Facing Human Suffering: Psychology and Psychotherapy As Moral Engagement

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Summary: A cogent call for a more morally grounded psychology!
Review: Psychology has two general traditions. One is a "natural science" model that sees psychological phenomena as no different from the atoms and molecules studied by physics and chemistry. This approach is associated with experimental group studies, "value-free" determinism, reductionism, and quantitative, statistical modes of knowledge. The other approach is a "human science" model that views psychological action and experience as distinctive from physical phenomena and as uniquely human, in line with the disciplines of the humanities. The human science model is associated with case studies in naturalistic context, a value-grounded acceptance of free will, and narrative modes of knowledge.

Generally over the course of psychology's last 100 years, the natural science model has strongly predominated, although with a few exceptions, such as the flourishing of humanistic psychology in the 1960s. For a variety of philosophical, social, and cultural reasons, in recent years the human science model has been increasingly gaining a hearing and encouraging discussion between natural science and human science advocates. Ronald Miller's new book, "Facing Human Suffering: Psychology and Psychotherapy as Moral Engagement," adds a wonderful voice to this dialogue. In cogent and clear language, and using a dazzling display of scholarship, he sets out bold, far-ranging, and persuasive arguments articulating the human science view.

Because of the great divide and contrast between natural and human science, it is not unexpected that at times the dialogue between advocates of the two models becomes very heated - psychology's own version of the "culture wars." (Miller nicely captures these wars in the title of his first chapter, "American Psychological Dissociation," a take-off on the discipline's main organization in the U.S., the "American Psychological Association.") Thus, by their very nature, a number of the ideas in Miller's book are quite provocative; but he always presents them in a scholarly and reasoned manner, encouraging continuing discussion and accomplishing in the process a most important contribution to constructive dialogue in the discipline.

Miller's argument focuses on the underlying nature of psychotherapy and related ways to improve it. The natural science model views therapy as a "value-neutral," technical activity for intervening with and modifying discrete deterministic mechanisms that lead to "psychological distress" and "behavioral dysfunction." In contrast, the human science model views therapy as a moral activity intrinsically arising out of the existential condition of human beings, who have free will and who continuously struggle among choices and externally imposed limitations that can lead to suffering. The only way to understand the human condition, argues Miller, is to view the individual as a complex, multisystemic organism who can only be understood holistically in context. The best way to do this, continues Miller, is through the clinical case study, which comprehensively describes the client, therapist, and therapy process in full, comprehensive, "thickly described," qualitative detail. Miller presents a beautifully developed model for creating case studies that will add to the foundational knowledge base of psychological therapy. Importantly, he also creates and discusses a database of published cases that he developed by heroically and critically combing through a voluminous psychology literature that has generally relegated case studies to the corner of a dark back room.

All in all, Miller is to be applauded -- for his clarion call for an alternative, more humanistically informed view of psychology and psychotherapy, and for the intellectual feast he lays out for the reader who has an interest in psychology, particularly the reader who also has a philosophical bent.

Daniel B. Fishman, Ph.D., Professor of Clinical Psychology, Rutgers University