Self-cognition or pharmacotherapy? Philosophical implications of the dispute around soma and psyche in Roman Markuszewicz’s concept of psychotherapy

The problem of how to apprehend the relationship between the human body, its physiological basis and human mental life has been the object of fiery philosophical debate for centuries. In modern psychiatry and psychotherapy, it revolves around the question of the extent to which human mental life is autonomous or is determined by the physiological processes of the human body. This dispute is not confined to the strictly anthropological dimension; it concerns also the question of the psychiatrist’s choice of an appropriate method of therapy for a patient. In this article, I present the standpoint adopted on this issue by Roman Markuszewicz, a prominent psychoanalytically-oriented Polish psychiatrist in the period between the two world wars. He was critical both of traditional forms of therapy ‘through faith’ and also of modern forms of therapy based on psychosurgery and pharmacotherapy. I discuss his main objections to these two different forms of therapy and his arguments for the effectiveness of a Freudian model of therapy based on dialogue with the patient and on an attempt to transform his self-understanding.

Keywords: psychoanalysis, psychiatry, psychotherapy, hermeneutics, dialogue, pharmacology, psychosurgery, psychodynamics

Samopoznanie czy farmakoterapia? Filozoficzne implikacje sporu wokół soma i psyche w ujęciu psychoterapii przez Romana Markuszewicza

Kwestia ujęcia relacji między ludzkim ciałem, jego fizjologicznym podłożem, a sferą życia psychicznego człowieka od stuleci była przedmiotem zażartych dysput filozoficznych. We współczesnej psychiatrii i psychoterapii przybrała ona postać sporu wokół tego, w jakim stopniu sfera ludzkiego życia psychicznego jest autonomiczna, w jakim zaś jest zdeterminowana przez fizjologiczne podłoże ludzkiego ciała. Spór ten ma nie tylko ściśle antropologiczny wymiar, ale dotyczy zarazem kwestii obrania przez psychiatrę odpowiedniej metody terapii pacjenta. W artykule przedstawiam stanowisko, jakie zajął w tej kwestii Roman Markuszewicz, wybitny polski psychiatra o orientacji psychoanalitycznej, działający w okresie międzywojnia. Podkreślam zarówno jego krytycyzm wobec tradycyjnych form terapii „przez wiarę”, jak i wobec orientacji deterministycznej, stawiającej na psychochirurgię i farmakoterapię. W artykule przytaczam jego podstawowe zarzuty przeciwko tym obu formom terapii oraz argumenty na rzecz efektywności Freudowskiego modelu terapii, opartego na dialogu z pacjentem i dążeniu do zmiany jego samowiedzy.

The problem of how to apprehend the relationship between the human body, its physiological basis and human mental life has been the object of fiery philosophical debate for centuries. In modern psychiatry and psychotherapy, it revolves around the question of the extent to which human mental life is autonomous or is determined by the physiological processes of the human body. This dispute is not confined to the strictly anthropological dimension; it concerns also the question of the psychiatrist’s choice of an appropriate method of therapy for a patient. In this article, I present the standpoint adopted on this issue by Roman Markuszewicz, a prominent psychoanalytically-oriented Polish psychiatrist in the period between the two world wars. He was critical both of traditional forms of therapy ‘through faith’ and also of modern forms of therapy based on psychosurgery and pharmacotherapy. I discuss his main objections to these two different forms of therapy and his arguments for the effectiveness of a Freudian model of therapy based on dialogue with the patient and on an attempt to transform his self-understanding.