Wizard of Oz, MD

"It is common for an analysand (the patient) to say that the [psycho]analyst is the most important person in his life. When I was in therapy, I thought of this attachment as the "Wizard of Oz" phenomenon. For me, my therapist became a floating head that accompanied me everywhere, with whom I had conversations that extended way past my sessions, late and night and early in the morning. Psychoanalysts often explain these intense feelings as the reenactment of childhood experiences, but they probably owe their intensity to the weird asymmetry of the therapeutic relationship… Therapy, when it is working well, is a powerful, intimate experience. … Their therapist can be their personal, sacred, perfect source of wisdom." (Of Two Minds, 104)

Can you smell the seductive scent of power? You too can be someone's personal Wizard of Oz! It is very sobering to think about the power one person gives to another. Why do we allow people to have such strong influence in our lives? And this really is not only psychiatrists, but extends to teachers, pastors, mentors, role models… Heck, if David Powlison told me that he really didn't I wasn't cut out for counseling, I'd probably drop everything and be a dermatologist or a pastry chef instead.

I think we're all hoping that someone has the answer. It might take a lot of looking under rocks and finding dirt, but we all cling to the hope that someone out there can fix us and all our problems. There's someone out there can understand us truly , can figure out why we seem to get stuck in the same muck, who can speak just the right words that will free us from the spell and hand us the key to life, love, and happiness. I want to believe that there's that perfect counselor out there, somewhere. (Cue Fivel: Somewhere, out there, beneath the big blue skkkyyyy…..)

We're built for worship, as David Powlison and his colleagues at CCEF say, and so we're primed to look for heroes to turn into our gods. And that's the danger of being a psychiatrist - that you could have that much power over a person. The mystique is only increased by the asymmetrical relationship, and you can read the silence of the psychiatrist as the deep brooding of an oracle of truth.

Yet what can be done about this? How do we counteract the tendency towards savior-complex and hero-worship? Jay Adams' solution was through biblical counselors sharing how they worked through any similar struggles, through being honest as a sinner before another sinner. He also proposed interchangeable counselors, so that a patient would come not to depend on having a particular counselor for help, but begin to look to God.

The latter solution doesn't look particularly workable in the psychiatry framework. But how about the former? Some of the best counsel I have received from my mom is when she's shared stories of her related struggle, and how she moves past that. And I think part of its effectiveness is because I start to recognize that I am not the first and only one to struggle with a particular issue, (say, of rejection) , and it gives me a door outside of my prison cell of self-centered thought, to caring and thinking about other people, and recognizing the same symptoms in others.

So what will be the consequence of handing this power to psychiatry? The ideas of psychiatry inevitably trickle down and wash culture in a bath of theories of the unconscious and guilt and self… What will be the consequence of giving psychiatry the throne of God?

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Bird Taxonomy

You could smell the earth waking up last Saturday, in a riotous cacaphony of chirps and in the warm breath of the wind. I hadn't realized I had been Next to the meadow, I ran into Grady, who had traded in his watch for a pair of binoculars to go bird-watching.

And somehow, we got to talking about how easy it is to flatten people, and make them one-dimensional. When you first meet people, it's easy to be excited and see them as mysterious, full of promise, fascinating. But when the shininess wears off, it's the in-between time that's hard. You know them, enough so that you can move around each other in the kitchen in a careful dance, how to make passable small talk, how not to step on the other person's toes. Enough to close the folder and file away in your list of useful information. But in sorting and labeling people into manipulable categories, you lose something. You lose the color of a person, the look of vulnerability in their eyes, the sound of their joyous laughter, the shimmering beauty of seeing that person at his finest, the sweat of agony on their brow as they decide between the harder higher path, or the easy lowland one. I am troubled by my flattening of people. It becomes so easy to judge, to condemn or, even worse, dismiss (as in, whatever, he's just like that. ) Sometimes, with some people, you get past the flatlands, and they start to pop back into 3-D, and relationships grow deeper, and sweeter, and you learn to cherish their friendship. But how do you get there?

I've been talking and asking about how to choose between different positions on an issue, like women's leadership in the church, or eschatology, or the work of the Holy Spirit. Drew said that it's ultimately a leap of faith. I like that answer. Deciding to believe in God as revealed by Christianity is like choosing to get married to Adam. Or vice versa. You don't have all the information, and you can't really fully objectively research all the possible alternatives. You ultimately have to take the information you know, the place you're at, and commit. And so, whether or not some may accuse it of heresy or fundamentalism, I like biblical counseling. I like biblical counseling because it seems to be the only perspective that really looks at people and sees people - people with stories, contexts, hopes, struggles, joys, sorrows, people who make choices but also suffer. The Freudian psychoanalysts, the biological materialists, the Christian psychology integrationists, the pastoral counseling camp, and the nouthetic counselors - of all the detectives in the business of taking a magnifying glass to a person, I think it's really the biblical counseling people who get it right.

What troubles me about psychiatry is that it is in the business of quickly and efficiently categorizing people, so that you can assign them their appropriate medication and send them on their way. They develop, like bird-watchers, the ability to pick up on small details that help you to identify and categorize a person. There's an anecdote in the book I'm reading, Of Two Minds, about a psychiatrist who can glance at a patient as they walk through the door and have the disease diagnosed before they speak a word. But unlike bird-watching, the difference between manic-depression and schizophrenia aren't like the difference between a sparrow and a turkey vulture. The y lie on a spectrum of characteristics. But the pressure on psychiatry to act like medicine makes them treat the disorders as distinct diseases. "Understanding how psychiatrists see is also terribly important, because madness is both frighteningly palpably present, and yet elusive. There are no diagnostic tests in psychiatry… You cannot draw someone's blood, stick someone into a magnetic resonance imager, or take any medical reading that will tell you definitively whether that person is depressed or not… To understand psychiatric ways of seeing, we have to proceed knowing that what counts as "fact" is a tinted window onto a world you cannot step outside to see." (10)

I enjoyed the show and tell of the boxes we made for Jordan's art therapy teaching day last week. It captured a second dimension to each of you that I had forgotten - the inside to the outside. There is one more dimension to each of us, however, more than the dimension of who you see me as and who I see me as, and that's who God sees me as.

I need God. I need God desperately. My mentor, Sonya, suggested that the reason I might be struggling with my relationships, why I'm finding it difficult to love and be curious about other people, might have something to do with my relationship with God. I've been running on recycled fumes. Who i know myself to be will spill over into how I perceive others. I know the answer is in here somewhere, a clever turning of the metaphor of bird-watching, people-relating, and psychiatry, but I'm not sure yet what it is. Perhaps you have a suggestion? But I think this is what it would mean to see people rightly:

It is a serious thing to live in a society of possible gods and goddesses, to remember that the dullest and most uninteresting person you talk to may one day be a creature which, if you saw it now, you would be strongly tempted to worship, or else a horror and a corruption such as you now meet, if at all, only in a nightmare. All day long we are, in some degree, helping each other to one or other of these destinations. It is in the light of these overwhelming possibilities, it is with the awe and the circumspection proper to them, that we should conduct all our dealings with one another, all friendships, all loves, all play, all politics. There are no ordinary people. (C.S. Lewis, The Weight of Glory)

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A Human God

The part of Jesus that I find so easy to forget is His humanity. I can believe that He was God, that He is Lord of all and existed before time. What's harder to remember is that not only am I to be like Him, but that He actually became like me.

Why does this matter? Because if Jesus wasn't very human, I would find it hard to understand His suffering. To be human would mean that He could doubt, He could fear, He could know what it is to plunge into a bottomless pit of pain and despair. And it means then that He could pay the price for sin with a pain that I could understand.

That is why I found The Passion so powerful. There are always going to be inadequacies and failures in trying to depict Jesus, but I think one thing I think is good about depicting Jesus in movies is that you realize that Jesus wasn't just an abstract nice idea, but Jesus is a human. I could see what it cost Him to lay down His life, to not deliver Himself from each lash of the whip, from the coarse sharp mockery, from the excruciating pain. And this is where His divinity does not lessen His sacrifice, but makes it deeper. He was not helpless in the face of His suffering - He could have ended it at any moment - and yet He chose to endure the pain because He loved those who inflicted the pain on Him. He sought to win for them something they neither desired nor deserved - reconcilement with God. And the blood spilled by Christ - the blood that poured out of the wounds from His body, the pools of it staining the white floor, the blood that spattered and dripped on onlookers - this is the blood that won us life. This is the blood that cleansed us of our sin and freed the earth from the curse. The Passion was gory and it was violent, but the torn up body and oozing blood we see is the self-same blood which we are to remember:

Now as they were eating, Jesus took bread, and after blessing it broke it and gave it to the disciples, and said, “Take, eat; this is my body.” And he took a cup, and when he had given thanks he gave it to them, saying, “Drink of it, all of you, for this is my blood of the covenant, which is poured out for many for the forgiveness of sins.” (Matt 26: 26-29)

Last Sunday, my chief thought when we were passing the bread around during communion was how to tear off the piece of bread where every else's germy hands hadn't touched. With the shiny silver sterility and pretty ceremony of the communion we receive on Sunday mornings, it's easy to forget how ugly and visceral Christ's death was. Experientially, it seems more akin to the act of cutting a lamb's throat for the Passover supper, draining it of its blood, and smearing it over your doorway. It's even a little sickening as you read it:

The Lord said to Moses and Aaron in the land of Egypt, “This month shall be for you the beginning of months. It shall be the first month of the year for you. Tell all the congregation of Israel that on the tenth day of this month every man shall take a lamb according to their fathers' houses, a lamb for a household. ..Your lamb shall be without blemish, a male a year old...and you shall keep it until the fourteenth day of this month, when the whole assembly of the congregation of Israel shall kill their lambs at twilight. Then they shall take some of the blood and put it on the two doorposts and the lintel of the houses in which they eat it. They shall eat the flesh that night, roasted on the fire; with unleavened bread and bitter herbs they shall eat it. Do not eat any of it raw or boiled in water, but roasted, its head with its legs and its inner parts. And you shall let none of it remain until the morning; anything that remains until the morning you shall burn. (Exodus 12:1-10)

It is significant that for the first time, we are commanded to drink blood, and the blood of a human who is God, no less. God had declared, “If any one of the house of Israel or of the strangers who sojourn among them eats any blood, I will set my face against that person who eats blood and will cut him off from among his people. For the life of the flesh is in the blood, and I have given it for you on the altar to make atonement for your souls, for it is the blood that makes atonement by the life. " (Lev 17:10-11) This time, it is not just God consuming the blood offered on the altars as atonement. It is we who drink the blood. Physically, His body and blood become nourishment as they are incorporated into our bodies. We take His life into ourselves, and it is His blood that runs in our veins, and we are His body.

Jesus was physical, he was a human. And the sacraments which commemorate and make God's work real to us - baptism, the Lord's Supper - are physical acts too, which care and renew our bodies. A burial and washing away of our filthy selves, a rising and blessing with water. A slaking of hunger and thirst through eating His body and drinking His blood. We have a new Spirit because of our reconciliation with God. But Christ's humanity - His incarnation, life, crucifixion, and resurrection - all point to a renewal and redemption of our bodies as well.

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Walk With Me

One thing I realized as we were driving home from the CCEF conference on addictions two weeks ago, was how different it was to walk alongside someone as a sinner, versus as someone who rains down advice and judgment on you from an Olympian throne. The CCEF faculty up there on stage were strikingly humble and compassionate as they spoke to some three thousand conference goers who furiously taking notes on their every word and would replay their conference CDs over and over when they got home. They talked wisely, intelligently, and most of all humbly and compassionately about addictions. Addictions - to anorexia, sex, drug abuse - these are addictions that clinicians talk about wearing rubber gloves and face masks. But these Biblical counselors they talked face to face, with the intimacy possible only because they knew they were addicts themselves. For addictions, really, are just another name for idolatry, and idolatry is what we do when we all fall into sin.

As Christians, we counsel, encourage, rebuke other Christians as those on the same playing field. For we are sinners too. We can condemn no one knowing, first, the grievousness of our own sin (as Bonhoeffer discussed) and, secondly, because we know that it is only by God's grace that the seeds of the same sins which dwell in our hearts have not taken root and bloomed. Murder, incest, and drug addictions are neither so distant cousins nor more foul than the secret sins, lies, and idolatry which we daily commit.

I'm still trying to fully understand what Paul says about being the "worst of sinners" - how do you keep on thinking yourself the worst of sinners without beating yourself on the head all the time and holier-than-thou groveling? - but what Bonhoeffer concluded resonates strongly with me. "How can I possibly serve another person in unfeigned humility if I seriously regard his sinfulness as worse than my own? Would I not be putting myself above him; could I have any hope for him? Such service would be hypocritical. (97)"

One of the things that worries me about being a doctor is that I'll have to be the expert. I've never really liked the idea of being on a pedestal, doling out my knowledge and prescriptions to the lowly crowds. An expert normal person fixing the helpless pathologized abnormal. I'm not saying that it's bad to be authoritative. You certainly want your doctors to be knowledgeable and to know what they're doing. The danger is how easy it would be to shift from a compassionate caring doctor who cares for his patients as people, to an authoritative arrogance which demeans and looks down on his patients.

What I like much better is the Biblical counseling paradigm of a counselor walking alongside the counselee, as one who understands the problem and can empathize with that struggle. It's one sinner pointing another sinner to the light. Bonhoeffer explains this further when he says,

"In the presence of a psychiatrist I can only be a sick man; in the presence of a Christian brother I can dare to be a sinner. The psychiatrist must first search my heart and yet he never plumbs its ultimate depth. The Christian brother knows when I come to him: here is a sinner like myself, a godless man who wants to confess and yearns for God's forgiveness. The psychiatrist views me as if there were no God. The brother views me as I am before the judging and merciful God in the Cross of Jesus Christ. (119)."

Often, the words spoken by one who walks alongside you are more powerful than the words of one who speaks down to you, especially when it comes to experiential decisions. We see this in the power of the testimonials: the "Look what Pro-Activ did for me and my self esteem!", in how we've come to trust the common-people tomatometer on Rotten Tomatoes more than the expert-meter, in how the recipes on Allrecipes.com with the highest number of five stars are the likeliest of being foolproof. When words are spoken by those who walk alongside, the words do not rest on the authority or greatness of the speaker, but to the good given in the words themselves.

Could it be that it is impossible for those who are the teachers, the pastors, the doctors to truly walk alongside others as equals? Bonhoeffer suggests so when he says,

" It is not a good thing for one person to be the confessor for all the others. All too easily this one person will be overburdened; thus confession will become for him an empty routine, and this will give rise to the disastrous misuse of the confessional for the exercise of spiritual domination of souls…. In order that he may not succumb to this sinister danger of the confessional every person should refrain from listening to confession who does not himself practice it. Only the person who has so humbled himself can hear a brother's confession without harm (120)."

The prescription he gives to avoiding a savior complex is an interesting one - that all those in the business of being confessors must also confess. Can we extend this beyond confessing? That all those who are doctors must also be patients? That all those in authority must submit themselves to the authority of others? It seems to work. There must be a humility, a servant leadership, that, as Mr. B says, is made possible through our salvation by grace.

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Normal?

During the presidential debates, Obama and McCain were asked, is healthcare a right, or a privilege? Listening to life stories this week made me wonder, is having a 'normal life' a right, or a privilege?
To draw the question to its root issue: is normal a right, or a privilege?

One of my concerns about American culture is how everything has become about rights (leading to our increasingly litigious mindset). We have a right to life, liberty, property ownership, and the pursuit of happiness. The American Dream is founded on the belief that everyone has a right to success; with hard work and ingenuity, we can all get there. Which is not all bad; I'm all for life and liberty. What's dangerous is that what we call our 'rights' are also those things which become our demands.

I personally think that healthcare is a privilege. And that is because the target of "good health" is a moving one. In the 1700s, given the high mortality rate, good health is surviving until age 60. Losing a couple teeth or arthritis were annoyances, but overall, the norm. But today, good health has become being pain free with all your body parts functional and accounted for. Braces have become almost a right, rather than a privilege. And soon enough, the definition of health becomes perfect vision and flawless skin and a full thick head of hair like David Norman's …

As a culture we have a pathological fear of any pain and turmoil. People demand to be able to have a perfect night's rest, to wake refreshed, bright-eyed and bushy-tailed. But I think a good night's rest shouldn't be considered a right - it's a privilege. "God gives his beloved rest." I think it's a gift from God. The same thing with depression (and I might be on a shaky limb here) - to a certain extent, it is normal and perhaps even good to go through a dark night of the soul - for it is in the darkness that your heart learns to yearn and treasure the light. Part of depression is a working out of a real struggle - like Luther's long agonized despair over his sin. Imagine if we'd prescribed him Prozac. There is real fruit that can come of what we call "illness."

"3 “Blessed are the poor in spirit, for theirs is the kingdom of heaven.
4 “Blessed are those who mourn, for they shall be comforted.
5 “Blessed are the meek, for they shall inherit the earth.
6 “Blessed are those who hunger and thirst for righteousness, for they shall be satisfied."

I'm sure those who have studied human rights can provide a much more thoughtful and accurate definition, but off the cuff, here at 12 PM, I think rights are those things which allow each person their dignity as human beings. I think as Christians we have to be careful about our use of the word "right." Because "rights" quickly become things we demand of God. I'll bet that's most of the reason why we get angry at God: we get angry at God for not giving us things we consider essential to our happiness. Things like perfect health. Perfect parents. A happy childhood. A trauma-free life. Success when you've worked your butt off. A happy marriage when you were faithful, and good. When our relationship to God becomes that of protecting and demanding our rights, and we try to argue with God, we put God on trial and appoint ourselves the judge.

When we stand before God, I don't know if we have any rights at all. We are all horrible sinners. We all deserve eternal damnation, and lifetimes of bad weather, malformed bodies, getting up on the wrong side of the bed, fruit flies, starvation, abuse, self-hatred, and being surrounded by people who hate us. Any good, or happiness, or wholeness we have experienced in our lives is the totally gracious gift ofGod. He gives rain to all. There's a common view that there's this line called normal, which we all are trying to attain, or deserve to have. Normal health. Normal families. Normal lives. But hey, none of us is normal. Normal is a fiction, to which we have no rights at all.

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