People are freed from evolutionary pressures

Psychotherapy and philosophy: the optimized person and the good life

The first of this year's Lindau Psychotherapy Weeks was devoted to questions about the sense of optimization, people's striving to improve themselves, their desirability and their limits.

According to Friedrich Nietzsche, the human being is the “animal that has not yet been identified”, so there are theoretically no limits to his continuous improvement or enhancement, his “enhancement”. Since their inception, people have tried to improve themselves, their desire for self-improvement is part of their evolutionary program. In a narrower sense, the term “enhancement” denotes strategies that go beyond moral education, physical training and school learning. In an increasingly economic way of life, the advantages are obvious: the optimized gain significant advantages in the fight for scarce, coveted and valuable goods, such as attractive jobs, reputation and prosperity. But can humans be optimized at all? And how do optimization and the associated pressure to perfection get along with the good life, that is, with a conception of happiness that teaches you to strive for certain values ​​and avoid others?

With a view to Theodor W. Adorno's dictum “There is no right life in the wrong one”, Prof. Dr. phil. Susan Neiman, Potsdam, in the opening lecture, Possibilities of a Good Life. According to Adorno, our society with its “limitless accumulation of toys” (Neiman) is “wrong”. Neiman contrasts this with Immanuel Kant and his call to the individual to free himself from immaturity he is responsible for. According to her, "limitless mistrust instead of limitless trust" does not yet mean maturity. Neiman contrasts growing up with an infantile society as subversive. By this she does not mean resignation (“The world is cloudy, but it no longer hurts so much”), but the ability to accept and endure uncertainties. According to Kant, the world is not reasonable. Reason helps us not to accept this and try to make sense of the world - according to Neiman, a “difficult balancing act” that can only be accomplished with courage.

The downside of autonomy

Prof. Dr. med. Ulrich Streeck, Göttingen, traces the development that led to self-optimization as a “contemporary imperative”. Until the mid-1960s, “self-fulfillment” was hardly known, changes were primarily aimed at external conditions. With increasing individualization, i.e. decreasing ties to a social class and normative institutions, people turned their attention to “nature that we ourselves are”. This was accompanied by an increase in income and a reduction in working hours. In 1998, Alain Ehrenberg spoke in his book “The Exhausted Self” of the “strain of being oneself” and suspected the downside of autonomy in the depression: A society that is increasingly based on personal initiative, freedom of choice and self-realization reveals deficiencies in the ego-structuring, which in a disciplining society was not even noticed. Authors such as Diana Diamond and Christopher Lasch see the neurotic personality being replaced by the narcissistic personality, although, according to Streeck, an increase in narcissistic personality disorders has not been proven. According to him, medicine and psychotherapy are involved in this development: While a formerly “pure repair medicine” now naturally also focuses on health and its maintenance, psychotherapy is no longer limited to the treatment of mental illness, but extends its mandate to questions such as "Good life". In the subsequent discussion it becomes clear that boundless self-optimization can also reveal a fear of death and the desire to overcome death. Last but not least, money is made with the demand for self-optimization in a market economy.

Anyone who deals with the optimization of humans cannot ignore pregnancy and the first two years of life. Prof. Dr. phil. Dr. rer. nat. Gerhard Roth, Bremen, asks about the effect of pre- and postnatal environmental influences on the brain and psyche. Psychobiological animal studies show epigenetic effects of early relationship experiences (1): According to Roth, caring behavior via the serotonin level influences the gene expression of the stress hormone cortisol. These phenomena are inheritable. Abuse, mistreatment and neglect also leave (epi) genetic traces behind.

In a main lecture, Prof. Dr. med. Joachim Bauer, Freiburg, the neurobiological perspectives of the “good life”. The concept of a successful life (eudaimonia) goes back to Aristotle and is more the subject of a philosophical and social discourse. According to Bauer, the neurosciences can only describe a framework of life possibilities that are beneficial to humans. Sigmund Freud considered the pleasure principle to be dangerous and its replacement by the reality principle, that is, a “temporary tolerance of pain”, was indispensable. In this sense, according to Bauer, the limbic system is by no means the “gate to paradise”, but a possible “source of evil”. Because a lack of belonging, social exclusion, and experiences of separation frustrate and promote both aggression and violence as well as depression. According to Bauer, self-control and self-regulation are “part of the biological determination of humans”, hence his “ticket to success”: “Others can fight, bite, scratch much better.” He sees the “hope of a good life” in the prefrontal cortex. frontolimbic loop "make people into people: In the prefrontal cortex, you and I are coded as a" I-you coupling ", this is where decisions are made, anticipated and weighed, and the ability to put oneself in the shoes of others is also located there. These centers are "informationally empty" at the time of birth, and in the first 18 to 24 months a person develops his or her representations of me and you. According to Bauer, this process must be dyadic until around the end of the second year of life and can be disrupted - for example through neglect, experience of violence, dysfunctional rear-view reflections on the child and insufficiently staffed day-care centers. Only at the beginning of the third year of life do “executive functions” develop, such as cognitive learning, working memory, and adapting behavior to new rules. A lack of self-control results in poorer physical health, a greater tendency to depression and substance dependence, higher delinquency, unstable partnerships, and lower socio-economic status (2).

Manuals and guidelines

The psychotherapists themselves also have to deal with questions of their optimization. Manuals and guidelines make a contribution to this. Prof. Dr. med. Stephan Doe-ring, Vienna, traces the development there: A first phase of psychoanalytic treatment (1895–
1912) the first operationalizations followed, such as the “container” model (1912) and the abstinence requirement (1915). From 1975 manualizations are written. Doering points out that manuals were developed for psychotherapy research and cannot and should not replace a textbook. From 1990 onwards, manuals are increasingly specific to disruptions. In the “heyday of biological psychiatry”, it was essentially a question of proving the effectiveness of psychotherapy compared to the extensive evidence of the effectiveness of drug treatment. William P. Henry, for example, expressed criticism of the manualization of psychotherapy: a focus on the disorder, an emphasis on technology and a devaluation of "unproven" therapies. In addition, manuals do not provide any evidence of the change mechanisms of a procedure. Doering does not ignore the weaknesses of this type of psychotherapy research: monomorbid patients are treated under “laboratory conditions”, which in reality usually do not even exist. The demand for “field studies” is derived from this, which appropriately takes comorbidities into account, for example. Doering's conclusion: A manual does not make a bad therapist a good therapist, but it can help a good therapist to become a better one.

Prof. Dr. phil. Finally, Heidi Möller, Kassel, reports from her own four-year study on the “development of skills in psychotherapists in training”, in which 17 institutes nationwide are participating. Attachment behavior, who chooses which procedure, and professional and private interpersonal behavior are examined. For self-awareness, according to Möller, the “development of a friendly, self-caring introject is crucial,” the length is practically irrelevant. At the end of the training, 81 percent are securely bound, of which 15 percent are “earned secure”. It is not surprising that greater job satisfaction results when psychotherapists choose a procedure that suits them. The majority of them would return to the profession. No significant personality differences can be assigned to the candidates or the different procedures. With regard to the therapeutic attitude, behavior therapists tend to see support and psychoanalysts more insight as a curative factor.

Christof Goddemeier

Zhang TY, Meaney MJ: Epigenetics and the Environmental Regulation of the Genome and Its Function. Annual Review of Psychology 2010; 61: 439-66.
Moffitt TE, et al .: A gradient of childhood self-control predicts health, wealth, and
public safety. Proceedings of the National Academy of Science 2011; 108: 2693-98.
Example Michael Meaney 2010