Anton Boisen Reconsidered: Psychiatric Survivor and Mad Prophet

Including Seward Hiltner, Paul Pruyser, Henri Nouwen, Harry Stack Sullivan, Ann Taves, Donald Capps, Robert Dykstra, and Bonnie Miller-McLemore.

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.

In 1920, 1930, and 1935.

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.

For an analysis of Boisen’s hybrid character from the perspective of Foucauldian discourse analysis and queer theory, see Coble (2014).

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.

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).

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.

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).

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).

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).

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.

William James’ “radical empiricism” is likely in the background here.

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).

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).

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).

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.

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.

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).

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).

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.

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.

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.

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).

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).

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.

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.

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 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/​Psychosis-Responding-to-a-Loved-One-in-the-Face-of-Uncertainty, 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.​psychosisscreeni​ng.​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.”.

“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.”.

See note 22.

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.

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.

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).

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.