10 Points on Presocratic Philosophers and Psychotherapy

Henri Estienne, 'Poesis philosophica'. First published anthology with presocratic texts, containing forty fragments from Heraclitus.
Wikimedia Commons

1. The presocratic philosophers were a group of ancient Greek philosophers who lived and wrote before Socrates and who are credited with laying the foundations of Western philosophy.
2. The presocratic philosophers were concerned with understanding the nature of the world and the fundamental principles that govern it. They sought to explain the world in terms of natural forces and processes and from a purely logical standpoint, rather than relying on mythological explanations or supernatural intervention.
3. Both presocratic theory and psychotherapy emphasize the importance of understanding one's own thoughts and feelings in order to make sound decisions about how best to live one's life as opposed to relying on external factors to justify outcomes. Both approaches offer tools for self-understanding which can be used as catalysts for personal growth in order to create a more fulfilling existence for oneself.
4. The common denominator: One of the key figures in presocratic philosophy was Thales of Miletus, who is credited with being the first Western philosopher. Thales believed that the fundamental principle of the universe was water, which he saw as the source of all life and matter. Of relevance to psychotherapy is Thales’ perspective there is a common, objective denominator underlying all experience and there is unity in diversity. Another important presocratic philosopher was Anaximander, who argued that the fundamental principle of the universe was an infinite, indeterminate substance known as "άπειρον, apeiron." Anaximander believed that the apeiron was the source of all things and that it was responsible for the creation and destruction of the universe. Anaximander's theory of an immeasurable, boundless entity, that is the underlying, immediate cause of the world, has its parallels in the psychodynamic psychotherapy formulations of the immeasurable unconscious as the immediate source and generative power of conscious processes.  Furthermore, Anaximander's belief that the universe is infinite and that all things come from and return to a single, undifferentiated substance has been compared to certain approaches to psychotherapy that emphasize the interconnectedness of different aspects of the self and the importance of finding meaning and purpose in life.
5. The role of change: The presocratic philosopher Parmenides of Elea argued that change is an illusion and that reality is eternal and unchanging. This view has been compared to certain approaches to psychotherapy that emphasize the importance of acceptance and the need to work with rather than against difficult circumstances. The presocratic philosopher Heraclitus of Ephesus, on the other hand, believed that change was a fundamental aspect of the universe and that everything is in a state of flux. His philosophy has been interpreted as having parallels with certain aspects of psychotherapy, such as the idea that individuals and their circumstances are constantly changing and that it is possible to adapt and grow in response to these changes.
6. The basic building blocks: The presocratic philosopher Democritus believed that the universe is composed of atoms, which are indivisible and indestructible. This atomic worldview has been interpreted as having parallels with certain aspects of cognitive-behavioral therapy, which emphasizes the role of thoughts and beliefs in shaping an individual's experiences and behaviors.
7. The role of past experiences: The presocratic philosopher Pythagoras believed in the concept of metempsychosis, or the transmigration of souls, and taught that the soul is immortal and can be reborn into different bodies. This belief in the continuity of the soul has been compared to certain approaches to psychotherapy that emphasize the role of the unconscious and the importance of exploring past experiences in order to understand and heal from present difficulties.
8. Dynamic balance: The presocratic philosopher Empedocles argued that the world is governed by the four elements of earth, air, fire, and water and that these elements are in constant tension and conflict with one another. This view of the world as being in a state of dynamic balance has been compared to certain approaches to psychotherapy that emphasize the importance of finding a balance between different aspects of the self and between different emotions and behaviors.
9. The presocratic philosophers were influential in the development of Western thought and continue to be studied and debated by philosophers and scholars today. Their ideas and concepts have also been interpreted as having potential relevance to the field of psychotherapy and the understanding of human psychology and behavior.
10. It is important to note, however, that the presocratic philosophers lived and wrote over two thousand years ago and that their ideas should be understood and interpreted within their historical and cultural context. While their ideas may have some overlap with certain concepts and approaches in contemporary psychotherapy, it is important to recognize that there are also significant differences and that the presocratic philosophers should not be considered the definitive source of knowledge or insight on these topics.

Nihilism and Psychotherapy

Nihilism is a philosophical stance that suggests that life has no inherent meaning or value. Instead, a nihilistic view posits that all values, morals, and beliefs are subjective and ultimately meaningless. While nihilism may seem like a bleak and depressing perspective, it can actually be a relevant and useful concept in psychotherapy.

Many people struggle with feelings of inadequacy, guilt, or self-doubt due to internalized beliefs about what is "good" or "bad." By recognizing that these beliefs are subjective and ultimately meaningless, individuals can be more accepting of themselves and their own experiences. One way in which nihilism can be relevant to psychotherapy is by helping individuals to let go of unhealthy or unhelpful beliefs and values.

Another way in which nihilism can be useful in psychotherapy is by helping individuals to find meaning in their own lives. Many people struggle with feelings of purposelessness or meaninglessness, and this can lead to depression, anxiety, and other mental health issues. By recognizing that meaning is not something that is given to us by external sources, but rather something that we must create for ourselves, individuals can be empowered to find meaning in their own lives. Through its emphasis on the meaninglessness of life, nihilism, like existentialism, can help free people from the tyranny of externally imposed meaning and purpose so that they can find their own sense of purpose and meaning.

Nihilism can also be relevant to psychotherapy by helping individuals to accept the inherent uncertainty and unpredictability of life. Many people struggle with feelings of anxiety and fear due to their attempts to control or predict the future. By recognizing that life is inherently uncertain and that we cannot control everything, individuals can learn to be more accepting of the present moment and more resilient in the face of change.

In conclusion, nihilism can be a useful concept in psychotherapy by helping individuals to let go of unhealthy or unhelpful beliefs, find meaning in their own lives, and accept the inherent uncertainty of life. While nihilism may seem like a bleak perspective, it can actually be a valuable tool for helping individuals to live more fulfilling and meaningful lives.

The unexamined life is not worth living

This post is a re-posting of a previous post on the PLoS Mind the Brain blog. As part of my re-focusing on this blog I will bring here relevant posts that I've published elsewhere. The goal is to have this blog as a one stop station for all my more philosophically flavored musings on psychiatry.

... states Socrates [through Plato] in his Apology. You might think this is a metaphorical statement. And thus the surprise when Socrates chooses to drive this most important point home by proceeding to drink the poison that literally ends his life.

From the psychiatrist's corner this looks a bit like suicide by cop. Socrates has the ability but not the willingness to save his life; one may argue that he effectively leads the jury to condemn him to death and then carries out his own sentence.

Is this a reasonable decision and course of action? Or alternatively, did Socrates have capacity?

For starters, Socrates' view of life as being worth living under a certain set of circumstances [but not others] is at odds with the view of modern [read Western] psychiatry which emphasizes the absolute value of life regardless of its circumstances.

Arguably, the majority view nowadays is that the ideal mental health is a state where the drive to live prevails no matter what. As a consequence, those who are ideally "mentally fit" would have the potential to overcome and survive whatever circumstances and challenges life would throw in their way. Which pretty much means they will make the choice to live regardless or they would prize life above anything else.

This view of life as having an absolute value is at odds with moral systems that consider life's value as contingent on the fulfillment of other norms and values. In middle age Europe chivalry valued bravery above living, in Japan the samurai Bushido code recommends suicide by seppuku as preferable to living without honor. And of course Socrates argues that is better to die than to life an un-examined life.

Along this line of thinking, choosing an honorable death over a shameful life can be understood as the logical consequence of subscribing to a clear moral code - and as such can be accepted as proof of competency in making life/death decisions.

However Socrates reaches his final decision following a moral code that is dictated by his daemon, in essence an auditory hallucination.

There is ample evidence that Socrates experienced auditory hallucinations in addition to what might be considered as a very specific set of compulsions. In his De Genio Socratis Plutarch states that...

"Socrates' sign was a sneeze, his own and others; thus, when another sneezed at his right, whether behind or in front, he proceeded to act, but if at his left, desisted; while of his own sneezes the one that occurred when he was on the point of acting confirmed him in how he had set out to do, whereas the one occurring after he had already begun checked and prevented his movement".

Now,  in the context of concurrent psychiatric symptomatology, when one's life/death decision follows the prompting of an auditory hallucination - even if in accordance with a pre-specified moral code - does it meet criteria for capacity?

Or would the consulting psychiatrist recommend starting a neuroleptic and holding off on proceeding with the execution until the medication will take effect?

© Copyright Adrian Preda, M.D.

Notes on Jaspers

Jaspers in quotes:

"The question of what underlies all phenomena in general used to be answered in the old days by the notion of evil spirits. These later turned into disease entities that could be found by empirical investigation. They have proved themselves however to be mere ideas’.

The mere ideas of evil spirits or neurotransmitter abnormalities are explanatory models based on [to date] insufficient evidence. Such models serve as temporary organizing models for mental disorders until enough evidence accumulates against the model to demonstrate its inadequacy. Enough experimental evidence has accumulated to convincingly demonstrate that the evil spirits model is inadequate; almost enough evidence has accumulated to demonstrate the neurotransmitter model is inadequate. Looking at the relationship between theoretical models and their translation in practice, it appears that most of the time, until a conceptual model is invalidated, the model tends to be seen as valid and used as if it is valid in day to day practice. Psychiatry is no exception to this rule.

‘We have intuitions of a whole which we call schizophrenia but we do not grasp it; instead we enumerate a vast number of particulars or simply say “ununderstandable”, while each of us only comprehends the whole from his own experience of actual contact with such patients’.

Our understanding of the unintelligible is filtered through the lenses of our own experience. While what is clear is clear to everyone in the same way, what is unclear is unclear to each individual in a individual way. 

Concepts to compare and contrast:

• psychopathology of "the sick human individual" vs. psychopathology of "human sickness" [Musalek 2013]
• superficial checklists of diagnostic criteria vs. understanding of a patient's experience of his illness [Musalek 2013]
• • professional, authoritarian, expert monologue vs. therapeutic, democratic dialogue [Musalek 2013]
• expert opinion vs. genuine curiosity
• see patients as they are vs. "through the distorting prism of our own preconceptions" [Sims 2013]

MAYA: The Physics of Deception

On being a psychiatrist: Is an MD sufficient?

Sigmund Freud

Freud argued that a psychoanalyst did not necessarily need to have a background in medicine. Think about it: would the study of medicine or, alternatively, the study of psychology, anthropology, sociology, history and, of course, the proper way to think about things, i.e., philosophy ideally prepare one to understand the dynamics of the psyche?

At odds with this view, psychiatrists are physicians first. In the US system, following graduation from medical school, they enter a one-year internship, followed by a three-year residency in psychiatry. During internship, a psychiatrist typically splits his time between medicine and neurology (for six months) and six months of inpatient psychiatry. For the next three years, the future psychiatrist gains experience in treating a variety of patient populations (inpatient and outpatient, patients with major mental illness such as schizophrenia, bipolar, major depression or Alzheimer's dementia, illicit drug users, or severe personality disorders). As a trainee, a psychiatric resident learns how to use a variety of psychotropic medications and psychotherapeutic interventions.

It is a lot to master and that leaves little time for anything else.

At the same time, psychiatry is so much more than just making a diagnosis in accordance with the medical model and then prescribing an evidence-based intervention. In psychiatry, an evidence-based appraisal of data is only the beginning, of a psychiatric assessment, formulation, and plan.

By allowing itself to be reduced to an exclusive medical model perspective, psychiatry loses the ability to meaningfully understand the complexity of human experience. This is a complex discussion (HERE for a link) but the point is relatively straightforward.

As the medical model only partially informs a psychiatrist expertise, it follows that psychiatrists need to be more than just evidence-based physicians. A psychiatrist's expertise in describing pathology and offer evidence-based interventions should be comparable to the expertise of any other physician in any other medical specialty. But while the study of philosophy is irrelevant to the outcome of an appendectomy, philosophy plays an organic part in understanding and treating any form of mental illness.

Critical thinking, good humor, perspective, skepticism, and a dialectic understanding of complex facts are as essential to good psychiatric practice as the skills of carrying a psychiatric review of systems and mental status examination.

Thus, a good psychiatrist, while a physician first, also has a working knowledge of philosophy. Which should exude throughout a visit with a patient.

You are not sure where your psychiatrist stands on the above issues? Not a problem.

Email this post and ask for an opinion. If you get a response, please bring it back here.

Discussing, debating, trying to understand each other's perspective will make us all better patients, better doctors, better fellow beings.

© Copyright Adrian Preda, M.D.

On being a psychiatrist: Is an MD sufficient?

Sigmund Freud LIFE

Freud argued that a psychoanalyst did not necessarily need to have a background in medicine. One might argue that to properly understand the dynamics of the psyche one might be better served by studying anthropology, sociology, history and, of course, the proper way to think about things, i.e. philosophy.

At odds with this view, like it or not, psychiatrists are physicians first.  Following graduation from medical school they enter a one year internship, followed by a three years residency in psychiatry. During internship, a psychiatrist typically splits his time between medicine and neurology (for six months) and six months of inpatient psychiatry. For the next three years, the future psychiatrist gains experience in treating a variety of patient populations (inpatient and outpatient, patients with major mental illness such as schizophrenia, bipolar, major depression or Alzheimer's dementia, illicit drug users, or severe personality disorders). As a trainee, a psychiatric resident learns how to use a variety of psychotropic medications and psychotherapeutic interventions.

It is a lot to master and that leaves relatively little time for anything else.

At the same time, psychiatry is so much more than just making a diagnosis in accordance with the medical model and then prescribing an evidence-based intervention. When it comes to psychiatry, an evidence-based appraisal of data should be the beginning, not the end of a psychiatric assessment, formulation and plan.

By allowing itself to be reduced to a medical model only perspective, psychiatry loses the ability to meaningfully translate and enrich the complexity of human experience. This is a complex discussion (HERE for a link) but the point is fairly straight forward.

I would like to propose that psychiatrists should aspire to be more than just evidence-based physicians.

We agree that a psychiatrist's expertise in describing a mental illness and then offer an evidence-based intervention should be equal to the expertise of any colleague in any other medical specialty. But while the study of philosophy is irrelevant to the outcome of an appendectomy, philosophy plays an organic part in understanding and treating any form of mental illness.

Critical thinking, good humor, perspective, skepticism, and a dialectic understanding of complex facts are as essential to good psychiatric practice as the skills of carrying a psychiatric review of systems and mental status examination.

Thus, a good psychiatrist, always a physician first, also needs to have a working knowledge of philosophy. Which should exude throughout the course of a visit with a patient.

You are not sure where your psychiatrist stands on the above issues? Not a problem.

Email this post and ask for an opinion. If you get a response, please bring it back here.

Discussing, debating, trying to understand each other's perspective will make us all better patients, better doctors, better fellow beings.

© Copyright Adrian Preda, M.D.