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LEVINAS, PSYCHOTHERAPY, AND
THE ETHICS OF SUFFERING
EDWIN E. GANTT is an assistant professor ofpsychology at Brigham Young University inProvo, Utah. He received his doctorate in psychol-ogy at Duquesne University in 1998. He is the au-thor of several articles on Levinas and psychol-ogy, including “Truth, Freedom, and Responsibil-ity in the Dialogues of Psychotherapy,” “SocialCon- structionism and the Ethics of Hedonism,”and “Intimacy and Heteronomy: On GroundingPsychology in the Ethical” (with Richard N. Wil-liams). He is at present completing work (with
Richard N. Williams) on a collection of essays on the contributions ofLevinasian thought to psychology and psychotherapy.
This article argues that by adopting a medical approach to the con-ceptualization, diagnosis, and treatment of emotional and psycho-logical distress, contemporary psychotherapy has robbed itself ofthe possibility of genuinely understanding the radically ethicalnature and significance of human suffering. This article discussesboth some of the original sources and assumptions that provided theimpetus for the adoption of the medical model in psychotherapy andalso some contemporary restatements of these original positions. Inopposition to both the dualism and reductionism inherent in medi-cal approaches to psychotherapy, this article aims at providing amore hermeneutic-phenomenological understanding of human suf-fering, particularly as detailed in the work of the French philoso-pher Emmanuel Levinas. Such an alternative approach will seek toexplicate the radically ethical nature of human suffering by recog-nizing therapists’ fundamental responsibility to “suffer-with” and“suffer- for” their clients.
Despite tremendous theoretical diversity among the variousschools of psychotherapy, the various psychotherapeutic theoriesand practices are united by the foundational desire to alleviate
Journal of Humanistic Psychology
, Vol. 40 No. 3, Summer 2000
human suffering and pain. Although clearly allied with medicinein this way, the psychotherapeutic enterprise has traditionallybeen concerned with those forms of suffering presumed to liebeyond the scope of a solely medical—that is to say, biophysi-cal—technology or knowledge. Thus, psychotherapy has sought toaddress the emotional, psychological, experiential, and moraldimensions of human suffering more than physical incapacity orpain. Indeed, as Adrian Moulyn (1982) has pointed out, it is con-ceptually vital that the therapist “separate pain in the bodily senseand of a physical nature from the pain of suffering” (p. 191). It isthis later pain, this pain of suffering that “is the core of the humancondition in a world of imperfections, contrasts, conflicts, dichoto-mies, and fractures,” (Moulyn, 1982, p. 222) and to which psycho-therapists must be most attentive.
Oddly, however, a careful and detailed psychological study of
human suffering has only begun to take place within recentdecades. In striking contrast to the lengthy and extensive historyof philosophical and theological inquiry into the nature and pur-pose of suffering—an inquiry that stretches over centuries, if notmillennia—the more strictly psychological discussion of thesources and meaning of suffering seems to stretch back onlythrough the past three decades, and even then typically only fromwell outside the psychotherapeutic mainstream (e.g., Bakan,1968; Copp, 1974; Duffy, 1992; Gilbert, 1989; Moulyn, 1982; Siu,1988; van den Berg, 1972; Yalom, 1980).
Indeed, it was only in the early 1960s that the Viennese psychia-
trist Viktor Frankl first began to broach the question of human suf-fering in a psychological manner with his landmark work Man’sSearch for Meaning
(1963). Frankl detailed both his own andothers’ experiences of finding meaning in their suffering whilebeing held captive in the Nazi extermination camps of the SecondWorld War. As a survivor of both Aushwitz and Dachau, Franklcame to view suffering as a unique and inevitable human experi-ence: inevitable, in that all of us must at one time or another expe-rience suffering; and unique, in that each individual will alwayssuffer in his or her own way. Frankl (1961) maintained that in suf-fering the individual is provided the opportunity to realize his orher essential freedom to choose the meaning of that suffering, aswell as the meaning of his or her life. Thus, Frankl (1986) can saythat “human life can be fulfilled not only in creating and enjoying,but also in suffering
” (p. 106). This is possible, he argues, because
as human beings we possess a fundamental will-to-meaning thatcompels us to seek out the subjective meaning of our lives regard-less of the particular circumstances in which we might happen tofind ourselves.
American existentialists such as Rollo May (1950, 1969) and
Irvin Yalom (1980) have contributed their voices to this dialogueby drawing not only on the work of Frankl but also the philosophi-cal writings of Kierkegaard, Heidegger, Buber, Sartre, and Tillich.
For May and Yalom, acknowledging that there exists a “deep anxi-ety inherent in the tragic possibilities of living” (Reeves, 1977, p.
193) is of paramount importance if one is to become centered andfind the power to choose for oneself one’s values and meanings (vanDeurzen-Smith, 1997). Suffering as a form of powerlessness, aninability to experience oneself as responsible, is intolerable; “Forno human being can stand the perpetually numbing experience ofhis own powerlessness” (May, 1969, p. 14). According to Yalom(1980), engagement in life, a willful and autonomously chosen“leap into commitment and action” is the only real cure availablefor one’s own suffering, the only way in which authentic meaningcan be generated in the face of the powerlessness of suffering. Themeaning of human suffering is found, then, in the willful act of theautonomous subject resolutely choosing to forge meaning andvalue in the midst of anguish and powerless passivity.
More recently, Cassell (1991, 1992) has attempted to provide an
outline of the various physical, psychological, and spiritual dimen-sions of human suffering. A key point in Cassell’s work is that suf-fering should not be understood as simply the equivalent of pain,particularly when pain is conceived of in solely physiological ormedical terms. Rather, the sources of human suffering are to befound in the challenges that threaten the individual’s “intactness”as a complex and unified psychosocial being. Despite some minordifferences in emphasis, Cassell’s work shares much in commonwith that of Frankl, May, and Yalom. Like each of those authors,Cassell seeks to articulate a conceptual framework within which tonot only make sense of the experience of suffering as a phenome-non of the person (rather than just the body) but also to grasp thenature of suffering at the level of its individual meaning.
In a slightly different context, and serving a slightly different
theoretical purpose, Cassell (1982) has also argued that medicine’sadoption of Cartesian mind-body dualism in the 17th century ledto the problematic presumption that questions concerning the
nature of suffering did not belong within the purview of medicalscience. For, it was held, if suffering involves the whole humanbeing and medicine’s focus is solely the physical body, then ques-tions concerning the nature of suffering are by definition beyondthe realm of a strictly medical inquiry. However, refuting in partthe seductions of a simplistic Cartesian dualism, Cassell hasargued that suffering is experienced by the whole person, notmerely by physical bodies or insubstantial minds or souls, andthus suffering, inseparably connected as it is to both body andmind, is most assuredly within the professional and scholarlyrealm of medical and therapeutic—rather than simply religious orphilosophical—inquiry.
Given this brief background, it is possible to see that because of
the dualistic assumptions adopted by medical science, psychology—in particular, psychotherapy—came to be seen as the appropriatescientific arena within which to address the human experience ofsuffering (Bakan, 1968; Moulyn, 1982). Unfortunately, however,most traditional formulations of the psychotherapeutic enterprisehave been somewhat uncritical and contradictory in their concep-tualizations of just exactly what human suffering is, what itmeans, or how it ought to be treated. Due to an inadequate explica-tion of the nature and meaning of human existence, and the natureand ethical significance of suffering in that existence, psychother-apy has ironically adopted the very methods and diagnostic tech-nologies of medical science that were initially presumed inade-quate to the task of healing emotional and psychological distress.
This article intends to show that by adopting the technical and
methodological trappings of the medical model in its attempts totreat emotional, psychological, and moral problems, psycho-therapy has robbed itself of the possibility for genuinely under-standing the ethical significance of human suffering. In contrast tothe technological presumption of traditional medical-model psy-chotherapy, this article aims at providing a more hermeneutic-phenomenological understanding of human suffering, particularlyas detailed in the work of the French philosopher EmmanuelLevinas. Such an approach seeks to understand the radically ethi-cal character of human suffering by recognizing the fundamentalresponsibility of the therapist to suffer-with and suffer-for theclient.
KRAEPELIN, FREUD, AND THEEMERGENCE OF THE MEDICALMODEL IN PSYCHOTHERAPY
It was largely, although not exclusively, through the pioneering
efforts of psychiatrists such as Emil Kraepelin, Eugen Bleuler,Karl Kahlbaum, Adolf Meyer, and Sigmund Freud that theso-called “medical model” came to be accepted as fundamental tothe theory and practice of psychotherapy (Bankart, 1997; Shorter,1997). Kraepelin systematized and delineated nosological entitiesin the field of psychopathology in much the same way that entitieswere delineated in the field of general medicine. Thus, for example,dementia praecox
, a term popularized by Kraepelin (1893/1921)but later renamed schizophrenia
by his student Bleuler (1911/1950), was seen as an illness in very much the same manner that adisorder such as cancer or pneumonia was seen to be an illness inmedicine. Kraepelin’s diagnostic structure maintained that therewere several individually discernible psychiatric diseases, or ill-nesses, each distinct from the others. Thus, depression, schizo-phrenia, mania, and the like were different from each other just aspneumonia, rheumatism, and cholera were different from eachother. In short, mental illnesses were just that: diseases of themind (i.e., brain) or nervous system or other bodily organ or sys-tem. Although Kraepelin no doubt recognized the conceptual diffi-culties inherent in applying the disease model to mental events, itwas nonetheless his firmly held conviction that dementia praecox,for example, was the result of a metabolic irregularity, and thatother forms of mental illness, although perhaps less severe anddisturbing, also had their origins in similar physiological dysfunc-tion. For example, in the fifth edition of his famous Psychiatrie: EinLehrbuch für Studirende und Aerzte
(1896), he placed DementiaPraecox right next to Thyroid Psychosis and Neurosyphilis.
In such a view, then, mental illness as illness possessed, as such,
a definite etiology and pathogenic outcome. Indeed, according toShorter (1997), in the psychiatric community, being a “Kraepe-linian” came to mean that “one operated within a ‘medical model’rather than a ‘biopsychosocial’ model . . . . A medically oriented psy-chiatrist believed in approaching psychiatric illness just as a cardi-ologist would approach heart disease . . . ” (p. 108).
Although clearly not as “biologically disposed” in his explana-
tions as his colleague Kraepelin, Freud’s (1957) psychological
model of explanation nonetheless drew heavily on medical modelassumptions of illness. For, in Freud’s theory of neurosis—whatsome have termed a “compromise model of mental illness”(Rychlak, 1981, p. 83)—the sufferings of the neurotic are under-stood as merely the symptomatic expression of an underlyingintrapsychic conflict taking place in the unconscious mindbetween id, ego, superego, and external reality (Freud, 1961a). AsFreud remarks in The Interpretation of Dreams
(1965), “Neuroticsymptoms show that the two systems [the preconscious and theunconscious] are in conflict with each other; they [the symptoms]are the products of a compromise which brings the conflict to anend for the time being” (p. 620).
Like Kraepelin and Bleuler, Freud believed that a given
psychopathology had its own specifiable etiology and essentiallypredictable developmental course and outcome. This can mostclearly be seen when Freud writes to his friend and confidant Wil-helm Fleiss that
The course taken by the illness in neuroses of repression is in gen-eral always the same: (1) The sexual experience (or series of experi-ences) which is traumatic and premature and is to be repressed. (2)Its repression on some later occasion which arouses a memory of it;at the same time the formation of a primary symptom. (3) A stage ofsuccessful defence, which is equivalent to health except for the exis-tence of the primary symptom. (4) The stage in which the repressedideas return, and in which, during the struggle between them andthe ego, new symptoms are formed which are those of the illnessproper. (Freud, 1989, p. 91)
Ultimately, for Freud (1961b), the genuine source of mental illnessis “always present somewhere or other behind every symptom
” (p. 99,italics added).
Despite a fair amount of progress having been made in the field,
such early views find a continuing restatement in the discussionsof psychopathology and its treatment that are taking place in ourown day (e.g., Bergin & Garfield, 1994; Goodwin & Guze, 1989;Roth & Fonagy, 1996; Williams, 1992). For example, Maxmen andWard (1995) discuss two different, but readily compatible, diag-nostic approaches employed in contemporary psychology and psy-chiatry, which they term the descriptive
and the psychological
Maxmen and Ward explain that the descriptive approach topsychopathology is “based on relatively objective phenomena thatrequire nominal clinical inference; these phenomena include
signs, symptoms, and natural history” (p. 8). The psychologicalapproach, on the other hand, is “based primarily on inferred causesand mechanisms . . . [and] considers descriptive phenomena, butmerely as superficial manifestations of more profound underlyingforces” (p. 8). In harmony with Maxmen and Ward, the AmericanPsychiatric Association makes this statement in The Diagnosticand Statistical Manual of Mental Disorders
(1994): “Whatever its[the particular mental disorder] original cause, it must currentlybe considered a manifestation
of a behavioral, psychological, or bio-logical dysfunction in
the individual” (p. xxii, italics added).
Thus, it seems clear that with its adoption of the medical model,
and the concomitant dualism and reductionism1 inherent in thatmodel, psychology has been led into a position that (a) equates suf-fering with pain; (b) presumes such suffering to be merely symp-tomatic of a deeper, underlying disorder (i.e., the person’s sufferingis simply the effect of some other, more significant, cause); and thus(c) interprets the phenomenon of suffering as essentially meaning-less in itself, or at least meaningful only insofar as it serves to pointtoward something more significant that exists behind or beneaththe suffering (Gantt, 1995). Unfortunately, this type of theoreticalgrounding has provided psychotherapy with a professional workfocus that is frequently at odds with itself. On one hand, psycho-therapy is about helping clients understand and appropriate theirsuffering so as to emerge with new and authentic possibilities ofhuman being (Patterson, 1966). But, on the other hand, the phe-nomenal content of the suffering is reduced to the status of meresymptom or sign and, as such, is of little more than diagnostic rele-vance to the therapy. This leads directly to that state of affairsdescribed by Goldberg (1986) where, although expected to be con-cerned with human suffering as part of their daily endeavors, clini-cians end up doing little to actually address the real suffering oftheir clients.
How, then, is psychology to deal with this difficult and perplex-
ing paradox? How is psychotherapy to approach the phenomenonof human suffering such that its meaning is both retained andrespected? How will it be possible to articulate that meaning insuch a way that the fundamentally social and moral dimensions of
human suffering are brought into sharpest focus? What, if any,theoretical and philosophical perspectives are there available to usas psychotherapists that will permit a more adequate and appre-ciative understanding of this dominant feature in human exis-tence? I will argue that only by looking outside the dualistic andreductive traditions of mainstream psychological and psychothera-peutic theory can we discover an approach to these vexing questionsthat will yield genuinely fruitful and satisfying results. I will furthersuggest that the hermeneutic-phenomenological tradition in contem-porary Continental philosophy offers a more fruitful means of inquiryinto the meaning and nature of human suffering.
As articulated in the writings of such seminal thinkers as Mar-
tin Heidegger (1927/1962), Maurice Merleau-Ponty (1962/1989),Hans-Georg Gadamer (1976, 1960/1994), Paul Ricoeur (1981a,1981b), and Emmanuel Levinas (1969, 1991), hermeneutic-phenomenology2 has been advanced as the method of faithful des-cription of “meaningful human phenomena in a careful and detailedmanner as free as possible from prior theoretical assumptions”(Packer, 1985, pp. 1081-1082). Originating in the work of Husserl(1913/1982), phenomenology was conceptualized as a scrupulousinspection of the intentional acts of consciousness and its objects soas to arrive at a genuinely empirical understanding of the mean-ings and essences assumed to transcend all human thought.
Husserl believed, as indicated in his famous dictum “back to thethings themselves” (Zurück zu den Sachen
), that we should allowthe phenomenon under investigation to speak for itself withoutimposing on it our own arbitrary and limiting preconceptions. Inother words, if we are trying to make sense of the experience of atable, then we must set aside or, to use Husserl’s terminology,“bracket” the various assumptions and preconceptions we mighthave concerning the nature of the table so as to more adequatelyattend to how it is in fact given to us in our direct experiencing of it(Husserl, 1913/1982).
However, in the hands of Heidegger and his students (most
notably Gadamer and Ricoeur), a hermeneutic or “interpretive”dimension has been incorporated into the phenomenological pro-ject. Originally devised as a method, or set of techniques, for inter-preting the hidden meanings and divine messages contained inbiblical texts, hermeneutics was appropriated by Heidegger andhis followers for the study of the meaning of human action andexperience as it shows itself in its “textual and narrative struc-
turedness” (Ricoeur, 1981a). The hermeneutic method is particu-larly sensitive to the inherently historical and socioculturalsituatedness of all human existence. Thus, it regards the acts ofexplanation and understanding as primordial acts of renderingsensible and meaningful accounts of current historically situatedand contextualized concerns and problems, rather than attemptsto uncover the atemporal or ahistorical laws and structures under-lying and determining reality. In this way, the hermeneuticapproach seeks to provide a progressive disclosure of our under-standing of that which we are studying, all the while recognizingthat such a project can never be fully completed. For, given the factthat human existence is by its very nature radically temporal andhistorical, any attempts to render an account of that existence nec-essarily inform and alter it and thus create the need for furtherexplication. Such is the essence of the so-called “hermeneuticcircle.”
Dedicated as it is to a faithful description and continuing inter-
pretation of human phenomena, hermeneutic-phenomenologycalls us to more careful consideration of the lived and experientialnature of suffering. As a method of inquiry into human experience,it provides both a means and a justification for undertaking thismore careful consideration. Hermeneutic-phenomenology seeks toremind us of the primordial call to response, the cry for aid, and theplea for meaning that so completely characterizes human misery.
It encourages us as psychotherapists to recover the meaning thatlies at the very heart and soul of our profession: the fundamentaldesire to alleviate the suffering of others. In so doing, however, itwould dissuade us from over hastily reducing the lived reality andmeaning of suffering in some misguided attempt to “cure” it byexplaining it away as just a symptom or diagnostic signpost. Her-meneutic-phenomenology solicits us to see that there is no myste-rious and ultimately unknowable realm of causal entities lyinghidden behind, or more real than, the phenomenal immediacy ofhuman anguish.3 In short, hermeneutic-phenomenology teachesus that the suffering is
the symptom and the symptom is
In addition, a hermeneutic-phenomenological approach seeks to
continually remind us that suffering and the meaning of sufferingare never private, individual matters. Suffering always impliesand is always experienced by more than one person, by more thanthe individual subject. Suffering is fundamentally a social and
moral phenomenon and, as such, involves not only the one who ismost directly suffering but also the one called on to respond to thatsuffering, to answer in some way for it, to care. Thus, the meaningof suffering is, from within a hermeneutic-phenomenologicalframework, never solely the property of the autonomous and freelywilling individual resolutely forging meaning, but rather it is thenegotiated and socially constructed product of our human(inter)relatedness and responsibility to and for one another.
It is in light of this necessity to heed the call to responsibility in
the face of suffering that, I believe, the potential contributions ofthe French phenomenologist Emmanuel Levinas can most clearlybe seen. Although long recognized and well established in Euro-pean philosophical circles, only recently has the work of Levinascarved out for itself a well-deserved place in the philosophical dis-cussions of the Anglo-American world. In such seminal works asTotality and Infinity
(1969), Time and the Other
(1987), and Other-wise Than Being or Beyond Essence
(1991), Levinas confronts thequestions of otherness (alterity), the Other, and the nature of good-ness.4 His work offers itself as an unrelenting challenge to thosephilosophies and therapies that seek to “totalize” (i.e., reduce) oth-erness (the not me) into sameness (the for me) by apportioning dif-ference into pre-established characteristics, properties, andcategories.
Quite obviously, the problem of the other person is one of
immense importance to both the theory and practice of contempo-rary psychotherapy. Unfortunately, however, because the over-whelming majority of theoretical writing in the discipline has beenpreoccupied with issues of diagnostics, technique, and normaliza-tion, the question of the other has often been ignored or trivialized.
As I have argued elsewhere (Gantt, 1994), this has led to a situa-tion in the discipline in which the absolute otherness of the Otherand the fundamentally ethical and moral responsibility engen-dered in the face-to-face encounter with the suffering Other havebecome subordinated to the “seemingly” more weighty matters ofproper technique and successful method. The end result of thistype of theoretical prejudice is that the suffering individual andthe psychotherapeutic system are correlated with one another in
such a way that “the system defines what cure is . . . and the cureoccurs because of the correct application of the method of cure gen-erated by the system” (Heaton, 1988, p. 5). Thus, when psychother-apy looks into the pleading face of the suffering Other, it isequipped only to see reflected there the presence of certainpre-established diagnostic categories and/or causal conditions; tosee individuals “reduced to being bearers of forces that commandthem unbeknown to themselves” (Levinas, 1969, p. 21).
In contrast to the reductionistic promise characteristic of so
much of contemporary medical-model psychotherapy, theLevinasian position insists that the otherness of the Other cannever be fully comprehended (literally, “taken in hand,” “grasped”)or captured. Rather, the presence of the other qua other willalways come as an irruption of our projects and an excessive over-flowing of whatever established categories or preconceived biaseswe might have. Levinas (1969) has argued the following:
The alterity of the Other does not depend on any quality that woulddistinguish him from me, for a distinction of this nature would pre-cisely imply between us that community of genus which already nul-lifies alterity . . . . The Other remains infinitely transcendent, infi-nitely foreign; his face in which his epiphany is produced and whichappeals to me breaks with the world that can be common to us,whose virtualities are inscribed in our nature and developed by ourexistence. Speech proceeds from absolute difference. (p. 194)5
Levinas maintains that it is only in the radical plurality of abso-
lute and irreducible difference that a genuine sociality can come topass; a sociality that begins in the unilaterally ethical command:Thou shalt not kill. This, however, is not to be construed as somelogically derived and abstracted ethical principle or Kantianmaxim that, through the force of its conspicuous rationality,demands our (intellectual or political) submission. It is, rather, theeminently concrete moment of the ordinary, simple, and everydayfact of the other person who stands facing me, soliciting aid andpleading for respite, forcefully calling me out of the hollow void ofegocentrism with a gentle demand for moral response (cf. Levinas,1969, p. 150). Levinas would have us come to understand thatwhat is truly meaningful occurs in that infinite gap separating andjoining the I and the other in ethical proximity; in the I who is mor-ally subjected to the sufferings of an-other in that “pain [that is]lightly called physical” (Levinas, 1987, p. 69). This moral subjec-
tion, or perhaps more appropriately, moral identity, is revealed in“the face of the other [who] is destitute; it is the poor for whom I cando all and to whom I owe all. And me, whoever I may be, as a ‘firstperson,’ I am he who finds the resources to respond to the call”(Levinas, 1985, p. 89). In other words, I am who I am both because Ihave been called by the other to response, to render an accountingof my existence, and because I am thus the only one able to rendersuch an accounting to and for the other. Again, as Levinas (1985)has said, “I am I in the sole measure that I am responsible, anon-interchangeable I . . . . Such is my inalienable identity as sub-ject” (p. 101).
The real work of psychotherapy, when conceptualized from
within this Levinasian perspective, takes place as the therapistresponds to the ethical obligation to suffer-with an-other in thehere-and-now immediacy of his or her suffering-through the inevi-table and inescapable vicissitudes of daily living. As Levinas(1988) notes in a recent essay, this perspective allows “a radicaldifference to emerge between suffering in the Other
, which for me
isunpardonable and solicits and calls me, and suffering in me
, myown adventure of suffering whose constitutional or congenital use-lessness can take on a meaning, the only meaning to which suffer-ing is susceptible, in becoming a suffering for the suffering—be itinexorable—of someone else” (p. 159). The point here is that it is inand through “suffering-for” the “useless suffering” of an-other thatexistence can derive a genuine meaningfulness.
Thus conceived, suffering-with in suffering-for the suffering of
an-other, becomes, in the words of Stephen Gans (1988), “the nec-essary and sufficient context for analytic-therapeutic or ethicalrelatedness” (p. 88). For it is in suffering-with that I am called outof the solipsism of my everyday self-concern and entreated to“cease living ‘as if’ by going through the motions, turned away frommy fellow man in despair, and instead respond to the address of theface which touches my heart and asks me to tell the truth” (Gans,1988, p. 88). Of course, I can always attempt to uproot myself fromsuch responsibility. I can, Levinas says (1990),
deny the place where it is incumbent on me to do something, to lookfor an anchorite’s salvation. One can choose utopia. On the otherhand, one can choose not to flee the conditions from which one’s workdraws its meaning, and remain here below. And that means choos-ing ethical action. (p. 100)
In thus providing a nontotalizing context wherein the therapist
can responsively attend to the Other as
Other, suffering-with pro-vides a genuine opportunity for desire to find ethical expression inthe primordiality of the face-to-face. As such, the therapeutic situ-ation is no longer conceived of in terms of a dialectical or authori-tarian totality: the one who will heal the one in need of healing.
Suffering-with is a moment in which, rather than dogmaticallypursuing a pre-established mode of therapy with a particular client-type to realize a particular outcome, we stand open to the beingof the other person, a radical otherness that reveals a world ofmystery—a world that cannot be appropriated in terms of precon-ceived categories or totalizing systems. The call of the Other is asummons to sociality; a call to take on ourselves the arduous taskof “living an equitable life” in suffering-with and suffering-for thesuffering of the other person. In short, the ethical call to responsi-bility is the grounds on which any discussion of therapeutic tech-nique or practical application must begin. The call to suffer-withis, thus, morally prior to any formal articulation of any particularform of therapeutic intervention.
Clearly, the Levinasian alternative articulated here has much
in common with that offered in the writings of Maurice Friedman(1985a, 1985b, 1998) and others (e.g., Krasner & Joyce, 1995). Forexample, drawing on the philosophical work of Martin Buber,Friedman (1985a) argues for a conceiving of therapy as “dialogue”and “meeting,” in which “What is crucial is not the skill of the ther-apist, but rather what takes place between
the therapist and theclient and
between the client and other people” (p. 3). Further reso-nating with the Levinasian perspective offered here, Friedman(1985a) argues that “Only if the therapist discovers the ‘otherness’of the client will he or she discover his or her own real limits andwhat is needed to help the client” (p. 6). In short, then, psychother-apy is not just about “healing in the negative sense” (i.e., curing adeficit or solving a problem) but, more fundamentally, it is “amovement in the direction of a climate of trust, a caring commu-nity, a community that confirms otherness” (Friedman, 1985a, p.
Within such a framework, it can be seen that therapy as a re-
sponse to the call to suffer-with the other in his or her sufferingprovides for a radically alternative understanding of the thera-peutic relation. As such, it should not be confused with a facile orsimple-minded suggestion that we ought to quietly commiserate
with our clients as they trudge in and out of the consulting room.
Suffering-with is far more radical than any proposal for either con-venient co-misery or simplistic sympathy. It is, paradoxically, asupremely concerned moment of un-concern in which we abandonthe vain justifications of our professional self-indulgences and, intheir stead, offer up ourselves in ethical response to the plea of thesuffering other we find before us (cf. Gantt, 1994; Halling, 1975). Insuffering-with as a suffering-for we take upon ourselves the painsand torments of the other in a selfless act of understanding andgiving; an act which in no way brooks condescension on our part.
Whereas cure, the alleviation of suffering, may well occur in ther-apy, from this perspective the question of curing the other is seento be ancillary to (or perhaps, more accurately, derivative from) thecall to suffer-with and suffer-for.
Thus, it would be conceptually misleading to construe suffering-
with as simply one more empathic technique among others thatmight be profitably employed in bringing about some “egalitarianframework of shared power and disclosure . . . [where] each takesresponsibility for himself in the relationship” (Rogers, 1977, p. 287).
Suffering-with is not, as Rogers conceived of empathy, “a technicalchannel by which the therapist communicates a sensitive empathyand an unconditional positive regard” (Rogers, 1989, p. 233). For,suffering-with as suffering-for is neither technique nor “technicalchannel,” but quite literally an offering of oneself for an-other. Assuch, it is in its very essence opposed to the mechanicalized worldof therapeutic techniques and technical manipulations.
This is not, however, to say that technique is never warranted or
has no place or purpose in our therapeutic endeavors. Such anassumption would prove to be not only impractical but absurd.
Rather, it is to say that suffering-with another in the very momentof their anguish is ethically prior and morally superior to anymethod or technique, any of which must ultimately be seen asderivative from and subservient to the call to ethical response inthe face of suffering. In other words, method and technique mustalways be guided by and subordinate to our fundamentally moralresponsibility to the Other; a responsibility in which we find our-selves always already obligated to attend to the needs of the otherperson. Only when psychotherapy comes to admit this ethical pri-ority, to take on itself the requirements of ethical obligation, will itbecome truly “therapeutic” in the fullest and richest sense of thatword.6
Thus conceived, the work of psychotherapy can begin a move-
ment away from the dehumanizing dualism and mechanicalreductionism of modern medical-model psychotherapy and towardsatisfying the ethical obligation to suffer-with the other in thehere-and-now immediacy of his or her misery. Such a move shouldnot, of course, be seen as a technical move toward some system oftherapeutic intervention that might be operationally implementedso as to increase positive outcome probabilities. Neither should itbe understood as one more in the long tradition of “theories of cure”(Bankart, 1997). Rather, the Levinasian alternative outlined hereseeks to radically recast the meaning of human suffering so as toalert us to the fundamentally ethical summons embodied in thatsuffering, a summons that demands that we be willing to shoulderthe heavy and agonizing burdens of an-other’s pain. For the thera-pist, suffering-with as a suffering-for the suffering of an-other mayresult in some measure of relief for that other, but ultimately, thequestion of relief is subservient to the necessity of response.
1. The reader may wonder at my suggestion that the medical model is
both dualistic and reductionistic in nature, particularly because these twopositions are often understood to be antithetical to one another. I wouldargue, however, that in the case of the medical model we can see both posi-tions in simultaneous operation. First, we see the dualism assumed in thedistinction that is made between physical entities and mental entities.
Second, we can see a mechanistic reductionism in the tendency to adoptone of these entities as being of central disciplinary importance (i.e., thebody in medicine and the mind in psychology) and then reducing the cho-sen entity down into its component mechanisms and isolate functions. Formore on this issue, see Medard Boss’s Existential Foundations of Medicineand Psychology
(1994) and Drew Leder’s The Absent Body
2. The term hermeneutic-phenomenology
is taken originally from
Heidegger’s masterwork Being and Time
(1927/1962, pp. 49-63), where itis used to describe the fundamentally interpretive character of human ex-istence. Unfortunately, however, for many traditional phenomenologists,particularly those who identify their work’s affinities as being more withHusserl than Heidegger, the term is seen to be little more than a contra-diction of itself. They argue, with a certain amount of cogency and persua-siveness, that the purpose of the phenomenological method is to attain a
vision of consciousness untainted by prior influences or interpretations. Inother words, the point of phenomenology is to let the facts of experiencespeak for themselves without any prejudicial interruptions or interpola-tions on our part. However, Heidegger and other hermeneutic thinkers,such as Gadamer and Ricoeur, want to honor both terms of their descrip-tive methodology. They wish to both let the facts speak for themselves andappreciate that there are no uninterpreted facts. Obviously there is a sig-nificant intellectual dilemma involved here, and one that is still verymuch under discussion in a number of philosophical circles. Unfortu-nately, it is a dilemma that lies well beyond the limited scope of this arti-cle. For a more detailed treatment of this interesting question of the rela-tionship between hermeneutics and phenomenology, please see Dostal(1993), Gurwitsch (1966), Kockelmans (1988), and Ricoeur (1981b).
3. This is not to say that the origins of suffering are always directly or
clearly manifest. Rather, it is to say that appeals to an “unconscious” mustavoid conceptualizing it in object-like terms, as though it were an actualentity endowed with causal power over lived experience. For provocativeexamples of alternative ways of conceptualizing the unconscious as hu-man activity rather than causal entity, see van den Berg (1972) and Boss(1963, 1990).
4. Throughout this section, in dealing with the contrasting pair of
, I will be adhering to the early translation conven-tions of Totality and Infinity
(Levinas, 1969), conventions that were not
continued in the subsequent English translation of Otherwise than Beingor Beyond Essence
(Levinas, 1991), although the translator involved wasthe same in both cases. In Totality and Infinity
,or the personal other, the other person. In contrast, other
is employed torepresent l’autre
, or otherness in general. Levinas takes great pains toshow that the other always already requires the Other: “The other quaother is the Other [L’Autre en tant qu’autre est Autrui]” (1969, p. 71).
5. It is perhaps appropriate here to alert the reader to the often vividly
hyperbolic nature of Levinas’s rhetorical style. Drawing on not only philo-sophical but religious sources for inspiration (particularly the language ofthe Bible), Levinas often uses highly metaphorical and symbolicallycharged terminology in making his arguments. As such language and rhe-torical style are not often found in journal articles dealing with psychologi-cal issues, this section may prove somewhat challenging until one is morefully acclimated to the Levinasian style.
6. The Greek word from which we derive the term therapy
a term that denotes service or attendance as well as healing. In addition, itconnotes an act of service, or “tending to,” that is freely and devotedlygiven rather than forced or purchased (for a more detailed treatment ofthis point, see R. N. Williams & Faulconer, 1994, p. 346).
American Psychiatric Association. (1994). Diagnostic and statistical man-
ual of mental disorders
(4th ed.). Washington, DC: Author.
Bakan, D. (1968). Disease, pain, and sacrifice: Toward a psychology of suf-
. Chicago: The University of Chicago Press.
Bankart, C. P. (1997). Talking cures: A history of Western and Eastern
. Pacific Grove, CA: Brooks/Cole Publishing.
Bergin, A. E., & Garfield, S. L. (Eds.) (1994). Handbook of psychotherapy
and behavior change
(4th ed.). New York: Wiley and Sons.
Bleuler, E. (1950). Dementia praecox, or the group of schizophrenias
York: International Universities Press. (Original work published 1911)
Boss, M. (1963). Psychoanalysis and daseinsanalysis
. New York: Basic
Boss, M. (1990). The Unconscious: What is it? In K. Hoeller (Ed.), Read-
ings in existential psychology and psychiatry
(pp. 237-249). Seattle,WA: REPP.
Boss, M. (1994). Existential foundations of medicine and psychology
(S. Conway & A. Cleaves, Trans.). Northvale, NJ: Jason Aronson.
Cassell, E. J. (1982). The nature of suffering and the goals of medicine.
New England Journal of Medicine
Cassell, E. J. (1991). The nature of suffering
. New York: Oxford University
Cassell, E. J. (1992). The nature of suffering: Physical, psychological,
social, and spiritual aspects. In P. L. Starck & J. P. McGovern (Eds.),The hidden dimension of illness: Human suffering
. New York: NationalLeague for Nursing Press.
Copp, L. A. (1974). The spectrum of suffering. American Journal of
Dostal, R. J. (1993). Time and phenomenology in Husserl and Heidegger.
In C. Guignon (Ed.), The Cambridge companion to Heidegger
Cambridge, UK: Cambridge University Press.
Duffy, M. E. (1992). A theoretical and empirical review of the concept of
suffering. In P. L. Starck & J. P. McGovern (Eds.), The hidden dimen-sion of illness: Human suffering
. New York: National League forNursing Press.
Frankl, V. E. (1961). Logotherapy and the challenge of suffering. In K.
Hoeller (Ed.), Review of existential psychology and psychiatry
63-67). Seattle, WA: REPP.
Frankl, V. E. (1963). Man’s search for meaning: An introduction to
. New York: Holt, Rinehart, and Winston.
Frankl, V. E. (1986). The doctor and the soul: From psychotherapy to
(3rd ed.). New York: Vintage Books.
Freud, S. (1957). Aetiology of the neuroses (Draft B). In J. Strachey (Ed.
and Trans.), The standard edition of the complete psychological worksof Sigmund Freud
(Vol. 1, pp. 179-184). New York: W. W. Norton andCompany. (Original work published 1894)
Freud, S. (1961a). The ego and the id and other works. In J. Strachey (Ed.
and Trans.), The standard edition of the complete psychological worksof Sigmund Freud
(Vol. 19, pp. 3-66). New York: W. W. Norton andCompany. (Original work published 1923)
Freud, S. (1961b). Civilization and its discontents
(J. Strachey, Trans.).
Freud, S. (1965). The interpretation of dreams
(J. Strachey, Trans.). New
Freud, S. (1989). The neuroses of defence. In P. Gay (Ed.), The Freud
(pp. 90-96). New York: W. W. Norton and Company.
Friedman, M. (1985a). The healing dialogue in psychotherapy
Friedman, M. (1985b). Healing through meeting and the problematic of
mutuality. Journal of Humanistic Psychology
Friedman, M. (1998). Buber’s philosophy as the basis for dialogical psy-
chotherapy and contextual therapy. Journal of Humanistic Psychol-ogy
Gadamer, H.-G. (1976). Philosophical hermeneutics
(D. E. Linge, Ed. and
Trans.). Berkeley, CA: University of California Press.
Gadamer, H.-G. (1994). Truth and method
(J. Weinsheimer & D. G. Mar-
shall, Trans.). New York: Continuum. (Original work published 1960)
Gans, S. (1988). Levinas and Pontalis: Meeting the other as in a dream. In
R. Bernasconi & D. Wood (Eds.), The provocation of Levinas:Rethinking the other
(pp. 83-90). London: Routledge.
Gantt, E. E. (1994). Truth, freedom, and responsibility in the dialogues of
psychotherapy. Journal of Theoretical and Philosophical Psychology
Gantt, E. E. (1995). The therapeutic context of human suffering: An empiri-
. Unpublished manuscript,Duquesne University.
Gilbert, P. (1989). Human nature and suffering
. Hillsdale, NJ: Lawrence
Goldberg, C. (1986). Concerning human suffering. Psychiatric Journal of
the University of Ottawa
Goodwin, D. W., & Guze, S. B. (1989). Psychiatric diagnosis
(4th ed.). New
Gurwitsch, A. (1966). Studies in phenomenology and psychology
Evanston, IL: Northwestern University Press.
Halling, S. (1975). The implications of Emmanuel Levinas’ Totality and
for therapy. In A. Giorgi, C. Fischer, & E. Murray (Eds.),Duquesne studies in phenomenological psychology
(Vol. 2, pp. 206-223).
Pittsburgh, PA: Duquesne University Press.
Heaton, J. (1988). The Other and psychotherapy. In R. Bernasconi & D. Wood
(Eds.), The provocation of Levinas: Rethinking the other
(pp. 5-14). NewYork: Routledge.
Heidegger, M. (1962). Being and time
(J. Macquarrie & E. Robinson, Trans.).
San Francisco, CA: Harper and Row. (Original work published 1927)
Husserl, E. (1982). Ideas pertaining to a pure phenomenology and to a
phenomenological philosophy—Book one (F. Kersten, Trans.).
Dordrecht, the Netherlands: Kluwer Academic Publishers. (Originalwork published 1913)
Kockelmans, J. F. (Ed.). (1988). Hermeneutic phenomenology: Lectures
. Lanham, MD: University Press of America.
Kraepelin, E. (1896). Psychiatrie: Ein Lehrbuch für Studirende und
Aerzte (5th ed.) [Clinical psychiatry: A textbook for students and physi-cians]. Leipzig, Germany: Barth.
Kraepelin, E. (1921). Clinical psychiatry: A textbook for students and phy-
(4th ed.; A. R. Diefendorf, Trans.). New York: Macmillan. (Orig-inal work published 1893)
Krasner, B. R., & Joyce, A. J. (1995). Truth, trust, and relationships: Heal-
ing interventions in contextual therapy
. New York: Brunner/ Mazel.
Leder, D. (1990). The absent body
. Chicago, IL: The University of Chicago
Levinas, E. (1969). Totality and infinity
(A. Lingis, Trans.). Pittsburgh,
Levinas, E. (1985). Ethics and infinity
(R. A. Cohen, Trans.). Pittsburgh,
Levinas, E. (1987). Time and the other
(R. A. Cohen, Trans.). Pittsburgh,
Levinas, E. (1988). Useless suffering. In R. Bernasconi & D. Woods (Eds.),
The provocation of Levinas: Rethinking the other
(pp. 156-167). NewYork: Routledge.
Levinas, E. (1990). Place and utopia. In Difficult freedom: Essays on Juda-
(S. Hand, Trans.)(pp. 99-102). Baltimore, MD: Johns Hopkins Uni-versity Press.
Levinas, E. (1991). Otherwise than being or beyond essence
Trans.). Dordrecht, The Netherlands: Kluwer Academic Publishers.
Maxmen, J. S., & Ward, N. G. (1995). Essential psychopathology and its
(2nd ed., revised). New York: W. W. Norton and Company.
May, R. (1950). The meaning of anxiety
. New York: W. W. Norton and
May, R. (1969). Love and will
. New York: W. W. Norton and Company.
Merleau-Ponty, M. (1989). Phenomenology of perception
Trans.). London: Routledge Humanities Press. (Original work pub-lished 1962)
Moulyn, A. C. (1982). The meaning of suffering: An interpretation of
human existence from the viewpoint of time
. Westport, CT: GreenwoodPress.
Packer, M. J. (1985). Hermeneutic inquiry in the study of human conduct.
Patterson, C. H. (1966). Theories of counseling and psychotherapy
Reeves, C. (1977). The psychology of Rollo May
. San Francisco, CA: Jossey-
Ricoeur, P. (1981a). The model of the text: Meaningful action considered
as a text. In P. Ricoeur (Ed.) & J. B. Thompson (Ed. and Trans.), Herme-neutics and the human sciences
(pp. 197-221). Cambridge, UK: Cam-bridge University Press.
Ricoeur, P. (1981b). Phenomenology and hermeneutics. In P. Ricoeur (Ed.)
& J. B. Thompson (Ed. and Trans.), Hermeneutics and the human sci-ences
(pp. 101-128). Cambridge, UK: Cambridge University Press.
Rogers, C. R. (1977). Carl Rogers on personal power
. New York: Delacorte.
Rogers, C. R. (1989). The necessary and sufficient conditions of therapeu-
tic personality change. In H. Kirschenbaum & V. L. Henderson (Eds.),The Carl Rogers reader
(pp. 219-235). Boston: Houghton Mifflin.
Roth, A., & Fonagy, P. (1996). What works for whom? A critical review of
. New York: The Guilford Press.
Rychlak, J. F. (1981). Introduction to personality and psychotherapy
Shorter, E. (1997). A history of psychiatry: From the era of the asylum to the
age of Prozac
. New York: John Wiley & Sons, Inc.
Siu, R. (1988). Panetics: The study of the infliction of suffering. Journal of
van den Berg, J. H. (1972). A different existence: Principles of
. Pittsburgh, PA: Duquesne Uni-versity Press.
van Deurzen-Smith, E. (1997). Everyday mysteries: Existential dimen-
sions of psychotherapy
. London: Routledge.
Williams, J. M. (1992). Psychological treatment of depression
Williams, R. N., & Faulconer, J. E. (1994). Religion and mental health: A
hermeneutic reconsideration. Review of Religious Research
Yalom, I. (1980). Existential psychotherapy
. New York: Basic Books.
Reprint requests: Edwin E. Gantt, Brigham Young University, 1086 SWKT, Provo,UT 84602; e-mail: firstname.lastname@example.org.
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