Sense and Meaning in Psychotherapy
In his Tractatus Logico-Philosophicus Ludwig Wittgenstein gives us quite a bit to think about when it comes to stoves. At least that’s how Maria Balaska sees it in her paper, “Seeing the Stove as World: Significance in Early Wittgenstein”. The paper is an interesting examination of the way words like “sense”, “meaning”, “significance”, and “value” show up in this classic text. Given Balaska’s status as someone who work diligently at the point of overlap between therapy and philosophy, and often finds interesting ways of bridging that gap, works like these certainly seem worthy of consideration as pertains to their use (another interesting word for Wittgenstein) in the work of therapy.
In the context of psychotherapy, Wittgenstein’s philosophical positions may seem an odd bed fellow. I at times have certainly had trouble figuring out how to place him. Though one of the most influential philosophers of the last century, and someone who drew his own influence from the entire corpus of the history of philosophical thought, his work often seems at times too firmly entrenched in the world of logic and language to find its way into the rich emotional and experiential spaces we sometimes find with some of the philosophers whose ideas feel more easily pulled into psychotherapeutic practice (by which I mean primarily those in the Continental tradition). But for many, including myself, Wittgenstein’s philosophy often seems to dance right on the cusp of moving into Continental spaces, being not about language in terms of truth-value and validity, but more so about how can or does language say what it means and what that in turn means about what it is like to exist (to be) in a world with language (and other symbols/objects which contain or convey meaning).
In thinking about these relationships, I want to proffer two relevant considerations for psychotherapy that Wittgenstein’s thoughts about language may be helpful in better understanding the philosophical underpinnings of the discipline: 1.) the structures of meaning relevant to the clients we work with and 2.) the prickly problem of diagnosis.
To the former, let’s return to Wittgenstein’s stove. In discussing language and symbols, Wittgenstein is pretty clear in the fact that things only take on meaning in the context of the world in which they are used. In his words “as a thing among things, each thing is equally insignificant; as world, each one equally significant”. This to me seems comprehensible in the same vein as Heidegger’s idea of being-in-the-world, in which all things in the world are that which make up the world (Wittgenstein and Heidegger’s points of similarity and divergence is a fascinating topic and one which I may take up in a later post). For Wittgenstein, it is the relationship between symbols that grants significance, meaning that nothing can have significance in and of itself.
Balaska draws an interesting parallel here to the world of mindfulness meditation, noting that the kind of practices that demand a singular focus on a particular object, a kind of mindful attention, contributes nothing to the significance of an object (separate perhaps from the fact that within its relational symbolic context it could be an object of contemplation). Objects only have relevance in as much as how we use them, with “use” not simply pertaining to the idea of physically engaging with an object, but how we think about or render it in the context of other logical propositions. Balaska does not get into this, but this seems to me to suggest the kind of hermeneutic relationship I am fond of and so often seems representative of some kind of truth about our existence. In this case, the relationship is one in which the world gives us meanings for things based on how it chooses to interact with us, but that we then interact back on to the world impacting in our own way the meanings of things, which in turn impacts the kind of symbolic messaging we (and others) get back on what a proposition/object/symbol/piece of language might mean, and so on and so forth. Each interaction carrying forth some kind of semantic influence in either direction that is constantly reconstituting and reconstituted (I could see Heidegger saying “reconstitutive” here).
I think we can see how this kind of structural understanding of meaning could be relevant for the clients we work with. Everything that comes through the field of perception carries meaning for us. The world is, if nothing else, meaningful. What is relevant for Wittgenstein, is that this meaningfulness is not innate or determinate, but is part of the complex web of interactional meanings in which it falls. If things in themselves are valueless as individual objects, that offers us a very compelling space to move into when we are recontextualizing the propositional integrity of the world and our relationship/response to it. Therapy can offer us as space to interrogate the meanings of the individual properties that populate our existence. I will quote a passage here from Balaska where she talks about some of the ways we might want to understand the relational meaning constitutive of the stove:
“A thing can become significant insofar as it carries with it this referential whole, in virtue of which anything has meaning: any contemplation of a thing as significant cannot but lead us to other things, an environment in which they exist, a human practice, yet another human practice, etc. For example, as already mentioned, the stove is related to the environment of a kitchen, and to the practice of cooking. But the practice of cooking refers not only to the practice of eating but also to that of gathering and nourishing others, and perhaps to a manifestation of love. In this sense, a stove could also be regarded as constitutive of what we call a home. Grasping the stove as world might include grasping the loving aspects that the activity of cooking has come to have. In doing so, in recovering these contexts of human activity we open possibilities of meaning, and engage in an imaginative and attentive activity of understanding (active contemplation rather than intuition) that makes the stove significant.”
We see here the kind of complexity that meaning can take on. We are talking about something richer than merely language and symbolic logic. Or at least what these things might merely be is shot through with sophistication and complexity. When we talk of a stove, we are not simply talking of the material nature of the object, we are talking about the ways in which it gets taken up into an entire web of social, cultural, and emotional propositions as well. Wittgenstein is certainly in some ways most interest in mind as a cognitive apparatus, but I often think his writing betrays a more nuanced understanding of what a mind is then that. For him, emotions, cultural context, the social dimension of existence are not incidental to the linguistic and cognitive operations of the individual mind, they are central to the ways in which that mind gets constituted and are reciprocally constituted by what that mind does with and to them. These things are all part of how the mind emerges.
If this is all true, then part of what we must help our clients to see are these interactional patterns and how they influence our interactions with this world of signification and value. This is one way we could critically work with, from, and out of the cognitive dimensions of existence in a way that wouldn’t seem thin or overly reductive. This way of thinking isn’t about cognitive distortions, it isn’t even quite about something like the “schemas” of Schema Therapy (which I mostly like much more than run of the mill CBT). It is about a relational ontological basis for what it means to be a human being; recognizing that with a perception that honors those relational structures, we are then provided the opportunity to move into those spaces where relationship emerges to reconfigure and reconstitute some of what we understand those relationships to be.
Which brings me, briefly, to the realm of diagnosis. I have long had a problem with the diagnostic conditions of psychotherapeutic practice (which is in part why I find myself entertaining the move away from managed care and insurance). Diagnostic practice in psychotherapy is fundamentally unlike diagnostic practice in any other “medicalized” profession. Though there are folks who will try to convince you otherwise, I have yet to see or experience much evidence of the idea that we can come to an accurate understanding of what may be going on for someone by charting a particular constellation of reported behavioral observations, strapping some labels on that, and manualizing a treatment protocol around it. The DSM, as currently constituted, does a terribly insufficient job for creating a basis of understanding dimensions of human existence related to the social, relational and emotionally complex conditions of what it means to be human, or even more simply, to be. To assume that a reductive set of quasi-measurable behavioral conditions are all that is needed to understand the sophisticated underlying structural problems that may be at play, to say nothing of the idea that symptom reduction should be the only goal of therapy, misses this fundamental quality of meaning-making and what Spinelli calls the “worlding” quality of what it means to be human.
Balaska at one point quotes Wittgenstein as having written, “Everyday language is a part of the human organism and is no less complicated than it. It is not humanly possible to gather immediately from it what the logic of language is. Language disguises thought.” I get why we try to do it and why it is believed we should be able to diagnose consistently across entire patient populations and all the arguments for this kind of process. But psychotherapy is different even from the field of academic and scientific psychology, never mind endocrinology, or oncology, or nephrology, etc. The kind of problems we try to address are not just embedded within this linguistic web we are talking about. They fully emerge from it. No other set of problems for which people seek “treatment” are as inextricably bound up in this mobius strip of meaning-making, experience, and a reliance on the subjective functions of both of these. The enchantment of operationalizing “disorders” and developing “evidence-based treatments” is, I think, rooted solely in the hope of their ability to assuage the anxieties of the practitioners who otherwise would have to do the more difficult work of entering into this symbolic web that is plaguing the suffering other and figuring out how to wander out with them. To me, it’s the difference between Orpheus journeying into the underworld versus throwing a rope down into a pit, pulling someone halfway up, saying “isn’t that better?”, and abandoning them to be convinced this is as good as it can get.
Of course this is a strange and unscientific way to think of the process of doing therapy, but even Wittgenstein, the seminal philosopher of an analytic philosophical movement that was all about concerns related to truth-values and finding some empirical basis for the uses of language, one that was overwhelmed by mathematicians and logicians, could be strange and unscientific. We are strange and unscientific. In our work we talk about things like love, desire, hope, dread, despair, angst, wonder, and awe. We must talk about these things in order to understand our clients, which in turn will hopefully help them to better understand themselves. We must help them begin to be curious about and (likely) interrogate the referential meaning-systems within which they dwell. Our processes and the techniques/principles of practice we adhere to should honor and reflect that.
