Aristotolean Medicine: The Physician and Patient Dynamic

I believe I understand the ethical and therapeutic dilemma(s) you’re facing.  I took a peruse through Schofield’s Psychotherapy, The Purchase of Friendship and a number of other journals/articles of differing viewpoints to accurately gauge the significance of the predicament you are faced with. After doing some considerable research/reading on the topic of gift-giving, how it relates to Psychotherapy and objectively contrasting over-analysis versus autonomous thinking in common socially acceptable practices, I would like to share some of my own thoughts on the matter.

In only speaking for myself, I totally reject the notion of the clinical relevance and to the rationalization processes attached to the act of gift-giving. Furthermore, I hold no adherence to the idea that individuals in certain positions requiring a distinction to be made due to the nature of the different capacities they find themselves to be in, are unable to enjoy a cordial relationship of mutual respect or even a meaningful friendship. Apprehension to this dynamic demonstrates cognitive faculties capable of intricate hierarchical processing beyond the average individual.

It would be detrimental for me not to state that I believe myself adherent to unconventional thinking which in essence, according to my own interpretation, leads to fluidity of thought. This is actually one of the reasons, most probably, I suffer from social anxiety; being oversensitive to stimuli in my environment. The question remains, though, whether this heightened awareness of my environment is deleterious to, or beneficial to my successes both socially and pragmatically. Fluidity of thought, in accordance to my own interpretation, is when an individual is capable of processing external stimuli from their environment and internalizing it with innate or honed faculties of perception considered to be an extension of the normal or most prevalent (or accepted) form of thinking. In regards to my own experience, we are aware that due to a number of extraneous factors coupled with my (perhaps fallible) flexibility in processing external stimuli in my environment, I sometimes experience hypersensitivity leading to social anxiety and also regressive thinking that has negatively affected my routine performance and material accomplishments.

As aforementioned, divulging into some readings on the matter I came across a number of concepts that gave me a more tangible grasp upon some conflicts we may have due to the nature of our psychotherapist/patient relationship; the imbalance of the relationship due to its dependence upon a financial transaction being considered as one. I was caught off guard, I must say, by the line of thinking one must have to adapt in order to be in your profession. I was also exposed to the idea of the therapist undertaking the role of “substitute friend” resulting in successful integration of the patient into a normal relationship (friendship) within society, i.e. a real friendship. I also read about transference/counter-transference.

While at first I was confused at the end of our last session and by what I came across during initial study of the issues at play, I reflected on the humanistic aspect of all social interaction; there is no single interaction two individuals exchange that does not affect a person consciously or subconsciously. Secondly, I thought about the professional implications a seemingly innocuous receipt of a gift may have in your occupation. The former thought I believed to be completely ridiculous in the context of our dynamics but then again, that may most probably be me just overreaching my understanding of you — as a person, not a therapist.

In the European Journal of Pragmatism and American Philosophy (2011, III, 2), in a piece by David H. Brendel, entitled Can Patients and Psychiatrists Be Friends?, I was reintroduced to the medical modality taught by Aristotle that embraced friendship. In the journal, it is made known how Aristotle recognized friendships in which there are “inequalities between parties” but can still be “abiding and excellent” and also have the potential to realize Aristotle’s concept of the “perfect friendship” which is “the friendship of men who are good, and alike in virtue”. (Brendel 202). Some examples of an imbalanced relationship are: a father and son; a rich and poor person; a teacher and pupil; a sick and healthy person; a social and non-social individual. It is argued further in this journal “that no friendship is ever fully co-equal, as inherent differences between two individuals immediately and necessarily sets up a substantive inequality.” (Brendel, 206).

I discovered that there is no clear definition of friendship nor are there any constraints put on them other than the ones we place on ourselves or are placed by professional guidelines to protect the professional and also in order to make them more efficient in their practice. Brendel (202) says “There is no well-considered reason that such friendship cannot develop between an emotionally attuned psychiatrist and a healthy patient over the course of a long treatment. Such a development is a rare event, certainly, perhaps even a black swan; but it may constitute the very best outcome of a psychiatric treatment rather than be something we feared, regulate against or punish.”

So although I am fully aware of multiple aspects that may have prompted you to be skeptical or even to ascertain my exact intentions for giving you a gift, I did not think it would affect you in this manner. Your reaction was normal, if not, the replicate of the established boundaries you’ve been taught are necessary in a patient/psychiatric relationship. Being an unconventional humanist, it’s in my nature to not allow invisible lines to mandate my social interactions with another whom I believe to be of equal or greater intellect and one who also possesses the salient features of a potential friend. This includes the ability to exchange interesting, meaningful dialogue regarding a variety of issues and provide encouragement in obtaining ambitions set in for life.

Feelings of budding friendships or closeness with one’s therapist are very common and the relationship is professional in nature. The barriers that prevent forging a friendship are quite blurry and that the possibility exists, perhaps, over the course of time, we can adapt pragmatism where we understand all relationships contain tension.  Although you  provide me with your medical guidance, an exchange of other sorts occurs as well, one where we both mutually evolve as people, learning from one another in various aspects benefiting both our intellects and in which there is a potential for an “Aristotelian” friendship to evolve.

Aristotle says, “It’s natural that such friendships should be infrequent for such men are rare.”  Fluidity of thought and unconventional thinking are always important when making rational well deliberated decisions; the future cannot be predicted with absolute certainty.  Allowing our own forethought to play against the rigidity of

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