Der Weg des Diogenes

Eines Tages saß Diogenes auf der Schwelle irgendeines Hauses und aß einen Teller Linsen. In ganz Athen gab es kein billigeres Essen als dieses Linsengericht. Anders gesagt, einen Teller Linsen zu essen bedeutete, daß man sich in einer äußerst prekären Situation befand.

Ein Minister des Kaisers sagte zu ihm: »Wie bedauerlich für dich, Diogenes! Wenn du lernen würdest, etwas unterwürfiger zu sein und dem Kaiser ein bißchen mehr zu schmeicheln, müßtest du nicht so viele Linsen essen.«

Diogenes hörte auf zu essen, hob den Blick, sah den wohlhabenden Gesprächspartner fest an und antwortete: »Bedauerlich für dich, Bruder. Wenn du lernen würdest, ein paar Linsen zu essen, müßtest du nicht so unterwürfig sein und dem Kaiser ständig schmeicheln.«

(Quelle)

Ein Passant fragt: „Wo geht’s denn hier zum Bahnhof?“ Es antwortet ihm ein:

Gesprächspsychotherapeut: „Sie wissen nicht, wo der Bahnhof ist und das macht Sie nicht nur traurig, sondern auch ein Stück weit wütend.“

Verhaltenstherapeut: „Heben Sie zuerst den rechten Fuß und schieben Sie ihn vor. Setzen Sie ihn auf. Sehr gut. Super!“

Psychoanalytiker: „Sie meinen diese dunkle Höhle, wo immer was Langes rein und raus fährt?“

Familientherapeut: „Was glauben Sie, denkt Ihre Schwester, was Ihre Eltern fühlen, wenn die hören, dass Sie zum Bahnhof wollen?“

Provokativtherapeut: „Ich wette, da werden Sie nie drauf kommen!“

Lösungsorientierter Therapeut: „Gab es schon mal die Ausnahme, dass Sie den Bahnhof gefunden haben? Was hatten Sie da anders gemacht?“

NLPler: „Stell dir vor, du bist schon im Bahnhof — welche Schritte hast du zuvor getan?“

Gestalttherapeut: „Du, lass es voll zu, dass du zum Bahnhof willst.“

Psychodramatherapeut: „Zum Bahnhof. Fein. Das spielen wir mal durch. Geben Sie mir Ihren Hut, ich geben Ihnen meine Jacke und dann…“

Hypnotherapeut: „Schließen Sie die Augen. Entspannen Sie sich. Fragen Sie ihr Unterbewusstsein, ob es Ihnen bei der Suche behilflich sein will.“

Tiefenpsychologe: „Sie wollen verreisen?“

Pädagoge: „Ich weiß natürlich, wo der Bahnhof ist. Aber ich denke, dass es besser für dich ist, wenn du es selbst herausfindest.“

Sozialpädagoge: „Ich weiß es auch nicht, aber ich finde es total gut, dass wir beide so offen darüber reden können.“

Sozialarbeiter: „Keine Ahnung, aber ich fahre Sie schnell hin.“

Bioenergetiker: „Ihr Körper kennt die Antwort schon. Machen Sie mal: sch… sch… sch…“

Esoteriker: „Wenn du da hin sollst, wirst du den Weg auch finden.“

Neurologe: „Sie haben also die Orientierung verloren. Passiert Ihnen das öfter?“

Psychiater: „Bahnhof? Zugfahren? Welche Klasse?“

Coach: „Wenn ich Ihnen die Lösung vorkaue, wird das Ihr Problem nicht dauerhaft beseitigen.“

Lehrer: „Wenn Sie aufgepasst hätten, müssten Sie mich nicht fragen!“

Priester: „Heiliger Antonius, gerechter Mann, hilf, dass er ihn finden kann. Amen!“

(Quelle, leicht verändert und gekürzt)

First a rough translation of the text: Jesus came to the world to save us from sins. Thor came to the world to save us from ice giants. Now: The world is full of sins… But there isn’t a single ice giant. Thor wins. Where is your god now?

The first and obvious problem is the absence of a pre-intervention „baseline“ measurement. We don’t know if there were even any ice giants around when Thor came here — he could have played a great trick on us. Also, we have few information on how much sin there was in the world over 2000 years ago. The Thor issue reminds me of a joke I can’t tire of telling people for its deeper implication about anxieties: The psychiatrist sees a patient who has just been admitted to the psychiatric hospital. Already during the first sentences he notices the patient keeps clapping his hands. „What do you clap your hands for?“ he asks. The patient replies: „To scare away the elephants“. Psychiatrist: „But — there are no elephants here.“ Patient, triumphantly: „See how well it works!“

Apart from that, even if we set out to measure the amount of sins in the world, we would have trouble coming to a good definition and measurement procedure. Also, you can safely assume that a lot of sins are committed in private, making the practical measurement even more problematic.

The most stunning objection, and one which immediately reminded me of issues in psychotherapy research, was my friend saying: „Jesus didn’t come to save us from sins. He came to forgive them.“ It’s often not as easy as you would think to tell what somebody (or a group of people) is aiming at with a complex intervention, especially when you’re not part of that group. And so outside measurements and comparisons can get really tricky.

The last and somewhat nerdy (ok, even more nerdy than before) point concerns standardized effect sizes. As success of Thor’s and Jesus‘ social intervention is obviously on different scales (reduction in ice giant population vs. reduction in (frequency? intensity? of) sins), how do you compare them? What you would typically do is compare the change that is attributable to the intervention to natural fluctuations in the phenomena of interest. That would be hard to do here, even though theoretically possible — how did ice giant population and sins change over time before our two so different saviors came along? But of course, it doesn’t actually tell you anything about the clinical significance of each change. Maybe something similar to a change of quality occurs at some point of the scale — if ice giant population falls below a certain point, they retreat to their mystical homelands and leave humans alone. If sins are reduced beyond a certain point, society changes, preparing the earth for eternal heavenly rule. In psychotherapy, we mostly assume something like that actually, where the clinical disorder or syndrome (of, say, depression or phobia) is seen as no longer existing after a certain threshold, but often still measured as a severity of symptoms.

You see, the thing about shock… is not that it upsets some people, I think; I think that it gives others a momentary joy of liberation, as we realised in that instant that the social rules that constrict our lives so terribly are not actually very important.

And earlier, this is what he says about „Gray“ in that respect:

He loved to shock. In fact, Gray, more than anyone I knew, embodied and symbolised all that was most offensive and juvenile in Monty Python. And his delight in shocking people led him on to greater and greater feats. I like to think of him as the pioneering beacon that beat the path along which fainter spirits could follow.

Nothing to add, really. Oh, maybe this.

Tragic dimensions vs. optimism

For existential philosophy anxiety is the flip side of freedom, which is one of the fundamental existential givens. It arises in the wake of avoided possibilities. It is not the cause but, rather, the symptom! Guilt is equally not a cause; rather, it is a result of the feeling of avoided life activities and missed encounters.

Although separation and parting, as well as the transitory nature of life and death, are often relevant in psychotherapeutic practice, it is notable how little these themes have been taken into account by Rogers. If we look at the title of one of his later publications „Growing old – or older and growing“ (1980), we see that his dominant perspective is growth, even when he was already 78 years old! At the end of a video recorded in 1984 he states stoically: „When death comes, it comes“.

„Call“ of the world and dialogue vs. the actualizing tendency

The actualizing tendency is the only a priori axiom in the person-centered approach. It promotes the maintenance and enhancement of the organism including its sub-system, the self (Kriz and Stumm 2003, 18–21). Together with the human need for positive regard and self-regard, it represents a cornerstone of person-centered developmental theory. It is thought to have specific characteristics, for instance movement in a constructive and social direction.

The concept of the actualizing tendency has a great impact on person-centered therapeutic practice, as it implies a rather non-directive attitude. As just stated above, person-centered theory tends to facilitate the client’s capacities by providing specific therapeutic conditions, thus actualizing the client’s potential. This often leads to a rather passive understanding of the therapist’s role in the therapeutic process. To use a metaphor, person-centered practice sees the client rather as a wind-surfer taking advantage of the power of the wind. As compared to that, existential practice sees the client — and the therapist — rather as rowing through rough waters, and sometimes facing the calm of the wind with no other means than their own efforts to move forward. Existentialism holds that the human being is asked and called by the world.

Friedman — a Buberian — brings to light the opposition between self-actualization and dialogue. He holds that existential thinking views the dialogue as a goal and the self-actualization as a by-product; for Rogers sometimes the encounter is seen as a value in itself, while at other times it is just a means of promoting self-actualization — according to Friedman (1986, 416) a „pseudobiological“ construct.

Here’s finally an issue that seems most controversial and unclear to me right now:

Loneliness/existential isolation vs. relationship/„encounter“

In my opinion, this controversial field is well illustrated in Rogers‘ commentary on the case of Ellen West (1961b/1980). In this case, Rogers arrives at very divergent opinions and evaluations from the Daseinsanalyst, Ludwig Binswanger, who in 1944 had presented the case. While Binswanger focused on the tragic fate and existential isolation of the young woman, who finally committed suicide, Rogers‘ comments on the case reveal both his therapeutic optimism and his deep conviction that the self-alienation and loneliness of the client could have been kept at bay through healing care and appropriate understanding in a nurturing relationship. For Rogers, „existential isolation“ is definitely not an „existential given“.

And I would like to close by quoting from the author’s summary what I agree is the valuable foundation that the person-centered approach provides:

At the same time, existential therapies can also profit by valuing, implementing, and applying in practice some person-centered principles. The positive effects of being client-centered, in terms of being open to the world as the client perceives and experiences it, seem obvious to me. These include the crucial role of empathy in the person-centered approach; a clearly non-authoritarian stance; a view critical of the therapist as an expert of client’s matters, while seeing the client as the ultimate judge relying on their ability to figure out their concerns, experiences and decisions; and a reservation against methods and techniques that might interfere with the therapist’s immediate experience of the client and of the encounter between the client and the therapist.

Or should we become modern priests after all?

Thanks to a conversation at the recent SPR conference in Montreal among colleagues from different cultural traditions (Bae et al., 2005), I became aware of how unnatural the bodymind dichotomy (with its consequent distinction between „physical health“ and „mental health“) appears from other cultural perspectives, and of how grossly it distorts the evident psychosomatic continuity of the living human person. When this basic continuity is conceptually split into „psyche“ and „soma“, a mysterious quality is created as the byproduct (much as energy is released when atoms are split) — a mysterious quality that is labeled (and as much as possible viewed dismissively) as „the placebo effect.“ This effect, mysteriously labeled in Latin, is viewed as a „contaminant“ in research designs — but, struggle as researchers do to „control“ it (rather than understand it), they typically fail in the attempt because the „effect“ reflects an aspect of our reality as human beings that cannot be eliminated.

As a side note, I found my views on all the fuss that is made about neuroscience these days put very concisely:

Another widely shared bias of modern culture that complicates and distorts the work of researchers on psychotherapy and psychopharmacology (and medicine more broadly) is the implicit assumption of an essential distinction or dichotomy between soma and psyche (or matter and mind), notwithstanding the efforts of modern philosophers like Ryle (1949) to undo this Cartesian myth. Because of this, findings that psychological phenomena have neurological or other bodily correlates (e.g., using MRI or CT scans to detect changes in emotional response) are viewed as somehow amazing and worthy of note even in the daily press.

The whole text alongside other interesting stuff can be found as a reprint in the publicly accessible journal „Existenzanalyse“ (English and German articles) 2008–1. And here is their archive of issues.

Humility is not an end result of spiritual practices and denials. Humility is not an achievement, it is not a virtue to be cultivated. A virtue that is cultivated ceases to be a virtue, for then it is merely another form of achievement, a record to be made. A cultivated virtue is not the abnegation of the self, but a negative assertion of the self. […] You cannot become humble. The very becoming is the continuation of self-importance, which conceals itself in the practice of a virtue. How strong is our will to succeed, to become!

That makes a lot of sense to me, and is actually what I observe a lot in the practice of meditation and spirituality in the west. At the same time, it clearly leaves the question: If you realize you are not humble right now, and are told there is no way of becoming humble, what can you do?

To me, while I acknowledge that from a purely logical point of view this is indeed a paradox, there is a solution in viewing our mental and emotional activity on two levels — that what our primary thoughts and feelings are, and our thoughts and feelings about these. The realization came to me in attempts at meditation, and at quieting my mind. I realized I could not do that, but I could at least be quiet about that, not have the second order reprimands on top of the incessant flow of first order thoughts and feelings. Now, of course, the magic is that the moment I realized that, the first order thoughts and feelings do begin to be more quiet also.

I believe and feel it works the same also for the other qualities that we aspire for — I cannot make myself be accepting of everything, but I can start immediately by being accepting of not being accepting. I cannot make myself humble — but I can be humble about the fact of not being humble. And so on. And for me, that really feels like how I understand Krishnamurti: it’s not a process of becoming, it starts with a sensation of realization that is its own fulfillment, even though of course it leads to a slow process of change on the first level of mind and emotion.

As a closing remark: Only in writing this I realized how close the title I chose is to what Gestalt Psychology calls the „Paradoxical Theory of Change“, which in more worldly but also maybe more complicated terms basically says the same thing: In order to change, we have to first accept what is.

Das erstaunliche Ergebnis ist jedenfalls, dass Patienten, die glaubten, mit 75% Wahrscheinlichkeit das aktive Medikament zu erhalten, sich deutlich (und auch was die bei Parkinson recht gut bekannten neurochemischen Veränderungen angeht) von den anderen Gruppen abhoben, insbesondere auch von der Gruppe, die davon ausgingen, dass sie mit Sicherheit das aktive Medikament erhalten würden.

Bezüglich des Verschreibens von Placebos wäre das ein klares Argument dafür — es würde allen Verschreibungen vom Arzt eine zusätzliche „rein psychische“ Wirkung geben, wenn wir uns nicht mehr ganz sicher wären, dass das Medikament „echt“ ist!

Dennoch bin ich insgesamt eher gegen eine derartige Psychologisierung des Allgemeinarztes. Ich finde, es entspricht nicht einem modernen Verständnis von psychologischen Interventionen, wenn derart mit Täuschung gearbeitet wird. Im Gegensatz dazu ziehe ich aus meiner Prüfungslektüre zu systemischer Therapie und Beratung die Vermutung, dass sich ein ähnlicher Effekt auch mit einer sehr kurzen Psychotherapie erreichen ließe. Ich denke, dass ein großer Teil dieses Placeboeffekts bei ungewisser, aber hoffnungsvoller Erwartung durch eine veränderte Aufmerksamkeit zustande kommt, die sich mehr auf die Beobachtung dessen richtet, was sich vielleicht verbessert oder verändert hat. Und das gehört zum Standardinventar systemischer Techniken, mit denen Probleme „verflüssigt“ werden. Übrigens gibt es in dieser Therapierichtung auch schon viel Erfahrung gerade mit chronischen Krankheiten mit starker biologischer Mitverursachung (z.B. Asthma oder Diabetes bei Kindern).

Und im Gegensatz zur wunderheilerartigen Placebointervention wird dabei gleichzeitig die Selbstbestimmung und Autonomie der Patienten/Klienten gestärkt, und ihr Vertrauen in ihre eigenen Problemlösefertigkeiten. Und — ich möchte eine potenzielle Einschränkung meiner Neutralität in dieser Frage nicht verschweigen — mir geht nicht so schnell die Arbeit aus…