EP90 Invited Address 05a - The Construction of Therapeutic Realities - Paul Watzlawick, PhD

Description:

The criterion of reality adaptation as a measure of mental health or pathology is a totally fictitious one, since what reality "really" is remains an arbitrary definition which, in turn, leads to a reification. However, out of these reifications can grow very important practical consequences - both positive and negative ones.

Educational Objectives:

1. To become acquainted with the modern constructivist view, according to which realities are not "discovered," but "invented."
2. To obtain an overview of the importance of this view in our field, especially with regard to the criterion of a person's "reality adaptation."
3. To show how therapeutic "realities" can be created 

*Sessions may be edited for content and to preserve confidentiality*

Outline:

Opening Remarks

• Watzlawick humorously reflects on aging and his past disdain for older speakers

• Discusses the absence of a universally accepted definition of normality in psychotherapy compared to medicine

• Explains the philosophical and metaphysical problems of defining sanity

• References Enlightenment thinkers and Freud’s definition of normality

Historical and Philosophical Perspectives on Normality

• Enlightenment viewed the human mind as divine, which later justified atrocities

• Freud’s definition of normality (to love and to work) deemed insufficient for many cases

• Critiques reality adaptation as a normality criterion, arguing it's based on objective reality assumptions

• References Hume, Kant, and Schopenhauer on subjective and arbitrary perceptions of reality

The Role of Observation and Theory in Science

• Discusses observation and theory in natural sciences, citing theoretical physics and quantum mechanics

• References Heisenberg and Schrödinger on the constructed nature of known reality

• Introduces the observer effect—the act of observation changes the observed

• Cites Hans von Foerster and Francisco Varela on self-reference and observer primacy

Cultural and Social Constructs of Reality

• Shares a story from Italy where schizophrenia diagnosis reflected social context

• References David Rosenhan’s study on psychiatric misdiagnosis

• Mentions Margaret Mead’s courtship study illustrating cultural misinterpretation

• Example from Brazil shows how cultural norms shape perception and behavior

Historical Examples of Reality Construction

• References Walter Cannon’s work on voodoo death: belief can have fatal consequences

• Cites Viktor Frankl’s Holocaust observations on belief and survival

• Mentions Thomas Szasz’s critique comparing mental health practices to historical inquisitions

• Quotes from Couchio Criminalis on witch trials constructing guilt-based realities

Gregory Bateson's Perspective on Reality Construction

• References Bateson’s work on double binds and paradoxes

• Discusses “similia similibus curantur” (like cures like) in clinical application

• Shares Plutarch’s story of suicidal maids in Miletus, cured by shifting norms

• Quotes Epictetus: “It is not things that bother us, but our opinions about them”

The DSM and Self-Fulfilling Prophecies

• Criticizes the DSM for creating diagnostic realities

• Discusses how predictions about behavior can cause the behavior (self-fulfilling prophecies)

• Examples include the California gas shortage and Robert Rosenthal’s classroom studies

• Placebo effect used as evidence of belief influencing outcome

Distinction Between First- and Second-Order Reality

• Defines first-order reality as perception and second-order as attributed meaning

• Personal anecdote illustrates how shifting perspective reshapes experience

• Uses example of hypnotist with a flower allergy to show constructed attribution

• Emphasizes constructivist insight in therapy: clients live in second-order realities

Radical Constructivism and Limits of Knowledge

• Introduces radical constructivism: we can know what reality is not, but not what it is

• Cites Ernst von Glasersfeld’s view of knowledge as experience organization

• Breakdown of assumptions reveals limits of constructed reality

• Example of a Doberman reacting to an empty bowl shows even animals construct reality

The Role of Hope in Psychotherapy

• Argues that hope is the essential good left from Pandora’s box

• Shares Greek myth to emphasize the importance of hope in therapeutic contexts

• Suggests therapy replaces unworkable realities with better illusions

• Concludes that psychotherapy’s practical aim is to reduce suffering and improve perceived reality