This work builds upon the paper Biological Energy and the Experiencing Subject (Gamper, J, Axiomathes, 2020). The focus is to show how the idea of an experiencing subject can be conceived of within modern psychotherapy. We follow the track from conditioning for animals (without concern for an experiencing subject), via behavioral therapy for humans with an experiencing subject and cognitive behavioral therapy for humans with an experiencing subject where we give the subject a rational for the behavioral modification, to psychodynamically oriented therapy where we confront the very subject without going via her behavior. The three methods are explained within the context of macro psychology, a psychology extracted from the paper Biological Energy and the Experiencing Subject. Conditioning concerns therapeutic methods that does not address subjective experiences of the patient and neither address subjective experiences methodologically. For instance, you do not give the patient instructions since you do not rely on the patients ability to understand them. Behavioral therapy concerns methods that that are mediated by instructions. The patient is told to follow a procedure. Cognitive behavioral therapy adds explanations to the behavioral therapy. Psychodynamically oriented therapy concerns thesubject’stendency to repress difficult inner material to feel better. This material is focused in the therapy and the patient is informed about how the therapist understands the dynamic. The framework, thus, that is presented, encompasses the major psychotherapeutic methods of today.
1. Introduction
The paper Biological Energy and the Experiencing Subject (Gamper, 2020) contains a definition of biological energy that permits a purely mental energy that should be accounted for in its own right. Here we will look at some fundamental psychotherapeutic principles that can be drawn from that standpoint.
2. Macro psychology
Macro psychology is built upon the notion of biological energy as suggested in Gamper (2020). Biological energy is construed as the organisms ability to recover from the load it is exposed to. That load entails a need of recovery that grows with the load. The available energy has a maximum and when that is reached as far as the ongoing recovery is concerned, the available amount of energy is decreased if the load continues to grow. This is illustrated in figure 1.
For experiencing subjects it is conjectured that the need of recovery on the one hand is mediated by signals thereof, and on the other hand that the subject has a lower ability to perceive those very signals, the stronger they are, as illustrated in figure 2.
This dynamic for experiencing subjects has the odd consequence that even though the energy level lowers when load is increasing at high levels of load (compare figure 3) the subject tends to put pressure on herself to avoid the troublesome signals of need of recovery in order not to perceive them (compare figures 4-6).
3. The experiencing subject
The introduction of the experiencing subject allows for new possibilities for the organism to cope with load. We need to disentangle first, though, the biological object from the experiencing subject. For the biological object as such there is no dynamic to talk of. The object recovers if it needs to and can. When the organism is exposed to signals of need of recovery there is an experiencing subject that perceives them. Whereas the need of recovery is an abstract feature of organisms the signals of need of recovery are a reality for the experiencing subject. As depicted in figure 4 the signals can be attended to as they are perceived. This means that the biological needs of recovery are met via the experiencing subject. This, of course by assumption, is to say that the biological very needs of recovery are not perceived directly. The dynamic, however, is one dimensional — the organism recovers more or less.
The experiencing subject, on its side, can cope with its signals in other ways. To look at those possibilities we first have to focus on the the very subject. For the biological object the need of recovery is an abstract feature. The subject on the other hand has real signals of need of recovery so it is something that has the experiences of the signals. This something, the subject, has its parts. We will assume that the subject is composed of some parts as illustrated in figure 7.
3.1. Repression
The disentangling now comes to work. Whereas the biological object has need of recovery as an abstract but absolute feature the experiencing subject has its signals of need of recovery as real but with degrees of freedom to engage with them. The suggestion here is that the subject can project troublesome signals onto a single part and then repress it. This leaves the repressed part emptied of energy while the remaining parts are energized. This process can be reiterated (compare figures 8-12).
4. Psychotherapeutic principles
The psychotherapeutic processes that are interesting are the reversed ones as compared to the ones previously mentioned. Those were concerned with avoiding difficult signals of need of recovery. Whereas conditioning concerned non subjective features of the biological organism behavioral therapy (BT), cognitive behavioral therapy (CBT), and psychodynamically oriented therapy (PDT) concerns processes related to the experiencing subject.
4.1 BT
The psychotherapeutic principle of BT in the context of macro psychology is that the therapist instructs the patient to take explicit recovery measures. The patient by following the instructions recovers and by doing so has to endure the previously withheld difficult signals of need of recovery. A typical example is behavioral activation for depression where the therapist may instruct the patient to take daily walks.
4.2 CBT
The psychotherapeutic principle of CBT in the context of macro psychology is that the therapist instructs the patient to take explicit recovery measures and explains why (according to some model). In the CBT variant of macro psychology the rational would be that the patient avoids recovery to avoid the signals of need of recovery. Therefore she should try to recover even though it hurts in order to gain energy. A typical example is to accept sick leave in cases of exhaustion.
4.3 PDT
The psychotherapeutic principle of PDT in the context of macro psychology is that the therapist tries to emphasize with the patient in order to identify aspects of the patient that she has repressed. If the patient can acknowledge repressed contents she is instructed to try to endure the associated difficult signals of need of recovery that comes with it in order to regain access to her own repressed parts.
5. Applications
Scenarios with a maltreated dog, its owner, and a therapist.
Conditioning
The therapist takes the dog to a safe environment.
Behavioral therapy
The therapist instructs the owner to take regular long walks with the dog, to feed it regularly, to let it have access to fresh water and to stop hitting it.
Cognitive behavioral therapy
The therapist instructs the owner to take regular long walks with the dog, to feed it regularly, to let it have access to fresh water and to stop hitting it. The therapist also tells the owner why.
Psychodynamically oriented therapy
The therapist tries to help the owner to reconnect to repressed parts that cares for the dog.
Standard definitions of causal closure focus on where the causes in question are. In this paper, the focus is changed to where they are not. Causal closure is linked to the principle that no cause of another universe causes an event in a particular universe. This view permits the one universe to be affected by the other via an interface. An interface between universes can be seen as a domain that violates the suggested account of causal closure, suggesting a view in which universes are causally closed whereas interfaces are not. On this basis, universes are not affected by other universes directly but rather indirectly.
As physical things have mathematical properties we in this paper let mental things have biological properties. The work is based on recent metaphysical findings that shows that there could be interfaces between separate ontological domains. According to this view there could be mathematical objects, physical objects, and also mental objects. The aim of this study is to establish a view of the biological object that allows it to possibly generate the experiencing subject. Based on the notion that energy per se is related to the ability of a system to do some work, biological energy is defined as a biological object’s ability to recover from the load it is exposed to. Introducing the concept of the experiencing subject, the experiencing subject would be the agent experiencing the biological object’s need of recovery from the load it is exposed to. Once established, the experiencing subject may develop non-biological needs. On this basis experiencing subjects have biological properties without being biological in exactly the same manner as physical things have mathematical properties without being mathematical (would that be the case).
We see two papers in juxtaposition and ask if they add up to something more.
In my old manuscript “Formal Theology”(2023a) that now is out as a preprint I show that science and theology can be founded upon the same set of basic assumptions. Can Formal Theology also be used to ground a religion? “Religion“, in this regard, as related to beliefs. Well, of course, that depends. A positive argument is the claimed revelation “Led 4 (us), (Gamper 2023b). I had this revelation in December 2022. A typical Abrahamic prophet confirms the basic assumption in Formal Theology. I don’t feel especially Abrahamic and do believe that the basic assumption in Formal Theology can ground any religion’s concept of a First Cause, seen through the glasses of modern science. There is no contradiction.
Den yttersta frågan är hur det är. Framför den står frågan hur vi kan få reda på hur det är. Ontologi och epistemologi. Med David Hume vet vi att det inte räcker med att se efter. Vad vi än ser kan vi inte veta att det kommer att se ut så imorgon. Induktionen är inte säker. Om vi stannar upp vid att vi ser så kan vi naturligtvis vara säkra på att att vi ser. Om vi ser så ser vi. Här stannar väl också Berkeley, vid att vi bara kan vara säkra på sinnesintrycken och de andra ”upplevelserna” vi har. Ett intressant problem här är den monistiska materialismen. Om endast det fysiska finns, finns ju inte upplevelserna. Den monistiska materialismen är ju inte heller något vi kan veta, bara anta. Vi kan ju dock inte heller sluta oss till det fysiska utifrån upplevelserna. Det är här E-teori kommer in. E-teori handlar om att finna en mer abstrakt utgångspunkt för vetande än empiri och fenomenologi. En ontologi som är neutral i förhållande till vad som finns och som istället undersöker vad som kan finnas. Modal ontologi.
Four out of five patients at a primary health care center could benefit from counseling but only one out of five is referred. Of those referred 20 percent cancel their appointment or just do not show up. In that group 80 percent manages as good on their own and the other 20 percent need counseling the most. Of those who come to counseling 80 percent needs help to understand and cope with their current situation whereas 20 percent are in the need of a broader approach. In the group that needs a broader approach 80 percent is best treated in the primary care with an eclectic stance while the other 20 percent for the best is referred to secondary psychiatric care.
The group that is accepted for RCT (randomized controlled trial) studies is found among the 80 percent of the patients with the need of a broader approach of the 20 percent of the patients in counseling. In that population 80 percent is not accessible for the scientists (due to life et cetera). The other 20 percent is subject to research. Approximately 20 percent of this group of 20 percent are the very patients that are part of the RCT studies (they have accepted to be randomized for CBT (cognitive behavioral therapy) or TAU (treatment as usual), they have allocated time for all tests, they have showed up for all sessions and done their homework, and they have taken part of the follow ups. Lately it has been shown that internet based CBT and group based CBT is as god as CBT with physical sessions. This research is based on the group of 20 percent of the population that accept and endure physical sessions CBT.
Pareto’s law is an empirically based statement that identifies a 80/20 relation in various situations. At a primary health care center, for example, 20 percent of the patients stands for 80 percent of all the appointments.
When the healthcare is under pressure from stakeholders to produce more and more evidence based appointments there is a risk that Pareto’s law collapses into what I call Pareto’s curse. In this particular case evidence based practice translates into CBT which translates into good practice. CBT is good. But without individually customized CBT and without more than one line of treatment only 20 percent of 20 percent of 80 percent of 20 percent of those who come for counseling will benefit from the treatment. That is 0,64 percent or one patient out of 156 patients needing counseling.
To understand why this threatens healthcare systems we have to look at Goodhart’s law. Goodhart’s law can be formulated as “When a measure becomes a target, it ceases to be a good measure.” The evidence based practice movement initially wanted to give research its natural place next to clinical experience and the patients preferences. This measure then became the target.
To overcome Pareto’s Curse we must return to Pareto’s Law and do what is best in each situation.
(A counselor the other day went with her daughter to a primary healthcare clinic for teenagers for a first meeting with a psychologist. The daughter spent 80 percent of the session filling in forms and talked with the psychologist for 20 percent of the session. The daughter decided to not return.)
(Note, this is only a problem in 80 percent of 20 percent of the world’s countries.)
Adalja 