Observations From an Open Circle

The following observations were made over a period of four months during a fortnightly philosophical reading group with patients in a psychiatric rehabilitation institution. Friedrich Nietzsche’s "On the Genealogy of Morality" was read.

Milan Röhricht
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There were ten of us at the first meeting. I introduced myself and made clear that I am not there as a therapist, nor a teacher, but likewise as an individual interested in philosophical questions. After everyone else introduced themselves, we spoke about our prior knowledge of philosophy, which turned out to be very limited: only one participant had studied philosophical texts (mainly Nietzsche’s) in any depth.

I asked what had moved them to join, and where their interests lie: the question was followed by a passivity that I had not expected. After all, they had shown up of their own accord. A sense of “open and interested to see what happens” seemed to be the prevailing attitude, signaling to me they would not actively partake in shaping the reading group as I had hoped—a horizontal, democratic egalitarian structure. This would have involved collectively deciding on the very essence of what our open circle should be (within the limits of time and date, for it was also an extra-curricular group for me): what to read; how to read it; how to discuss what we were reading; and so on.

We decided to read Nietzsche’s On the Genealogy of Morality. Or rather, I suggested this to the group and it was quickly and gladly accepted. It seemed important to choose a text which was not too difficult, the construct too abstract or the topic too familiar. I thought these pitfalls would be alienating: it would be difficult to follow, slow, unsatisfying, and impossible to reconnect if one meeting was missed or certain pages not read.

With this in mind, Hegel’s preface to Phenomenology of Spirit, Binswanger’s essay Dream and Existence (along with Foucault’s preface to this text), and Kisker’s Dialogic of Madness: An Attempt at the Borders of Anthropology were possibilities I explored but consequently discarded.

Nietzsche, though, seemed ideal. The provocative, polemic and largely metaphorical nature of his work would provide an accessible basis. Further, within the group’s minimal prior philosophical experience, Nietzsche was a pillar of comparable expertise.

The second meeting gave me a real sense of hope. We had agreed to read the nine-page preface and everybody seemed to have done so. Many had highlighted sections or questions for discussion. Of the initial nine participants only one excused herself, and as one new person showed up there were ten of us once more.

It quickly became apparent that many of the participants were far less interested in the application of the theory, not challenging Nietzsche’s ideas and views, but instead concerned with a careful, literal examination of the text. We analysed individual words and sentences until the precise meaning, or a collective understanding as to what Nietzsche might mean, was distilled. Often this far surpassed my own reading of the sentence and enveloped a completely different framework of understanding. Whether this was more or less accurate ceased to matter; it was astounding to see how far individual interpretations could diverge, whilst maintaining a unifying narrative.

A wonderful moment unfolded with my closing question to the second meeting: “How far shall we read until next time?” In unison the group agreed to read the first discourse, a total of 28 pages. One person exclaimed: “I’m slightly scared of my own courage, but I also think we should read all of it.” Within a mere three hours this open circle had gained an optimistic perspective which was completely absent to begin with.

Unfortunately, I had naively underestimated the impact of formalities.

While planning the appointments for the first months, I figured a fortnightly meeting would be most realistic to allow sufficient time to read the designated pages. However, by the third meeting the fortnightly rhythm was disturbed: I was away from the city for a few weeks and had therefore scheduled the third meeting not two, but three weeks later. Initially I did not think this would be a problem. The invitation with the dates for the first four months was pinned to the notice board, and I had discussed with the team that it would remain there for reference. I had also reminded everyone of this change at the end of our second meeting.

Despite this, only one person turned up to discuss the text. Several others came to excuse themselves from the group, citing distress, fatigue, and illness as reasons. So as to not leave everyone else behind, I decided to cancel the meeting, postponing the content for two weeks.

In the meantime, I was left to ponder: Were my colleagues correct? They had predicted an immense challenge ahead that would make it almost impossible to maintain a reading group over a prolonged period of time. Were these sincere excuses? Was this lethargy a symptom of the varying conditions which necessitated the participants’ therapy?

It felt strange to be treated as an authority whom the participants asked to be excused, not least because we were on an informal, first-name basis. A barbecue was taking place, and I had the feeling some of them did not want to cite this as their reason for missing the meeting. Out of pride, I did not go down to check, but I did wonder to what extent this attempt was inherently flawed by professional boundaries, which might have been dispersed in my imagination but never completely within the walls of this particular institution, nor probably within the walls of many others.

At the same time, it became apparent over the next weeks that there were difficulties not directly related to the group which complicated participation for some participants. One person was having personal, emotional problems with another participant and wanted to avoid all contact between them. Another person was triggered by the group discussions, in effect struggling with thematic distance and metaphysical abstraction. Someone else was experiencing a crisis and could not concentrate on reading.

Around this time, I began questioning whether the whole thing had been a good idea. Had I forgotten, in the excitement of planning, that these were patients suffering from psychological problems to the extent that they required year-long, all-day therapy? Had I underestimated the challenges difficult moral problems can pose, and the sense of insecurity which these may arouse within ourselves—even more so in the provocative tone of Nietzsche? Had I wrongly disregarded my “therapeutic role” and consequently ignored an ancient consensus on the psychoanalytic rule of observational distance?

About four of us continued reading. Each meeting began with several participants excusing themselves; often I thought I perceived a sense of defeat and disappointment in their expressions. In this smaller, intimate group the discussion became more personal; the prior reluctance of deviating from the text gave way to explorations of how Nietzsche’s thoughts relate to our own lives.

Inspired at the end of one such debate, a participant expressed how the open circle had helped her gain a new perspective, especially as the reading group was “one of the only therapies offered where we discuss not our own individual problems, but universally relevant topics.” She explained there was only one other group therapy that went beyond exploring individual psychopathology–and this in a relatively progressive institution that has been around for 20 years.

Nonetheless, because of the evident problems, I questioned the merit of utilizing philosophy in a psychiatric setting. The fundamental idea of approaching therapy through philosophy is to situate individual experiences and problems in a new context. It is not about offering more explanations of psychological phenomena, nor is it about developing further treatment blueprints for individual execution.

Instead, philosophy considers the impact of society, and inevitably capitalism, on mental health—what Deleuze and Guattari call the deterritorialisation of the socius. It requires us to question the prevailing narrative which elides societal factors from psychiatric pathogenesis. Notably, this approach opposes the underlying psychotherapeutic stance that therapy is about addressing individual crises, anxious and obsessive thoughts, depressive moods. Therapy, as it is currently understood, is not about politics or how to change “the system,” it is an examination of one’s own life.

Incorporating philosophical debate into psychiatric care forces us to confront the assumptions of therapy. Many “progressive” psychiatric institutions may have been built on solid foundations revolutionary for their time, yet they run the risk of coming to a standstill without continuous and vehement debate. Notions such as suicide, assignment of responsibilities, staff training, security guards, involuntary commitment, restraint and many more require perpetual scrutiny.

In Heidegger’s words: “The real ‘movement’ of the sciences takes place in the revision of these basic concepts, a revision which is more or less radical and lucid with regard to itself. A science’s level of development is determined by the extent to which it is capable of a crisis it its basic concepts. In these immanent crises of the sciences the relation of positive questioning to the matter in question becomes unstable.” A stronger incorporation of theoretical substance into everyday practice, fueled in particular by a lively debate with the patients, may guide this continual revision of our basic concepts.

If holding myself to the same standard, I must reflect on my position in the reading group. As an employee of the rehabilitation institution there was an implicit hierarchy from the outset—which I tried to dismantle. We agreed on a first-name basis. I made clear to the participants at the start that I was not a therapist, nor a teacher, nor a philosopher. I have absolutely no formal education in philosophy, nor had I read the text prior to the group.

I think this informality was pivotal: it was a reading group, and not psychoanalysis or any other form of psychotherapy which require a formally qualified therapist. But what does this mean for future endeavors? What changes once I complete my formal education, when there is a role that I have qualified for and am thus expected to fulfill?

In the current setting, I stood to gain as much from the group as the other participants did. In this sense it was “therapy” for me as much as for anyone else. However, as the initiator, moderator and person ultimately responsible, I also stood with more to lose. It was out of pride, for example, that I did not go down to the barbecue—for I did not want to have been lied to. The difficulties predicted by colleagues at the outset acted as an incentive to work harder, to prove them wrong, to demonstrate that it is possible to overcome professional boundaries and the hierarchy they embody, and to revise the basic concepts of therapy to address societal factors.

Ironically, it was this very attitude which hindered an extension of the group after we had finished On the Genealogy of Morality.

The German language has formal and informal personal pronouns. Within medical institutions it is common for the formal pronoun to be used between patients and staff, whereas patients and staff amongst themselves use the informal pronoun. I tried to dismantle this hierarchy by using the informal pronoun with the participants (as well as all other patients at the institution, to ensure there was no favorable treatment).

The management of the rehabilitation institution was made aware of this hierarchical break-down and deemed it in conflict with the collective institutional stance. They asked me to revert to using the formal pronoun or else discontinue the group. Under this condition I could not continue with the reading group, for it opposed much of what I had been trying to do.

The participants seemed sad to hear of this decision, and angry that somebody had evidently informed the management of our unconventional approach. However, it was difficult to discern whether they were disappointed about the discontinuation of our reading group, or about the imposed change to our interaction—whether they would miss the change in perspective engendered by philosophical debate, or the attempted revision of the basic concept upheld across most psychiatric institutions, the hierarchy between ‘healthy staff’ and ‘ill patients’.

Photo by Oliver Bassemir (http://oliverbassemir.de/)

29 COMMENTS

  1. Interesting, I’d never quite thought about how German’s use of formal and informal pronouns would intrinsically create a separation between doctors and their patients. I would imagine patients tend to use the formal pronouns with their doctors? And do the doctors also tend to utilize the formal pronouns with the patients? Or do they utilize the informal pronouns with the patients?

    As to “the hierarchy between ‘healthy staff’ and ‘ill patients’.” Given the fact that none of the psychiatric DSM disorders are “valid” diseases.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

    And given the reality that the ADHD drugs and antidepressants can create the “bipolar” symptoms. And the antipsychotics/neuroleptics can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome, as well as create the positive symptoms of “schizophrenia,” via anticholinergic toxidrome.

    https://www.alternet.org/2010/04/are_prozac_and_other_psychiatric_drugs_causing_the_astonishing_rise_of_mental_illness_in_america/
    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
    https://en.wikipedia.org/wiki/Toxidrome

    But it is the psychiatrists who can’t seem to garner insight into these truths. Thus meaning it is the psychiatrists who harbor the “delusional” belief system. Is a “hierarchy between ‘healthy staff’ and ‘ill patients’” appropriate? Since it is, in reality, the “healthy staff” who are the delusional people?

  2. Don’t be too hard on yourself. Learn the lesson and move on. Personally, nothing beats a BBQ. Even talking about a BBQ and BBQ recipes, nothing beats that. Cooking classes, that’s an idea….not so philosophical, yet then again…there could be a philosophy twist to a BBQ recipe that I cherish. Just kidding.

    • Redcat,

      I hope Milan takes your suggestion seriously. And I hope a ‘patient’ is ‘allowed’ to run the class.
      It seems Milan has superiors, after all, in mental health, we need superiors to make sure the rules on what makes patients ‘better’ are followed.
      A few are blessed to know what that looks like. I’ve been told that one goes to school for 8 years to learn what makes people tick and how to fix their tickers.
      Perhaps all the patients could be sent to psych school for 8 years to become experts of their own minds.

      • Forgive me, I love BBQs.

        Read Nietzsche or eat delicious succulent ribs and chicken wings, without utensils, outdoors? Discuss a book in a circle or voraciously feed a hungry stomach? Let’s ask NFL fans what they prefer. Why hypothesize that patients are different than the average american? I find the book club kinda heavy as an activity.

        • I think on the whole, “mental patients” are steeped in negative environments, why not make it a bit more fun? We can’t have that.
          Who ever heard of a “ward” with Zumba classes, basketball, clock repair classes? Math, writing classes?
          Skip the ‘therapy’, see what happens. Brain pasticity? How is that possible by not stretching the brain to possibilities?
          Who ever heard of considering a shrink equal to his client, each with their own set of problems?

          • They did have some activities at the Ariel Castro Memorial Hospital but I think it was more about training the staff into the belief that the patients were hopeless cases. Anyone with ideas like this soon ended up thinking “why bother”. A bit like those captured soon realise there is no way of escaping.

            Food is a great way of getting captive animals to trust you. Bite the hand that feeds you bbq? Given that the Minister and Chief Psychiatrist in my State do not have any issues with the ‘spiking’ of citizens (and certainly not patients) i’d be careful what I ate and drank in these environments.

            The issue with my ‘spiking’ after all was that if I were a “patient” all was fine, but because I was actually a citizen then they needed to make me into a “patient’ lest they be seen for what they are, criminals. Ergo, drugging patients without their knowledge, fine with them.

            My newly self appointed ‘guardian/carer’ was quite prepared to authorise anything they wished to do, under threat of course but all of that is inadmissible they tell me. Imagine that, hospital commits offences against a person and they then appoint someone as their carer so that they can not complain and can then conspire to commit offences against the victim of their crimes.

            I had no idea I even had a carer who was being threatened by the hospital staff to get me to sign documents that would ensure their criminal conduct could not be exposed. “Get him to obtain a referral from a G.P. and then he is a “patient” and we can go to town on him”. Lucky no one is interested in what was done huh, until it’s their families being fuking destroyed I guess.

            I suppose it all spiralled out of control and i’m sort of glad someone did actually notice when they were going to overdose me in the Emergency Dept. Takes a thief to catch a thief I guess. And how effective is their slander in getting people to turn their backs while they do this sh*t. I must say I have great admiration for the Operations Manager who is fuking destroying peoples lives because they make legitimate complaints. I’ve no doubt her actions have resulted in many deaths from suicide, and well I have ex army friends who did three tours in Vietnam who have killed less people. And she’s getting family members to help her while she does this, by threatening them if necessary.

  3. “The management of the rehabilitation institution was made aware of this hierarchical break-down and deemed it in conflict with the collective institutional stance. They asked me to revert to using the formal pronoun or else discontinue the group. Under this condition I could not continue with the reading group, for it opposed much of what I had been trying to do.”

    Dear me, such stuffy managers. Reminds me of school.

  4. It seems likely that such a group would not be fully successful unless it started with a full discussion of the power dynamics entailed in you being the “professional” and organizing the group. It is apparent from your description that they patients viewed you as the “expert” regardless of any provisos you may have put out there. In fact, your ability to frame the conversation in terms of your role is already an exercise of power over the participants. Unless this set of assumptions, which may have largely been unconscious or subconscious, are fully deconstructed, the group as you envisioned it was unlikely to develop.

    Of course, if you HAD conducted such a discussion, your hierarchical peers would have felt their power threatened and almost certainly would have shut you down, just as they did with the “du” vs. “Sie” issue. Why would it bother them for you to use informal pronouns, except to the extent that it threatened their role as the “experts” speaking down to the “patients?”

    I have to wonder what Nietzsche himself might have said about the process.

    • I so agree with your view Steve.

      Also I question the reading material chosen. I understand the participants ‘agreed’ to it, yet perhaps if the group was simply instructed to research material and then come to a meeting to present their choices, where it could then be decided as to which book?
      Philosophy can induce navel gazing and as “Redcat” noted, perhaps cooking classes would have built a better ‘community’ and caused a shift in ‘what’ and ‘who’ to think about.
      Philosophy can easily lead me to becoming absorbed and depressed feeling, it is also highly interesting and debatable. Much like psychiatry, except that psychiatry is NOT interesting or interested, unlike philosophy, it draws conclusions on endless possibilities.

      Forever the hierarchy that treats people like it’s subjects.

    • I wonder if he already said it Steve in Beyond Good and Evil, We Scholars?

      Mind you it’s been a long time since I had access to my books, or anything else for that matter. Birth of Tragedy and Geneology of Morals was one of my favorite ‘pick up’ books way back when I had ‘stuff’. But mental health services and police soon fixed that with a ‘verbal’.

      I sometimes ponder what it must be like to go to work and leave waves of chaos behind you, destroying lives and leaving a mess for others to try and resolve, and all the while thinking that your a good person and what your doing might on the surface appear as criminal but in the end it will, in some Machiavellian formula, work out for the best. Doing things that is resulting in the death of people can’t surely be seen as ‘good’? Unless of course they know something we don’t? And then the killings might be justified?

      I mean try as I may I have wondered how this mental health practitioner managed to make observations of my thoughts that occurred three weeks before I even met him. I did study psychology and this is a new development for me, though not for the Chief Psychiatrist who supports this guys claim to thought reading and time travel, in writing. And this then provides justification for incarceration and forced drugging. Luckily they are not relying on any science to justify their position, nor anything that might be called “reasonable”, because they would fail miserably. They are simply snatching anyone that has the misfortune of having a finger pointed at them from their beds and fabricating evidence to support their position. Perhaps a reading of another German authors book The Trial (Franz Kafka) may be in order? How prophetic was that when we look back at the shape of things to come?

    • There might be a place for philosophy in psychoanalysis, however, my view is that psychoanalysis represents religion (AKA folly), the old nemesis of philosophy, given its search for truth and wisdom. Will philosophy help you “heal souls”? I dunno. Kinda have to consult a priest on that one.

  5. Hi Milan, thank you for the responses.
    I think what seems as B/W comments, are a response to the B/W practices of psychiatry.
    Yes I am all in favour of a community like environment, activities and choices shared.

    We cannot pretend that clients ever feel equal, no matter how it is presented.
    It is not difficult to imagine how it feels to be part of groups, in the context of something being wrong in
    their heads.

    There are books on the truths of drugs, and thoughts on the DSM. Possibly clients would like to discuss those.
    I understand that choice of books were discussed, I just don’t know if there was a list books, or any book to choose from.
    I give you credit. To work in the environment that you work in, does not allow you much freedom.
    Much less freedom for clients. A client is not allowed to ‘think’ that psychiatry is wrong. Not without backlash and anger directed at the client.

  6. I was interested in this article mostly for the concept behind it, not so much for how things turned out in this particular case, which was just a bit predictable.
    My viewpoint and training suggest that a philosophical approach to the problems of the mind is an absolute necessity. In other words, concepts of God, of Spirit, of Matter, of “life” (biology), of Mankind, of groups, of sex and of oneself all impinge themselves on the mind and contribute to any resulting happy or unhappy mental consequences. Of course, a workable therapy must also be worked out. But it has been!
    It’s just considered anathema by the psychiatric community for reasons that they could probably explain a lot better than I could.

  7. Milan, do you sometimes have a group of children come over and play? When I do, I ask them if they want to bake cookies and decorate them…OR if they want to go play outside…OR…if they want to listen to music…OR play legos….Sometimes they will moan that painting is boring or that they don’t feel like playing school “on their vacation day”. Sometimes, they will start playing school and go for hours.

    My point? The reading club or the choice of the book – for your group doesn’t sound like it succeeded. It didn’t sound “fun”. No biggie, change the situation.

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