DOING PSYCHOTHERAPY IN A CULTURE DOMINATED BY NATURAL SCIENCE
Philip McKenna : What is Psychotherapy Day January 6, 2018
Psychoanalysis makes a basic assumption, the discussion of which remains the preserve of philosophical thought, and the justification of which lies in the results. We know two things about what we call the psyche (or psychical life). Firstly, we know about the brain (nerve system), the psychical organ and scene of the psyche; secondly, we know that there are acts of consciousness that are presented to us in their immediate form and that no description can bring us any closer to. Everything in between is an unknown quantity to us; there is no direct relationship between these two endpoints of our knowledge. If there were such a relationship, it would at most give us an exact location of the processes of consciousness, and would not in the slightest help us to comprehend them.
Sigmund Freud, An Outline of Psychoanalysis 1939 Penguin Edition P.175
In 2005 when HPRAC was preparing to advise the Minister of Health whether to regulate the profession of Psychotherapy in Ontario, they questioned various associations of therapists as to whether they wanted regulation or not. Eventually they said they had heard from a significant number who did want it.
When I made my submission to the commission on behalf of CAPT, I pointed out that probably they saw it as a path to social recognition.
I explained that in our current culture dominated by medical science and pharmacological psychiatry, psychotherapy was seen as ”what we doctors used to do before we knew what to do (scientifically)”. We psychotherapists didn’t mind this derogatory estimation of our work. Our kind of work was ill suited to the medicalised health system. Insurance was too meager to be of much use, and we didn’t particularly want to be part of a team in any agency or hospital where confidentiality is under serious pressure in the name of records and inter- professional collaboration.
This was my first public encounter with hostility towards psychotherapy on modern scientific grounds. As a Catholic priest I had frequently encountered battles between science and religion. Now I noticed the irony that while psychotherapy in its origins had seemed to be “against” religion on scientific grounds, it now seemed to be itself attacked along with religion as being contrary to modern science.
I think the issue is worth exploring. It affects each of us personally as we participate in our contemporary culture. It affects our profession especially as we come under regulation by a state health system governed at the highest level by political judgments and dominated at the next level down by medical scientific judgments.
And thirdly, as we sit across from a client we have to negotiate the boundaries between us.
It is the therapist’s job to find a psychological pathway for really deep and fruitful communication while practically bracketing areas of potential disagreement—religious, scientific, political, ethical, aesthetic and so on.
There is much to be said about all and each of these, but today I want to concentrate on the relationship in theory and in practice, in general and in each person, between psychotherapy and natural science.
I want us all to take some time to reflect on how we each relate to the body of natural science that is largely accepted in our present shared culture.
Was there scientific knowledge in your family? Did you study science at school? Physics? Chemistry? Biology? Botany? Cosmology? History of Science? Geology? Climate? Human Anatomy and Physiology? Did you become interested in a particular kind of science?
Did you study Mathematics, Relativity, Quantum Theory? Genetics? Neuroscience?
Did you ever hear about Unified Science?
Were you aware of, or did you study, the connection between the rapid technological changes in the last century and the scientific knowledge that made such knowledge possible?
Were you aware of the effort made by the “human” sciences (psychology, sociology, political science, economics) to be accepted as fully accredited sciences along with the natural sciences?
(I wonder if one or two of you would volunteer to dialogue with me about these questions so that the issues would appear more concrete for all of us here. As we talk people will compare their own experiences with yours. Afterwards some of the historical and theoretical issues we take up will maybe have more relevance for you.) (this was omitted on the day)
Before I begin this next section wherein I will be making some vast historical generalizations, I want to raise several cautions for your consideration.
( Because of the overwhelming complexity of presently available human knowledge and opinion, we all tend to seek authoritative simplifications and generalizations. How do we discern what is authoritative/trustworthy?
Often we go with what Heidegger call “Das Mann” “the They”. “They say …” Especially if we grew up among people who “All say…
Especially if a group with whom we are passionately identified “all say …
Too much of this and we find ourselves repeating slogans in place of knowledge.
This of course trenches/builds on the fact that almost all our knowledge inevitably requires an element of trust. Trusting testimony of other people.
One of the great ways to avoid the seduction of slogan thinking is to reflect carefully on how omnipresent is our trust of testimony in making our way through life. —————————————————————————————-
The big issue is not really between natural science and the human science of psychology but between generalizing knowledge (natural science & psychology) and individual (actual) knowing connection between two humans, that is only possible because of an evolution towards this possibility and concretely possible only if one is empathic and committed to the process of connection. ( see Hrdy)
Of course in an individual encounter each (adult) person will also speak out of an enculturated self, assuming many truths and beliefs, including those embedded in their common language.
But when we see a baby and a mother communicating we are aware of a large reality that is pre-linguistic and largely independent of the particularities of the mother’s culture.
This pre/non linguistic reality remains always within or under our adult encounters with others in psychotherapy sessions. It may be “the talking cure” but there’s much more going on than the literal talking. —————————-
I would like to take an example from history that can show us how we can both ‘know’ something but need to hold our mind open to better or fuller knowledge. (referenced the public letters between Umberto Eco and Cardinal Montini)
Our ancestors looked “up” at “the heavens” and saw (pretty much) what we see. They worked very hard to do and record accurate observations of periodic movements. They needed the knowledge for agriculture and for its own sake (theology), as the heavens appeared closer to the unchanging divine than this earth where generation, corruption and change ruled all.
This eventually led to an explanatory theory, the Ptolemaic theory of a series of concentric spheres: one for all the stars, and one for each of the planets and for the moon—all of them moving around the earth in the predictable repetitive pattern that had been carefully observed over many years. They knew that any explanation had to, as they said, “save the appearances,” that is, they knew the theory had to rely on accurate observations.
So why did the rival astronomy of a sun-centered world cause such a convulsion in Western civilization? It also “saved the appearances>”
The problem arose not only from academic opposition but from the Church authorities who were the custodians of God’s revelation through Jesus, the prophets and the Biblical Scriptures.
They thought that when the book of Genesis said that God made a dome and separated the waters so that there were waters above the dome (which God called Sky) and waters below the dome, that this guaranteed that there was such a dome and waters above it. They didn’t read Genesis as an imaginative account of creation with the religious message that God created everything.
They had ceased to hold open the meaning of “the heavens” for expansion and specification.
In our time we see the same struggle carried out with regard to gender and sexuality. “Male and female God created them.” Then we dismiss how this simple binary is actually full of complexities at many levels—hormones, anatomy, orientation, psychic self regulation, and cultural identifications.
Many religious leaders can’t allow this new knowledge to fill out, amplify for them what God created, but they hold onto that simple binary and treat everything else as against nature (against God).
Another completely unnecessary conflict.
Historically then, the scientific movement gradually (not suddenly) moved to a position generally hostile to all religious interpretations of reality as superstitions.
As the cultural movement of the scientific revolution gained in confidence and gained general popular acceptance especially because of its manifestly successful technological applications, it gradually dismissed as irrelevant all other pathways to human knowledge, not only theology (formerly the “Queen of Sciences”) but also philosophy, and also all the prescientific Wisdom of the Ages.
This need not have happened and paradoxically it leads to a narrowing of the mind and an abandonment of the holding of concepts and systems open for completion and connection.
“Scientism”—the view that our only knowledge is through modern science—demonstrates a kind of fundamentalism we usually associate with some religious positions.
There are numerous ways we could describe the modern challenges to the dominance of scientism with its ideal of a unified science about everything.
One of these is post-modernism which in extreme form holds that all variations in languages and theories or all kinds are arbitrary (i.e., freely chosen) cultural artifacts. So the idea of a universal trustworthy science is just such an arbitrary choice in our culture.
Another critique (not unconnected) comes from the sociology of knowledge that traces the social construction of knowledge systems and highlights the influence of political aims in shaping theories of all kinds. ( Foucault)
These are issues we could spend a WIPD on but we won’t take them on today. I would like to refer you to 4 sources: 1. John P.A. Ioannidis on the chronic flaws in most medical research:
Why Most Clinical Research is not Useful
- The Mad-in-America folks at www.madinamerica.com
for their careful critique of pharmacological psychiatry and their promotion of more human practice.
- Nancy Cartwright and the Stanford school on the limits of Science.
- Charles Taylor in “A Secular Age” for his masterful appreciation and critique of post-religious secularism.
What I do want to address today is more specifically the meeting between brain science/neuroscience and psychology.
Concretely does all the new neuroscience about the human brain show that the brain is the mind?
Edward F. Kelly writing the Introduction to Irreducible Mind notes how most of mainstream theoretical psychology in the 20th century was dominated by desire to create a psychological science on the model of the “hard sciences” that relied on third person observation, controlled experiments, reproducible data, and generally materialism.
Watson’s Behaviorism that tried to explain the specifically human by scientific observation from the “outside” alone, dominated the field for decades.
So naturally the study of the brain was understood as study from the outside. And what an exciting field it proved to be! Much research was stimulated by working with the terrible brain injuries caused by history’s most terrible wars.
Great advances were made in knowledge of what human capacities were damaged when various parts of the brain were damaged. Evolutionary history showed that certain parts of the brain were more so called “primitive.” We have a reptile brain, a horse brain and a human cortical brain for higher functions.
When the new emerging techniques were discovered: EEG, MRI’s, PET scans, scientists could now measure in living function, and they could examine fairly non-invasively, normal brains as well as damaged brains. The early experiments with brain damaged patients are very revealing for our topic. Because the surgeon would stimulate a spot in the brain and ask the patient what he was experiencing.
So the correlation of brain location and activity with some kind of memory or experience, depended on trusting the reports of human subjects. When the patient would say “I see the farm I grew up on” he is not referring to his brain; he is reporting on his own experience at the moment.
Without all the communication by subjects of their psychic experiences the scientist would have absolutely no idea what all the electrical activity in the brain had to do with anything.
This is the crux of the matter and led me to choose as an epigraph the text from Freud which names two irreducible paths of knowledge.
Freud famously tried to write a totally scientific account of psychology,
“Psychology for Neurologists” as he said of his “Project for a Scientific Psychology.” (1895) He thought originally he could quantify psychic energy and model mental functioning on mechanical principles.
In the end Freud rejected the Project, as Strachey writes in his Introduction, Standard Edition I, 293.
“And after all we must remember that Freud himself ultimately threw over the whole neurological framework. Nor is it hard to see why. For he found that his neuronal machinery had no means of accounting for what, in the Ego and the Id (1922b, Standard Edition Ed, 19,18), he described as being “in the last resort our one beacon light in the darkness of depth psychology—namely. “the property of being conscious or not.” (SE I, 293)
One extreme line of thought, exemplified in the American doctrine of behaviourism thinks it possible to construct a psychology which disregards this fundamental fact.” (Outline of Psychoanalysis, SE 23,157)
The fact is that, as Freud worked on the Project, he became more and more interested and fertile in exploring strictly psychological matters that require communication about matters that can only be understood and talked about by people who have consciousness and can speak of personal experiences, inaccessible to third person observers.
In 1958 G.E.M. Anscombe, a famous British philosopher, student and translator of Wittgenstein, wrote a small book called “Intention”. In the course of writing a critical theory of intentional action she made the seemingly simple distinction between : Knowledge by observation and
Knowledge without observation.
She argues totally convincingly that when a person executes an intentional action, that one knows their intention in the doing, not by an observation of the intention.
The ‘observation ‘ referred to here is the kind of perception of things shareable by two or more people, and so measurable etc.
This gives me a rich idea for understanding what is special to psychology and psychological theory/science. When we go through the long process of learning our culture’s common language about ourselves and others as live, conscious beings, with thoughts, beliefs, feelings, habits, actions, we can easily forget how remarkable it is that this shared language can refer to our subjective experiences and to those of our own kind with whom we have an empathic bond.
And we are using pathways to knowledge quite distinct from our common pathway to knowledge of measurable physical objects.
The scientistic attempt to reduce all knowledge to knowledge by observation gains a modicum of plausibility from the fact that our language for naming and describing observable things seems to be more basic than our language for naming and describing states of consciousness, feelings, or intentional actions. The latter language seems to be built on the model of simpler object descriptive language.
So we see our mental self as having structure, higher and lower functions and so on
(I have spent my entire adult life as a theologian doing what is called negative theology—trying to understand the divine by removing all spatio-temporal models from theological language. There is an appropriate role for similar purification of psychological language in the development of theories).
The second thing that might explain the confidence of scientism is that the scientists arrive at their task, already in possession of a rich common sense language about psychological/mental life, which because of our embedded existence is married closely with language of physical description; thus, e.g., the intentional act of closing the window also includes the closing of the window that can be described in purely physical terms.
What is unconscionable is that brain scientists should neglect to acknowledge that how they know the psychic realities they correlate with (or reduce to) the electrical neuronal activity, was not from observing electrical activities, but was a gift to them from a community of conscious beings able to understand and share their experiences.
There were a few philosophers in history who were materialists—among the Greeks Epicurus and Democritus, and among the Scholastics of the Middle Ages “stultissimus Durandus” (Stupid Durandus) as he was called by St Thomas Aquinas. (the only time in the Summa that Thomas gets personal)
Only in modern times and in our culture has there been something like a dominant culture of materialism.
Fortunately there are trends within physics and cosmology to focus more on invisible realities and a growing awareness of how limited is our present knowledge. Neurology though excited by knowledge of the bicameral brain and especially the plasticity of the human brain, is also aware of how much more must be explored.
Psychology and even psychiatry has shown a new openness to religious quests for meaning and to mindfulness traditions from the East.
I haven’t said much yet about actual psychotherapy practice. I want to share with you the theory of anthropologist S.B. Hrdy in Mothers and Others. She says anthropologists have a ‘dirty secret’—they can’t explain the monumental evolutionary shift to homo sapiens. Her theory is that what sprung it was the need for human infant care that required more than one mother and general protection by the group. The human baby had the capacity to “seduce” extra helpers…the mother had to be ample enough to understand and accept helpers…the ‘alt parents’ needed to be able to communicate emotionally with mother and baby. All this she hypothesizes required the development of empathy, altruism and emotional communication typical of homo sapiens. She thinks that this preceded rather than followed the creation of language.
You see where this connects with our kind of psychotherapy. We privilege the therapeutic relationship as the heart of psychotherapy—before insight or techniques of intervention. In the encounter with the client we are evoking ground zero of evolution before our theories and our specific words.
We have to unlearn something here. We are in a unique act of relating to a unique person. So much happens and we both know so much before and beyond words.
Our whole human development of knowledge skills and language begins in the unitary meeting/encounter with the Mother, the altmothers, so we must learn to know this as the basis for all we do in therapy.
Emotional, body encounter is our ground. We have to be serene with uniqueness that is fuller than words that instantly divide and generalize. We must trust what our gaze says, get what another’s gaze gives, as we struggle to bring to words what is needed to be said today in this case.
Anscombe, G.E.M., Intention , Oxford, Blackwell 1958
Cartwright, Nancy, The Dappled World: a Study of the Boundaries of Science , Oxford, University Press, 1999
Hrdy, Sarah Blaffer, Mothers and Others: the Evolutionary Origin of Mutual Understanding, Cambridge, Harvard University Press, 2009
Ioannidis, John P.A., Why Most Clinical Research is Not Useful , journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002049
Kelly, Edward F. Irreducible Mind: toward a psychology for the 21st century/Edward Kelly, Emily Williams Kelly, and Adam Crabtree: Lanham, Boulder, New York, Toronto. Plymouth UK; Rowman & Littlefield Publishers Inc. 2007
Siegel, Dan Mindsight www.drdansiegel.com
Taylor, Charles A Secular Age Cambridge Mass., London England; The Bellknap Press of Harvard University Press, 2007