Ron Morstyn

Cognitive Behavioural Therapy (CBT), is a therapy based on cognitive manipulation which denies the existence of ontological truth. Merleau-Ponty warned of such a development which he labelled a “decadent psychoanalysis.” Merleau-Ponty believed in the existence of ontological truth, not as a matter of cognitive representation nor as something that can be designated by positive indices such as those of psychometric measures or statistical analysis, but as an ontological dimension of the pre-cognitive world. Openness to this pre-reflective truth differentiates a therapy based on truth from one based on suggestion and manipulation. When a suicidal patient, approaches a psychotherapist for help and is told that he or she can feel better by adjusting his or her dysfunctional thinking in normative directions, this truth of lived experience is denied, and so is the opportunity for patient and therapist to recognise their shared ontological pre-reflective connection in which truth may find a way to express itself safely, that is, intersubjectively.

Objective: During my illness and transplant I experienced an overwhelming existential crisis involving a complex intertwining of meaning and body which was often ignored, rejected, or misunderstood by others and at times by myself, which led to painful feelings of alienation. My treatment and my own conceptualizations seemed founded on assumptions of a separation of body and mind that were not true to what I was experiencing. I searched for a more accurate understanding, which I eventually found in the writings of the French existential philosopher Merleau-Ponty. Conclusions: Merleau-Ponty's extensive elaboration of the deep ambiguity of our existence as body-subjects provides an alternative model to those of the mind/body dichotomy currently in vogue in medicine and psychiatry. I found his writings a useful framework within which to comprehend my experiences. I wanted to write about these experiences and how they relate to Merleau-Ponty's insights because I found that those individuals who were able to relate to me at this level of existential ambiguity were invaluable to my recovery.

Objective: The aim of this study was to examine logical positivist statistical probability statements used to support and justify “evidence-based” prescribing rules in psychiatry when viewed from the major philosophical theories of probability, and to propose “phenomenological probability” based on Maurice Merleau-Ponty's philosophy of “phenomenological positivism” as a better clinical and ethical basis for psychiatric prescribing. Conclusions: The logical positivist statistical probability statements which are currently used to support “evidence-based” prescribing rules in psychiatry have little clinical or ethical justification when subjected to critical analysis from any of the major theories of probability and represent dangerous “spin” because they necessarily exclude the individual , intersubjective and ambiguous meaning of mental illness. A concept of “phenomenological probability” founded on Merleau-Ponty's philosophy of “phenomenological positivism” overcomes the clinically destructive “objectivist” and “subjectivist” consequences of logical positivist statistical probability and allows psychopharmacological treatments to be appropriately integrated into psychiatric treatment. Read More: http://informahealthcare.com/doi/abs/10.3109/10398562.2011.603333

Objective: The aim of this paper is to examine the gulf between clinical<br>experience and the doctrine of evidence-based psychotherapy from the<br>perspective of the philosophy of Maurice Merleau-Ponty.<br>Conclusions : Evidence-based psychotherapy, which requires that psychotherapists ignore their thoughts and feelings with individual patients in favour of following standardized manuals and guidelines, is being increasingly promoted as part of evidence-based medicine (EBM). However,this represents an inappropriate extension of logical empiricist philosophy and significance testing methodology, on which evidence-based medicine is founded, to psychotherapy. It sacrifices a search for truth in psychotherapy, for an illusory search for certainty. The inevitable consequence of this is that psychotherapy becomes a commoditised pseudorelationship. Merleau-Ponty provides an alternative ontology, based on the primacy of perception, that gives an epistemological foundation for the search for truth and integration as a basis for psychotherapy. The practice of evidence-based psychotherapy raises serious ethical concerns about pseudorelationships being passed off as authentic, which could lead to missed opportunities to engage mentally ill patients in treatment and to reinforcement of their damaging sense of alienation.<br>.

Objective: To explore the limitations of the concept of ‘truth’ in the ontology of evidence-based psychiatry and to provide expanded ontological foundations for psychiatric practice based instead on the ontology of the French existential-phenomenologist, Maurice Merleau-Ponty. Conclusions: Evidence-based medicine is founded on a ‘scientific’ ontology of ‘causality’, which equates ‘truth’ with effecting statistically-significant changes in objective measures of disease by a specified treatment. Because of the absence of biological markers of disease in psychiatry, evidence-based psychiatry equates ‘truth’ with effecting changes in observable psychometric measures of behaviour. This is the same ontology underlying marketing ‘spin’ and all attempts to effect pre-determined behavioural change. In contrast, Merleau-Ponty’s ontology rejects causality and mind/body duality, and views ‘truth’ as the expression of our deepest embodied feeling and perception of the world, which establishes all our thinking, and on which all our thinking relies, including ‘scientific’ thinking. Merleau-Ponty’s ontology is therefore a preferable foundation for psychiatric practice, because it allows psychiatrists to consider the ‘truth’ of clinically important, but non-measurable, aspects of psychiatry while not excluding ‘scientific’ thinking, but recognising its limitations and potential for misuse.