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A Note to the Reader

Each of us is a singular narrative, which is constructed, continually, unconsciously, by, through, and in us—through our perceptions, our feelings, our thoughts, our actions; and, not least, our discourse, our spoken narrations. Biologically, physiologically, we are not so different from each other; historically, as narratives—we are each of us unique.

-Oliver Sacks

I had hoped that Oliver Sacks would be able to write the foreword for this account of psychotherapy and clinical pragmatism, but he died shortly after I began the project, seven months after he was diagnosed with metastatic liver cancer. Even so, he remains a presence in these pages. Over the years I have returned to his essays in my teaching, and his collections of case histories— “studies, stories” he called them—continue to deepen my appreciation of essential concerns in the practice of psychotherapy, documenting our capacities for change and growth following adversity and misfortune. His essay, “Neurology and the soul,” published in 1990, helped me negotiate the gap between the “gray” of theory and the green and golden colors of life, as Goethe had put it, challenging students and clinicians to rediscover the richness of the phenomenal world of experience that defies classification or categorization—the world of the experiencing, active, living “I” that he captured so fully in the moving accounts of his practice. In a return to the tradition of the case history’ that had shaped understanding in the 19th century. Sacks emphasized the concrete particularity of people and lives and the crucial place of observation, empathy, and imagination in help and care.

When we met in 2002 we found that we shared a range of concerns, interests, and enthusiasms. Each of us had come to think of William James as an “essential other”—he spoke of him as “that adorable genius”—and we recounted the way's in which we called upon his concreteness of mind and pragmatic sensibilities as we carried out our clinical practice, he as a neurologist, I as a psychotherapist, ever suspicious of grand theory', searching for the “cash value” of ideas in the given case. “Like you,” he wrote in a letter, “I find James a compass... I think I am on my fourth, fifth, n-th reading of the Principles” and he planned to reread The Varieties of Religious Experience shortly. Sacks reminded me that James brings the realms of neurophysiology and the transcendent together—“where they belong.”

We continued to meet and correspond over the years, sharing accounts of our cases, clinical experience, reading (and re-reading), and we found ourselves returning to the writings of James, exploring points of connection between pragmatic philosophy, the science of mind, and the day to day practice of psychotherapy. He exemplified the values and principles that shape the account of clinical pragmatism I offer in this book, approaching the patient as a human subject first and last, engaging the “experiencing, active, living ‘I’” (Sacks, 1984, p. 177).

In following a clinical pragmatism, as we will see, we do our best to understand the phenomenal world of subjective experience, taking account of the richness and the complexity and the contingency of the human situation, coming to appreciate what it means to be a unique individual. “We have, each of us, a life story'... Biologically, physiologically, we are not so different from each other; historically, as narratives—we are each of us unique” (Sacks, 1985, p. 110). It is crucial to listen to our patients and to imagine their worlds, bridging observation, conversation, empathy, and careful description with the collective wisdom of our professions and the findings of scientific research as we work to understand what is the matter and what carries the potential to help.

The reader will note that I use the first person pronoun “we” throughout the book. Paradoxically, our focus on the concrete particularity of the individual deepens our appreciation of the ways in which we are all “much more simply human than otherwise,” as Harty Stack Sullivan proposed in his “one genus postulate,” whether we happen to find ourselves in the role of the patient or the clinician (Sullivan, 1953, p. 32). Although many psychotherapists use the term “client,” I prefer the term “patient.” The Latin root, from “patientem,” meaning “suffering,” “bearing,” and “enduring,” most fully captures my sense of the vulnerability, resilience, and steadfastness I rediscover in the day to day practice of psychotherapy.

William Borden University of Chicago

Chicago, IL July 14, 2020


Sacks, O. (1984). A leg to stand on. New York: Simon and Schuster.

Sacks, O. (1985). The man who mistook his wife for a hat. New York: Simon & Schuster. Sacks, O. (1990). Neurology and the soul. New York Review of Books, Nov. 22.

Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: Norton.

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