Book Review: Wittgenstein and Psychotherapy: From Paradox to Wonder

Wittgenstein and Psychotherapy: From Paradox to Wonder

John M Heaton. (2014). Basingstoke: Palgrave Macmillan

This book follows hard on the heels of Heaton's previous The Talking Cure (Heaton, 2010) again focusing on his profession of psychotherapy; looked at in the style of Wittgenstein's thinking. I put it like this to emphasise at the outset that this is not the application of Wittgensteinian ideas to psychotherapy, with a view to suggesting that this is an improvement on competing explanations. Rather, Heaton, following Wittgenstein's example, is reminding us of the consequences of thinking in particular ways: specifically, of the difficulties and confusions that arise when psychotherapists allow their thinking to harden and coalesce into sheer belief. This is highly relevant for a practice which aims to help free people from this very state of affairs; how can a therapist help if he too is convinced to the point of bewitchment of the correctness of his viewpoint?

If Heaton focuses on Psychoanalysis and Cognitive Behaviour Therapy (CBT), he does so not to criticise these disciplines per se. After all there are plenty of practitioners of both disciplines who prove helpful for their patients. Rather, Heaton's examples show what can happen when the psychotherapist forgets that his practice is foremost an ethical one which, more like meditation than surgery, does not depend on technique. Heaton's friend and colleague, the late R.D. Laing, put it well by suggesting that treatment is concerned with how we treat people, and as psychotherapists how we treat or are treated is not just commensurate simply with the ideas or methods employed.

It is, however, easy to be mistaken about Heaton's aim here just as it is when reading Wittgenstein, notwithstanding the latter's warning about the 'craving for generalisation'. How difficult it is not to follow these ideas as if they were instructions to achieve a desired outcome! If this craving for generalization was what Heaton was aiming at, then his 'Wittgensteinian' therapy would swell the ever-increasing number of therapies appearing, each claiming certain defining features with evidence presented as to its winning effectiveness as a method of treatment.

The question of what counts as evidence is contemporaneous with the modern history of psychotherapy from the Enlightenment onwards. Such evidence has become largely an empirical matter, with a case study at the centre clothed not only in the language of the laboratory but considered to be only truly revealed by the methods of the laboratory. Very seldom does the case study simply describe; the tendency is to utilise a persuasive technical language, which turns the singular case into one that can be generalised in support of the particular psychotherapeutic methodology.

Psychoanalysis is a good example of this with its conceptual framework presented in terms analogous to a scientific enquiry, emphasising observational neutrality and representational fidelity. As this is clearly not satisfactory to the stubborn empiricists (think Ernest Gellner, 1985), the most contemporary version of this involves findings from neuroscience said to vindicate many psychoanalytic ideas. However even when the importation of neuroscience as a legitimate scientific methodology, into the field of psychotherapy is eschewed, the case for psychotherapy is often made conceptually, utilising a technical language which mimics the scientific one in its representational function.

Founding yet another school of psychotherapy is not Heaton's intent. On the contrary, he follows in the footsteps of his old mentor – Peter Winch – in a rigorous attempt to retain for psychotherapy that which Winch was claiming for the 'social sciences' (Winch 2007); namely that the problems and possible solutions under scrutiny are indeed conceptual through and through. They cannot be rendered outside the complicated, knotted, opaque language that expresses them. The detached observational view of science is not needed here but rather Phronesis – a knowledge and understanding arising out of participation in the life that gives rise to such singular difficulties.

In terms of the conceptual work needed, Heaton's criticisms of Psychoanalysis and CBT are not therefore that of a philosophical under-labourer with the task of removing the rough edges to make way for a 'new improved model'; all the better to be empirically rendered. Instead Heaton's critique is in the service of holding a mirror up to the language of psychotherapy, to suffering and its alleviation. It is a reminder that what helps has little to do with the particular ideas the therapist holds but rather 'the placebo effect, the quality of the relationship between therapist and patient, and other non-specific factors are what are important' (Heaton, 2014: p 1). This is not about polishing the mirror all the better for focusing the beam through the microscope, but using the mirror to let light fall where it will. This might be contrasted to the work of, say, of the psychoanalyst, Roy Schafer, where his 'action language' seems to fit with Winch's notion of the conceptual task of the under-labourer; expunging substantive notions from Freudian corpus and replacing them with a 'language of agency' (Schafer 1976).

All this however, abruptly brings us to the aporia that Heaton reminds us can never be solved but may lead, nevertheless, towards liberation – but liberation from what? The argument Heaton advances is not that what is needed is a more refined, precise, exact language on which to base the practice of psychotherapy, or a language that more accurately represents what is at stake for the suffering patient as if seen from the outside. Rather, and here the mirror may deceive, because we embody language to the core, we cannot see ourselves seeing but we are constantly enticed by the notion that we can. Heaton's first book (Heaton, 1968) was on the Phenomenology of Eye Disorders which helps clarify the illusion that no amount of detailed description of the structure and function of the eye increases an understanding of seeing. So liberation, if it comes, is from the illusion that we can step outside our embodiment in language. So strong is this illusion that we will almost certainly be tempted to forget that this aporia lies right under our noses as we read Heaton's book, hoping that his account will trump all others and show us psychotherapists the 'way out of the fly-bottle'.

Thus Heaton's book is no textbook, let alone the 'manualisation' of techniques of liberation, so what kind of a book is it? This same question of course is applicable to Wittgenstein and plays an important part in the 'Tractatus' (Wittgenstein, 1986). This has been taken up by many commentators of his work, particularly those who come under the rubric of rendering a 'therapeutic' reading of Wittgenstein. Much has been made of the framing remarks at the beginning and the end of the Tractatus: 'This book will perhaps only be understood by those who have themselves already thought the thoughts which are expressed in it – or similar thoughts. It is therefore not a text-book' (ibid, p 27);.... 'My propositions are elucidatory in this way: he who understands me finally recognises them as senseless, when he has climbed out through them, on them, over them. (He must so to speak throw away the ladder, after he has climbed up on it)' (ibid, p 189). These remarks thus seem to point a way towards understanding these texts as being more like riddles, aphorisms or koans which are written to bring about a change in the perception of the reader rather than illuminate this or that feature of life.

In so far as such remarks equally apply to Heaton's book, remaining entombed in a fly-bottle seems certain as one is tempted to follow the instructions ('throw away the ladder...') as if these could be relied upon even as the other 'propositions' are to be treated as senseless. Elucidation seems so naturally to involve the accumulation of knowledge that it is so easy (too easy), to forget that the account one is reading is an account of the author's struggle to 'get out of the fly-bottle'. Even if one has 'similar thoughts' this allows no respite to having to think through to the limits of one's own thinking. The difficulties are immense and demonstrated by the dismal state of contemporary psychotherapy when faced with the aporetic aspects so deeply embedded in language and arguably that which psychotherapy seeks to relieve.

Heidegger (2000) understood this difficulty, for instance in the Zollikon seminars, of persuading his audience of psychiatrists and psychologists that even as these appendages are essential to human life, the brain doesn't think neither does the eye see: thus of not reducing vital persons to animated corpses. In spite of such efforts to counter the tendency to reduce human experience to body parts we should ponder on the fact that 60 years later a growing and influential group of psychotherapists of all persuasions is embracing neuroscience as the legitimising substratum of their practice. Heaton's emphasis on the aporetic aspects of language lead me to further consider that in the space of 20 or 30 years exploratory psychotherapy has all but disappeared from the National Health Service (NHS) in the UK. It has been replaced by a truly grotesque charade of 'psychological interventions' where if you are not trying to gain solace from a computer screen, you are anxiously completing your checklists to demonstrate that the six sessions you have been allocated have been wisely used! It would be wrong to suggest that such procedures never help but it would be a mistake not to see a deeply anti-human streak at work amongst the appeals to 'the evidence' and 'the science' that animate such interventions as they ablate the complexities of human suffering.

This tendency for contemporary psychotherapists to eradicate complexity in the way they conduct their business is also to be found in the burgeoning practice of Mindfulness. What originated as an integral part of that great system of liberatory thought, Buddhism, is increasingly taught as merely a technique to achieve a particular end. Yet even a cursory knowledge of the meditation practice of Shikantaza found in Soto Zen, for instance, shows the importance (and paradox) of sitting with no aim. Such an 'aimless aim' is not the way to the thought that will liberate but a disinterested attention to thoughts as they come and go is the Way. Incidentally the Tao of Zen is a good reminder of what is involved in becoming a psychotherapist – a connection noted, amongst others, by Alan Watts (1971): it profoundly undermines the contemporary tendency to regard the practice of psychotherapy as a technique that can be acquired and dispensed stripped of all commitment except in a bureaucratic and operational sense. However whilst such brevity is routinely scorned by those favouring the traditional psychoanalytic landscape, both sides ablate the aporia by treating language as if it were solely representational. In this sense the depression you suffer from as evinced by the Hamilton Rating Scale when you consult your CBT therapist, is identical to the repressed hostility you harbour towards your father in your unconscious as revealed on your psychoanalyst's couch. Another way of approaching this gaping chasm is that language can neither be dispensed with nor relied upon, captured perhaps by Wittgenstein's remark: – 'For the place to which I really have to go is one that I must actually be at already' (Wittgenstein, 1998: p 10).

It would be a profound misreading of Heaton to understand that he is setting out a method of how psychotherapists might achieve such a goal: he aligns himself with a sceptical tradition that stretches from Pyrrho to Montaigne to Wittgenstein. These varied writings at their best might be thought of as reminders and exemplars of what is at issue in the 'aimless aim' of 'finding a way out of the fly-bottle'. This is why Heaton's book is so important and in a sense such a rare occurrence in the psychotherapy world. The importance lies not in persuading therapists to adopt a particular set of ideas as being liberatory in themselves, but of realising that any set of ideas too closely held can blind one to that 'place I am already at'. This takes time and an attitude towards teaching that resists the idea that this involves the inculcation of a set of beliefs, which remain unchallenged. Arguably the best example of this amongst the many psychotherapy training organisations remains the Philadelphia Association (founded by R.D. Laing) and with which Heaton has had a long association, helping to retain conceptual enquiry at the heart of learning to be a psychotherapist.

Much of the difficulty in understanding Heaton's book is to remember how to read it bearing the foregoing remarks in mind. Thus so with Wittgenstein: if all the 'propositions are senseless' then clearly no instructions about how to read this book can be unequivocally spelled out. Perhaps hints can be given in the form of allusions, ironic phrases, conundrums and puzzles but it still takes someone to understand the place of such tropes in language. Maybe having 'similar thoughts' is crucial here but how similar? If the content can't be relied upon to have a determinate or persuasive effect on the reader then familiarity with the 'scene' being written about – here the 'language game' of psychotherapy – probably makes all the difference. So whilst any particular book has to be part of, or to emanate from a way of life to at least stand some chance of being understood, so too the reader must have some familiarity with this scene as well. Over the last 40 years or so Heaton has been working and re-working the same themes in previous books, papers and talks. He has not formed a school around him (but he has plenty of fellow travellers) and he has kept open a much-needed conceptual space as an exemplar for other psychotherapists. This space, however, is not one that is simply created by using the correct language but one that can only be created through an appreciation of the aporetic qualities which language brings to life. Heaton demonstrates this through his writing(s), and for those psychotherapists with 'similar thoughts' and willing to forego any premature conclusion about what psychotherapy is, they might discover this book to be the most important one that they come across in their professional life.

References

Gellner, E. (1985). The Psychoanalytic Movement: Or The Coming Of Unreason. London: Palladin.

Heaton, J. M.(2010). The Talking Cure: Wittgenstein's Therapeutic Method For Psychotherapy. Basingstoke: Palgrave Macmillan.

Heaton, J. M.(2014). Wittgenstein and Psychotherapy: From Paradox to Wonder. Basingstoke: Palgrave Macmillan.

Michael Miller