Ulrich Koch

This article uses the early history of methadone maintenance treatment (MMT) as a lens to draw out the epistemic and ethical-political stakes of rehabilitation as an overarching aim of addiction treatment in the United States. It does so by bringing into focus the various factors that led to the undoing of rehabilitation as a ‘boundary object’ for the evolving addiction treatment field in the early 1970s. In the two preceding decades, rehabilitation had advanced to a central yet ill-defined category, consistently invoked by policy makers and treatment providers. However, with the introduction of MMT, along with the expansion of a competing treatment modality, therapeutic communities, the aims and means of rehabilitation became more contested. Political exigencies, federal regulations, and efforts to establish treatment efficacy led to a focus on steady employment as a neutral, seemingly uncontroversial treatment aim. At the same time, this goal moved increasingly out of reach with vocational rehabilitation efforts lacking political and institutional support. The loss of the concept’s interpretive flexibility, skepticism about using employment as a marker for treatment success, and the perception of MMT as a biomedical intervention, I argue, prompted the abandonment of rehabilitation and the reclaiming of the more individualized notion of ‘recovery’ as an overarching aim of addiction treatment.

The last few years have seen a marked increase of interest in the ethics of psychotherapy. As the field of mental health has recently taken on a new level of prominence, renewed commitment to the ethical analysis of psychiatric and psychological treatment is clearly required. In this review essay, we survey recent work on psychotherapy ethics, taking a critical yet generally sympathetic view of the new literature. There are important considerations that remain neglected or overlooked entirely, in our view, and several substantive and methodological trends are in need of diagnosis and critical response. We structure the discussion around several themes, including the inherently moral nature of psychotherapy, the heterogeneity of such practices, the significance of social, cultural, and historical context, and, finally, questions concerning prevailing methodological assumptions.

The last few years have seen a marked increase of interest in the ethics of psychotherapy. As the field of mental health has recently taken on a new level of prominence, renewed commitment to the ethical analysis of psychiatric and psychological treatment is clearly required. In this review essay, we survey recent work on psychotherapy ethics, taking a critical yet generally sympathetic view of the new literature. There are important considerations that remain neglected or overlooked entirely, in our view, and several substantive and methodological trends are in need of diagnosis and critical response. We structure the discussion around several themes, including the inherently moral nature of psychotherapy, the heterogeneity of such practices, the significance of social, cultural, and historical context, and, finally, questions concerning prevailing methodological assumptions.

How to Do Things with Metaphors: Reflections on the Role of Metaphors and Metaphor Theory for the History of Science Using the Example of Shock Metaphors in Medicine.In recent decades, metaphors have attracted a great deal of interest within the history, philosophy, and sociology of science. The article takes the growing interest in epistemic metaphors as the starting point of a discussion of two conflicting motives prevalent in theories of metaphor and metaphoricity: On the one hand, metaphors are associated with the indeterminacy of scientific discovery and the emergence of new epistemic objects; and on the other hand, metaphors are said to provide a filter of possible meanings and vantage‐points. It is argued that an approach, which aims to do justice to both tendencies, cannot exclusively rely on linguistic models but must expand its scope of inquiry to include the practical trajectories of a metaphor’s usage as well as the problematizations to which they respond, since both engender metaphorical meaning, albeit at the cost of semantic precision. The exemplary case discussed in the article, the psychologization of nervous shock in nineteenth century medical discourse, demonstrates that the incremental process of shock’s shifting semantics would be inadequately characterized as a metaphorical transfer. Instead, it is shown how the actualization of earlier meanings, in particular of shock as a state of altered consciousness, in novel professional and cultural contexts acted as a catalyst for the psychologization of shock and related nascent concepts such as psychic trauma. As a possible, and methodologically fruitful way of overcoming the one‐sidedness of linguistic notions of metaphor, a combination of Jürgen Link’s concept of inter‐discourse with a philosophical metaphorology (Blumenberg) is discussed in the final section of the paper.

ArgumentThe article retraces the shifting conceptualizations of psychological trauma in experimental psychopathological research in the middle decades of the twentieth century in the United States. Among researchers studying so-called experimental neuroses in animal laboratories, trauma was an often-invoked category used to denote the clash of conflicting forces believed to lead to neurotic suffering. Experimental psychologists, however, soon grew skeptical of the traumatogenic model and ultimately came to reject neurosis as a disease entity. Both theoretical differences and practical circumstances, such as the technical challenge of stabilizing neurotic symptoms in rats, led to this demise. Yet, despite their reservations, experimental psychologists continued to employ traumatic stimuli to produce psychopathological syndromes. In the 1960s, a new understanding of trauma evolved, which emphasized the loss of control experienced by traumatized animal subjects. These shifting ideas about trauma, I argue, reflect both varying experimental cultures, epistemic norms as well as changing societal concerns.

Ausgehend von den jüngeren Erfolgen bei der psychopharmakologischen Behandlung psychischer Störungen wird der wissenschaftstheoretische Status psychotherapeutischer Verfahren erörtert. Es wird gezeigt, dass die dichotome Aufspaltung zwischen am Körper ansetzenden Interventionen auf der einen Seite und psycho- und sozial-therapeutischen Verfahren auf der anderen eine theoretische Fiktion ist, die vor dem Hintergrund der Entstehungsgeschichte der modernen Psychotherapie begriffen und hinterfragt werden muss. Anhand eines historischen Fallbeispiels und unter Rückgriff auf den wissenschaftstheoretischen Ansatz Bruno Latours wird der Versuch unternommen, psychotherapeutische Selbsttechniken als Transformations- bzw. Vermittlungsprozesse neu zu konzeptualisieren. Die rhetorische Trennung zwischen somatischen und psychotherapeutischen Selbsttechnologien wird damit hinfällig.Taking the recent advances made in the psychopharmacological treatment of mental illness as a starting point, this article discusses the epistemological status of psychotherapy. It will be shown that a dichotomy between somatic therapies and psychotherapies is untenable. The coming about of this rupture will be understood – and critically assessed – on the basis of its historical evolvement. Drawing on a historical case study as well as on Bruno Latour’s actor-network theory I will attempt to conceptualize self-technologies as processes of mediation, thus rendering the rhetorical split between somatic and psychotherapeutic self-technologies obsolete

This article investigates the changing justifications of one of the hallmarks of orthodox psychoanalytic practice, the neutral and abstinent stance of the psychoanalyst, during the middle decades of the 20th century. To call attention to the shifting rationales behind a supposedly cold, detached style of treatment still today associated with psychoanalysis, explanations of the clinical utility of neutrality and abstinence by ‘classical’ psychoanalysts in the United States are contrasted with how intellectuals and cultural critics understood the significance of psychoanalytic abstinence. As early as the 1930s, members of the Frankfurt School discussed the cultural and social implications of psychoanalytic practices. Only in the 1960s and 1970s, however, did psychoanalytic abstinence become a topic within broader intellectual debates about American social character and the burgeoning ‘therapy culture’ in the USA. The shift from professional and epistemological concerns to cultural and political ones is indicative of the changing appreciation of psychoanalysis as a clinical discipline: for psychoanalysts as well as cultural critics, I argue, changing social mores and the professional decline of psychoanalysis infused the image of the abstinent psychoanalyst with nostalgic longing, making it a symbol of resistance against a culture seen to be in decline.

This chapter reviews past and present debates about the therapeutic relationship in order to draw out the ethical implications of relational practices in psychotherapy. The therapeutic relationship has been understood differently across psychotherapeutic approaches, with each tradition responding to the attendant ethical challenges in distinctive ways. Aside from practitioners’ theoretical and practical commitments, the therapeutic relationship has also been, and continues to be, shaped by broader societal influences. The chapter discusses the shifting ethical implications of relational practices, then, as situated in their theoretical and historical contexts. The variability of concerns raised by the therapeutic relationship requires continued ethical analysis in order to confront the diversity and complexity of contemporary clinical practice.

In the most inclusive sense, psychological mechanisms offer a type of causal explanation of mental states and behavior, often with reference to underlying processes, systems, activities, or entities. By postulating and investigating such mechanisms, researchers have sought explanations of a wide range of psychological phenomena. However, the concept has been deployed in dramatically different ways, with very different meanings, depending upon the particular school or tradition of psychology (and specific research program therein). In fact, usage has been so diverse as to defy easy categorization or definition. But a historical perspective, even if rather selective, can trace the broad outlines of the significance of psychological mechanisms for the study of the mind. Perhaps most notable is the role they have played in the psychoanalytic tradition; research efforts within behaviorism and cognitive science have also made liberal use of versions of the concept in their explanatory frameworks (for discussion of evolutionary psychology, see the entry “evolved psychological mechanisms”). Cutting across all of these traditions are several key themes relating to psychological mechanisms, including questions concerning the scope of the relevant causal claims, debates about causal determinism and regularity, and the unresolved relation between mind and body.