Past the clinical paradigm

I am going to talk about the preservation and nurturing of dialogue, or sustaining the boundary places where 'joint action' arises. And the way I will do this is to address its inverse, monologue. The concern will be what institutional process sustains monologism and what contrary process will break it down. Specifically, I will try to get past the 'stuckness' at the traditional clinical paradigm, and get to the way this paradigm is an institutionally based monologism.

Shotter presents the analysis of the client Fraser in terms of moving from the 'empty feeling' to 'conversation'. "And the beginning of his 'cure' .. is the bringing of this 'feeling' (of emptiness) back into that special, conversational realm of human interaction, in which it had originated, and in which now, new possibilities for its formulation, new ways in which it can be talked about, can be formulated." 2 But why emptiness? And wherefore originary formulation?

In fact, the originary formulation comes from a social conditioning process to which the client has been habituated. The helping dialogue takes place in, is framed by the clinical conversation, but it retrieves a process that is 'other' to the clinic. Both the strength and the weakness of the clinical conversation is in the controlled situation of the clinic, in its rationality. In other words, the institution is the controlled situation, and the rationality amounts to a (two-person) monologue. Sometimes this rationality, this monologism, serves to leverage external (or internal) situations, that is a strength. Other times, though, it is disrespectful to the way of being of these external situations, opaque to the dialogue 'out there'. The trade-off of the helping process ('psychotherapy') of today is felt to be in the development of clarity, in the value of the concentration stemming from running this monologism.

Then again, the 'emptiness' is an intuition which I claim matches the social psychological hermeneutics of Cushman's 'empty self' (1992: 52), an analysis of the mass psychology of modern (especially, but not exclusively American) society. This 'empty self' is identified as the central spontaneous component of the experience of self under today's fragmentation-producing social conditions. Identifying it amounts to a recognition of the client's 'other' by its ground in sociohistorical reality. In effect, this is a 'happier' or less vexing version of the 'Jovian sky' metaphor above, than the 'fools' play' norm postulated above for the alien experiment type of social formulation. That is to say, the clinical monologism can bring us face to face with the foolishness that is central to social context, can connect us with reflections of it. But the monologism will stumble when it touches on the full-fledged irrationality of such a 'generalized other', and will be liable to break apart.

In addition to the clinic being a tendentially monological social institution, today's psychological paradigm also reinforces the monological direction. Were we to adopt a Vygotsky-style formula of individuality deriving from social being, we have to mean that the character or personality of the person achieves meaning dialogically. In Shotter's words (1993: 111), "Vygotsky is concerned to study how people, through the use of their own social activities, by changing their own conditions of existence can change themselves." Changing 'conditions of existence' means being involved with changing of institutions themselves. But our psychology, grounded in individualism, passive toward institutional change, is a priori a narrow kind of rationalization of being, an axiomatized monologism.

Here then we have two sources of monologism, the clinical institution and the ideology of individualism. Any remedy or upgrading of this kind of helping process must (1) operate at an institutional level and (2) re-connect the individual dialogically. This, then, compels a process of planned disconnect from the habituated social dynamics of non- communication, of as it were staged foolishness. And it compels the 'filling' of the 'empty self' (and similarly with other reflections of individualism) - by intensifying involvement.


A developmental deconstruction

We have reasoned that if we are to turn our philosophical tool to the helping realm, we need to get past the 'calculus of beings' to the ontological difference itself, and look at Being (Derrida, 1994). We have further argued that the originary formulation of our experience of Being is connected to a Vichian style social conditioning history, thus pushing us to challenge the rationalizing character of the social institutions themselves. Madness "takes place whenever man is incapable of meeting that which we can name the claim of Being. This is always manifest for man in a concrete situation, urging him to the appropriate response so as to meet the claim made on him" (Grassi and Lorch, 1986: 48; Sass, 1988; Georgaca, 1995). Thus the topic becomes not any more mind but situation, external and internal, moving us over to the problematic of the act (Natanson, 1956: 17- 18).

I am going to cite at length an example of 'meeting the claim of Being' when it has a history of being problematical. The example is from the San Francisco Bay Area, starting about 1993. The following rendition of events is metaphorical, incomplete, and represents a reading from the vantage point of direct involvement. It reflects an effort to work at the 'boundary' of the institution, where philosophy and 'psychotherapy' were (and are) in issue.

This work proceeded in stages: I label them the 'timely madness', the 'training hothouse', the 'connecting nudges', and the 'dialogue percolation'. The 'claim of Being' was that mental health service delivery was not adequately productive, and that the participation of the 'target population' in service delivery was insufficient.

At the first instance, a dialogue developed in a small group, regarding the monologism of the institution of psychiatry. The dialogue transcended the habituated conversations and focused on deconstructing the social psychology of them. Arguing for a dynamic of personal respect helped build the 'clearing' for a work space on the ontological difference. A symbolic demonstration was organized at a national psychiatric convention (1993). The spirit of this, its 'madness', was timelybecause it was organized around deconstructed habituation and this needled the habitual processes of the institution. That is, their monologism was reflected in habituated behavior.

In the second instance, a 'joint action' was developed in the unique context of a dysfunctional situation which was on the edge of working. The deconstructed habituation was channeled with politically mediated official support, under the guise of 'training', into this well selected situation where it could be reinforced to maximal effect. The habitual monologue of the community (Sonoma County, CA) around mental health service delivery issues was transformed by this initiative. Pre-existing creative forces were empowered to move into the resulting 'clearing'. Metaphorically speaking, it was the slogan "accept no chocolates" - a kind of Vygotskian prosthetic (Shotter, 1993: 113-114) - that enabled us to move in on the timingof this monologism and extinguish its hold upon conversation.

In the third instance, the 'karma yoga' of selfless action became the broad focus of a conversation between the county mental health directors association and the associated mental health client activists. A 'partnership' approach of working on a Bay Area employment conference nudged and again nudged the dialogue closer to the originary formulation of mental health service delivery (see Foucault, 1995). Social relations which had been considered inappropriate for the workplace had to progressively rearrange themselves as connections were made between people in different social situations (Fisher, 1994). An experience of Being, an existential moment organized somewhat like a 'be-in', predominated.

The last instance is a stage in progress, which involves spreading the scope of the dialogue - another 'joint action', another visionary selfless commitment. 'Percolation' means the liquid seeps through and dissolves and gathers solids. The old dialogue location of the client employment conference becomes a multitude of dialogue locales at different social and institutional levels. We heal the social process by divining the artifice in the originary formulation of the 'therapy' institution and reviving the dialogue around its nature.

Such an approach uses a kind of reversal of Vygotsky's view of the instrumental and prosthetic use of language (Shotter, 1989). Thus, taking this view into account enables the activist to detach him/her self from metaphysically formulated attachments to language. This puts the monologuers face to face with their own metaphysics, which usually they would avoid and not 'get'. But here the stages effect enables a presentation in 'small doses' and the politics encourages a non-defensive response, because we are teaching, we are training. What was prosthetic on their part without their identification of it, now comes to be identified.

By working the institution this way we give its people insight into its dysfunction. 'Knowing from' the institution's disconnected response informs its workers. The 'linguistic labyrinths' (Wittgenstein, 1953: #203) of daily work practice get highlighted in this condition of detachment. If we didn't only argue philosophy with them, still there was an element of that. In our dialogue, we reduced our experience of system dysfunction to the 'micro-offenses' of interaction (Pierce, 1970), and then we declined to attend to them or complain.

I am going to look at who it is that constructs a dialogue where sense is made on the 'boundaries'. Thus, if this 'developmental deconstruction' needed to be made, what was the human form of the 'boundaries'? What handle enabled us to move between philosophy and 'psychotherapy' on an institutional level? And what encouraged people to do things they'd never done before?

This analysis indicates that having the opportunity to do 'psychotherapy' in a way that works is a privileged position. Doing it in the spirit of Wittgenstein's philosophy could be a powerfully positive approach - when this is available - and still not have general validity (Albee, 1991). On the contrary, our usual situation has more in common with a sottie type environment where the role of the foolish 'other' predominates. One requirement for a helping project would surely be that it include institutional sensitization practices like the developmental deconstruction presented above. The conditions under which people operate are socially habituated and not "up to speed." Creativity, in the sense of production at the 'boundary', is degraded. So we must look to the alienated condition of the general population and reflect back what it tells us about the appropriate level of discourse.

Knowing in a systematic stress context