Douglass Carmichael's Web Site   minor updates March 16, 2004

This essay follows from the brief introduction, Psychotherapy, a 21st Century Orientation, which should be read first.

The trend towards lack of accountability except to the system, medical and societal, has gone totally against the grain of the wisdom of my best teachers, from grade school to people like Erik Erikson and Erich Fromm, who consistently put the good of the person ahead of any system. The medical model is shifting under pressure from the one side of tech and insurance, towards more and more mechanical models of symptom management at the cost of real health. At the same time, the rise of alternative medicines has led "patients" (that is, the passive ones in the relationship) towards more and more active involvement. The Internet and increased complexity have contributed to these dual shifts. The outcome is going to be a struggle, and the outline of the possibilities are not yet clear.

There is a fundamental discipline in medicine that I admire, but a mechanization and bureaucratization I do not. In the alternative medicine worlds there is often heart and life experience that I admire, but a lack of discipline that is distressing, because it is practice by received methods, not by understanding of causes - mechanical or spiritual. How many homeopathic practitioners are smart about the origin of the formulas, all arrived at and fixed in the 19th century?

What we want is a full interchange between person centered understanding and general understanding of the body, its relation to the environment, and to the self who owns it. This should be an open, intellectually and scientifically and clinically challenging exploration for both of the people . But the lack of interest in person as a sensitized perceiver is recklessly blitzed by an ignorant model of normative functioning that precludes critical examination of a person's understanding of their world and their experience in it.

There was the supervising psychiatrist who said "when I hear someone believes in god I know they are psychotic" - little understanding that he has his own gods. There are the increasingly self-satisfied conversations that things like dreams "are just molecules going bump in the night." Try bringing politics in to a meaningful psychotherapy session. "Prozac will get rid of your pessimism." [when the real societal crisis comes, it will turn out that our leaders are on Prozac]. Try talking about relationships at work, and you'll be met by a look of "oh, here we go again" and the words, "its your parents not your boss". And yet the attitude of the therapist is a subtle political one throughout, leaning on authority, and comfortable in this society and hoping you too will be soon.

Psychiatry is in many ways usually the worst offender, and the level of training in intra-psychic worlds and interpersonal and community relationships is almost non- existent. The idea that one can practice word centered therapy without any reading of history, novels, poetry, drama, or philosophy, comparative religion, or anthropology - supported by travel - is just pathetic. The personal analysis, here the future clinician is under going the kind of self observation he or he will soon be "practicing" with clients, is long gone in most psychiatric practice. The year on the psychiatric ward (I supervised for three years at St. Elizabeth's in Washington) is exactly the wrong training to build an interpersonal peer-to-peer relationship between therapist and client. There are deeper issues about drug-based therapy, primarily that this mode treats the person as manipulable and that drug giving is psychically similar to punishment, because it is an external aimed at getting rid of bad behavior - an external intervention without insight. I am talking here not just about opinion, but the way the emotional attitude of the "patient" takes it in as a passive dependence on some entity that knows better and will change her. The idea that insight can be dispensed in parallel with drugs is similar to the illusion of delivering love through spanking. It fosters dependence and awe rather than clarity and awareness. The situation with Ritalin is too obvious and painful, taking docility as the norm, punishing children (again, your body makes you do this) who are high energy and want some contact with love and the outdoors. Society is at fault, and puts a drug into a child as a solution (no pun unintended).

James Hillman and Michael Ventura helped clarify the trend in their book, We've Had A Hundred Years Of Psychotherapy And The World Is Getting Worse. The basic thesis is that each of us is sensitive to the soul quality of our environment, and what we see makes us sick. So we go the psychiatrist who says "tell me about your parents, " thus making political and community idiots of us.

Society wants each client back on the treadmill. The insurance companies want you back on the treadmill (not too fast because after all, the greater the cash flow through, the better they do, if they can contain costs. Their arguments are usually with the employers, who are paying the insurance costs, and the client is sandwiched in between.) Many people in trouble agree with this view and want symptom relief so they can get back to work as rapidly as possible. But almost all of them are also skeptical, and looking for deeper insight. But full disclosure or discussion is not to be had, because he practitioners do not know how to do it, and have not participated.

Of course the practioners and their teachers are getting more sophisticated (in a way),and "drugs will cure your depression" has been replaced with "drugs are a stopgap until we understand which gene to tweak in your DNA so you won't have this feeling." Since those who prescribe the drugs can't charge very much for doing so, they kept the talking hour, where the real cash flow is, but with so little belief in it that they are not usually self motivated to try to study, read and experience what is going on there. And much more often than not are just fairly naïve advice givers, or agents of socialization, without critical awareness, either of the needs of their "patient" or the pressures of society.

The sad history of American psychoanalysis and its medicalization, contra Freud, has been self-serving and counter-productive. Where is psychoanalysis today? Nearly on the scarp heap - a quaint remembrance of a more humane past - killed by the mechanical approach to the billable hour and the dead model of almost non-interaction that came increasingly dominant as psychoanalysts doubted themselves ( see Psychoanalysis: the Impossible Profession by Janet Malcomb, and the Making of a Psychiatrist by David Viscott).

We must notice that medicine is creating longer lives, with no sense of what they are for. That is for the "patient" to figure out, or society. But the "patient" is not encouraged to be active in getting to live longer, just absorb the techniques of medicine. This is not good training for then trying to figure out what life is for. The reason we don't have wise elders is, in part, few middle aged people are doing what wpuld be necesssry to get: it is not even a goal.

The same problem in psychotherapy, leading to increased ability to be "normal", follow orders in school, and work and citizenships, with no help on what the purpose of "normal" is. Medicine, which has drugged active children to help teachers and parents keep them tractable, as childrens' access to nature and unsupervised time shrinks, is way too much helping that society move along lines that are not good for people, and suppress the very symptoms that tells us.

The place of the human in a world of facts is slippery. But important. I think it is important to know the body, but at least as important to know what causes it to be graceful. Most of the real problems of the body: diet, movement, stretching, balance, hand-eye coordination, and social and artistic expression, are not understood by medicine anyway, which for the most part is not smart about life patterns and illness. The medical model, which I think is still worth knowing (colitis, shallow breathing, postural problems, circulatory blockages) the model of physical causality keeps practioners from enthusiastically moving on to the real issues: how to help evolve a therapy that is poetic, dramatic, community and historically aware, soul-making and collaborative.

See the article in the references, an Interview with Hobson, which supports much of the general framework reported above, coming out of general psychiatry..

Philosophy and Psychotherapy - the Idea.

There are a number of ways into the humanization of psychotherapy. I am going to focus on a discussion of one of the hardest approaches, hard mostly because we are so unprepared for it. That of philosophy as a therapy of the good life. I pick it by inclination, but also because some excellent work has been done that can serve as the basis for a discussion.

So the following thoughts are really but the gloss on the work of Martha Nussbuam, especially her book Therapy of Desire.

Ms. Nussbaum, trained as a classicist and comparative literature expert, was married to Amytra Sen, who was head of the American Economic Association, and very influential in highlighting aspects of world poverty and hunger. She now is in a relationship with one of the most prestigious law professors in the country. She has written widely on social issues and teaches now in the Law School at Chicago, after many years at Brown. I mention these to show the range of her involvement in the real world.

Her other relevant books are The Fragility of Goodness, which is an exploration of Greek ethics and the view that to be virtuous one must be interactive with others, which means that we are vulnerable to their character and hence to fate. Moreover, that unlike the Kantian view, each situation does not have a logically clear best choice of action, because real situations embody conflicting goods, which again means we are compromised. But a full life cannot be imagined without these dependencies.

Her next book Is Love's Knowledge, where she argues that the most important questions in philosophy cannot be dealt with by philosophical language, but require literary language.

With these as foundation she then wrote Therapy Of desire, which is a very detailed account of the Hellenistic Greek culture's approach to philosophy as the therapy to lead towards a good life. I am taking it as the model for my own approach to therapy. (there are a number of other books, each of which increases the scope of thinking).

To which I need to add that my own approach is rooted in my psychoanalytic training, which Fromm made very person-centered and alive. He made explicit that the passive person sitting behind the couch is not a neutral person, because such an attitude is outside the norms of society and requires contortioned logic for its justification. The analyst sitting in clear sight, and seeing, engaged as a listener and interactively interesting without being dominating, was the model. I have added to what I learned there some greater amount of attention to the movement and expression of the body, and blend in some physical movement (perhaps like tai chi and yoga) into the flow of the discussion, because sometimes just sitting is too deadening for the person's energetics, and sometimes sitting becomes an overly energized obsessive holding on that is paralyzing of mind through the rigidity of the body.

One last thought. The world of emotions has entered into the mainstream with books like Daniel Golman's Emotional Intelligence. These efforts are especially appreciated in business. But note, emotions are treated as worth understanding because they can ruin a project or course of action. They are not treated as valuable in their own right, valuable in the sense that one would chose to live an emotionally rich and rewarding life.

Notes from the book with occasional comments.

" The Hellenistic philosophical schools in Greece and Rome-Epicureans, Skeptics, and Stoics-all conceived of philosophy as a way of addressing the most painful problems of human life. They saw the philosopher as a compassionate physician whose arts could heal many pervasive types of human suffering. They practiced philosophy not as a detached intellectual technique dedicated to the display of cleverness but as an immersed and worldly art of grappling with human misery. Pg 3

Comment: throughout history there were wise people who were trying to be conscious about how to live: Buddha, the Taoists, Confucius, Hebrew prophets, Jesus, the Greek philosophers, and their roman followers. What is unique is the degree to which the effort of these thinkers were marginalized and clarity about the question - what Socrates asked of us , "what is the fit life for a human being?" was marginalized. David McNeil's The Rise of the West, shows how the clarity of these questions was undone by the rise of the great empires which forced allegiances to Empires. Modest efforts like that of Freud, aimed to recover the autonomy of an interior life and the ability to question oneself. The prophets were in many ways replaced by the creative writers, Cervantes, Shakespeare, Goethe, Dante, Tolstoy - who kept the question alive, from a much more alienated position - not as participants in life but as creative mirrors. The direct participants were too controlled by the needs of their Empires. As modern times kept up the pressure we see the great writers more extreme, like Dostoyevsky, Joyce, and our own Melville and Faulkner.

" What is distinctive about the contribution of the philosophers is that they assert that philosophy, and not anything else, is the art we require, an art that deals in valid and sound arguments, an art that is committed to the truth. These philosophers claim that the pursuit of logical validity, intellectual coherence, and truth delivers freedom from custom and convention, creating a community of beings who can take charge of their own life story and their own thought. pg 5

The reader probably, as I was already boggled by the strength of the assertion, and its attractiveness. Truth here is not dogmatic truth but ordinary truth, such as smoking ruins your breathing, and hence your grace, or for those who think that beer, TV and sex without companionship are life's great pleasures at the end of a working day are suffering through ignorance and artificially limiting their life. The nature of the limitations on their lives will grow clearer as we proceed down this path.

" [which] will be a somewhat idiosyncratic account of certain central themes, guided by an obsessive pursuit of certain questions - taking as its central guiding motif the analogy between philosophy and medicine as arts of life. Pg 7

What will be interesting is the mixture of convergence and divergence from the medical model.

" How exciting it is to study the history of ethics in this period, when one understands it not simply as the history of arguments, but also as the history of practices of argumentation and psychological interaction aimed at personal and societal change. P9

The theme of creating a society that works for all, central to Aristotle, should also apply to our clients, because if that hope is not there, then the client must be accommodating to a society without hope for some of its members, with which part of the unconscious - connected to compassion - identifies. People really believe that if someone is getting a raw deal, then they too are not free.

" If passions are formed (at least in part) out of beliefs or judgments, and if socially taught beliefs are frequently unreliable, then passions need to be scrutinized in just the way in which other socially taught beliefs are scrutinized. But this seems to b policy from the point of view of any philosophical view (including Aristotle's) that holds that some ethical beliefs and preferences are more reliable than others. P9

The very idea of inquiry into beliefs lies outside the strategy of most psychotherapy.

" The major Hellenistic schools are all highly critical of society as they find it; - and all are concerned to bring the necessary conditions of the good human life to those whom society has caused to suffer. P 10

Most psychiatrists and many psychotherapists are too busy coping with career demands to take this seriously for themselves, and hardly ever extend it to their clients.

" Aristotelianism sets exacting worldly conditions for the good life, making virtuous activity dependent in many ways upon material and educational conditions that are beyond the individual's control. But Aristotle I then assigns to politics the task of bringing those conditions to people: the - good political arrangement is the one "in accordance with which each and every one might do well and lead a flourishing life" (Pol. 1324a23-25). P 10

" Both Aristotle and the Hellenistic thinkers insist that human flourishing cannot be achieved unless desire and thought, as they are usually constructed within society, are considerably transformed. ample, that most people learn to value money and status far too highly and that this corrupts both personal and social relations. p11

" Furthermore, the Hellenistic focus on the inner would does not exclude, but in fact leads directly to, a focus on the ills of society. One of the most impressive achievements of Hellenistic philosophy is to have shown compellingly and in detail how specific social conditions shape emotion, desire, and thought. - p11

This is central to James Hillman's work: that the soul quality of our environment is a soul part of ourselves. As the Spanish philosopher, Ortega says "I am I and my circumstance, and if I cannot fix it I am done for".

" Their philosophical therapies both describe and model a new approach to the design of educational practices; and in their representation of the relation between teacher and pupil, they represent, as well, an ideal of community:p12

The standard model of psychotherapy has at the core the radical separation and unknowability of the therapist. They should not meet, at the supermarket, the ballet, the movie (go forbid). This however implies an urban alienated class layered society where encounters are at least potentially never to occur. Since this is not the ideal community, how can it be a model of practice? My own training in Mexico made it very clear that encounters and co-participation in the community were to be expected. The standard model implies, for example, that either the therapist, or the client, or both, shall not participate in public life. An exception has always been made for books, even novels, with the idea that "they don't read anyway, certainly not something so esoteric."

" Chapter 1 Therapeutic Arguments

" Epicurus wrote, "Empty is that philosopher's argument by which no human suffering is therapeutically treated. For just as there is no use in a medical art that does not cast out the sickness of bodies, so too there is no use in philosophy, unless it casts out the suffering of the soul. P 13

" Or as Cicero, speaking on behalf of the Stoa, more succinctly puts it: "There is, I assure you, a medical art for the soul. It is philosophy, whose aid need not be sought, as in bodily diseases, from outside ourselves. We must endeavor with all our resources and all our strength to become capable of doctoring ourselves." P 14

" In short, there is in this period broad and deep agreement that the central - motivation for philosophizing is the urgency of human suffering, and that the goal of philosophy is human flourishing, or eudaimonia. P 14.

" ..an art that works in a pragmatic partnership with those it treats. _ p 19

" But the challenge of medicine is always to make connection with people's deepest desires and needs and their sense of what has importance. It must deliver to them a life that they will in the end accept as an improvement, or it cannot claim success. P 21

" The upbringing of young people is held to be deformed in various ways by false views about what matters: by excessive emphasis, for example, on money, competition, and status. P 26.

Most psychotherapy does not question the process of socialization and mainstream beliefs. The focus is usually on the lack of expression of emotions and causes in the familial past.

" The philosophical doctor must, then, be even more skeptical than the medical doctor about any report made by the pupil based on her own immediate judgments and perceptions, knowing that the very same parts that produce the report are the ones that are, or may be, diseased. And yet how can the teacher know them, except by asking them to speak? p 26.

" A corrupt and corrupting society may well have formed the patient's beliefs about the good life, and even about herself, makes it necessary for the philosopher not to be too quickly trusting. P 27

" Hellenistic ethics combines immersion with critical distance in something like this way - insisting on the rigorous scrutiny of belief and desire, while insisting, too, that it is to real people and their beliefs and desires that ethics must ultimately be responsible. P 28.

We must balance questioning belief with staying close to livable outcomes - not ideology but wisdom. Wisdom however is usually beyond the task of psychotherapy, which deals with people taken to be weaker than ourselves, and helping them move in the direction of our level is sufficient. But in fact every patient is in some ways stronger than we are, and our own level of development should be neither a goal nor hindrance to the growth of the client's understanding and health - full flourishing. Good psychotherapy always involves maturation for both therapist and client, often in a see-saw unpredictable way.

" Three closely related ideas
" A tentative diagnosis of disease, of the factors, especially socially taught beliefs, that are most prominent in preventing people from living well.

" A tentative norm of health: a conception (usually general and to some degree open-ended) of the flourishing and complete human life.

" A conception of proper philosophical method and procedure. p 29

Most psychiatry and psychotherapy are not so analytical and treat these three together as an object of their own gut reaction and intuitive feel. The problem is that such a method does not teach the client to be a careful observer, but to acquiesce to the therapist's reactions.

" Ordinary-belief philosophy is compatible with a recognition that some, or even many, people are doing badly. But since it is thought that the defects in their lives - a lack of financial resources, for example, or of friends, or of political rights-have not damaged belief and desire themselves, it also seems that it is not the job of philosophy to deal with chose deficiencies. That looks like the job of politics or friendship. For a medical ethical philosophy, by contrast, the commitment to action is intrinsic. P33

" Conception of the philosopher's task as a medical one makes compassion and love of humanity central features of it. Having understood how lives are diseased, a philosopher worthy of the name - like a doctor worthy of that name - will proceed to try to cure them. The whole point of medical research is cure. The whole point of philosophy is human flourishing. The medical analogy expresses this basic commitment.

" The diseases that impede human flourishing are, above all, diseases of belief and judgment. P 34

" A medical moral philosophy is committed to philosophical argument. Indeed it has a very high opinion of the worth of argument. And this is only natural, given its diagnosis. For if the diseases that impede human flourishing are above all diseases of belief and social teaching, then philosophy will seem to be necessary, perhaps even sufficient, for getting people from disease to health. P 34

" Thus medical philosophy, while committed to logical reasoning, and to marks of good reasoning such as clarity, consistency, rigor and breadth of scope, will often need to search for techniques that are more complicated and indirect, more psychologically engaging, than those of conventional deductive or dialectical arguments, must find ways to delve into the pupil's inner world, using gripping examples, techniques of narrative, appeals to memory and imagination, all in the service of bringing the pupil's whole life into the investigative process. P 35

It takes courage, education, and maturity to be able to work at this level. Part f the problem of the insurance system is, it expects the recent graduate to be at full fee. This then implies that what they have been taught should be sufficient for standard level of performance. That "standard" level then becomes the goal of practice. In the old days, young therapists started with the poor, students, artists, who in fact were great educators of their helpers. Therapists grew in stature and gained community prestige based on experience and perceived helpfulness. No longer. Anonymity rules, which means that bureaucratic markers of authenticity become more if not the only guide to client choice.

" The philosophical critique of emotion must be highly informed and culture-specific. P 39.

" For the passions are made up out of beliefs and respond to arguments. P 39.

" And yet Aristotle also criticizes the medical analogy at certain points, arguing that there are some very important ways in which ethical philosophy should not be like medicine. P 42.

" Three core emotions to treat: Passionate erotic love, the fear of death, and anger. P43.

" And the therapy of desire and judgment is its central focus in ethics. P 43

" The self-governing and self-critical powers of the soul gives rise to a distinctive conception

" Little victories over fear, resentment, and confusion will make [clients] attentive participants. P 45.

" Chapter 2 Medical Dialectic: Aristotle On Theory And Practice.

" From Homer on we encounter, frequently and prominently, the idea that logos is to illnesses of the souls as medical treatment is to illnesses of the body… The diseases in question are frequently diseases of inappropriate or misinformed emotion. P 49

" It seems to have been Democritus, however, who first really developed the analogy at length in a clearly philosophical context. "Medicine," he wrote, "heals the sicknesses of bodies; but wisdom rids the soul of its sufferings. (Diel-Kranz B 31 ) p 51.

" Isocrates - "But for souls that are sick . . . there is no other drug but logos that will forcefully strike those who are in error..To get well people are going to have to hear arguments that will give them distress ." .

" Not just by being causes, but by giving reasons. This would be a particularly important task for a philosopher who was anxious to distinguish his professional activity as ethical logos-giver from that of the unreliable rhetorician or the practitioner of mere eristic (contentious disputation). Pg 52

" Guided by the view that "all people seek not the way of their ancestors, but the good." (POL. 1269a3-4), he views the different traditions as contributions to common project, whose aim is to define and defend a general account of human functioning and human flourishing that can guide ethical choice and political planning in any human community. Pg 57

Freud and Marx "practiced at about the same time. The reason Freud focused on sexuality was, he said, because it was he pone desire that was molded by socialization and early experience. He missed the obvious, that the child's way of getting a living - eating primarily - was also molded by socialization. Freud said that eating was constant. He saw the broader social dimensions of sexuality, but not those of eating (See the new book Near a thousand Tables a history of Food By Fernandez-Armesto)

" "So much for our outline sketch for the good life. It would seem to be open to anyone to take things further and to articulate the good parts of the sketch ; and time is a good discoverer and ally in these things. That is how progress takes place in the sciences [techne] too: it is open to anyone to supply what is lacking. (EN 1098a 22-26). "` For everyone has something of his own to contribute to the truth, and it is from these that we go on to give a sort of demonstration about these things" 1216b1-2; cf. section V)." p 57
" Aristotle's ways of speaking, in that what the individual sees more clearly is a conception of the human good that is to form the basis for shared life and for social planning; and the communal agreement is, as Politics VII stresses, above all an ag conditions of the good human life for "each and every" citizen.
" : "Won't knowledge of it . [The good] make a great shift in the balance where life is concerned, and won't we, like archers with a target before us, be more likely to hit on what is appropriate."
" The search for truth is the search for the most accurate account of the world, as we do (and shall) experience it.
" The good human life must, in the first place, be such that a hunman being can live it. Pg 61
" The good life must be "common to many {polukoinon}: for it is capable of belonging to anyone who is not by nature maimed with respect to arete, through some sort of learning and effort" .
" "For if living finely is one of those things that comes about by luck or by nature, it would be unhoped for by many - for its attainment would not be secured by effort and would not be up to the people themselves and their own activity. But it consists in being of a certain sort oneself, and in actions that are in accordance with oneself, the good would be both more common and more| divine - more common because more people could share it, more divine because eudaimonia would then be available for those work in order that they and their actions should be of a certain sort."

We are not, as therapists, in a secret pact with our clients against the world, not in a pact to merely help them fit into it, but to examine closely, and look for what is fitting for this particular person. I recall a dream of a high-ranking exe, "I was in a coffin talking to my staff by phone." The misfit, somewhere, is obvious. Only exploration can help her out into a world of her own choosing, in meaningful relationships with others.

" For he argues that a life containing only (the state of ) virtue, but no action from it out in the world (where the agent's efforts encounter the buffeting of chance), will not be judged by a reasonable person to be complete and lacking in nothing. In fact, says Aristotle, nobody would hold the view that the state of virtue is sufficient for eudaimonia. Pg 63.

" Participants must now be asked what they believe are the deepest and most indispensable appearances, the ones they can least live without. P 64.

" For Aristotle's interest in intuitions about the good life in a variety of societies there I ample evidence: above all, perhaps, the practice of constitution-gat)erring, and the study of varied forms of social life (in Politics l1). Here Aristotle follows a tradition of ethically motivated ethnography that begins with Hecataeus and Herodotus (perhaps even with Anaximander).

" Aristotle gives his reasons for excluding children and insane people for "they are in need not of arguments, but, in the former case, of time to grow up, and the later case, of either political or medical chastisement - for the administering of drugs is a form of chastisement no less than beating is" …for medical treatment, the conjunction of the two passages implies, is a form of external causal intervention. Argument is something else, something apparently gentler, more self-governed, more mutual.." Pg 69

The argument is for mutual peer-to-peer investigation, not leaning on the client. Drugs take away autonomy and create as bad a model as punishment, and in fact the giving of drugs is the giving of something because of intractable bad behaviors or state of mind. It is externally induced change. The psychological meaning of that must be grasped in its full negativity, and yet it is often rationalized as "care giving", while creating horror of the person towards the bad body, and dependency, not insight. "First we control your behavior, then we can talk." But if the drugs are removed, the bad state of mind returns, so we have to talk "while your emotions are under control." The idea that our depression or anxiety is trying to tell us something very real is pushed aside. The sensitive part of our soil treated as an alien.

" Medicine has an intellectual asymmetry about it. Its practical benefits require that the doctor should know, but not that the patient should know; its logoi are authoritative and one-sided. He does, however, go on to dispute the claim vigorously for ethics, arguing that the study and application of intellect have a practical value for everyone . Ethics appears to be more democratic than medicine is: the benefits of its logoi require| each person's active intellectual engagement. ..Ethical logoi are unlike medical treatment, in that they involve a reciprocal discourse in which the pupil is not ordered around by an authority figure or manipulated by coercive tactics, but is intellectually active for herself. Pg 70.
" You have to be on your guard, he says, against the sort of philosopher who argues clearly but is lacking in the proper connectedness to human experience.
" Medical treatment is directed at the health of the individual, seen as a separate unit. Aristotelian ethical argument, by contrast, addresses individuals as members of familial and political communities, separate units, but bound to one another by shared ends and ties of affection and concern.
" In medicine, the characteristic procedures of the art are purely instrumental to the production of an end.
" The standard virtues of philosophical argument - logical consistency, definitional clarity, and so forth- are treated as merely instrumental in the medical analogy, and perhaps even, like the techniques of the doctor; dispensable, if a cure were found that short-circuits them. But they are absolutely central to the practical benefit. Aristotle insists that we move beyond the muddle of daily life, and come into agreement with one another only by ferreting out inconsistencies and seeking clarity in all our discourse; and both consistency and clarity appear to be valuable for their own sake, as elements in the exercise of practical wisdom and intellectual excellence.

Rare is the therapist who wants intellectual excellence as a goal of therapy. Symptom relief is the desired end, and termination is all too often masked as fatigue with the process, not achieved clarity. But I believe that dignity and self-esteem are key to a person's feeling better about themselves and life, and the level of aspiration is high - which many therapists miss, because it is not an active part of their own quest, or central to technique.

" 7. The medical analogy creates a sharp asymmetry of roles: doctor and patient, authority and recipient of authority. She is to emulate the philosopher, entering actively info the give and take of criticism, being not subservient but independent, not worshipful but critical. Pg 74

Those that come out of the medical model have a hard time assuming peer-to-peer relationships, regardless of the talent and life experience of the "patient". The healthiness of experiencing two adults in a conversation of equals is lost to the process if the therapist holds the asymmetrical assumption. "You sick, me cure." But it is obvious looking at any therapist, that there are issues, major ones - overweight, awkward office aesthetics, and lack of grace in body or social relations. The basis for a more radical symmetry is present but actively denied. I once taught a seminar to a group of therapists in Washington. The goal was to be able to frankly talk about ourselves, who we are, and the impact our presence has on people. It took two years, so unusual a task it is. But once established, newcomers could pick up the spirit in a session or two. It was one of the best experiences I've had. The official "neutrality" of the therapist cannot survive a first visit by a client, and listening to them talk about their new "therapist' would be amusing if not so painful. Of course they rarely tell these impressions to their therapists, who in fact would try to "interpret" them as transference, not as perception.

" The medical analogy discourages the sympathetic dialectical scrutiny of alternative views. The doctor goes on with his own way. It is at best peripheral, at worst confusing and dangerous, to instruct the patient in other available ways. But this respectful dialectical scrutiny is a fundamental part of [philosophy].

CHAPTER 3 Aristotle on Emotions and Ethical Health

" Emotions are not blind animal forces, but intelligent and discrim parts of the personally. It calls for cultivation of many emotions as valuable and necessary parts of virtuous agency.
" According to some influential modern views that have left a deep mark on popular stereotypes, emotions like grief, anger, and fear come from animal irrational side of the personality that is to be sharply distinguished from its capacity for reasoning and for forming beliefs. Emotions are simply bodily reactions, whereas reasoning involves complex intentionality- directedness toward an object, a discriminating view of the object. Emotions are unlearned or innate, whereas beliefs are learned in society. Emotions are impervious to teaching and argument, beliefs can be modified by teaching. Emotions are present in animals and infants as well; belief and reasoning belong to matuhuman beings alone. These are some of the common cliched about emotion.

Of course we now face the further view that thought too is just mechanical and chemical, and consciousness itself a mere symptom of t underlying state of the chemical mind.

" In a famous discussion of philosophical speech, john Locke compares the emotive uses of language to the wiles of a seductive woman: delightful when one wants diversion, pernicious when one is on the track of the truth. One still finds many similar statements, even though the analysis of emotion that supported Locke's view of argument no longer wins broad acceptance.
" This, however, was not the view of the emotions held by any major ancient Greek thinker. There are three assumptions by the Greeks.

" The emotions are forms of intentional awareness. Anger, for example, is not, or not simply, a bodily reaction (such as a boiling of the blood). To give an adequate account of it, one must mention the object to which it is directed, what it is about and for.
" Emotions have a very intimate relationship to beliefs, and can be modified by a modification of belief. My anger, for example, requires a belief that I have been deliberately wronged by someone in a more than trivial way. Should I decide that this belief was false (that the alleged wrong did not in fact take place, or was not in fact a wrong, or was not done by the person in question, or was not done deliberately) my anger will be removed, or shift its target. Pg 80.
" All this being so, emotions may appropriately be assessed as rational or irrational, and also (independently) as true or false, … Thus, rather than having a simple dichotomy between the emotional and the (normatively) rational, we have a situation in which all emotions are to some degree "rational".

It has to be seen as amazing how much we lost by rooting our social theory in the world of Locke and the materialists. (I am not asking for matter and spirit, as in stones and angels, but matter and pattern, like the material and pattern in the chessboard, which is dependent on but not derivable from the material. However, once we accept the presence of dreams and projections, and know about the origins of angels, we then have a much richer theory than that of the chess board.).

References
Near a thousand Tables: a History of Food By Fernandez-Armesto)
0743226445

Janet Malcomb the Impossible Profession
0394710347

David Viscot The making of a Psychiatrist, out of print
B00005WC7S used

Nussbaum
The Fragility of Goodness
Love's Knowledge
Emotional upheaval
The Therapy of Desire

James Hillman and Michael Ventura We've Had A Hundred Years Of Psychotherapy And The World Is Getting Worse

articles

Theodore M. Brown The Rise and Fall of American Psychosomatic Medicine New York Academy of Medicine November 29, 2000 http://human-nature.com/free-associations/riseandfall.html

LIKE DRUGS, TALK THERAPY CAN CHANGE BRAIN CHEMISTRY
By Richard A. Friedman, M.D.
New York Times
August 27, 2002
http://www.nytimes.com/2002/08/27/health/psychology/27BEHA.html

ADD 'not a real condition'
By Joel Dullroy
31Aug02 http://www.news.com.au/common/printpage/0,6093,5006568,00.html

A Rebel Psychiatrist Calls Out to His Profession By CLAUDIA DREIFUS
http://www.nytimes.com/2002/08/27/health/psychology/27CONV.html
excerpt..
When Dr. J. Allan Hobson, 69, a Harvard psychiatrist and dream researcher, arrived for an interview, he had a notebook filled with his writings, photographs of his extended family and renderings of his summer house in Italy.
Q. In a nutshell, why has psychiatry gone "out of its mind"?
A. Because it's lost its way. In 1960, when I first went into it, the specialty felt very coherent. But psychiatry, at the time, was being held together by psychoanalysis. Over the years, psychoanalysis became "the god that failed." At the same time that many psychiatrists became disillusioned with psychoanalysis, they failed to pick up on its humanistic implications, the idea that people, on a one-to-one basis, could help each other. Finally, there's been the unwitting success of medication, which enabled psychiatrists to empty the mental hospitals without really caring for patients.
Q. Has psychiatry "lost its way" partly because of the economics of mental health financing?
A. Oh, absolutely. The states no longer take responsibility for the mentally ill. There's a constant call for privatizing the care of these people, which is impossible. No one will ever be able to make any money off of this kind of business. It's silly. These people have severe handicaps. Even if they're walking around the streets on Thorazine or whatever, they're still very impaired people. When I began my training, I couldn't have anticipated the emptying of the mental hospitals and seeing people on the streets. But these are the most disenfranchised of the disenfranchised, and almost no one speaks up for their interests. My own institution, Massachusetts Mental Health Center, which is located on a very prime piece of medical real estate, is constantly threatened with closure.
Q. Why did psychoanalysis become "the god that failed"?
A. I think people became disillusioned with psychoanalysis, because it was, ultimately, a strange way of caring for people. There was this tendency in the psychoanalytic world to imply that everything was psychodynamic.In my own training, I saw things that seemed cruel and that I believe, partly, led to the downfall of psychoanalysis. Very strange, for instance, was this business of distancing oneself from patients in order to obtain what was thought of as a crucial objectivity. Even stranger was the idea of blaming mothers for what happened to their kids. Or worse, blaming the patients themselves. This notion that everything was psychodynamic, I think, led to poor patient care. During my years of training, I was told, for instance, to control psychosis with psychoanalysis, which couldn't work.
I was told that I shouldn't give anyone medication, because it would muck up transference. I mean, I was dealing with catatonic schizophrenia people who were really, really crazy.Then came the revolution of psychopharmacology, and suddenly the pendulum swung the other way. Psychotherapy was down the drain, including the more useful parts, like humanistic psychology and an understanding of the unconscious. At the same time the field was declining, there have been tremendous breakthroughs in the brain sciences. I want to say to medical educators, "We've finally got what Freud always wanted, the chance to make a psychology based on brain science."
Q. How would you reorganize medical training so that you'd attract better and more students to your specialty?
A. I'd tell them that they have a chance to work on one of the last great medical frontiers, which psychiatry could be. This is a field where they'll have license to talk about psychology and physiology and philosophy, all together. Where else can you do that? I'd make the courses exciting. There was a professor named Fred Barnes at Brown University who's always said it is astonishing the way psychiatrists had managed to mess up the field and make it unexciting. In his psychiatry courses, he had actors come in and act out these little dramas for medical students. The students got hooked, emotionally, by what they saw. The rest was easy.
Q. Let's return to the clinical part of your work. Considering the state of mental health care, if you were an ordinary citizen with run-of-the-mill health insurance and a teenager showing schizophrenic symptoms, where would you go for help?
A. I would be at a loss. It's devastating. The families watch their kids founder because, in most cases, there's no place for them to go.

Notes
From participation in the srl list,
"The therapy/coaching discussion raises the important question of goals. Does
therapy have a goal? I often sense from collegial discussions that it is
practiced as if it doesn't , with the working assumption that "somehow the
client will make good use of their presence with the therapist" - but it is
not explicit, and hence can't be a part of the technique or strategy. If we
start with the view that at it best the client sets the scene for the
session (rather than the therapist providing the skeleton structure and the
client fleshes it out), is our presence and participation goalless?

Then some will say the client sets the goal. But do we not question goals of
clients, and don't we have some kind of goal of consistency, livability, and
flourishing in mind to guide us?

Doug"