Journal of Religion and Health (2023) 62:228–254 https://doi.org/10.1007/s10943-022-01697-0 ORIGINAL PAPER Anton Boisen Reconsidered: Psychiatric Survivor and Mad Prophet Glenn J. McCullough1 Accepted: 12 November 2022 / Published online: 5 December 2022 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, corrected publication 2022 Abstract Anton Boisen was a seminal figure in the psychology of religion and pastoral psychology, but scholars have remained skeptical about his theoretical contributions and have perpetuated the stigma surrounding his psychiatric diagnosis and incarceration. I argue that Boisen was a prophet, ahead of his time, and that the academy has been slow to hear his salient critiques of the psychiatric system, and his contention that “psychosis” and “mystical experience” are overlapping phenomena. Most significantly, scholars have ignored the kernel of prophetic truth in Boisen’s own visionary experience, which, remarkably, in 1920, predicted the ecological crisis of our current age. Reclaiming Boisen’s unique voice might help us reclaim the uniqueness of the disciplines he helped birth. Keywords Anton Boisen · Clinical pastoral education · Psychology of religion · Pastoral psychology · Practical theology · Psychosis · Mystical experience · Antipsychiatry · Mad pride · Mad studies He was a forgotten man, by many remembered more because of his idiosyncrasies and schizoid personality than for his contributions in the field of the psychology of religion and pastoral psychology. But perhaps there is need for time and distance to be able to see the full stature of the man… - Henri Nouwen (1968, p. 63) And though the LORD persistently sent you all his servants the prophets, you have neither listened nor inclined your ears to hear. - Jeremiah 25:4 (NRSV) * Glenn J. McCullough glenn.mccullough@utoronto.ca 1 Practical Theology and Spiritual Care, Emmanuel College of Victoria University in the University of Toronto, 75 Queen’s Park Crescent, Toronto, ON M5S 1K7, Canada 1Vol:.(1234567890) 3 Journal of Religion and Health (2023) 62:228–254 229 Introduction Like most prophets, Anton Boisen (1876–1965) was ahead of his time. This paper argues that what we call “the scholarly consensus” is only now catching up to him. While Boisen’s work has been discussed by some of the leading names in pastoral theology and the psychology of religion,1 he is usually viewed with considerable ambivalence. On the one hand, Boisen is known and respected for his practical legacy as the founder of the Clinical Pastoral Education movement, who was largely responsible for making the empirical case study a standard tool for theological education. On the other hand, Boisen’s theoretical contribution—which offers deep critiques of the psychiatric system and tends to blur the lines between “psychosis” and “mystical experience”—has often been downplayed, sanitized, or simply ignored. This in turn is connected to an ongoing pathologizing of Boisen’s character and personality as “mad,” “odd,” “difficult,” or just plain “weird.” In what follows I want to celebrate Boisen’s weirdness, realizing that some of the most clear-eyed prophets of various spiritual traditions have come with a streak of eccentricity. I also want to celebrate some of the weirdness that Boisen has bequeathed to the fields of pastoral theology and the psychology of religion—disciplines that have spent much of their history trying to “fit in,” and appear academically acceptable, within the regnant orthodoxies of religion and science respectively.2 Like Boisen, scholars in these fields have been trying to pass for normal and not altogether successfully. It might be time to simply embrace our uniqueness and to see its strengths. Boisen was involuntarily hospitalized on three separate occasions3 for a form of mental distress that, as he noted, hovers between the accepted definitions of “psychosis” and “mystical experience.” He had the courage to discuss his experiences openly, honestly, and in print, and to note the unhelpful and inhumane treatment he experienced at the hands of the system. Boisen’s interpreters have generally failed to note the salience and prescience of his critiques of the system. And, more importantly, his interpreters have failed to note the kernel of prophetic truth in his psychotic/visionary experiences, which, remarkably, in 1920, pointed to the ecological crisis in which we now find ourselves. Instead, Boisen’s interpreters have used his experiences to place a cloud of suspicion over his person and work, especially 1 Including Seward Hiltner, Paul Pruyser, Henri Nouwen, Harry Stack Sullivan, Ann Taves, Donald Capps, Robert Dykstra, and Bonnie Miller-McLemore. 2 Robert Dykstra (2005) sums up the field of pastoral theology well, and alludes to Boisen, when he says that “Pastoral theology was born of madness and, one could argue, has yet to fully recover. A fragile, sometimes fragmented identity on the margins of church and society seems to be its peculiar portion and destiny” (p. 2). This marginality also comes with certain advantages, as I hope this essay will show. Likewise, the field of the psychology of religion was always a little embarrassed by the strange phenomena of religious experience, the study of which was relegated to the sub-field of “parapsychology,” now called “psi research.” William James, for example, spent much of his time as a scholar investigating spirit mediums, but said very little about it. It is astounding how much (ignored) empirical evidence there is for the existence of various spiritual, “paranormal,” or “psi” phenomena. See e.g. Radin (1997), who offers meta-analyses of extant research. See also Kripal (2011) for a good analysis of the paranormal and the sacred, in the “Chicago school” tradition. 3 In 1920, 1930, and 1935. 13 230 Journal of Religion and Health (2023) 62:228–254 around ideas that our academic and religious cultures were not ready for, but which might now find an audience. We might finally have ears to hear this strange prophet, whose neurodivergent and mystically touched mind helped birth the conversation between psychology and religion. In many ways Boisen can be seen as a precursor to the “anti-psychiatry” movement of the 1960s, and the more recent movements of “mad pride” and “mad studies,” which seek to foreground the voices of psychiatric survivors, and to unmask the politics and power dynamics inherent in the psychiatric system and its medical knowledge base.4 Boisen of course did not use the language of contemporary activism; he continued to use the psychiatric language of his day, but usually in ways that profoundly questioned the assumptions on which it was based. I will do the same in this paper. This use of language reflects Boisen’s unique location as both a psychiatric survivor who experienced real trauma at the hands of the system, and a pioneering psychiatric chaplain who tried to reform the system from within.5 Like many of the mad pride activists of today, Boisen critiqued the medical model for its dominant focus on biology, pathology, and contextless individuality.6 Instead, he framed his own mental distress and its visionary symbolism as fundamentally about meaning-making and transformation, and he saw his experiences as embedded within the socio-political web of language and culture. Like today’s mad studies scholars, Boisen shows remarkable awareness of the sociological dynamics inherent in psychiatric categories and institutions: he foregrounds the social stigma of permanent pathological labels, and the many forms of isolation, marginalization, and violence created and perpetuated both by the psychiatric system and its surrounding culture. Boisen experienced these deep wounds, and as a pioneering psychiatric chaplain he came offering, above all, dignity and hope to those still within the system. Ultimately, however, Boisen goes much further than any sociological analysis by reframing mental illness in terms of the history of religious experience and mysticism—a history he knew quite well—and by positing a transcendent spiritual process in many forms of mental distress. In this reframing he sees psychiatric survivors not as ill but as spiritually gifted—their deep inner conflicts as indicative of 4 As social and academic movements, “anti-psychiatry,” “mad pride,” and “mad studies” are diverse, controversial, and contested. For example, the name “anti-psychiatry” was always controversial because the movement itself contained several prominent psychiatrists who were trying to reform the system from within. Similarly, many contemporary psychiatric survivors who agree with the sentiments of “mad pride” do not want to reclaim the word “mad” to describe themselves. Some historians trace the genesis of “mad pride” to Toronto’s Parkdale neighborhood, where I used to live, and where a high concentration of boarding homes sprang up historically as beds in local psychiatric facilities were eliminated during the “deinstitutionalization” of the 1960s and 1970s. On Sept 18, 1993, Parkdale hosted the first “Psychiatric Survivor Pride Day.” As an academic movement, “mad studies” likewise has strong roots in Toronto, at Toronto Metropolitan University (previously Ryerson University) and York University. See e.g. Fullerton (2007), LeFrançois et al. (2013). The International Journal of Mad Studies was launched in 2021. 5 For an analysis of Boisen’s hybrid character from the perspective of Foucauldian discourse analysis and queer theory, see Coble (2014). 6 Psychiatrists have aspired to a “biopsychosocial” model for some time now (Engel 1977). But it is no secret that biological factors continue to dominate medical science and practice, mainly because they are easier to measure and to medicate. See e.g. Ghaemi 2009. 13 Journal of Religion and Health (2023) 62:228–254 231 profound spiritual sensitivities, and possible transcendent breakthroughs. Where the medical establishment saw illness and pathology, Boisen saw spiritual potential and even genius. But he did so without romanticizing or minimizing the seriousness of these inner struggles, and the possible dangers for those who lose their way. The tragedy, as Boisen knew, is that the distress of spiritually sensitive souls is often met by a profoundly insensitive system. And the lingering question his work poses is whether this system is in some ways exacerbating the problems it claims to cure. The psychiatric system has of course changed significantly since Boisen’s day, but many of these changes are a matter of degree, rather than the fundamental shifts Boisen hoped for. In what follows we will trace Boisen’s first experience of mental distress, his first experience of the psychiatric system, and the perceptive critiques he expressed in letters shortly after. In these letters we will see Boisen’s “both/and” logic, which held together psychosis and prophetic vision in a way that his interpreters have never been very comfortable with.7 We will also note the remarkable core of prophetic truth in Boisen’s own initial vision/psychosis, which has been totally ignored by his interpreters. In exploring Boisen’s experiences, we will note his view of the root causes of his distress, and the best treatment for it, which contrast sharply from the medical model of both his day and ours. Again, Boisen expressed these ideas in letters right after his first disturbance, and they remained remarkably consistent throughout his lifetime. Finally, we will explore the reception history of Boisen’s ideas, and the lingering distrust around both his theoretical contribution and the prophetic value of his visions—a distrust that was often expressed in ad hominem critiques of his character and personality. While I cannot demonstrate this in detail, I hope this essay will suggest that Boisen can be located within an academic stream that would include, most notably, C.G. Jung, R.D. Laing, and Michel Foucault. Boisen anticipated many of the ideas of this trio, and he also avoided many of their mistakes.8 Like Jung, he saw the symbolism of psychosis/visionary experience as purposeful, and as itself pointing to a cure, often by describing symbolically the resolution of an inner conflict. Like Jung, Boisen also saw certain visionary experiences as attempts to describe and heal the broader wounds and divisions of collective culture. Like Jung and Laing, Boisen saw religion and spirituality as fundamental for understanding and reframing mental distress,9 and Boisen likewise approached both religion and mental distress 7 The main exception to this rule is Sean LaBat’s (2021) excellent Anton Boisen: Madness, Mysticism, and the Origins of Clinical Pastoral Education. But even here the thesis is timid: “Boisen at times saw visions, dreamed dreams, heard voices… I assert these states should not be automatically dismissed as illness, while not denying that he required treatment and even hospitalization during the midst of many of them” (p. 4). 8 I am not trying to endorse uncritically the ideas of Jung, Laing, and Foucault, but more to note the academic and popular appeal of their ideas. There was a social receptivity to these ideas that was not present in Boisen’s day, which is another indication that his ideas were ahead of their time. 9 In contrast to Freud, Jung saw religions as “the great psychotherapeutic systems of humanity” (1937/2019, p. 244). Laing (1967) follows this in The Politics of Experience, especially Chapter 6: Transcendental Experience: “In this chapter I wish to relate the transcendental experiences that sometimes break through in psychosis to those experiences of the divine that are the Living Fount of all religion.’ (p. 108). 13 232 Journal of Religion and Health (2023) 62:228–254 phenomenologically and existentially.10 Finally, like all three thinkers, Boisen was aware that psychiatric categories, including binaries of in/sanity, were to some degree socially constructed. Most significantly, Boisen noticed that these constructs encoded power relations that were often unmasked by the delusional/visionary symbolism itself. His own visions, in fact, revealed this to him, as we will see. Strange but True In his most important theoretical work, The Exploration of the Inner World (1936), and later in his deeply intimate case history and memoir, Out of the Depths (1960), Boisen describes, with his typically understated neutrality, the traumatic chain of events involved in his first psychiatric incarceration. In 1920, at age 43, while experiencing unemployment in his vocation as a Presbyterian and Congregationalist Minister, Boisen was staying with his sister’s family and his mother in their large home in Arlington, Massachusetts. On October 2nd he began reworking the “Statement of Religious Experience,” and “Statement of Belief” that he had submitted nine years ago for his ordination, and he became “intensely absorbed” in this work, so much so that I lay awake at night letting ideas take shape of themselves. This was for me nothing new… This time, however, the absorption went beyond the ordinary. I was no longer interested in anything else, and I spent all the time possible in my room, writing (1960, pp.78-79). On October 6th he began having “strange ideas” that “came surging into” his mind “with tremendous power,” appearing with a curious sense of authority and fear (p. 79, p. 81).11 Initially he kept these ideas to himself: “For several days I said nothing to my family, but finally I broke the rule of silence and began to share my fears.” After confiding in his mom and sister, he soon felt “another source of terror,” that “the words which I had spoken would bring about my undoing.” His disclosure to his family proved to be a bad idea. On October 9th he describes a “sickening sensation… that something awful had happened. I did not know what it was, but I thought I had been “betrayed.” Then I went into the next room and found there a man I did not know. This was a physician who had been called in, but I did not know it at the time, for he did not question me. He just watched and listened (1960, p. 86). 10 While Boisen is not always explicit about his theoretical frame, he clearly follows William James’ pragmatism, which has much in common with both phenomenology and existentialism. He also follows James’ radical empiricism. The pragmatism of Richard Rorty and many of his students, in contrast, follows the former but not the latter. See Springs (2010). For more on James’ influence on Boisen see Taves (1999, p. 306) and LaBat (2021, pp. 44–45). 11 Boisen’s emphasis on the authority of these ideas echoes William James’ framing of the “noetic quality” of mystical states: “They are states of insight into depths of truth unplumbed by the discursive intellect… and as a rule they carry with them a curious sense of authority for aftertime” (1902, p. 329). 13 Journal of Religion and Health (2023) 62:228–254 233 Boisen’s intuitions of “betrayal” soon proved prescient. Without telling him, and likely in discussion with the above physician, his family had decided to have him committed: My first intimation that they were thinking of sending me to a hospital was when six policemen came marching into the room where I was working, and one of them announced that I had better come quietly or there would be trouble. The size of the squad gave evidence of my family’s alarm… there was at no time any manifestation of violence on my part (1960, pp. 86-87). It would be nice if such an overwhelming show of force in response to a confused and troubled individual were a thing of the past. But then as now, the use of “law enforcement” for incarcerating those in mental distress continues, both as a revealing cultural symbol (i.e. irrationality is dangerous and unlawful) and an extremely blunt instrument.12 Boisen likewise describes his lack of agency, and an initial assumption that he would be violent, when he was admitted to the Boston Psychopathic Hospital on October 9, 1920, at about 10 pm: I had asked that I might be taken to a certain friend whom I trusted, because I did not want to talk to doctors whom I did not know. Dr Gale said, “That is clear proof that he belongs here”… the next morning… I was lying in bed, apparently asleep, when I heard one of the nurses say, “He is here on a homicidal and suicidal charge. There must be some mistake. He does not look in the least violent”… This hit me like a thunderbolt. I knew that I had never had the slightest thought of injuring any one, and as for the idea of taking my own life, that had been held only for a short time and immediately rejected. Such a charge was clear evidence that evil forces were at work (1960, p. 87-88). Like his intuitions of “betrayal” above, Boisen’s reference here to “evil forces” is partly an admission of what he calls his “frank psychosis” (p. 79) or “abnormal state” (p. 81), and partly a demonstration of the accuracy of some of his “strange ideas.” The facts he documents show that “evil forces” really were at work—the hidden forces of a cultural system primed to scapegoat those who think and act irrationally, and to project violence onto them, while perpetrating violence against them. Here we also see Boisen’s “both/and” logic, which uses the language of psychiatry in order to reframe it. Boisen documents his experiences with the scientific neutrality of a case history, in hopes that readers will reach logical yet radical conclusions, far beyond the precincts of regnant scientific theories.13 That is, many of Boisen’s “strange ideas” were strange but true. In a certain sense he was “betrayed,” a betrayal no doubt hidden behind his family’s best intentions, and following the best medical advice of the day. Likewise, hidden “evil” cultural forces really were “at work.” 12 Mad pride activists often note that police officers are not trained to deal with those in mental distress, and they frequently escalate situations toward predictably violent confrontations when de-escalation is called for. Evidence for this pattern is ubiquitous. 13 William James’ “radical empiricism” is likely in the background here. 13 234 Journal of Religion and Health (2023) 62:228–254 Here and elsewhere Boisen holds his “both/and” logic fully and paradoxically. He fully believes that his ideas were strange, and “psychotic” according to the accepted definition. He also fully believes that his ideas contained truth, albeit a truth clothed in metaphor and symbol, and needing interpretation. Boisen recovered from his first disturbance after about three weeks, and he wrote the following to Fred Eastman less than a month after his recovery: I have from the beginning recognized the abnormal character of my own experience. I have recognized that those experiences which have been for me so vitally important would be classed by physicians as insanity. But I have chosen deliberately to follow the thing out. I have been following a trail which has taken me through some very dangerous country. But I believe it has been worth while, and I would make the same choice again (1960, p. 102).14 The clarity of his conviction here is striking, but not uncommon for psychiatric survivors. Boisen saw that his ideas were both “abnormal” and potentially quite significant, indeed “vitally important,” and he set about trying to make sense of them. This effort put him in real conflict with the psychiatric system. Boisen did not reveal the full content of his psychotic/visionary experiences until his memoir was published in 1960, five years before his death. But in 1936, in The Exploration of the Inner World, he published a tiny portion of his visions. From this we can see that he had managed to discern which of his “strange ideas” reflected his own personal struggles, and which of his ideas were intended prophetically for the wider culture. He kept silent about the former and published the latter on page three of the introduction: there came surging upon me with overpowering force a terrifying idea about a coming world catastrophe. Although I had never before given serious thought to such a subject, there came flashing into my mind, as though from a source without myself, the idea that this little planet of ours, which has existed for we know not how many millions of years, was about to undergo some sort of metamorphosis. It was like a seed or an egg. In it were stored up a quantity of food materials, represented by our natural resources. But now we were like a seed in the process of germinating or an egg that had just been fertilized. We were starting to grow. Just within the short space of a hundred years we had begun to draw upon our resources to such an extent that the timber and the gas and the oil were likely soon to be exhausted. In the wake of this idea followed others… (1936, p. 3). I have yet to find an interpreter of Boisen who acknowledges, let alone highlights, the prophetic truth of these words. The coming catastrophe of exhausted natural 14 Similarly, in a letter to Fred on Dec 11, 1920, Boisen wrestles with the truth of his ideas: “This does not mean that I hold these ideas as true. While I do believe there may be some truth in some of the ideas, I am concerned chiefly with the mental processes which are involved” (1960, p. 107). Likewise, in a letter to Norman Nash on Feb 14, 1921, “along with abnormal and pathological elements which I have always recognized, it has brought me what I have regarded as most sacred and most authoritative” (1960, p. 113). 13 Journal of Religion and Health (2023) 62:228–254 235 resources, and the imperative to use our nonrenewable resources wisely, in order to build a sustainable future, are truly visionary insights for Boisen’s time.15 But no one listened. In describing the above vision of our fragile planet, Boisen does not explicitly identify it as a prophecy, or himself as a prophet. Such a claim would have been too unscientific for him—he had little evidence to support it. And Boisen surely knew how such a claim would have been received. But a careful reader cannot fail to notice that Boisen’s 1960 description of his first psychotic/visionary experience encompassed some nine pages, while here in the 1936 description he has included only one paragraph—precisely the aspect of his vision that presages our current crisis. It seems likely that Boisen chose this part of his experience because he sensed it had broader applicability. Its presence in the opening pages of the introduction also sets the stage for the ensuing argument of The Exploration of the Inner World. In Part One he describes “some successful explorers” of the inner world from his own religious tradition: Ezekiel, Jeremiah, Jesus Christ, the Apostle Paul, John Bunyan, Emmanuel Swedenborg, and the figure who most intrigued him, Quaker founder George Fox.16 In his detailed analysis, he notes that Fox’s “openings” or visions became “more and more trustworthy” (p. 67) and, further, that Fox emerged from his disturbances “with certain socially valuable insights” (p. 69). A few pages later, in his assessment of the Hebrew prophets, Boisen says: The question therefore arises whether some of them, like Fox, may not have so completely identified themselves with their people that they went down into the depths with their people in their sufferings. Their severe disturbance might thus be explainable not so much in terms of their own personal conflicts and inner difficulties as in terms of group danger. They would thus be those who were fine enough and farseeing enough to feel with and for their nation… (1935, p. 75). This sounds suspiciously like a description of Boisen’s own experience, as if his vision of impending ecological crisis was itself a warning of “group danger.” It certainly seems that way today. Later in the book he is more candid: “I believe therefore that this experience of mine, with all its pathological features, was akin to that of the prophets of old. Furthermore, even though the psychologists disagree, I believe that such experiences do serve to reveal new truth” (1936, p. 115). In a follow-up paper I will explore the question of how Boisen could have separated his personal psychosis from his public prophecy, and how he came to 15 It is worth noting that Boisen studied forestry at the Yale Forest School and served briefly as a forester in New Hampshire. He describes his deep religious feelings for nature and for the rare and beautiful trailing arbutus flower (1960, p.50). 16 These historical examples provide the empirical foundation in part one of The Exploration of the Inner World (pp. 15–122), which is followed by the “Theoretical Implications” in part two (pp. 125– 215). Interestingly, the Quakers were largely responsibly for founding the “moral treatment” movement, which was, at the time, a more humane approach, that also took issue with the biological view of the medical model of the day. 13 236 Journal of Religion and Health (2023) 62:228–254 understand the feelings of grandiosity and terror that accompanied his visions. Significantly, the need for these specific areas of discernment was clear to him in the letters he wrote right after his first disturbance, as we will see below, although the discernment process took time. This process involved recognizing which aspects of his visions referred symbolically to the microcosm of his own psyche, and which aspects referred to the macrocosm of the outside world. The correspondence between microcosm and macrocosm, which is a tenet of many religious systems, is what makes the process of discernment so difficult. This aspect of Boisen’s theoretical contribution—separating personal distress from collective vision, and understanding grandiosity and fear—is remarkably helpful, even today, for therapists and those who experience visions/delusions. Boisen’s ideas on these points also independently replicate certain ideas of C.G. Jung, which have so far received very little attention. And, interestingly, Boisen’s visions also contain a Jungian “mandala” figure at their core (the “family of four”). But these Jungian resonances will have to wait for a subsequent paper. Here we will simply note Boisen’s general understanding of mental distress, his critiques of the psychiatric system, and their lukewarm critical reception by our field. Your Friends are Coming to Help You Boisen describes his first week of “violent delirium” in the Boston Psychopathic hospital, during which he was treated with the therapeutics of the day, including sedatives (“knock-out drops”), hydrotherapy baths, and cold wet sheet packs (like wet swaddling clothes), the coldness of which was thought to sedate excited patients.17 Antipsychotic medications did not yet exist, which is a significant contrast with current practice, and yet the treatments offered still presumed biological causes. During this first week Boisen says he “spent most of the time reposing in cold-packs or locked up in one of the small rooms on Ward 2 [the ‘Disturbed Ward’], often pounding on the door and singing” (1960, p. 87). He also notes, again with characteristic neutrality, that he was given “severe beatings” by the hospital attendants, which left him unable to walk for two days, and which were apparently a very common occurrence.18 He then notes sarcastically that, on October 16th, seven days after he was admitted, he had “the honor of being transported” to Westboro State Hospital “in a strait jacket” (1960, p. 95).19 17 Hydrotherapy and wet pack treatments basically ended with the advent of antipsychotic medications, but their use continues to be discussed favorably in certain quarters (Harmon, 2009; Ross et al., 1988). 18 Boisen writes, “One of the older attendants told me later that I was given what was known as ‘the old bughouse knockout’” (p. 100). His neutral description of these beatings could be a sign of unprocessed trauma, but it could just as well reflect the “scientific” tone he adopts in many of his writings. My read is that this tone was Boisen’s attempt to build a case that would be noticed by the scientific authorities of his day (psychiatrists and psychologists), and that would lead them to well-founded but radical conclusions. We will see below that Boisen’s credentials as a scientist were later questioned by psychologist Paul Pruyser. 19 I was shocked to find, during my first chaplaincy position (1999–2001) in a New Jersey State Psychiatric Hospital, that straightjackets were still in use. It is difficult to find good statistics on the ongoing use of straightjackets, and other restraints, in psychiatry (a fact which is itself revealing) although there is good data on their harmful effects. See Jimenez (2012) for a review and historical summary. 13 Journal of Religion and Health (2023) 62:228–254 237 At Westboro, for another two weeks Boisen remained, in his own words, “acutely disturbed.” But then his state of consciousness suddenly shifted, “much as one awakens out of a bad dream” (1960, p. 95). Significantly, Boisen notes that his recovery occurred just after a visit from his sister and Fred Eastman—the friend Boisen mentioned above when he was admitted to the hospital, whom he trusted more than the doctors, and to whom he had already revealed his “strange ideas” in a remarkably honest letter. After this visit Boisen notes that he “improved rapidly,” because the visit had “repaired the broken communications” caused by his hospitalization (1960, p. 101).20 But by this time Boisen had also been given a diagnosis of “dementia praecox,” or what we now call “schizophrenia,” which then as now was seen as a fixed pathological category—a life sentence.21 His family and friends were told that “there was no hope of recovery” (1936, p. 4). As Boisen tells it, again with the patience and equanimity that a “patient” is forced to adopt, “in consequence, when I did recover, I had difficulty in convincing [my family and friends] that I was well enough to leave, and my stay in the hospital was for this reason longer than it would otherwise have been” (1936, p. 4). Boisen gives only a brief hint of what it felt like to realize that, although he had recovered, he might remain permanently incarcerated in the mental health system, and permanently isolated from friends and family. He does suggest, however, that this realization might have contributed to his second disturbance: For four and a half months, I gave most of my attention to the attempt to understand my experience and also to convince my friends [through correspondence] that I was as well as I had ever been. But the harder I tried the less they believed it. The result was to increase my own fears and my own sense of helplessness. There followed then another period of disturbance quite as severe as the first and ten weeks in duration instead of three... On coming out of it, I changed my tactics and said nothing about release (1936, p. 6). It was not only his friends who could not be convinced; the psychiatrists were also skeptical of his first recovery: While talking with one of my physicians, I remarked that while I recognized the grotesque character of the ideas I had had during the disturbed period, I still felt that in the experience there had been some purpose. It was not all a mistake. He shook his head solemnly and said I was entirely wrong (1960, p. 109). Because of this remark about the “purpose” of his experience, Boisen’s planned New Year’s visit to Fred Eastman’s home in New York was canceled. In his letter to Eastman the doctor states, 20 Boisen writes to Fred on November 8, about a week after his recovery, “Your visit has meant a lot to me. It has been for me as though I were dead and am alive again” (1960, p.96). 21 Revealingly, Jung notes that at the turn of the century, “Schizophrenia was considered incurable. If one did achieve some improvement with a case of schizophrenia, the answer was that it had not been real schizophrenia.” (1961, p. 128). 13 238 Journal of Religion and Health (2023) 62:228–254 I do not consider Mr. Boisen well enough to visit you at your home during the coming week-end… although his conduct is not greatly disturbed, it is easy to see that his mind is far from right. He still believes that the experience through which he has been passing is part of a plan which has been laid out for him… (1960, p. 109). The very fact that Boisen’s attempts to demonstrate his wellness and to make sense of his strange ideas were themselves taken as symptoms of continued illness placed him in a cruel double bind—one that is familiar to many psychiatric survivors. The second disturbance followed soon after.22 Subsequent research has confirmed some of the sociological dynamics that Boisen highlights above. We now know that the Diagnostic and Statistical Manual of Mental Disorders (DSM) has serious problems with reliability and validity. According to one study, the first edition of the American Psychiatric Association (1952) was only 54% reliable, meaning that different clinicians were only likely to agree on the diagnosis of a particular client 54% of the time (Beck et al., 1962). This is an embarrassing statistic for the medical establishment. Studies disagree on whether the current fifth edition of the American Psychiatric Association (2013) is better or worse (Aggarwal, 2017; Comer & Comer, 2019; Wakefield, 2015). The 1918 Statistical Manual for the Use of Institutions for the Insane, the DSM predecessor under which Boisen was diagnosed, was likely similar. Validity is also a huge problem. That is, if a diagnostic category truly exists, then we should be able to make certain predictions about people who fit the category (“predictive validity”). This is rarely the case. Because of these validity problems, the National Instituted for Mental Health (NIMH), which is the world’s largest mental health funding agency, no longer funds clinical studies that rely exclusively on DSM criteria. As NIMH Director Thomas Insel noted (2013), “symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.” So the question is not just whether Boisen had catatonic schizophrenia,23 as his doctors contended, but whether catatonic schizophrenia exists at all, except in the minds of clinicians. We also now have a significant body of literature on the social stigma created by psychiatric labels (Casados, 2017). Boisen’s diagnostic life sentence not only prolonged his incarceration in the hospital, but it remained as the dominant lens through which he was viewed by his family, friends, future colleagues, and by later interpreters in our field. Boisen’s own belief was that his recovery was helped significantly by a visit from his sister and Fred—by repairing the “broken communications” with friends and family. As he said in his letter to Fred, right after Fred’s first visit, “Only 22 Just to clarify, I am not suggesting that Boisen’s later disturbances were caused solely by his psychiatric treatment. There were other traumas in Boisen’s life that doubtless contributed to his condition, and these have been well described by his interpreters. See especially Capps (2005). My only question here is whether his psychiatric experience ameliorated or exacerbated his condition. 23 Hart (2001) suggests that Boisen actually had bipolar disorder, and Capps (2005) suggests that he had paranoid rather than catatonic schizophrenia, according to the DSM criteria. 13 Journal of Religion and Health (2023) 62:228–254 239 one thing gives me apprehension—the prolongation of my stay in the hospital. I do hope I may soon be restored to normal conditions among my friends” (1960, p. 96). Revealingly, this idea was also symbolized during Boisen’s first period of visionary disturbance, after he was admitted to the hospital: “In some way, I could not tell how, I felt myself joined onto some superhuman source of strength. The idea came, ‘Your friends are coming to help you’” (1960, p. 89). Indeed, his friends did help him, but his isolation in the hospital and his diagnostic life sentence significantly impeded this help. As Boisen said later, in relation to the “causative factors in dementia praecox… the primary evil lies in the realm of social relationships, particularly in a life situation involving the sense of personal failure. We have found one characteristic common to the group as a whole: they are isolated from their fellows through a social judgment which either consciously or subconsciously they accept and pronounce upon themselves” (1936, p. 28). Foucault would agree. From this point on, Boisen’s work emphasized the important role of community and social acceptance in mental health and healing.24 The Wall Between Medicine and Religion In the five-month period between his first recovery and his second disturbance, Boisen wrote letters that included a remarkably insightful discussion of his first disturbance, its causes, the lack of effectiveness of the hospital’s treatments, and the systemic pressures, fears, and violence that no doubt contributed to his second disturbance. It is worth noting that Boisen, at this point in his life, was highly educated. During his undergraduate years he had mastered several languages and studied French and German literature, and when he began graduate school in 1897 he notes that he connected deeply with William James’ Principles of Psychology. He later earned a Bachelor of Divinity from Union Theological Seminary (1911), where he focused his studies in the psychology of religion under Professor of Practical Theology, George Coe.25 After Seminary, Boisen and his friend Fred Eastman led 24 Bonnie Miller-McLemore describes how she coined the term “living human web” in 1993, as distinct from Boisen’s “living human document,” in order to shift from a “focus on care narrowly defined as counseling… to a focus on care understood as part of a wide cultural, social, and religious context” (1993, p. 367; 2018, p. 311). The above quote from Boisen shows that the idea of a contextual social web was implicit in his thinking from the start. In this instance it took the scholarly field about sixty years to catch up to him. 25 Powell (1976) calls Coe a “thoroughly Jamesian psychologist of religion” (p. 7), but Taves distinguishes between Coe and James: “Whereas James judged religious experiences of this sort in terms of their ability to unify a divided self, Coe judged them in terms of their ability to promote social change” (p. 302). Boisen points to distinct differences between himself and Coe: “I took all the courses [Coe] offered, and found them helpful and stimulating. On some important issues I could not agree with him. For me, faith in the reality of mystical experience was fundamental. For Professor Coe, it was something in the nature of a red flag. He had long been leading a crusade against the excesses of middle western revivalism and he was convinced that the mystic derives from his mystical experience nothing he has not brought to it” (1960, p. 62). Boisen also says that James’ Varieties “had as yet found little place” in the curriculum of Union or any other seminary at the time (p. 60). Coe arrived in Boisen’s second year at Union (p. 62). 13 240 Journal of Religion and Health (2023) 62:228–254 sociological surveys “dealing with all phases of rural economic, social, and religious life” for the Interchurch World Movement,26 the results of which were published in 1916 in the American Journal of Sociology (1960, p. 68). Boisen thus had experience thinking systemically about the interconnected web of American culture and its dominant institutions, including its churches and hospitals, and he was an interdisciplinary thinker when the word “interdisciplinary” had not yet been invented. He interpreted his own experiences theologically, historically, psychologically, and sociologically, and this methodological breadth proved confusing for his readers.27 Here again Boisen was ahead of his time. In 1924 he was already arguing that liberal Protestant seminaries should expand beyond “the traditional disciplines, the scriptural languages and literature, church history, systematic theology and homiletics” to “the human personality in either health or disease or the social and economic forces which affect it” [Boisen’s italics]. But interestingly, as Boisen himself notes, at the time of his first disturbance he had “no reading whatever in psychiatric literature” (1936, p. 10). In his first letter to Fred Eastman, within a month of emerging from his first disturbance, Boisen was already making sense of his own “case” from his past study of the psychology of religion, while also showing significant self-awareness about how these attempts would sound to those around him: I suppose every inmate of such a place as this has ideas and theories of his own and feels much aggrieved because others will not accept them. I feel, however, that I have some understanding of my own case. I have been dealing with it for twenty years, and you will remember that practically all my Seminary work centered around this problem (1960, p. 97). “This problem” is the problem of religion and psychology, especially in relation to mystical experience. Boisen’s attempt to understand his disturbance in this light certainly found little support from his doctors, who “did not believe in talking with patients about their symptoms, which they assumed to be rooted in some as yet undiscovered organic [biological] difficulty. The longest time I ever got [with a doctor] was fifteen minutes” (1936, p. 5).28 In the same letter, Boisen is already outlining a significant theoretical point that would stay with him for the rest of his life. With his typically balanced approach, he grants validity to the biological view of his doctors in some cases: I would distinguish between two main types of insanity. In the one there is some organic trouble, a defect in the brain or a disorder in the nervous system, or some disease of the blood. In the other there is no organic difficulty… The difficulty lies in the disorganization of the patient’s world. Something has 26 These were under the direction of Dr. Warren Wilson of the Presbyterian Board of Home Missions. Seward Hiltner (1952) notes this confusion: “he has drawn upon many branches of knowledge—psychology, psychiatry, sociology, history, as well as theology—with the result that a publisher or a librarian may say: But where does he belong?” (p. 8). 28 It remains the case today that hospital psychiatrists frequently only meet briefly with patients to monitor medications. Longer talk therapy is often provided (if it is provided) by psychologists and psychotherapists. 27 13 Journal of Religion and Health (2023) 62:228–254 241 upset the foundations upon which his ordinary reasoning processes are based. Death or disappointment compel a re-organization of his world from the bottom up. That, I think, has been my trouble, and it is the trouble with many others also” (1960, p. 97). It was precisely this distinction that, when Boisen tried to explain it to one of his doctors, resulted in the cancelation of his New Year’s visit to Fred, noted above (1960, p. 109). As a patient, his ideas about his own illness had very little standing. But remarkably, Boisen’s point here is a fresh articulation of one of the central fissures in the history of twentieth-century psychiatry: whether disturbances are “somatogenic” (caused by biological factors) or “psychogenic” (caused by past psychological experience, including trauma). The psychodynamic revolution in psychiatry, which was just beginning in North America at the time Boisen wrote these words, was based in Freud and Jung’s demonstration that many illnesses are indeed psychogenic, and their symptoms—like dreams and visions—often point to past experiences and traumas. Freud was largely successful in getting psychiatrists to see that neuroses—like anxiety and depression—are often psychogenic in nature, and this insight has stayed with us to some extent, even though today antidepressant medications continue to be overprescribed, for both anxiety and depression, and often in the absence of any talk therapy treatment. By contrast, Jung’s insight that psychotic disturbances—like schizophrenia— can likewise be psychogenic in nature, never really found a wide audience. Then as now doctors tend to see the kind of disturbance suffered by Boisen as rooted in biological causes. There is indeed significant evidence that schizophrenia is based in a genetic predisposition, but this fact does not tell us why some people with this predisposition exhibit chronic symptoms, while others have almost no symptoms. Nor does it tell us why symptoms emerge or worsen at particular times.29 The somatogenic approach to psychosis is also the basis for the practice of “redirecting” patients away from their delusional thinking. That is, if the illness is ultimately rooted in biology, there is no need to pay attention to the nonsensical fantasies and visions. “Redirection” remains a basic treatment method today, and it tends to meet with about as much success as it did with Boisen.30 Three months after his first recovery, Boisen wrote to his mother: “Dr. D suggested the other day that I ought to try to forget these abnormal experiences. My reply is that I cannot forget and that I can see no reason to disbelieve” (1960, p. 111). Boisen’s “belief” here was not in the literal truth of his visions, but in some symbolic significance, a distinction his doctors did not seem to understand. As Boisen noted in 1936, the strange ideas of his first disturbance “remain indelibly burned into my memory. There is probably no three-week period in all my life that I can recall more clearly. It seemed as 29 The currently dominant “diathesis-stress” model (Pruessner et al., 2017) suggests that a genetic predisposition (a “diathesis”) will be activated only if certain kinds of stressors are present. And yet the broad category of “stress” is more of a dismissal than a description of any psychogenic process. On the success of the “biopsychosocial” model in psychiatry, see note 6. 30 In my own work as a psychiatric chaplain, I was frequently reminded by hospital staff to redirect patients away from their delusions, likely because so many patients looked to the chaplain as someone 13 242 Journal of Religion and Health (2023) 62:228–254 if I were living thousands of years within that time” (p. 3). Even today there is little evidence that redirection has a beneficial impact, and it has the negative effect of creating a profound split between the experiencer’s belief that their ideas are significant and authoritative, and the doctor’s belief that they are nonsense. This likely has a significant impact on the therapeutic alliance, which, as a common factor, accounts for about 20% of recovery from mental illness and addictions (Comer & Comer, 2019, p. 96). Boisen intuitively followed a more helpful practice, which was to acknowledge the power of the visions/delusions, to let go of literal interpretations, and to remain curious about their ultimate symbolic meaning. In other words, Boisen’s intuitive self-treatment was hermeneutical. This was precisely the view that Jung had already reached at the turn of the century, in his work with schizophrenia at the famous Burghölzli Clinic in Zurich, under Eugen Bleuler, who coined the term “schizophrenia.” At this point Jung had not met Freud, but this hermeneutical approach—Jung’s in relation to psychoses and Freud’s in relation to neuroses—would form the core of their future friendship. As Jung said in his 1961 memoir: It was always astounding to me that psychiatry should have taken so long to look into the content of the psychoses. No one concerned himself with the meaning of the fantasies, or thought to ask why this patient had one kind of fantasy, another an altogether different one; or what it signified… Such questions seemed altogether uninteresting to doctors of those days. The fantasies were simply lumped together under some generic name as, for instance, ‘ideas of persecution.’ It seems equally odd to me that my investigations of that time are almost forgotten today. Already at the beginning of the century I treated schizophrenia psychotherapeutically (1961, p. 127). Footnote 30 (continued) who might finally understand their religious ideas. As one nurse told me during my first week as a chaplain, “about half of these patients are sexually preoccupied, and the other half are religiously preoccupied. You will be very popular with the latter group.” “Redirection” can be applied in different ways, the current practice being to neither affirm nor deny the delusions (but still basically to ignore them). The current website of the National Alliance on Mental Illness, for example, cautions that “going along with a loved one’s delusions—even unintentionally—can reinforce the delusional thought patterns” (https:// www. nami. org/Blogs/NAMI- Blog/ June- 2019/ Psych osis- Responding- to-a- Loved- One- in- the- Face- ofUncertainty, accessed 26 July 2022). A current Boston-area psychosis screening website for doctors and health care workers offers this example of redirection: “During her annual physical, Marie tells you she sometimes speaks to people who are not physically there. When you ask her more about this, Marie shares that her church teaches that the spirits of deceased relatives provide protection and guidance to those still living. Marie’s mother confirms that this belief is shared by the rest of the family. You might respond to Marie: ‘I’m glad that you can get comfort from your relatives. Are things feeling overwhelming right now?’ If yes, or there is reason for concern that she may not be coping well, ‘Would it help to maybe talk with a counselor who is trained to teach people skills to get through tough times?’ Consider culturally acceptable and sensitive options for additional education, support, or therapy.” (https://www. psychosisscreening.org/path-1-reassure--redirect.html, accessed 26 July 2022) Despite the reference to “cultural sensitivity,” most patients will understand the implications of these questions, and will understand what is not being said in this conversation. The fact that “redirection” leaves crucial issues unspoken can itself be “crazy-making.”. 13 Journal of Religion and Health (2023) 62:228–254 243 Even today Jung’s work in this area remains undervalued, and almost forgotten, by psychiatrists. As R.D. Laing noted in 1967, “Jung broke the ground here, but few have followed him” (p. 137). Remarkably, Boisen intuitively knew that searching for the meaning of his visions was part of the cure, and he applied his considerable academic training to the task. Interpretation of delusional/visionary material requires significant knowledge of the cultural symbol systems in which these narratives are embedded. For Boisen, the knowledge the doctors lacked was precisely the knowledge he himself had, that of the humanities—of philosophy and religion: The fundamental difficulty seems to me this: A man whose fundamental derangement is not of the body but in his philosophy of life is sent to a place where they look only at the physical side. Most of the doctors, I think, are not religious men. Many of them regard religion as a superstition which is responsible for many of the ills they have to treat. Such men are not fitted to deal with religious problems. If they succeed in their aims, the patient is shorn of the faith in which lies his hope of cure (1960, p. 101-102). Boisen’s visions/delusions were almost entirely of a religious nature, including a vision of heaven complete with “choirs of angels… the most beautiful music I had ever heard” (1960, p. 89) and a “little lamb” who needed protection. This was followed by a vision of hell complete with the “odor of brim-stone,” “witches,” “black cats,” and “broom-sticks” (1960, p. 91). This series of visions ended with an impressive scene: “I found some sort of process of regeneration which could be used to save other people. I had, it seemed, broken an opening in the wall which separated medicine and religion.” Breaking through this symbolic wall would become Boisen’s life work, and in this vision it was revealed to him as his “new mission” (1960, p. 91). The “little lamb” was also significant in Boisen’s vision as a symbol of innocence,31 often identified with Christ, the sacrificial lamb: “I was worrying about that lamb, and I kept inquiring about it. The idea came, ‘The doctors were very much interested in it and they immediately killed it and preserved it in alcohol because of its scientific interest” (1960, p. 90). The scientific proclivity for making a dead specimen out of a living symbol was another prophetic word from Boisen’s visions, which likewise fell on deaf ears. This vision also provided a potent symbol of the sacrifice, or murder, by the psychiatric system, of the innocent part of Boisen’s own soul—what today we might call his inner child. At the end of his letter to Fred, a month after his first disturbance, Boisen comes to a remarkable conclusion: “This is a long and wearisome and fragmentary account of a very unpleasant experience. I have given it with a definite purpose. It suggests what seems to me a very important principle: The cure has lain in the faithful carrying through of the delusion itself” (p. 101). The cold baths, cold sheet packs, and 31 “Little lamb” evokes the nursery rhyme, “Mary had a little lamb,” which was well known in Boisen’s day. It also evokes William Blake’s “Songs of Innocence and Experience,” where the “little lamb” is contrasted with the “Tyger Tyger, burning bright.”. 13 244 Journal of Religion and Health (2023) 62:228–254 redirection were all attempts to suppress his delusions. But Boisen was much more interested in letting these visions speak, and in making sense of their meaning. This was no small task, and indeed it became his life’s work. But Boisen was almost totally alone in this work. He had nobody to help him in his search, aside from the sympathetic pastoral ear of Fred Eastman. Interestingly, upon receiving this remarkable letter, Fred had the presence of mind to send Boisen a copy of Freud’s Introductory Lectures on Psychoanalysis. Boisen’ notes that, at this time, he “did not even know that such a man as Freud existed.” He devoured the lectures, electrified by the resonances with his own ideas, and promptly wrote to Fred again: Freud’s conclusions are so strikingly in line with those which I had already formed that it makes me believe in myself a little bit once more. I refer in particular to two propositions: He asserts in the first place that neuroses—i.e., abnormal, or insane conditions—have a purpose. They are due to deep-seated conflict between great subconscious forces and the cure is to be found not in the suppression of the symptoms but in the solution of the conflict. That is just what I tried to say in my last letter (p. 103). Boisen’s lack of familiarity with psychiatric literature is evinced by the fact that he does not understand the basic distinction between neuroses and psychoses. But the resonances with Freud are nonetheless sound. The remainder of the letter brilliantly frames his own experiences according to Freudian theory. As Boisen says, discovering Freud was like looking to the back of a textbook, and finding “that my answer was right” (1960, p. 104). A few months later, now emboldened by the resonances with Freud, and just before his second disturbance, Boisen wrote to his mother with a summary of his new mission (Feb 1, 1921): “In many of its forms, insanity, as I see it, is a religious rather than a medical problem, and any treatment which fails to recognize that fact can hardly be effective. But as yet the church has given little attention to this problem” (1960, p. 111). The same could be said today. Devils with the Pitch‑Forks of Authority In the same five-month period after his first disturbance and before his second, Boisen shows remarkable clarity about the stressors within the system that were weighing on him. In the letter to Fred about a month after his first recovery, Boisen notes that the hospital’s treatments made him worse. After his first recovery, the assistant superintendent paraded him in front of the attendants who had brought him to Westboro a couple of weeks earlier: “Quite a change, isn’t there?” said the superintendent. “It’s certainly a good ad for the hospital.” Boisen writes to Fred, with characteristic politeness, that he is “indeed appreciative of all they have done for me here,” but adds that he “cannot agree” with the superintendent’s “conclusion.” “If I have recovered, as I think I have, I cannot ascribe it to the methods of treatment” (1960, p. 99). Here, thinking like a sociologist, Boisen includes in the word “treatment” 13 Journal of Religion and Health (2023) 62:228–254 245 both the official medical practices of hydrotherapy and cold sheet packs, and the unofficial and brutal physical violence hidden within the system: the treatment given only made me more violent. So far as I can recall, I have never refused to do anything when I was requested to do it by some one in whom I had confidence. Nevertheless, I have been given severe beatings, all because in my bewilderment I did not obey some harsh order by some young attendant. There was little attempt to make use of persuasion or to cultivate hopefulness and self-respect (1960, p. 101). Boisen describes these severe beatings in some detail. The first occurred when he did not immediately obey an attendant’s request to leave the hydrotherapy area: “three young attendants threw me down on the floor and began to beat me up, starting in the small of the back and working upwards.” He soon returned to the hydrotherapy room, and was given a more severe beating. I can feel the effects of it now, even after five weeks… One of the older attendants told me later that I was given what was known as ‘the old bughouse knockout.’ As I was being carried back—for I was not able to walk—I had the momentary consciousness of being once more myself (1960, p. 100). At least two things are worth noting here. First, beatings appear to be a routine unofficial treatment within the system, and second, the initial trauma of the beating temporarily pulled Boisen out of his visionary/delusional state. The latter fact is a caution against all psychiatric treatments that may appear to produce improvement: a short-term reduction in symptoms might come at the cost of a long-term worsening of the overall condition. The trauma of the beatings certainly stayed with Boisen for the rest of his life. The fact that doctors are often oblivious to the actions of attendants allows systemic violence to continue. Boisen returned to this theme throughout his career: “There is no one upon whom the patient’s welfare is more dependent than the nurse or attendant who is with him hour after hour during the day” (1936, p. 10). When he began the CPE movement, his plan was to put seminary students in the role of attendants, hoping that they would provide better, more empathetic care. Continuing his discussion of the violent beatings, Boisen applies his characteristically balanced and logical approach to the general topic of coercion for those in mental distress: Have I, perhaps, failed to recognize sufficiently the need of force in such cases as mine? That need I take for granted. I do not suppose that I would ever have gone to the hospital willingly. My grievance is rather the lack of any attempt to use persuasion or to explain what is being done and why (1960, p. 102). The relevant question is not whether coercion is needed, but how it is done. It is the lack of humane treatment and respect—the dehumanization—that Boisen highlights here and throughout his work. Boisen then continues, confronting another prevailing view within the system: 13 246 Journal of Religion and Health (2023) 62:228–254 The other point is my apparent failure to recognize the seriousness of this disturbance. My answer is that there is hardly any need of stressing the gravity of my situation. The hopeful factors are less apparent, and it is upon these that any constructive future must be built (1960, pp.102-103). Hope is the key. And here Boisen is already adopting the tone of the chaplain and advocate he would later become. We now have research showing that a client’s sense of hope is one of the main common factors affecting recovery from mental illness and addictions. “Hope and expectancy” contribute to about 15% of overall recovery. And, remarkably, this is equivalent to the “therapeutic model” used by the therapist, which also accounts for about 15%. (Comer & Comer, 2019, p. 96). Initially, after his first recovery, the doctors spoke of Boisen’s possible release. On Dec 11, 1920, he writes, “my doctor says I can go home [at] Christmas if the family invites me and that I can be released shortly after New Year’s” (1960, p. 107). From this time forward his correspondence, as he notes, is “concerned chiefly with the obstacles to an early release” (pp. 107–108). He writes to Fred on Dec 16 that “I should prefer not to be transferred to another hospital but to come out under your care.” His reasoning is that he does not want to be retraumatized by another intake process. The system itself, rather than his delusional state, is his main source of fear and rumination: “One of the hold-over ideas I can’t get away from is fear of the doctors and fear of imprisonment.” Specifically, he cannot endure the thought “of having to bare my very soul again,” to a doctor whose main reality paradigm is the medical model: “I don’t like to be dissected as a pathological subject. I don’t want to say more than is necessary and then only to those I trust absolutely” (p. 109). We are reminded here of Boisen’s visionary symbol of the “little lamb”: “The doctors were very much interested in it and they immediately killed it and preserved it in alcohol because of its scientific interest” (1960, p. 90). Holding space for the soul, especially the innocent and fearful child within, is a difficult task, and it is little wonder that the medical model continues to be heavily critiqued by psychiatric survivors. Traumainformed standards of care are now making health workers aware of how standard intake procedures can retraumatize, mainly through the repeated, cold, institutional tone of the questioning. But psychiatric survivors like Boisen were aware of this phenomenon a century ago. After being denied the New Year’s visit to Fred because he spoke of the “purpose” of his delusions to a doctor, Boisen’s letters become darker but more honest. In a letter to Norman Nash, another friend from Seminary, right before his second disturbance, Boisen writes: “I am now in the hands of doctors who do not understand and with whose view-point I am quite at variance… The hardest thing is to realize that those of us who are here are practically counted as among the dead. We have no standing in the eyes of the law. We have no rights. Our word counts for nothing, and our wishes, our feelings, our judgments are only so many reasons for doing otherwise. If I had to describe this place, I would say it is a place of weeping and gnashing of teeth, where the light is gone and the loved ones cut away, while those in control are industriously engaged in suppressing the symptoms which might lead to recovery, all too often through the agency of devils with the pitch-forks of authority in 13 Journal of Religion and Health (2023) 62:228–254 247 their hands… Perhaps this is a bit strong, and yet I feel that it is not far from the truth. This is indeed a place of lost souls and the methods of treatment are nil. It is just a great prison which they call a “hospital.” I am not complaining of my present treatment. I am living very comfortably, too comfortably. I am accomplishing nothing. I am rusting, and sometimes I get very impatient (1960, p. 113). Boisen’s prophetic voice again shines through here, and in the symbolism of this perceptive critique he pictures the psychiatric system through the lens of the visions/ delusions of hell he experienced a few months before. Again, evil forces are at work. We also see him pinpointing the lack of meaningful work, which is an issue he set about ameliorating right after his second disturbance, when he successfully advocated to be the hospital photographer. Meaningful work was another lifelong theme in Boisen’s writing, and it became central to his vision for CPE. Boisen’s second disturbance began as the date of his transfer to a new hospital drew near. The date of transfer was “set for March 25, but on March 24 I became acutely disturbed and had to be sent to Codman Upper, a disturbed ward” (1960, p. 114). Five brief letters to Fred, leading up to the transfer, indicate an increasingly apocalyptic view, as Boisen’s “strange ideas” once again took hold. But in the midst of it he continued to show insight about his own fears: I am feeling anxious about my release, for I am under a heavy strain and I am afraid they may keep me here, when what I need is to be with friends who understand. If anything should prevent my release this week, I fear for the results. The doctors have no understanding of my problem (1960, p. 117). In a letter the next day, he writes, “it is the fact of being still in custody which makes me so fearful” (p. 117). The second disturbance followed shortly after this. According to Boisen, it “was quite as severe as that of the previous fall, and it lasted ten weeks instead of three” (p. 119). It would be impossible to pinpoint any single cause for this second disturbance, and Boisen himself notes that “the causes of this relapse were somewhat complex” (p. 114).32 But I hope it is clear that Boisen’s own understanding of the many forces involved was far more nuanced than that of his doctors: the fact that upon admission to a new hospital he would again have to “bare his very soul,” and be “dissected as a pathological product” by the medical model and its followers—what today we would call retraumatization; the prospect of continued involuntary incarceration, and continued isolation from friends and family; the “suppression of symptoms that might lead to recovery”; the lack of meaningful work; and above all the dehumanization and loss of agency. These critiques are prophetic, prescient, and still relevant. Some of the most damning evidence against the western psychiatric system emerged from a 10-country study conducted by the WHO, published in 1992 (Jablensky et al., 1992; see also Vahia & Vahia, 2008; Dein, 2017; Jablensky, 2000). While the overall incidence of schizophrenia was fairly uniform across various 32 See note 22. 13 248 Journal of Religion and Health (2023) 62:228–254 countries, the study showed that the course and outcome of schizophrenia were considerably worse in more industrialized (the study calls them “developed”) countries. For example, 63% of the cohort in less-industrialized countries experienced complete remission of schizophrenic symptoms, compared to only 37% in more-industrialized countries. And this was in spite of the fact (or maybe because of the fact) that 92% of the industrialized cohort were hospitalized, and 61% of them received heavy antipsychotic medications, as compared to only 44% and 16% respectively in the less-industrialized cohort. Likewise, 42% of the more-industrialized cohort experienced impaired social functioning, versus only 16% in the less-industrialized cohort. There are many possible interpretations of this large data set, but the evidence is clearly alarming. Western medical treatments appear to be making patients worse. Boisen’s explanation, offered far ahead of its time, is that poorer outcomes are associated with isolation in a hospital, social stigma, lack of meaningful work, and suppression of symptoms that might themselves offer therapeutic solutions. Boisen’s Reception History Shortly after Boisen’s death, Seward Hiltner, Paul Pruyser, and Henri Nouwen all published papers about his life and work. Sean LaBat (2021) rightly says that this trio of scholars “may represent the most nuanced, informed, and searching critics of Boisen and his work during his later years” (p. 116). All three are appreciative in certain respects, but all three also engage in vaguely ad hominem critiques of Boisen’s character and personality. Often these critiques are framed as a general scholarly or popular consensus, which the author is attempting to mitigate in some respects. But it would be difficult to imagine how such a consensus could have been reached or measured. It is quite likely that the stigma of Boisen’s pathological life sentence played into these descriptions. And interestingly, the references to Boisen’s odd personality are often connected to his continuing critique of and resistance to the system that incarcerated him. Psychologist Paul Pruyser of the Menninger Clinic actually shared a number of Boisen’s theoretical conclusions. But Pruyser seems more interested in distancing himself from Boisen in the article he published in 1967, two years after Boisen’s death. Here Pruyser sums up what he takes to be a consensus opinion, including the suspicions in some self-respecting scholars that [Boisen] cannot be counted as an important figure in the psychology of religion. With so much personal involvement and so much self-confessed psychopathology, with such ministerial aspirations and such an urge to share his frustrated love-life publicly, indeed with such a religious orientation, can [Boisen] be trusted as a scientist? Can he be seen as a psychologist at all? Were his observations objective? Are they repeatable? Did he have hypotheses, or were his leading thoughts only pet peeves or exalted hunches? Did he use respectable methods of sampling, data gathering and statistical analysis? Was he not, after all, a somewhat odd or sick clergyman? (in Asquith, 1992, p. 147). 13 Journal of Religion and Health (2023) 62:228–254 249 My sense is that these suspicions have more to do with Pruyser than any general scholarly consensus, if the latter even existed. In private, in an interview with Henri Nouwen given in the same year that the above words were published, Pruyser apparently said that Boisen “was not a scholarly man,”33 which, as Sean LaBat notes, is a harsh dismissal for “someone with over eighty published academic writings” (2021, p. 119). In the above quotation it is also easy to detect the pecking order of the psychiatric system, which placed “true scientists”—psychiatrists and psychologists—at the top, and an “odd or sick clergyman” a fair distance below them. In the same article Pruyser notes Boisen’s affinity for George Fox as a sign of Boisen’s own dual character: “the lonely, sick, weird and unique George who was also the socially responsible Fox, symbol of a group and founder of the Society of Friends” (1992, p. 153). Pruyser implies that Boisen’s theories were too indebted to his own experience. He notes that “almost all his writings are intensely autobiographical.”34 And privately, in a letter to Nouwen, he offered the following assessment of Boisen’s autobiography, Out of the Depths, which is “exactly the impression” Pruyser had of Boisen himself: “The language is beautiful, topics are moving, but there is something utterly pathetic about it all. There is something of homesickness in it, ennobled by a sense of suffering” (in Asquith, 1992, p. 158). Publicly, in the 1967 article, Pruyser notes that Boisen’s “preoccupation with his own psychiatric syndrome, its causes and implications, was not without obsessional features” (in Asquith, 1992, p.146). And presumably as evidence for this claim, Pruyser offers the following anecdote: I remember vividly his deep chagrin in telling me, seven years ago when he was working on [Out of the Depths], that the superintendents of the mental hospitals where he had been a patient had persistently rebuffed him when he had earnestly asked that his own case record be released to him for study” (in Asquith, p. 146). Today, of course, patients have a right to see their medical records, and it was survivors and advocates like Boisen who made this right a reality. The power dynamics in the above statement are hard to miss, with Pruyser, the psychologist, viewing Boisen, the patient, as obsessive in his quest to see his own case records, and casting Boisen’s very honest and courageous account of his case history as “utterly pathetic.” Pruyser does mention some positive aspects of Boisen’s work (which are mostly areas of agreement with Pruyser that acknowledge little if any indebtedness). But in general Pruyser’s article casts more shadow than light, and at best Boisen is damned by faint praise. 33 Paul Pruyser Interview, June 14, 1967, Box 290, File 333, Henri Nouwen Papers, John M. Kelly Library, University of St. Michael’s College, Toronto, ON. 34 Henri Ellenberger’s monumental The Discovery of the Unconscious (1970), notes that early psychotherapeutic theories were heavily indebted to the “creative illnesses” of both Freud and Jung. Their personal struggles were part of the genius that birthed their respective theories. The same could be said of Boisen, but Pruyser does not frame it this way. Further, the confessional nature of many of Boisen’s writings aligns him with a stream of spiritual and artistic writers that might include, for example, Augustine’s Confessions and James Joyce’s Portrait of the Artist as a Young Man. 13 250 Journal of Religion and Health (2023) 62:228–254 Likewise, Seward Hiltner, who helped define the field of pastoral psychology and was concerned above all to make it academically respectable, suggests at times that the CPE movement succeeded in spite of Boisen. In an article published in the year of Boisen’s death (1965), Hiltner begins with a tame and generally appreciative summary of certain themes in Boisen’s work, but he ends with a section on Boisen’s “personal heritage.” Here he mentions William Bryan, the superintendent of the Worcester State Hospital, “who had the courage to hire Boisen, an ex-mental patient, as chaplain, and who became a strong promoter of the clinical pastoral education movement,” but who found Boisen’s personality “unattractive.” Hiltner’s assessment is that Bryan “had to say no on many occasions to Boisen’s single-minded devotion to getting the budget he needed for his work… where conviction was concerned, Boisen could set friendship aside” (in Asquith, p. 143). Hiltner’s genteel disapproval, like Pruyser’s, seems oblivious to the sociological power dynamics that were so central to Boisen’s work. Hiltner sees the “courage” of the superintendent who hired the “ex-mental patient,” but pays little attention to the one employee on the hospital staff who never escaped the designation of “ex-mental patient.” Hiltner says nothing of Boisen’s courage in single-handedly confronting a system that had abused him terribly, and in attempting to secure a budget for his fledgling CPE movement by confronting a class of medical professionals who at one time represented his greatest fear.35 The young Henri Nouwen was clearly fascinated by Boisen: He devoted a good deal of his graduate work, including two unfinished doctoral dissertations, to Boisen’s legacy. Nouwen’s article, published three years after Boisen’s death, is probably the most nuanced and perceptive in terms of Boisen’s social location. Where Pruyser sensed “something utterly pathetic” in Boisen’s life story, Nouwen found an honest pathos in Boisen’s loneliness and unrequited love. But Nouwen begins by quoting a personal letter from Pruyser that again issues a cruel and pathologizing indictment, highlighting the ongoing stigma against Boisen, even after his death. Pruyser writes: The most outstanding feature of the man at the time I knew him was his flat affect. There is an awful psychiatric expression referring to chronic schizophrenic patients, who have made a good hospital adjustment, or sometimes have been discharged and live on the outside. That expression is “burned out case.” This phrase came into my mind time and time again when I talked with him and saw him act. He was not without humour and delicacy, but something had happened to his feelings and their expression (in Asquith, 1992, p. 158). If the expression is awful, one wonders why he would continue to use it. Pruyser shows little empathy for what exactly was involved in a “good 35 Hiltner was one of Boisen’s first CPE students at Elgin State Hospital in 1932, and he was on the faculty of Princeton Theological Seminary from 1961 to 1980. In the same article he points helpfully to the fact that Boisen’s vision defied classification: “The old-fashioned liberals were baffled by the pietistic element; the neo-liberals were puzzled by both the pietism and the mysticism; mystics could not understand the devotion to empirical and scientific inquiry; scientists could not quite reconcile themselves to the mysticism and the mental illness; and so on. Boisen did not always make it easy for the theological critic” (in Asquith 1992, p. 139). 13 Journal of Religion and Health (2023) 62:228–254 251 hospital adjustment”—the trauma of adjusting to a carceral existence as a permanently pathologized individual. But while he begins with this quote from Pruyser, Nouwen himself is much more perceptive in uncovering Boisen’s core critique of social stigma: Boisen considered the primary evil in mental illness to be in the realm of social relationships. “We have found,” he writes, “one characteristic common to the group as a whole: they are isolated from their fellows through a social judgment which either consciously or subconsciously they accept and pronounce upon themselves” (in Asquith, 1992, p. 162; Boisen, 1936, p. 28). This is the core of Boisen’s prophetic social critique, and Nouwen is the only interpreter I have found, writing before the twenty-first century, who saw it clearly. It may be that Nouwen’s own social location, as a closeted gay priest whose struggle with loneliness and depression is clear in his writing, allowed for a more perceptive reading.36 Conclusion At the end of a paper like this, and by way of anticipating criticism, it might help to be clear on what I am not saying. I am not saying that all people who experience visions/psychosis receive prophetic messages for the wider culture. In my experience with clients and historical case records, the majority of visionary/psychotic symbolism refers only to the psyche of the experiencer. And yet there are also quite a few cases, like Boisen’s, where some of the visionary symbolism refers to the wider culture. These cases tend to be overlooked and understudied. (There is virtually no research on them.) I am also not saying that all prophecies come in psychotic/hallucinatory/visionary forms, or that all of the prophets of various traditions would be classified by contemporary psychiatry as psychotic. In my work as a therapist I also frequently work with clients’ dreams, and I have been surprised to see how often dreams speak of future scenarios that end up coming true. Often these scenarios involve only the particular situation of the client, but sometimes they also speak prophetically to the wider culture. And often these prophetic dreams arrive with such little fanfare that they are easily dismissed or forgotten by the dreamer. I am also not saying that the hermeneutical method of understanding and treating psychotic/visionary episodes is right for all experiencers. I have known several experiencers who find stability in anti-psychotic medications, and in ongoing reminders that their visions are false and unhelpful. Given that anosognosia or “lack of insight” tends to accompany many psychotic/visionary states, it can be difficult to convince experiencers that their visions are symbolically significant but not literally 36 Subsequent interpreters of Boisen include Powell (1976), Aden & Ellens (1990), Capps (2005), Dykstra (2005), Kramp (2012), Coble (2014), and LaBat (2021). I would single out Capps for his perceptive Freudian analysis of Boisen’s character and psychological conflicts. LaBat’s excellent book is really the first to highlight the ongoing stigma Boisen faced in both his personal and scholarly life. See note 7. 13 252 Journal of Religion and Health (2023) 62:228–254 true. The hermeneutical method of working with psychosis/visions thus needs to be approached with caution and skill. But given all these qualifications, what I am saying is that Boisen was an ignored prophet in at least two senses. First, his warning about our current ecological crisis was prescient. And second, his unique voice as a psychiatric survivor offered a clarion call for social justice both in our psychiatric system and in our broader cultural treatment of those in mental distress. Both aspects of Boisen’s prophetic voice went largely unheard, even by the interpreters who knew his work best. 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