The Talking Cure: Wittgenstein's Therapeutic Method for Psychotherapy

What kind of truth can psychiatric experts know about their patients? Scientific theory can be learned from reading books, so why is that therapists need to talk to their patients? Why can't they simply point people to the most relevant papers? This excellent book explains Wittgenstein's therapeutic approach to language, with a particular focus on the way that classical psychiatry has failed to understand the relevance and importance of Wittgenstein's ideas. Highly recommended for anyone involved in psychiatry or psychotherapy, or for students of the philosophy of mind.

Before I offer an opinion on the book, two things: First, I have huge admiration for the philosopher Ludwig Wittgenstein. I’m not a philosopher, nor can I claim to have a deep appreciation of the technical aspects of his work. But it seems to me that Wittgenstein wanted to make the world a better place. He devoted the whole of his life to that objective; which he believed will eventually come about when, (1) we come to see the world with complete clarity - with perspicuity (he was a perfectionist after all) - and which he argued is only possible guided by his philosophy. And, (2) by adopting a scrupulously ethical attitude to life, of which he said very little but to which he attached considerable importance and agonised a great deal. Secondly, I am extremely critical of psychiatry and psychotherapy for reasons that will become apparent. So, turning to John Heaton’s book, its attraction for me lay in the prospect of adopting Wittgenstein’s philosophy to justify an activity which, for the most part, does more harm than good in my view.Guided by his considerable - and enviable - grasp of Wittgenstein’s philosophy, John Heaton does an excellent job in forensically demolishing the two most influential approaches to psychotherapy, namely Freud’s psychoanalysis and cognitive approaches. The implication being that all theory-laden approaches to psychiatry and psychological therapy are erroneous. The cat is, once again, let out of the bag. Orthodox psychiatry and psychotherapy are revealed as a pig in a poke.According to Heaton, the taken for granted assumption which suggests that therapists possess a special expertise based on rigorous psychological theories is a semantic trick, made possible through not questioning the initial claims of theorists like Freud. We trust that psychiatry and psychological therapy are based on a thorough appraisal of all the pertinent facts - evidence-based - which on Heaton’s analysis is simply not the case. Instead, the author grounds his understanding of the world and human behaviour on the importance Wittgenstein attached to language.Heaton walks the talk and avoids imposing any dogmatic theory on the ‘patient’ as commonly occurs with other approaches. Instead, he argues that ‘neurosis’ and ‘psychosis’ come about when the ‘patient’ is held by beliefs and ideas that are inconsistent with the way the world is. In allowing the ‘patient’ to express themselves in whatever way they wish, relief occurs by attending to what is said and how it is said through voice modulation, facial expression, and gestures. By focusing on the language of the presenting difficulty the ‘patient’ is eventually able to ‘spontaneously’ realise the underlying error that precipitates their distress. And for some people this strategy appears beneficial for reasons that are entirely plausible. This then allows us to add Heaton’s talking cure to the five-hundred or so other therapeutic approaches that also claim to ‘work’. I don’t doubt that in their different idiosyncratic ways, someone somewhere finds that talking about the ‘problems of living’ offers comfort, encouragement and, possibly, even clarification regardless of how you go about it.So while I accept John Heaton’s position up to a point, in my view most (not all) but most mental distress arises out of social injustice and the abuse of power. In the face of an extraordinary rise in ‘mental health problems’ in recent decades, I take the view that in the long-term prevention is better than the occasional cure, which will only come about through, (1) adopting collective values that are altogether more egalitarian and bring about policy initiatives that meet everyone’s elemental social and economic needs, and, (2) establishing a more realistic understanding of human behaviour to replace the one upheld by diagnostic psychiatry and psychologies-of-the-mind. Putting all our eggs in the dyadic therapy basket does not address the root of the problem, which on my reading would be Wittgenstein’s view. As the late George Albee perceptively observed, no mass distress or disease has ever been satisfactorily addressed one person at a time.Yet despite this criticism on balance this is a book I’m pleased I bought; not because it represents a therapeutic magic bullet to alleviate all emotional distress. I doubt we will see the NHS roll-out Heaton’s talking cure like mass immunisation to address the tsunami of mental health problems - particularly ‘depression’ - that the World Health Organisation acknowledge is sweeping across the planet. No, I’m pleased I bought the book because it helps to demolish the fatuous idea of therapeutic expertise based on specious psychological theories and biomedical dogma. And for that reason alone it was a delight to read and well worth the money.Chris Willoughby