Midwifery: The Paradoxical Nature of Contemporary and Ancient Therapy

Midwifery: The Paradoxical Nature of Contemporary and Ancient Therapy
Douglas Harrison Dean

Abstract
Contemporary psychotherapeutic practice not only reflects the diversity of ancient Greek thought but also shares many of the same basic philosophical questions and approaches with little awareness of their origins. A brief review of literature will reveal how ancient philosophers from Socrates onward viewed the primary function of their philosophies as therapeutic. Focus of this paper will be on Socrates’ midwifery as a paradigmatic case for therapeutic discourse. Midwifery will be analyzed in terms of meta-complementary communication patterns that are subject to paradox as described by Bertrand Russell’s Theory of Type and applied to psychotherapy by Gregory Bateson and Jay Haley. This model of psychotherapy posits that paradox is embodied in all forms of psychotherapy and is the essential source of therapeutic change. Carl Rogers’ client-centered approach, the most straightforward contemporary form of psychotherapeutic midwifery, will be used as a comparison to Socratic midwifery. Generous use of quoted material is used in an effort to offer the therapist’s view in their own words.

For one swallow does not make a summer.
– Aristotle

Midwifery:
Much of contemporary Western civilization’s character has been inherited from the ancient Greeks and pervades Western thought today, whether recognized as such or not. For example, the phrase “One swallow does not make a summer” made its way through time from the 4th century BCE writings of Aristotle’s into the 1997 Wechsler Intelligence Scale where the aphorism is used to determine an individuals’ Intelligence Quotient [IQ].1 This saying is also found in the writings of the legendary Greek fabulist Aesop, a slave who lived in Samos in the 6th century BCE.2 Although the cultures and languages that have transmitted this phrase varied and changed with time, the conveyed meaning survives unscathed, e.g., there is risk in over-generalization.

Simo Knuuttila is chair of the History of Mind Research Unit at the University of Helsinki, which is devoted to the exploration of philosophy of mind from Plato to Kant. He acknowledged that

“Knowledge of ancient discussions is important for the study of later philosophical views, since ancient ideas were embedded in various ways in early medieval thought, medieval university teaching, and the early modern philosophy of the emotions” (2006, p. 3). In many ways “there is nothing new under the sun.”3

My comparison of contemporary psychotherapy with ancient Greek philosophy will not only expose the echoes of ancient wisdom on today’s psychotherapeutic practice but will also offer new reflections on ancient conundrums. This will be accomplished in three parts. The first will establish that ancient Greek philosophers thought of their philosophy as psychotherapy (therapy for the psyche). The second part will reflect on how Bertrand Russell’s Theory of Type relates to Socrates’ Disavowal of Knowledge paradox as well as the Liar Paradox. This discussion will serve as groundwork for applying the Theory of Type to psychotherapy. The third part will identify Socratic and Rogerian midwifery as identical meta-complementary ways of relating paradoxically to a patient.

A Brief History of Ancient Greek Psychotherapy

Our contemporary word ‘therapy’ is in itself ancient. It comes from the Greek word therapeia, which means “to be attentive to.” The therapeutic aspect of ancient philosophy is acknowledged today but continues to be greatly overshadowed by ontological and epistemological studies. Everson states, “The gulf between ancient and modern psychology may be more apparent than real, and the differences in approach may preview useful new perspectives rather than just blocks to useful comparisons” (1991, p. 5).

Sorabji (2003) attributes the idea of philosophy as psychotherapy to the PreSocratics, Plato, and Aristotle. In 5th century BCE the Sophist Antiphon was reported to have invented a way to cure men’s minds by words and advertised his services near the marketplace of Corinth. Mestrius Plutarchus (c. 46 AD – 120 AD), better known in English as Plutarch, is attributed authorship of Lives of the Ten Orators:

While [Antiphon] was poetically inclined, he invented an art of curing distress of the mind, as physicians can provide cures of bodily diseases. And having at Corinth built him a little house, in or near the market, he set a notice over the gate, to this effect: that he had a way to cure distress of men’s minds by words; and let him but know the cause of their malady, he would immediately prescribe the remedy, to their comfort (Plutarchus, p. 833).

Sorabji reports of Antiphon that, “No sorrow was too great for him to expel it from the mind by his art of banishing distress in pain-killing lessons. The subjects he covered included loss of money and marriage difficulties” (2003, p. 18). Guthrie writes that Antiphon knew “the roots of physical illness were to be sought in the mind and that it could sometimes be explained as an escape-route from active life” (1977, p. 291). Gottlieb reports that Antiphon had a particular interest “in dreams and their interpretation” (2002, p. 113).

The agora, or marketplace, of Athens was where Socrates (470 BCE – 399 BCE) conversed as part of his divine mission to expose hubris. Gregory Vlastos (1994) commented that the Method used by Socrates played double duty as a search for truth and as a form of therapy. Socrates influence cannot be overestimated and his legacy is all the more intriguing since he left no writings of his own. We know of Socrates primarily from the writings of Plato, Xenophon, Aristotle and Aristophanes.

By the time of the death of Alexander the Great in 323 BCE, the three main Hellenistic philosophic schools, Epicureanism, Skepticism, and Stoicism, began proposing varying paths to ‘living well’ (Gottlieb, 2002; Guthrie, 1971; Long, 1986). Each of these philosophical schools defined the human condition, and the curative solution, in their own terms. What they shared was practicing philosophy as a therapeutic art (Gottlieb, 2002; Nussbaum, 1996). Epicurus (341-271 BCE) stated:

Empty are the words of that philosopher who offers no therapy for human suffering. For just as there is no use in medical expertise if it does not give therapy for bodily diseases, so too there is no use in philosophy if it does not expel the suffering of the soul (Gottlieb, 2002, p. 283).

Marcus Cicero’s (106 – 43 BCE) Tusculan Disputations also reflects the magnitude of the ancient’s concern towards disturbances of the psyche; “But there are more disorders of the mind than of the body, and they are of a more dangerous nature; for these very disorders are the more offensive because they belong to the mind and disturb it” (Cicero, Book III, Chapter III).

The Hellenistic schools shared with each other the idea that the greatest malady affecting humankind was disorders of the psyche caused by diseased beliefs. Their ‘curative’ philosophies have been recently referred to as the “Hellenistic therapeutic argument” (Nussbaum, 1996, p. 7), “epicurean therapy” (Gottlieb, 2002, p. 310), “skeptical therapy” (Nussbaum, 1996, p. 304) and “stoic cognitive therapy” (Sorabji, 2003, p. 159). The schools all claimed intellectual descent from Socrates despite the diversity of their therapeutic philosophies.

In regards to contemporary cognitive psychotherapy, Morton Hunt writes “Nearly two thousand years ago, the Stoic philosopher Epictetus composed an apothegm that anticipated the theory behind a major form of current psychotherapy: ‘People are disturbed not by things but by the view which they take of them’” (1994, p. 578).

Albert Ellis (1913 – 2007), creator of Rational Emotive Therapy [RET], credits the ancients for his form of cognitive therapy:

Going back to philosophy, I combined the best elements of Stoicism, Epicureanism, and several other phenomenological-humanistic-existential philosophies and formulated the ABC theory of emotional disturbance, which then became the core of most of the other cognitive-behavior therapies that began to follow RET in the 1960’s and 1970’s (Caro & Read, 2002, p. 298).

Ancient philosophy and contemporary psychology advocate therapeutic dialogue supported by divergent theories and methods.4 But what, if anything, do these distant psychotherapies have in common beyond using dialogue to decrease distress and/or increase tranquility? A common factor in therapeutic change based on the Theory of Types was advocated by the Bateson Project during the mid 20th century. It is to this theory we now turn.

How Bertrand Russell’s Theory of Type Deals with Paradox
Bertrand Russell (1872 -1970) was a prolific writer and eminent Welsh philosopher, mathematician, historian and logician. His influence is primarily within the analytic philosophy of the 20th century positivists. His Principia Mathematica (Whitehead & Russell, 1997) is widely considered one of the most seminal works in mathematical logic and philosophy. This tome, written in conjunction with Alfred North Whitehead, was an attempt to prove the identity of mathematics and logic.

In 1901 Russell struggled with a logical paradox while working on the Principia. The logical paradox plagued and depressed Russell for an entire summer as he obsessed about the paradoxes’ ramification for the foundation of mathematics he was seeking. Russell eventually found a way of avoiding the paradox by means of his Theory of Types. He stated, “We are now in a position to show how the theory of types affect the solution of the contradictions which have beset mathematical logic” (Whitehead, Russell, 1997, p. 60).

Theory of Type and Socrates’ Disavowal of Knowledge Paradox
Understanding Bertrand Russell’s Theory of Type is a daunting task for non-mathematicians. For this reason, the second part of this paper will utilize Socrates’ Disavowal of Knowledge paradox, and the Liar Paradox, to illustrate its application in the areas of epistemology and semantics. Later, in part three, the Theory of Type will clarify the paradoxical similarities of ancient and contemporary midwifery.

The Disavowal of Knowledge paradox has always perplexed Greek scholars. After fifty years of teaching Plato, the renowned Greek scholar Gregory Vlastos considered it a mistake, ‘a real whopper’ in his words, to have dismissed the paradoxical nature of Socrates as the key to his philosophy. This paradoxical nature of Socrates’ life was the magnitude, and disavowal, of his wisdom.

It concerns what I had made of Socrates’ central paradox, his profession of ignorance. He asserts that he has no knowledge, none whatsoever, not a smidgin of it, ‘no wisdom, great or small’ (Apology 21B-D). But he speaks and lives, serenely confident that he has a goodly stock of it – sufficient for the quotidian pursuit of virtue. And he implies as much in what he says. To keep faith with Socrates’ strangeness some way has to be found to save both the assertion of his ignorance and the implied negation (1991, p. 3).

To make sense out of Socrates’ Disavowal of Knowledge other ancient Greek scholars have reported the identification of various distinctions, or hierarchies (Guthrie, 1971; Kerferd, 1981), in the areas of knowledge (Brickhouse & Smith,1995; Gonzalez, 2004; Schmid,1998; Vlastos, 1994; Woodruff,1992), ends (Cooper, 1986), desires (Schmid, 1998), virtues (Brickhouse & Smith, 1995) and wisdom (Vlastos, 1991). Irwin sees Plato distinguish “practical wisdom” from “productive knowledge” (1994, p. 72) and he proposes a Socratic “superordinate” scientific knowledge (1994, p. 61).

Wooddruff identifies “two conceptions of knowledge with different epistemic standards” that he refers to as “expert knowledge” and “non-expert knowledge” (1992, p. 90). Vlastos differentiates Socrates’ use of knowledge as “KnowledgeEclectic“ and “KnowledgeCertainty“ (1994, p. 57).

Forster (2007) identifies three classes of explanations within the secondary literature for Socrates’ Disavowal of Knowledge. The first class includes authors interpreting Socrates as disingenuous in his profession of ignorance, primarily to intellectually hustle his interlocutors by concealing what he knows. The second class sees Socrates as being sincere in his denial of wisdom by idealizing it to the point of being beyond human comprehension. The third agree in Socrates’ sincerity, but attributes this to his commitment to skepticism. Forster proposes a fourth interpretation, which distinguishes knowledge from true belief:

The only route for a reconciliation to take, it seems, would be via a distinction between knowledge and true belief. For if Socrates recognized such a distinction, he might consistently hold both that he had no knowledge about (important) ethical matters and that he none the less had true beliefs about such matters (2007, p. 7).

Most relevant to a paradoxical account of Socratic therapy is Vlastos’ insight that the Disavowal of Knowledge relates to two types of irony; simple and complex. Simple irony is when “what is said just isn’t what is meant” while complex irony is when “what is said both is and isn’t what is meant.” Vlastos concludes that Socrates’ disavowal of knowledge and of teaching “is intelligible only as a complex irony.” In other words, when Socrates “professes to have no knowledge he both does and does not mean what he says” (1991, p. 31).

Bertrand Russell exploration of the distinction between a level and a meta-level comes exceptionally close to what Vlastos was gesturing at as Socratic ‘complex’ irony. This makes Vlastos’ distinction between simple and complex irony an excellent starting point for demonstrating the interactive paradoxical nature of both ancient and contemporary psychotherapy. Paradoxical psychotherapy emphasizes interactive communication patterns occurring in the ‘here and now’ as individuals work out how to relate to each other. Vlastos took a step away from philosophical analysis, based on the logical content of the Socratic dialogues, to a more interactional analysis by incidentally focusing on the ironic nature of how Socrates approached his interlocutors.

To get a sense of how the historic Socrates related to his interlocutor we must turn to Plato’s earlier writings where Socrates’ Disavowal of Knowledge paradox was presented in less metaphysical terms. Vlastos acknowledges that “In every one of [the earlier dialogues] prior to the Meno Socrates maintains epistemological innocence [and] methodological naivety” (1994, p. 25). Here, in the early Apology, the denial of wisdom unfolds within the context of Socrates’ life.

The Disavowal of Knowledge in the Apology describes two levels of Knowledge. The Apology begins with Socrates’ trial for impiety and other allegations (Hamilton & Cairns, 1963). Socrates asks the jury to disregard the manner of his speech because he has “not the slightest skill as a speaker” and implies that this is due to the fact that he is only able to “speak the truth” (17b).5 This backhanded statement was meant to contrast Socrates’ method of personal one-on-one dialogue to that of the Sophists who offered persuasive, but specious, speeches to juries of 500 or more. These speeches were sold in an effort to exculpate a defendant regardless of the truth of the accusation. Sophistic ‘wisdom’, or rhetoric, was known for making “weaker arguments defeat stronger ones” and was falsely attributed to Socrates by his accusers at his trial. In the Apology Socrates attempted to distance himself from Sophistry:

I have gained this reputation, gentlemen, from nothing more or less than a kind of wisdom. What kind of wisdom do I mean? Human wisdom, I suppose. It seems that I really am wise in this limited sense. Presumably the geniuses whom I mentioned just now are wise in a wisdom that is more than human. I do not know how else to account for it. I certainly have no knowledge of such wisdom, and anyone who says that I have is a liar and willful slanderer (Apology 20d-e).

The ‘human wisdom’ and ‘more than human wisdom’ distinction began for Socrates years before the trial. Socrates’ friend, Chaerephon, went to Delphi and asked the oracle “whether there was anyone wiser than” Socrates, to which “the priestess replied that there was no one” (Apology 21a). Socrates was perplexed when he heard about this because he thought of himself as possessing no wisdom at all. He then decided to seek out men known to be wise so as to show the oracle mistaken. But when he questioned the wise he found that they really were not wise and merely thought of themselves as wise. Socrates tells the jury about a politician he interviewed to “check the truth” of oracles’ words:

In conversation with him I formed the impression that although in many people’s opinion, and especially in his own, he appeared to be wise, in fact he was not. However, I reflected as I walked away, Well, I am certainly wiser than this man. It is only too likely that neither of us has any knowledge to boast of, but he thinks that he knows something which he does not know, whereas I am quite conscious of my ignorance. At any rate it seems that I am wiser than he is to this small extent, that I do not think that I know what I do not know (Apology 21d).

By “conscious of my ignorance” Socrates is saying, “I do not think that I know what I do not know,” unlike the politician who “thinks that he knows something which he does not know.” The extent that a human can claim wisdom, to Socrates, is in having “knowledge” about “what one knows or doesn’t know.” Although he mentions that it is nothing to boast about, Socratic wisdom, in the Apology, includes the wisdom to distinguish between “knowledge about knowledge” and “knowledge.” The politician doesn’t recognize this since no distinction can be made between being not “conscious” about that which one “does not know.” Socrates doesn’t possess more-than-human-wisdom but he does have the human-meta-wisdom about his lack of more-than-human-wisdom. The politician is neither wise nor meta-wise.

The Theory of Type shows how Socrates’ two levels of knowledge relate paradoxically.
The application of Russell’s Theory of Type to Socrates’ Disavowal of Knowledge places “knowledge about knowledge” and “knowledge” at different abstract logical levels which relate to each other as classes do to members. A self-referencing paradox is avoided by not identifying a ‘classification about an item’ with ‘the item that is classified.’ In more logical terms, even though the “class of non-X” is not itself an “X,” it would violate the Theory of Type to classify the “class of non-X” as a member of itself. In simple terms, the Theory of Type avoids the endless oscillation which occurs when no distinction is made between a ‘class’ and a ‘member the class is about.’ Groucho Marx, the famous comedian of the Marx Brothers, intuitively hit upon the class/member paradox relationship when he said, “I don’t care to belong to a club that accepts people like me as members.”

Apply Bertrand Russell’s Theory of Type to the Liar Paradox
The Liar Paradox is another example that will help illustrate the Theory of Type before extending its application to psychotherapy. This paradox can be restated as, ‘All my statements are false.’ If Epimenides makes this statement and then, in a second statement, claims to be mortal, his two statements would merely non-paradoxically contradict each other. Instead, a paradox occurs in the attempt to decide what the implications of saying ‘All my statements are false’ has in reference to itself; is Epimenides making a false statement as he is saying ‘All my statements are false?’ When referring to itself, ‘All my statements are false’ sets up a recursive oscillation between its own truth and falsity. This endless circularity suggests that the statement is ‘neither true nor false’ or ‘both true and false.’ This occurs, according to the Theory of Types, whenever a ‘statement about a statement’ is one of the statements it refers to.

To avoid paradox, ‘All my statements are false’ must not be identified as a ‘statement,’ but as a ‘statement about statements’, i.e., as a meta-statement. No recursive oscillation occurs if Epimenides somehow indicates that ‘All my statements are false’ is a meta-statement. That is, ‘All my statements are false’ is not itself one of the statements being referred to because it only refers to statements, not ‘meta-statements’ like itself. The identification of semantic meta-levels is demonstrated in the fact that the word ‘cat’ has never scratched anyone; otherwise it would be the same as confusing a map with the territory.

Apply Bertrand Russell’s Theory of Type to Communication Patterns

Russell’s paradox is logico-mathematical (syntactic – the class of all classes which are not members of themselves) and the Liar Paradox plays with hidden inconsistencies in the level of thought and language (semantic – I’m a liar). Now it is time to explore how paradoxical communication, like Socratic complex irony, can affect behavior (pragmatic – disobey me; be spontaneous; there will be a surprise exam next Friday).

Vlastos (1991) explains that complex irony is conveyed in Plato’s writings through subtle verbal/non-verbal descriptions, contextual cues, and the implicit ‘extra-linguistics’ found in deadpan humor. Vlastos (1994) recognized that Socrates himself did not use any ‘meta-elenctic inquiry’ (the Elenchus being Socrates’ method of questioning). This lack of ‘meta-elenctic inquiry’ as an explicit topic of conversation by Socratic is compensated for by Plato’s genius as a writer of dialogues. A further analysis of Vlastos’ ‘extra-linguistics’ will help to tease the complex irony from ‘between the lines’ of Socrates’ dialogues. The Theory of Types was first applied to extra-linguistics communication patterns by Gregory Bateson.

The Theory of Type was used to describe meta-communication by the Bateson Project in the early 50’s. The anthropologist Gregory Bateson researched ‘extra linguistic’ communication as meta-communication; the “nonverbal media of posture, gesture, facial expression, intonation, and the context for the communication” (Bateson, Jackson, Haley, Weakland, 1956, p. 4). Between 1952 and 1954 Bateson was the director of the “Research Project on the Role of the Paradoxes of Abstraction in Communication.” In January 1952 Bateson went to the Fleishhacker Zoo in San Francisco to observe behavior that indicated the recognition of signs as signals between mammals. In observing mock monkey combat Bateson wrote, in a paper that was presented to the A.P.A. Regional Research Conference by Jay Haley, “Now, this phenomenon, play, could only occur if the participant organisms were capable of some degree of metacommunication, i.e., of exchanging signals which would carry the message ‘this is play’” (Bateson, 1955, p. 179).

Play, especially among animals, we have studied at some length. It is a situation that strikingly illustrates the occurrence of metamessages whose correct discrimination is vital to the cooperation of the individuals involved; for example, false discrimination could easily lead to combat (Bateson, et al., 1956, p. 19).

In order for monkeys to relate as playmates there must be some type of signaled agreement that classifies any apparent combat behavior as “really not combat.” The “this is play” message is important to each monkey because if their signals get crossed, “monkeying around” could turn into real combat. In other words, any hostile appearing gesture is itself not to be confused with that which classifies their relationship as “the friendly type”.

Bateson saw that any observable behavioral message signaling the type of relationship the monkeys shared was, in essence, at a higher abstract level than the behavior it classified or referred to. This meta-communication level (communication about communication) set the terms of the relationship. The ‘this is play,’ or “don’t believe this is real combat behavior,” message became an exemplar for paradoxical communication that conformed to Russell’s Theory of Type. Bateson writes,

The next step was the examination of the message ‘this is play,’ and the realization that this message contains those elements which necessarily generate a paradox of the Russellian or Epimenides type – a negative statement containing an implicit negative meta-statement. Expanded, the statement ‘this is play’ looks something like this: ‘These actions in which we now engage do not denote what those actions for which they stand would denote’ (Bateson, 1955, p. 179).

Each monkey must appropriately respond to classifying each other’s actions as ‘play’ or ‘not-play.’

Pragmatic paradoxes occur when class/member levels are crossed in the same way as syntactic and semantic paradoxes do. Paradoxical directives are a type of pragmatic paradox and take the form of “disobey me” or “disbelieve this.” Paradoxical directives have a particular effect on personal relationships whenever there is a recognizable dominate hierarchy or anywhere there is a perceived need to take another’s directives seriously. This occurs in relationships where one individual has a higher domain relative social status that is recognized by the other; hypnotist/subject, manager/employee, sage/seeker, parent/child, teacher/pupil, or therapist/patient relationships. In such relationships the person in the relative one-down position is hard pressed to ignore or comment on a paradoxical directive. When a reasonably way to withdraw from a paradoxical directive is prevented a paradoxical response can occur. As in Vlastos’ complex irony, “what is said both is and isn’t what is meant.” In the words the Bateson Project,

If one person directs another to do a particular act, a paradox is not necessarily evident, but when one person directs another not to follow his directives, the paradox is obvious. The receiver cannot obey the directive or disobey it. If he obeys the directive not to follow the directives, then he is not following directives. This paradox occurs because one directive is qualified by another in a conflictual way. If it is qualified by another, it is at a different level of classification from the other (Haley, 1963, p. 17).

The statement ‘disobey all my directives’ is a paraphrasing of ‘disobey me.’ Recall that the way to avoid paradox is to identify ‘disobey all my directives’ not as a directive, but as a meta-directive; a ‘directive about directives.’ A meta-directive tells how to respond to a directive, similar to the American childhood game ‘Simon says.’ In this case the meta-directive ‘disobey all my directives’ refers to directives other than itself, since it is a meta-directive and not itself a directive. If the ‘meta’ distinction is ignored, then a paradox is caused by the self-reference of the directive. This can cause mind-numbing results. Aristotle recognized such paradoxical ‘thought binding’ as a eristic function of the arguments used by the Sophists:

Further, the Sophistic argument presents a difficulty; for, because they want to produce paradoxical results to show how clever they are, when they succeed the resulting inference presents a difficulty (for thought is bound fast when it will not rest because the conclusion does not satisfy it, and cannot advance because it cannot refute the argument) (Nicomachean Ethics Book VII 1146a20, trans. Barnes, 1984, p. 1810)

Given that most animals, humans included, actively engage in the determination of how they relate relative to one another socially, it’s not surprising that dominate and subordinate issues are found in activities from mating (marriage) to territorial disputes (military). Human ranking issues that operate beneath unaided detection have been reported by Waal:

The frequency band of 500 hertz and below in the human voice [is]…nothing but a low-pitch hum…But it was found that this low hum is an unconscious social instrument. It is different for each person, but in the course of a conversation people tend to converge. They settle on a single hum, and it is always the lower status person who does the adjusting (2005, p. 6).

Strictly established social orders, like the military, have far fewer internal disputes over who’s in charge than within marriages between equals, where the give-and-take of when which mate gets their way generally shifts depending on the context. Put in simple language, these issues are about ‘who gets to decide who gets to tell who what to do,’ or as Haley say, the “struggle over who is to govern what sort of relationship there will be” (1976, p.80). Whether personal conflicts like ‘who put you in charge,’ or with authority conflicts involving formally established social structures, pragmatic paradoxes cause real confusion and perplexity beyond the ruminations of a logical paradox’s ‘it’s both true and false’ or ‘it’s neither true nor false’.

Pragmatic paradoxes were found to be fundamentally relevant to the nature of psychotherapy. From 1954 the Bateson Project received 10 years of funding for research of schizophrenic communication. The team approached their research as anthropologists seeking field sightings of paradoxical relationships (Haley, 1976). In the process they laid the theoretical foundation of Family Therapy for decades. John H. Weakland, one of the first members of the Batson Project, commented retrospectively that the “project involved the most crucial sort of scientific work, the beginning of reformulations of a whole field as broadly discussed by Kuhn in The Structure of Scientific Revolutions (1962)” (Bateson, et al., 1976, p. 107). A “paradigm shift” was attributed to “a communication description of psychotherapy and a novel theory about the cause of therapeutic change” (Haley, 1976, p. 95 italic added).

This ‘novel theory’ included the claim that paradoxical ways of relating are to be found in all forms of psychotherapy in spite of the diversity of the theories and methods that embody them; Behavioral, Psychoanalytic, Humanistic, or Cognitive. Haley writes that the projects’ “[essential] argument was that the source of therapeutic change resides in the paradoxes posed patients by therapists rather than in the self-understanding which was traditionally thought to be the cause of change” (Haley, 1976, p. 97).6 Psychic epiphany7 was posited as unnecessary for therapeutic change and served as a post hoc rationale for, or the byproduct of, the unbeknownst paradoxical nature of psychotherapy.

The Bateson Project members spawned an assortment of auxiliary theories to explain the effectiveness of the paradoxical interventions that were being incorporated into a growing number of clinical practices (see Stanton, 1981). Attention was taken away from paradox as the essential source of therapeutic change as factions hurried to embody paradox within their own philosophical perspective.

The third section of this paper describes the therapeutic commonalities between Socratic and Rogerian approaches utilizing the original vision of the Bateson Project; the communicative behavior of social animals relating to each other can be understood based on a paradox model derived from Russell’s Theory of Type. Carl Rogers’ nondirective method will now be used to identify its paradoxical commonality with the Socratic approach.

Midwifery Is Used Therapeutically By both Socrates and Carl Rogers
A Haleian similarity between ancient Socratic and contemporary Rogerian psychotherapy can be demonstrated. Two opposing methods, the Elenchus8 for Socrates and Reflection9 for Rogers, are packaged and delivered in identical therapeutic wrappings: Midwifery. In each approach, midwifery is the way each ‘frames,’ or meta-communicates, the therapeutic relationship with a patient.

The basic semblance of the analogy of psychological midwifery to that of biological midwifery is that a midwife cannot transfer from herself that which is to be brought out of the other. A midwife can only assist another to bring forth that which the other possesses.10 Pedagogically, midwifery posits that knowledge cannot be conveyed from a teacher to a student. The teacher, or the sage therapist, does not provide the knowledge that the student is to possess because the possession of knowledge can only occur when it is realized from within the student himself. In other words, knowledge is never taught by another, it can only be discovered for oneself.

Kierkegaard’s Midwifery Connection to Socrates and Carl Rogers
There is a historic intermediate connection between Socrates and Rogers via Søren Kierkegaard regarding midwifery. In the early days of exploring the “forces and laws of human relationships,” Rogers apparently caused quite a stir in presenting his “deepest views” to an audience regarding a “demonstration of ‘student-centered teaching’ – teaching based upon therapeutic principles” (1961, p. 273). Rogers gave this presentation to a Harvard University audience after a winter trip to Mexico where he “immersed himself” in the writings of Kierkegaard. Although Rogers doesn’t specify which particular Kierkegaardian text impressed him so, the following section from Roger’s presentation hints that it was Kierkegaard’s discussion of Socratic midwifery. Rogers wrote,
As soon as an individual tries to communicate such experience directly, often with a quite natural enthusiasm, it becomes teaching, and its results are inconsequential. It was some relief recently to discover Søren Kierkegaard, the Danish philosopher, had found this too, in his own experience, and stated it very clearly a century ago. It made it seem less absurd (1961, p. 276).

In Philosophical Fragments Kierkegaard considered the way Socrates’ related to his interlocutors as an exemplar of the highest form of magnanimity; “Herein lies the profundity of the Socratic thought, and the noble humanity he thoroughly expressed, which refused to enter into a false and vain relationship with clever heads, but felt an equal kinship with a tanner” due to the fact that “for between man and man the maieutic relationship is the highest” (1976, p. 13). The maieutic relationship Kierkegaard referred to comes from the Greek word maieuesthai, which means to act as midwife.11 In Theaetetus Plato characterizes Socratic midwifery:

My art of midwifery is in general like theirs; the only difference is that my patients are men, not women, and my concern is not with the body but with the soul [psyche] that is in travail of birth…it is clear that they have never learned anything from me. The many admirable truths they bring to birth have been discovered by themselves from within. But the delivery is heaven’s work and mine (150c-d, italic added).

Compare this to what Rogers stated his book, Client-Centered Therapy, to be primarily about:

[I]t is about me as I rejoice at the privilege of being a midwife to a new personality – as I stand by with awe at the emergence of a self, a person, as I see a birth process in which I have had an important and facilitating part (Rogers, 1951, p. x-xi).

Roger’s method of Reflective Listening stands directly opposite to Socrates’ method of Elenchus questioning. Roger’s stanchly refrained from questioning a patient except for occasionally questioning whether he had mischaracterized what the patient expressed. Socrates’ Elenchus is a cross examination very similar to many contemporary non-client-centered therapies. Yet both Rogers and Socrates base the rationale for their therapeutic methodology on the principle of midwifery.

Compare Plato’s, Kierkegaard’s and Roger’s account of the outcome of midwifery: Plato; “This knowledge will not come from teaching but from questioning. He will recover it for himself” (Meno 85c), Kierkegaard; “The underlying principle of all questioning is that the one who is asked must possess the Truth in himself, and be able to acquire it by himself (Kierkegaard, 1976, p. 15), Rogers, “I have come to feel that the only learning which significantly influences behavior is self-discovered, self-appropriated learning…Such self-discovered learning, truth that has been personally appropriated and assimilated in experience, cannot be directly communicated to another” (Rogers, 1961, p. 276).

Midwifery as a Meta-Complementary Relationship
Psychotherapeutic midwifery is a type of meta-complementary relationship. Regardless of the ‘true’ nature of hypnosis, Haley’s clearest example of a meta-complementary way of relating is in how a hypnotist responds to the resistance of a subject seeking to be hypnotized: 12
When he meets with particular kinds of resistance, a hypnotist may explicitly place himself in a secondary position with a subject while implicitly taking control at the meta-complementary level…the hypnotist may appear to hand over control of the relationship over to the subject by saying that he is only guiding the subject into trance and must follow the subject’s lead with whatever he wishes to do (Haley, 1963, p. 28).

This is a typical response of a hypnotist when approached by a subject looking to be hypnotized. The hypnotist will first tell the subject that no one can be hypnotized who doesn’t want to be hypnotized and that no one can be made to do something that they are not willing to do. Sometimes a hypnotist will insist that all hypnosis is self-hypnosis, which the subject will need to ‘let happen’. This way of relating to another is the same midwifery used by Socrates and Rogers; the hypnotist insists that control be turned over to the subject with a meta-directive to ‘act as if the reason for your action is not my directive.’

Haley states that, “The resistance of the subject is met by shifts to metalevels of direction so that resistance is redefined as cooperation and no move the subject can make is labeled as initiated autonomously” (1976, p. 102). In reference to the hypnotherapist Milton Erickson, Haley states that “When a hypnotic subject resisted, Erickson encouraged him to resist, thereby stepping to a metacommunicative level and defining resistance as cooperative behavior” (1976, p. 96).

Thus, a midwife way of relating to another is when an expert, asked by a seeker to ‘tell me what to do,’ tells the seeker that what to do is ‘not to do what she, the expert, tells him to do.’ A seekers action must be for a reason other than for the reason of being directed by the expert, the expert insists. When an action communicates a meta-directive to ‘resist seeking direction from me;’ or ‘disobey me,’ it is literally an ‘action about action,’ i.e., ‘a meta-action’ or ‘a reason for an action.’ The seeker has been midwifed when a seeker’s reason for resisting direction from a midwife is the seeker being cooperative with a midwife’s meta-directive.

The issue of ‘who gets to decide who tells whom what to do,” or “who gets to determine the reason for an action,” within a therapeutic context is subtler than hypnosis. Yet it is still played out at a meta-level of communication. Haley states:

When a patient takes his problem to a therapist he wishes to place himself in the hands of an expert who can and will help him. Yet his basic problem is usually the way he deals with people who try to help him. When he meets the psychotherapist, he faces an expert who takes charge by placing the patient in charge. The therapist assumes the position of an expert, and within that framework he disinvolves himself from offering expert advice and places the initiative for what is to happen in the hands of the patient” (Haley, 1963, p. 185).

The midwife relationship as advocated by any expert, such as a therapist or a sage, is paradoxical denial of the experts’ own one-up position relative to the patient. When the expert takes the non-expert position that “only the patient himself can be his own expert,” then any resistance by the patient to the therapist has been predefined by the therapist as the patient cooperating in attempting to be his own expert. If this relationship is agreeable to the patient, the expert has paradoxically establishes the position of being the one who determines the reason the patient resists the therapist and thereby has established a meta-complementary relationship in midwifery terms.

The paradoxical therapist, or ironic sage, relates to the patient in such a way that the patient cannot be uncooperative under the therapeutic influence of midwifery. A midwifery relationship typically remains actively salient until the patient effectively assumes responsibility for interdependently cooperating within the give and take of his social space.

Rogerian Midwifery
Contrary to the Rogerian insistence on the non-directedness of their therapy, the fact is that the only meaningful response a patient receives from Rogers is subsequent to talking about his experience. The patient quickly picks up on the direction therapy is to proceed; “When I share content of an experiential nature my therapist responds by restating my experience – and nothing more.” Rogers says of the process of therapy that, “It is of interest to me that I present the facilitating relationship, and the outcomes, with no description of, or even comment on, the process by which change comes about” (1961, .p 31 italic added).

Rogers found the personal aspect of the therapeutic process an exceedingly profound and unique experience for both him and the patient. It “greatly challenged” Rogers to be “faced by a troubled, conflicted person who is seeking and expecting help” (1961, p. 31). We get a sense of Rogers as a pioneer explorer of the human psyche with his psychological theory seeming to be almost an afterthought relative to the value he put on the quality of interaction with a patient. But what does the patient learn from the process of interacting with Rogers if it is not theoretic knowledge?
It is a type of learning which cannot be taught. The essence of it is the aspect of self-discovery… in the significant learning which takes place in therapy, one person cannot teach another. The teaching would destroy the learning…there can be no direct communication of it, or even about it. The most that one person can do to further it in another, is to create certain conditions which make this type of learning possible (1961, p. 205).

Remember that Rogers structures his relationship with a patient under the idea that “The counselor is not the one who is responsible for the direction which the client’s life will take” (Snyder, 1947, p. 3). The rationale for the contextual social structure of Rogerian psychotherapy is psychological midwifery, which, paraphrased, goes something like this:

Even if I could answer all your questions for you, this would not give you the insight that results from experiencing your own solutions for yourself. It is this experience within yourself I want to help you get in touch with. Only in this way will you gain the insight necessary for self-acceptance. The answers you seek can only be found within you. Even if it were possible, I would not deprive you the experience of discovering those answers for yourself.

In other words, therapeutic knowledge, if there is such a thing, is never taught by another but is only discovered for oneself. Snyder, referring to Rogerian psychotherapy, claims that “New mental integrations and social adjustments cannot successfully be imposed from without. Real nondirective counseling depends on nurturing a wholesome growth from within the individual personality of the client who is being counseled” (1947, p. viii).

By limiting the method of therapy to the clarifications and restatements of the patient’s experiences, the type of relationship the patient and therapist have is determined and maintained in terms set by the non-directive psychotherapist. In the case of Rogerian psychotherapy, the therapist paradoxically directs the patient, as therapy, to not take direction from the therapist. Snyder puts this succinctly; “The major factor which differentiates the non-directive method from others is that it is client-centered. By this expression we mean that the direction of the therapy process is essentially in the hand of the client rather than in those of the counselor” (1947, p. 2, italic added).

Socratic Midwifery
Socrates, like Rogers, structures the way his interlocutors participate in dialogue with him with as little comment at the meta-level as possible. Recall that Vlastos recognized this when he stated that Socrates “never venturing into meta-elenctic argument intended to probe the validity of his investigative method or the truth of his ontological presuppositions” (1994, p. 14).

Socrates related to his interlocutors not as a teacher of theoretic knowledge but as a therapist to a patient; personal enough to be life changing (Brickhouse & Smith 1995). From this perspective the philosophical content is secondary to Socrates’ mission. Plato brings out what it was like to be involved with Socrates through the words of Nicias during a symposium:

Nicias:
Because you seem not to be aware that anyone who is close to Socrates and enters into conversation with him is liable to be drawn into an argument, and whatever subject he may start, he will be continually carried round and round by him, until at last he finds that he has to give an account both of his present and past life, and when he is once entangled, Socrates will not let him go until he has completely and thoroughly sifted him… Indeed, I was fairly certain all along that where Socrates was, the subject of discussion would soon be ourselves (Laches 187e -188b).

Meno is a book of the middle period where Plato develops the philosophical underpinnings of Socrates’ Elenchus. While still maintaining Socrates’ Disavowal of Knowledge, Plato introduces a new epistemology: The Doctrine of Recollection. The Doctrine of Recollection is thought to be injected into the middle period of Plato’s works without actually having been held by the historic Socrates. Primarily Pythagorean, the Doctrine of Recollection posits a pre-birth life where one’s psyche on earth becomes numb to the truth it knows due to its fall from heaven and resulting incarnation. This is Plato’s supporting ideology for the discover of truth by recollection and consequent need for midwifery.

Theaetetus is the first of Platos’ books to describe Socrates’ as a midwife. Theaetetus is a young orphan with great intellectual potential who enters into a dialogue with Socrates regarding the nature of knowledge. Here Plato’s Socrates uses midwifery as the reason Theaetetus need not resist the Elenchus:

Socrates:
And now for the upshot of this long discourse of mine, I suspect that, as you yourself believe, your mind is in labor with some thought it has conceived. Accept, then, the ministration of a midwife’s son who himself practices his mother’s art, and do the best you can to answer the questions I ask (Theaetetus 151b-c).
Socrates awareness, in real-time, of the distinction between a level and a meta-level while dialoguing is clearly demonstrated in the following passage from Meno:
Meno:
I see, Socrates. But what do you mean when you say that we don’t learn anything, but that what we call learning is recollection? Can you teach me it is so?
Socrates:
I have just said that you’re a rascal, and now you ask me if I can teach you, when I say there is no such thing as teaching, only recollection. Evidentially you want to catch me contradicting myself straightaway (Meno 81e-82a italic added).

Plato’s Socrates constantly defers to his interlocutor’s wisdom and, with the introduction of the Doctrine of Recollection, this wisdom lives forgotten within everyone’s psyche just waiting for a midwife to facilitate its birth. Notice, along with this new rationale for the Elenchus, Plato changes Socrates earlier philosophy of finding no wisdom in others to now assisting others to find it within themselves.

In spite of Plato changing Socrates’ philosophy, Plato maintains the meta-complementary way of approaching others with an attitude of ironic submission, while encouraging the other to continue to be in control of the content of the dialogue. When the terms of a one-up position are determined by a complex ironic one-down position, a meta-complementary relationship is established. Psychological midwifery is one such way of relating.

Conclusion
Psychotherapeutic midwifery is an exemplar of Haley’s proposition that it is the process of paradoxical interaction within a relationship that produces therapeutic change. Psychic insight is constituted of the midwifery ideology itself. The ideology is midwifery because it embeds paradoxical responses towards any resistance to classifying individualistic insight as the reason for therapeutic change. The particular methodology of the therapist is conducted within this midwifery framework. The Elenchus, then, is Socrates’ therapeutic method of questioning while Reflection is Roger’s therapeutic method of listening. At the meta-level both Plato’s Socrates and Rogers use midwifery as the rationale for their methodology. When a participant resists the method of a midwife, the midwife is in the position to deal with the participant in a way where no matter what the participant does, the participant is said to be following the midwifes’ directives and ‘resisting’ by reason of the midwife.
A person desperately seeking the advice of an expert generally finds it difficult to argue the point when he is told that he already possesses what he seeks. The need then, if the seeker is agreeable to this arrangement, is to provide a ‘reason’ for having been previously unaware of what he possesses. Different answers for psych unawareness follow from different philosophies. Yet, whether it’s Platonic or Rogerian midwifery, the seeker need not look any further than his own psyche once the relationship with the ‘sage’ has been established. When the sage ‘grants’ self-knowledge, which the seeker is said to possess, a seeker either stops seeking or finds fault with the advice.

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Footnotes

1 Wechsler Adult Intelligence Scale (WAIS-III) – Third edition. The Psychological Corporation, Harcourt Brace & Company, 1997.

2 “A great spendthrift, had run through all his patrimony and had but one good cloak left. One day he happened to see a Swallow, which had appeared before its season, skimming along a pool and twittering gaily. He supposed that summer had come, and went and sold his cloak. Not many days later, winter set in again with renewed frost and cold. When he found the unfortunate Swallow lifeless on the ground, he said, ‘Unhappy bird! What have you done a young man? By thus appearing before the springtime you have not only killed yourself, but you have wrought my destruction also’.” Retrieved February 18, 2007from Aesop’s Fables, or Aesop’s Fables from Proverbs. Database. Reference.com. Crystal Reference Encyclopedia. Crystal Reference Systems Limited. http://www.reference.com/browse/crystal/9062

3 “What has been will be again, what has been done will be done again; there is nothing new under the sun”. Ecclesiastes 1:9 (New International Version) New International Version (NIV) Copyright © 1973, 1978, 1984 by International Bible Society

4 For an alternative view of ancient psychotherapy see Gill (1985).

5 Greek text references will be used as translated from “The Collective Dialogues of Plato,” edited by Hamilton, E. and Cairns, Huntington (1963) unless otherwise specified.

6 In Strategies of Psychotherapy Haley (1963) makes his case for all therapeutic change being the result of a paradoxical relationship; “When a more full description of psychotherapy is made, one factor which is held in common by all types of psychotherapy is the way the psychotherapist poses paradoxes for the patient” (Haley, 1963, p. 180). “[Haley]…has utilized the insights of communication analysis to discover a common factor in various methods of psychotherapy” (Haley, 1963, Forward by Don D Jackson, M.D. vii.); “A variety of methods of psychotherapy are described with the general argument that the cause of psychotherapeutic change resides in the therapeutic paradoxes these methods have in common” (Haley, 1963, ix.). “Methods can be shown to be formally similar if one examines the peculiar types of relationship established between patient and therapist” (Haley, 1963, ix.); “Methods of psychotherapy from the point of view of the paradoxes posed by psychotherapists” (Haley, 1963, x). Contemporary paradoxical therapy, sometimes called ‘brief therapy,’ purports hierarchical levels, or communicational meta-levels, in describing paradoxical ways of relating. Qualification, or classification, of behavior occurs at the meta-level and allows for paradoxical relationships that can induce, or eliminate, symptomatic responses depending on the circumstances.

7 Epiphany is Greek (epifaíon?) for “appearance” or “revelation.”

8 The function of the elenchus has varied with scholars. Ausland claims that Socrates’ used the elenchus to ‘confute or confuses’ Euthyphro (2004, p. 59). Tarrant identifies the purpose of the elenchos as refutation of interlocutors (2004, p. 63). Irwin sees a ‘therapeutic function of the elenchos’ when pretentious knowledge is purge (1991, p. 38), and O’Brien, along with Tarrant, suggests that the propositional logic of the elenchus is secondary to the contents of an interlocutors’ cognition (O’Brien, 1967, p. 10; Tarrant, 2004). Brickhouse and Smith both argue that the nature of the elenchus extends beyond propositional logic in a way that was meant to affect the very lives of Socrates’ interlocutors (1995, p. 13). This gives the elenchus an existential dimension according to both Vlastos and Schmid (Vlastos, 1995, p. 9; Schmid, 1998, p. 28). In Plato’s earlier works what came to be known as Socratic midwifery sorely ended in stillborn wisdom (aproia). The self-proclaimed wisdom of Socrates interlocutors did not hold up to his method of inquiry and it is this critical cross-examination that is associated with the elenchus, or Socratic method. This frequently resulted in Socrates interlocutors complaining of confusion, puzzlement and numbness after conversing with him. Others merely became angry.

9 Psychotherapy, for Rogers, is a process that bestows full unqualified acceptance of a person by another so that the person then accepts herself for who she truly is. Roger establishes this type of relationship by repeatedly restating any noticeable passion of the patient in a way that brings non-judgmental attention to the experience, sometimes even amplifying experiences with overstated paraphrases. A Rogerian psychotherapist is a looking glass virtually reflecting back the self-image the client is presenting in the here and now; “[As the client] finds someone else listening acceptingly to his feelings, he little by little becomes able to listen to himself. He begins to receive the communications from within himself – to realize that he is angry, to recognize when he is frightened, even to realize when he is feeling courageous” (Rogers, 1961, p. 63). The “Reflective Method” does not offer direct reassurance, interpretations, or agreements/disagreements; only clarification of feelings and restatements of content. The following are two excerpts from a recorded therapy session between Carl Rogers and a patient, Mary Jane Tilden, demonstrating this; Patient: “It is a long story. I can’t get on with people. If there is any criticism or anyone says anything about me I just can’t take it. When I had a job, if anyone said anything critical, it just crumpled me.” Rogers: “You feel things are all going wrong and that you’re just crushed by criticism” (Snyder, 1947, p. 129). Patient: “Yes. The trouble is, why can’t I answer it back and say, ‘Well, I have done all right.’ There’s always that doubt, that I haven’t. And why it should matter so much, I don’t know, but it does.” Rogers: “You just feel that gnaws away at you”(Snyder, 1947, p. 153). Rogers describes the therapeutic process as an empathetic understanding attitude rather than a technique foisted upon the patient by virtue of the therapist’s superior knowledge stating, “I would willingly throw away all the words of this manuscript if I could, somehow, effectively point to the experience which is therapy” (Rogers, 1951 p. ix). He emphatically rejects the practice of giving direct advice or an opinion, emphasizing that psychotherapy is only accomplished when the therapist has clarified and openly stated feelings.

10 I do not mean to cover the ramification of how someone can possess something and not know they possess it, or not possess it in a way that is useful. The assumptions of this article are based on the observable pragmatic nature of communication, not of unconsciousness.

11 Socratic midwifery should not be confused with the Socratic Elenchus, which is the method of interrogating the statements of an interlocutor for consistency.

12 The resistance mentioned here is not psychic resistance, but resistance to another’s’ directives.

13 If a patient breaks away from the “Expression/Reflection” nature of the therapeutic relationship by asking a question, or by appealing to the therapist for advice, the Rogerian will treat the query as merely another experience to be restated. Here is are two examples of Rogers dealing with a patient (Mary Jane Tilden) asking for information about the process of therapy; Patient: “Does that actually help, attacking each idea as it comes to you, I mean each thought about something?” Rogers: “At least you are wondering whether you could really tackle what you feel is wrong with your ideas as well as what you do.” (Snyder, 1947, p. 156) When repeated restatements of the contents of the therapeutic process by the psychotherapist seems arduous to the patient, Rogers will “restructure” the therapeutic context by explicitly setting the terms of the therapeutic relationship. Here Rogers’s response to Mary Jane Tilden when she directly asks what the process of therapy should be. Patient: “Is it just the talking about things? I mean, is that the whole thing? You don’t say a word? (laughs.) I mean you try to understand, but I mean you don’t guide people in any way, do you?” Rogers: “I won’t be giving you a lot of answers, except to help you work through some of the answers that you would be satisfied with. It’s just like you say – someone may say, ‘You’re nuts’ and some people may say, ‘No, you’re normal.’ Well, I could tell you you’re normal, someone else could, somebody else could tell you you’re nuts. There’s no – the thing that really matters is how you really feel about yourself.” (Snyder, 1947, p. 139)

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