Ratio Juris: Why Seek Psychoanalytic Therapy?

What makes a person seek analysis? I can’t recall a philosopher, as a member of that select group who’ve both sympathetically explored and critically examined Freudian psychoanalysis, treat this question in any more than a perfunctory manner. In Freud, Insight and Change (1988), Ilham Dilman now provides us with an exception to the rule. In the excerpt that follows below, Dilman “briefly review[s] the kinds of ostensible psychological problems for which people seek analytic psychotherapy.”

At a future date I would like to discuss to what extent the “categories of problems” for which people seek psychoanalytic therapy amount to reasons that are the same as, different from, or overlap with, the reasons for which people may become intellectually and emotionally interested in, or spiritually and philosophically attracted, to Buddhism. Psychoanalysis is a therapy designed for certain forms of mental disturbance, disquiet or illness rooted in Western traditions of philosophy, psychology, and mythology. It has conspicuous scientific, rationalist, and humanist dimensions, while paying due respect to the cultural currents and psychological motivations that animated nineteenth-century Romanticism as an attempt to speak to aspects of human nature and behavior suppressed or ignored by Enlightenment rationalism if not much of Western philosophy. Buddhism’s roots, on the other hand, are planted firmly in Indic religious and philosophical traditions, later absorbing elements from several Chinese worldviews as Buddhism traveled northward and eastward. And yet, as a growing body of literature attests, there is, whatever their profound differences, provocative similarities or overlap between psychoanalytic therapy and Buddhism, at least to the extent that both are what Helen Nussbaum described as “therapies of desire” in her classic study of Hellenistic philosophies, engaged in what might also be termed “philosophy as therapy” (while this may be clear in the case of the Hellenistic schools, as explained by Nussbaum as well as Pierre Hadot, it’s far less obvious, I suspect, with psychoanalysis, so it will have to suffice for now to note that the analyst is in many respects akin to the Socratic midwife, and his or her (clinical) temperament is one we might see exhibited by the best philosophers or, with Jonathan Lear, we may find ample reason to conclude that ‘philosophical inquiry lies at the heart of psychoanalytic technique’).

The medical model and analogy that Nussbaum finds prominent among Hellenistic philosophers is likewise found in Buddhism. To cite just one and perhaps the best known example, the Four Noble Truths (better rendered in English as ‘the four truths [‘known by the spiritually’] noble,’ meaning those who stand apart from the rest of us because of their extremely rare spiritual knowledge and understanding) are often taught by way of a medical analogy, one which provides (1) a symptomatic diagnosis of a “disease” or illness of sorts, (2) an etiology of the causes (there is in fact more than one cause), (3) a prognosis that the “disease is curable,” based on the profound knowledge or wisdom possessed by the “physician” (one of the epithets of the Buddha is ‘the Great Physician’) who belongs to a spiritual tradition which has cultivated and passed down such knowledge; and (4) a prescription or therapeutic regimen that leads to this cure (otherwise known as ‘the eightfold path’ or the Dhamma more broadly).

The aim of philosophical, moral and psycho-spiritual therapy in Buddhism is a spiritual healing that results in “awakening” or spiritual liberation (from ‘suffering,’ which has metaphysical, epistemic, psychological, and physical facets), although its positive therapeutic effects can be evidenced far short of nibbāna/nirvāṇa. The aims of Freudian psychoanalysis are considerably more modest and yet, for the analysand, substantially arduous if not elusive. I hope to speak to these topics at length in the future. For now, let’s return to Dilman’s effort to list the broader motivational reasons one might have for seeking the help of a psychoanalyst:

“The first thing to notice is that it takes some self-awareness to be conscious of such problems as problems so as to be able to seek help for them. Though the categories of problem for which psycho-analytic help is sought merge into one another, one could put these problems, in a rough and ready way, under the following headings:

Various forms of self-dissatisfaction—that is, dissatisfaction with the self, with oneself. One may, for instance, feel a sense of inferiority, or worthlessness, or feel oneself to be a poor sort of person morally or otherwise. One may desperately try to compensate for this and be dejected by one’s failure to do so. This sense of one’s own inferiority or worthlessness or unacceptability may mar one’s relationships in the way, for instance, that one seeks other people’s regard and approval. It may mar them, alternatively, in that what one gives others is itself infected with this sense of one’s own worthlessness or unacceptability. It is obvious that such dissatisfactions would make life problematic.
Various forms of dissatisfaction with one’s life. It may appear limited or empty; one may feel one is wasting one’s time, have no absorbing interest, find little fulfilment in the things one does. Obviously one would have to feel some responsibility and think of oneself as at fault and the cause of this state of affairs in order to be able to seek help.
Various kinds of incapacity that leave one with unsatisfied needs. One be shy or awkward, one may continuously rub people up the wrong way, etc. One may, in consequence, find oneself isolated and yet feel that one is oneself the cause of this. (The needs that one is unable to satisfy may themselves be neurotic needs that may diminish and disappear in the course of the analysis.)
More passively, one may suffer from a feeling of helplessness, ineffectuality, impotence. One may feel that one makes no difference to other people, that one is not needed by anyone, that as far as others are concerned one may as well not exist.
Various kinds of failure for which one feels responsible and that one believes reflect badly on one, such as a series of broken marriages or relationships.
Specific distressing fears and incapacitating anxieties. I am thinking of cases where the emphasis is on the distress itself and where people most of all crave relief from the distress.
Specific troubles that one keeps finding oneself in and that one feels unable to avoid, such as associating with the ’wrong’ sort of people, picking up ‘bad’ habits and, as a result, losing out on things that one aspires to.

These are broad categories with vague contours, and there are psychological problems that it would be difficult to know where to fit in this scheme. The classification is not meant to be of practical value. Its main purpose is to highlight how much the problems in question have to do with a ‘breakdown’ of the self—its chronic discontents, incapacities, failures, pains – and some failure in its development. It is this that makes life and relationships problematic—isolation, emptiness, feelings of failure, envy, guilt, dejection and depression—in a way that make people ask for personal help—involving the desire to communicate, to be listened to, to receive attention and care. It is a combination of these desires, together with some recognition of personal failure and the wish to do something about it—though this is in conflict with a wish to maintain palliative strategies—that makes a person seek psycho-analytic therapy.”—Ilham Dilman, Freud, Insight and Change (Basil Blackwell, 1988): 165-167.

Further Reading

Ganeri, Jonardon and Clare Carlisle, “Philosophy as Therapeia,” Royal Institute of Philosophy Supplement: 66 (Cambridge University Press, 2010). All of the essays in this volume are worthwhile, but I want to highlight for our purposes David Burton’s contribution, “Curing Diseases of Belief and Desire: Buddhist Philosophical Therapy,” pp. 187-217.
Haldane, John. “On the Very Idea of Spiritual Values,” in Anthony O’Hear, ed., Philosophy: the Good, the True, and the Beautiful. The Royal Institute of Philosophy supplement: 47 (Cambridge University Press, 2000): 53-71.
“The Therapeutic Model of Philosophy: Philosophy as Applied Philosophy.”