Abstract

In lieu of an abstract, here is a brief excerpt of the content:In, Out Me, You Mental, Moral Where Do I Begin?Mark D. Rego (bio)I once attended a Buddhist meditation retreat, led by an American meditation teacher. The instructor had studied and practiced is Asia for many years and was well versed in the practices and teachings of Buddhism. Among his opening remarks was something along the line of the following: "One question that is asked on every retreat is, 'if there is no true self, then who is it who has come here to become free of the illusion of a self?' The answer is, I don't know, but we can start anyway."This sense of practicality in the face of unanswerable questions is built into Buddhism, as is the relationship among the particularities of each individual, a process akin to externality, mental well-being, and morality.I raise Buddhism both because of its central interest into the nature of the self (an obviously germane consideration in the papers under discussion) and because of this second feature noted, namely the comfortable integration of individuality, character building, ethical action, and mental well-being (the issue of the true self will, thankfully, have to wait). It is this theme that I raise via the discussion of externality.The commentaries of Talmadge and Graham, unintentionally I think, pull me toward a beguiling observation in my daily practice of psychiatry. Namely, patients commonly report their clinical improvements in terms of how they deal better with others, how they are more thoughtful and even handed (with themselves included), and how they better cope with the demands of their individual lives. In senses both highly individual and highly principled, and in ways both explicit and implicit, when patients feel better they often feel that they are better people (all the kinds of treatment mentioned in my paper equally apply; there is no exclusivity in this result).There is also an interesting consistency in a dual manner in which this is expressed. In one way people report the improved coping, handling, and so on mentioned. In the next breath the same person commonly says, "I feel like myself."The meditation instructor would be pleased; it appears that through a process of becoming aware of and letting go of some form of negativity an individual feels better, acts better, and feels more unified. (As the instructor was psychologically sophisticated, he would not mistake the "like myself" sentiment as a Buddhist heresy. Rather, he would understand it as a reflection of being more at ease with and aware of disparate parts of himself.) And all this without figuring out who the real self is. [End Page 331]I mention these observations about Buddhism and clinical care because when I consider the processes of evaluating, deciding, and forging identity and volition it seems to me that somewhere between the lines the individual is aligning himself with some sense of what is good. The resultant experience of volition and cohesive identity is, often but not always, experienced as good both psychologically and morally.Change, Others, and ValuesIn the two commentaries that follow my paper on Frankfurtian externality and therapeutic change (Rego 2004), Talmadge (2004) and Graham (2004) highlight different aspects of externality and therapeutics. Talmadge, an addiction psychiatrist, expands the theme of volitional change in recovery from addiction. For Talmadge, as for most in the field, the question of when and how an addict has truly committed to change (hitting "rock bottom"? accepting the first of the twelve steps?) is perennially in the air. Such knowledge would be invaluable in guiding addicts along their rocky paths.Although still far short of the mark, Talmadge finds some illustrative guidance in Frankfurt. The shift that takes place within the addict to place him on the road to recovery is not necessarily "rock bottom," or conformity to a program's dictates or a state of new knowledge. Rather, it is a shift in will. By whatever process (and Talmadge is quite aware that there seem to be many paths) the addict has come to care about sobriety in a way he or she did not before. He or she now cares in a way that is part of him or her...