“Existential psychologist Rollo May (1986) warned, whenever you perceive a person merely as a particular diagnostic disorder, neurological deficit, biochemical imbalance, cognitive schema, set of behavioral patterns, genetic predisposition, collection of complexes, or “as a composite of drives and deterministic forces, you have defined for study everything except the one to whom these experiences happen, everything except the existing person him [or her] self” (p. 25). Existential psychotherapy strives to empower and place the person–and his or her existential choices–back at the center of the therapeutic process. To cite Sartre on this subject: “We are our choices” (Stephen Diamond: ‘What is existential psychotherapy’)

In my last blog discussed the relationship between Existential Psychoanalysis and Behavioural Science. In this blog I want to further consider Existential Psychoanalysis and the merits of adopting this approach to mental health issues. There are many thinkers working in the field and rather than analyse a particular theorists views on the topic I will instead consider the subject from a broader perspective and consider what the merits and disadvantages are of adopting this approach.

Existentialism is an approach to philosophy which can be traced back somewhat idiosyncratically to thinkers like St. Augustine, St Aquinas, or Pascal. The historical birth of the movement is typically traced to the work of Kierkegaard (1813-1855). Later philosophers who were sometimes spoken of as existentialists were Heidegger, Sartre, Jaspers, Marcel, amongst many others. Philosophers like Jean Paul Sartre also expressed their existentialist ideas through works of fiction like his famous ‘Le Nausea’, while other artists like Camus, and Kafka wrote what they considered existentialist novels like ‘The Outsider’, and ‘The Trial’.

Some existential philosophers like Kierkegaard, Marcel, and Jaspers, were Christian while others like Nietzsche, Sartre and Camus were atheists. But all of them rejected the systematic way that philosophers before them had try to explain the world (and in particular man) in terms of an all-encompassing overarching theory of the world. Existential philosophy focused on man’s thrownness into the world, their freedom to act, and the inevitability of death. A further primary concern of theirs was the inauthentic ways that man had to evade his own inevitable death through being busy in the world as a way of avoiding our existential predicament.

When discussing existentialism on its own it all sounds a bit wishy-washy and one would be forgiven for thinking that while existentialist positions may make interesting literary fiction, and appeal hip young teenagers, it is hardly a serious philosophical or scientific position to hold. However a close reading of central philosophical texts in Existentialism shows that the position cannot be as easily dismissed as one might think at a first glance. Martin Heidegger’s classical work ‘Being and Time’ contains a detailed phenomenological analysis of the world of experience as it reveals itself to us in our daily activities. His analysis of thrownness, anxiety, freedom and our relationship to death is painstakingly drawn from a detailed phenomenological analysis.

Nonetheless when one considers the work of Freud it seems to be entirely alien to the work of existentialists. Freud started out as a neuroscientist and when he created psychoanalysis he noted that he used his psychoanalytic concepts as placeholders to be replaced when neuroscience became more advanced. His analysis of things like parapraxes, and his use of free association all relied on his assumption of psychic determinism. His metapsychology was constructed using the model of the unconscious and conscious mind on the model of hydraulic pressure. All of this is a million miles away from the existentialist emphasis on freedom to choose and existential anxiety[1].

Furthermore Freud’s emphasis on our sexual and aggressive nature which we are biologically born with; his emphasis on society which forces us to curtail our biologically driven nature to some degree and repress it, is very different than the story existentialists tell. Likewise when Freud focuses on our childhood, our relationship to our parents, our attachment to peers etc determining our adult behaviour he is again telling a story which is at odds with anything we see in existentialist philosophy. So to some degree the name existentialist psychoanalyst seems like an oxymoron.

But there is more to the story than this obviously. Over and above Freud’s metapsychology, his views on neuroscience and his determinism was Freud the clinician dealing with human suffering. Freud dealt with childhood experiences as described by his patients; he dealt with his patient’s current preoccupations, anxieties, and worries. He noted that his patients were busy avoiding problems which they were barely or sometimes totally unaware of. Existentialists were likewise concerned people’s relation to their worlds, their pasts, present and future.

From a clinical point of view psychoanalysts used Freudian theoretical apparatus to explain what was going on in their patient’s life and to help their patients gain a greater understanding and hence control of their behaviour and thoughts. Psychoanalysts would use theoretical terms like Ego, Superego, ID etc, or if they were influenced by Klein they would use theoretical terms like Paranoid Schizoid position, Depressive position etc. But despite the fact that psychoanalysts were using these theoretical abstractions to interpret the behaviour of their patients the psychoanalytic encounter was operating at interpersonal level. Patients were talking to their analysts about real world problems such as sexual problems, anxiety about death, devastating inner turmoil, loss of meaning, etc. Despite the fact that Freud emphasised the nature of psychoanalysis as a placeholder for future neuroscience the psychoanalytic encounter typically took place at the personal level as opposed to the sub-personal level. It is because of the clinical emphasis of a person talking to another about emotional problems and crises that existentialism became a natural bed fellow to psychoanalysis.

Some of the early theorists who were interested in merging psychoanalysis and existential phenomenology felt that psychoanalytic concepts actually stood in the way of analysts reaching their patients at a personal level. In his (1960) book ‘The Divided Self’ R. D Laing criticised psychiatrists for interpreting patients almost entirely at the sub-personal level. To illustrate this point he discusses the case of Kraepelin who when talking to a schizophrenic patient treats the verbal replies of the patient as signs of the patients organic disease. Laing though manages to give a quite plausible explanation of the meaning of the patient’s words by interpreting the patient at the personal level. He argues that if we really want to understand patients and the suffering they are experiencing we need to do so at the personal level of explanation.

Outside of phenomenological circles the relation between personal and sub-level explanations has been a core concern of philosophy of mind. In fact the same year that Laing published his ‘The Divided Self’ Willard Van Ormond Quine published his classic book ‘Word and Object’. ‘Word and Object’ as a text had little to do with the concerns of psychotherapy or phenomenology. In fact Quine’s concerns would have seemed very alien to anyone interested in phenomenology. He was interested in naturalising philosophy, of purging mentalist discourse from our theories of how people go from stimulus to science. His central problem was in naturalising epistemology and in naturalising metaphysics. For Quine epistemology is simply a branch of empirical psychology while the best metaphysics we can hope for is a translation of our best physics into the syntax of first order logic.

Now at face value this project is as far from the spirit of existential phenomenology as it is possible to be. You certainly won’t find analysis of Anxiety, Authenticity, or brooding on the inevitability of death in the entire corpus of Quine’s writings. Quine began his career as a logical positivist, and while he critiqued central aspects of logical positivism, his criticisms lead him towards an even more austere form of naturalism than even the science friendly logical positivists would have supported. From the start of his career Quine was obsessed with removing anything psychological from his ontology. So given that Quine’s project seems so far from existential phenomenology a critic could be forgiven for wondering what the relevance of Quine is to this discussion.

The relevance is that while Quine started out with an aim of ontological minimalism and of reducing our ontology to its simplest components by ridding us of unnecessary posits like, meanings, ideas, and propositions, he ended up supporting some claims which are congenial to the view of existential phenomenology. Firstly Quine emphasises our embeddedness in our social and physical world of experience, there is no way according to Quine we can step outside our conceptual scheme we must repair and develop it within our lived world of experience:

“Neurath has likened science to a boat which, if we are to rebuild it, we must stay afloat in it. The philosopher and the scientist are in the same boat. If we improve our understanding of ordinary talk of physical things, it will not be by reducing that talk to a more familiar idiom; there is none. It will be by clarifying the connections, causal or otherwise, between ordinary talk of physical things and various further matters which in turn we grasp with ordinary talk of physical things.” (Quine: Word and Object p. 3)

Heidegger[2] never showed much concern with science but the above passage by Quine is very similar to claims made in ‘Being and Time’ about the relation between the ‘Ready-to-hand’ and the ‘Present-at-Hand’.

The kind of dealing which is closest to us is as we have shown, not a bare perceptual cognition, but rather that kind of concern which manipulates things and puts them to use; and this has its own kind of ‘knowledge’… Such entities are not thereby objects for knowing the ‘world’ theoretically; they are simply what gets used, what gets produced, and so forth…We shall call those entities which we encounter in concern “equipment”. In our dealings we come across equipment for writing sewing, working, transportation, measurement. (Being and Time pp. 95-97)

“Being-in-the-word, according to our Interpretation hitherto, amounts to a non-thematic circumspective absorption in references or assignments constitutive for the readiness-to-hand of a totality of equipment…The Presence-at-hand of entities is thrust to the fore by the possible breaks in that referential totality in which circumspection ‘operates’(ibid p. 107)

As we can see from the above quotes from ‘Being and Time’ Heidegger also viewed us as embedded creatures whose concern is with coping with reality. Heidegger, like Quine, emphasises that our scientific theories which he thinks of as thinks of interms of ‘presence-at-hand’ are arrived at as part of our embedded involved interactions with the ordinary world of lived experience.

Quine of course aimed to modify our ordinary language and make it more precise using the tools of first order logic. This approach is obviously at odds with anything that Heidegger would have recommended. But it is interesting that while pushing, his behavioural, naturalistic, logical approach to its limits Quine couldn’t altogether eliminate personal level explanations of human behaviour. Near the end of ‘Word and Object’ when discussing Brentano’s argument about the irreducibility of intentional idioms, Quine noted that there are two ways to react to this fact. (1) Brentano’s way of accepting the reality of intentional idioms. (2) Arguing that intentional idioms scientifically baseless. Quine chose option 2 but with an interesting qualification. He argued as follows:

“Not that I forswear daily use of intentional idiom, or maintain that they are practically dispensable…If we are liming the true and ultimate structure of reality, the canonical scheme for us is the austere scheme that knows no quotation but direct quotation and no propositional attitudes but the physical constitution and behaviour of organisms…But if our canonical notation is meant only to dissolve verbal perplexities or facilitate logical deductions, we are often well advised to tolerate the idioms of propositional attitudes.” (Word and Object p. 221)

Quine later (under the influence of Donald Davidson) even ended up supporting a form of Anomalous Monism which as he put it says that while there is no mental substances there are irreducibly mental ways of grouping physical states and events (Pursuit of Truth: p.73). He even emphasised that when trying to translate the utterances of an alien tribe we needed to rely on empathy:

“We all have an uncanny knack for empathizing another’s perceptual situation, however ignorant of the physiological or optical mechanism of his perception… Empathy guides the linguist still as he rises above observation sentences through his analytical hypotheses…” (Pursuit of Truth: p. 43)

So here we have Quine mad dog behaviourist admitting that we cannot entirely do away with intentional idioms that anomalous monism is true, and that empathy is essential for translation to occur etc.

So far we have seen that like Heidegger Quine emphasised the embedded nature of our dealings with the world. Like Laing he emphasised that for some purposes personal level explanations are more appropriate than sub-personal level explanations. But it is obviously a massive stretch to say that Quine would have supported any kind of existential psychoanalysis. Quine’s emphasis on our knowledge coming from our neural nets being stimulated is obviously radically at odds with any kind of existentialist analysis[3]. Likewise his hard core naturalism and emphasis on scientific metaphysics is not remotely congenial with existentialist theories.

The point of mentioning Quine is that he was writing at the same time as Laing, and despite starting from an entirely different stand point he ended up drawing some similar conclusions. Laing was writing at a particular time in the history of psychology. Behaviourism was still dominant in 1960; Skinner’s ‘Verbal Behaviour’ was just published a few years before hand. Behaviourists were pretty trenchant that the mind had no place in our scientific psychology. Behaviourists were press darlings and popular articles were filled with claims that the mind was a simply a relic from our primitive past. That thinking that people had minds was as absurd in thinking that the moon rotated around the earth because it wanted to. The cognitive revolution was only in its infancy and from theorists like Laing’s point of view there was a real danger of people having their subjectivity ignored because of behaviourist restrictions. However as the case of Quine indicates even behaviourists were being forced to admit that it is not as easy to do away with propositional attitude explanations as behaviourists originally believed. So Laing’s worry can be construed as a reaction to some overblown hype in the popular press by some behavioural scientists.

In philosophy of mind Quine’s double standard has been subjected to incredible scrutiny over the last 55 years by the world’s leading philosophers. Hyperrealists like Fodor, eliminativists like Churchland, eliminativists/slash pragmatists like Rorty, and stance-stance theorists like Dennett have all have a crack at the problem. I obviously don’t have time to deal with all of these approaches but it suffices to say that 55 years after Laing wrote ‘The Divided Self’ we are still no nearer to eliminating personal level explanations as we were when Laing was writing. People like Paul Churchland who is a defender of eliminative materialism will cheerfully admit that it is an ongoing research programme that will only be justified by future empirical research. So Laing’s worry about people being treated as bags of neurons, or mindless machines mouthing verbal behaviour were misguided.

Nonetheless Laing et al were not merely concerned with psychology crushing human subjectivity they was also concerned with the effects of psychiatry treating humans as a bunch of symptoms of a disease instead of a person concernfully engaged with the world. We saw this in Laing’s discussion of Kraepelin’s inadvertent dehumanising of his patient. Over the last 50 years we have developed further and further psycho-pharmaceutical treatments of mental disorders. Likewise with every new copy of the DSM we are treated to a new classification of some form of aberrant behaviour that can be treated by medication. We have medical doctors handing out drugs for various different behavioural problems despite the fact that the doctors have no training in psychotherapy or psychiatry. This state of affairs leads to more and more meds being prescribed in dubious circumstances.

I think that this state of affairs is worrying. Not because drug based therapies do not work but because not all problems are problems that need be addressed by medication. Some problems are lived problems which we face because of the human condition. It is a fact of the human condition that everything you know and love will decay and die at some time, and so will you. The human condition is a tissue of contingencies in which at any moment any of form of disaster can strike. Existential psychoanalysts are right to notice that this feature of reality can have serious psychological consequences for people. They are right to try do understand the whole person in their interactions with the world and others in it. Nonetheless, I think existential phenomenology would be well served by adopting a more loose pragmatic approach of using whatever tools we have at our disposal to help people in mental distress. There is no evidence that existential psychoanalysis is any better than CBT or traditional psychoanalysis in treating people with mental illness. Furthermore it should be emphasised that while the personal level of explanation is important, there are times where sub-personal explanations will only do. There are times where simple behavioural approaches and medical treatments will trump any kind of personal level of analysis. In my next blog I will consider the empirical evidence available on what type of treatments are more likely to work for what psychological predicaments.

[1][1] Neuropsychoanalysts consider themselves to be following on from Freud as a neuroscientist. They now seek to begin Freud’s original motivation turning psychoanalysis into a natural science grounded and justified by neuroscientific research. Mark Solms and Joseph Dodds are two key theorists in this field.

[2] When I speak of Heidegger I am referring to him at the period he wrote ‘Being and Time’ I will not engage with the later Heidegger at any stage in this blog-post.

[3] Though Davidson’s emphasis on distal as opposed to proximal stimulation and triangulation could be used as a way of modifying Quine’s theory and making it more consistent with the insights of Heidegger.