Abstract
The part played by psychotherapy in the treatment of different clinical conditions such as functional disturbances, neuroses, psychosomatic disease and a variety of somatic diseases varies in importance. It can be the treatment, an important part of a course of treatment, or only supportive to other clinical measures. In spite of differences in psycho-therapeutic approach, all forms of psychotherapy have one thing in common. They all attempt to normalize a pathologically altered relationship of the patient’s personality to himself, to important persons in his life history or to groups engaged in the actual management of life – all by psychological means. This gives psychotherapy as a circumscribed medical discipline the characteristics of a cross-sectional discipline. It follows that the conditions of treatment and aims of psychotherapy will depend on a theory of personality and neurosis. One will find considerable differences in various psychotherapeutic methods and their theoretical foundation and in the resulting working hypotheses. It is a fiction to postulate a method without a theory. That would be the result of a lacking realization of theoretical implications. To solve the problem of integration of theory, method and practice one has to elaborate a basic, scientifically founded evaluation of the relationship between empirical and theoretical levels of knowledge in psychotherapy and the theory of neurosis upon which it rests. From the Marxistic point of view the concept of ‘image of man’ marks the nature of man and his place in the world (nature and society). The general dialectic and historical-materialistic mode of description is relevant in all those fields of science which are concerned with the human personality. Consequently we consider that there exists no specific medical concept of the essence of man as a whole. When diagnosing and treating the mentally disturbed person one therefore always has to consider the mutual relationship between the biological, psychic and social dimensions. This is expressed by the diversity of specific therapeutic methods at different levels of integration. The insights of historical and dialectic materialism are reflected in the important thesis about the determinating impact of society on man, without forgetting the biological dimension. The second criterion of the Marxistic image of man is the conscious active discussion of the personality with the natural and social milieu to investigate how psychotherapeutic methods depend on the image of man. We postulate that the normative structures of the historically formed socio-cultural space play an important role in determining the contents of thought and emotional and behavioural experience in the individual. The person’s individual selection of information with the appropriate underlying emotion therefore consist of two parts of a dialectic unity: 1. individually dominated significant structures in the actual life situation, 2. individually typical patterns in the person’s life history. Within these one finds nearly without exception the influence of the specific regulations of the social period on behaviour and attitude expressed in individual ways. Proceeding from the classical psychoanalytic concept of man as a being determined by instinctual drives the relationship between psychotherapy and the underlying concepts is demonstrated in the work of the neofreudian Fromm (1–3). It here becomes obvious how by more vigorously including social factors in therapy the importance of instinctual drives can be minimized, this in spite of the underlying depth psychological theories. Fromm recommends depth psychological procedures on a large scale to ‘cure’ the mentally sick society. He mainly stresses ways of adapting to the existent social conditions, thereby reducing the active components of the creative personality. We find a consistent separation from the psychoanalytic premises in the client centered therapy of Rogers, Tausch and Truax. But even if they build on a view of man which does not take into consideration the concrete social and economical structures, there still exist therapeutic and theoretic connections with important characteristics of the Marxistic image of man, both stressing the value of consciousness and self-realization of the living person. When the Marxistic image of man can be realized in actual socialistic life circumstances, this will be of benefit to the therapeutic process between therapist and patient.
