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Article Excerpt
The concept of human nature as an enduring set of capacities and mechanisms capable upon observation and reflection of being understood and facilitated in their proper function is basic to understanding the assumptions upon which clinical psychology rests. Clinical psychology assumes there is sufficient stability in the underlying capacities of human nature to test observations, draw generalized conclusions and reliably predict behavior. This essay's aim is to make a case for the importance of articulating a normative account of human nature for clinical psychology; and then to set forth a concise account of the basic constituents and capacities of human nature. The account takes the form of a set of descriptive premises that together constitute a concise philosophical conception of the human person that the authors think can serve as a normative theoretical and abstract foundation for reasoning in the field of clinical psychology.
Accounts of human nature in clinical psychology:
In his exchange in 1980 with Albert Ellis on the role of religious values in psychotherapy, Allen Bergin argues that psychotherapy's practical aim of facilitating therapeutic change requires systematic prior judgments as to what changes are desirable. Such judgments, he asserts, are necessarily value judgments: they entail evaluations about what constitutes human psychological well-being. It follows, he says, that psychotherapy undetermined by at least an implicit ethical worldview is a fiction: "a value-free approach is impossible" (Bergin, 1980, p. 97). The outspoken atheist Ellis fully concurs. To the assertions that "values are an inevitable and pervasive part of psychotherapy," and that "value-laden factors pervade professional change processes," Ellis responds, "I, as a clinician and a probabilistic atheist, can heartily agree"(Ellis, 1980, p. 635).
Was Ellis agreeing with Bergin's view that religious values are important to psychotherapy? Assuredly not. Ellis in fact argued the opposite. (2) But he agreed that some set of values is always implied in the therapeutic endeavor. Therapy is directed towards a client's well being. This implies an evaluative judgment that some conditions of mental health and human experience are better than others. This is a value judgment. A judgment is the rational conclusion of a deliberative process over the truth or falsity of a proposition. A value judgment is such a conclusion in regard to a proposition assigning value to something (e.g., such and such is true, is good, is beautiful, ought to be done, should be pursued or avoided, is better than, worse than, as good as, worth-while, etc.). Value judgments can be derived from many sources, such as scientific investigation (e.g., brain tumors are bad for human health), or from social consensus (e.g., drapetomania-slaves running away from their masters--is dysfunctional behavior), or from religious belief (e.g., obedience to Allah and the writings of the Prophet are most consistent with human well-being), or from personal taste, political affiliation, ethnic or tribal loyalty, ethical reasoning, etc. Even the judgment that therapy ought to proceed entirely on the basis of the client's subjective notion of the good, and that it should impose no conception of mental health beyond what the client conceives, is itself a value judgment asserting (at least implicitly) that a non-directive approach is superior to an approach based on pre-specified therapeutic aims. So both Ellis and Bergin agreed that therapy is purposeful, and purposeful precisely in relation to one's set of therapeutic values.
Bergin went on to say that arriving at concepts of mental well being precise enough to direct psychotherapy to practical goals "necessarily requires a philosophy of human nature that guides the selection of measurements and the setting of priorities regarding change" (Bergin, 1980, p. 97). He did nor elaborate the meaning of "philosophy of human nature," nor did Ellis reply to his assertion. Did he mean that a commitment to clinical values implies an explicit commitment to an articulated philosophy of human nature? Presumably he did not, since not all therapists have a detailed account of human nature worked out in their minds. So what did he mean? Daniel Robinson says something similar, though more strongly: "in the absence of a developed conception of human nature, there are simply no grounds on which to base therapy at all" (Robinson, 1997, p. 678). And Robinson certainly did not mean that everyone committed to the business of psychotherapy is practically committed to a theoretical model of human nature. What then is being asserted?
Robinson and Bergin are asserting that an implicit assent to a conception of human nature amenable to therapeutic influence is presupposed by all who undertake the therapeutic task. Such a conception is implied in the very concepts of mental disorder and dysfunction. There can only be disorder because there is departure from right order; and dysfunction by definition implies a concept of right function.
This is not to say that contemporary psychology defines its categories of health and pathology deductively from an abstract account of human nature. It generally establishes its categories by gathering statistical data from research derived from tested observation. The truth value of its conclusions derives not from their logical consistency with the premises of a philosophical anthropology, but rather from the fact that classification schemes are supported--"demonstrated"--by empirical evidence. Some researchers, like R. E. Kendell, even consider "truth value" to be irrelevant. "Diagnostic terms," he writes, "are no more than convenient labels for arbitrary groupings of clinical phenomena." Categories, he says, are "justified only by their usefulness" (Kendell, 1983, p. 51). But even Kendell's view poses no fundamental argument against Bergin and Robinson's assertion. It merely begs the questions of what underlying anthropological conditions ground the consistently observed "usefulness" of the diagnostic terms. In other words, it implicitly assumes an account of human nature.
If it is the case that some account of right function is presupposed in all inquiry into dysfunction, then the question of what the thing is that's functioning is not an ancillary question but rather at the heart of understanding the aims of the science. It is reasonable, then, to ask what the human person is. Determining which predicates are essentially attributable to humans is not the business of the Diagnostic and Statistical Manual. Its purpose is to set forth the consensus of specialists on current formulations of evolving clinical knowledge regarding psychopathol-ogy. But the consensus itself implies there is sufficient stability in the human psychosomatic subject matter that observations can be tested, general conclusions drawn, and behavior based on the conclusions reliably predicted.
Clinical psychology assumes this stability. This does not imply that human nature is static and unchanging. But its changes do not imply a change in the kind of being the human person is. The changes are developments in the possible actualizations of which human nature is capable. Dewey's call to "free the possibilities in human nature" (Dewey, 1951) must not be taken to absurdity. To have any intelligible meaning it must assume an account of nature as a set of underlying possibilities capable of being actualized. Human nature is manifestly not "free" to become four legged, winged, unicellular, invisible, or three headed like the infernal Cerberus. Oxford philosopher John Finnis writes human nature (does not change) in its basic possibilities of fulfillment, possibilities which are adequately known only by adverting to the basic forms of human flourishing ... is there, then, anyone for whom it was not or is not or will not be the case that life and health, knowledge of truth and beauty, excellence in work and play, the harmony in friendship with others, the procreative friendship of marriage with another, personal harmony in interior integrity and peace and outer authenticity, and harmony with the source of all meaning and value, are the basic reasons for action, the basic forms of the human fulfillment in which he or she would wish to share and outside of which no benefit or goal could seem really worthwhile?" (Fin-nis, 1992, pp. 24-25)
Beneath the instantiations of human possibilities as variously actualized in history is an enduring set of capacities that enable us to identify the human person as a particular kind of being. And these are unchanging. If human nature at a fundamental level was unstable, episodic and subject to alteration, it would lack the unity necessary to reliably define function and dysfunction. (3) Adams writes in the Comprehensive Handbook of Psychopathology that "a dysfunction is a failure of some mechanism to perform its natural function as designed by nature" (Adams et al., 2001, p. 9). Wakefield says something similar: "a disorder exists when the failure of a person's internal mechanisms to perform their functions, as designed by nature, impinges harmfully on the person's well-being" (Wakefield, 1992, p. 373). The twice stated clause "as designed by nature" is understood along evolutionary lines to mean that the most adaptive capacities and mechanisms for survival have been selected by nature and characterize the organism as we know it today. If one minimally construes the concept of human nature to refer to the natural mechanisms and capacities that characterize the human person in his environment, and construes clinical well-being to refer to the proper functioning and fulfilling...
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