Plato, Not Prozac!

by Lou Marinoff
Harpercollins, 1999
Review by Christian Perring, Ph.D. on Aug 11th 1999

Lou Marinoff’s new book will be important for the burgeoning philosophical counseling movement in the US. Up until now, it has been relatively unclear what you might experience if you went to a philosophical counselor. Plato, Not Prozac! is full of case examples from the practices of Marinoff and some of his colleagues. The largest, middle, section of the book, Managing Everyday Problems, is given over to nine categories of problem, including seeking a relationship, maintaining it, ending it, work, mid-life crises, the meaning of life, and loss.

To take an example at random, Larry and Carol were married for twenty five years, had brought up two children, and both had successful careers. After the children had left home, Larry found that he no longer had much in common with his wife, and wondered whether to leave the relationship. Carol refused to even to talk with him about their relationship. Larry had no interest in meeting with a psychotherapist or psychiatrist, so Carol suggested he try a philosophical counselor. Larry met with Marinoff to discuss his quandary, and as a result of their conversations, Larry and his wife decided to end their marriage. Marinoff characterizes Larry’s problem as essentially philosophical: he was unsure what value to place upon his marriage vows, what value he should place upon his now unrewarding marriage, and how to balance those with his desire for fulfillment in life. For most of his clients, Marinoff does not assign readings. Instead he simply explains to them in lay terms some of the philosophical ideas relevant to their problems. Marinoff judges that Larry is a very logical sort of thinker, and so he explains the Kantian theory of perfect and imperfect duties, which he judges is closer to Larry’s implicit moral approach. He explains that it is possible to have duties to oneself as well as to others, and thus it may be morally permissible, or indeed morally required, now that his children are grown, for Larry to foster his own emotional growth by leaving the marriage.

Marinoff explains that he takes a different approach with different people. Some of his clients have studied philosophy previously, and may gain from doing some "bibliotherapy," homework with some carefully chosen philosophy texts. If Larry's intuitive moral scheme had seemed to be one of simply maximizing the happiness of people around him, presumably Marinoff would have explained, instead of the Kantian theory, the theory of Utilitarianism derived from Bentham and Mill, that one should maximize the long-term happiness of everyone in society, including oneself.

Marinoff does not restrict himself to the Western cannon of philosophy. For instance, for some people in Larry’s situation, Marinoff says he would talk about the ancient Chinese text Tao Te Ching, which emphasizes that everything changes, and also emphasizes the importance of acting blamelessly.

Philosophical counseling is meant to enable a client to come to his or her own decision. It is not for the counselor to impose his or her values on the client. The prime aim of counseling is to increase the autonomy of the client. This involves helping the client to come to a resolution of a problem through a variety of different ways. Of course, there is no universally accepted definition of what philosophy is, so it is not surprising that there is no simple list of methods of philosophical counseling, and there is bound to be disagreement about what counts as philosophical. For instance, some would say that the ancient Chinese texts that Marinoff is fond of using are more religious than philosophical.

Marinoff distinguishes philosophical counseling from more traditional psychotherapy by saying that it does not generally involve an investigation of the client’s past. His attitude towards psychiatry seems somewhat ambivalent. He is ready to agree that there are some problems that are genuinely psychiatric rather than philosophical, and he will refer clients with such problems to psychiatrists. He also insists that many problems are not psychiatric, but are instead philosophical. Some ethical problems fit into this category. However, a great many problems are in a gray area between pure psychiatry and pure philosophy, and it is especially here that Marinoff is proposing his approach as an alternative to psychiatry. This of course is the message of the title of his book. It is here that he comes closest to adopting an antagonistic attitude towards psychiatry, criticizing the "medical model" of mental illness, condemning the increase in the number of disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, and showing outrage at the increase in the prescription of psychotropic drugs like Ritalin.

It is clear from his examples that one way in which philosophical counseling is distinctively philosophical is that the counselor will often mention the ideas of famous philosophers as a way of providing a structure of thought that may be helpful to the client in sorting through complex questions. This is what happens in Marinoff’s example of his discussions with Larry who was thinking about leaving his wife Carol. But Marinoff also says that his methodology in counseling also goes beyond traditional psychotherapy. He calls this method (with some gumption) "The PEACE Process." This is a five step approach to resolving personal problems.

Identify the problem.
Take stock of the emotions that the problem causes.
Analyze the options available.
Step back and contemplate your entire situation.
Reach a state of equilibrium and act on your decision.

Now it is hard to see what is distinctively philosophical about this approach, since it seems applicable to any form of psychotherapy or problem resolution. This PEACE process made me think of what I tell my students in medical ethics classes when examining particular cases, such as, for example, when family members disagree amongst themselves about whether to turn off the life-support machines for their comatose loved-one. This is what I tell them to consider:

Be clear about what the problem is.
Consider what options are available. (This requires creative thinking.)
Weigh the consequences of each option.
Consult your conscience, pray, or consult others (friends, family, clergy, ethicists, your horoscope).
Think it through. What ethical principles are involved? Can you decide which principles are most important?
Come to a decision.
Reflect on your decision and be ready to revise it.

It may turn out that in my teaching, I had already become a philosophical counselor without knowing it. Maybe most psychotherapists are also unwitting philosophical counselors! Marinoff doesn’t think so. When I put this point to him in an e-mail, he replied, "most psychologists to whom I present this schema become lost, if not at the 'A', then certainly at the 'C' and 'E' stages." Marinoff also condemns the way that some psychotherapists make their clients dependent on the therapy. In contrast to much psychotherapy, he emphasizes, philosophical counseling is often finished in just one or a few sessions.

Many of Marinoff’s criticisms of the mental health profession are fair. It is true that many psychiatrists are responding to the pressure put on them by HMOs by simply handing out medication to patients without exploring problems. Psychotherapy is not well regulated, and one hears countless horror stories about therapists who are clearly incompetent or overworked, have too many of their own personal problems, or have become overenthusiastic proponents of the latest fad. Nevertheless, Marinoff tends to draw too strong conclusions from these weaknesses of the mental health profession, and he occasionally paints a rather out-of-date picture of modern psychotherapy. For instance, he stresses that, in contrast to psychotherapists, he never discusses his clients' sexual fantasies or Oedipal complexes. But very few therapists today would raise such issues in ordinary therapy. Marinoff also characterizes psychiatry as obsessed with the categorization of disorders. But psychiatrists use diagnostic categories mainly to fill out insurance forms, and they generally acknowledge the limitations of their classification system. Good psychiatrists know that it is the welfare of the patient that is important, and not what particular diagnostic label that has, for largely bureaucratic reasons, to be given to the patient.

However, my most pressing concern about philosophical counseling is whether and how it really counts as an alternative method to psychotherapy. Marinoff’s criticisms of the mental health profession do suggest that much counseling could be done better, and especially in a more thoughtful, reflective way. Some people will benefit more from a philosophically-oriented therapy than others, in the same way that some people are more suited to analytically-oriented therapy than others. Other people might benefit more from group therapy or psychodrama. Some people simply need some help for them to sort through an ethical problem, and maybe in those cases philosophical counselors are purely consultant ethicists. So philosophical counseling certainly intersects with a variety of already existing therapeutic and consultant practices. But is there something distinctly different about philosophical counseling that separates it from thoughtful therapy and ethical consulting? If so, do we want such a distinctive option?

Any good psychotherapy and psychiatry will inevitably touch on philosophical aspects. These may include, for example, how to deal with the uncertainties of love and trust, when to forgive others and when to hold on to one’s anger, what one should aim for in life, and whether psychiatric drugs make one a different person. Conversely, if a person comes to a philosopher for emotional help, his or her sessions can’t avoid including many of the concerns that occur in traditional psychotherapy, or any process in which one person pays another for help through talking. Furthermore, the difference between philosophical counseling and psychotherapy will diminish as financial pressures tend to push therapy to be briefer, including less focus on exploring a person’s whole past. Indeed, it is likely that philosophical counselors have noticed just this trend, and see the opportunity to capitalize on this change in the therapy market.

There were times, reading through Marinoff’s case examples, when the line between philosophical counseling and mere advice-giving seemed to dissolve. It may have been a result of the compression of long discussions into a few pages, but often the points made seemed simplistic. In many cases, he balances Existentialism (one must take responsibility for one’s position in the world) with Buddhism (one should not worry about what one cannot change). Some judicious combination of these two elements does seem to provide good advice. Consider, however, what he says in response to one client, Susan, a woman in her thirties, who hadn’t yet found the right man to settle down with, and was worried that her standards were too high. Marinoff discusses with Susan the idea of a long-term courtship.

Exploring a relationship slowly could build the basis for something lasting, or at least uncover a sound reason for not continuing the relationship. Susan planned to be honest with potential partners about her need for someone patient in this regard. As a society, we’ve become so permissive that we lack restraint in most areas, including relationships. Everything moves at a fast and impulsive pace. Whatever the benefits of Internet access or air travel, excessive speed is damaging to courtship. If you are looking for someone to lay a foundation for your house, you want the person who’s going to do the strongest, most solid work, not the one who promises to do it overnight.This may be good advice, (although it overgeneralizes a little). Yet how is it different from what one might read in a self-help book or an advice column? Marinoff goes on to back up this passage with a short discussion of Aristotle’s view of happiness, but this "philosophical" addendum doesn’t change the fact that the central discussion of relationships in this case could occur equally well in a completely non-philosophical context. It’s only philosophical in the sense that it is thoughtful, and in that sense, any counseling or advice can be philosophical.

Susan’s case also highlights the worry concerning how difficult it is for a counselor to take a genuinely neutral position. The counselor is in a powerful position, and it seemed at many points that Marinoff could have just as well mentioned a different philosopher from the one he did mention, and the likely conclusion of the discussion could have been totally different. He could, for example, have talked to Susan about the Existentialist idea of Otherness, and how other people are ultimately unknowable, which would have given her a very different perspective. She might have stopped searching for a relationship altogether! These worries about the interaction between the counselor and the client occur in all forms of therapy, so they are not peculiar to philosophical counseling. What this means, though, is that philosophical counseling will have to have more in common with other forms of counseling if it is to seriously address these worries.

In the end, we should not be looking for paradigms of a variety of kinds of counseling, but rather we should simply be looking for good counseling. Different clients have different needs, and of course it makes sense to have counselors with different emphases and areas of specialization. However, too much specialization and compartmentalization is not good. Different skills are best integrated rather than separated.

Marinoff has written a rich book. He aims at a general readership, and so necessarily simplifies many philosophical ideas, but despite this, the book contains a variety of interesting suggestions. I hope that philosophical counseling as a movement will continue to grow, and as it does so, it will become more sophisticated. I have no doubt that philosophical counselors can help some people as much as psychotherapists. As with other forms of psychotherapy, it may not be the theory used by the counselor, but rather the human bond between the counselor and the client that really does the therapeutic work. Nevertheless, philosophers could make important contributions to the way that counseling and psychotherapy are practiced. Plato, Not Prozac! is at least a step in the right direction.

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