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Thinking for CliniciansReview - Thinking for Clinicians
Philosophical Resources for Contemporary Psychoanalysis and the Humanistic Psychotherapies
by Donna M. Orange
Routledge, 2009
Review by E. James Lieberman, M.D.
Jun 22nd 2010 (Volume 14, Issue 25)

This small book has to be read slowly.  Like the author's message, the work of therapy cannot be rushed. Donna Orange, Ph.D., psychoanalyst and philosopher who teaches in New York and Rome, has several books including two co-authored with psychologists George Atwood and Robert Stolorow. She attracts and comforts a reader like me by introducing philosophers as human beings and by stressing the role of "perpetual beginner" that excludes cult leaders and gurus who "are no longer really philosophers for those who follow." (p. 5)  An untutored, undisciplined philosopher, I have trouble remembering who among the big names said what. As a reader of psychologist-philosopher Otto Rank, I need to know more about the connection between the disciplines that Orange and he represent.

She chose five thinkers of the last century as resources: Martin Buber, Ludwig Wittgenstein, Maurice Merleau-Ponty, Emmanuel Levinas, and Hans-Georg Gadamer, presented in chronological order of their most important work. Why only men? Orange salutes Martha Nussbaum and Julia Kristeva, and regrets that women have been blocked from the field for so long. The glossary (over 90 philosophical terms) and bibliography are valuable. The most referenced words in the index include: dialogue, ethics, experience, language, subjectivity and understanding.

Some terms. Hermeneutics--"The study of interpretation, originally biblical interpretation"--a dominant theme in psychology as well as philosophy. Biblical and psychoanalytic hermeneutics share an authoritarian certainty that is refreshingly absent from the manner of this book. Phenomenology,  starting with Edmund Husserl, emphasizes experience over preconceptions and theories, bringing intersubjectivity and empathy into focus.

Orange presents each thinker with a biographical sketch and application of their thinking to therapy in the broadest sense: dialogue; conversation; interpretation; relationship; ethics. For me the last chapter seemed easiest--both accessible and most relevant. That may be due to preparation by the preceding text, or the author's practical and moving summation, or both.

Of the five philosophers, Martin Buber is probably best known to therapists as the "philosopher of dialogue, inclusion, and confirmation." (p. 15). His contrast of the I-Thou and the I-It distinguishes relationship to person vs. thing. He, like other figures in this study, values surprise as a marker of personal dialogue with a real You. The interlocutor must be wary of objectifying and theorizing--a Freudian occupational hazard. The relationship in therapy as in parenting and teaching, is asymmetrical, not "fully reciprocal, and is not mystical. It is, however, intimate, surprising, risky, and creates a genuine We." (p. 22). 

Ludwig Wittgenstein focused on dialogue: language and its myriad games. Attending to these complex mixtures of customs and rules makes us better therapists, according to Orange, because "we are slower to assume that we know what the other person means." (p. 41) Famous for the concept of "family resemblances" among languages, Wittgenstein avoids the tendency to reduce to essence and separate by dualism. He criticized Freud for confusing causes with reasons, areas of discourse involving completely different language games. "Causes were irreducibly plural and joined only by family resemblance....such confusions risked reducing personal motives like desire to mechanical causes like tension reduction," Orange writes. (43). This is a philosopher of experience and expression. He noted the limits of language: much of importance can be shown but not said.

The writings of Maurice Merleau-Ponty are difficult, his lectures more accessible. For him perception is somatic as well as mental. All perception is embodied, inner and outer are intermingled, in contrast with Descartes' separation of mind and body and consonant with neuroscientist Antonio Damasio. Merleau-Ponty adds to clinical insight on skilled coping, sense of choice, will, and the future.  "We are neither body nor mind, but body-subjects." By the end of the chapter one may be able to read "embodied intersubjectivity" without flinching.

Emmanuel Levinas, Lithuanian-Jewish-French holocaust survivor, made ethics the the central focus. His concern is relationship to the other, not objectified, but as the "face" of our ethical responsibility. "Levinasian intersubjectivity means that...the subject is constituted in its responsiveness to the other." (88). Sincerity and hospitality are two concepts resonant with therapy: "for Levinas, the face of the suffering neighbor precedes all relation." (92) The emotional connection of understanding transcends any amount of explanatory knowledge. "Our responsibility for the other is what makes us human, and in this sense, Levinas challenges us clinicians to join him as ethical humanists." (95).

Hans-Georg Gadamer (1900-2002) was still lecturing at 94. A student of languages, he viewed the process of understanding as learning the language of the other. For Orange, therapy is a process where we learn the patient's language while the patient is learning ours. Gadamer was interested in conversation, dialogue, in which control is shared by the partners. It is alive, involving, and self-correcting. Changes occur in things that were taken for granted. Evolved considerably from Sigmund Freud's,  Gadamer's hermeneutics teaches us "(a) to regard the patient in the dialogic situation as an important source of truth, (b) to take developmental and cultural contexts seriously, and (c) to adapt an attitude of serious play that puts the clinician's emotional life and convictions at risk for the sake of the possible understanding."  (108)

This book makes a fine supplement to the Oxford Textbook of Philosophy and Psychiatry (2006), a massive study guide and reference (872 large pages plus CD). Wittgenstein and Freud have significant coverage, Merleau-Ponty has a little, Gadamer a mention, but no mention of Buber or Levinas.

Donna Orange, multilingual, multicultural, compassionate, is a good teacher whose love of philosophy and of helping imbue this valuable book.  "Hermeneutics preserves the psychoanalytic emphasis on interpretation and the relational emphasis on engaged understanding. At the same time, as practical wisdom or phronesis--unlike technique--it keeps us humble and flexible." (117) Otto Rank called himself a philosopher of helping; his presence here is implicit in her mention of Rollo May and Carl Rogers. All therapists are philosophers, as are physicians--as shown currently in the writing and teaching of Abraham Verghese. This book requires us to think more and better about what we are doing and feeling. It is a gift, small but weighty, really worth taking on the trip.


© 2010 E. James Lieberman



E. James Lieberman, M.D., Clinical Professor of Psychiatry, Emeritus, George Washington University School of Medicine


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