December 19, 1920 -- February 26, 2014
Without a philosophy, a psychotherapist is like a navigator without a map or a destination. This paper offers such a philosophical approach to some of the issues surrounding the nature and future of psychoanalysis. It proposes a philosophy broad enough in its purview to shift the emphasis of psychoanalysis from its present focus on the pathological to that of the normal.
A Contribution to Clinical Philosophy
by Arnold Bernstein, Ph.D.
1. the rational investigationof the truths and principles of being, knowledge,or conduct.
2. the pursuit of wisdom.
We may insist as often as we like that man's intellect is powerless in comparison with his instinctual life, and we may be right in this. Nevertheless, there is something peculiar about this weakness. The voice of the intellect is a soft one, but it does not rest until it has gained a hearing. Finally, after a countless succession of rebuffs, it succeeds.
Psychoanalysis encompasses far more than merely a technique of psychotherapy. It is an exotic mix of art, science and intuition. Though it endeavors to be scientific in its theoretical constructs, it is a performing art in its practices. Even the most cursory examination of the titles of Freud’s publications will reveal the sweep of his interests. Besides psychopathology and psychotherapy, Freud applied the psychoanalytic method to the analysis of dreams, sexuality, human development, character and personality, everyday life, wit and humor, the family, the human condition, biography, history, religion, cultural anthropology, civilization, folklore, and countless other topics. Indeed, as I hope to show, Freud was hardly just a psychoanalyst, but he was in addition, what I will identify as a clinical philosopher.
Strictly speaking, the psychoanalytic
method or what is usually called psychoanalyzing, consists of interpreting.
Interpreting is a form of thinking that involves the translation of the
symbolic or unconscious meanings of words and deeds into conscious thoughts.
Such interpretations or thoughts can then be written or spoken or simply
allowed to remain the silent basis of the actions used in the service of
psychotherapy. Proficiency in the art of interpretation is
the hallmark of a psychoanalyst.
Today we shall be talking about the formulation of a new discipline, which could be called clinical philosophy. Clinical philosophy would be an amalgam of psychoanalysis (which would remain as its core) augmented by the applicable findings from other related fields, mainly psychotherapy, psychology and philosophy.
Since its beginnings in the last century, the theory and practice of psychoanalysis has undergone many changes. At the same time it has had to resist certain other changes in order to preserve its identity. From a specialized treatment of the symptoms of psychoneuroses (which were at that time thought to be diseases of the nervous system), it has gradually grown into a general theory of the mind that is applicable to understanding the whole range of human emotions and psychic misery. This is what Freud meant when he predicted that, "The future will probably attribute far greater importance to psycho-analysis as the science of the unconscious than as a therapeutic procedure."
My hope today is to stimulate some
new thoughts about psychoanalysis by looking at some old ideas and placing
them in a new context. In each instance, although the words and ideas
used by me will be familiar, I hope that by reframing them in a larger
context they will acquire fresh meanings. For example, take
the word soul. By a soul I will simply mean a person: - as in the
expression, “She is a good soul.“ But also notice the
implications of emphasizing that she is a good soul (as contrasted to saying
that she has a good soul). She is then seen as the person that she
is, rather than as the body that she has: - hence the expression, “body
and soul.” We will return to the subject of the soul later.
And now we must address another familiar concept, that of resistance: - first the concept of resistance in general, and then later the particular kind of resistance shown by analysts, that though very common, goes largely unnoticed.
I feel obliged to do this because I intend to introduce a different way of looking at things. And the general resistance to which I refer is the one that occurs almost universally when any new or different idea is introduced, or a change is suggested in the accepted way of doing things. It is the resistance to changing one’s mind.
It was this resistance that greeted Freud when he first introduced psychoanalysis to the world, and it is this resistance that continues to be mobilized almost every time a new innovation in psychoanalytic theory or practice is suggested. Max Planck, the great physicist once remarked, not totally with tongue in cheek, that we never succeed in convincing our contemporaries. We just have to outlive them.
But there really isn’t anything
so surprising about this, because resistance-to-change is a universal phenomenon.
It is evident not only in the world of ideas but in the physical world
According to physicists, inertia is a fundamental property of all matter. Inertia is defined as the resistance that a body presents to a change in its speed or position (upon the application of a force): or the opposition that an object or a substance presents to passage through it. So resistance is in the very nature of being. Something in the sensory world is known to “exist” only when it resists!
Consequently resistance is a fundamental
property of existence. If something doesn’t resist, it isn’t there.
In the psychological sphere, identity and character are sources of such
In biology, resistance refers to the self-preservative mechanisms of living creatures by which they defend themselves against disease: - or the capacity of tissues to withstand the effects of harmful environmental agents. In politics, resistance refers to the forces that oppose oppression. In a general sense, a resistance is any defense of the status quo. It is any opposition to change. And it can be either passive or aggressive.
But inertia, force and resistance have psychological meanings as well. Thus the term, resistance can be used to describe any force, physical or psychological, that opposes or retards motion or change. In psychology and psychoanalysis the forces that are at work are described as ideas and urges, impulses and drives. We can speak of the force of ideas and the power of words and the sexual drive and their resistance to changing.
In psychoanalytic treatment, as
in any human interaction, resistance usually refers to behavior, emotion
or thought that interferes with progressive communication.
Resistance leads to inhibition of words, thoughts and ideas and can be
an impediment to progress in science as well as in treatment.
Freud long ago identified the compulsion to repeat (also known as the repetition-compulsion resistance) as an “expression of the inertia inherent in organic life,” which he called Thanatos. This led to the paradox that repetition is a resistance, that is to say a form of staying the same. What Lewis Carroll described as, “Running fast to stay in the same place.” Death, the return to the inorganic state, becoming the ultimate repetition, in which there is no change. Life resists death. And death resists life. Things in motion tend to remain in motion and things at rest tend to remain at rest.
One of the least noticed and most
common counter-transference resistances is a therapist’s over commitment
to a particular theory or method of treatment, or a particular belief system.
An over zealous commitment to a particular theoretical point of view acts
as a resistance to considering any other point of view either from colleagues
or patients. Freud remarked that, "Whoever is familiar with
the nature of neurosis will not be astonished to learn that even someone
who is very well able to carry out analysis upon others can behave like
any other mortal and be capable of producing violent resistances as soon
as he himself becomes the object of analytic lnvestlgation.”
These resistances get in the way of analytic progress in and out of treatment.
But how does one overcome the resistance presented by what someone believes? How does one change a belief, any belief? The answer proposed by psychoanalysis is that one must first address and resolve the resistance before a new thought can emerge. And resolving resistances to progressive changes in thought patterns is what the psychoanalytic enterprise is all about.
Obviously an existing belief system
presents an impediment to the acceptance of new ideas
I believe that psychoanalysis will thrive as a profession separate from medicine, during the next century, only if it can again offer the world a new way of thinking about human beings. Offering the world a new way of thinking was after all, Freud’s great and ultimate contribution to the history of culture. To do this, psychoanalysts will need to shake loose from their fascination with the nineteenth century paradigm of mental illness that continues to bedevil their thinking and practices.
What we need is a new philosophy,
or as it turns out, to improve upon an ancient one. The notion that
mental illness is the product of biological dysfunction leaves them helpless
to prevail in the face of the discovery and widespread use of psychotropic
medication during the present century.
But important and admirable as these advances in psychopharmacology may be, they cast no light upon how human beings can live better and happier lives (without drugs) and how they can avoid feeling miserable in the first place.
Besides, only the tiniest fraction of human madness and misery emanates from diseases of the brain and nervous system. Moreover, on balance, it must be admitted that psychotropic drugs, administered either with or without a physician’s prescription, have probably damaged at least as many lives as they have improved.
Witness also the world wide hidden as well as not so hidden social and psychological costs and ravages of chemical substance abuse.
Since so many varieties of human suffering cannot be attributed to disorders of the body, any endeavor to understand human psychological suffering solely in terms of brain neurophysiology and which attempts to remedy it solely through medical means is bound to fail. Both chemotherapy and psychotherapy have their places in the scheme of things but the role they will continue to play depends largely upon what therapists and the profession believes about the nature of mental illness. This situates the mind-body issue at the very core of the present philosophical revolution that is unfolding in the field of mental health. And this reintroduces the distinction between body and soul, soma and psyche, the organism and the person.
Perforce we have to discriminate between two different universes of discourse: that of the brain and that of the mind. The words used to describe the mind are different from those used to describe the brain. And the events to which they allude are different phenomena.
It is unfortunate that Sigmund Freud’s translators had a resistance to the word soul, because instead of translating the German word Seele into the English word soul, which it means in German, they translated it as psyche, which means soul or mind in Greek. But in fact Freud had referred to psychoanalysis as Soul Psychology. “Indeed,” Freud wrote, “the word Seelesorge might well serve as a general formula for describing the function which the analyst has to perform in relation to the public.” The German word Sorgen means "one who cares for." So Freud had in mind that a psychoanalyst is a Seelesorge, someone who cares for the soul.
To the extent possible, James Strachey
avoided the use of the word soul in his translations of Freud and in this
instance elected to translate the German word Seelesorge into English as
“secular pastoral counselor.” (A designation comparable to our own
term “clinical philosopher.”) Since translation is a form of
interpretation, to the extent that Strachey mistranslated Freud, he misinterpreted
Interpretation is at the very heart of classical psychoanalysis. Classical psychoanalysis was a method for discovering unconscious meanings in the service of attaining insight and understanding. In that sense it was a research tool. An interpreter is a translator and this is what psychoanalysts have traditionally been. They translated dreams. They translated the unconscious into the conscious. But modern psychoanalysis, as you know, has pretty much abandoned interpretation as its tool. What used to be the goal of classical psychoanalysis (which was the understanding of unconscious meanings) has now become the means employed by modern analysts to attain the goal of resolving resistances. The goal of modern analysis is not to translate the unconscious into the conscious so much as to relieve suffering.
The objective of all forms of psychotherapy is to relieve suffering. The future of modern analysis lies with helping people to find happiness. It has gradually moved from using interpretations of the unconscious for the purpose of curing diseases to a human enterprise with the purpose of increasing happiness.
So what Freud really thought was that unlike physicians who are curing bodies, psychoanalysts were curing souls. That's the message that lies buried in our mostly forgotten past. And our message for today is that in our past lies our future. In the 21st century, we may finally remember what psychoanalysis is all about.
But it must also be remembered that Freud was a scientist and an atheist. So he was not talking about the soul in a religious sense. Nor are we talking about the soul in a mystical sense. We're talking about the soul as the quintessentially human, the human being, i.e. the person as contrasted to the organism. That part of the individual that we experience verbally, when we ask an analysand to lie down on the couch, break eye contact and to say everything.
No one has written more eloquently than Thomas Szasz has about the malignant consequences that follow from the failure of professionals and society to appreciate the philosophical implications embedded in matters pertaining to "mental” health. Particularly unfortunate are the consequences that follow from confusing so-called mental illnesses with organic disturbances of the brain and nervous system and in incorporating their treatment under the rubric of medicine without appreciating the philosophical and social implications of doing so.
Szasz submits the following fundamental
philosophical proposition. "Disease... means and should only mean,
a disorder of the body." And accordingly, his argument goes, medical
"treatment means, and should only mean, a physicochemical intervention
in the structure and function of the body."
Within the framework of this formulation most forms of so-called “mental” illness and their "treatment" would, strictly speaking, properly fall outside of the province of medical science. As would also the mental suffering normally propagated by the tragic vicissitudes of everyday life. This does not preclude recognizing that some psychic suffering can be alleviated through medical means (i.e., medication) or that on occasion some physically induced suffering can be relieved through psychological means (i.e., psychotherapy). The psychosomatic continuum is a two way street that can be entered at either end.
It is easy to confuse means and ends here. Medical means can sometimes be used to attain psychological ends, just as psychological means may sometimes be employed to achieve physical ends. There is a compelling need for the consistent use of more precise definitions in fields like psychiatry, psychoanalysis and psychotherapy in which ambiguities, glib formulations, unsupported speculations and especially the careless use of undefined terms is so common.
It is misleading, Szasz says, to
think of the actual practice of psychotherapy as if it were a form of medical
treatment. Indeed, he says, it should be regarded as a form of the
special branch of philosophy that Aristotle called rhetoric (persuasive
speech) rather than as a branch of medicine.
Since the practice of psychotherapy usually is implemented mainly in the form of an exchange of words and feelings between persons, as a practice it clearly has more in common with a Platonic dialogue than a medical treatment. And in fact, until the philosopher, William James, wrote his precedent setting textbook, Principles of Psychology, the whole field of psychology was itself a branch of philosophy and was taught as such in university departments of philosophy.
Philosophers from the time of Plato
have sought to provide their students with general guidelines to help them
in their search for increased inner peace and happiness: in this world
through personal enlightenment, raised and expanded consciousness, love
and understanding, - and in preparation for the next world, through a belief
in gods and in the fantasy of other lives after death.
So it seems that what we have been calling psychotherapy is really a new edition of an old discipline which can now more properly be identified as clinical philosophy.
Clinical philosophy or psychotherapy can be defined as “the therapeutic practice of wisdom”: - the application of philosophy to the relief of human suffering. It would consist of the development and the application of a general theory of the treatment and cure of persons (souls, human beings), as contrasted to clinical medicine, which concerns the treatment and cure of bodies.
The objective of formulating such a philosophy of psychotherapy would be to provide practitioners of the various schools of psychotherapy with a common framework within which they could implement their own particular methods of relieving psychogenic human suffering.
From a purely philosophical point of view, what is needed is some kind of lingua franca, a sort of grammar of general treatment principles, consisting of common definitions sufficiently operational so that psychoanalysts and psychotherapists of diverse schools could at least agree as to what it was that they were talking about. Because there is actually a considerable body of agreement among mental health professionals of different schools of thought that is concealed by their differences in terminology. The actual practices of experienced therapists of different schools do not differ as much as their vocabulary might suggest.
A clinical philosopher would be a special kind of a teacher (doctor) who might also be qualified as a physician, a psychologist, a pastor, a nurse, a social worker, a philosopher or be trained in any of the humanities or social sciences. Many synonyms and modes of address for such teachers readily come to mind: professor, master (as Zen master), doctor (from Latin for teacher), rabbi (Hebrew for teacher), guru (Hindi for teacher), counselor, healer, mentor, spiritual guide; or psychotherapist and therapist (from classical Greek for helper), facilitator (from Gestalt therapy), and psychoanalyst. It is perhaps somewhat unfortunate that in the United States the medical profession has preempted the title of doctor. And though its original meaning (teacher) is still preserved in academic circles, it is more often than not used as if it were a synonym for physician for which it is popularly substituted.
Ideally, such teachers would be highly evolved human beings with a broad background in the liberal arts and sciences, as well as having had specialized training in one or more of the various methods and techniques of interpersonal influence. They would hopefully have sought and undergone a personal psychotherapeutic experience and they would also be knowledgeable concerning theories of human development, especially psychoanalysis, and to have mastered the art of applying these in clinical situations. These doctors (teachers) might also continue to refer to their students as patients, but by this they would mean “persons who are suffering”.
I prefer the adoption of the appellation clinical philosopher to that of clinical psychologist or psychoanalyst because it would not only demystify the true nature of psychotherapy but would liberate practicing professionals from the strangling network of licensing laws and state regulations that have frozen our field in a procrustean tangle of antique paradigms, to satisfy insurance companies and self serving professional interests.
So our future lies in our past.
You may recall that Freud compared psychoanalysis to archaeology. An archaeologist, he said, digs to find artifacts from the past in order to reconstruct the past from these artifacts. But it's very clear that the archaeologist is not digging in the past. The archaeologist is digging in the present. The artifacts that he uncovers exist in the present. He reconstructs the past, in the present, from artifacts that he has in the present. Very much the way a psychoanalyst is searching in the present for memories and associations from which to reconstruct the past. The “past” is in the present.
But how does one look into the future?
In a sense the future is not a place but merely an idea of a place.
When an astronomer peers into outer space, is she looking at the future
or looking at the past? Well, the astronomer thinks she's looking
at the past. But when a space ship is launched into outer space,
is its destination in the past or in the future? What then, is the
future? What then, is the present? What then, is the past?
Past, present and future become extraordinarily complicated ideas.
One metaphor about life is that living life can be compared to rowing a boat. We are backing into the future. And that's a way of describing what we're doing here today. We're backing into the future. In the sense that we are viewing the past, in the present, and extrapolating into the future. Moreover the future we refer to is not a place. It's an idea. The future is an idea in the same sense that the past is an idea. A memory is an idea about the past. But a memory is not itself a past event. A memory is a current event, taking place in the brain now. It's a present idea about the past. There is a link between our memory of the past (which is in the present) and our fantasy of the future (which is also in the present). How else can we get to the future except from our present position, rowing into the future so to speak, backing into the future by looking at the past.
© Arnold Bernstein, Ph.D. 1999
From Roberta Russell:
I offer my gratitude to my friend Arnold for his enduring and life-changing teachings, love, courage and friendship. For decades he was my family. Here is the reference he gave me that tells part of our story.
To offer your memories or an e-mail response to Roberta Russell a friend and admirer of the just-deceased author click the icon