04 Jan Being With Vs. Doing To

By Connor Tindall

The goal of this paper is to distinguish between two very different approaches to the treatment of people going through psychotic episodes. I have termed these two approaches “being with,” and “doing to.” I have chosen these terms in part because they are broad but also because I believe that they capture the two basic premises that treatment of psychotic states proceeds from, as well as the basic idea of how one should carry oneself when working with people in extreme states.

The approach of “doing to” can be seen as the conventional treatment approach in western society. It is active, in that it makes an active effort to “fix” the problem of psychosis, usually with the stated goal of symptom reduction. This attitude encompasses the pharmacological treatments that are typically employed with individuals in altered states, as well as behavioral therapies that aim at symptom reduction or a change in the individual’s outward behavior, such as cognitive behavioral therapy.

The “being with” approach on the other hand does not view psychosis as a problem that needs to be “fixed,” but as a meaningful process that needs to be gone through, ideally with caring support. In comparison to the “doing to” approach it is relatively passive in attitude, and the role of the helping professional is seen as one of being available, without being overly intruding or psychically penetrating. This approach ideally encompasses many forms of psychoanalysis and non-behavioral talk therapy (though sadly this is too often not the case), as well as the radical therapeutic communities which were started in the 1960’s and 70’s by people such as R.D. Laing, Loren Mosher, and John Weir Perry.

The term “being with” was first introduced by the philosopher Martin Heidegger in his magnum opus Being and Time, and he used it when talking about the existential position of “being-with- others.” However, this is not how I first encountered the term. I first came across the idea of “being with” while volunteering at Soteria-Alaska. Like Gnosis Retreat Center, the Soteria model was inspired by the work of R.D. Laing and I suspect that its founder, Loren Mosher, may have picked up the term “being with” from him, as Laing’s work was inspired by existential philosophy.

To be with someone at Soteria was to be available to them for use as support in whatever way a person might need in the moment. I often thought of it as being an anchor for someone in distress, someone that they could use to ground themselves if they so wished. This most often took the form of listening, but it could take many other forms as well. A person might want someone to accompany them on an errand, help them cook a meal, or just sit by a fire with them and chat. It was also common for people at Soteria to use me for reality testing, by asking questions such as “is someone standing behind me?” or “Is there a person hiding in that bush?” These were questions that I would answer in the most reassuring and authentic way I could.

Everything listed above is a form of being with, and there are many more forms that this way of being with others can take. The unifying factor however is that I am passive, but available. If I was truly embodying the “being with” attitude I would not make them run errands with me, or make them cook a meal with me, or sit by a fire with me. I may suggest that we do these things as anyone might, but I would not force these things upon them. This is a way of

helping that is non-coercive, which may seem odd in the context of a culture that is often hell-bent on “fixing” things, and far too often on “fixing” people. This brings me to the type of interventions that I am calling “doing to.” Even the term “intervention” implies something in stark contrast to the attitude I discussed above. It implies something active, penetrating, something designed to “fix.” The way of “doing to,” to my mind, encapsulates pharmacological treatments, behavioral treatments, and the authoritarian attitude that is often found in mental hospitals which seek to control their inhabitants, through means both subtle and obvious.

The problem with taking this position towards people is that it does not regard them as people. They may be a complex interaction of neurotransmitters, a set of ill adapted behaviors and cognitions, or a dangerous animal which needs to be controlled, but they are not in this view seen as people. They are seen as problems.

One of R.D. Laing’s greatest insights was that psychosis is a process rich with meaning, and it is a very human process. Thus, if we are to understand this process we must “recognize the dialectical complexity of human reality and refuse to reduce all human action and experience to process terms” (Cooper). Human experience cannot be broken down into parts, like a broken appliance in need of a replacement part. We are holistic, and to look at us
otherwise makes us into “things” rather than human beings.

I am not in this paper suggesting that psychiatric drugs and behaviorally oriented treatments are not efficacious, as that would be a topic for another day. What I am suggesting is that the conventional way of treating and thinking about psychosis is fundamentally flawed. Treatments that aim to “do to” those in these alienated states rather than “be with” them, do not aim to help the people they claim to help. The proponents of such treatments certainly believe that they help, but in reality, all they do is suppress. The goal of conventional psychiatric treatment is less about helping people through an experience of madness, and more about creating a situation where the people who consider themselves “normal” do not have to look madness in the face, so as to avoid confronting the fact that the human grasp on reality is tenuous at best. Why else would we employ interventions that are so othering, and that reduce people to things with parts that need fixing?

Gnosis Retreat Center is a project that aims to operate outside of this dominate paradigm of “doing to.” We hope to provide a safe, non-coercive space where people may have their experience in the company of compassionate, available others who embody an attitude of “being with.” It is the people that make a home, and what we envision is a non-hierarchical community of people living side by side, who together tackle the challenges of each day as they arise. As Laing would say, Gnosis will be a “melting pot where preconceptions [are] melted down in the nitty-gritty of living together.” This is a daunting task in our culture, which seems allergic to just letting people be. Though we may be a small light in the darkness, darkness is the condition where a small light can be a beacon for others to follow.