6. Conceptions of Health

6 Conceptions of Health GEORGE P. GRANT To start from a traditional platitude: Health and disease are generally described in relation to each other, and therapy is de fined with emphasis on one or the other. Thus, in the Oxford Dictionary one finds under "therapy" such phrases as "the art of healing" and "the curative treatment of disease." The verbs "to heal" and "to cure" are both defined as "to restore to health." To restore is to give back, and so curing implies the loss of something that is normally present and that now through therapy is given back. We are inclined, however, to look at the matter the other way around when we are being practical. We think of our breath .. ing only when it is obstructed. Health is thought of as the absence of disease. Indeed, in the disease-therapy-health progression, ther .. apy inevitably looks both ways, and in the various moments of its activity fastens its gaze now this way, now that. This is true of all the influential systems of therapy, both in the past and in the present. From the western tradition I single out the two most influential-the Platonic progression, "ignorance--conversion to dialectic-illumination," and the Christian progression of "sin repentance through grace-salvation." These two have often been united; they have often been thought of as one. Without discuss ing this subtle matter, I will for the present purposes distinguish them. From the modern world I single out the medical pattern.

"neurosis-psychotherapy-normality." 117 1.18 Psychiatry and Responsibility In these systems, therapy has its positive and its negative moments. The philosopher must be continually aware of his ignorance if he would persevere in the pursuit of wisdom. If the Christian is to be in true repentance before the Cross, he must face some of his past acts as sins. The patient must admit the unconscious source of some of his acts if the analysis is to be a success. On the other hand, philosophy will be frustrated by mis ologism if its dialectical struggles are not known as leading to the Good. The Christian's repentance will leave him a Stoic or a Pharisee if it is not seen as preparation for the divine love. The modern patient must give some meaning to the idea of normality. Indeed, one aspect of the art of the therapist is to find a rhythm between these positive and negative moments suitable to the indi vid ual case.

As modern psychotherapists have made their art central to North American society and established an institutional frame work appropriate to their social power, two phenomena about their theory and practice become increasingly evident-the cer tainty of their conceptions of disease, the vagueness of their con ceptions of health. To account for this would require a book of social history and is not my purpose here. Some generalizations about it can, however, be made. 1) In the work of the master himself, therapeutic pessimism is continually present. This seems to me to arise above all from Freud's ambiguous relationship to modern science and the modern assumptions about man and civilization which are the framework of that science. He writes of himself as one of the dedicated priesthood of science who have put aside the ancient religious and metaphysical superstitions and who can, therefore, dis tinguish provable knowledge from mythology. Basic to this positivism is the identification of knowledge with human power to change the world. At the same time, one result of his science ,vas an account of the structure of the mind in which reason is viewed both phylogenetically and ontogenetically, as arising from the suppression of the instinctual in man. That suppression of the instinctual is seen as the very cause of personal and social disease. The gaining of power over nature, central to modern Conceptions of Health 119 science, is the very cause of disease when applied by man to himself.

This ambiguous relation toward science is illustrated in the very history of Freud's work and in his account of that work. In his writings before 1919, he is firm in stating the methodological principle that his conceptions are not final, but are hypotheses to be changed readily in the light of observation and practice. Yet even these earlier techniques and conceptions are themselves based on something extrascientific-his own self-analysis of the 1890's. To see that this self-analysis is extrascientific in psycho analytical terms, it is only necessary to state that since Freud's day all professional analysts must themselves be analyzed by somebody else. The very term "self-analysis" is one of ridicule to the orthodox. Yet for psychoanalysis to come to be, there had to be an original self-analysis. It is for this reason that Freud's most loyal disciples, while praising him as the great scientist of the psyche, still write of this self-analysis in language that believers would use about the redemption of the world by the passion of Jesus Christ. According to Edward Glover, there have been two moments in history of crucial significance-the first repression buried deep in primitive times and Freud's recognition of the causes of repression in his self-analysis. That language of unique ness and victory is best found in Ernest Jones' life of Freud on the first page of the chapter on the self-analysis. "Once done, it is done forever," writes Jones as a latterday St. Paul. This is not said to cast ridicule on this great act of Freud by comparing it with the act of acts, but simply to point out that the basis of modern psychotherapy is not a scientific discovery in the proper sense and that there is an ambiguity in the Freudians resulting from their insistence both that they are scientists and yet that they must pay homage to this act.

Indeed, in Freud's later writings (Civilization and Its Discon tents most particularly), he passes completely beyond the scientific into the metaphysical. Eros and Thanatos, which are the final rulers of human existence, are not written about as scientific hypotheses, but as postulated realities from which he deduces a metaphysic of history in terms of which his therapeutic and 120 Psychiatryand Responsibility social pessimism, implicit in his earlier practical works, is lifted to a new level of intelligibility. Civilization is a product of the ego and the superego, which arose as the individual was forced to come to terms with "reality" -that is, to live by the reality prin ciple rather than by the pleasure principle. Freud works out this tragic history, not only in terms of the life of the individual, but of the race as a whole. Sexuality is the basic manifestation of the life instinct, Eros. Civilization is produced by sublimated Eros.

But sublimated Eros is desexualized Eros. Thus, though civiliza tion is built by Eros, constant desexualization is necessary as civilization broadens its sway. Hence, Eros is weakened, and the death instinct is released, with all its potentialities for destruction. In fact, civilization moves to its destruction as it moves to its fulfillment. Here is no optimistic "gnosticism" of progress, but a statement of certain necessary limits to human existence. The earlier insistence by Freud that psychoanalysis is part of the liberating tradition of modern science here openly meets the facts that western civilization's modern mark has been science, that the mark of that science has been the pursuit of power, and that, therefore, modern science is a result of the successful repression that western man has imposed on the free play of his instincts, and this in turn causes the releasing of the death instinct.

Freud's therapeutic pessimism is thus understandable, and it is no wonder that health for man is a very limited state. Therapy does not result in a return of the repressed instincts to full play, but to a sublimation through recognition of what has been re pressed-a sublimation which holds in check the death instinct, but which has inevitable stoical undertones. It is not too much to say that health becomes for Freud the making of the best of a bad job. His metaphysical and tragic sense of life leads him to assumptions about human existence very different from the optimism so characteristic of the science of his day. Such a posi tion could not include any clear or positive account of what constitutes health for human beings. 2) As the psychotherapeutic movement changed from its origins as a minority of secularized Jews living in the alien atmosphere of the Hapsburg Empire to the wielders of social power that they Concep tions of Health 121 are now in North America, it is not surprising that their con ceptions of health should have been modified. Their enormously rapid rise to a position of ascendance ,vas partly made possible by the fact that they remained within the medical profession. In early t\Nentieth-century America the medical profession had un equalled prestige because it combined the power of modern science with the practical "do-goodery" of liberal Protestantism.

And the medical profession itself-particularly its more advanced members, who were held by the religion of science-had a clear interest in accepting psychotherapy. The very arrogance of the modern medical profession saw in the new successes of psycho therapy-assumedly carried out entirely within naturalist as sumptions-the chance for themselves to be the arbiters not only of the body but of the mind. American scientists and doctors were much more practical and immediate than the Europeans from whom psychoanalysis had sprung. Freud may have thought that he had freed his mind from finalist conceptions in the name of positivism, but this for him was mere theory compared to the unphilosophical practicality which was the very fabric of the American Protestant scientist. In accepting psychotherapy, there fore, American medicine was not only influenced by it, but also put its arrogant practical stamp upon it.

Further, as psychotherapy took over the leadership in providing mental health in a mass society, it was inevitably caught even deeper in the dilemmas of responsible success. So psychotherapy was influenced not only by American medicine but by the whole fabric of American culture. Professions do not gain power in any society unless in large measure they do what powerful influences in that society want. Psychotherapists adjusted themselves to the needs, desires, and interests of the industrialized, democratic, capitalist society. Finally, as responsibility for the mass society grows, the very immediacies of practicality push the profession farther and farther away from clarity about its ends. When a physician attends a child with earache, obviously something needs to be done. When the child is better, the doctor has a waiting room full of patients and has little time to define health other than to say that the child can now do what children generally 122 Psychiatry and Responsibility do in our society. Most parents and doctors will settle for such a pragmatic account of health. So equally the office of the psycho therapist is crowded, and beyond is the specter of the mental hospitals. The patient may still be neurotic, but she can now function as a wife and mother and need not come to the office or, worse, go on to the mental hospital.

In this paper I am criticizing the emptiness of modern psycho therapy in terms of ultimate truth. But let me state unequivocally that "getting on with the job" is a necessary moral maxim for all men. What the world tends toward without it is seen in quietist societies, and against this we may thank God for our activist tradition. Any theorist who neglects the circumstances that make the maxim necessary neglects an essential aspect of truth in the name of theoretical pride. This is so even in North America, where the maxim is so often an excuse for idolatry. At the same time, however, it is permissible for the theorist to point out the ambiguity in men who arrogate to themselves more and more social power and then justify their confusion by how much work they have to do. The absence of any definition of health in modern psychotherapy is certainly in part a function of this latter process.

This absence of interest in the meaning of health is seen not only in the everyday work of the clinician, but in the supposedly theoretical books. that influence the practitioner. a) Otto Fenichel's The Psychoanalytic Theory of Neuroses is (I am told) influential among practicing therapists. They use it to pick out a description of some symptom they have met in their work. It is a plumber's manual for the Freudians. It achieves this by eliminating all of Freud except that which concerned the immediately useful to the practicing therapist. It takes Freud's writings (between his self-analysis and 1919) and turns them into clear-cut accounts of a method of therapy written entirely within the assumptions of naturalistic positivism. The result of this "demetaphysicizing" process is six hundred pages of details about techniques of therapy and a few vague lines about the purpose of therapy. Fenichel gives some meaning to that purpose by making a short obeisance to genital primacy, but he does not Conceptions of Health 123 give substance to that term or show what it means within a systematic account of human nature and destiny.

b) Personality and Psychotherapy by Dollard and Miller of Yale is an influential book in the conversations between psycholo~ gists and psychotherapists. It attempts to integrate the "learning theory" of modern experimental psychology with the methods and ideas of the Freudians. Here pragmatic American good sense is right in the picture, so that the metaphysical and aesthetic elements in Freud are further eliminated, and solid American individualism can come more clearly to the fore. Though I am sure that personality cannot be a solely objective category and that we shall not find out much about persons as personalities by limiting ourselves to the observational methods of modern science, there is something to be learned about persons by such methods and no great harm is done as long as the results are not thought of as self-contained. Dollard and Miller, indeed, say some quite interesting things about the learning process. But they also claim to be writing of therapy, and here, of course, their method has greater limitations because therapy is a practical art concerned with realizing goals in human life. The result is that when they write about therapy, they write about its methods, implying that all sensible middle-class Americans know what the goals are. Their assumed goals are the perfectly decent ones of liberal and gentlemanly minded eastern seaboard professors. The assuming rather than the rational examination of such goals obviously implies a reliance on the massive middle-class con~ sensus about such goals. Such an assuming of the consensus always exerts more immediate influence than the attempt at theoretical clarity. But it is bought at the price of that sloppiness which more and more characterizes the social sciences in North America. From it we cannot expect any clear thought about human health.

c) Psychotherapy by Reciprocal Inhibition by J. Wolpe is an account of an attempt to use the findings of Pavlovian behavior ism for the purposes of therapy. In the era of coexistence the Russians are looking more favorably to Freudianism, \vhile the West is looking more favorably to behaviorism. It is to be 124 Psychiatry and Responsibility doubted whether the West has got the best of the bargain. Pro fessor Wolpe has been willing to go in for the systematic manipu lation of cats so that he can discover means by which human beings can be brought to "natural" behavior. As in the case of Dollard and Miller, the meaning of the "natural" is just assumed, and it is a cruder meaning than theirs-the tough and insensitive middle-class life of the British Dominions. Here we have two hundred and twenty pages of technique and one sentence of positive description of the goal of therapy. With Professor Wolpe one cannot avoid the rhetoric of anger and outrage, for he has that staggering blend of inane innocence and arrogance which goes with the social engineers who have been educated only in the physiological and mechanical aspects of the tradition. Freud knew so well what causes men to enjoy manipulating people by stringent techniques.

d) My last example is Current Concepts. of Positive Mental Health-a report to the American Joint Commission on Mental Health and Illness by Dr. Marie Jahoda. After Wolpe, here we return to the human. It is an attempt to describe the content given to the idea of health in the mental health movement. The writer is a civilized American scientist and therefore can present her material systematically. The positive content described, how ever, is an extraordinary amalgam of ideas from the American tradition-Hautonomy," "mastery of environment," Hperception of reality," "attitudes to the self," etc. It is remarkable to find the common-sense platitudes of current American civilization (a mixed bag of many subtle traditions) being put dovvn as the result of objective psychological investigation and thus given status as scientifically established. The truism that America is the only civilization with no history before the age of progress is here brought home by the complete acceptance of the scientific mythology and the disregard of the metaphysical and religious issues that western man has always assumed were involved in the concept of health. One can understand why certain Europeans doubt whether we really belong to that tradition at all, when there seems to be no knowledge of it before 1800. For example, "autonomy" is taken as a criterion (how could it not be in Conceptions of Health 125 democratic, pluralist America with its Protestant traditions?), and yet any systematic account of what is meant by it, or why it is good, is entirely absent. Thus, the attempt to be positive about health only ends up with accepting the general standards and giving them status by disguising them in the jargon of the social SCIences.

In contrast to the growing vagueness about health among psychotherapists, there is one group of Freudians who give a definite and positive content to their concept of health and justify that account within a philosophy of nature and history. They are those who have attempted to unite the thought of Freud and Marx. For the rest of this paper I intend to describe and comment on these thinkers. I do so because in them the assumptions of modern humanism about man and society are enunciated in a most explicit way and also because in them much that is un systematically assumed in official therapy is openly asserted. To put the matter historically: Since 1914 it has surely become obvious that the truth of the assumptions of modernity cannot be taken with quite the uncritical certitude that they were pre viously. (I use "the assumptions of modernity" in the broad sense to distinguish them from those of the antique world and from those of Christianity). Yet modern psychotherapy is essentially a product of that modernity. And in these thinkers this modernity is given its widest scope. Therefore, in them the assumptions of modern psychotherapy are most openly explicit. I am also quite confident that the view of existence of these thinkers is becoming and will become increasingly a popular faith in our society.

Before specifying who these thinkers are, I must give them a common name. "Marxist Freudians" or "Freudian Marxists" only describes their chief teachers. Professor Voegelin uses the term "gnostic" in his political theory to describe those moderns whose chief end is the realizing of the Kingdom of Man on earth. I will, therefore, call these thinkers "orgastic gnostics" because they believe that the liberated life of the instincts will provide the positive glory of that kingdom. In the therapeutic movement itself the chief of these men is Wilhelm Reich. The last years of Reich's life have been so full of personal and functional idiosyn126 Psychiatry and Responsibility crasies (in excommunicating him his orthodox brethren accused him of paranoia) that it is easy to dismiss him simply as a crank. But in such works as Einbruch der Sexualmoral} The Function of the Orgasm and Character Analysis} the relation, between psy choanalysis and modern social theory is worked out compre hensively. The assumptions of gnostic modernity may be false (it is my contention that they are), but in Reich they are put forward honestly and openly rather than in the covert and half hearted way in which they are presented in the general run of psychoanalytical writings. In his later works Reich was clear about the type of sexual actions,that follow from his doctrine, in a way that other modern writers avoid (even if they believe the same) for fear of offending the common-sense traditions of restraint.

Reich's influence may seem to have been dissipated by the last years of his career, but one finds that Norman Mailer (writing as the chief theoretical voice of the "hipsters") takes Reich as the psychoanalytic prophet of the coming liberated world. 1 And let us have no hesitation in recognizing that among the clever and alienated young (of which there are a growing number in our society) Mailer's writings are taken with high seriousness, what ever he may intend by them. Positions close to Reich's have been put forward in two clever books by philosophers-Eros and Civilization by H. Marcuse and Life Against Death by N. Brown. 2 As is to be expected from a Marxist theoretician of the highest order (and many western philosophers have been foolish since 1945 in implying there are none such), Marcuse's work makes the fusion of Freud and Marx in the most brilliant way. In what follows I will rely above all on his account of this position. Brown's Life Against Death has basically the same thesis as that of Marcuse. It is, however, less systematic than the latter's, because, though his philosophic debt is more explicitly to Hegel than to Marx, Brown interprets Hegel in a Marxian way without being seemingly aware of the depth of Marx's criticism of Hegel. Indeed he is incomparably less aware of the modern philosophic tradition than is Marcuse. Brown's book is a worthy supplement to that of Marcuse, however, because it reconciles with Freud many elements from art and religion in Conceptions of Health 127 both the antique and modern traditions to which Marcuse pays insufficient attention.

The concept of health in these thinkers is reached by com bining the progressivist view of history (as found in its most sophisticated expositor, Marx) with Freud's assumption that the alienation of man from his job is caused by .the alienation of man from his instincts. In describing that position, I take the Marxist account of history as given. 3 These men believe, how ever, that Freud's recognition of the alienation of man from his instincts leads him to a therapeutic pessimism (as described above) because it is interpreted within a simple nineteenth-cen tury naturalism. He expresses the relationship of man to nature biologically instead of historically. Scarcity for Freud is, therefore, seen as an ever-present condition, imposing the need for domi nance and therefore repression in any possible society. He does not understand man's relation to nature as an historical process (to be understood dialectically) in which the domination of nature by man overcomes the very conditions that it arose to meet. He cannot conceive a society in which scarcity has been overcome and in which man can turn his full attention to liberating his instincts from repression by the very methods that he himself has discovered. Thus, he is forced to see the struggle between Eros and Thanatos as everlasting (I scorn the use of the word eternal in this debased sense) and one in which there can be no final overcoming of evil.

Marcuse distinguishes between basic and surplus repression. Basic repression is caus~d by the very conditions of our childhood and can be overcome only by the methods of psychoanalysis car ried out in a proper society. Surplus repression has arisen from the necessities of class dominance in the age of scarcity. It is historical and can be removed when it is no longer historically necessary. Now that historical conditions have brought us to the point where our dominance over nature makes prosperity pos sible, men will come to realize that the surplus repression of a class society is no longer necessary and will undertake the social action necessary to that liberation. As surplus repression is elimi nated in society, it will be possible to organize society so that 128 Psychiatry and Responsibility human beings can spend their time liberating themselves from the repressions implicit in the very form of the instincts of birth and of the family.

Here it becomes obvious that the intellectual debt is not only what Freud pays to Marx, but also vice versa. The perennial objection to the end of history has always been that true joy lies in striving and choice and in the presence of tasks to be done and evils to be overcome. A realized human society would be limited and dull. This criticism is a reminder of the eighteenth century idea (found, for example, in Lessing) of the dullness of salvation-an idea that is deeply embedded in all the modern attacks on the traditional religion. And it is indeed true that Marx, as he concentrated his intellectual rage on the overcoming of the evils of his present, gave little attention to the positive content of the Kingdom of Man which he considered lay ahead. To the thinkers I am discussing, Freud has given the answer to what that content will be. It will be an unrepressed polymorphous life of the instincts. According to Brown, man will be concerned with the resurrection of the flesh in the world. Here Reich's conception of object-oriented orgastic satisfaction gives the fullest description of what will be the goal of this unrepressed sexuality.

More than any of these writers, he is unequivocal in stating that man's end is orgastic satisfaction. (Because of his claims to the mantle of the modern scientist, he probably would not like this teleological terminology, but it is unavoidable from the way he writes of the orgasm). At this stage in history the "redeemed" therapist can be concerned only with individuals or a cult, but the organization of society finally will be given over to a priest hood of therapists who will help to move youngsters through the necessarily incomplete stages of sexuality to the achievement of this orgastic state of realized satisfaction. Reich is honestly un equivocal in stating that this requires the full development of the love life proper to children, adolescents, and adults. As Mailer makes clear, those capable of the "good" orgasm are saved; those who have the "bad" orgasm are damned. It must be remarked that Mailer seems at odds here with his masters. He seems to imply that the "good" orgasm can be achieved with either a homoConceptions of Health 129 sexual or a heterosexual partner and with a changing set of partners. Reich and Marcuse seem to assert that this will be achieved only when persons pass through polymorphous perversity and reach an object-oriented love of one partner of the opposite sex. Mailer's views on this point are perhaps not to be taken seriously, as he always tries to combine the role of the prophet with the pseudo sophistication necessary to commercial success among American authors.

According to Hegel, history comes to an end with the dawn of the age of reason (first realized in his thought, which is no longer philo-sophia) but sophia itself). So with these Marxists, true humanity will come to be in this world of realized sexuality, in which the orders of freedom and necessity are at last made one. The ecstatic longing for a free society that has lain as an illicit dream in the history of mankind now arises as a concrete pos sibility before us. ("How're they going to keep him down on the farm, now that he's seen Paree?") In the full tide of gnostic prophecy, Marcuse asserts that in such a society man will be able to conquer his old enemies-time and death. In the world of the instincts, measured time, the very mark of repression, ceases to exist. Reconciled at last in the union of freedom and happiness, persons will choose to go down to the grave when they so desire.

Across this blissful world will fall one shadow-the memory of those in the past who died in alienation. The Kingdom of Man will thus be darkened, but even this darkness will be alleviated by the knowledge that evil was not in vain. On the subject of death, Reich is at odds with Marcuse and Brown in that he denies the existence of the death instinct. There is for him, therefore, no such thing as nonrepressive sublimation. This gives his concept of health a simple objective content--orgastic satisfaction. It is this in turn that leads Reich in his later writing to depart more and more from Marxism and to see man as a simple bio.. logical entity. So when he gets on to the subject of what else people do when they have Hgood" orgasms, he writes of work and thought and art with a naivete worthy of Edward Bellamy. For Mar~llS~ and Brown, on ~be other hand, the acceptance of 130 Psychiatry and Responsibility the death instinct means that the end of history will not be a return to the primitive, because it will take into itself the negative moment of the death instinct and its overcoming. In true Hegelian fashion, Eros must, through struggle, take into itself the over coming of Thanatos. This is such a mystical conception that the only way I can think about it is as an immanentized version of St. Paul's transcendent conception of the spiritual body in Romans. Thus, the conception of health in Marcuse and Brown includes not only the realized orgasm, but also the nonrepressive sublimation of art and nonalienated work. Here they join the general humanist tradition with a great deal of uplifting talk about the therapeutic value of art. Art is more than a poor sub stitute for the "good" orgasm; it is a minor part of polymorphous sexuality.

There is only space for two comments on this orgastic gnosti cism, though many more are required. a) It brings out unequivocally that virtue and vice are not part of the Freudian account of man. This is often slurred over in North America because of the very brilliance of Freud's account of the history of the instincts and the liberating effect the accept ance of that account can have for us personally. Our debt is so great because Freud shows us in detail how the very conditions of our early existence twist and chain us and how we may overcome these distortions of our instincts. Moreover, to speak theologically, Freud's discoveries give content to the doctrines of Providence, Fall, and Redemption by showing ho\v we do not move simply and directly to our end, but must move to it by overcoming the ambiguities and tragedies that are not accidental, but of the very necessity of our existence. He is closer to the Biblical doc trines of the Fall and Providence than to the oversimplified Aristotelian teleology that skirts the question of evil by saying that nature achieves its purposes only in the main. To admit this greatness on the part of Freud, however, must not allow us to forget that his account of man denies the essential practical truth about us-namely, that we are beings who must choose between virtue and vice. Nor must we minimize or sentimentalize this theoretical denial, because society has and will continue to Conceptions of Health 131 pay a steep price for it. That this denial is made by Freud is most easily seen in his account of the structure of the mind as id, ego, and superego. 4 The id is the determinative aspect of us all. The ego and the superego arise from it through historical circumstances. Thus, for Freud, thought is somehow artificial to man, something forced on him by necessity. In his own words 'it is "a detour from the memory of gratification." But even within this assumption, he does not think of thought in a way that would make possible virtue and vice. Thought for him is simply technical reason as conceived by nineteenth-century scientism.

For where the ego is made the seat of reason, the superego is made the seat of morality. Thus, it is not reasonable to be moral, and morality belongs less truly to man than his ability to calculate. If reason is simply a calculating instrument and cannot teach us to choose between virtuous and vicious acts, then there is no objective morality in the public or personal sphere. The orgastic \gnostics bring out this theoretical implication with the greatest clarity, for they openly deny the platitudes of the old rational morality. The traditional morality presented itself in day-to-day practice as two simple statements that were taken as self-evident: (i) men should care not only for themselves but for others; (ii) they should sometimes control their instinctual appetites in the name of some greater good. These great platitudes were the court to which the doctrine of virtue and vice publicly appealed. Of course, the denial of virtue and vice is part of the whole tradition of modernity. One sees its beginnings in the arrogant immanentism of Spinoza (i.e., in his attack on the act Of repentance as unworthy of a rational man). But it has never been made more clearly than in these orgastic gnostics. We may thank them for this lack of equivocation, for it brings out (what is else where often slurred over) that the assumptions of modernity can not consistently include a doctrine of right and wrong.

Of course, these gnostics have an answer to this criticism that is traditional among all gnostics. 5 When people achieve genital primacy or orgastic potency, there will be no need for the idea of virtue, because the activities that the tradition called vicious will just disappear. Just as the Marxists, true to their dogma that 132 Psychiatry and Responsibility the cause of evil lies in property relations, believe, therefore, that· evil will largely disappear when that cause has been elimi nated, so these gnostics unite as the cause of evil bad property relations and sexual repression and believe that the overcoming of both will lead to the good society. Here indeed we come close to the very center of modern man's image of himself. Evil is not in the free will, but arises from the realm of necessity. The most obvious implication of this is that it cannot be called sin. b) Although this account of health must be condemned as having no moral doctrine, it has great religious advantages com pared to the other types of humanism (educated and uneducated) that characterize our society. The chief of these is that it is a doctrine of hope, and Christians must believe that true hope is a virtue even when it has an inadequate object, just as true charity in an atheist is supernatural. There is no doubt that the young who read Mailer or Miller are attracted to this worship of the orgasm because it seems a true affirmation compared to what they have heard elsewhere. The young are, after all, reared in a society avid in its concentration on the mortal and the immanent.

Yet in these days of tightened organization and the possibility of technological nightmare, an immanentism of despair is all too easy. Such an immanentism is the most influential philosophic basis for therapy in Europe today (Daseinsanalyse).Moreover, in the tightened society, sexuality is often the only form of creativity left open to persons and is certainly a more universal foundation of hope than the aestheticism of the culture addict or the worldly .. wise empiricism of the social engineer. This is true even if we take this orgastic gnosticism at the point where it is most horrify ing to the believer: Reich's techniques of overtly sexual therapy (horrifying particularly when applied to children). Is there not more hope even here than in the widespread and indeed indis criminate use of insulin and electric shock treatment carried out by order of the social engineers in the name of short-term adjustment?

Moreover, sexuality is for many not only the road to gratifica tign b!lt t9 ecstasy. "With my body I the~ worship." The object Conceptions of Health 133 of worship among the orgastic may be limited to the immanent and may therefore be justly characterized as idolatry. Neverthe less, in their very worshipping they seem to discover something of the sacred in nature that has been lost by those held by the philosophy of human power and self-confidence. The rediscovery of that sacredness may be a condition for the rediscovery of a worship that is more than natural. For all its dangers, idolatry may be the only road back to worship. To carry this train of thought further, it would be necessary not only to criticize the modern view of nature but also to consider why our North American Christianity was so influenced by that view of nature that it failed to have any adequate theology of human love.

Having praised this concept of health for its hope, I must end by insisting that it fails religiously by placing its hope in life alone. The truism need hardly be supported here that suffering and death are as much facts as life and gratification. Yet this gnosticism cannot include these facts within itself despite all its efforts. The concept of health given us by Him who says, "Take up your gallows tree and follow me" is complete in a way that no modern conception is, because it includes suffering and death in health, recognizing them not simply as the negation of happiness, but as the voluntary shedding of the mortal necessary to the putting on of immortality. Christianity may too often have for gotten a proper affirmation of life and gratification (and modern therapy has done well to remind it of this forgetting); but its incomparable truth has been never to forget that suffering and death must be included in health as much as life and gratification.

Nowhere has modern psychotherapy more mirrored and influ enced our society of progress than in the way it disregards death or looks at it with stoicism. NOTES 1. See Mailer's essay, "The White Negro," Dissent, Winter, 1958, and a discussion in the same journal. 2. See also the controversy between Marcuse and Fromm in Dissent, Summer, 1955, et seq.

134 Psychiatry and Responsibility 3. For my understanding of this account, see my Philosophy in the Mass Age (New York, 1960), chap. v. 4. The full implication of my point can be better seen in the light of the original German es~ ich~ and ilberich. 5. It is not accidental that Plotinus' criticism of antique gnosticism was that it had no place for the discipline of virtue as a necessary means to health.