We take a preliminary look at ethics

Strange as it may seem, the original Greek word “ethos,” from which our word ethics is derived, is related to the barnyard. The word “ethos” can be traced back to the meaning of “stable” or the “stall” of barnyard animals, so that “ethics in the human area” does for us “what the stall would do for animals; namely, provide security and stability,” according to Paul Lehmann in his book Ethics In A Christian Context.1 Someone has said: “Everything has been said before. Our task is to think anew.” My indebtedness to other writers appears in a bibliography appended to this essay in order that my article on Ethics may deal ethically.

Ethics is the science that treats of morals and right conduct. Morals, the Latin equivalent of ethics, is from the plural noun “mores,” meaning customs, unwritten laws of conduct. What has ethics to do with psychiatry, which is an art and science?

We commonly speak of “the science of medicine,” of which “science” psychiatry is one division. Most scientists would assert that all sciences are anthropocentric. Nevertheless, in the science and art of medicine, from the earliest times of human history, the practice of medicine has had codes of ethics, written rules of right conduct and practice, which represent a strong theocentric element in medicine. The Hippocratic oath is an ethical code sworn to, in the name of pagan gods, by many generations of physicians on graduation from medical college. Even before that Grecian physician, Hippocrates, regarded as “the father of medicine,” and Aesculapius, the Roman god of medicine, there was the Babylonian code of Hammurabi which included ethical medical injunctions some nineteen hundred years before Christ.

Also written in the early years of humanity’s history were the five books of Moses, the Pentateuch, which, as well as being religious, include many medical, hygienic and psychologically ethical injunctions, including the Ten Commandments which form the basis of many codes of law on which our modern laws are based. Returning to today’s scene, the American Medical Association has its booklet: Principles of Medical Ethics.

Psychiatry, and psychiatric practice especially, is involved in ethics even more intimately than other branches of medicine. The very field of battle on which we daily conduct our campaigns of therapy with our patients, that realm we call the “psyche” or the “soul,” is the very ground that in earlier ages of therapy belonged to the priests.

To those of us in psychiatry whose heritage includes the Bible and faith in God, our psychotherapy often seems to enter that very soil where man and God seem to be in confrontation, and we feel in awe as if we must obey an ancient command uttered to a man Moses at a burning bush: “Draw not nigh hither; put on thy shoes from on thy feet, for the place whereon thou standest is holy ground” (Exodus 3:5).

Naturally, the many workers in psychiatry represent many life and world views, many ideologies Christian (which may at once be divided into Protestant and Roman Catholic); Jewish; other “faiths”; some who assert they have no faith or are agnostic or atheistic or pagan—psychiatrists do not all see the battleground in the same light, nor do they use the same techniques in helping their patients solve their problems and conflicts. But none of us can get away from the field of ethics. Jung could not, nor can J. Freud could not, nor can you. Psychiatry, especially on its ethical side (and that is what we are dealing with now), bristles with theological (or at least philosophical) implications, whether we like it or not. No therapist remains philosophically (or theologically) neutral.

Sigmund Freud and the battle of the giants for the conscience Sigmund Freud, during his lifetime, waged a tremendous conflict with his contemporary psychiatrists, his contemporary psychologists, the philosophers of his day and the theologians. His very nearest and dearest disciples left him, one after another. He was a giant in mental stature, a pioneer explorer in that land of mystery where the roots of the life of mankind have their centers: where the psyche of man (or, if you will accept the term, the very soul of man) has its being. Freud was invading the territory which ethics and philosophy and religion had staked out ages before Freud was ever heard of—when Freud, too, tried to answer that question posed by the Psalmist in Psalm 8: “What is man?”

I rank Freud as very important in the realm of ethics, not because I agree with his philosophical conclusions or the results of the ethical implications of his amazing world-shaking psychological researches, but because of the nature of the giants with whom he crossed swords in that field one would have thought at first had little to do with psychiatry as a pure science; namely, the realm of conscience.

Of course, we are all aware that Sigmund Freud stepped far outside his field, the field of psychiatry, in those more theoretically philosophical works, such as Moses and Monotheism, The Future Of An Illusion, and Totem and Taboo. Naturally, these serve as red flags would serve in a bull fight arena in which he was masochistically almost inviting attacks against his teachings from those who held other brands of ethics. Freud was very honest in his intentions. He was against religion. Freud made no secret of this. (Bib. 12) The fundamental tilting in the lists—Freud against religion; Moses, and a cloud of witnesses for religion—occurred in the tournament of the contest for the very life of the conscience, with Freud introducing his own secret weapon called the super-ego. In that spectacular contest Freud took on as opponents Moses and all the Old Testament, all previous life and world views based on the New Testament, the Greek tragedians, the church, and especially the “summa theologica” of Thomas Aquinas, as well as theologico-philosophical writings of minds such as Immanuel Kant, Martin Luther, and John Calvin. We cannot disregard the fact that Freud colors the views of ethics mightily today and is a figure to be reckoned with. l owe great recognition to Paul Lehmann’s work previously mentioned1 in this comparison of Freud with these giants.

Briefly, the Greek tragedians viewed conscience as a painful gift of the gods, born with (very soul, a fear-inspiring witness, an accuser from which man cannot escape; man’s private knowledge within himself by which he knows he is blameworthy, guilty. Let man but stray from the right and his conscience stabs him with pain. According to Greek tragedy, conscience is not a teacher of morals. “It is the bearer of ethical negation and futility.”1 With Thomas Aquinas “conscience is the bond between law and responsibility.” Man’s Con-Science becomes “the knower-with,” the mutual knower; it is that faculty in man by which man knows “with himself” that he has either chosen with natural law or against it, and with that choice goes corresponding approval and peace of mind, or uneasiness, condemnation, and guilt. It is achieved by man’s use of reason, judgment and freedom of choice.1

Man is able to make choices. Man can distinguish between good and evil if he will. Conscience is thus much like a divinely built-in device for spot-checking right from wrong in a world of natural law. Man can then choose the good or the bad. Thus writes Aquinas.

Immanuel Kant is “strikingly similar yet strangely different”1 from Aquinas. Man’s conscience is his consciousness of his own existence as “determinable only by laws which he gives to himself through reason.” Reason here is king. “The consciousness of an internal tribunal (a moral law in man), is conscience. It is not something which man himself makes. Kant almost identifies the voice of conscience with the voice of God.”1

Then came Sigmund Freud who sought to dethrone any such concept of conscience by means of his superego doctrine. Man becomes his own architect and builder of a super-ego, a sort of conscience, which guides and threatens him as did his parents or authority figures. The super-ego takes the parent’s place as censor, judge and condemnor. A neurotic manifestation results. Man dreads his super-ego or conscience.1

Man is aware of guilt feelings, of deserving punishment. I would say that he might cry, “Wretched man that I am” (Rom. 7:24), but he cannot add, “who shall deliver me from the body of this death?,” for he has no faith in the supernatural. There are no absolutes in that wilderness. Man feels helpless. The Freudian “do-it-yourself, you-built-it-yourself” type of super-ego is no greater than each human being himself.

Man lives in an environment of conscious decisions and choices. If that environment is one of a conscience machine, making man a robot; or if it is a voice of God, leaving man no choices, the emerging humanity of man dies a-borning, for man is dehumanized. If one makes the Freudian choice, he commits himself to the Freudian method of therapy, which is psychoanalysis, or at least commits himself to its philosophy, which is strictly humanistic, materialistic, and, in fact, anti-religious.

A Christian psychiatrist need not “soft-pedal” this fact. Sigmund Freud, himself, did not hesitate to state openly that his book The Future Of An Illusion proclaimed religion to be a neurosis-provoking illusion which had no future, would pass away. In a book Psychoanalysis and Faith12 a book which contains “The Letters of Sigmund Freud and Oskar Pfister,” pages 109–110, Freud writes to his friend, the Rev. Dr. Pfister, that the subject matter of the book soon to appear, (The Future Of An Illusion), is exactly his “completely negative attitude to religion, in any form and however attenuated.”

His friend, Dr. Pfister, answers Freud that as to his anti-religious pamphlet, “there is nothing new” to him in Freud’s “rejection of religion.” The letter relieves Freud’s mind very much, and he answers Pfister’s “magnanimity” and refers to his book as “my declaration of war” (pages 112, 113). On page 63 Freud refers to himself as “a completely godless Jew.”

Now it is true that Sigmund Freud is referred to as “the father of modern psychiatry” just as George Washington is called the father of our country. But we have progressed a long ways since Washington and the oxcart era, and new political voices have been raised since 1776. So also, new psychiatric theories have been advanced since Freud, and the psychiatric giants include a Carl Jung, Alfred Adler, Adolph Meyer, Harry Stack Sullivan, Carl Rogers, and others. True, practically none of these had any place for the Spirit, except Jung in his writings, especially in Modem Man In Search Of A Soul. But there is an earnest group of Christian psychiatrists today seeking to formulate a Christian approach to psychiatry through C.A.P.S., the Christian Association for Psychological Studies.

In the Freudian materialistic psychoanalytic treatment one comes to terms with the “ever-present threat of dehumanization aimed at the ego by the super-ego, by a therapy in which the ethical role and function of the conscience must be transformed into a psychoanalytic one. In this therapy the therapist illuminates the struggle, he highlights for his patient the conflict that patient is having between his own self-manufactured super-ego and his ego, with the idea of achieving and accommodation of his human psyche to his natural and social environment.”1 To paraphrase the Scriptures, it is a defiant, an exultant cry, like: “Oh, conscience, where is thy sting? Oh, super-ego, where is thy victory?” “I know you for what you are. I made you myself.”

In this therapy self-knowledge, when mature, is supposed to lead to serenity through a manageable reduction of the tensions which arise from involvement in the stresses and strains of living.1 It is as if the therapist is saying, “Accept the fact, oh patient, that your clinical material exposes a moral bondage upon all mankind from which there is no egress. Be content with the precarious tranquility of the measurably uninvolved life. The uneasy conscience cannot be put entirely at ease. Expose it for what it is (your own self-manufactured boogey man or slave driver), and you will thus subdue it.”

The rationale behind this is that man as a human organism, a unity, can exist and grow and he can manage his anxieties even in an environment of both good and evil. The patient will inevitably know both of these in his life. His super-ego must be subdued; the constricting walls of conscience will then fall through the patient’s rejection of the hostile conscience as demonstrated by the therapist as the patient becomes aware of the ethical impotence and uselessness of the conscience. But, without foundations which rest on God, this is almost sure to lead to ethical disintegration, and Freud had no place for God in his psychological system. But values are implicit in psychotherapy. The psychotherapist works toward moral goals.

One’s concept of the origin and the nature of the conscience is closely related to one’s concept of the origin and nature of anxiety and guilt. Freud (and especially his disciple Otto Hank) postulates that we have anxiety even before birth. Freud states: “We think it is the experience of birth…an experience which involves just such a concentration of painful feelings…(so that birth has) become a prototype for all occasions in which life is endangered, ever after to be reproduced again in us as the dreadful anxiety condition.”3

The condition bringing on the dread anxiety is as follows: the unborn child, after serenely floating for nine months in the amniotic fluid in the womb, its temperature controlled by thermostat of the mother, protected against all wounds by a fluid cushion, is suddenly subjected to being pushed through a narrow birth canal. The child is thus anxiously ushered into a world of anxiety, according to Freud. In fact, the word “anxiety” is from the Latin “anxietas” which means “narrow.” The word is rendered in the Greek by “angustus” which means “narrow”; in German it is “angst” which refers to “narrowness,” and in the Dutch is rendered by “benaauwd.” The word “naauw” is “narrow” and “bennauwd” is “to be narrowed down,” or, as we say in English slang, “to be pushed through a knothole.”

Freud arrived at this fantastic idea “that birth is the source and prototype of the anxiety” when he was a young house physician. He heard another young intern ridicule an answer a midwife had given in an examination when she was asked as to the significance of the fact that meconium (that is, the unborn child’s excreta), at times was present in the waters at birth; to which this midwife candidate replied, “It means that the child is frightened.” The other intern ridiculed this. Freud took her part and felt that this poor, unsophisticated woman’s “unerring perception” had revealed a very important connection.

A Christian concept of anxiety, guilt, and conscience

Be that as it may, we as Christians must disagree with this explanation of the birth-canal being the origin of all anxiety and that the birth experience is the prototype of all anxiety manifestations. Man did not come into this world first of all through the birth canal but through a creative act of God. He did not appear on this globe as a babe but as a fully formed perfect adult; “male and female made He them,” perfect in knowledge, righteousness, and holiness. Man was made in the image of God in adult form; it was in the Garden of Eden setting that anxiety first was born. Man as first created was devoid of pathological anxiety until the fall. Anxiety was born as a result of disobedience to God.

The prototype of all anxiety, the prototype of guilt and the sense of guilt is to be found in Eden. Anxiety, and especially that form of anxiety which is moral anxiety (which is guilt), is the inevitable consequence of original sin and later personal sin. It is only then that man hides himself from the presence of the Lord God among the trees of the garden and must be sought out with the question, “Where art thou?” It is only then that man first says, “I was afraid; I was naked; I hid myself.”

Guilt in this sense becomes something almost measurable, something almost quantitative. Guilt is the separation from God that occurs as a result of sin. It is so profound a disturbance of the relationship of the individual to God, his creator, that man is intensely aware of it. It is this awareness that is the sense of guilt. The sense of guilt must be sharply differentiated from guilt itself. The sense of guilt is an affect, is a feeling, is an awareness laden with anxiety of the deepest nature; whereas guilt is a measurable, objective something as real as the writing of an indictment on a page, which can be wiped out only by a divine Judge through expiation, confession, restitution and divine grace. Even punishment cannot remove guilt.

The sense of guilt is accompanied by a sense of an impending penalty and with it a knowledge of the justness of this transaction. Not all men have this sense of guilt to the same degree, nor fear the penalty to the same degree. Nevertheless, unless the guilt-laden sinner will find peace by dealing with God, there are few in whom the results do not somehow come out in the form of some psychological complex as anxiety and fear and remorse and despair and depression. Simply re-repressing the guilt may still the uneasy conscience and bring about a false peace and get the genie back into the bottle from which it was escaping so menacingly after years of being held a captive in the unconscious, but it is still there, to be dealt with some day. Leaving God out, as the “superego” concept does, and as modern “psychology without a soul” does, cannot deal adequately with guilt. We cannot equate the super-ego with conscience, for the two arc not identical. Conscience is a far greater and broader concept than is Freud’s super-ego.

Calvin on the conscience

John Calvin5 in his Institutes makes a distinction between two “worlds” of conscience. The reference is  to be found in Calvin’s Institutes, Book Ill, Chapter XIX, paragraph XV, where Calvin says concerning conscience: “Man is under two kinds of government…one spiritual, by which conscience is formed to piety and the service of God; the other political (or we might say, social, S.B.) by which a man is instructed in the duties of humanity and civility, which are to be observed in his intercourse (or relations), with mankind….The former species of government (the spiritual) pertains to the life of the soul, and the latter relates to the concerns of the present state (including such things as), clothing, enactment of laws to regulate man’s life among his neighbors by the rules of holiness, integrity and sobriety. For the former (the spiritual) has its seat in the interior of the mind, while the latter (the political or social) only directs the conduct. One may be termed a spiritual kingdom, and the other a political one.

“For man contains as it were two worlds, capable of being governed by various rules and various laws….These two always require to be considered separately, and while the one is under discussion, the mind must be abstracted from all consideration of the other” (Calvin). (The Apostle Paul is perhaps speaking similarly in Romans 7:19–24.)

It will be of use first to know what conscience is. The definition of it must be derived from the etymology of the word “conscience.” Calvin goes on to say that the “science” part of the word conscience is “to know, to have knowledge.” The “con” part means “with” or “in addition to.” “Their conscience bearing witness therewith, and their thoughts one with another accusing or else excusing them” (Rom. 2:15, 16).

“So, when they (that is sinful men, S.B.) have a sense of divine justice, as an additional tribunal of the supreme judge, that sense is called conscientia, conscience. For it is a kind of medium between God and man; because it does not suffer a man to suppress what he knows within himself, but pursues him until it brings him to conviction” (Calvin).

Modern psychiatry and modem determinism in education based on behaviorism, holds to the mechanistic view that each present psychological event is the inevitable result of some preceding act or event to which the person is conditioned, the result being an almost cause-and-effect relationship. The adult is almost a complicated robot fashioned by the child he used to be. We do not believe this is a true evaluation of man. It is the spiritual core of man that directed his personality development, often imperfectly and erroneously and even hostile to God in the natural man; more wholesomely and morally in God’s children, who in addition have the Spirit of God in a special sense, these often being very early conscious of a God-centered direction in life.

These have a consciousness, as the Heidelberg Catechism expresses it, that with body, mind and soul they are not their own but belong to their faithful Saviour, Jesus Christ. The very hairs of their head are numbered. “I will teach thee and guide thee with mine eye” God tells them in Psalm 32:8.

Likewise, there can scarcely be any doubt that all men after Adam and Eve’s fall go through the enrichment and broadening and natural development of their conscience, for we come into the world as babes. We, unlike our primal parents, Adam and Eve, have been born as babes through a birth canal and from birth onward we have had to have the bombardment of the drives and the instincts of the natural man. All our maturing years and our adult years we have exhibited our proneness toward that which is against God, our incapability of ourselves doing any spiritual good, our total depravity and our proneness toward all evil. It is only as God works in us that these things change. God does not operate the same way in all men.

The development of this conscience, this moral censor organ within us, no doubt depended on the moral counsels of our father and mother, our teachers, our preachers, the sermons we heard, the Bible we read, and was opposed by all the evil things we have seen in life, the pornography and salacious literature and lascivious images. We thus further developed, just as a result of living in this world, this internalized code of morals. But again we maintain that this development was directed by a spirit in man and the Divine Spirit.

(Conclusion in next issue)

BIBLIOGRAPHY

1. Ethics In A Christian Context, hy Paul Lehmann. Harper & Row, publishers, 1963. Address; 49 E. 33rd Street, New York 16, New York.

2. MoroIs Medicine, by Joseph Fleteher, Professor of Pastoral Theology and Christian Ethics, Episcopal Theological School in Cambridge, Mass. The Princeton University Press, Publishers, 1954. Address: Princeton, New Jersey.

3. A General Introduction to Psychoanalysis by Sigmund Freud, page 344.

4. A Commentary of the Old, by Jamieson, Faussett and Brown, Vol. VI, page 234 under verse 23, regarding “different” law.

5. Calvin’s Institutes, Book III, Chapter XIX, paragraph XV.

6. Proceedings of the Colloquium on Medical Ethics, The Lutheran Academy for Scholarship, 801 De Mun Avenue, St. Louis 5, Missouri.

7. The Ethical Basis of Medical Practice, by Willard L. Sperry. Paul B. Hoeber, Inc., c/o Harper & Brothers, 49 E. 33rd St ., New York 16, N. Y.

8. Principles of Medical Ethics. The American Medical Association, 535 North Dearborn 51., Chicago, Illinois 60610.

9. Christianity Today, Volume X, Number I, pp. 19–23, October 8, 1965. Article “Have Psychiatry and Religion Reached a Truce?” by Orville S. Walters, psychiatrist, Ph.D., M.D.

10. Christianity Today, July 2, 1965, page (1015)3–(1018)6 —“Psychotherapy and Spiritual Values,” panel discussion.

11. Cruden’s Concordance, Alexander Cruden, M.S. See under “Conscience.”

12. Quotations from Psychoanalysis and Faith, The Letter.; of Sigmund Freud and Oskar Pfister, translated by Eric Mosbacher, Basic Books, Inc., Publishers, New York, 1963. pp. 109–110; 112–113; p. 63.

13. Foundations for Reconstruction, by Elton Trueblood. Chapter XI, pp. 66–69 ( Revised Edition ) 1961. Harper & Brothers, Publishers, New York.

Dr. Stuart Bergsma, chief of staff at Pine Rest Christian Hospital and thoroughly at home in both medicine and psychiatry because of his rigid training and large experience, is eminently capable of presenting a Christian confrontation to his field and the problems which must be met there. He focuses the reader’s attention especially on “conscience” and the related issues of anxiety and guilt.