In somatic medicine, biological knowledge is the base of the therapeutic actions, and when questions arise, experimental works which are focused on better therapeutic behaviors are used. Psychotherapy, a therapeutic intended activity, lacks an equivalent basis. Being a land belonging to what Dilthey denominates Sciences of Spirit (as opposed to those of nature), the experimental method is of dubious application. While there are a growing number of jobs that deal with the results of psychotherapy, assimilation of the validity of these results to those obtained by experimental methods in biology is problematic. On the one hand, the diagnosis and evolution is often established by scales in which the results require an interpretive step that makes them lack the same value an objective fact has (even though it is pretended that they DO have the same value). Furthermore, if you try to compare treatment groups with “placebo” groups, such is the number of variables exposed to interpretive bias (diagnosis, features of each case, training and personality of the therapist, technique, rapport) that the results (even though they may statistically favor any technique in relation to others) do not yield, in general, certain conclusions. Another limitation of this type of testing is that the data are retrospective and, as such, do not rule out other intercurrent factors in the course of treatment that influence its evolution. This is not intended to question the various psychotherapeutic methods or the type of research in which the limitations are based on the object of study, but shade their conclusions, and therefore reaffirm the need for a basis for the psychotherapeutic task because it is not found in the scientific field, but in other fields that have always been taking care of reflecting on the human being: the philosophy and philosophical anthropology. It is in this quest that we find the work of José Ortega y Gasset, which we want to share as a basis and resource for therapeutic action.

Regarding implicit philosophical thinking, Ortega says:

Strictly speaking, the truth is that the ground on which man always stands is neither Earth nor anything else, but a philosophy. Man lives from and a philosophy. This philosophy can be scholarly or popular, from others or from ourselves, old or new, brilliant or stupid; but the fact is that our being always ensures its living plants in one. Most men do not notice because that philosophy that they live is not shown as a result of intellectual effort (therefore, that themselves or others have done) but it seems “The Truth”; i.e. “reality itself.” [1]

The philosophy which we might call “implicit,” as opposed to that which will later be proposed as “explicit,” in the case of psychotherapy consists of the conceptual knowledge with which the human being is focused and the manifestations of his conduct. Currently, what will happen more often is that Darwin (and in other cases Pavlov), with their common positivist affinity, will underlie in what “most men do not notice.”

It is necessary, if any clarity is intended in any topic related to humans, to start from an anthropological hypothesis that provides an answer to the inevitable question: What is man? So far it has been the positivist thought and biologist who have taken care of that answer, with good results, precisely, in the aspects that depend on biology, but that approach involves a human nature similar to that of our brother mammals, with whom we have much in common, no doubt, but leaves out the most important thing that is to be determined: what is specifically human in man.

…Man has no nature. Man is not his body, which is one thing; nor is he his soul, psyche, consciousness, or spirit, which is also a thing. Man is not a thing, but a drama—his life, a pure and universal event that happens to everyone and in which everyone is not, but an event as well [2].

And because of this it is not the pure reason, eleatic and naturalist, who will ever understand man. So far, man has been a stranger. [3]

A workaround for the lack of that foundation is to try to obtain it from “experience.” From a certain amount of experience which is considered favorable, these are generalized and a true anthropology which argues that difficulties in human life originate in this or that conflict that takes universal dimensions is built. Be it (the conflict) Oedipus, the need for power, early objective relationship, projective identification of the primal trauma, predator behavior, filicide, the search for meaning or simply an inadequate conditioning and such occur and proliferate “schools” that populate the auditorium of the specialty.

Again, we insist that no value is removed for any of these buildings or is their effectiveness questioned. With a covering philosophical foundation, each of these approaches may become cosmopolitan and live with each other, because when they each cease being the “ultimate truth” about the human being they would be illustrative examples of possible conflicts.

The importance of Ortega to the topic at hand is:

Since 1914 (see my Meditations on Quixote, in Collected Works, Vol. I) it is the intuition of the phenomenon known as “human life” that is the basis of all my thoughts. [4]

Therefore, it is a philosophy of man. Not only on humans but, for it, it is located from humans.

…Whatever we think about our life and its ingredients is something we do by being in our life; it, then, with all its ingredients, is already before we get down to thinking about it and them, respectively. [5]

There is the “fact” previous to all facts, in which all others float and that all emanate from: human life as it is lived by each person [2].

This condition of “previous event” to all has led Ortega to regard life as “radical reality”:

To live is the way to be radical: all the ways of being which I find in my life, inside it, as it´s details and referring to it… The most abstruse mathematical equation, the most solemn and abstract concept of philosophy, the universe itself, God himself: these are all things I find in my life, things that I live. [ 6]

“Radical Reality” implies that it is also a fundamental fact. It is the data that do not require any other concept to be “explained.” This is possible because life is evidential:

All living is to live ourselves, to feel alive, know to exist, where knowing does not involve any intellectual knowledge or special wisdom, but it is that surprising presence that life is for everyone; without knowing that, without realizing that that toothache would not hurt us. [7]

Any consideration needs to rise from important data that does not depend on another and that constitutes…

…An order or area of reality that, because of being radical, does not leave any other under him, rather, because of being the basis, all others are forced to appear over it.

This radical reality in strict contemplation on which we need to base and ultimately ensure all our knowledge of anything is our life, human life. [8]

To the ancient Greeks, those irreducible or fundamental data were provided by the objective, physical world: “things.” But objects deteriorate and change, we do not know if they exist when we do not see them, so at the middle of the seventeenth century, Rene Descartes proposed thought as fundamental and irreducible data. The thought is immediate, what people think, it is what certainly exists and furthermore, certifies the existence of the human being: “cogito ergo sum.” Life moves away from itself and moves toward the thought, but:

The basic fact of the universe is not, simply, that either thought exists or I exist—but if there is thought there are, ipso facto, I, who thinks and the world in which I think, and they exist with each other, without possible separation…I am for the world and the world is for me. If there are no things to be seen, thought, or imagined, I would not see, think, or imagine. Therefore, I would not be. [9]

The basic fact of the universe and as such basic, undeniable, and obvious and that does not require demonstration, is the fact of everyone’s life. And that, the life of each one, is what everyone is.

The being of man is what he calls his life. We are our life. Now, the life of each of us consists on that it is found having to exist in a circumstance, environment, world, or whatever you want to call it. [10]

Life, then, is a relationship between the “I” who lives and the “circumstances” in which he lives. There is no I if it isn’t in a circumstance or a circumstance that isn’t one for I. It may exist in an infinite set of objects, but these would not be integrated in that particular perspective that organizes them in world or circumstance for who lives between them until an I appears to face them.

This circumstance or world in which, like it or not, we have to live, cannot be chosen by ourselves. Without our prior consent, and without knowing how, we were fired at it, dumped toward it, shipwrecked on it, and forced to sustain it, to live. We are left no choice but to always do something, to “go take a swim”. [11]

One of the conditions of human life is to always face a situation and have to do something about it. Because unlike our brothers on the zoological scale, humans lack the instinctive knowledge that provides responses to the environment:

Our life, therefore, is given to us—we have not given it to ourselves—but it is not given to us already made. It is not a thing whose being is fixed once and for all, but it is a task, something that needs to be done, a sum, a drama. [12]

The circumstance will submit favorable and unfavorable aspects to us, and the I (us) must have a plan to stick to those alternatives and avoid being destroyed by an unfavorable circumstance. Because the circumstance is, in addition to the present, the inscrutable future and that future’s uncertainty is the origin of the anxiety of human existence that at times acquires an epidemic character.

Now materialize some elements of Ortega’s thoughts that approach the application to psychotherapy. When Ortega argues that life is the radical reality and the fundamental fact, he rescues the human being from both the old realism (for which the human being is another object among objects, an animal with some virtue or capacity added, such as being rational), and the modern idealism that considers that being is made up of thinking. Ortega says that man’s being IS his life, and that it precedes any attempt of identifying it, or of including it in any theory “about” the human being that limits it and considers it a thing, an object. With that Ortega rescues man from nature without needing to enroll him in any supernatural context. The human being is…his life. And this allows him to…be whatever he wants to be. Nothing is determined. This way of seeing is different from others that preset their needs, ambitions, and goals, which make it difficult in achieving them, the cause of their suffering and “disease.”

What is the value of this in the therapeutic context? To appreciate this, we must include it in the picture of what can be considered as “bad weather” these days. Consultation motives have changed much since the “five lectures on hysteria” at least in the regions of the world which consider it useful to employ the professional assistance that receives the curious name of psychotherapy. At that time the difficulties appeared to be a result of a repressive and Victorian culture. Freud would have ended up creating much more negative reactions than the ones he had initially intended, and consequences far worse for their author. Actually this aspect of psychoanalysis was an attack against a terminal state of culture. However, today it is not sexual repression or the Victorian culture which can be blamed for the discomfort that increasingly spreads in the “civilized” world, as we shall see, currently, what is repressed is the contact with oneself, the authenticity, to be what everyone one is. People live shallowly and, consequently, aimlessly. Meanwhile, the World Health Organization (WHO) foresees that by 2020 depression will be the second largest public health issue, and that by 2030 it will be ranked first, in addition to the huge growth of anxiety disorders and unspecified forms of unease that haven´t found their place in the many diagnosis manual (such asDSM IV, CIE 10). It seems that the undoubted and stunning advances in science are not accompanied by an equivalent improvement in the way people feel in life.

…The culture is the interpretation that man makes of his life, the number of solutions, more or less satisfactory, which he invents to obviate his vital problems and needs; being understood under these words is the same as for those of material order or of a spiritual kind. [13]

When these solutions are no longer satisfactory, what is perceived as “critical problems and needs” deepens, and unrest, uncertainty, and anxiety grow. Successful solutions are those in which the human being lives his life and feels acceptably safe either in the “material or spiritual order.” Faced with these difficulties, this situation takes a turn towards the medical area, it suffers a detour to the fields of medicine, which is not assumed as cultural failure and, incidentally, medicinal drugs are sold. Therefore, whoever is not happy with the “way things are” is sick.

…In short, what is called “crisis” is but the transition man goes through from living pinned to some things and leaning on them to live on and supported by other things. [14]

Ortega theorized three crises in the West: the first was caused by the fall of the Roman Empire, after which humanity decided to settle on Christianity. The second was the Renaissance, in which the Christian faith is replaced by faith in science, clarifying that it is not because of being science, but because it is another kind of faith: faith can only be replaced by another faith. And the third, in which we are currently engaged, is that we have lost faith in science as a solution to the problems of human life and we have not yet found a replacement.

As always occurs when a new faith emerges, an amount of time to establish its promise was given to it faith. But as the time passed it was seen that while science was prodigiously solving problems regarding things about man, it kept proving itself less and less able to say anything clear about the deepest of human problems. [15]

The inability of culture to fulfill its role of providing security to those who integrate it leads to a reaction that, in turn, worsens the situation. Insecurity and instability, along with the resulting distrust in the links and institutions increases expectancy and sharpens the need to “find” a way out. However, this is searched for precisely where it cannot be found: in the “outside” because as the situation is a crisis, there is nothing in the social context in which the person can steady him or herself. So, a true vicious circle appears. In it the greater insecurity and instability cause an equally high expectation of something to emerge. This something would calm this insecurity and instability, and causes the individual to turn more and more “outward,” making him lose touch with himself. Personal and social lives become shallower and this causes most of the difficulties that sometimes end in the patient consulting a professional.

…The origin of the crisis is precisely for the man to feel lost, because he has lost touch with himself. [16]

This trend toward increasingly shallower lifestyles had already been announced by Ortega more than 80 years ago in many of his works, emphasizing that humans should get back in touch with themselves, pouring inward on a process he called “withdrawal” or “inward-looking.” The opposite, to be turned outward, he called “alteration” and manifests as an inexplicable feeling of emptiness, lack of meaning even in the midst of situations apparently favorable. Intimacy in situations of coexistence becomes problematic, because for a deep connection with another person to take place, a deep connection with our inner self is needed by everyone. The marriage and family life is invaded by the “outside” and this implies the need to always be doing something. Predominance of the action for the action itself: confusion. Failure in relationships because this leads to situations of loneliness, which becomes intolerable because there is no ability to find any possibility of inner calm. Solitude (even though one is physically accompanied) sharpens fears and anxiety and gives way to depression, in which despair manifests.

We do not know what happens to us, and this is precisely what happens to us, not knowing what happens to us… [17]

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