The idea of philosophy as a form of therapy has been present since antiquity. In fact, many scholars have argued that Stoic Philosophy is a philosophical form of therapy. Epictetus described a way of living, an ethic with peace of the mind or serenity as the main goal, and was already busy with creating a philosophy that could assist the individual in achieving peacefulness.
Although the possibility of philosophical therapy or counselling has often been ignored by the Anglophone tradition, there are also scholars, some psychologist but mostly philosophers, who recognize that there is a need for an alternative approach to psychological therapy.
The issue is that psychology regards and treats human distress in medical terms – such as stress ‘disorder’– in which observable behavioural symptoms inductively lead to a medical diagnosis. Indeed, psychotherapy and psychopathology operate from an empiricist and medical framework, since its main objective is the determination of an underlying disorder or illness in the concerned individual. Using medical and generalizing terms, such as symptoms and diagnosis, certain deviant human behaviours are externalized and thus objectified.
Conrad and Slodden call this process of redefining previously considered normal human conditions as medical conditions, medicalization. The Diagnostic and Statistical Manual of Mental Disorders (DSM) facilitates this process, since this is the book that psychologists use to define and refine the symptoms and steps for diagnosing mental disorders. The mental disorders in ‘the bible of psychology’, however, are subject to constant change, which indicate that mental disorders are social constructions instead of intrinsic values or properties of the individual. For example, homosexuality was considered an illness 50 years ago. Likewise, the conceptualization of PTSD has been subject to many paradigm shifts throughout history.
The diagnosis of PTSD as trauma labels the individual, and thus categorizes and generalizes him or her into those who have a mental disorder. This process reduces the individual’s identity to a social construct, to a cosmetic reality, to an essence. Sartre would, in fact, argue that this process is alienating and deceiving, since the self is equated to an essence, while “existence comes before essence”.
The aim of this paper is to step away from the diagnosis of the mind in scientific and medical terms, because this reductionist and objectivist model makes fundamental mistakes about the self and objectifies human experience and distress. The reader will therefore be provided with scholarly and literary insights from existentialism on the nature of crises, how to cope with them, and on questions about the nature of the self.
In order to step away from defining human distress in dehumanizing medical terms, such as traumatized and PTSD, a traumatic experience will be equated with an existential crisis. Existential literature has provided us with lessons on how to cope with these kinds of crises. In contrast to psychology, where great emphasis is put on what the traumatic event is, existential literature puts more emphasis on how to deal and cope with the traumatic event. Nietzsche’s metamorphosis of the mind provides very clear steps about how to turn this burden of personal history into a moment of ownership and new beginnings, in which the individual can recreate the self. Calling traumatic events existential crises normalizes the emotional state that goes along with these experiences, which is a necessary step because it allows for self-creation and thus provides a glimmer of hope.
The objective of this paper is to show that applying philosophy to these moments of crisis is more appropriate than going to a psychotherapist. In the case of PTSD, psychotherapy and psychopathology “dehumanize human distress” because the sciences overlook subjective individual experience. There is a need for an alternative model of therapy since the current therapeutic approach in psychology relies too much on a medical model, in which the individual is reduced to a label of mental disorder and is turned into a victim of one’s history.
In this paper, philosophical counselling is proposed as an alternative to existing therapies within the field of psychology. Philosophical counselling is a relatively new field within practical philosophy, which aims to guide the participant through the complexities of life in a philosophical way. Through the art of questioning, interpreting, and understanding, philosophical counsellors aid their visitors in exploring their own paths.
As mentioned before, the idea of philosophy as therapy has existed for almost as long as philosophy has existed. The purpose of this paper is to show that philosophy can be very comforting and empowering in coping with crises or traumatic events.
This paper will therefore argue that the teachings and wisdoms from philosophy, especially existentialism, provide a more humane account of human distress, and therefore that philosophical counselling should be employed instead of psychotherapy. First, psychology and the way it has framed human distress will be problematized from an existential and philosophical perspective. Second, the existential nature of human distress and notions of the self will be brought forward, in order to further demedicalise human distress. Lastly, the possibilities and limitations of philosophical counselling as an alternative to psychotherapy will be explored.
What is the Contemporary Problematic Framework of Diagnosis in Psychology?
The scientific discipline of psychology is based on the logic of induction, in which a series of observations of specific human behaviour lead to conclusions about the identity of a particular human being. Diagnosis, which is also based on inductive logic, is thus implicated in this way of doing research. Diagnosis in psychology relies on the observation and accumulation of pre-defined abnormal symptoms, which are part of a so-called mental health problem. Through the use of these medical terms – observation, symptoms, and diagnosis – a medical model is employed, in which diagnosis is based on pathologies of human behaviour.
Observed symptoms are treated as truth telling about the identity of an individual, within the paradigm of the discipline of psychology. In other words, there is a general consensus on which symptoms are an accumulation of which mental disorders since these are systematically written down in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In this book, mental disorders and diseases are defined and classified based on their symptoms. The DSM provides a contextual framework for psychologists to categorize their observations and justify their diagnosis.
Psychology thus relies on an epistemology of empiricism, since only those behaviours that can be experienced through the senses or observed in experiments are taken into consideration for diagnosis. The premise for this epistemology is that psychologists or psychotherapists draw these observations objectively, since sensory experience justifies observation. Put bluntly, the discipline observes, measures, diagnoses, generalizes and thus objectifies human behaviour.
In contrast to existential philosophy, psychology tends to objectify and “dehumanize human distress”. Dehumanization occurs when a human condition is objectified, meaning that this condition is presented in a physical sense and externalized into an object of study. The condition is externalized and put into medical terms and frameworks of science. In the case of psychological trauma, psychology objectifies stress, agony, or pain after an impactful event. Indeed, Joseph argues that the concept of trauma in scientific literature is problematic since human responses to life, implicating experiences, are pathologised and seen as negative behaviour that should be treated. Due to the discipline’s objectivist and reductionist approach, psychology tends to overlook the individual’s experience and neglects the positive effects a ‘traumatic experience’ can have on one’s life.
Indeed, scholars have argued that Post Traumatic Stress Disorder is a deviant human condition that is medicalized.
The medicalization of mental disorder can be seen as the original case of the medicalization of deviant behaviour […] medicalization occurs when previously nonmedical problems become defined (and treated) as medical problems, usually as an illness or disorder […] medicalization describes a social process—like urbanization or secularization—that does not imply that the change is good or bad.
Psychologists consider human distress after an impactful event abnormal and thus define it as a symptom of a ‘disorder’ that can be treated. So, through the normalisation of behaviour, meaning that some behaviour is normal while others are not, medicalization of deviant or abnormal behaviour after a trauma occurs. Human stress is thus translated and externalized into medical terms, which dehumanizes the specific behaviour.
The same scholars argued that the DSM-V facilitates the creation and recreation of mental disorder, thus aiding the disappearance of previously considered mental disorders – such as homosexuality. “The development of the Diagnostic and Statistical Manual of Mental Disorders became the touchstone and official “bible” for designating mental disorder in the USA and increasingly internationally”. Categorical and conceptual frameworks addressing what behaviour is normal or abnormal define the symptoms of trauma, which are written and updated in the DSM.
Psychology could be considered a normal science since the discipline relies on a tradition of certain assumptions captured in the DSM. As the paradigm changes, these premises are rearticulated accordingly. The psychotherapist treats a traumatized person with a priori knowledge of how the trauma should be solved, thus overlooking individual phenomenological experience in treatment. This is problematic since the individual is framed and defined as a set of assumptions, which is objectifies the individual and limits her freedom.
The History of Diagnosis in Psychology
Today, psychology is defined as the study of the mind, more specifically, the science of human behaviour. Definitions and practices of psychology have changed through time; however, in modern psychology diagnosis is essential.
At the end of the 19th century, Freud created psychotherapy and became the father of psychoanalysis. Psychoanalysis is the treatment of psychopathology through discourse between the patient and the psychoanalyst. Mental disorders were now diagnosed through conversation.
The Freudian gaze both muted and extended the medical model of mental disorder. It muted the biological emphasis by focusing on the intrapsychic nature of mental symptoms but also greatly expanded the notions of mental disease to include hysteria, obsessions, compulsions, homosexuality, drunkenness, sexual deviation, children’s misbehavior among others, as psychological disorders and subject to medical psychiatric treatment.
However, diagnosis in psychology, or psychopathology, has a long history. Psychology used to be considered a branch of philosophy. The early Greek philosophers such as Thales, Plato, Pythagoras, and Aristotle already thought about notions of the psyche or soul. The Stoics were already busy with questioning the nature and structure of the mind, and wrote the first philosophical self-help book. Although the roots of mental illness and their explanations are found in the Greek period, sociologists argue that the medical diagnosis of mental disorder originated in the early nineteenth century.
In 1812, Benjamin Rush was the first one who was convinced that physicians should guard or take care of ‘mad’ people. This was a fundamental change, as those who performed abnormal behaviour were just considered different and were allowed to live among the normal people in the time before Rush. Since ‘The Father of American Psychiatry’, medical diagnosis of human behaviour has been prominent in institutions. During this time lying, crimes, and alcoholism, for example, were human behaviours that fell under the category of madness.
As mentioned above, the DSM became the main tool for designing and redesigning the diagnosis of mental disorder. The number of mental disorders and diagnostic features grew immensely throughout the five editions. The most recent edition, the DSM-V, includes 297 diagnosed mental disorders and covers more than 900 pages.
This [great number of mental disorders] reflects a proliferation of diagnoses including a greater range of human behaviour. […] Psychiatric diagnoses are not necessarily indicators of objective conditions but are better seen as a product of a negotiated interactive influenced by socio-political factors. […] Diagnoses related to behaviour or cognition are frequently contested or controversial, but inclusion in the DSM reflects that the condition is legitimated as a medical disorder. While the DSM by no means includes all human conditions that are medicalized, it is a diagnostic repository of legitimated psychiatric conditions.
Thus, the history of the medical diagnosis of human behaviours has evolved since the 18th century. The emergence of the DSM legitimizes the diagnosis of human behaviour. Since the bible of psychology is subject to constant change according to the spirit and belief of the time, we could say that diagnosis relies more on external factors than on factors intrinsic to the individual.
Paradigm Shifts in the Conceptualization of Trauma and PTSD
The most recent version of ‘the diagnostic bible of psychology’, the DSM-5, classifies PTSD as a ‘trauma-and stressor related disorder’, in which “exposure to actual or threatened death, serious injury, or sexual violence” leads to a set of distressing symptoms that endure for more than one month. These distressing symptoms are “clustered in predefined categories of re-experiencing, avoidance, negative alterations in cognitions and mood, and marked alterations in arousal and reactivity”. According to the DSM-V in the case of PTSD, re-experiencing entails reoccurring, often involuntary, memories and dreams of the traumatic event, which are also called flashbacks. These ‘symptoms of intrusion’ are avoided by the subject through the repression or avoidance of external cues and feelings, memories, or thoughts about the traumatic event. Additionally, the subject experiences an inability to remember parts of the event, to experience positive emotions – e.g. happiness – and to let go of persistent negative emotions. Moreover, subjects suffer from sleep disturbances and feelings of detachment. Diagnosis of PTSD relies on these symptoms. Additionally, PTSD is related to other psychological deviancies, such as depression, anxiety disorder, and psychotic disorder.
In short, the discipline of psychology defines PTSD as a series of deviant behaviours after a seriously stressful event. This group of behaviours is considered undesirable and abnormal, and therefore serves as symptoms. Psychologists label those who experience these symptoms as being mentally ill, which is in this paper considered problematic from a philosophical point of view. But first, let us explore the many shifts in the conceptualization of trauma and post trauma behaviour, which will indicate the constructive nature of the diagnosis of people who are ‘mentally ill’.
In 1980, PTSD was included for the first time in the DSM-III and this represents, according to Jones and Wesseley, a paradigm shift in the conceptualization of post trauma behaviour into an illness. This research found that mental health professionals continuously “reinterpreted psychological trauma in response to wars, disasters and cultural undercurrents”. In other words, besides the assumed psychological and intrinsic component, there is an important sociological, external factor in the conceptualization of trauma and post-trauma behaviour.
In the early 20th century, trauma was usually conceived of as physical injury. In the aftermath of the Franco-Russian War (1870-1871), it was the first time a hypothesis was stated that a terrifying event might have other effects besides the physical injuries. Charcot was the first to define a set of distressing symptoms including: “palpitations, exhaustion, chest pain, dizziness and fainting, headache, back pain, trembling of the hands and neck, difficulty sleeping and mental disorientation”, as ‘‘névrose traumatique’’ and ‘‘hystérie traumatique’’ where a distressing event or a war served as a trigger for the development of these disorders. Charcot’s student, Pierre Janet, “suggested that subconscious fixed ideas (‘‘idee fixe subconsciente’’), established at earlier periods in the subject’s life, were responsible for neurotic symptoms seen after a traumatic event”. In other words, certain subjects where genetically predispositioned for attaining a traumatic neurosis, and the traumatic event merely served as a trigger.
Sigmund Freud and Joseph Breuer used and expanded these ideas of a traumatic neurosis in their paper Psychical mechanism of hysterical phenomena. “Having identified fright, heightened by surprise, as the driving force, they too argued that the crucial factor was not the event itself but the ‘susceptibility of the person affected’”. It was also suggested that the patient was unaware of the trauma that affected these symptoms. This is where a notion of causality comes into play; those that both have been exposed to distressing events in early life and have a predisposition are more sensitive for a traumatic experience to serve as a trigger to become neurotic. Freud proposed a way to cure this neurosis, “once the emotion attached to the memory had been discharged, Freud believed, the patient would be cured”. The notion of being cured indicates the first signs of the pathologization of altered behaviour after a terrifying event.
In the decades after, multiple wars were fought: The First World War, the Second World War, and the Vietnam War. Interestingly, after each war, traumatic neurosis was redefined. It was not until 1980 that PTSD was explicitly mentioned. Back then; they defined it as ‘post-Vietnam syndrome’ or ‘delayed stress syndrome’.
Additionally, in the first half of the 20th century, theories of mental breakdown were framed within the dynamics of the group instead of the individual. Concepts such as the ‘herd instinct’ were brought into the discussion of the cause of trauma neuroses.
Described in 1908, but given impetus by World War One, Trotter (1919) argued that an individual should not be conceived in isolation as an autonomous being but as a gregarious animal whose ‘‘cardinal mental characteristic . . . is his sensitiveness to his fellow members of the herd’’ (p. 148). External threats, such as war, he believed, gave an intense stimulus to the herd instinct, while the ‘‘virtues of the warrior’’, courage, endurance and enterprise, were grounded in the ‘‘homogeneity of the herd’’ (p. 150). It followed, therefore, that those who broke down were in some fashion abnormal and some argued that a ‘‘weak herd instinct’’ could be detected in many soldiers who were diagnosed with shell shock.
In other words, before 1980, trauma was understood as a failure of group dynamics. “Until the Vietnam War, war neurosis was often conceived as a failure of attachment and identification with the group”. Those who were unable to conform to standards of behaviour, meaning those who did show any signs of stress after the intense event, were considered as outcasts. After 1980, the focus switched from the group dynamics to the individual. It continued to be believed that those vulnerable to mental disorder were more likely to develop a mental disorder with regards to their trauma as compared to those who are not.
The shifts in the paradigm of the conceptualization of trauma are thus, according to Jones, related to sociological factors such as war or any other terrifying events. As shown in the previous sections, the notion of trauma and PTSD is subject to continuous change due to external social factors in the discipline of psychology. Consequently, the mental disorder is not necessarily part of the individual, as the discipline presents it, rather, the condition is just a mere reaction to the environment, which has become a significant behaviour in psychology. Trauma or PTSD is thus not intrinsic to the individual; rather the disorder and notion is a social construct subject to change, which must never be equated to the reality of the individual, as it objectifies and individual and impedes her freedom.
What We Can Learn from Existentialism and What Is Trauma in an Existential Framework?
Lessons from Existential Literature
From an existentialist perspective, a traumatic experience could be equated to an existential crisis. An existential crisis is triggered by a life changing event, or more specifically, when someone’s moral framework collapses. The second existential period, which started when Darwin published his famous work The Origen of the Species in 1859, is characterized by a fall of the Christian paradigm. This meant that dominating rules grounded in Christian thinking that defined human nature and human conduct fall away. It is a fall of absolutisms. During the demolishment of one’s absolutisms, big questions of life arise. Who makes the rules now? What is justice? What is morality? Who am I? What do I want? If God is no longer a consideration, how should the individual act?
To phrase it differently, an existential moment is stress or a catastrophe in kosmos. As opposed to phusis, which is the nature or materiality of things, kosmos is the world of ideas, context and morality. Kosmos is the mental reality in which meaning is created. In an existential moment, all points of reference with regards to meaning, morality and human nature are suddenly gone. An existential moment, and the cosmic crisis it leads to, is a unique opportunity to redefine and rethink your morality.
In existential literature, this moment of distress is framed as a possibility to take ownership of your life. In contrast to psychology, in which the crisis of the individual is medicalized, existentialism regards this moment as an opportunity for self-creation – and development. The wonderful philosopher and existentialist thinker Friedrich Nietzsche describes the quest for self-authenticity during cosmic stress.
In Thus Spoke Zarathustra, Nietzsche proposes a metamorphosis of the mind in which true ownership of one’s life can be achieved. There are three stages: the camel, lion, and child. The camel walks around with a hump, which symbolizes the burden of culture. This burden of culture could be interchanged with a burden of personal history, or the burden of trauma. This burden involves one’s kosmos, which includes: one’s name, gender, parents, religion, state, and all the rules of conduct that embody these influences that determine one’s identity. The individual does not choose these influences; rather, they are imposed factors that govern the individual’s life. Nietzsche invites us to lose this imposed paradigm, and to take ownership of our life. By entering into the stage of the lion, you become aware of the baggage that you are carrying around. You become aware of the past that you are embodying. While, it is not you, it is cosmetic. You become aware of the edges of the framework you are carrying with you. When the lion is aware of his imposed baggage, his task is to push this away. In other words, you challenge your kosmos; you, for example, challenge your name, your gender, or your past. Nietzsche makes the analogy of the lion fighting the dragon, which must be done in solitude. During this battle, certain factors in one’s kosmos are affirmed while others are denied. For example, one may choose to keep his or her name and gender, but at the same time decides to never see his or her family again. The Zarathustrian moment is the moment of true ownership of one’s life, which occurs when the imposed paradigm is fully contested. Then, the last stage is entered: The Child. This last stage of Nietzsche’s metamorphosis is characterized by new beginnings. It is a stage of purity, a stage where one may choose his own framework. It is a moment of self-creation. The metamorphosis of the mind is completed.
This metamorphosis of the mind could be applied to the concept of trauma. A traumatic experience is a burden and part of one’s identity that the person carries by choice. At first, the person might not even know she decisively carries a trauma with her. During this process of becoming aware, she has the possibility to choose whether she still wants it to be part of her life and identity or not. During the stage of the Lion, it seems completely natural to exhibit distressed behaviour, since one becomes aware of the way she is constructed. The stage of the Lion provides an opportunity for an existential crisis and thus a moment in which one can own her life. When she succeeds in challenging and fighting her personal history, there is an opportunity for self-creation, where everything is possible.
Likewise, the psychologist imposes a ‘kosmetic’ identity on the individual diagnosed as mentally ill, which must be questioned according to Nietzsche’s metamorphosis in the mind. One must constantly challenge the identities imposed on them in order to remain authentic and free. Diagnosis of mental disorder, such as PTSD, limits individual freedom and development. The unauthentic diagnosed individual embodies the identity of being mentally ill. Authenticity requires the challenge of the diagnosis of mental disorder. The self must not be equated to illness or brokenness, since there are no rules that define the limits of the self. It is an option if one may choose to be defined in these terms, but it should not be the default for defining the self after a traumatic experience.
Problematizing the Scientific Notion of the Self from an Existential Perspective
Since the early history of philosophy, there has been a debate about what the self is. This seems like an easy question; however, it is quite difficult to give the exact answer. In this on going debate, there are basically two camps. One camp defines the self as something fixed. In this case, there is a core self throughout one’s lifetime that does not change. In this camp, the self is conceived as a permanent quality to the individual. There must be a fundamental core that defines the self in every individual. Psychopathology and the medical diagnosis of deviant human behaviour relies on this framework of the self. It is a framework of the self in which the self is put in between brackets where the limits of conduct are defined. However, in existentialist philosophy, the self is generally seen as something fluid. Heraclitus, an ancient philosopher from the first existential period, is on this camp; he provides a metaphor in order to explain his case for the self as an ongoing process. According to Heraclitus, life is like a river. Every peak, descend, or bend of the river, is part of the flow of life. Nature is in a constant flux. Plato, in the Cratylus (402a), says: “Heraclitus says somewhere that everything is moving and nothing stays still, and likening things to the flow of a river he says that you could not step twice into the same river .“ We cannot step into the same river twice. This is because the river is constantly changing. The exact water one steps into at the first time, will have flowed away further in the river when another entry in the water is made. The river you stepped into for the first time is different from the river you stepped into the second time. The river is in a constant flux. So are we humans, as we are according to the monist Heraclius, by necessity part of the materiality of nature. We are living organisms, who live a biological life: a life of birth, flourishing, decay, and death. We are changing beings and part of the flux of life. When we step into the river, not only the river changes so do we. Moreover, what is it that a river is? Is it the water? The riverbed? The flow? Indeed, it is highly difficult to point out what the core of a river is, likewise for the determination of a core self. Or as Herman Hesse in his Steppenwolf regarded this debate: there is not one soul but one has more than a thousand souls.
Jean-Paul Sartre agrees with the ancient philosopher Heraclitus. He regarded the self as a fluid and ever changing quality. Kate du Toit interprets Sartre’s philosophy of self-consciousness: “there are no predefined patterns of human nature but rather, existence precedes essence meaning that we are dynamic in nature and free to create ourselves in any way we wish within the givens of our existence”. Indeed, ‘existence precedes essence’ served as a doctrine for his thought. It is applicable to the discussion of the self too. The only thing you are is what you are. You would deceive yourself if you would say that you are a waiter. You can never say; ‘I am depressed’ or ‘I am traumatized’. These are all masks you put on that give you identity. These masks are logically incorrect: if person A equals himself with B, it follows that A=B. The only thing that would be correct is A=A. I (A) am (=) a traumatized person (B), is thus logically incorrect, because A and B will never be the exact same thing.
By equating the self to another concept or essence, one’s true reality is denied. Remember, Sartre’s dogma existence precedes essence is used in his reasoning. He says that to refer to an essence when describing the self is self-deceiving because there is nothing about the self that has a deeper meaning or essence that can be unravelled. In fact, Sartre is addressing an issue of metaphysics and ontology. Essences operate in the cosmetic nonphysical realm, while existence or being functions in the ‘lower’ form of reality; the physical world. There is a hierarchy in this dualism. Sartre disagrees with referring to the self in ontological and essential terms. The diagnosis of an individual with a mental illness such as PTSD or depression is therefore self-deceiving.
Freud aimed to justify that individual experience and trauma are fixed in one’s psyche. He does this by proposing splits in the human psyche: the superego, ego, and id; and the unconscious and conscious. The superego is the parental part of the psyche, which has a moral component including what society expects you to do. The id is the deep and hidden part of the self. It is where the raw, animalistic, instincts live. The ego lies in between the superego and the id. It is the centre of the self, which makes choices; it moderates between what the body desires and what society expects you to do. The unconscious realm of the mind is symbolized as a basement; it is deep, dark, and hidden. Memories that must be repressed and traumas, according to the Freudian model of the psyche, are located in this unconscious realm. These can float to the conscious realm and then come to an expression of neuroses. Freud thus designed a limiting and rather causal framework of the self, in which deviant behaviour could be justified as something intrinsic to the individual.
In contrast to Sartre and Heraclitus, science and psychology regard the self as a rather fixed and predefined entity, as a property between brackets: [x]. The brackets/framework of the self is defined, and when this framework is exceeded person [x] is equated to being mentally ill. In cases of ‘disorder’, person [x] is sick or broken. A cannot be B; A is A. In the scientific discipline of psychology essence precedes existence.
In existentialism, however the self would not have any predefined brackets. The individual lives in a monist closed system in which the individual has the absolute freedom and mobility to redefine and create the self. This created self cannot be equated to a non-physical concept such as a mental disease, since existence precedes essence. Psychology equates the person and his or her identity to a mental state. Rather, in existentialism it would be more appropriate to say that person x acts abnormal, which indicates impermanency and process.
The Existential Nature of Trauma: Crisis and Injury
“The word ‘trauma’ derives from the Greek word ‘trayma’, which means wound or injury”. Indeed, in the beginning of the 20th century trauma was seen as a physical wound, and not yet as a psychological thing. Today, it is still used in the medical profession as a physical injury, however, in the discipline of psychology ‘trauma’ is used in a metaphorical sense, as it does not necessary involve materiality. In other words:
Human responses to aversive experience are not analogous to a physical trauma: people do not passively register the impact of external forces (unlike, say, a leg hit by a bullet); rather, they engage with them in an active and problem-solving way. Suffering arises from, and is resolved in, a social context: shaped by the meanings and understandings applied to events, evolving as the conflict evolves. It is subjective appraisal that determines what a stressful event means: one man’s [sic ] trauma is another’s heroic sacrifice.
Thus, physical and psychological or metaphorical trauma may not be confused, since it could be oversimplifying the individual subjective experience. By using the word ‘trauma’ there is a danger of seeing it as a generalized psychological injury. In fact, Thompson and Walsch argue, “[…] a traumatic experience can be understood as an assault on the self”. A traumatic experience can cause the individual to lose the sense of who he is. In a way, one’s selfhood is challenged.
Trauma can therefore be seen as an existential injury, insofar as it can damage, distort or even destroy our sense of self and how we fit into the wider world. It undermines the basis of our existence, severely altering how we see the world and how we make sense of it — in effect, destabilising or even shattering our frameworks of meaning, our spiritual and existential foundations.
In other words, traumatic experiences are like existential crises. In both instances, absolutisms are shattered. In order to challenge the notion of trauma as a medical and generalizing deviancy, Du Toit proposes to call a traumatic experience a crisis. The coined term ‘crisis’ takes away the medical aspect of feeling distressed with the world around you and values the individual. This crisis is existential in nature, since it “challenges one’s existing ways of being-in-the-world by evoking the so called ‘big questions of life’”. Yalom defines this crisis as a boundary situation, which is “an urgent experience that propels one into a confrontation with one’s existential ‘situation’ in the world”. This existential situation refers to the sudden awareness of the uncertainty of human existence; a dreadful nauseating feeling that involves death, meaninglessness, isolation, and freedom. These uncertainties of existence are usually covered up with narratives of certainty, but when one experiences something in which tone’s existence becomes uncertain, this uncertainty and the distress accompanied comes to light, which scientists and psychologist reduce to a medical problem.
According to Du Toit, the reductionist and objectivist approach taken by psychologists and scientists overlooks subjective individual experience. Strictly adhering to this oversimplification of trauma may shut down the possibility of a diversity of experiences, denying many individuals the existential nature of such traumatic responses, thus stifling their ability to emotionally process their experience in purposive and meaningful ways.
In contrast to this generalizing scientific framing of human distress, existential literature values individual experience. Existentialism regards human distress as being part of the daily dilemmas of human existence. This does not mean that the value of agony should be downplayed, but it rather means that everybody will encounter this moment of crisis where absolutisms falls down. Since, “it is in the essence of emotional trauma that it shatters these absolutisms, a catastrophic loss of innocence that permanently alters one’s sense of being-in-the-world”. In moments of crisis in the kosmos, the framework through which one perceives the world is shattered.
Indeed, for those who are sensitive, a traumatic experience could destroy certain absolutisms in one’s life. For example, a child who suffers from child abuse could experience a shattering of his framework of how a family should be. This loss of an absolute or framework, may it be personal or social, brings with it a feeling of grief.
Attig (2002) writes of two types of pain that people experience when they are grieving: soul pain, which refers to the pain of losing our sense of rootedness in our everyday normality; and spiritual pain, which refers to the suffering involved in losing our sense of transcendence, leaving us dispirited, joyless and hopeless. Trauma, as a grief inducing experience, produces the same reactions—soul pain and spiritual pain. Both can be related to the existentialist concept of ‘ontological security’.
This concept of ‘ontological security’ is used to determine how secure one is with her identity and whether one is secure or confident in challenging the harmful events that are inevitably part of human existence. Since in existentialist philosophy the self is generally conceived as something fluid; identity in this context should be conceived of “as a linking thread of meaning that connects past to future”. Trauma, as in grief, distress, or pain, could demolish this linking thread, and thus one’s ontological security.
Unlike the medical model’s narrow and simplistic stimulus response model of trauma […], the notion of crisis places phenomenology at the heart of the experience; it is neither the essence of a traumatic event nor symptoms that are of primary importance, but rather one’s inner reception of the experience, alongside how one contains, reflects on and acts upon it.
In existentialism, it is about how one deals with crises and there is less focus on the traumatic event that took place in the past. Rather the focus is on how the individual copes with a crisis and is in this sense more future based.
According to Kate du Toit, we should not only regard a traumatic experience or crisis as something negative that has to be repressed. Although it can be a painful path, we should regard a “crisis as an opening of existence in which the individual has the opportunity to take stock of their life on a deeper level”. Although this path can be very painful, it provides a possibility to re-create oneself. One will possibly be better in dealing with the challenges of human existence than another. However, there is some potential or gift in traumatic experiences or crises.
The suicidal crisis, depression, or any period of severe suffering constitutes a break in the continuity of life. It disrupts life goals and plans and causes disarray in our beliefs, hopes and dreams. Yet in every such fissure, a gift can also be found, the gift of new understanding that comes from such a rift in our lives. In helping to find this gift we help prevent the experiences of suffering from being superfluous and worthless. The gift can take many forms. It can be a new outlook on life, true maturity, increased understanding of others, the satisfaction of being able to withstand the suffering and survive it, or the ability to share and teach others what one has learned. Recognizing the gift in any hardship gives meaning to the suffering. It can turn weakness into strength, inferiority into pride, and the sense of helplessness into potency.
So, while at the same time there is a story of sadness, grief, anger, loss, and despair; the way existentialist philosophy regards trauma provides a glistering of hope and positivity. Through the metamorphosis of the mind, as proposed by Nietzsche, an individual first becomes aware of one’s suffering. This can be a painful and sad process, and one’s ontological security might be affected negatively. However, after one’s cosmic identity is challenged or fought, there is a place for new beginnings. Existential crises provide a unique possibility for the individual to rephrase his or her own worldview, including his or her identity. New beginnings are times of nothingness and shapelessness, which provides true freedom to give form and meaning to one’s life.
Proposing an Alternative: Philosophical Counselling
Issues With Psychological Counselling and Psychotherapy – The Need for an Alternative
Although the medical framework of trauma provides a useful language to speak about the psychological phenomenon, the loss of depth implicated in psychology ensures that individual experience is overlooked. Due to the objectivist and reductionist approach, the individual’s distress and pain is framed within a discourse that is dehumanizing. In fact, the current therapeutic framework of psychological trauma prevents those affected from exploring ways for personal growth, as a crisis could serve as a catalyst for self-development and self-creation.
If we strictly adhere to the absolutisms inherent within the medical model of our field, we run the risk of potentially shutting down our clients thus preventing them from the possibility of discovering new ways of being-in-the-world that facilitate resilience and growth.
Kate Du Toit, who is a psychotherapeutic counsellor, recognizes that there is a need for an interdisciplinary approach to explore and further explain and specify human distress. Throughout her research, she repeatedly mentions that existentialism can make significant contributions to the ways in which therapeutic institutions conceptualise and treat notions of trauma. She recognizes that there must be “an interdisciplinary dialogue between scientific observation and experiential domains, between art and science, and between doing and being”.
Instead of relying on diagnosis of behaviour and thus equating the individual to a broken or ill something, there is a need for an alternative approach. Psychology fails to listen carefully to those that are in crisis; instead, they become reduced to objects of study. Thus, there is a need for an alternative approach that does not regard and judge the distressed individual from an assumed ‘objective’, ‘truthful’ and ‘essential’ perspective. There is a need for an alternative approach that does not dehumanize and reduce the individual to a medical object of study. There is a need for an alternative approach in which the counsellor listens to the counselee, in which power relations are diminished, in which the counsellor does not claim to speak the objective truth about the counselee.
In this section, an alternative to psychotherapy and psychological counselling will be proposed: philosophical counselling. The possibilities and limitations of the relatively contemporary movement in practical philosophy will be examined accordingly.
Philosophical Counselling: a New Paradigm
Philosophical counselling and practice emerged as a new paradigm from a critique on psychotherapy and academic philosophy from 1970 onwards. Although the new field of practical philosophy meets some of Kuhn’s requirements of paradigm – such as theory, examples, meetings, journals – consensus is lacking on what the nature and methods of philosophical counselling or practice is exactly. Hartelow defines philosophical practice as “the work of a philosopher in a spoken dialogue with people who do not need to have (academic) training in philosophy”.
Hartelow addresses this question in his research and states that there are “three basic competences for philosophical practice: (i) the art of questioning, (ii) the art of interpreting and (iii) the art of understanding”. These competences are arts since they are skills acquired during a study in philosophy. These are not just competences to get a conversation going, as they are grounded in a tradition of philosophy. In the next pages, philosophical counselling will be analysed according to these three competences.
The Art of Questioning
Philosophical counselling relies on the Socratic tradition of daily philosophical inquiry. The ancient philosopher, known through Xenophon and Plato, guided the youth in reflecting, questioning, and making sense of relationships, love, values, emotions, justice, death, life, and so forth. Socrates assisted in giving their lives philosophical meaning and taught them the art of living through discussion, which made life less unbearable.
From a Socratic perspective, philosophical counselling can be viewed as a conversational process guided by dialectical reasoning aimed at reflecting upon concerns and issues that normally arise in the course of living your life—as well as on the meaningfulness of your life as a whole.
Today, those who have existential concerns about the meaning of suffering and death are either expected to repress these thoughts or sent to the psychotherapist for treatment. Rather than contributing to the oppression of existential crises, philosophical counselling aims to guide one philosophically through these terrifying questions of everyday life.
The philosophical counsellor requires “a Socratic attitude of ‘not-knowing’”, which involves questioning the obvious in order to break away from any absolutisms, so that the visitor will come to an authentic reconstruction of his worldview and attitude. By posing the right questions, the visitor and the philosophical counsellor together come to a philosophical and critical understanding of the problem. This understanding is not a final solution to the posed issue, but rather a final philosophical question of the problem, which does not need to be answered. This philosophical questioning liberates the visitor from any preconceived dogmas and leaves the visitor with a philosophical and critical attitude.
The Art of Interpreting
The working model of the tradition of interpreting in philosophical practice is the translation of the words of the visitor into philosophical terms. The translation of everyday problems and crises into philosophical terms is a Stoic tradition. First the concerns of the guest are translated into philosophical terms, and then philosophical examples are given in order to support the philosophical translation of the problem. This translation does not necessarily solve the problem, but rather changes and improves the language and dialogue.
Lou Marinoff gives an example of philosophical interpretation in counselling. A conservative mother and rather free minded daughter walk into her practice. The mother wants her daughter to change her lifestyle. Instead of judging them pathologically, Marinoff diagnosed them philosophically in terms of absolutism and relativism. The conversation completely changes. First the conversation was about who was right or wrong, then the subject of the conversation turned into the objectivity/subjectivity of values.
Although one could argue that the interpretative tradition in philosophical counselling is rather therapeutic since it translates the visitor’s issues into medical terms such as signs, symptoms, and diagnosis, this is only in its form and not in its content. The content is strictly philosophical and not medical. The art of interpretation aims to translate the visitor’s issue into philosophical language, so that the dialogue changes and improves in such a way that the crisis finds some comfort.
The Art of Being/Understanding
Philosophy is first of all a way of living. Wisdom can have no other origin or locus than the personal way of living of this or that philosopher here and now. Support for this position can be found in ancient Greece at the very dawn of the western philosophical tradition.
Philosophical counselling retrieves the original meaning of philosophy: the love for wisdom. Besides the common conception of philosophy as a bulk of knowledge or as a discipline at the university, philosophy is a way of life or as Heidegger puts it “…the Greek word philosophia [φιλοσφία] is a path along which we are traveling”. Seeing philosophy as a way of living instead of something capitalised, is fundamental for comprehending the practice of philosopy. “In [the art of] understanding, a counsellor connects philosophy to the life of a guest, so that it explains a development, a choice or a lifestyle […] philosophical practice is a way to deal with life, referring to a lifestyle, an art of living”.
Philosophical counselling aims to guide and understand those who have troubles with those finding their ways in the complexities of life. A philosophical practice, which was firstly introduced by Achenbach, differs from religious practices and practices of psychology in two ways: first the practitioner is an academic philosopher, who completed a university master in philosophy; secondly the practitioner shares the visitor’s problem empathically, meaning that the visitor’s issue is made their own. In philosophical counselling, empathic understanding replaces the distancing medical diagnosis.
Thus, in philosophical counselling, the practitioner takes the individual’s experience seriously. The practitioner aims to understand the visitor’s distress. Achenbach, who is one of the founding fathers of practical philosophy, designed his hermeneutics of philosophical practice: hermeneutische Eros, which has been translated by Schuster into an “erotics of understanding”. In contrast to psychotherapy – in which the visitor is framed within a medical paradigm of diagnosis, which implies unravelling an underlying hidden essence – interpretation in philosophical counselling is framed within a context of understanding and of empathy.
Philosophical Counselling as an Alternative to Psychotherapy: The Case of Trauma/PTSD
Some scholars have argued that the difference between psychotherapy and philosophical counselling is minimal, since philosophical counselling borrows techniques from psychology. Indeed, certain ideas are borrowed which shape the way in which philosophical counselling is performed. However, psychology fails to include virtues and lessons of philosophy in their advice. So in philosophical counselling the form might be therapeutic, the content, however, is completely philosophical.
It is problematic that in psychology emotional distress during or after a crisis is considered ‘disorderly’. Emotional distress cannot be considered as being ‘in order’ as in being part of everyday life. This distress evokes existential and ethical questions, which are often ignored in psychotherapy and psychological counselling where the focus mostly lies in feelings or emotions of the patient. Schuster argues that it is in fact very normal to feel distressed and insecure, and that philosophy is perfectly appropriate to find comfort, consolation, and hope in times of crisis. Philosophy does not offer universal or absolute answers to the visitor’s questions of terror and distress; philosophical counselling rather offers a way to think differently about these personal issues.
Adding a medical aura to strong feelings, such as ‘clinical’ depression and stress ‘disorder’ and supressing these by the administration of drugs can cause a psychological blindness towards the self. Instead of giving the feelings a clinical name, philosophical counselling aims to comfort the visitor in having these feelings. It is okay to feel stressed after a crisis. Indeed, instead of ‘patient’ or ‘client’, philosophical counsellors prefer to use ‘visitor’ or ‘guest’. This takes away the medical and dehumanizing air of counselling.
Moreover, rather than claiming to speak ‘scientifically proven’ and objective truths, philosophers have an awareness of the fact that multiple interpretations are possible. In contrast to scientific therapies in which the therapist is in the powerful position to judge the patient’s identity, philosophical counselling is based on questioning, interpreting, and understanding.
These three competences of philosophical counselling are used in circularity; a series of questions lead to a series of answers, which must be interpreted and understood, and then questioned again. This stimulates critical thinking, and offers a dynamic path to exploring the questions of life in times of shattering of absolutisms. Philosophical counselling in this sense aids their visitors in undergoing a metamorphosis in their minds, with freedom as the ultimate goal. “Philosophical practice offers, at least potentially, what philosophy itself was to offer: freedom from the pre-conceived, the ill-conceived, the prejudiced, and the unconscious”.
The aim of this paper was to show that philosophy is a perfect alternative for thinking about and coping with human distress. In this paper, philosophical inquiry into emotional distress is argued to be more appropriate and less dehumanizing than the ‘objective’ scientific approach to human behaviour in the discipline of psychology. Psychology medicalizes and pathologizes deviant human behaviour, which is subject to changes in society. This indicates that mental disorders, more specifically PTSD and being traumatized, are social constructs. The process of diagnosing an individual with psychological trauma objectifies a person because the individual is made a victim of his history and is reduced to a mental disorder or concept. Psychology thus makes fundamental philosophical mistakes about the self. Through the diagnosis of mental disorders psychology deceives their patients’ selves by equating them to a mental disorder, to a higher reality, to an essence, while in fact I have argued that existence precedes essence.
Besides the common perception of philosophy as an academic bulk of knowledge, there is an original conception of philosophy: philosophy as a way of life. Philosophy is a path along which those who love wisdom are travelling. To live a philosophical and Socratic life is to invite others to question everything that is taken for granted. This paper has questioned the dominant and scientific conceptualization of human distress by applying philosophy.
Teachings and wisdoms from philosophy, especially from existential periods, have shown to be very comforting and helpful during impactful events. In contrast to the authoritative and judgemental nature of psychotherapy, philosophy allows the individual to explore his or her own paths for self-creation, thus recognizing the positive aspects of being in a crisis.
Consequently, philosophical counselling has been proposed as an alternative to psychotherapy since its purpose is not to supress the emotions, worries, thoughts, and terrifying questions of life, but to guide the concerned participant through this phase of distress. The philosophical counsellor has mastered the art of questioning, interpreting, and understanding, and employs these masteries to guide the visitor to a critical and philosophical attitude towards the problem. This attitude allows the visitor to question the previously considered serious, and in some cases, pathological, personal issue from a relativist philosophical perspective. This allows the individual to take charge of her life, instead of hiding behind the identity of being mentally disordered.
Although this research aimed to be as inclusive as possible, the critique on psychology was mostly focussed on psychotherapy, psychopathology, and psychoanalysis, while there are many other branches of psychology that were not discussed in this paper. This is a limitation of this paper. Suggestions for further research would therefore involve looking at different types of psychology, including more recent forms of psychosocial therapy.
 Christopher Gill, “Ancient Psychotherapy.” Journal of the History of Ideas (1985), 307; Konrad Banicki, “Philosophy as Therapy: Towards a Conceptual Model.” Philosophical Papers 43, no. 1 (2014), 10.
 Epictetus, Discourses and Selected Writings (New York: 2008), 221-245.
 Kate Du Toit, “Existential Contributions to the Problematization of Trauma: An Expression of the Bewildering Ambiguity of Human Existence.” Existential Analysis: Journal of the Society for Existential Analysis 28, no. 1 (2017), 172-173; Banicki, “Philosophy as Therapy: Towards a Conceptual Model”, 8; , Shlomit C. Schuster, “Philosophy as if it Matters: The Practice of Philosophical Counselling.” Critical Review 6, no. 4 (1992), 588.
 Peter Conrad and Caitlin Slodden, “The Medicalization of Mental Disorder.” In Handbook of the sociology of mental health, Springer Netherlands, (2013), 62.
 Ibid., 65.
 Edgar Jones and Simon Wessely. “A Paradigm Shift in the Conceptualization of Psychological Trauma in the 20th Century.” Journal of anxiety disorders 21, no. 2 (2007), 165.
 Jean Paul Sartre, “Existentialism and Humanism,” in Existentialism from Dostoevsky to Sartre, ed. W. Kaufmann (Pickle Partners Publishing, 2016), 348.
 Du Toit, “Existential Contributions to the Problematization of Trauma” 167-168.
 Du Toit, “Existential Contributions to the Problematization of Trauma”, 167-168.
 Conrad and Slodden. “The Medicalization of Mental Disorder,” 62.
 Ibid., 65.
 Ibid., 63.
 Epictetus, Discourses and Selected Writings New York: Penguin, 2008.
 Conrad and Slodden. “The Medicalization of Mental Disorder”, 62.
 Ibid., 63.
 Ibid., 63-64.
 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub, 2013, 271
 Du Toit, ‘Existential Contributions to the Problematization of Trauma’, 168.
 American Psychiatric Association, DSM–5, 279.
 Jones and Wessely. “A Paradigm Shift in the Conceptualization of Psychological Trauma in the 20th Century”, 164.
 Ibid., 166.
 Ibid., 166.
 Ibid., 166.
 Ibid., 173
 Du Toit, ‘Existential Contributions to the Problematization of Trauma’, 167-168.
 Friedrich Nietzsche, Thus Spoke Zarathustra Harmondsworth: Penguin Books, 1961
David Aiken, “Nietzsche” Lecture, University College Roosevelt, Middelburg, February 17, 2017
 Hermann Hesse. Steppenwolf. London: Penguin, 2012, 68.
 Du Toit, ‘Existential Contributions to the Problematization of Trauma’, 167.
 Daniel L. Pals, Eight Theories of Religion. Oxford University Press, USA, 2006, 56-61.
 Neil Thompson, and Mary Walsh. “The Existential Basis of Trauma.” Journal of Social Work Practice 24, no. 4 (2010), 378.
 Derek Summerfield, “12 Cross-cultural Perspectives on the Medicalization of Human Suffering.” Issues and Controversies (2004),241-242.
 Thompson and Walsch, “Existential Basis of Trauma”, 378.
 Ibid., 379.
 Du Toit, ‘Existential Contributions to the Problematization of Trauma’, 169.
 Irvin D. Yalom, Existential Psychotherapy. Basic Books, 1980, 159.
 Du Toit, ‘Existential Contributions to the Problematization of Trauma’, 170.
 Ibid., 169.
 Robert D. Stolorow, “The Phenomenology, Contextuality, and Existentiality of Emotional Trauma: Ethical Implications.” Journal of Humanistic Psychology 51, no. 2 (2011), 4.
 Thompson and Walsch, “Existential Basis of Trauma”, 379.
 Ibid., 380.
 Du Toit, ‘Existential Contributions to the Problematization of Trauma’, 170.
 Ibid., 171.
 Israel Orbach, “Existentialism and Suicide.” Existentialism and Spiritual Issues in Death Attitudes (2008), 311.
 Yalom, Existential Psychotherapy, 159.
 Du Toit, ‘Existential Contributions to the Problematization of Trauma’, 173.
 Ibid., 172.
 Harteloh, Peter. “On the Competence of Philosophical Counsellors.” Practical philosophy 10, no. 1 (2010), 36.
 Schuster, “The Practice of Philosophical Counseling”, 588.
 Walsh, “Philosophical Counselling Practice.”, 501.
 Harteloh, “On the Competence of Philosophical Counsellors”, 41.
 Ibid., 41-42.
 Ibid, 41.
 Robert D. Walsh, “Philosophical Counselling Practice.” Janus Head 8, no. 2 (2005), 497.
 Martin Heidegger, “What is Philosophy?, trans.” W. Kluback and JT Wilde. New Haven (1956), 29.
 Harteloh, “On the Competence of Philosophical Counsellors”, 42
 Schuster, “The Practice of Philosophical Counseling”, 588.
 Ibid., 589.
 Lydia B. Amir, “Three Questionable Assumptions of Philosophical Counseling.” International Journal of Philosophical Practice 2, no. 1 (2004), 8.
 Shlomit C. Schuster, “In Times of War and Terror: Philosophical Counselling as an Alternative to Treatment of Post-Traumatic Stress Disorder.” Canadian Journal of Community Mental Health 21, no. 2 (2009): 79-90.
 Ibid, 83.
 Harteloh, “On the Competence of Philosophical Counsellors”, 43.
 Schuster, “The Practice of Philosophical Counseling”, 598.