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."
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
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-
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
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
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