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Why all this stuff and not some other stuff?


The choice of Hercules: Virtue versus Vice.


Why all this stuff and not some other stuff?

So, what makes us choose between one phenomenon and another? Are we preprogramed or do we make choices as the need arises? If choice does not exist, then how do we justify psychotherapy which views clients as change agents who can explore past choices and their consequences and make new even healthier choices? Why all this stuff and not some other stuff?

Renton, the main character in the film Trainspotting spoke of how he chose heroin over other choices in his life:


“People think It’s all about misery and desperation and death and all that shite, which is not to be ignored, but what they forget – is the pleasure of it. Otherwise, we wouldn’t do it. After all. We’re not stupid. At least, we’re not that stupid. When you’re on junk you have only one worry: scoring. When you’re off it you have to worry about all sorts of shite. Got no money: can’t get pished. Got money: drinking too much. Can’t get a bird: no chance of a ride. Got a bird: to much hassle. You have to worry about bills, about food, about some football team that never wins, about human relationships and all the things that really don’t matter”.


“But did he choose rationally?” (Allingham, 2002). Renton speaks candidly about his choice. It may be a choice taken by few. However, he expresses his logic and reasoning behind his choice. He looks at the alternatives to his choice but decides there is too many consequences. The psychotherapeutic process could explore such a choice. However, could be criticised by Postmodernists for enforcing what psychotherapy thinks is best and that may involve not choosing Heroin. Nonetheless, Renton provides plenty to explore if he were to attend for psychotherapy. We may conclude that he is in a pre-contemplative stage of change. It may also be said that Renton would not present to psychotherapy until his life choices become consequential or problematic for him. He may attribute choice to a disease of addiction which is out of his control. We as therapists may inadvertently support this by facilitating his journey through methadone treatment. Such views would not be uncommon in the therapy room. If we and Renton believed that there is no choice but are preprogramed, which some hard deterministic philosophers argued to be true, there would then be no room for providing or receiving psychotherapy. Let’s look at some theory.


Debates on Choice.

When we look at choice, a myriad of philosophical debates arises, mainly that of Free Will and Determinism, Consequentialism, Foucault’s Power theory and Post Modernism. Most of which I have addressed in Renton’s case. Herein lies the link between philosophical and psychotherapeutic reflection.


Choice Theory

Aristotle (384 – 322 BCE) is said to be the founder of choice theory (Allingham, 2002). He concluded that choice, logic, and reasoning are all linked and occur to achieve a particular goal. Spiritually, Sri Aurobindo (1872 – 1950) conceded that we have a soul that travels from body to body during reincarnation. We may experience the consequence of a past life’s choices in the next life, the notion of ‘Karma’. Jean Paul Satre, (1905 – 1980) an existentialist, concluded that what matters is what we make of our environments. We make meaning within what we choose, engage with, and intend.


Free Will versus Determinism

Probably most complimentary to psychotherapy is Walter T. Stace’s (1886 – 1967) theory of compatibility between Free Will and Determinism. He posed that “acts are freely done are those whose immediate causes are psychological states in the agent. Acts not freely done are those whose immediate causes are states of affairs external to the agent” (Christensen, 2002). This is basically saying some acts are within one’s control and some are outside one’s control. The latter being that of Determinism and the former Free Will. It is noteworthy that the term action comes into play here. Soft Determinism allows for compatibilists, of which is not the case in hard determinist thinking. Hard determinists argue that everything is determined and a sense that we could act differently is a delusion.


Consequentialism

I have mentioned consequences several times and the theory are termed Consequentialism. Meaning that right or wrong actions are judged so based on their consequences. Furthermore, psychotherapists address consequentialism in hindsight. That is, we look at the precursors, from a behavioural perspective we may look at the antecedents and behaviour that led to the consequence or we may address it from a purely cognitive standpoint and look at the activating event and related belief that led to the consequence. B. F. Skinner (1904 – 1990) argued against internal forces of cognitivism opting for a more consequentialist and scientific view that choices are determined by causal factors which are only to be observed as opposed to unobservable internal forces.

Power and Post modernism

Post-modernist and philosopher Foucault spoke about Biopower which views the body as something to be managed in relation to strategies of economic and social management of populations. In his view power of an individual or institution is the ability to achieve something, whether by right, control or influence. He posed that where there is power, there is also resistance to that power. Furthermore, post modernism holds a general distrust of theories, narratives and ideologies that attempt to put all knowledge into a single framework, for example the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and International Statistical Classification of Diseases and Related Health Problems (ICD-11), categorization systems used by psychiatry.


So, why all this stuff and not some other stuff?

Why am I a forensic psychotherapist working with mentally ill offenders and not something else? Why do I do what I do? Is it of benefit? One answer is that I believe in free will and choice. I believe that people are change agents. Is philosophy relevant in your practice? It is in mine? I can see here how philosophical questions can be raised in every aspect of therapy, no matter how extreme the idea.


Andrea Nulty is a Forensic Psychotherapist specializing in Forensic Mental Health and is a candidate on the Doctorate in Psychotherapy programme with DCU.


References

Allingham, M. (2002). Choice Theory. Oxford. University Press.

Buckingham, W., Burnham, D., Hill, C., King, P. J., Marenbon, J., & Weeks, M. (Eds.). (2011). The Philosophy Book. London. DK.

Blackburn, S. (1994). The Oxford Dictionary of Philosophy. Oxford. Oxford University Press.

Christensen, K. R. (Ed.). (2002). Philosophy and Choice. London. Mc Graw Hill.

Dupre, B. (Ed.). 50 Ideas You Really Need to Know Philosophy. Quercus.

Howard, A. (2000). Philosophy for Counselling & Psychotherapy. Hampshire. Palgrave.

Meynen, G. (2010). Free will and mental disorder: Exploring the relationship. Theory Med Bioeth. 31, 429 – 443. DOI 10.1007/s11017-010-9158-5

Pernu, T. (2017). The Five Marks of the Mental. Frontiers in Psychology. 8, 1 – 19.

Pierre, J. M. (2014). The neuroscience of free will: implications for psychiatry. Psychological Medicine. 44, 2465 - 2474. DOI: 10.1017/S0033291713002985.

Pies, R. (2007). Hume’s Fork and Psychiatry’s Explanations: Determinism and the Dimensions of Freedom. Psychiatric Times. 24, 1 – 5.

Royce, J. R. (1982). Philosophic Issues, Division 24, and the Future. American Psychologist. 37, 258 – 266.

Weisman De Mamani, A., Gurak, K., Maura, J., Martinez De Andino, A., Weintraub, M. J., & Mejia, M. (2016). Free will perceptions and psychiatric symptoms in patients diagnosed with schizophrenia. Journal of Psychiatric and Mental health Nursing. 23, 156 – 162.

Zucher, T., Elger, B., & Trachsel, M. (2019). The notion of free will and its ethical relevance for decision-making capacity. BMC Medical Ethics. 20, 3 – 10.



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