2. Contemporary Psychiatry and the Concept of Responsibility

2 Contemporary Psychiatry and the Concept of Responsibility D. ELTON TRUEBLOOD 1. The Influence of Psychiatry Psychiatry is, by any valid standard of measurement, a highly important feature of contemporary culture. It affects not only those who are mentally ill and the families concerned with illness, but all who try to keep abreast of thought. It is an important fact that "Freudian" has become a household word. The work of Sigmund Freud and his school, including those who were in it and later separated from it, has been widely com pared to that of Copernicus and Galileo in earlier generations. l Though most of our people naturally get their ideas about psychiatric practices and theories at second hand, the permeation of the popular mentality has been amazingly rapid and wide spread. Thus, Dr. Karl Menninger can truthfully say, "For not only medical science and psychological science and sociological science, but literature, art, anthropolgy, pedagogy, and even popular speech show the influence of Freud's discoveries and show them in unmistakable terms." 2 Every thoughtful person is· gratefUl to individual psychiatrists and psychoanalysts who have helped people to recover normal 19 20 Psychiatry and Responsibility powers and to continue with normal living. Psychiatry, at its best, is a ministry J an effort to serve in making life happier and fuller. Sometimes it fails, but at other times it brings immense relief. Macbeth's famous question, addressed to the physician, has been, in many cases, answered in the affirmative. We cannot, of course, prove that the healing has come as a result of what the psychiatrist has done. There is a final sense in which the skeptic cannot be answered, for we cannot be absolutely sure that the patient would not have become well anyway, without the attentions of the psychiatrist, but most of us are not that skeptical. We accept humbly the probability that some men and women are today functioning in normal life, when, without psychiatric assistance, they would still be mentally ill. It must be noted in the beginning of this paper, therefore, that all that is said about the profound danger of some psychiatric teachings is said against a background of gratitude for actual service that has been rendered in a demanding and disciplined profession. The multiplicity of psychiatric jokes does not obscure the reality of the debt.

It is no denial of the sense of gratitude to go on to say that many thoughtful people have strong misgivings about the cul tural and moral effects of some of the ideological aspects of some teachings by psychiatrists. The most common form that the mis giving takes is the suggestion that the popular understanding of certain alleged teachings of psychiatry has served to undermine a sense of moral responsibility. The common expression is, "I am not to blame; I couldn't help what I did; my actions were the necessary result of the events that occurred when I was two or three years old." The area in which this argument has been most dramatically considered is that of jurisprudence. When there is a popular cry for understanding or even for absolute leniency toward the rapist or the kidnapper, the major basis of the appeal is that the recognition of childhood influence takes away all rational possibility of blame. It is an easy step to move from such tolerance toward others to tolerance toward oneself.

What is needed at this juncture is a careful examination, con ducted in the spirit of philosophic inquiry, of the accuracy or Contemporary Psychiatry 21 inaccuracy· of the popular conclusion to the effect that psychiatry undermines the sense of responsibility. Is the popular conclusion a completely unfair perversion of psychiatric teachings or is it possibly based on something that gives a species of validity to the inference? Since it is impossible in the scope of one paper to deal with a great many psychiatric systems, and since, as Dr. Menninger has told us, Freud's system is the one that still has the major influence, it is reasonable to emphasize Freud's work. 3 But we cannot make a serious· study of the cultural effect of Freudian psy chiatry unless we distinguish three markedly different elements in the system. The total work of Freud may be seen as (1) therapy, (2) psychoanalytic theory and (3) metaphysics. We may rightly conclude, as lay people, that the first of these has been and is essentially beneficent. The present author does not claim to be competent to deal with the second. But his entire training and professional interest give him some reason to deal ,vith the third. In so far as Freudian psychiatry is not merely the practice and theory of how to heal the mentally sick, but is, in addition, a philosophical world view concerned with the normal as well as the abnormal, it is only fair that it be judged by philosophic standards. Since a number of well-known modern psychiatrists have set up speculative systems that go far beyond the particu larities of their· science, these systems must be judged not only in terms of their inner consistency and factual reliability, but also in terms of their logical consequences and necessary impli cations. The authors must be ready to defend, not only their original positions, but the subsequent positions to which these necessarily lead.

Perhaps the most surprising fact about the disciples of Freud has been their relative freedom from concern about the ethical implications of their central positions. 4 Sometimes this lack of concern arises from the failure to recognize that they have a philosophy at all. It is often said that they are dealing in purely scientific terms. Some feel that, since, in their estimation, they are presenting the objective truth about human life, they need not be concerned about the consequences in the public mind.

22 Psychiatry and Responsibility The whole point of this paper is the contention that such unconcern for implications is not adequate. Every science is based on philosophical presuppositions and every position entails intellectual consequences. Though this is true even of a physical science, it is even more evidently true of a science that is con-' cerned with human behavior. 2. The Hypothesis of Psychological Determinism We can distinguish today between Sigmund Freud's work as a doctor and his work as a philosopher, but this was something that he was unable to do. Many of his' metaphysical assumptions were so truly unconscious, and therefore, unstated, that he apparently did not even realize that he was making them. This is vividly clear in The Future of an Illusion) in which all the illustrations of religious experience are taken from the infantile, the primitive, and the abnormal, upon the assumption that the fundamental features are thereby made more clear. 5 It is easy for us today to see that this is merely an illustration of the genetic fallacy, the notion, which is far from self-evident, that a thing is really what it has come from. There is just as much logic, and far more common sense, in Aristotle's conviction that the true nature of anything is seen in the light of what it becomes} in full maturity. The end may be far more adequately understood by attention to developed science than by concentration on the magic from which it originally arose.6 The glory of Freud's method of psychoanalysis lay largely in the way in which he convinced all who would listen that the full understanding of any life depends on knowing what is under neath the surface of consciousness. "All that Freud did," says a prominent psychiatrist quoted earlier, "stems from one simple discovery, a discovery based on knowledge which many had possessed before him. This was the knowledge that beneath the surface manifestations of human life there are deeper motives and feelings and purposes which the individual conceals not only from others but even from himself." 7 Freud's originality Contemporary Psychiatry 23 lay in discovering a method of ascertaining and revealing much of this hidden material. He found, as did many of his students, that relief often came when the hidden material was brought out into the open and boldly encountered by the patient.

The philosophic system with which this relatively novel insight was associated, that of reductive naturalism, was by no means novel and by no means necessary, even though many have accepted it uncritically on the assumption that it is simply an integral part of science. At the heart of this world view is a doctrine of deter .. minism which, in psychiatry and especially in the popular con~ ception of psychiatry, has often involved the conviction that all later events in a person's life are the inevitable result of events in earliest childhood. Ira Progoff has put the point in one vivid sentence by saying, "Freud's most obvious weakness lies in the determinism that underlies his work." 8 When a scholar of the character of Progoff wri tes of Freud's determinism, he is not being, in any sense, unfair to the founder of psychoanalysis. Though Freud was not a systematic philosopher and did not always realize that he had a philosophy, his assertions of complete psychological determinism are amazingly unquali fied. An example of his assertion is the following, an assertion which, so far as known, was never renounced: I have already taken the liberty of pointing out to you that there is within you a deeply rooted belief in psychic freedom and choice, that this belief is quite unscientific, and that it must give ground before the claims of a determinism which governs even mentallife. 9 Freud realized, of course, that his doctrine was at variance with the universal experience of freedom, but his loyalty to the world view of reductive naturalism was such that he felt he had to choose between the doctrine and experience, and he had no doubt on which side his choice would fall. Of course, he would have had to maintain, in strict consistency, that he actually did not choose between them, but that even his world view was already determined, but either he did not see 24 Psychiatry and Responsibility this or, if he saw it, did not say it. His rejection of the experi mental evidence of personal free choice is clear and explicit, as follows: Many persons argue against the assumption of an absolute psychic determinism by referring to an intense feeling of conviction that there is free will. This feeling of conviction exists, but is not incompatible with the belief in determinism. lO Freud accepted determinism resolutely and perhaps sadly, because it seemed to him an intrinsic element in the scientific world view, and what we now know as "scientism" was his creed, adopted with almost evangelical zeal. He saw no way to conduct the scientific enterprise without the concept of causality and, partly because he knew so little philosophy, he identified causality with external determinism. This is the significance of the follow ing crucial passage: Does he mean to maintain that there are any occurrences so small that they fail to come within the causal sequence of things, that they might as well be other than they are? Anyone thus breaking away from the determination of natural phenomena, at any single point, has thrown over the whole scientific outlook on the world (Weltanschauung.) 11 Freud failed to realize that he was espousing a philo~ophy, because he believed, uncritically, that he was merely being a scientist and nothing more. Thus, he could say, in all sincerity, that psychoanalysis has no need to create a Weltans.chauung) "for it is a branch of science, and can subscribe to the scientific Weltanschauung." 12 He did not mind being criticized by theologians or men of letters, but criticism by scientists hurt him terribly. Science was his religion, and determinism was a cardinal tenet in the creed. Though Freud has been criticized by psychia trists in the decades since his philosophy first appeared, there has been surprisingly little criticism of the bearing of his determinism on responsibility.

Contemporary Psychiatry 25 What seems so strange to us now is the fact that Freud did not see clearly the logical consequence of his basic assumption. I t is easy for us to see now that, whether psychological deter minism is true or false, if it is true, the entire basis of human responsibility is undermined. Superficially, determinism appears to be a beneficent doctrine, in that it makes planning possible. We can, so the argument runs, set the conditions in the develop ment of character and thereby be sure of the results. Determinism thus seems to be the philosophy that makes human progress possible. A more careful scrutiny, however, makes us realize that the doctrine, if taken seriously and in full consistency, undercuts itself. Planning is indeed possible, if the planner is free, while the subjects of the planning are necessitated, but there is no reason whatever to make this exception. What the planner under takes has itself been necessitated. Therefore, on the basis of determinism, genuine planning is impossible. Each does what he must, and that is the end of the matter. The physician does what he must, and the patient does what he must.

What is highly important to say is that, in so far as the popular reaction has been one of irresponsibility, it is the result of a sound logical deduction, and in no sense a perversion. If my actions can be explained reductively by reference to the events of early childhood, then I am certainly not to blame for what I do. There is no possible escape from the fundamental insight of Immanuel Kant to the effect that there is no "ought" where there is no "possibility." "Should" implies both "can" and "cannot." People, Kant pointed out, are never responsible for failure to do what they cannot do. 13 The stone which rolls down the mountain may cause the death of a man on the road below, but no person in his senses would make a moral judgment on the stone. The action is amoral) and it is amoral because it is exter nally necessitated. If the adult person is equally necessitated, there is no freedom, and consequently there is no responsibility.

Such a position, if taken to its logical conclusion, utterly destroys any rational basis of moral judgment, either about our selves or about others. If determinism is accepted, not only am I not to blame for what I do to my children; neither are my 26 Psychiatry and Responsibility parents responsible for what they did to me, because they had to do it, being determined by their own childhood events. The state is not to blame, for the state is made up of persons, all of whom are in the same amoral predicament. Thus, responsibility may be avoided completely by the simple device of infinite regression. If the Freudian system is true, then Freud and his disciples were predetermined to create or to adopt it, just as their critics were predetermined to adopt their criticism. Truth, under these circumstances, loses its august significance. That which under mines everything really undermines nothing, because it has already undermined itself. A world without either truth or respon sibility would be a world in which great human enterprises, including psychiatry, would be no longer possible. If men are not responsible, i.e., if they are moral automatons, we must eliminate from our speech both praise and blame, including self-blame. It is not intellectually honest to take a position and then be unwilling to take the necessary implications of that position. The basic logical formula, in this regard, is that the denial of the consequent necessitates the denial of the antecedent.

If PJ then q. Not q; therefore, not p. If complete determinism, then irresponsibility: I cannot accept irresponsibility; therefore, I cannot accept determinism. One of the most harmful results· of the popular conception of psychiatric teaching is the undermining of a sense of guilt. "Why," the popular question goes, "should I be penitent when I was conditioned to become the way I am?" The rapist or the kidnapper may actually contend that he is not blameworthy, because he was brought up in a broken home. What seems like confused sentimen tali ty toward the criminal is really common sense, if determinism is accepted as true. Thus, an element in human life which has been almost universally honored would be removed. Much of our literature has celebrated the moral grandeur of the person who criticizes his own act, saying, "I did it, but I ought not to have done it. I am ashamed of myself." Otto Rank points out that psychoanalysis sought to remove guilt by calling it "neurotic." Thus, the sense of guilt tended to Contemporary Psychiatry 27 be seen, not as one of the noblest of human experiences, but as something to be removed as harmful. Now it is undoubtedly true that there is neurotic guilt, sometimes with no basis in fact, and anyone who cares about human welfare hopes to see it removed,14 but to attempt to eradicate all guilt would effect a terrible reduction in human experience. In our great tradition of Western philosophy the sense of shame has. been seen as some thing of which men should not be deprived. In Plato's Symposium we reach a very high point when Alcibiades bears witness that Socrates is the only man who has ever made him feel ashamed.

It was his noblest experience. For he makes me confess that I ought not to live as I do.... And he is the only person who ever makes me feel ashamed, which you might not think to be in my nature, and there is no one else who does the same. For I know that I cannot answer him.I 5 What needs to be made clear at this point, though it is not frequently said, is that the full acceptance of the implications of psychological determinism makes for a remarkable sense of comfort. It allows a man to look upon his own acts with a mood of detachment, in which he can be as tolerant of himself as of others, because the acts are literally not his, inasmuch as they are caused by outside events. Even his character has been formed by anterior influences. Thus, he can look at himself with as much freedom from remorse as he would at another. In short, he has a device that frees him from ethical concern altogether.

He may say, in the light of what he knows now, that he would not have done the same thing then, but this is a perfect way to save the ego, for he did not know the same thing then and con sequently was not guilty. True remorse involves a careful recogni tion of the temporal reference. The deed I criticize in myself occurred then) not now. If I am truly penitent, I mean that I abhor what I did then) in the light of what, I then was and what I then knew. A fully deterministic view of human actions renders forgiveness both unnecessary and foolish. If the person does what he must, 28 Psychiatry and Responsibility there is nothing to forgive. Naturally, many people love such a doctrine and wish that it were true, because it brings so much comfort. It is, therefore, a prime example of wish fulfillment. We all know that the conscious mind really loves to escape responsi ... bility. The easiest way to escape is to claim the innocence of the automaton.

The strength of psychological determinism, as a logical case, always lies in presenting the alternative as a system devoid of causation and therefore unacceptable to natural science. What ever in our world is completely undetermined, in the sense that there is no causal order, obviously cannot be fruitfully studied. The determinist makes plausible his particular theory of order by reference to the confusion of disorder, which we are bound to reject. But the fallacy of this approach is the fallacy of assum ing that there is only one possible alternative. The alternative presented, in order to be summarily rejected, is often referred to in what is little better than caricature, that of the capricious ness that follows from the complete absence of causality. What is important to say is that no philosopher of any stature has ever espoused a conception of psychological freedom as wholly un caused. What the great tradition has taught is that there is a third possibility, which is as far from capriciousness, on the one hand, as it is from absolute determinism, on the other. We need, in each succeeding generation, to give our most careful thought to the elaboration of this third possibility as something that is com patible with human experience when it is critically examined, without the obscuring effects of dogmatism.

One of the most helpful of contemporary thinkers in regard to this particular problem is Albert Outler, who follows many great philosophers in rejecting both determinism and indeter .. minism as popularly understood. In regard to determinism he writes: There are admirable motives for maintaining this general view-all except the final contention that this outlook is self-sufficient.One of the good motives is to deny the antithesis of indeterminism and to affirm that human events belong to an orderly and intelligible process. An· Contemporary Psychiatry 29 other valid motive is to deny that human willing could; under any circumstances, effect an increase in the fixed quantum of the world's energy system-and also to affirm that all human actions operate in the same energy system as do all other determinate events. One may readily agree to all this and still be far from being persua~ed that determinism-even a soft determinism-gives us an account of the experience of responsibility which we know as an essential aspect of sel£hood.16 What contemporary psychiatry needs is ihelp on the philosophi"

cal leveL It is fair to assume that men deeply concerned with their patients do not really want to espouse a doctrine that is harm" ful to our general culture and hurts those who are not their patients. The problem· is that they see one side of a dilemma so vividly that they are unable to see the other, or, more precisely, that they do not see how to construct a world view in which both a measure of freedom and a measure of determinism can be included without contradiction. The philosophical task, for the psychiatrist or for any serious thinker; is how to state the in" evitable paradox without transgressing the logical law of non .. contradiction. We need the introduction of creative ideas, two of which are eminently clarifying. 3. The Idea of Personality The first of these is the conception of what it means to be a person. The common mistake; particularly among positivists and all who have made a dogma of "scientism," is to fall into the oversimplification of confusing person and thing. We know some"

thing very important about the world when we know that it has persons in it; and this we know at first hand rather than by specu lation because we are persons ourselves. The significant fact is that there is a radical difference between persons and things. Hegel was followinga logical order when, in his Phenomenology, he introduced the conception of thing before he introduced the conception of person, for thinghood is comparatively simple. A thing is fundamentally an object rather than a subject. We are 30 Psychiatry and Responsibility deeply indebted to Blaise Pascal for showing the staggering dis proportion between the reality that man knows directly within himself and that which he finds in the world that surrounds him. The world consists of things, but man is a subject. "Therefore he cannot hope to comprehend his own nature by means of the sort of knowledge whereby he apprehends the external world." 17 To apply to man the same kind of causation that is observed in the external world is to be guilty of a manifest non sequitur.

It is more reasonable to expect a new kind of causation where there is a new kind of reality. No one has stated better than has Pascal the fundamental discontinuity in reality as experienced. "From all bodies together," he writes, "we cannot obtain one little thought; this is impossible, and of another order. From all bodies and minds, we cannot produce a feeling of true charity; this is impossible, and of another and supernatural order." 18 Since the orders are different, it does not follow from the fact that actions of things are necessitated that the actions of persons are similarly necessitated. Whereas a thing is essentially passive, dependent upon outside forces for changes in its movement, a person is essentially active. The category of necessity need not apply to personal decision, because, though the prior conditions may set limits, they do not provide all the factors. The extra factors arise from the person's ability to initiate true novelty. Only man, says Kierkegaard, makes history, and this he makes precisely because, being personal, his decisions become active and hitherto nonexistent factors in the producing of events. Man cannot make any machine that is free, but he himself is free, in that he challenges rather than merely accepts and obeys the dictates of conditions. Man's true role is that of an actor.l 9 Therefore, though he is never entirely free of conditions and conditioning, he is more than the sum of condi tions. He is the creature who can say no to his temptations, and this he does, whenever he does it, in the light of a personally accepted standard that may not be identical with any standard handed down to him.

A person is most truly a person in moments of decisions, par.. ticularly those in which he makes decisions that lead to subse ..

Contemporary Psychiatry 31 quent decisions, both for his own future and the future of others. Many decisions are extremely difficult because they are fraught with danger, whether the danger of commission or of omission. Such a decision was that of President Truman, when, in the summer of 1950, he decided to resist aggression in Korea. If anyone wants to say that such decisions are Ulere resultant~ o£ prior forces, he is free to do so, but, in doing so, he contradicts nearly all conscious human experience. What he is really doing is to prefer a dogma to well-attested experience and experience at the deepest level. It is easy to say that two persons with identical prior influences would perform exactly the same act, which is what orthodox psychological determinism says, but this is to introduce a purely hypothetical situation that never, in fact, occurs. Identical situa tions are purely fictitious. The only serious way to pass from dogma to empirical verification would be to engage in predic tion, but this is an enterprise in which the staunchest devotees of the doctrine are slow to engage, and understandably so.

We cannot speak truly of what it means to be a person without recognizing that freedom, in the sense that the very act of decision makes a difference, is not a speculation, but the factual base from which we start. The tree is just what it is, but man is never that. For man and for man alone, so far as our experience goes, ours is an open universe. This is both his danger and his hope. Conversion occurs, and it frequently occurs in maturity. A man sometimes starts a really new chapter, pointing his life in a new direction, and this he does by the magic of thought. That this occurs is much stressed by Dr. C. G. lung, who has shown us the phenomenon of a man getting a new picture of his own life, which becomes a dynamic factor in the determination of future events. This is far from indeterminism, but it is also far from the determinism of reductive naturalism. Freedom does not mean an absence of causation; freedom means that the person is a creature who can have a hand in making himself what he is to become. This often makes for anxiety, but it is better to be anxious than to be irresponsible.

32 Psychiatry and Responsibility 4. The Reality of Time Another conception that helps to produce an acceptable third possibility is that of temporalistic realism, a conception associated especially with the thinking of Professor A. O. Lovejoy, of Johns Hopkins University.20 If the factor of time could be neglected, there would be a certain plausibility in the kind of positivism that denies freedom. The forces and stresses would be similar to those studied in physics. But the moment we take time seriously, we have a striking emancipation from such a pattern of necessity. The present is not merely the sum total of the past, or the accumulated past in disguise; it is something truly novel. Every moment is actually new and therefore full of new possibilities. This is why the idea of emergence can be defended logically. The present emerges out of the past, but is not the past. It may be freely admitted that there is an element of mystery about time, but this is true of any significant feature of expe rience. We cannot really conceive, for example, what the con nection between body and mind is, though we know from experience that they are connected. We do not know how that which has mass can give rise to thought or awareness, in which the conception of mass is strictly meaningless, but we know, in fact, that the one leads to the other. Similarly we do not know how thought, which has coherence, but not weight, can lead to the change in circumstance of that which does have weight.

We do not know what it is to be merely corporeal, but we do not doubt that some objects are in this state. Thus, when we assert the reality of time and the radical distinction between the present and the past, we ought not to be diverted by the fact that we do not fully understand what time is. There is great merit, as T. H. Huxley suggested, in sitting down before the fact as a Iittle child. What do we reply, to the critic who says that freedom is simply not a fact? We can, ih the first place, ask him how he knows this to be true. When he tries to answer this question, he can hardly Contemporary Psychiatry 33 avoid noting that he is speculating and extrapolating. He is, in reality, denying an experience of his own in deference to what is only a doctrine. We are not likely to forget the wisdom of Dr. Samuel Johnson when he said, in discussing freedom, "Sir, no man believes himself to be impelled irresistibly; we know that he who says he believes it, lies." 21 When anyone says that a man's decision to act is the exact outcome of prior psychological forces, he is, often without know ing it, engaging in an analogy. He has some reason to think that the progress of a billiard ball depends exactly on prior forces, including the thrust of the cue, the resilience of the walls, etc.

But there is no self-evident reason for supposing the same situa tion will obtain in thought. To argue, on this basis, for psycho logical determinism is to make a mere analogy carry a logical burden for which it is not adequate. In the realm of thought, there are) of course, prior considera tions that are influences, but there is something else that is not a factor in the experience of the billiard ball. There is thought itself. Often a man waits, considers, defers action, thinks, and then finally acts. There is every reason to suppose that the new think ing is an actual component of the total cause. It is here that true novelty occurs. It is here, accordingly, that the sense of respon .. sibility has a rational basis. The second thing to say to the person who denies freedom as a fact is to demand that he follow rigorously the consequences of his own announced position. He must, accordingly, give up all use of praise or blame, either in regard to himself or to others.

It follows, if all apparent decisions are deceptive in that they are really necessitated, that no act in the world is more creditable than any other, for all are inevitable. This makes all the vast liter ature of moral judgment mere nonsense. We can have a certain respect for a person who will thus rigorously accept B when he says A) but we cannot honor him at all if he takes a position and tries to evade or avoid the logical consequences which that position entails. The fundamental form of the philosophical criticism of psychological determinism is thus a· reductio ad absurdum} based on the demand for intellectual consistency.

34 Psychiatry and Responsibility The defender of determinism has only two alternatives: either he must accept the unsavory consequences, or he must find some way of showing that these consequences do not really follow. If he tries the latter, he is going against the main historical stream of philosophical thought. 5. The Existential Contribution A new element has come into the public debate about psychiatry and responsibility in the work of contemporary existen tialists. Particularly valuable is the work of Karl Jaspers, who, in his long and eventful life, has been both a practicing psychiatrist and a philosopher of the front rank. The problems we are dealing with in this paper, which are fundamentally philosophical rather than psychological, help us to understand why Jaspers felt that he had to move over into philosophy. He early saw that he had to reject the monistic simplicity that is the hallmark of positivism, because "even if all phenomenal knowledge could be drawn together into a single, consistent system, man would not fall wholly within that system." Man would be outside the system, not because of temporary ignorance of conditions, to be removed by later refinements of method, but because he is fundamentally a subject, not an object, and therefore free. This makes a dis tinction of kind and not of degree. It opens the possibility of order, yet order of another kind than that of natural necessity.

No living existentialist has been more insistent on the impor tance and centrality of responsibility than has Jean-Paul Sartre. 22 Though with a theological conviction diametrically opposed to that of Pascal, he stresses, almost as much as Pascal did, the combined fact of man's littleness and grandeur. Sartre, like Pascal, knows that man is both bestial and the owner of some thing that beasts do not know. There are dark recesses, he realizes, in the human heart, but there is also the ability to recognize them for what they are and to oppose them. There is a strong tendency in con ternporary thought for man to be "deper sonalized," but Sartre notes with satisfaction that a man can Contemporary Psychiatry 35 resist this tendency, and he resists it by accepting his freedom. The task is to use nature so that it facilitates rather than engulfs , a man's freedoln of decision and action. Sartre really makes responsibility his philosophical fulcrum, on which all else depends. If any philosophical system is incom patible with the validity of the sense of responsibility, that is just too bad for the system, for responsibility, he holds, is the inner core of the indubitable. This seems to be one reason for his celebrated atheism. He is sorry, he says, that God is not, but his conviction that there is no God only strengthens his sense of being personally responsible for his decisions. Just as he cannot blame his present actions on his heredity or environment or on his childhood influences, so also he cannot blame them on Almighty God. If he goes wrong, he has himself to blame, and he hopes he has the manhood to accept the burden rather than to take one of the more fashionable ways of escape, including the religious escape of belief in divine determinism.

J aspers, who is more nearly agnostic than atheist, agrees with Sartre on the prime importance of a sense of responsibility, which he says psychotherapy should take as its basic category. In short, instead of encouraging people to believe that they are not respon sible, as some psychiatry does, the therapist must make it his purpose to build up the noble posture of nonescape. When a man can say, HI did it; I am ashalned; I shall try to do better," he is already on the road to genuine h~alth. A sense of responsibility can be lost, says Jaspers, but only pathologically. For the deeply ill person, liberation from a neurotic sense of responsibility may be highly desirable, but this is not the situa tion of the average man. The ordinary person, who is neither wholly well nor wholly ill, needs a philosophy of life which will strengthen his will and prevent the luxury of escape from respon sibility. In so far as psychiatric thinking can include such an approach, it will not only be better philosophically; it will also be better psychologically, because it will be closer to the truth about the human mind. The· best psychiatry will make the con cept of responsibility central, and it will accept a world view 36 Psychiatry and Responsibility in which responsibility makes sense. Even though it accepts the therapy of Freud, it must therefore reject, at a crucial point, the philosophy of Freud.

It has been the boast of psychiatry, including that kind of psychiatry that is conscious of its debt to Sigmund Freud as one of the revolutionary thinkers of the modern world, that it has been able to set men free. Men have sometimes been set free from burdens that they have been unable to lift alone. But psychiatry cannot succeed in its task of liberation unless it has a philosophical structure that makes responsibility a rational pos sibility. The danger is that it will espouse a system that finally undermines all that good men, including the psychiatrists them selves, hold dear. If persons are cured of some ills, but lose their sense of responsibility, the price paid in our general culture is unacceptably high. The good news is that a more careful atten tion to our philosophical heritage, both ancient and modern, renders the paying of this unacceptable price unnecessary. NOTES 1. Though the comparison of the work of Freud to that of Copernicus and Galileo is familiar to many, it may be a surprise to some to realize that Freud himself was apparently the first to make the comparison. See the essay by Alfred Kazin, ''The Freudian Revolution Analyzed," Freud and the Twentieth Century, edited by Benjamin Nelson (Meridian Books, 1957), pp. 13-21.

2. Karl Menninger, A Psychiatrist's World (New York: The Viking Press, 1959), p. 821. Dr. Menninger points to the paradox that the United States, of which Freud had a very low opinion, is "the country in which his theories are best known and most widely accepted," not merely by the public but by medical scientists as well. 3. Dr. Menninger's judgment in such matters is one that we are forced to take seriously, in view of the national reputation that the Menninger Clinic of Topeka, Kansas, now enjoys. 4. One of the few attempts,. on the part of those favorable to Freud's general philosophy, to face the consequences so far as responsibility is concerned is that of Abraham Kaplan in Freud and the Twentieth Century, chap. XIII. The chapter is called "Freud and Modern Philos ophy." Unfortunately, the author devotes only four pages to the subject and treats it lightly.

Contemporary Psychiatry 37 5. In another connection, in 1 'he Philosophy of Religion (New York: Harper and Brothers, 1957), chap. XIII, I have gone into this point in detail. 6. Note the pertinent remarks in the new book The Phenomenon of Man, by Pierre Teilhard de Chardin (New York: Harper and Brothers, 1959), p. 89: "It is not in their germinal state that beings manifest themselves but in their florescence." 7. Menninger, Ope cit., p. 821. 8. Ira Progoff, The Death and Birth of Psychology (New York: The Julian Press, 1956), p. 197. 9. Introduction Lectures on Psychoanalysis (London: George Allen & Unwin, 1923), pp. 87, 88. 10. Psychopathology in Daily Life (Basic Writings [The Modern Library, Random House, 1938]), chap. XII, p. 161. 11. Introduction Lectures on Psychoanalysis, p. 21. 12. New Introduction Lectures on Psychoanalysis (New York: Carlton House, 1933), p. 248. 13. A Critique of Pure Reason, Transcendental Dialectic, Bk. II, chap. ii, sec. 9, iii. "There is in man," says Kant, "a faculty of determination independent of necessitation through sensuous impulses."

14. Note Christ's removal of harmful guilt feeling in the cure of the paralytic. (Mark 2:9.) 15. Symposium, 216. 16. Albert Outler, Psychotherapy and the Christian Message (New York: Harper, 1954), p. 90. 17. David Roberts, Existentialism and Religious Belief (Oxford University Press, 1959), p. 36. 18. Pensees, No. 792. 19. This insight received its classic expression in Plato's Phaedo, 80a and 94b, particularly in the reply to Simmias. 20. See Professor Lovejoy's essay, "A Temporalistic Realism," Contemporary American Philosophy, edited by George P. Adams and William P. Montague (New York: The Macmillan Company, 1930), II, 85-104. 21. James Boswell, Life of Samuel Johnson, IV, 230. 22. See especially "Existential Psychoanalysis." This is available in Jean Paul Sarte, Existentialism and Human Emotions (New York: The Wisdom Library, 1957).