Monday, December 29, 2008

"Philosophical Therapy" and the Poverty of Psychology

Since there is no God, can life have any meaning?

Given the serious limitations on human happiness that exist, is there still a possibility for a good life?

Does one have a duty to remain alive if one wishes to die? Does one ever have a duty to die?

Can death be rationally desired?

The above are serious questions. Suicidal people - and even non-suicidal people - may have a deep, mature interest in figuring out an answer to these questions. The domain of philosophy takes questions like these seriously, and allows theories and arguments to develop with respect to them.

Good news for philosophers, however: psychology has magically answered all these questions! How? By taking their answers as axiomatic, and treating any dissent against these axioms as evidence of mental illness.

It is difficult to see, however, how a person with mature doubts as to whether life is desirable or meaningful would be helped by a psychologist repeatedly assuring him that life is meaningful and desirable, dammit and that he need only take his medicine to see it. This sort of "proof by table pounding" is laughable in other domains. Why is it permitted in psychology?

A different sort of approach might be more beneficial in the case of the high-functioning depressed patient with serious, genuine doubts as to whether he should go on living: taking his doubts seriously and engaging them in the manner of philosophy, without taking their answer as axiomatic.

Being able to discuss the core questions seriously, without the threat of involuntary hospitalization and without the irritation of smarmy bullshit, may not "cure depression." But it would have the effect of allowing the client to clarify his thinking, and there is some benefit to that. Being allowed to seriously consider whether suicide is an appropriate option might, in fact, lead many intelligent people to reject this option; psychology and psychiatry never take patients' philosophical doubts seriously and may not offer this option, even if it would be helpful. In addition, as I have argued, there may be times in which suicide is genuinely in a person's interest; psychiatry and psychology, which treat suicide as a product of mental illness and seek to prevent it through coercive means, certainly harm such people in such circumstances.

Medicine involves treating diseases with methods shown to be effective in treating those diseases. But what is a disease? A disease is a set of symptoms - and the FDA approves treatments for diseases - clusters of symptoms - not symptoms themselves. Again the question: what is a symptom?

Most symptoms in medicine are easy to recognize: they are painful or cause distress to the patient, and he seeks medical assistance in treating them. Suicidality and feeling that life is meaningless may sometimes be symptoms under this definition: people may distress because they feel suicidal or feel that life is meaningless, and desire medical assistance to change their feelings. I think this is fine. But what about people who feel suicidal, or feel that life is meaningless, but do not feel any distress about this and merely wish to end their lives? Are the "symptoms" still symptoms if they do not cause distress to the patient?

Within the domains of psychology and psychiatry, such questions are dealt with superficially if at all. "Ethics," to a psychiatrist, is a solved problem, a set of rules one must apply and not question, not a domain of inquiry. Unquestioningly following the "standard of care" with a patient who is thinking about suicide is a ludicrous and disrespectful way to deal with an intelligent human being. Philosophy does better. Medicine needs to do better.

Lou Marinoff is one of the best-known advocates of the practice of philosophical counseling; unfortunately, his work does not seem to be a serious example of the kind of philosophical counseling I am proposing.

4 comments:

  1. One of the most provocative and important pieces you've written thus far, IMO.

    I read the link you posted, and I agree the example is probably not the kind of thing you'd push for, but it also got me to wondering if such a thing would ever be possible. It seems that both sides of the argument are shooting for the same goal; demonstrating that you're fucked up, and setting you back onto the right path. Only, for one party it means uncovering your latent potty training hangups, and for the other, straightening out your epistemological fixation on rounding off pi. But God forbid you might actually have valid issues with life itself, or that contemplating suicide might be a SANE position for you to take. And with an attitude like that, how can it be called truly philosophical counseling? I mean, doesn't that require a bit more openness to ideas than the state would ever allow?

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  2. Yes. It would require us to abandon the position that preventing suicide by force is okay, as articulated by Justice (sic) Scalia in the Cruzan case.

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  3. I know this is completely irrelevant, but I can't help saying that I love your "sic"s.

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  4. It is absolutely insane to me that they, meaning therapists n judges n the like force u to b hospitalized for 72 whole hours, woo hoo yea thats gonna cure 40+ years of suicidal thoughts. Bullshit.

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