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Book Forum: Religion and Philosophy   |    
Philosophy Practice: An Alternative to Counseling in Psychotherapy
CHRISTOPH MUNDT, PROF. DR.
Am J Psychiatry 2002;159:1075-1076. doi:10.1176/appi.ajp.159.6.1075
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By Shlomit C. Shuster. Westport, Conn., Praeger (Greenwood Publishing Group), 1999, 200 pp., $59.95.

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Psychotherapy today is subjected to evaluation procedures for which almost identical criteria of efficacy and effectiveness are applied as for pharmaceutical studies if they are to be financed by health care systems. Counseling bodies like the Scientific Council to Psychotherapy Law in Germany discard therapies from their list of eligible "techniques" if they do not consider their efficacy as being evidence based, even if the therapies are highly appreciated by the public. A sizable number of these therapies, however, have formalized training programs and acknowledged institutionalized practice (systemic family therapy, for example). Some of the rebels against too-technical, evidence-based psychotherapy might rally around philosophy practice because one of its basic aspirations is to free the helping dialogue from methodological narrowness, uninterpreted aims, and the asymmetry between the patient and the professional caretaker.

In the introductory part of this book, the author criticizes "blind paternalism" in modern medicine, giving as examples case episodes for rational use of technical means against the patient’s emotional demands. She instead declares the right of freedom from therapy, from medicalization of life problems in general, and from suicide prevention in particular. The "neutral" philosophical educator is proposed as an alternative to the therapist. At first glance this intention appears a sympathetic and promising attempt to find access to patients who shut themselves off from medical overcare or find themselves in a predicament with unbearable loss of autonomy. However, the author’s reference to antipsychiatrists such as David Cooper, Ronald D. Laing, and Michel Foucault and to theologians like Paul Tillich or Martin Buber demonstrates that the ideas proposed here have a history of at least four decades or more and are in fact responsible for many changes that occurred in psychiatry in the 1950s to 1970s. Their renaissance sheds light on current shortcomings in the balance of our methodological canon and our ethics in psychiatry.

The history chapter goes through the different attitudes taught by philosophy in the past two millennia with regard to practical help for daily living. After elucidating statements of ancient Greek and the Renaissance philosophers on educational, ethical, and practical questions, the author concentrates on the work of the German philosopher Gerd Achenbach, who is considered the founder of philosophy practice in Germany. Achenbach does not hold a relationship to academic institutions, but there is a German-Austrian society for philosophy practice that can be approached through the Internet (www.philosophischepraxis.de).

One of the aims of philosophy practice, in general terms, is "distancing" by heaving the patient’s personal problems up to a general human aporia, a step that may cause relief from guilt, shame, and self-belittling. Above all, "distancing" conveys a notion of autonomy and bird’s-eye view on a situation in which the patient has felt constrained. The author introduces Nelson’s philosophy of antirelativism and resistance, exemplified for Nazi-time victims, without mentioning the ample psychiatric evidence-based research from the 1950s to today on trauma experience, which comes to very similar conclusions and recommendations as expressed in Nelson’s philosophy.

The chapter on philosophical care or "transtherapeutic" techniques points out some details of philosophy practice, resuming the idea of "distancing" and elevating the patient’s problems to a more general existential level as a feature of the condition humane. The author cites Paul Tillich’s "courage to be" and the antique Greek stoic’s "acceptance of the unavoidable" as well as the existential philosophers’ "transcendence of the givens of life." Such reality-oriented attitudes are certainly helpful in or after intellectualizing therapies with their inherent difficulties for the transfer of their results to real life. In addition, the initial detachment of a patient from a problem by introducing philosophy, with a superindividual view on that problem as one of mankind over centuries, helps overcome narcissistic barriers against accepting the problem and looking at it closely. It also may soothe the patient by acknowledging the tragic element in his or her fate and the strain of coping under oppressive circumstances. This step seems similar to therapy by means of fairy tales practiced by Gaetano Benedetti (1), which was meant to help deluded patients deal with the topic entailed in the delusion by detachment. From a psychotherapeutic point of view, one would say that such an approach can be helpful, provided it is not a joint defense of client and philosopher to avoid personal involvement and hence change. From the philosophy practice point of view, the philosophical discourse would suffice as a purpose in its own right.

The characteristics the author outlines for the nature of the client-philosopher relationship come close to those of the vast psychotherapeutic debate in both psychodynamic and even recent behavioral literature. Shuster emphasizes "seeing the illness from inside," a facet of psychotherapy that empathy research has worked on. "Positive reciprocity," "dialogue," "intellectual love," and "critical wonder" are elements that go along with the recent trend in psychotherapy research to render the patient with more symmetry of the therapeutic situation and more joint methodological responsibility. Sartre’s differential criteria of his psychoanalysis-derived therapy-like discourse summarize the intention of philosophers who offer a helping or clarifying dialogue—openness, beyond method, no prefixed aim, use of philosophical contents and means, and relating personal quests to philosophy.

About a third of the book is dedicated to narratives. In this chapter the author resumes the idea of the bird’s-eye view on oneself by means of philosophy, explaining such famous narratives as those of Augustine, Thomas, Montaigne, and Rousseau as walking on high places to overlook and to find the eternal in the elapsing, the general in the particular, the Zeitgeist manifestation in the personal life history. This would be a necessary part of growing self-awareness, an aim of Jasper’s "existential enlightenment," which acts against man’s alienation.

The narratives illustrate the spirits and intentions of philosophy practice very well. The main impression is the gain of coherence, reconciliation with those features of the self, the life history, or the situation with which the individual has been cross, which is helped greatly by the avoidance of "psychopathologization" of problems. The reported narratives have been generated by the author retrospectively years after the sessions, mostly without files. Hence, they may be formed by the constructive element of memory and be endowed with a higher degree of coherence than would have been conveyed by an objective account of what had been negotiated and what has come out of it.

To sum up my impression of this book, there are useful intentions and procedures outlined in philosophy practice, foremost among them putting the client’s problem into a wider frame of philosophical aporias. The rising attention philosophy practice is gaining at the moment is rooted in the unemotional, cold high-tech medicine with unsettled ethical limits to its ever-rising skills. Many aspects of philosophy practice put forward as original pleas in this book, however, correspond to a long history of research in psychotherapy. Hence, cooperation is desirable, not competition as the author describes. What remains unresolved is the responsibility of philosophers for unsuccessful counseling and with it the question of how to teach a method that wants to do without methods and be free of aims.

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