philosophy and psychotherapy 2011

philosophy and psychotherapy 2011 - CHAPTER 3 PHILOSOPHY...

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CHAPTER 3: PHILOSOPHY AND PSYCHOTHERAPY I recently listened to a lecture in which the speaker said that every psychotherapist must be a philosopher. I think of philosophy as that domain of thought that brings us to an awareness of our deepest assumptions, and certainly psychotherapists should in this sense become philosophers. But in my old age, I find that I have become impatient with discussions that become too abstract.. So I shall address this topic with a series of clinical stories, ones that to some extent relate to major areas of philosophy: metaphysics - the nature of the real; ethics – the nature of the good; epistemology – the nature of knowing; and aesthetics – the nature of the beautiful. Metaphysics: the Nature of the Real 1. My first story concerns a 30 year-old man with whom I sat down a long time ago when I was still a student, a man who had been given a diagnosis of schizophrenia. He was silent, for a number of minutes. I asked him finally: “What are you thinking about, brother?” The answer that came back was: “I don’t think. It thinks.” When I asked him what “it” was, he answered: “The machine. It is. I am not.” No matter what I said after this initial interchange, he kept repeating the statement that he did not think, was not there, and there was only a machine. What does one make of such statements? Most people would regard his words as in plain 1
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contradiction to all that is real. That would also be the view of contemporary psychiatry. My encounter with this gentleman took place during my student days, at a time when I had not yet understood the phenomenology of annihilation states and the imagery often used to express and symbolize it. Instead I was still captive to a Cartesian view, in which this patient seemed to have traveled into an alternate universe, a world of his own which had lost contact with objective reality. Phenomenological contextualism had not yet been born. How, I wondered, is one to establish communication with such a person? Conversation between human beings, I thought, requires a shared basis of understanding, and here we had a rift separating his world from ours. What is one supposed to do with such a discrepancy? Do we suspend our own reality and try to enter his? Do we tell him he is wrong and try to draw him into ours? There was no real guidance in the psychiatric setting where this was occurring, and neither I nor the other students and clinicians available were able to do anything constructive with this patient. He was eventually transferred to a long-term care facility for the chronically mentally ill. But I have never forgotten him, and I have tried to rethink what I experienced then in the light of my later training and clinical adventures.
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