“What is needed is a return to a culture of common sense and personal well-being, in which one is judged according to what kind of person one is and how one conducts one’s life.”
recent Merion West article by psychologist Tomasz Witkowski serves as a useful segue for entering into wider discussions about personal well-being, particularly when it comes to down-to-earth, common-sense notions of what it means to be a well-adapted, fully-functioning person. Additionally, Witkowski’s piece sheds light on what might be the best approach for addressing the psychological problems experienced by certain individuals. Witkowski recounts how psychotherapy has mushroomed into over 600 different therapeutic approaches, and yet the results achieved are not significantly better than everyday, common-sense methods to restoring psychological well-being. However, as with almost all attempts to characterize and address human problems, context is important.
Witkowski cites the work of Vikram Patel, who has written a book on how to deliver psychotherapy. Where There Is No Psychiatrist is aimed at lay-persons who can offer support to others. The premise is that poor, under-supported people may suffer from psychological problems as much as those with the time and money to dwell constantly on their mental health. The nature and distribution of the psychological problems might be somewhat different between the two groups; people without leisure or money tend to think and act very differently from those who have either or both. Still, there can be no doubt that poor mental health is not confined to those who have access to mental health services (i.e. wealthier people).
The barefoot doctor schemes introduced in the developing world more than half a century ago were very successful at delivering basic healthcare to those previously without any, and Patel’s (very successful) initiative looks very much like a kind of barefoot psychotherapy. It does not need any attendant infrastructure or organization. With none of the complications inherent in an expert/client relationship, the barefoot psychotherapist is delving into a kit-bag of possible solutions, while accepting that the recipient is ultimately the authority on which approach is acceptable and which works best.
This might seem a world away from the kind of therapeutic relationship we are accustomed to in the West, where theoretical orientation and technical skill are considered as important as the therapist’s personal qualities. This is why context is so important when assessing the cultural significance of psychotherapy and its allied pursuits of counseling and life-style coaching.
Having spent many years working in mental health settings before becoming an academic philosopher, and then many years studying the literature on theories of mental health and mental health treatments, I eventually came to the tentative conclusion that psychotherapy, in many cases, is an exercise in wishful thinking on the part of all concerned.
Even at the time (this was the late 1990s), this was not an unusual position to take. I knew of many practitioners in mental health who persevered in their careers only because they still hoped they were doing some good, even if the evidence did not support that view. We all carry emotional baggage at times, but some people are so attached to theirs that getting rid of it is unthinkable. A person’s psychological malfunction can become integrated into his sense of being to the extent that he can no longer distinguish one from the other.
The challenge of psychotherapy is as follows: Not only is it impossible to examine a person’s mind directly, but it is also impossible to test the efficacy of therapy straightforwardly. It all hinges on the sufferer’s subjective assessment of what the problems might be, whether the therapist’s characterization of the problems carries conviction, and whether the therapeutic approach used actually has a positive impact on the problems at hand. The bottom line is that this is all highly subjective.
The academic literature on psychotherapy is vast, with swathes of scientific studies—all claiming to be objective—examining psychological problems and proposed solutions. In order for the research models to be systematic and consistent, they must be derived from abstract theorizing about both mind and therapy. But even if this were possible (which it arguably is not) in psychotherapy, the acid test is itself subjective: the verdict of the recipient about what is going on inside his mind and the impact this has on his life. Those studies that claim to be entirely objective, confining themselves to a view from outside and ruling out any speculation about what goes on inside the mind (such as behaviorism and other forms of scientific reductionism), somehow, seem to miss the point. We are inextricably mental beings. To attempt to extricate the person from his mind is to ignore what it means to be a person for that person.
We each have a mind, and our minds are where we actually reside as people, even if our life is lived in a social environment. To claim to be a person is also—implicitly—to claim to have a mind. But the experience of having a mind is only intelligible on the basis of a system of ideas which are inherently socio-cultural products. That is to say, we can understand ourselves only by importing into our minds “meanings,” which originate outside of our minds. This import has motivated the claim that the idea of the mind is also—in essence—a socio-cultural phenomenon, but that is too large a topic for this short essay.
All of this is to say that we probably will never be without psychotherapy as a means of helping people make sense of their lives, even if the therapist is like a blind person attempting to shine a light into the darkness and the client is like a sighted person blinded by the light. This is another way of saying that other people’s solutions to one’s problems—even if based on fancy theories about how the mind works—are unlikely to be what one is looking for. This insight prompted Carl Rogers to develop his non-directive person-centered counseling technique in the 1940s, which can be criticized for not offering anything of value at all. Still, this might be just what some confused or distressed people need (though it must be said that Rogers developed a complex theory of human motivation and mental functioning to justify his therapeutic approach). The challenge facing prospective clients is: How does one know in advance just what one needs if one does not even know what the problem is? Maybe psychotherapy should—as Rogers advocated—simply confine itself to helping people find their own route to understanding their problems better, and they will do the rest themselves.
Perhaps that is all we need in most cases: a nudge in the correct direction that helps us to approach our problems more constructively. Simultaneously, this gentle nudge—or, if necessary, a firm push—should convince us that our problems are real and that we can render them less intolerable by having someone else (whom we see as wise and helpful) share our life journey for a short while, with neither participant really knowing where it leads except that both parties agree that the activity is necessary for their sense of well-being at that particular time. And it is here that context becomes paramount.
In traditional societies, socially-integrated, emotionally well-adjusted, and morally competent grandparents or tribal elders used to fulfill this function. With the extended family now almost abandoned (and our society slowly decaying into a dystopia of socially-atomized beings anxiously searching the Internet to find meaning in life), there seems to be a shortage of such wise life guides around. Enter the army of psychotherapists, counselors, lifestyle coaches, and social-media influencers, each peddling their own particular brand of palliatives to eager consumers. The traumas of life, it seems, can be put into better perspective by learning to live with one’s self. Unfortunately, knowing how to achieve this remains a challenge, particularly in a society where people are primarily seen as consumers of goods, services, and ideas rather than as individuals responsible for their own conduct.
Witkowski’s article—as I suspect he intended—left me with a mental image of a psychotherapist sitting in a rocking chair, swaying gently to and fro, with a fan attached to the chair actuated by the rocking movement and gently wafting air around. In this mental image, the psychotherapist is sitting next to a client, who is also in a similar chair, and they are engaged in the same activity. Both assure the other very sincerely that the therapy seems to be working. And, on each visit, the process of mutual reassurance must be repeated to keep the illusion going.
I do not intend this to be understood as a blanket condemnation of all psychotherapists, counselors, life coaches, etc. Some may do some good but probably not for the reasons they believe. And even if their guidance is free at the point of delivery, nothing is for free in the long run. There is always a cost to pay, even if that is only the realization that one has allowed a complete stranger to tell him what kind of person he should be (or try to become). Compare that to the traditional way of doing things: a little common sense guidance or advice from someone one knows and trusts, who might know more about life than he does. The results are much the same, and the pit-falls are similar, but the only cost is maybe a small dent in one’s pride.
I also do not wish to be interpreted as claiming that mental health problems are not real. Many are, indeed, disabling; the worst are terrifying; and some defy all attempts at resolution. These more serious cases require professional input.
At the same time, though, it is part of the human condition to be suggestible, which means that vulnerable but basically mentally well people can be induced by cultural influences to believe that their distress has a medical origin. Instead, the actual origin often lies in how they view themselves and choose to live their lives. A person who views himself as a perpetual victim and demands solutions and sacrifices from others will always be shallow and superficial, constantly struggling with unrealistic expectations. Further, each time harsh reality intrudes, the impact will be devastating to his mental equilibrium.
A shallow, mentally fragile person will lead a shallow, mentally fragile life, even if subject to intense emotions and great enthusiasm. To grow deeper requires making a distinction between learning to be stoical when faced with things one can do nothing about, while working to change those things which one has a responsibility to learn to deal with—and become a better person in the process.
The failure to make this distinction is one of the most disturbing features of the cult of personal well-being now sweeping the Western world, which, in turn, generates a social culture in which talking about one’s psychological maladies becomes almost a defining feature of the individual. This is the result of a failure of agency (and, in particular, moral agency), which is expressed as an unwillingness to take full responsibility for the decisions one makes, for what kind of person one is, and for how one’s life is lived.
What is needed is a return to a culture of common sense and personal well-being, in which one is judged according to what kind of person one is and how one conducts one’s life. It is the kind of society our grandparents lived in—up until the 1960s, when permissive liberalism became fashionable—and it was precisely such people who lent kindly guidance and advice when things were starting to go wrong in a younger relative’s life. This kind of traditional Western society has its origins in the Christian pastoral ethic of looking out for one another and in providing help and support when times are hard but otherwise leaving people to lead their own lives and take responsibility for them.
That is what we have lost with the arrival of our current age. Now, the challenge is how to restore old ways of supporting one another and reduce our reliance on narrowly-trained experts who see their role as introducing us to what makes our lives worthwhile.
They never could do that, and never will.
Paul Sturdee is a retired teacher of philosophy who leads a contemplative life.