Faith and good works versus insight and behavior change. My college roommate and I occasionally bickered about faith and good works. She was raised Catholic and I, Protestant. (If we weren’t bickering about this, we were bickering about transubstantiation. She believed that people indeed consumed the body of Christ at Communion. I believed that people were drinking grape juice or wine and eating a very dry cracker.)

“Paul makes it very clear,” I argued, “that man is saved by faith alone.”

“James makes it just as clear,” she responded, “that faith without works is dead.”

“Good works stem from faith. Theoretically, if one believes, one will naturally engage in good works.”

“But without good works, there is no evidence of one’s faith.”

And around we went. The point of disagreement was trivial. She and I both knew that we were both maintaining the schism between the Catholic and Protestant churches. Ecumenism is overrated. Martin Luther would have proud.

(Though I do not qualify to join The Brights, my faith is not what it once was.)

A similar disagreement occurs within psychiatry. There are those that believe that insight alone will result in behavior change… and then there are those that argue that insight alone does not necessarily result in behavior change and thus, one must also explicitly address behaviors.

For example, someone may enter therapy and eventually learn that the reason why he cannot enter intimate relationships with anyone is because (wait for it, wait for it…) of his childhood experiences. Whenever he shared his concerns and worries with his parents, they informed him that he worried too much, was weak, etc. and punished him with public and private ridicule. He subsequently lived his life in a guarded and stoic fashion, which garnered him success in his professional duties, but not with women.

Fine.

Just because he understands this, though, does not mean that he is now going to sashay down the street, hand out his business cards to every woman he passes, flash a bright smile, and ask the recipients to call him if they are interested in joining him for dinner. Some would argue that, if his goal is to participate in an intimate relationship, insight is not necessary: He simply needs to change his behavior. Thus, the therapist might instead coach the patient to increase the type and amount of contact he has with women, develop and hone skills in social interactions, and take action, even if he feels anxious to do so.

Fine.

However, one must have some insight to engage in behavior change, or the desired behavior just won’t happen. For example, this man in question may not require knowledge that his difficulties stem from his punitive parents, though that may certainly help him realize that his childhood experiences may not be valid in his contemporary life. It is helpful for him to realize, though, that perhaps the reason why he avoids contact with women is because he has underlying beliefs (regardless of origin) that women, across the board, do not find him attractive. What is the evidence for that belief? If the evidence is scant, then he may learn that he cannot believe everything he thinks and can challenge this thought through behavioral experiments that may ultimately demonstrate that, indeed, women like him.

And around it goes. Faith and good works? Insight and behavior change?

Should there be any surprise that there exists controversy in both religion and psychiatry?

The ways parents wound their kids. We’ve all said or done unkind things to our parents: Perhaps we told them, as adolescents, that they were THE WORST PARENTS EVER. Maybe we’ve stolen money or other valuables from them. Told them hurtful lies. etc.

The injuries, however, obviously do not flow in that single direction. The power differential that exists between parents and children can increase the magnitude of these injuries that children bear to heartbreaking proportions.

I refer specifically to those parents who beseech their children, “Please help me kill myself,” or “If you don’t do well in school, I will kill myself,” or “If you really loved me, you would help me commit suicide,” etc.

Augh!

Consistency and predictability. There is comfort in consistency. Once patterns are established, the need to consider other options (some of which may be distressing) is limited. However, if there are deviations in a pattern, this results in an aberrant piece of information that requires reconciliation.

Reconciliation requires effort. Furthermore, the justification process may insist that people completely reevaluate their worlds (or, more accurately, the perceptions of their worlds). To realize that the world may not actually work the way one thought is distressing. This mental conflict can be called “cognitive dissonance”.

Because cognitive dissonance is usually uncomfortable (physically, mentally, emotionally), people will often change (or really not change) to resolve this situation. For example—going back to the concept of faith—some people who already adhere tightly to circumscribed ideas about God may rigidly exclude any information (such as evolution) they learn to decrease the likelihood of experiencing cognitive dissonance. Because they may have invested so much time, energy, and resources into their perceptions of the world, introducing information that contradicts this world view may invalidate their existence and purported purpose in life. To incorporate differing information, whether valid or not, may require an agonizing reassessment and, really, who wants to feel agony?

(Think mid-life crisis.)

Thus, polarization is an appealing option. At least in that situation, there is consistency, there is predictability—and the path is clear as to how one ought to proceed. The sense that one is doing “the right thing” brings security. Ambiguity and uncertainty cannot offer nearly as strong of a support or anchor.

And, to be clear, we all do this. We all believe things—whether in people, things, science, medicine, religion, philosophy, arts—that may not actually have any basis in anything, but they help us lead our lives with a little more comfort. We believe that they offer stability and thus, we trust.