The Helen Flanders Dunbar (1902-59) Memorial Lecture on Psychosomatic Medicine and Pastoral Care
delivered 11/2/99, at Columbia Presbyterian Center of the
New York Presbyterian Hospital, New York, New York
ROBERT CHARLES POWELL, MD, PHD
ABSTRACT: This essay aims to stimulate rethinking about religious and medical "healing and wholeness." While psychiatrist (Helen) Flanders Dunbar is well known as a psychosomatic investigator and as "Medical Director" of the Council for Clinical Training, the initial home of Anton Boisen's ground-breaking movement for the clinical pastoral education of institutional chaplains and parish ministers, she is less appreciated as a theologically-trained scholar. This essay explores an earlier eras understanding of the "spiritual" and the more "soulful" components of healing and how Dunbar combined these to focus on helping all peoples become "free to think and act."
"a magnetic, charismatic woman, with . . .
an almost magical gift
of insight and intuition."1
Now is the time -- no, it is long past time -- to begin honoring Helen Flanders Dunbar, BD, MD, PhD, MedSciD, psychoanalyst and Dantean scholar, for her contributions to religion as well as to medicine.2 As the practical theoretician, loving friend, and guiding force behind the Rev.Mr. Anton Theophilus Boisens ground-breaking movement for the clinical pastoral education of institutional chaplains and parish ministers, she was brilliant, realistic, and sincere. Just as Boisens work focused on breaking "an opening in the wall which separated religion and medicine," Dunbars work focused on that broad area of healing and wholeness, where religion and medicine overlap.3
This memorial lecture can be seen as honoring the 70th anniversary of Dunbars first treatise, Symbolism in Medieval Thought . . ., which set the tone for all her subsequent work.4 It can be seen as honoring the 65th anniversary of her most beautiful and beguiling article, "What Happens at Lourdes? Psychic Forces in Health and Disease."5 It can be seen as honoring the 60th anniversary of her founding of the journal, Psychosomatic Medicine, and its associated society.6 It can be seen as honoring the 50th anniversary of Your Childs Mind and Body: A Practical Guide for Parents, the sequel to her best-seller, Mind and Body . . . .7 It can be seen as honoring the 45th anniversary of the fourth and final edition of Emotions and Bodily Changes . . . , which launched the mind-body movement.8 It can be seen as honoring the 40th anniversary of Psychiatry in the Medical Specialties, which was accepted for publication on the day of her death.9 From these standpoints and many others, "The Helen Flanders Dunbar Memorial Lecture" can be seen as an occasion well overdue.
Dunbar considered becoming "free to think and act" -- she underscored the word "free" -- as a basic goal for all those seeking help.10 It was her admonition to physicians and ministers trying to heal as well as to patients and parishioners hoping to be healed. She held that becoming "free to think and act" was an accomplishment open to all -- one that could also be achieved by parents, then taught to children, heading off future problems.11 In various forms, this liberating sentiment -- becoming "free to think and act" echoed throughout the era between the two world wars. In this essay I will lead you to explore the spiritual and the more soulful components of this admonition, how Columbia Presbyterian Hospital first became a font of knowledge on mind-body interactions, and how Flanders Dunbar became central to this ground-breaking enterprise, on both the religious and the medical sides. As a nonseminarian physician, I can only observe and hypothesize about theological matters, but I hope to stimulate your rethinking of what you thought you knew about religious and medical healing and wholeness.
While the era opened with much confusion about healing efforts within the church, this quickly evolved into an implied distinction between what I will call
(a) the "spiritual" [see definition below] and
(b) the more "soulful" [see definition below] elements involved
as well as an implied distinction between
(a) the remedial stance of curing illness and
(b) the more preventive stance of maintaining health. 12
As Dunbar saw it, "The priest . . . speaks first of goal" -- the spiritual, that which maintains health and wholeness -- and "brings promise of external assistance." In contrast, without promising any such "reinforcing of strength," the general physician tries to set the soul at ease by removing "objects in the patients path," and the trained psychiatrist focuses on "straightening out . . . disharmony" in the patients path itself.13 Religion alone, she suggested, could add spiritual confidence -- "The Lord is my shepherd!" -- "Shema Israel!" -- to the soulful contentment and quiet that either religion or medicine might achieve. Clergy and physicians both could focus more on the present as it unfolds into the future -- prevention, and less on the past -- the etiology of an illness or disease. Together, the psychiatrist, the physician, and the pastor might guide the person seeking help toward becoming emotionally, soulfully, and spiritually free to think and act.
Mrs. Ethel Phelps Stokes Hoyt, an intelligent, energetic laywoman, who wrote a remarkable little book called Spirit: A Study in the Relation of Religion to Health, and whose husband, industrialist John Sherman Hoyt, served on the Board of Columbia Presbyterian Medical Center, contributed greatly in the clarification of these issues.14 As early as 1923 she asked, "Will not those Churches which are interested in Spiritual Healing help the Cause more at present by emphasizing the Power of the Spirit in maintaining Health and Abundance of Life, rather than by putting the emphasis on 'Curing disease'?"15 On March 8 of that year she and her husband gathered "a small group of physicians and clergymen"
(a) to discuss "the possibility of better cooperation between Religion and Medicine in maintaining health and curing disease,"
(b) "to study the basic factors, physiological, mental, and spiritual, underlying the various healing cults," and
(c) "to strengthen the work of those groups which were earnestly seeking scientific guidance."16
As the Rev.Dr. Harry Emerson Fosdick is said to have phrased it at that meeting, "modern ministers are approaching this problem [of healing] in a scientific manner, trying to interpret spiritual laws with the same scientific spirit with which . . . doctors are working to interpret physical laws. We must work scientifically from both sides until the tunnel joins." Just as pastors might be taught a more careful, rigorous, clinical approach, it was suggested that physicians might be taught how to "rekindle latent faith in Patients." Overall, the controversies over religious healing were seen as an unfortunate stumbling block and as "only a small part of the greater problem of [obtaining] 'The Cooperation of the Church & the Medical Profession'."17 Mrs. Hoyt encouraged both sides to see that "the Church can do more in preventive & educational than in curative work" and that putting more emphasis on "religion as an aid in maintaining health" would make it "far easier for doctors and clergy to get together."18
This "small group of physicians and clergymen," which eventually developed into the "Joint Committee on Religion and Medicine of the Federal Council of Churches of Christ in America and the New York Academy of Medicine," initially focused on the role of "spirit," only later getting around to recognizing the role of "soul." One of Mrs. Hoyt's close friends at the Academy spoke of "a veritable and potent force in these specific emotional states associated with religious experience," and of "the importance that its use in modifying bodily functions be intelligently guided."19 The medical chair of the Joint Committee spoke of "Expectant emotion" as favoring "'the healing power of Nature'."20 Mrs. Hoyt's notes for a presentation quote a Professor Pupin's view of the role of "Purpose" and "Partnership" as "Stimulants" as well as of "Symbols" as "Tonics"; the general thesis asserted that "the symbolism of faith and purpose may arouse latent possibilities of power."21 The Joint Commission on Christian Healing in the Episcopal Church, of which Dunbar became one of the thirteen members, no doubt through the intercession of Mrs. Hoyt, similarly declared that "Effective prayer has the effect of a potent tonic; it vitalizes and energizes the whole personality of man."22 That is, as the Joint Committee was being organized, the original emphasis was upon the more dynamic role of inspiring and inspiriting in the encouragement of health.23
Once the Federal Council's "Subcommittee on the Relation of Religion to Health" had decided to join forces with the Academy's "Subcommittee on Religious Healing," the Joint Committee then found it hard to find "a clergyman with special interest in this field whose main emphasis in religious therapy was distinctly religious and not some form of amateur psychiatry."24 The irony, of course, is that what they did find was an unordained woman who was trained as a psychiatrist. As their official history tells the story: "In 1929 the [Joint] Committee became interested in Dr. Helen Flanders Dunbar, who had been working in the field of psychosomatic relationships for five years, first as a part of her studies for the degree of Doctor of Philosophy at Columbia University, then in connection with her Bachelor of Divinity degree from Union Theological Seminary and her . . . [Doctor of Medicine degree from] the Yale University School of Medicine."25 Now, it just happens that Dunbar had attended Brearley School and Bryn Mawr College with one of Mrs. Hoyt's daughters, and that both Dunbar's parish priest and one of her seminary professors were members of the Joint Committee.26 Returning now to their own narrative, "While she was continuing her work in Europe [in 1930, as her fourth year of medical school] she undertook to make certain studies at Lourdes and other healing centers for the [Joint] Committee [returning to Lourdes in 1933, again on behalf of the Joint Committee]."27 Let me interrupt again to note that, upon returning from Europe, she promptly became, in September 1930, "Medical Director," and later, "Executive Director," of the "Council for the Clinical Training of Theological Students," the program in pastoral education founded by her teacher, friend, and colleague, the Rev.Mr.Anton Theophilus Boisen. I should add that while Boisen was organizing his pastoral education program in the late 1920s, Mrs. Hoyt was attempting to place "certain Seminary students from Union [Theological]," where Boisen had trained and Dunbar was training, "at Stockbridge," that is, at the Austen Riggs Foundation, a private psychiatric hospital in Massachusetts.28 In addition, she was trying to get "the Human Welfare Group at Yale," where Dunbar was also studying, commuting between New York and New Haven, pulled in with the Academy of Medicine and the Federal Council of Churches as a third constituent of the Joint Committee.29 Returning again to the Joint Committee's own narrative, "In April, 1931, a year after her return, she [, Dunbar,] was appointed Director of the [Joint] Committee's work on a part-time basis."30 Actually she had already, during the opening months of 1931, been supervising the Joint Committee's preliminary "Study Project in Religious Healing" along side her own research on "physiological changes accompanying emotions."31 During the year between her studies in Europe, where she audited lectures at Vienna's Psychiatric-Neurological Hospital while serving as "Assistant" at Zurich's Burgholzli Clinic, meeting with Carl Jung nine times, and her assuming the leadership of both the Council for Clinical Training and the Joint Committee, Dunbar completed an internship in medicine, arranged by Mrs. Hoyt through the help of her husband and others, at Columbia Presbyterian.32
So who was this amazing "Dr. Helen Flanders Dunbar," who earned two bachelor's degrees and ultimately three doctorates by her mid thirties? To begin with, she was someone who agreed with the Joint Committee's initial assumption about the preeminent role of stimulating the "spirit" in helping to maintain health. An early manuscript of hers speaks of religion as "giving man power for the accomplishment of his ideals," and she certainly managed to accomplish more of her ideals than the average mortal.33 There is no doubt, however, that she understood even this simple sentiment as having more complexity than the average Joint Committee member could have grasped. Every aspect of Dunbar's history thus far touched has turned out to be quite complex, and we await additional insights gleaned from materials gathered by her daughter and the Rev.Dr. Allison Stokes.34
Thirty years ago I wrote, "Dunbar was a physician. She was also a woman with a mission . . . and with a mask, a persona progressively concealing her person."35 Five years later I wrote, "Who was Dunbar? That is a question even her closest colleagues asked and could not answer. No one knew . . . . [One] close associate has commented that 'after more than a generation of reflection,' Dunbar still remained to him basically an enigma. Some colleagues recall, without being able to account for it, the 'sense of mission' with which she inspired them, while others recall little but enmity toward her for reasons equally obscure."36
In brief, Dunbar was born in Chicago to an electrical engineer/ mathematician/ patent expert and to an ardent feminist/ translator/ genealogist. Her father withdrew and retired at age forty-six, moving Helen and her younger brother back to the ancestral territory near Manchester, Vermont, where Helen's overprotective mother, her strong-willed maternal maiden aunt, and her deeply religious grandmother, set the tone. Dunbar grew up more at home with books than with people. Following an erratic early education peppered with tutors, she studied at Brearley and Bryn Mawr with mother and brother in tow. During her years at Bryn Mawr, the then shy, unsophisticated Dunbar came under the influence of her maternal uncle's wife, who taught her the basic social graces and made it a point to introduce her to those listed in the New York Social Register, of Professor James Henry Leuba, a psychologist of religion, who proposed systematic "collaboration of religious idealism with science," and of the writings of fourteenth century poet, Dante Aligheri, who argued that religion and science were not antagonistic but complementary.37 Dunbar's first doctoral thesis took Dante's notion of complementarity entirely seriously, seeing his Divine Comedy -- and the world -- as interpretable "at one and the same time on different levels," these interpretations being "so closely interrelated that each is corrected by the other and that all are blended into an harmonious whole."38 This Dantean viewpoint, embracing multiple, simultaneous, complementary interpretations, was to guide Dunbar's intertwined medical/religious approach to the study of emotions and bodily changes.
So, Dunbar, finally graduating from her simultaneous enrollments at Union, Columbia, and Yale, became Director of the Joint Committee on Religion and Medicine in April 1931, but the committee itself had studied widely, spending eight years refining and expanding its grasp of the "religious healing" problem. The original meeting at the Hoyts' in 1923 had included plans for "Rest and Convalescent Homes," where "tired people" could go for "physical re-creation, mental re-education, and spiritual re-generation."39 While the Joint Committee did not take any such homes under its wing, leaving their private establishment to Mrs.Hoyt and her friends, it did endorse the idea of such so-called "preventoria."40 Similarly, Mrs. Hoyt's above cited notes for a presentation also quote a Professor Pupin's view of the role of "Peace" and "Trust" in providing "Sedative " effects as well as of "Faith" in providing a "Stabilizer" effect.41 The Joint Committee was beginning to recognize that, beyond examining the more dynamic inspiriting, stimulating "motives which will make life worth living," it needed to examine the more holistic, organismic rest, repose, and calming which go toward "modifying the fears" associated as either cause or effect of most illness or disease.42
The Joint Committee commissioned a research psychologist, Alice E. Paulsen, PhD, to review the principles apparently operant in contemporary religious healing. Her original outline noted, among the "Techniques for making faith more effective," the "reinforcement of rest and relaxation through prayer, meditation, suggestion, and visualization."43 Her final report gave considerable space to the work of the Rev.Dr. William Thomas Walsh, who in early 1931 had worked on the wards under Dunbar's supervision.44 Walsh, Paulsen noted, "states that there is in the Bible abundant evidence of a very definite technic of healing used by Jesus," which was, in essence, creating the conditions that make rapport possible.45 Walsh saw prayer as "the means of getting yourself into the state where you can receive God," and he believed in working hand-in-hand with a patient's physician "in order to get the conditions requisite to the working of divine power."46 In the conclusion of her formal report, endorsed and disseminated widely by the Joint Committee, Dr. Paulsen noted that "Each [healing] system in some way introduces the idea of cure or health after preparing the mind through one means or another [-- generally, "rest and relaxation" --] to accept it . . . ."47 With this study in hand, about one year before Dunbar assumed control, the Joint Committee "proposed that a study shall be made . . . not only of the more specific treatment of disease by spiritual means, but of the therapeutic values of the various forms of worship -- liturgy and hymnody, the exercise of private devotions and the contemplation of religious symbols and architecture."48 The die was set that they would study both spiritual stimulation and soulful repose.
Once Dunbar was officially in charge, she conducted, with four clergymen, "a preliminary study at Presbyterian Hospital, purely empirical in nature, based on the hypothesis that exposure to religion might prove valuable to the patient. . . ."49 The only restriction the Joint Committee placed upon her work was "that it should be carried on, as hitherto, without publicity of any kind."50 Whereas "isolated cases," primarily patients with cardiac and ulcer problems had been used earlier that year in her observations of the effects of the more soulful, rapport enhancing ministrations by the Rev.Dr. Walsh, Dunbar now proceeded systematically, adding, for what she and others thought would be a control group, "certain types of surgical patients, particularly those who are confined in hospitals for long periods of time, such as [patients with] fractures of the head of the femur."51 The patients were divided "into two groups of a more or less similar type, the one to be treated in the usual [medical] way, and the other with the aid of a clergyman's ministrations."52 Her plan was to determine "what contribution, if any, the stimulation of religious faith might make in . . . . [the] 62 patients treated simultaneously by clergymen and physicians."53 Those assigned to the clergy were seen an average of eight times, and one of the ministers involved suggested that while his inspiriting ministrations produced "no change in the process of getting well," they caused "an extraordinary acceleration of the process."54 Dunbar herself concluded that the clinical investigation of the effects of religious emotion, whether quieting, as in the first study, or invigorating, as in the second study, "was too complex for the present state of our knowledge," and that any further study "should be given background and perspective by a bibliographic survey."55
In October 1931, Dunbar defined the aim henceforth of the Joint Committee. Whereas a draft forwarded to her suggested that the aim should be to determine "what contribution, if any, religious faith can make in the maintenance of health and the healing of disease" and "under what conditions cooperation between physicians and clergymen may be effectively carried on," she broadened yet focused the scope as follows: "This committee proposes to investigate the border territory between religion and medicine, in other words, to study the problem resulting from the dichotomy of psyche and soma [,] with a view to a better understanding of the integrating forces and of the psycho physiological organism as a whole."56 The original draft supplied to Dunbar suggested that the committee focus on what unique contribution the minister may "contribute as a clergyman," as one "who believes that through religious faith we are brought into contact with cosmic forces . . . , and who uses his contact with the patient to induce in him an attitude which may make the resources of this faith available."57 Dunbar, rephrasing this in her even more poetic language, proposed that they try "to distinguish by careful experiment and observation" the "influence of a personality, of an atmosphere, of a symbol," on "restoring, mobilizing, or accelerating the healing processes as we know them," and specifically the influence of these on "reinforcing . . . that most indispensable and unaccountable of all our therapeutic resources"[:] "rest itself."58 Thus, again, the juxtaposition -- albeit this time, via Dunbar, more of a melding -- of the invigorating and the calming, the spiritual and the soulful.
"While the primary purpose of our Committee," suggested the draft, "is research, its ultimate purpose is education."59 Dunbar herself further asserted that progress required "both research in the sphere of relationship of psyche and body and actual experiment in cooperation between physicians and clergymen."60 Thus Dunbar's roles, as director of what she now called "psychosomatic research" at Columbia Presbyterian and as medical director of the Council for the Clinical Training of Theological Students, were subsumed under her directorship of the Joint Committee on Religion and Medicine.
The two divisions of the Joint Committee -- research and education -- were held together by Dunbar's overarching Dantean vision. In the opening pages of her first doctoral thesis, the magisterial Symbolism in Medieval Thought . . . (1929), she suggested that "nothing is more needed by the student of disorders of the human mind" -- that is, the psychiatrist -- "than a thorough study of the development of insight symbolism."61 By "insight symbol" Dunbar meant those special symbols -- almost "alive" -- which invite "continual re-creation and expansion" of meanings, in which "all meanings are true" and "are often all intended at once" -- reaching "out toward the supersensible," toward "a reality . . . greater and truer than the symbol in all its aspects."62 She considered such symbols as mediators between a person's inner and outer worlds, both physical and psychological.63 In a letter dated September 21, 1929, she confirmed that she was, indeed, "writing the thing [, a new version of her dissertation,] in psychiatric terms."64 This, I asserted thirty years ago, essentially became "Part One" of Emotions and Bodily Changes . . . (1935), the book whose publication was arranged by the Joint Committee and that essentially launched the American psychosomatic movement.65 "Part One" can, indeed, be seen as addressing the object of symbolism; in medical/psychiatric terms, Dunbar called this the "working out of the individual's relationship to his [or her] particular environment and personal problems"; in religious terms, invoking Dante, she called this the working out of the individual's "adjustment to the Infinite."66 While "Part One" of her first psychiatric classic thus constitutes a carefully albeit subtly argued treatise on "the organism as a whole" -- the mind-body functioning as a symbol -- and "Part Two" is straightforwardly a bibliography, a ". . . Survey of Literature on Psychosomatic Interrelationships: 1910-1933," as the book's subtitle declared, "Part Three," mentioned frequently in the Joint Committee's minutes as a bibliography on "the relation of religion to health," as "a factor in directing and controlling emotion," did not appear.67
As early as 1931 and as late as May 1934, two of Dunbar's secretaries were working on "the religious section of the bibliographical survey," and the Joint Committee employed the Rev.Dr. John W. Suter, a board member of the Council for Clinical Training, to produce the final manuscript, but "Part Three" never saw the light of day.68 As I have discussed in greater detail elsewhere, the missing religious, symbolistic part did appear later, in essence, as a volume by Boisen's successor at Worcester State Hospital, the Rev.Dr. Carrol A. Wise.69 When Emotions and Bodily Changes appeared in print in June 1935, hardly one word concerned religion.70 The following November, Dunbar reported to the Joint Committee her conclusion that "Religion itself, no matter how understood, is not a common element" in most "religious healing," and that religion, "So far as we have been able to determine," "is not essential to the healer, to the patient, nor to the setting."71 Nonetheless, she noted that "through the Council [for Clinical Training,] and through our clinical research projects we are accumulating relevant data" concerning "how religion fits into the psychosomatic regime . . . ."72
Let me emphasize, at this point, that while Mrs. Hoyt, understandably, became as furious as such a genteel woman could upon digesting Dunbar's conclusion that religion was not essential to religious healing, we should not assume that Dunbar meant her conclusion in any negative way. Even the Rev.Dr. Edward E. Thornton, an earlier historian of the clinical pastoral education movement, who, overall, certainly does not idolize Dunbar, nonetheless notes his findings that those working side-by-side with Dunbar "were loyal to her because of her intense commitment to the cause of relating the clergy to physicians in a constructive way and because of her genuine religious interest."73
Dunbar's religious -- or, perhaps, Dantean -- interest showed itself in a most peculiar way in late 1935. Mrs. Hoyt circulated a letter suggesting that, since "Helen Dunbar has so many extraordinary qualities and so much ability," perhaps "she should be released as far as possible from all the complications of administrative and directing activity and devote her time to the medical side of research . . . for which she is so uniquely well suited."74 Thus damned with praise, Dunbar was removed from her role as Director of the Joint Committee, which was itself dissolved into its original non-joint components. Then, much to Mrs. Hoyt's horror, the possibly infidel Dunbar managed to reconstruct her power base almost exactly as it had been before. Dunbar arranged to have representatives from the Academy of Medicine and the Federal Council of Churches appointed to her executive committee at the Council for Clinical Training, and arranged to have her personal secretaries accepted as representatives to the Academy and the Federal Council. Dunbar herself became "consultant" to the Academy's new "Subcommittee on Emotions, and her "executive secretary" within the Council for Clinical Training organized the Federal Council's new "Subcommittee on Religion and Health." Thus, within the space of only several weeks, Dunbar managed, as Mrs. Hoyt noted with alarm, to "again be virtually head of both Medical and Religious committees. . . ."75 The status quo was thus maintained, with both religious and medical aspects of the original project continuing to be run out of Dunbar's office. The primarily educational arm of her work, The Council for the Clinical Training of Theological Students, later renamed just "The Council for Clinical Training," expanded aggressively into new settings, and the primarily research arm of her work, the psychosomatic medicine division at Columbia, embarked on one of the world's first large scale studies, ultimately involving over 1,600 patients.76
So, again, who was this amazing "Dr. Helen Flanders Dunbar," who felt driven to maintain complementary religious and medical programs side-by-side as she explored "emotions and bodily changes"? While she agreed, as we have noted, with the Joint Committee's initial assumption about the preeminent role of stimulating the "spirit" in helping maintain health, she came to place equal emphasis on the importance of quieting the "soul." A later manuscript of hers speaks of "creating an atmosphere of quiet concentration and rapport" and she certainly was a master at putting people at ease.77 There is no doubt, again, however, that she understood even this simple skill as having more complexity than the average Joint Committee member could have grasped. Every aspect of Dunbar's history thus far touched has turned out to be quite complex, and her consummate skill with patients, her "magnetic, charismatic" capacity for empathic connection, has been called seductive when its use with foundation heads and department chairs allowed her to get whatever she could want, as she pursued her far-ranging studies of emotional, soulful, spiritual integration.78
Dunbar made at least three visits to the healing shrine in southern France at Lourdes. It was there that she seems to have had her first inkling of the complementarity of what I am calling the "spiritual" and more "soulful" aspects of religious emotion. Her 1934 article on Lourdes called these aspects "confidence" and "contentment".79 Taking her cue from the nurses and stretcher bearers at Lourdes, Dunbar noted that, of patients visiting the shrine, those overcome by hysterical excitement as well as those merely waiting for a miraculous cure were not the ones to return home feeling well. Patients achieving the most success were those who became able, with "deep confidence and quiet," to go about their day, helping themselves and others.80 That is, both spiritually and soulfully, they had become emotionally "free to think and act."81
If Dunbar was what I have called a "practical theoretician," "a woman with a mission," her focus regarding illness was on prevention and effective intervention. As you may recall, the era's initial confusion about healing efforts within the church had quickly developed into an implied distinction between
(a) the remedial stance of curing illness and
(b) the more preventive stance of maintaining health.
While Dunbar's early patroness, Mrs. Hoyt, saw a preventive rather than a curative focus as helping physicians feel more comfortable with the clergy, and while a Joint Committee document encouraged "affirmative . . . thinking and praying . . . as a preventive measure" counteracting "early tendencies to disease," it was Dunbar herself who carried this distinction the farthest.82 She saw this "public health" approach of maintaining health in order to prevent disease as one of the major reasons for encouraging cooperation between religion and medicine. She considered her research on mind-body interaction and integration as highly practical, as providing knowledge relevant to physicians' practice albeit disseminated through the clergy. The pastor, she noted, "has the opportunity to spot the first signs of incipient disease, physical or mental, before the parishioner has even realized the need of coming" to anyone for care.83 The pastor "should not forget," she admonished, that he or she "is the one officer of health who is welcome in these homes before illness has developed."84 While acknowledging the glamour of trying to cure, she hoped to impress upon the clergy that "an important part" of their mission is "to prevent disease of body and spirit."85 Clinically trained clergy, she envisioned, could "fill an important part in preventive medicine."86
Dunbar considered the clergy's "public health function" as extending beyond the mere finding of "cases." She saw belief, perhaps especially religious belief, as "the unifying power in personal life," "mediating relationships of our internal physiological world to the external world at large," and clergy as uniquely qualified to focus upon and clarify beliefs.87 Notice, by the way, her careful combination of words -- "unifying power" -- suggesting the amalgam of soulful and spiritual elements in one concept -- which she had spoken of elsewhere as the almost living, breathing, -- organismic -- "insight symbol." The pastoral task, as she viewed it, was in helping men and women "in their adjustment to their total environment, outer and inner."88 To carry out this role, clergy had to gain an appreciation of scientific method and study firsthand what her colleague, Boisen, called "living human documents," the actual stories of men and women in triumph and in distress.89 She insisted on calling the programs they developed "clinical" rather than "pastoral" training because then existing courses in "pastoral theology" focused on telling the theologue "what to do" rather than "giving the student opportunity for adequate contact with the human being whose problems he [or she] is discussing."90 Dunbar viewed the Council for Clinical Training "not only as a movement in education" but "as a laboratory . . . from which guidance may be expected."91
Above I spoke of the Council for Clinical Training as primarily the educational arm of Dunbar's work, and of her large scale studies of psychosomatic illness as primarily the research arm of her work. I said "primarily" in each case because each had a second, complementary, function. Just as she saw clinical pastoral education as a research environment exploring how clergy might best interact with their parishioners, she saw psychosomatic research as an educational opportunity for teaching patients and doctors about mind-body interaction. Dunbar, driven by her overarching Dantean vision, can be seen as a major stimulus in the development of the entire combined field. Her focus on "the border territory between religion and medicine," on "the problem resulting from the dichotomy of psyche and soma," led us all to "a better understanding of the integrating forces and of the . . . organism as a whole."92 The evolving, crisscrossing spirals of education/ research/ education/ research and religion/ medicine/ religion/ medicine, which finally led to the current rediscovery of mind-body interaction in medicine, initially had far more impact on religion, creating the clinically-based pastoral disciplines that we know today.
As author of a history of clinical pastoral education, I am well aware of and have worked with several of the national associations that have developed across the last seventy years. Within the fields of professional chaplaincy, pastoral counseling, and pastoral psychotherapy, however, the College of Pastoral Supervision and Psychotherapy has uniquely chosen specifically to encourage a return to the fields' roots in the work of Anton Boisen and Flanders Dunbar. Trying to retrieve something that once was lost but now is found, the CPSP Diplomates see themselves as "spiritual pilgrims," and the CPSP Covenant speaks of them as specifically dedicated to the "recovery of soul."93 Just as these serious men and women might find it hard to pin down exact definitions of their phrases "spiritual pilgrims" and "recovery of soul" -- which may be why they chose these phrases -- I, too, am perfectly aware that my reification in this essay of an era's and Dunbar's implied distinction between "spiritual" and "soulful" is a bit stretched and certainly not perfect. Nonetheless, there is a distinction to be made. Perhaps it is the distinction between a more active stance and a more passive stance -- a "doing" and a "being" -- without any implication that one is better than the other. If the "spiritual" suggests, at least to me, the more inspiriting, as in "Onward Christian Soldiers!" and most Hanukkah music, then the more "soulful" suggests, at least to me, solitude, rest, and receptivity, as in "Rock of Ages," and most High Holidays' music.
As I have noted elsewhere, it may be time for the College of Pastoral Supervision and Psychotherapy -- and the broader pastoral fields in general -- to rediscover the inspiriting virtues of remaining "Still Crazy After All These Years," adding these to their ongoing "recovery of soul."94 The true legacy of the Rev.Mr. Anton Theophilus Boisen, I have suggested, may be the courage to espouse beliefs not initially shared by others.95 The founding years of CPSP will most likely be remembered for their insistence that a soul was a terrible thing to waste. A legacy of Dr. Dunbar --BD, MD, PhD, MedSciD -- let me propose, may well be the willingness to tackle the apparently impossible task, of integrating the spiritual and the more soulful. Remembering Dunbar is to remember that much work lies ahead.
Without being explicit about it, CPSP members seem to have adopted Dunbar's liberating emphasis on becoming "free to think and act," applying it as much to their colleagues as to their patients and parishioners. Dunbar's basic approach was to try to set the person's mind at ease, "to help the patient get into condition to think for him[or her]self," and only then to give the person encouragement in solving his or her own problems.96 A recurrent theme throughout Dunbar's writings is that "few patients need to be given advice as to what to do when once they are emotionally free to think."97 In her master's thesis, seventy-five years ago, she noted that the true reformer must be "like the man in Plato's Allegory of the Cave who knew that his chief task was to turn the prisoners [watching shadows on the back of the cave] around [,] so that they could face in the direction of the sun" and the real-world sources of the shadows.98 We need only, she believed, to show patients or parishioners "the way out"; once they see the path "clearly before them," she believed, "they can be trusted to take it . . . ." "The ideal patient," in her view, was "the one who can proceed down the road to health on his [or her] own two feet -- with guidance but without having to be dragged or carried."99 You do not have to change many words to see this as, in essence, the approach to helping "spiritual pilgrims" in their "recovery of soul" that CPSP has tried to bring to the clinical pastoral fields. There are here, too, however, complementary, potentially crisscrossing spirals of soulful thought and inspiring action as we enter the new century.
The year 2000 will mark the seventy-fifth anniversary of clinical pastoral education and the tenth anniversary of the College of Pastoral Supervision and Psychotherapy. What began in 1925 with three students -- Boisen always called Dunbar "the first" -- expanded within Dunbar's overarching vision to become an epoch making movement worldwide in theological education and religious practice.100 In closing, let us stop for a moment and try to imagine a world without professional chaplains, pastoral counselors, or pastoral psychotherapists. Let us try to imagine a field of clinical pastoral education without the "return to Boisen and Dunbar" that CPSP has tried to provide. In the fascinating area of healing and wholeness, where religion and medicine overlap, we have now begun honoring Helen Flanders Dunbar, psychoanalyst and Dantean scholar, for her contributions to religion as well as to medicine.
Robert Charles Powell, M.D., Ph.D., a psychiatrist and historian, gratefully acknowledges that much of the research herein reported was conducted under the tenure of a fellowship from the Josiah Macy, Jr. Foundation and under US-PHS Training Grant TO 2 MH 05972-17. He may be contacted at 847/ 441-8283; 1520 Tower Road, Winnetka, Illinois, 60093-1627.