By Harold W. Anderson, M.A., M.Div., Ph.D., LMFT
As with every discipline, mental health and its related fields have developed its own vocabulary. Learning how to become a mental health professional includes learning how to be comfortable with and utilize this form of discourse. However, when one moves into the field and begins working with clients, one needs to develop a judicious sense of when to use “psychobabble,” as it is sometimes called. The clinician that fails to do so soon realizes that they are having a monologue rather than a dialogue, and the client retreats into an eerie silence indicating that they just don’t get it. Having spent most of my adult life in mental health and related fields means that I must be particularly astute when speaking to someone who may not know the language less my words fall onto deaf ears. “Doing therapy,” means developing a hermeneutics whereby the therapist invites the client to explore, understand and use the healing words and tools developed by mental health fields. In this essay, I wish to consider the hermeneutics needed to bridge the world of clients and the healing insights of therapy.
Frank admission of the social embeddedness of mental health “truths” is the starting point of all mental health work and cannot and must not be avoided. To do so not only truncates understanding, but it also betrays the existential complexity that defines a client’s humanity.
To those who embrace a strict empirical epistemology and define the field of mental health along the lines of empirical positivism, the sort utilized by the natural sciences, the term “hermeneutics” is controversial. While the reason for this evokes an age-old debate beginning with the progenitor of psychoanalysis, Sigmund Freud, the gist of this debate has to do with the uniqueness of being human and the psyche’s stubborn refusal to give itself over to strictly empirical examination. Put differently, the methodology of the natural sciences has led to an amazing understanding of the human body, which in turn birthed the development of incredible technological advances, astounding medical procedures and pharmaceutical developments that have assuaged physical and psychiatric illness. There is little doubt that modern natural science has transformed our world and bettered human existence in significant ways.
However, mental health professionals have often felt as if they were unwanted stepchildren when sitting at the table of the natural sciences. The subject matter of psychology, i.e., the self and all the messy emotions and thoughts associated with it, do not fit well into fold of the natural sciences. The psyche—the subject matter of the mental health professions—lacks physicality and is not easily measured by science even though the association between the psyche and the body is evident. If then, the psyche is not given to empirical observation, how do we measure it and how do we verify the effectiveness of differing psychological methods?
In an attempt to secure their place in the natural sciences, behavioralists have made the argument that the subjectivity of a person is akin to a black box into which no one can gaze empirically. Therefore, it is basically irrelevant. What is relevant, however, is what we can observe, i.e., behaviors. By observing and modifying behaviors, they hold, we can address the psychological needs of people. Many, however, feel this method leaves something out. People are more than their behaviors and while behaviors can provide a partial pathway into the psyche as cognitive behavioral therapy holds, the one cannot be reduced to the other. From the perspective of many, then, the empirical method of the natural sciences is simply not adequate to psychology, but whether natural scientists agree or not, mental health professionals think of their field as a science.
Much of the issue, pragmatist and philosopher Richard Rorty points out, is that the natural sciences have become akin to a modern religion with the mavens of the natural sciences equal to its high priests. This means that the realist perspective of the natural sciences tends to define reason as objective truth and that, universally. Put differently, natural science holds that embracing the scientific method reveals that which is objectively true, and anything less is irrational. From this perspective, then, the inability or unwillingness of mental health professionals to reduce the psyche to observable data means that the mental health sciences are inherently flawed and hence, less than reasonable. Rorty, however, rejects this definition of science. If science is to be adequate to human experience, he holds, then its purview must be broadened. We do this not by reducing the notion of science to the methodology of the natural sciences. Rather, “we first have to find a new way of describing the natural sciences” (Rorty, 1991). In other words, natural science and its method is not adequate to a broader appreciation of human experience and relying upon the natural sciences alone might mean that interests such as the humanities, the human sciences and the arts are either reduced to a place where they cannot function or are dismissed as somehow irrelevant (e.g., education does not need the fluff of music, art, philosophy, etc.). If, however, we find a broader category in which to understand science, one in which the natural sciences are only a part, then science and hence, the humanities and human sciences can be liberated from natural sciences’ stranglehold on truth and provide greater appreciation of the whole of human experience. Put differently, objectivity as defined by the natural sciences is not the only measure of truth.
In the end, mental health may be a science, but it is a science that goes beyond science because it moves the synergism established between client and therapist to the forefront.
The term Rorty uses to replace the object-oriented truth of the natural sciences is “solidarity.” What he means is that truth functions as a term denoting the ability of those who define a discourse to agree upon issues within that discourse. From a psychological point of view, the truth of the psyche is not provided by empirical observation alone, but the discussion among those who are interested to determine how the term “psyche” should be used. General agreement defines the term, but there is always an option for and the possibility of redefinition. To prevent parochialism, mental health professionals also invite those outside the area of mental health, e.g., Buddhists, cognitive scientists, communication theorists, scientists, philosophers, artists, etc., to join the debate thereby introducing new voices that advance the discussion. When a tentative agreement is framed by the members of psychological discourse, solidarity occurs and even though it may be short lived, it reflects a wider array of human experience relevant to the psyche than does the natural sciences alone. Because solidarity may be subject to change, however, it reflects what C.S. Pierce called “contrite fallibilism” (Rorty 1991), which evades relativism because it is relative to nothing but grows out of the consensus formed by the discipline. As scientific notables Paul Feyerabend, Michael Polanyi and Thomas Kuhn have pointed out, such fallibilism is not foreign to the natural sciences but may describe what natural scientists do better than the scientific method defined as objective truth Rorty, 1991).
According to Rorty, the interaction that drives discourse is circular (1991) and while he does not use the term “hermeneutics,” the back and forth he speaks of is hermeneutical. Or, as L.G. Agrey (2014) points out, the “function of hermeneutics is to stress the interpreter’s [therapist’s] relation to the interpreted [client] and the understanding that arises out of that relation” (189a). Argona and Marková (2015) express the same insight but from a mental health perspective: “[The] hermeneutic standpoint is based on the idea that mental symptoms are not mere facts, i.e. objects that are simply ‘given’ and that can be directly described as such. Rather, they are co-constructed in the therapeutic relationship” (601). What this means, Argona and Marková argue, is that symptoms are not things but are heterogeneous terms indicating that their origin is much broader and extend beyond the scope of the natural sciences. To understand the therapeutic relationship in a meaningful way is to understand that symptomology denotes a type of discourse drawing upon “nature (neurobiological activity), personal capacities and narratives, familial and social idioms of distress, and interpersonal negotiation of meaning…all operative and intertwined at different levels” (Argona & Marková, 2014, p. 602). Rorty’s understanding of science is validated by their concerns and places the work of mental health squarely within a hermeneutical framework.
Such a “hermeneutical turn” has a dramatic impact not only on how mental health research is conducted, but it also impacts the work of doing therapy. Frank admission of the social embeddedness of mental health “truths” is the starting point of all mental health work and cannot and must not be avoided. To do so not only truncates understanding, but it also betrays the existential complexity that defines a client’s humanity. If we are to begin to appreciate the depth of this complexity, we dare not set ourselves over-and-against the client’s expressions of concern, but join in a circular dance, the end of which is not only a better self-understanding for the client but is a dance of meaning that brings change within the context of the therapeutic relationship. Change is not without direction, however, but is guided by the client’s hope for improvement and the therapist’s position of empathy and care. While this is a hermeneutical dance, it is not simply a matter of words for the words of the client cannot embody the complexity of experience nor may the terminology of mental health bring meaning to the client’s life. Rather, it is a dance of the whole persons that includes emotional expression, posturing, personal, familial and social narratives, willfulness, commitment, and hope. The dance, then, extends far beyond the office of the therapist and continues its work in the thoughts of client and therapist alike. In fact, if the dance is successful, it will continue even though the therapeutic relationship has ended. Healing is defined as continuance of the dance, not just the absence of symptoms.
The hermeneutical dance is not something that can be reduced to method and the words of textbooks cannot fully teach it. That is why it is important to create a hermeneutical posture within those we teach that their gaze not be restricted simply to “the facts.” Their diagnosis will not grow out of formulaic bullet points of diagnostic manuals alone, nor will they restrict their involvement to the safety of therapeutic detachment. Instead, they and the client will form a solidarity, and meaning and understanding will be a matter of consensus that brings a greater clarity to the existential uncertainties that mental distress brings.
In the end, mental health may be a science, but it is a science that goes beyond science because it moves the synergism established between client and therapist to the forefront. It is not simply a test of observable data although it may include that. It is a hermeneutical dance that brings balance to the many complexities of life and as such, establishes meaning and understanding where before there was none.
Agrey, L. G. (2014). Philosophical Hermeneutics: A Tradition with Promise. Universal Journal of Educational Research, 2(2), 188-192.
Aragona, M., & Marková, I. S. (2015). The hermeneutics of mental symptoms in the Cambridge School. Revista Latinoamericana de Psicopatologia Fundamental, 18, 599-618.
Rorty, R., & Richard, R. (1989). Contingency, irony, and solidarity. Cambridge University Press.
Rorty, R. (1991). Objectivity, Relativism, and Truth: Volume 1: Philosophical Papers. Cambridge University Press.