Terruwe and Baars's "Mortification Therapy": A Thomistic Approach?

Drs. Anna Terruwe and Conrad Baars were once at the cutting edge of uniting psychiatry and Catholic thought. Practitioners of psychoanalysis, they attempted to unite the rational psychology of St. Thomas Aquinas with the ego psychology of Freud, and proposed a controversial way of alleviating repression called "mortification therapy." For reasons that were never stated, Terruwe was banned from treating clerics prior to the Second Vatican Council. Nevertheless, the ban was lifted soon after the council ended, and her practice, along with that of Baars, thrived: over several decades of combined work, they treated over 1,500 priests and religious, and a large number of Catholic laity. Terruwe and Baars published the details of mortification therapy in Psychic Wholeness and Healing: Using ALL the Powers of the Human Psyche, a work that focuses on treating people who worry and obsess. Following the lead of Freud, Terruwe and Baars suggest that sexual repression is the general cause of anxiety disorders.

Mortification therapy was designed for patients who have anxiety about religious themes. The spectrum of severity ranges from people who get occasionally distracted by sexual thoughts, or grow tense around sexual subjects, to more severe cases in which people suffer from continual intrusive thoughts about having sinned through impure thoughts or impulses, combined with incessant compulsions to wash or confess.

Mortification therapy begins by giving the patient three startling directives: first, "You may everything"; second, "For you there are no rules, laws, or commandments"; and third, "The pleasure you experience as the result of abiding by the other directives is the most perfect thing for you."¹ After receiving these directives, patients are directed to "tolerate" acting on their sexual impulses until they lose their fear of sexual feelings.

There was, after the council, no shortage of psychiatrists offering to treat priests and religious, nor was there any lack of priests and religious seeking treatment: both groups suspected that celibacy was the product of sexual repression, and both were often keen on dispensing with it. These psychiatrists often made clear their contempt for the moral teachings of the Church regarding the sixth and ninth commandments, and also openly encouraged priests and religious to violate their commitment to celibacy. Terruwe and Baars, however, did none of these things; they were personally committed to the Catholic faith, and went to great lengths to present their work in the context of the rational psychology of Aquinas. In doing so they won the public endorsement of a prominent Dominican theologian, and have been well accepted by orthodox Catholics, with favorable reviews of their work appearing on EWTN and Catholic Answers.

And yet, Psychic Wholeness is a startling read. For the lay reader, the shock is sure to come from the application of the three directives to various cases throughout the book; to a psychiatrist familiar with both Aquinas and Freud, the surprise comes even earlier, when the authors present the Freudian system in the language of Aquinas—as if it came from Aquinas. Terruwe and Baars's work, Psychic Wholeness, remains the most extensive attempt at synthesizing Aquinas, the Catholic faith, and Sigmund Freud.

In the thirty years since the publication of Psychic Wholeness, the Freudian domination of psychiatry has ended and cognitive-behavioral therapy, an approach based on scientific evidence, has gained widespread approval as a treatment of choice for many forms of mental illness. Cognitive-behavioral theory rejects the concept of repression, and instead proposes an understanding of emotions that is unwittingly Thomistic. This development gives us occasion to reconsider the relationship of Thomistic psychology to the central Freudian concept of repression, and will help us assess the claims that mortification therapy is an acceptable Thomistic approach to treating religious worries and obsessions.

The Importance of Repression

Freud redefined the word "repression" and founded his psychoanalytic theory upon it.² For Freud, repression is the defense by which the superego, or moral faculty of the mind, blocks the unacceptable drives of the id from entering the consciousness of the ego. These drives then intensify until they break forth in symptoms of neurosis or psychosis. The...