Philosophical Counseling And ‘Mental Illness’

Are philosophical counselors counselors qualified to ‘treat’ the ‘mentally ill’? The short answer to that is ‘no’ (associated with the query, ‘depends on what you mean by mental illness’.) A slightly more considered answer, which I attempt to provide here, makes note of the particular competences and constraints of the philosophical counselor.

First, a note about philosophical counseling practice and its interaction with traditional modalities of counseling and therapy. Its place is, and should be, similar to the relationship current modalities of talk therapy enjoy with psychiatry. That is, a philosophical counselor typically works with a psychiatrist for referrals–a psychiatrist might recommend that someone seek counseling as a supplement to the modalities of medication and psychiatric treatment (for talk therapy is often paired with pharmaceuticals to address both biological and cognitive aspects of ‘mental illness’), and conversely, a philosophical counselor might recommend that a prospective client should seek psychiatric, medical, pharmaceutical help as a supplement or exclusively. (Traditional psychotherapists often recommend some clients consider medication as a way of making their talk therapy sessions more efficacious; this allows moving past distracting behavioral symptoms to concentrate on more fundamental cognitive issues.) This arrangement requires good faith assessments of client requests for help: when should a prospective client be directed to an alternative modality of treatment?

My assessment during the initial free consultation I offer my clients is quite simple: May I engage in directed, interactive, conversation with the person who has come to me seeking help? If not, I will not attempt to counsel the person. If a person is afflicted with a ‘serious mental health disorder’ of some kind then they might not be the ones seeking help; rather, someone might make such a call on their behalf. In those circumstances, the default option is to seek psychiatric help. In one recent instance, I was consulted by a woman seeking assistance for her father, possibly suffering from borderline personality disorder; I referred the family to several psychiatrists practicing in the city, and offered supplementary ‘talk therapy’ if psychiatric treatment had commenced. As a supplement, and not as a primary modality; such ‘talking through’ as noted, is often paired with psychiatric treatment.

To emphasize: if a client comes to me seeking help, my initial consultation offers opportunities: a) for the client to investigate and determine whether I’m suitable for them and b) for me to assess whether this is a case that I can take on. Any doubts about the ‘fit’ of counseling into the ‘mental health space’ rest on this inquiry: Is a philosophical counselor competent enough to decide whether he should be taking on a case? Will the counselor err on the side of over-inclusion and take on cases that he should not be? Will he refer and ‘treat’ the right ones? The most serious risk is that I will ‘treat’ someone who is ‘mentally ill’ and do ‘harm’ of some varietal. This risk is tempered by my professional caution, my prudence over the possibility of committing malpractice, and my professional competence at assessing my capacity to be able to aid someone through the tools at my disposal: my philosophical knowledge and my personal and professional experience.

There are risks present in the world of psychiatry, counseling, and psychotherapy: that clients are over-diagnosed with mental illness on the basis of the conceptually incoherent DSM, that pharmaceutical medications are over-prescribed, that cognitive solutions to ‘mental problems’ are overlooked in favor of biological and neurobiological ones that ignore social context and personal history. (Should people with ‘life problems’ always seek medical help? No. They run the risk of being over-diagnosed and over-medicated. Are all ‘life problems’ evidence of mental illness? No. Are some folks incapacitated sufficiently by their particular ‘mental disorder’ that they require some form of pharmaceutical treatment? Yes.) Philosophical counseling is an intervention in this fraught space; it aims to provide an alternative, constrained by a guiding ethical principle that calls for modesty and prudence and humility. While claiming that many of the problems that take people into a therapist’s office can be resolved without recourse to medication, it acknowledges its limitations (and those of other therapeutic disciplines) and notes that often, when treating those whose minds are ‘disordered’ or ‘disturbed’ or ‘ill,’ we are seeking to minimize harm to them and their loved ones, that we are seeking to make them socially functional and competent, and that in those cases, a medication that provides such basic cover might be the best treatment possible.

The philosophical counselor is a professional bound by a code of ethics similar to the medical one: first, do no harm. My primary duty is to the person presenting to me, and my desire to ‘help’ is tempered by a knowledge of my limitations. Because of the risks involved, my guiding professional principle is to seek advice when required; my personal interests, capacity, and competence, dictate that I only take on some kinds of cases. A variety of issues–such as relationship crises or depression–underwrite the vast majority of cases that bring people into some form of counseling and therapy. It is here, in this domain, I seek to ‘practice.’ My ‘methods’ are inadequate for some cases; my initial consultation is designed to help me make such determinations when required.

The philosophical counselor does what he can, and no more. He is modest, yet not reticent, about philosophy and philosophical counseling’s ability to bring ‘relief’ to the most common of all afflictions: seeking answers on how to live our lives.