and the secular), the world is carved into fragments with which people then identify, encouraging identity divisions in the popular imagination that can then be exploited politically.10
The secularization theorists themselves do not advocate such crude misuse of their formulations. But whenever we approach these categories as reflecting actualities of human life rather than as analytic concepts imposed upon the total context of experience, there is a high risk that we will be misled. I do not mean to argue that the secularization theory is “untrue,” but that it can guide interpretation in a one-sided direction. For while this theory can reveal a dimension of reality, it can at the same time conceal another (the very other that may greatly problematize the reality it takes as true). What needs to be addressed is not why the world falls neatly into the so-called sacred and secular domains, but why some scientists believe that it does and how these beliefs actually shape reality. This perspective demands that we see theories not as explanations, but as ideas which themselves need to be explained, having as they do genealogies and implications.
- I am indebted to Danny Yee for his succinct definition of the secularization thesis in his 2002 review of Steve Bruce’s God Is Dead: Secularization in the West (Wiley-Blackwell, 2002). See Yee’s website: dannyreviews.com/h/God_Dead.htmlv (accessed February 2010).
- When distinguishing negative and positive models of suffering, it is important to say I am contriving what Max Weber called “ideal types,” to which actual on-the-ground systems may more or less approximate.
- Roland H. Bainton, Here I Stand: A Life of Martin Luther (Abingdon-Cokesbury Press, 1950), 82–83; from Walther Koehler, Luthers 95 Thesen samt seinen Resolutionen . . . (J. C. Hinrichs, 1903).
- Isaiah Berlin, The Proper Study of Mankind: An Anthology of Essays (Farrar, Straus and Giroux, 2000), 334.
- Marie N. Stagnitti, Antidepressant Use in the U.S. Civilian Noninstitutionalized Population, 2002, Statistical Brief #77 (Agency for Healthcare Research and Quality, May 2005).
- National Institute for Health and Clinical Excellence, 2004; and Victoria Lambert, “Anti-depressants: Just How Safe Are They?” The Daily Telegraph (www.telegraph.co.uk), February 23, 2009.
- David Powlison, Seeing With New Eyes: Counseling and the Human Condition Through the Lens of Scripture (P & R Publishing, 2003), 243.
- See Francine Lorimer, “Using Emotion as a Form of Knowledge in a Psychiatric Fieldwork Setting,” in Emotions in the Field: The Psychology and Anthropology of Fieldwork Experience, ed. James Davies and Dimitrina Spencer (Stanford University Press, 2010).
- To give just two examples: In “Christians: Take Depression Seriously,” on Beliefnet.com, Tony Campolo states that relying on “faith alone . . . can do devastating harm”; antidepressants are sometimes needed. And, a disclaimer on the Christianity Oasis website’s entry on depression reads: “This study is not intended for those who need medical treatment to treat the depression which they experience. Even Jesus said some who are sick, need a physician”; www.christianityoasis.com.
- See Amartya Sen, Identity and Violence: The Illusion of Destiny (W. W. Norton, 2006).
James Davies, a senior lecturer in social anthropology and psychotherapy at Roehampton University in London, is the author of The Making of Psychotherapists: An Anthropological Analysis (2009), and author of the forthcoming book The Importance of Suffering (Routledge, 2011). He holds a DPhil from the Department of Social and Cultural Anthropology, Oxford University, and is a practicing psychotherapist (UK Council for Psychotherapy).