The greatest psychiatrist you don’t know
The third of a trio of great thinkers that we should know and study well
You don’t know this psychiatrist, or you may have heard of him but don’t know much about him. Or you may claim to know him, but you don’t: you only partially understand a few of his psychiatric concepts, and you’ve hardly read, much less understood, his overall philosophy.
You don’t know him. Let me tell you about him.
There once was a psychiatrist who invented the concept of empathy; before him, the term was never used in psychiatry. He not only invented it; he made it central to his analysis of mental illness. Some people went to clinicians because they had problems of living; you could tell that was their main problem because you could empathize with them, you could appreciate their problems, could put yourself in their place. Other people went to clinicians with beliefs or feelings or experiences that didn’t make sense; no matter how hard you tried - and he insisted that you try hard - you couldn’t put yourself in their place. These people had diseases of the brain and mind, not problems of living. The problems of living belonged to the experiences of everyone in life; they were part of human existence.
I’m not implying that he was right about this distinction; it’s obviously more complicated when it comes to diagnosis and understanding a person’s experiences. But at the time, a century ago, no one even knew what empathy was, and such distinctions weren’t even imagined.
This psychiatrist emphasized this aspect of psychiatry; he tried to show that most of the problems that were deemed psychiatric were of this variety, not of the biological disease version. In his era, psychiatry was very biological, and Kraepelin had been the teacher of his teachers in Germany. Our hero didn’t reject Kraepelin completely and he didn’t deny the validity of psychiatric disease as a concept, or as a reality in its versions of dementia praecox and manic-depressive insanity. He just argued that many more people had the problems of living in existence. And they needed not a biological approach to diagnosis and treatment, but an existential approach to non-diagnosis and non-treatment. But of course, in the clinical situation, there is a clinician and a client, so there is some treatment that happens. This psychiatrist also used empathy for the first time as a mechanism of treatment. It was the method to heal the wounds of the problems of living. Freud never made such a claim. And still this method was a human method, a method that didn’t require a new set of licensing bodies, but rather a humane approach to human beings. Hence it was later called the “existential-humanistic” method.
Notice that this psychiatrist didn’t say that people with problems of living needed a psychological approach to diagnosis and treatment; he didn’t say that they needed a new psychotherapy school that our hero himself invented. That approach already had occurred with Freud, and this great psychiatrist accepted Freud too, just as he accepted Kraepelin, within the limits of what was valid for Freud’s new psychotherapy. It had been developed for hysteria, a specific kind of psychological condition that had its origin in mental states, not disease of the brain. Today we call it post-traumatic stress; there, a specific psychotherapy was useful, both for diagnosis and treatment. But those problems are not the problems of existence; not everyone experiences trauma, contrary to the claims of modern pan-traumatists. Not everyone sees death in combat; not everyone is sexually assaulted; many are, but many aren’t. Freud’s treatment was for those people, not the person who has a divorce or loses his job or gets sick or loses a loved one or dies. The latter aren’t traumata; they are life stresses, the experiences of existence for everyone. Kraepelin’s approach had its place for biological diseases of the brain with mental presentations; Freud’s approach had its place for psychological traumata with mental presentations. Our hero’s approach was for everyone else, meaning everyone. In that sense, it wasn’t about diagnosis, since everyone would be diagnosed; and it wasn’t about treatment, since everyone would need treatment. It was about a general philosophy of life. And so our thinker left psychiatry soon after entering it and became a professor of philosophy the rest of his life, and explained in great detail how human beings can understand and handle the shipwreck of existence, as he put it, to become aware, free, and authentically alive.
This thinker has a lot to teach psychiatry and a lot to teach outside of psychiatry for everyone. His name was Karl Jaspers. The best introduction to his work is a series of lectures he gave in the 1950s in Switzerland, translated into English as “Way to Wisdom.”
If you read those lectures, you’ll get a sense of what he was trying to say. You’ll understand half of it; read it again, and you’ll understand half of the rest. Then go to his other writings and study the man. The Great Philosophers is a series of his lectures in the last decade of his life that is accessible, being notes taken by his students in his courses on the history of philosophy. The notes have been published in small books in multiple volumes. “Socrates, Buddha, Confucius, Jesus” is a nice place to start.
Don’t just read General Psychopathology, which is what most psychiatrists do. They misunderstand his psychiatry by reading this book in isolation from his larger philosophy, and they don’t appreciate the overall structure of his thinking. Usually he is seen as critical of biological psychiatry and Freud and as an advocate of “existential psychiatry.” As explained above, this half-truth is untrue enough to be unworthy of the man.
There were three great thinkers that all psychiatrists should read and understand well. Many know and study Freud (I know he’s not a psychiatrist, that’s why I said “thinker”), though few really study him well these days. Many know but few study Kraepelin; he is viciously misunderstood. Few know and hardly any study the third great psychiatrist, who, in my view, was a greater thinker than the other two.
There’s much more to Jaspers’ thinking. I’m not summarizing it all in one blog post. Please read more about his ideas before either accepting or criticizing them. Have some empathy…