Exploding the Semantic Horizon

This title comes from derrida’s Positions (1972/2002), where he advocates refusing to take a position within a binary opposition, preferring to both shuttle between its poles and step outside the metaphysical frame of reference created by binaries. Repeated visits to Davidson and Shahar’s powerful paper revealed different ways in which it not only signals a reversal of psychopathology’s semantic horizon, from past to future; it also points toward its explosion. Because my first reading was distracted by minor puzzles within the text, not least the unusual rendering mental health writers give to the Oedipus myth, I summarize my understanding of the argument before elaborating clinical connections and research implications. This commentary is shaped by Deleuze and Guattari (1991/1994), from which these subheadings are quotations.

Concepts are Centers of Vibration

The authors open with an exposition of philosophical and empirical arguments for ceasing to look into personal histories for causes. Instead, we should seek to understand human agency as the creative force determining subjective life. Key to understanding the person’s subjectivity (as opposed to construing their behavior in objective terms) is eschewing history in favor of exploring their intentions.

This account of an apparent opposition between past and future subsequently becomes more nuanced as evidence from studies of depression is reviewed. This evidence indicates that interpersonal factors can be both antecedents and consequences; and both may be mediated or moderated by life events. Questions about the relative influence of these elements on human agency justify philosophical clarification of the relationship between them. The authors take a Heideggerian view on person–environment interactions, by construing the human agent as ineluctably in motion: the person-in-the-world has primacy, a person not seeking satisfaction of needs to achieve rest, but a person–environment relationship where action is itself the purpose of life. The task of both researcher and clinician is to understand what the person’s actions with/in the world intend to create, produce, or affirm. The authors argue that this is only possible by taking a first-person perspective; by referring to that agent. Eating disorders are cited as a prime example of a condition where it is important to understand under- or overeating within the framework of intentionality.

The therapist must avoid traps such as criticizing self-critical people for being too critical. Affirming the person’s desires is the first stage in joining them in the cab of their metaphorical train, with the longer-term goal not of derailing it, but of suggesting alternative routes and/or possible destinations. The authors construe psychopathology not as a gap that requires filling or a problem that requires cure, but as a source of distress within a life that is and will remain in motion. This results in them reconstruing therapy as one aspect of a more important and ongoing life process. The therapist should be interested in relief of suffering, but should also be concerned about the effectiveness of the person’s pursuit of pleasure and play.

The Concept itself.... Has Neither Beginning Nor End but Only a Milieu

What are the contextual considerations? How can this new approach to help-giving be constructed between the suffering person, the therapist, and the organization hosting the therapy? Deemphasizing problems in favor of intentions could result in concern from those funding treatment that those with the resource necessary to have intentions concerning their lives are lower priorities than hopeless individuals who are more needy or distressed. Another concern could be that criteria for treatment termination are too fluid. Thus, one issue raised by dialogic forms of practice with users is how to engage with practice contexts dominated by externally imposed audit and benchmarking criteria. Intervening to promote growth in play and pleasure may result in symptom reduction, but what happens if it does not? Is therapy justified by enhanced quality of life? Is it what those providing services are happy to fund? Is this what users want?

This draws us toward related questions about how this first-person, agentic position should engage with user groups, an imperative clearly, if unquestioningly, considered to be the guarantor of...