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He joins Jung, who stated that no one can boast that he has fully accepted himself.

Department of Psychiatry and Behavioral Sciences

Only a person who has overcome self-contempt and learned to love him- or herself will be able to love and to overcome contempt for others. In discussing the link between psychoanalysis or psychotherapy and theology, Tillich is of the opinion that psychoanalysis has much to offer theology and that psychoanalysis and theology need not be seen as being in opposition to each other but rather as being intimately interwoven.

Psychoanalysis is about the existential situation of man and the theology about the relationship between this existential situation and the essential nature of man. Tillich writes that psychoanalysis and existentialism have the common goal of describing the existential position of man, an existence of existential alienation, estrangement and finiteness. In opposition to this, existentialism and psychoanalysis see man as being driven by unconscious impulses and irrational urges. Existentialism, however, describes a situation of existential anxiety and alienation valid for everyone, whereas psychoanalysis explores the different ways in which man tries to escape his existential problems 'by fleeing into neurosis and falling into psychosis' p.

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This can be healed' p. Tillich implies here that healing through psychotherapy or psychoanalysis is about the re-establishment of a centre, it can lead to the re-integration of a person. Yet, he also says that our real enemy, selfishness or self-hate, cannot be overcome through a Pelagian attempt to muster self-love Pelagius, AD, emphasised the essential goodness of human nature and the freedom of the human will.

Man is too alienated, estranged and sick to be able to accomplish this on his own. This larger experience is one of grace: In grace something is overcome; grace occurs 'in spite of' something; grace occurs in spite of separation and estrangement. Grace is the reunion of life with life, the reconciliation of the self with itself. Grace is the acceptance of that which is rejected. Grace is however not the willingness of a divine father to forgive the weakness of his children. Such a belief needs to be rejected as it is a childish destruction of human dignity.

It is thus not about sins in a moral sense but about overcoming separation, which, as mentioned, is how Tillich defines sin. This separation is overcome through acceptance: 'You are accepted, accepted by that which is greater than you The courage to be is the courage to accept oneself as accepted in spite of being unacceptable, in spite of existential guilt.

Only this larger experience of acceptance, and the belief in it, can lead to self-acceptance, and only acceptance, never commands, can lead to transformation. Self-acceptance is only possible if one is accepted in a person-to-person relation. Tillich writes that the psychotherapist should not have spiritual counselling as prime focus, but that in the Christian tradition of Protestantism everyone can be a priest to the other. Treatment of narcissism. The psychoanalysts Kernberg and Kohut represent two contrasting approaches to the understanding and treatment of narcissism.

For Kohut, narcissism is the result of the parent's empathic failures, parents not responding with enough validation and admiration to satisfy the child's needs. Kohut believed that the therapeutic relationship and the internalisation of the other as a transformative self-object could facilitate the resumption of healthy narcissistic development arrested in childhood. For Kernberg, it is important that the patient recognises and develops an understanding of his child's contribution to his problems, and that the patient integrates idealisation and trust with rage and contempt, and develops concern for others.

Symington extends the boundaries of psychoanalysis; for him, it becomes a spiritual quest. Self-transcendence means to curb narcissism, to internalise 'the good' and to establish constructive relations. Reason is the tool needed to define 'the good'.

Psychiatry Residents’ Attitudes Toward Spirituality in Psychiatry

This psychoanalytic struggle is an act of virtue. It is interesting how primitive hatred and self-hate, linked to a lack of love and self-love, are seen as central problems of narcissism and emotional problems by Kernberg, Symington and Tillich. Tillich and Symington: similarities, inconsistencies and difficulties. The relationship between psychoanalysis and religion is important for both Tillich and Symington. Both state that psychoanalysis and religion can heal and help overcome a state of disintegration.

Both are not without contradictions. Symington speaks of psychoanalysis as a virtuous undertaking and a treatment for narcissism, 28 yet in a later book he writes that analysis alone was not enough to heal him, nor the majority of analysts and therapists, from narcissism. To be sane, it is necessary to 'stand outside of oneself', and this can never be done within one discipline of thought or ideology.

Is RELIGION/SPIRITUALITY incompatible with PSYCHIATRY?

According to him, it is extremely difficult to reduce the power of narcissism in the personality and a person would be extremely lucky if he achieved this outcome. Contributing to this, he writes, 26 'is that the majority of psychoanalysts and psychotherapists are themselves very narcissistic' p. If true, this would be a very sobering statement, considering that psychoanalysts have to undergo four to five times-a-week training analysis for several years.

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Narcissism as such is not addressed by Tillich. He, however, describes our real problems as being self-hate, self-contempt and selfishness, as well as feeling insecure and inadequate and not able to fully accept oneself. His description of psychopathology is very similar to the psychodynamic understanding of the narcissistic structure. In Tillich's opinion, psychoanalysis or psychotherapy can help with neurotic problems, with general psychopathology, but that it cannot deal with the ultimate existential issues of finitude, guilt and emptiness.

A larger experience of acceptance or grace is needed before self-acceptance is possible. Both Symington and Tillich thus note that something more than just psychoanalysis or psychotherapy is needed.

The difference, however, is that Symington writes that he had to do it for himself, whilst Tillich says that grace, something bestowed upon us, is needed. For Tillich, man is not a virtuous creature, virtue is not something we can acquire. Only God is 'the good'.


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Virtuous behaviour can only be an outflow of grace the question of why grace is bestowed upon some and not others, bringing up the complicated problem of theodicy, falls outside the scope of this article. Kohut, Kernberg and Symington have made valuable contributions to the understanding of narcissism and their approaches need to be integrated in the treatment of narcissism. But narcissism is a very difficult condition to treat and a purely psychoanalytic approach might not be enough for most patients.

The question remains what this 'more' is that is needed. For Tillich, this is the realisation of acceptance by the Ground of Being, who becomes, using Symington's concept, our Lifegiver. This can only be experienced through an accepting therapist who points towards a source of acceptance, which transcends both therapist and patient.

Spirituality and Psychiatry: Incorporating the Spiritual Dimension Into Clinical Practice

The aim of this article is not to promote a specific religion but rather to think about the borders of psychotherapy, religion and spirituality. This paper also suggests that the basic, unspoken existential stance of the therapist and his or her thinking about the essence of being will silently speak in the therapeutic process. Narcissism, the result of early, severe deprivation and a lack of secure attachment, is an ever-present and pervasive problem - a defence against man's underlying anxiety and fragility. In the struggle to get a grip on this, good nurturing experiences, transformative self-objects, a confrontation with the darker sides of the self and the message of ultimate acceptance or grace are all needed.

Religion and spirituality thus have an important contribution to make to psychiatric or psychotherapeutic treatment: We cannot compel anyone to accept himself. But sometimes it happens that we receive the power to say 'yes' to ourselves, that peace enters into us and makes us whole. Then we can say that grace has come upon us. The author would like to thank the theologian Volker Keding, PhD, for discussions on Tillich and for comments on a draft of this article. The author declares that he has no financial or personal relationships which may have inappropriately influenced him in writing this article.

World Psychiatric Association. Section on religion, spirituality and psychiatry. WPA; Janse van Rensburg ABR. South African Society of Psychiatrists guidelines for the integration of spirituality in the approach to psychiatric practice. S Afr J Psychiatr. Religion, spirituality, and medicine: Psychiatrists' and others physicians' differing observations, interpretations, and clinical approaches.


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    Yangarber-Hicks N. Religious coping styles and recovery from serious mental illnesses. This can only be experienced through an accepting therapist who points towards a source of acceptance, which transcends both therapist and patient. The aim of this article is not to promote a specific religion but rather to think about the borders of psychotherapy, religion and spirituality.