Explication or Explanation?

Mike Martin's paper raises questions about the process and the effectiveness of psychotherapy in the case of an Iraq war veteran, Colin, described by Dr. Bailey in his essay “A Painful Lack of Wounds”: does psychotherapy succeed? If so, why does it succeed? How far is and should psychotherapy be value free? The clinical phenomenon discussed in this paper is defined as a serious but not severe depression occurring upon returning from the Iraq war. The impression, from the vantage point of a psychotherapist, is that too many details are lacking from the account that is provided and that the case is hurriedly explained away invoking a naturalistic evolutionary model.

The psychotherapeutic, as well as the clinical (Stanghellini 2007) and the research (Stanghellini and Ballerini 2008) interview is a quest for meaning. Its first concern is an accurate unfolding of subjective experiences and the organization of these experiences according to a pattern of sense that is immanent to the experiences themselves; the interpretation or the explanation of these experiences according to a model that is not immanent in the clinical material itself may come as a later step.

The first step may be called the explication of case material. It consists in bringing out the raw feelings of the patient's experiences and the personal meanings that the patient attributes to his experiences. Here is a list a questions that a clinician would (tactfully) address to Dr. Bailey's patient to enrich the clinical explication of this case (a great deal of questions, of course, can be found also in Martin's [2009] commentary): What are the phenomenal features of Colin's “depression”? Which thoughts and emotions are involved? Anxiety? Anguish? Fear? Frustration? Anger? Irritability? Sadness? Apathy? Guilt? Shame? Which other experiences are involved, for example, physical pains or somatic symptoms? What is it like for Colin not to have proven his “manhood” in Iraq? What does it mean for him to be a “man”? Why does he want to be a man? How does it look like his “ideal” man? How does he exactly feel and what does he mean by “being a wimp”?

We also need to illuminate the internal relations of dependence between these experiences: are these phenomena each one independent form the others, or can we find a meaning organizer among them (Rossi Monti and Stanghellini 1996), for instance a core emotion that let us understand the manifold of symptoms as a unitary structure? Does Colin feel angry for not being assigned to a combat duty? Or guilty because he did not object to this? Or does he feel ashamed because he was judged not suitable for a combat duty? Apparently, there is a “basic” wound here, maybe a narcissistic one—the epicenter of a story that reminds us of Ajax's “madness” when the Greek generals did not offer him Achilles’ weapons. Looking for this wound with Colin and through Colin's words is much different from endorsing an armchair theory of his “depression.” The latter reminds us of someone who feels full after reading the restaurant menu.

We need to look for the relations between these clinical phenomena and the situation (event) in which they take place: what do we know about the pathogenetic situation? We know that the same person in different situations can behave and be valued in opposite ways. As Kretschmer pointed out, persons that in times of peace psychiatrists would label as psychopathic personalities in troubled times become celebrated heroes. In the same manner, a boy with an antisocial personality disorder can become a hero if he put his “qualities” to the service of military special forces. In particular, what did Colin expect from enrolling in the army? His expectations were his own or someone else's hopes? What happened exactly in Iraq? What does “Iraq” mean for the patient? What did he do and what did he not do to become a “man” or a hero there? Is Iraq the only place where someone can demonstrate to be a man? Is being a hero the only valuable way...