The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness

9 Desire and Self: Hellenistic and Eastern Approaches

C H A P T E R 9 Desire and Self Hellenistic and Eastern Approaches Empty is that philosopher’s argument by which no human suffering is therapeutically treated. For just as there is no use in a medical art that does not cast out the sickness of bodies, so too there is no use in philosophy , unless it casts out the suffering of the soul. —EPICURUS Lamps are many; light is one. —RUMI 1. In psychiatric training, as one learns to do psychotherapy, one soon realizes that there is an ethical component to psychotherapy. The therapist is intimately involved with trying to understand what the patient values, what the patient does in life, and why he does it; and what might be different. Freud denied that psychoanalysis was value-laden or that the work of his brand of psychotherapy involved ethics or value judgments. Yet, the new psychotherapist is faced with the clear impression that such is not the case. The question is, then, What is the ethical basis of psychotherapy? Besides traditional Hippocratic ethics on the one hand and standard moral philosophy (utilitarianism versus deontology) on the other, there is a system of ethics that has even more direct implications for the ethics of psychotherapy : Hellenistic ethics. 2. The schools of Hellenistic philosophy are quite unusual from the modern perspective. Today, philosophy often involves logic, attempts to prove arguments , and abstract systems of thought. Philosophy rarely has a therapeutic orientation. It is a fascinating historical fact that there was a time (the Hellenistic period) when philosophy was largely identified with ethics and seen to have an important role in the lives of human beings, a role that was analogous to medicine’s role. The Hellenistic schools saw philosophy as a field similar to medicine, where philosophers healed the soul as physicians healed the body. The explicit goal of philosophy for these schools was to promote human flourishing , eudaemonia. The first matter that one comes up against in considering the relevance of Hellenistic philosophy to psychotherapy is the issue of whether rational argument is useful in psychotherapy. The Freudian school would likely argue not; it might say that the patient ends up in therapy because rational argument has been ineffective in influencing her feelings or behavior. Otherwise, the advice of friends and family would have been sufficient. Besides, psychoanalytic theory would argue that the basis for much psychopathology is unconscious, instinctive, and emotional and thus not influenced by rational discussion. Even if one accepts this psychoanalytic notion, allowing for the important in- fluence of emotional factors in psychotherapy, one is still faced with the problem that Freud identified as resistance, the difficulty of effecting real emotional change in a person’s life. The Hellenistic philosophers addressed this issue head-on. In fact, Aristotle had previously laid out the same objection: to read discussions of ethics did not make one a more ethical person. The Hellenistic philosophers argued that reason influenced one’s emotions and that emotions were affected by true or false cognitive judgments. These days, this discussion would be supported by cognitive-behavioral theory and the empirically demonstrable effectiveness of cognitive-behavioral psychotherapy in many psychiatric conditions. Furthermore , research in neuroscience tends to blur the traditional distinction between reason and emotion. For instance, the frontal lobes are a part of the neocortex (which is generally associated with rational cognitive faculties) but have many connections to the limbic cortex (which is generally associated with emotional function). Thus, from the empirical standpoint, whether of clinical psychiatry or of neuroscience, a sharp distinction between reason and emotion does not exist. Among some philosophers as well, the view that reason and emotion are entirely separate realms has lost credence. Hellenistic and Eastern Approaches 117 3. As a result, the assumption, held by many psychiatrists, that reason has little influence on emotional conditions is less obvious than it may at first seem. If reason has a connection to emotion, then philosophy may have a role in psychotherapy . This is exactly what the Hellenistic philosophers supposed. The two main schools of Hellenistic philosophy were the Epicureans and the Stoics.1 I will focus on the school of Epicurus, since its potential links to current psychiatric theories are numerous. Epicurus, who was apparently a charismatic man, led a community of students in his “Garden” school of philosophy. He held a number of views with direct relevance to...