The New York Times
March 8, 1998, pp. 4-1, 4-4.
I Bill, Therefore I Am
Philosophers Ponder a Therapy
Gold Mine
By Joe Sharkey
When he was starting out
as a standup comedian in the 1960's, Woody Allen joked
about being expelled from college for cheating on a
philosophy exam: "I looked within the soul of the
boy sitting next to me," he said.
Three decades (and 30 years
of personal psychotherapy) later, Mr. Allen still sprinkles
his movie scripts with references to philosophers like
Kierkegaard and Kant, as well as to psychoanalysts like
Freud.
There may be a lesson here
-- at least if you're a philosopher. Taking note of
psychotherapy's mixed record during its century-long
domination of the effort to address people's practical
problems of living, some philosophers have begun to
scamper back down from the ivory tower to conduct business
the way Socrates did -- by returning, literally, to
the marketplace.
They are hanging out their
shingles. Springing from a movement that began in Germany
in the 1980's, a small but growing number of American
philosophers have opened private practices as "philosopher
practitioners," offering a therapy based on the
idea that solutions to many personal, moral and ethical
problems can be found not in psychotherapy or Prozac
but deep within the 2,500-year-old body of philosophical
discourse.
"Psychiatry and psychology
ultimately have failed people," said Lou Marinoff,
a professor of philosophy at City College in New York
who has been seeing private clients -- at $100 a session,
about what psychologists get -- since 1991. Dr. Marinoff,
who estimates that there are several dozen philosophers
in private practice in the United States, wants to lead
like-minded colleagues back to their ancient place at
the center of the emotional tumult of daily life.
Typical clients, he said,
are "refugees from psychotherapy," some seeking
deeper truths and others just looking for a better way
to deal with depression and anxiety.
"What we're suggesting
is, if you can be referred by your H.M.O. to a psychologist
or a psychiatrist, you should be able to be referred
to a philosopher, too," said Dr. Marinoff, who
is the president of the American Philosophical Practitioners
Association, which has several hundred members. The
group has drafted licensing criteria and is leading
a state-by-state drive for certification. The most notable
success so far is a bill making its way through the
New York State Assembly that would establish a board
to license philosopher practitioners, and thus propel
their campaign to qualify for insurance reimbursement.
Anxious Psychiatrists
With health maintenance organizations
already cutting back on coverage for traditional mental
health care, some psychiatrists and psychologists naturally
react with a mixture of anxiety and denial to any suggestion
of sharing the market.
Dorothy Cantor, a clinical
psychologist and former president of the American Psychological
Association, dismissed the idea that "philosophical
counseling, or whatever the heck they're calling it,"
has a legitimate claim on dealing with "something
as delicate as a person's mental health." Philosophers
who consider themselves mental-health therapists, she
said, suffer from a "naive assumption" that
purely intellectual discourse can address personal problems
that are intractably emotional and sometimes severely
debilitating.
"They totally ignore
the role of the unconscious," said Dr. Cantor.
For patients who need psychological help, she added,
"Plato isn't going to solve their problems."
Psychologists, she said,
need to make a better effort "to educate the public
as to what they should be looking for -- well-trained
doctoral-level providers" who are licensed in therapies
subject to stringent professional review. "Imagine
peer review by philosophers," she said.
Dr. Marinoff conceded that
his more scientifically grounded colleagues chuckle
at the idea of philosopher therapists. "People
think of a philosopher as someone you wouldn't send
out for a loaf of bread," he said. "In fact,
a lot of my colleagues, if I sent them out for a loaf
of bread, might come back with a quart of milk or with
an essay about why they spent the afternoon walking
around aimlessly." But he said philosopher practitioners
have adopted uniform standards and peer review procedures.
In New York, State Assemblyman Ruben Diaz Jr., a Bronx
Democrat who has an interest in philosophy, is sponsoring
the bill pushed by the philosophers to authorize state
certification.
Philosopher practitioners
usually have academic doctorates, Dr. Marinoff said,
and are trained to refer people with serious mental
disorders to the appropriate professionals. "You
don't want to try to treat severe personality disorders
with Sartre," he said. But he added, "If somebody
comes to me trying to reinvent Nietzschean morality,
struggling to transcend good and evil, we can have a
dialogue and I can say, 'Hey, that's very interesting.
This is something Nietzsche thought an awful lot about.'
Ultimately, they won't feel lost or isolated. They can
explore and address their dilemma through the long history
of thought, rather than through Prozac, for example."
Harriet Chamberlain, a philosopher
practitioner in Berkeley, Calif., suggested that clients
may find it appealing that there is no stigma attached
to counseling on philosophy. Clients are driven, she
said, by "normal weaknesses" over job-related
stresses, concerns over long-range goals, relationships
and general "existential anxieties" that are
intensifying in an increasingly complex world.
White Coats and Sandals
Dr. Marinoff said that philosophical
counseling rejects psychotherapy's "medical"
approach, which considers emotional distress to be a
disease, in favor of a humanistic approach that stresses
dialogue and self-reflection. "We are not like
the guys in white coats," he said.
"What do they wear,
sandals?" asked Deborah Chollet, vice president
of a health care group called Alpha Center, which does
medical insurance research. She said employers and legislators
can be overwhelmed by wide public support that marketing-savvy
proponents of alternative therapies can muster.
Philosophers are not the
only alternative therapists lining up for a piece of
the healthcare spending dollar. Some chiropractors want
to expand their uses of alternative therapies and are
lobbying hard to expand coverage for chiropractic treatment
to include a variety of ailments, like depression. Another
initiative is coming from a movement called personal
coaching, which includes thousands of therapists licensed
only by the movement. They use New Age motivational
and self-help techniques to counsel clients, who pay
as much as $500 a session.
It is crucial to require
proponents for an alternate therapy to "prove that
it is a demonstrably cost-effective treatment,"
Dr. Chollet said. In states that have put those kinds
of requirements in place, she added, there has been
a dramatic reduction in new mandates requiring health
insurers to cover alternate treatments.
The philosopher practitioner
movement is working to "accommodate itself to the
realities of insurance" in the American healthcare
market, said Keith Burkum, the chairman of the philosophy
department at Felician College, a small Catholic liberal
arts college in New Jersey that recruited Dr. Marinoff
to teach a course to train philosopher practitioners
who sought certification by his organization. So far,
Dr. Burkum added, "The track record for the profession
is primarily in Europe, but it's coming on strong here.
I don't want to pick a fight with psychologists, but
in this society psychoanalysis is in deep trouble."
Several hundred philosophers practice full time in Holland
and in Germany, and a smaller number practice in Israel.
But maybe accommodations
can be made, said Donald K. Freedheim, a professor of
psychology at Case Western Reserve University in Cleveland
and the author of "The History of Psychotherapy:
A Century of Change," published by the American
Psychological Association in 1992. Given the tightening
of insurance spending on psychotherapy, philosophers
might be able to come into the mental health industry
tent as certified "gate-keepers," under the
strict supervision of psychologists or psychiatrists,
he suggested. They could refer cases that need "a
more sophisticated, comprehensive approach" to
psychologists while handling the simpler counseling
cases themselves at a lower cost, he said.
"Actually, 80 percent
of the counseling that is done now could be done by
them," said Professor Freedheim.
