Psycho'therapy' and The Stories We Live By

Chapter 1:

Philosophical Issues

I have suggested that psycho”therapy” is a process in which individuals examine the life stories that they have both inherited and constructed in order that they may live lives that are less emotionally painful, less destructive to themselves and others as well as more loving, creative and democratic. An examination of the construction and content of the stories that guide our lives often not only reveals the source of much of our misery, but opens up vistas not dreamed of and choices previously invisible. The end result of an effective psycho”therapy” allows individuals to own their current life narratives rather than simply to continue living in them unchanged. As I have discussed earlier, it is not easy to question the factual and moral truths that we have been taught and personally constructed which guide the very way we choose to live. Changing the facts and moral assumptions that guide a life not only might lead to profound life choices but create serious conflicts with those with whom we share similar narratives. In my over 50 years of professional life I have met very few individuals who entered therapy or allowed themselves to learn new ideas lightly unless they were desperate about the lives they were currently living. If there is a skill in being a therapist it is to begin by understanding the narratives brought into the consulting room without judgement and then ask questions that allow the patient to reflect on the structure, facts and judgments that comprise their personal narratives. I have learned that a good place to begin to help individuals examine their stories is to help them frame them within the larger often unspoken and invisible narratives in which the personal narrative is contained.

All of our stories are contained within larger narratives that, unless and until they are explicated, prevent us from a full understanding as to why we might be repeating the same mistakes over and over and why things never seem to turn out as we would wish them to. We are like fish that see everything that is in the water with them but not the water itself. The moment a fish might be pulled from the water it learns something that could not otherwise be learned. A being living in one dimension could not imagine the experience of living in two dimensions, nor a being living in two comprehend living in three. Moreover, our stories are mostly constructed in a language steeped in a history that often prevents understanding ourselves from other vantage points. The rest of this chapter unpacks a variety of ideas, that by themselves can help create new vantage points for the stories we live by: The difference between descriptions and judgments; the role of nature and nurture in our development; the relationship of our minds and our bodies; and the nature of self and identity.

Descriptions and Judgments

All human beings are, in one way or another, scientists trying to figure out how they, others, and the world works in order to survive and thrive. The scientific enterprise, whether that of a trained or amateur scientist (which is what all people are), begins with attempts to describe the physical and social world in which we all live. A description is a statement as to how some object or event appears to our senses. It defines how something might look, sound, smell, feel, taste or behave. “The milk I poured into my coffee curdled” is a description. The statement “Judy is 5’8” inches tall, has blond hair, blue eyes and measures 34-22-34” describes Judy. “I just listened to a piece of music the lasted five minutes sung by a male singer who also composed the music” is a description. “I just got back my psychology test with a score of 58 and an F on the top” is also a description. “Last week I ate alligator meat for the first time and it tasted just like chicken” describes how alligator meat tastes to the person who ate it. John Jones stabbed his wife 10 times and she is dead as a result of the stabbing is another description of a series of events. There are an infinite number of objects and events in the world that can be described as to color, shape, size, movement, the sound it makes and the consequences of the events. If we believe a person’s description of an object or event we might take it to be a fact. When numerous independent observers all describe the same objects or events it becomes the basis of shared facts. The scientific method is one the most effective methods for creating shared facts.

All human beings, in one way or another, judge the objects and events that they describe. A judgment establishes the value or worth of an object or event in positive or negative terms. The judgments made of human behavior are known as moral judgments. “The milk is spoiled and could be poisonous”, “Judy is gorgeous”, “the music is a beautiful masterpiece”, “the Alligator meat was delicious,” and John is a bad person who did a very bad thing” are all judgments, the latter being a moral judgment. Judgments are as necessary to our ability to survive and thrive as are descriptions. It is our judgments of the world in and around us that guide our behavior and often determine the direction of that which we seek to describe. If, for example, we judge that a disease causes sickness and even death then it may be in our interest to try and understand the nature of the disease. Our understanding of the disease will not come from our judgment that it is harmful but from a process of analysis that begins with detailed descriptions of the symptoms and the causes of that sickness. Careful, prolonged observation often leads to increased understanding of the nature of the disease, including its causation and just who is prone to becoming ill. Better understanding leads to better predictions as to how to avoid becoming ill and ultimately the means to cure and prevent the disease from even existing as a problem that need concern human beings. The scientific method is a process that seeks to describe, understand, predict and control the objects and events in and around us.

It is our moral judgments of human beings that most often shape our interest in describing, explaining, predicting and controlling human behavior. Psychology, and Clinical Psychology in particular, are endeavors that seeks to utilize the scientific method to understand and deal with those human behaviors judged to be harmful to the self and or others. Psychology has not done all that well in helping us understand behaviors that cause suffering to the behaving individuals and those with whom they interact. Its failure has little to do with the motivation of psychologists to find answers but more to do with the narratives within which psychology is embedded and the failure of psychology, particularly clinical psychology, to self-examine and change the stories that it lives by. The first of these unexamined narratives is the fields continuing goal to be an objective science and therefore not focus primarily on the subjective experiences of the objects of their study. (This is not true of all areas of clinical inquiry particularly aspects of modern Psychoanalysis that deals with the social and intersubjective processes of both the therapist and the so-called patient.) But Psychoanalysis has moved from its once predominant position at the center of therapeutic inquiry to its periphery. The science of Clinical Psychology is preoccupied with providing scientific proof as to which method of treatment is most successful even though mountains of evidence suggest that they are all equally successful and that success seems to lie with the personalities of the therapist and patient and whether or not their relationship is based on trust and mutual respect.

Another narrative that has hobbled Clinical Psychology has been the too slow erosion of the idea that human problems lie within the individual rather than between the individual and his or her interactions with the other individuals with whom they share the world. When I was trained as a clinician the social environment was considered important but only to the degree that it was early life interactions with immediate family created problems. Strong, rejecting and seductive mothers and weak or abusive fathers were almost always held to blame. Today however, there are many explanations of suffering that include social injustice, economic poverty and abuse of power as playing critical roles in the creation of psychological difficulties. While I believe that these important trends are expanding our theories of mental difficulties, the practitioners of these narratives tend to ignore and even be hostile to the work of evolutionary theorists who not only posit that inborn biological factors create differences between individuals but that we share a common inherited human nature. The battles between the social and biological theorists often turns political and can be ugly to watch. I will discuss some of the hidden non-political assumptions related to the nature nurture controversy that are also preventing integrations of these two subfields from bearing the fruits that someday might change the field.

But the narrative that is most holding our field back from making real strides in understanding psychological difficulties are the mythological narratives created by the medical model that insists that moral judgements cast as medical diseases can explain both the nature of the problems we study and the methods by which they are to be ameliorated. Most Psychiatrists, Psychologists, Social Workers as well as others who are licensed to treat mental disorders depend on third party...