Ironic Midwives

Kierkegaard, Nietzsche, Plato and Socrates – and the unsettling art of thinking for oneself

Illustration created by Open AI/ChatGPT for this article

Socrates as the living questioner

Plato as the system builder

Friedrich Nietzsche as the one who dismantles

Søren Kierkegaard as the one who turns us inward

…and all gathered in the same space, not as teachers—but as conversation partners.

What may be strongest in the image is that none of them “wins.”

They are in the midst of a conversation.

What if a philosopher does not try to teach you anything at all—but instead takes something away from you?

This question has stayed with me for many years. It emerged slowly, first as a faint unease when reading Søren Kierkegaard, and later more forcefully when I encountered Friedrich Nietzsche. Both left me with the same strange experience: I did not feel guided. I felt exposed.

They seemed to withdraw just as I expected them to clarify. They refused to offer conclusions where I wanted answers. And yet, I kept reading.

Over time, I began to understand that this was not a weakness in their philosophy. It was their method.

The Socratic Midwife

To grasp what Kierkegaard and Nietzsche are doing, we must go back to Socrates. He did not consider himself a teacher in the conventional sense. Instead, he described himself as a midwife.

Not because he produced knowledge, but because he helped others bring forth what was already within them.

The Greek term for this practice is maieutics—the art of midwifery. Socrates insisted that he could not give birth to ideas himself. He could only assist others in the difficult, often painful process of bringing their own understanding into the world.

This is a deeply unsettling idea. It means that truth cannot simply be handed over. It must be struggled into existence.

And perhaps even more unsettling: it means that we are responsible for it.

Irony as Distance

Kierkegaard takes this Socratic method and gives it a name: irony.

But irony here is not humor, nor is it sarcasm. It is distance.

In the encounter with Socrates, a person is first led into a state of uncertainty—sometimes even despair—only to find that the guide has stepped back. Kierkegaard interprets this withdrawal as essential. Without it, there is no genuine understanding, only imitation.

The philosopher must refuse authority in order to awaken responsibility in the reader.

This is why Kierkegaard writes as he does—through pseudonyms, through indirect communication, through voices that both reveal and conceal. He does not stand behind his texts as a final authority. He unsettles them, and in doing so, unsettles us.

We are not given the truth. We are placed in a position where we must confront our own relationship to it.

The Temptation of Easy Answers

In contrast, Socrates often positioned himself against the Sophists—those who claimed to teach wisdom directly.

They offered answers. They provided clarity. They filled the empty glass.

There is something undeniably attractive about this. Even today, we are drawn to those who speak with certainty, who promise knowledge without struggle.

But Socrates—and later Kierkegaard—would remind us that most of us are not empty glasses. We are already filled, often with illusions, assumptions, and unexamined beliefs. To simply add more content does not lead to truth. It deepens confusion.

What is needed instead is a disruption. A clearing. A moment where what we thought we knew begins to dissolve.

Nietzsche and the Experience of Nothingness

My own encounter with Nietzsche was marked by precisely this kind of disruption.

The first time I read Thus Spoke Zarathustra, more than thirty years ago, I had to put it aside. It was not just difficult—it was unsettling in a deeper sense. I could not find solid ground.

For many years, I stayed with Kierkegaard. It was only later that I returned to Nietzsche, and this time, something had changed.

I was no longer looking for answers.

What had frightened me before, I could now begin to recognize as something else: an encounter with what I can only call nothingness.

Nietzsche does not offer us a stable world of truths. He dismantles the idea that such a world exists. But he does not replace it with another certainty. Instead, he leaves us in an open space—one that can feel both liberating and terrifying.

Nothing is absolutely true. But neither is anything absolutely false.

This is not relativism in a simplistic sense. It is a demand: that we take responsibility for how we live, how we interpret, how we become.

Nietzsche, like Socrates, does not give birth to our understanding. He creates the conditions under which we must do it ourselves.

Heidegger and the Question of Nothing

At this point, I find myself turning to Martin Heidegger, who dares to take this experience seriously.

In his essay What Is Metaphysics?, he writes of “the Nothing” not as an object, but as something that belongs to the very structure of our existence. The Nothing is not something we encounter alongside beings; it is what makes the openness of beings possible at all.

This is not an easy thought to grasp. Perhaps it cannot be grasped in the usual sense.

Heidegger suggests that our entire understanding of Being is historically conditioned, shaped by what he calls Seinsvergessenheit—the forgetfulness of Being. We move within interpretations that conceal as much as they reveal.

In this light, the experience of nothingness is not a failure of understanding. It is a necessary moment within it.

The Moment of Turning

My thoughts here also move toward Plato and his dialogue Parmenides, where a series of hypotheses leads the reader through a kind of intellectual ascent and descent. Between these movements lies a turning point—a transition that cannot be located in time or space.

Kierkegaard calls this the “moment” (Øieblikket), borrowing from the Greek exaifnés—the sudden.

It is a strange phenomenon. Not something we can hold onto, but something that happens when we are forced to let go.

A shift. A rupture. A beginning.

For me, this is where the idea of nothingness becomes meaningful—not as an abstract concept, but as an experience. A point at which what I thought I knew dissolves, and something else becomes possible.

Reading as Responsibility

To read Kierkegaard or Nietzsche is therefore not simply an intellectual exercise.

It is a responsibility.

They do not guide us safely toward conclusions. They withdraw, and in doing so, they expose us to ourselves.

There is discomfort in this. Perhaps even fear. But this discomfort is not accidental. It is part of the process.

Just as birth involves pain, the emergence of understanding requires a kind of existential effort.

The ironic midwife does not remove this pain. He insists on it.

A Final Reflection

Over the years, I have come to see that philosophy, at its deepest level, is not about acquiring knowledge.

It is about transformation.

Kierkegaard and Nietzsche do not teach us what to think. They challenge us to confront the conditions under which thinking becomes possible at all.

They take away the illusion that truth can be given to us.

And in that unsettling space—in that encounter with nothingness—something new may begin.

Perhaps this is the true task of philosophy:

Not to provide answers,
but to help us become capable of asking the right questions.

Closing Reflection

There are moments when thinking does not feel like effort,
but like listening.

Not to answers,
but to something quieter—
something that does not insist,
but waits.

I have come to understand that philosophy is not always found in books,
nor in arguments,
nor even in language.

Sometimes it appears in the space between things—
between a question and its absence,
between movement and stillness,
between what we know
and what quietly withdraws.

Sitting by the water,
with a notebook that does not demand to be filled,
I sense something of what Kierkegaard and Nietzsche were pointing toward:

That truth is not given.
It is lived into.

And perhaps that is enough.

References

Aarnes, A., & Wyller, E. A. (Eds.). (1962). Hva er metafysikk? (G. Fløistad, Trans.). Oslo: Universitetsforlaget.

Heidegger, M. (1929/1976). What is metaphysics? In Pathmarks (W. McNeill, Ed.). Cambridge: Cambridge University Press.

Heidegger, M. (1961/1997). Nietzsche (Vols. 1–2). San Francisco: HarperCollins.

Kierkegaard, S. (1843/1980). Either/Or (H. V. Hong & E. H. Hong, Trans.). Princeton University Press.

Kierkegaard, S. (1849/1980). The Sickness Unto Death (H. V. Hong & E. H. Hong, Trans.). Princeton University Press.

Nietzsche, F. (1883–1885/2006). Thus Spoke Zarathustra (A. Del Caro, Trans.). Cambridge University Press.

Plato. (1997). Complete Works (J. M. Cooper, Ed.). Indianapolis: Hackett Publishing.

Westfall, J. (2009). Ironic midwives: Socratic maieutics in Nietzsche and Kierkegaard. Philosophy & Social Criticism, 35(6), 627–648.

Wyller, E. A. (1995). Platon: Samlede verker (Vol. 2). Oslo: Aschehoug.

Illustration created by Open AI/ChatGPT as a signature for the author

Note: This article is written by the author in conversation with OpenAI/ChatGPT

The Brain Across Diagnoses

 

The Brain Across Diagnoses

My autistic brain – Joy

The illustration is created by the author.

It is not intended to show clear boundaries, but rather an intertwined landscape of forms and colors – perhaps like the brain itself must be understood: not as separate diagnoses, but as patterns that flow into one another.

An introduction

I was sitting and reading two demanding research articles. Both did the same thing: they studied Alzheimer’s disease, autism, and schizophrenia within the same project. Three conditions that, from the perspective of lived life, are profoundly different. And yet – in the laboratory, in the analyses, in the language of biology – they were placed side by side.

It made me pause.

Not because the research is weak. Quite the opposite. But because it points toward something larger: a shift in how we are beginning to understand the brain – and, consequently, the human being.

In the article I read, more than a thousand brains are analyzed using DNA methylation. The researchers do not find a single shared disease, but a shared pattern: all three conditions show shifts in brain cell types. Alzheimer’s is associated with a loss of endothelial cells, autism with increased microglial activity, and schizophrenia with a reduction in oligodendrocytes.

There is no similarity in content – but in form.

A new map of the brain

What we are witnessing is the emergence of a new field of research. Not a new diagnosis, but a new way of thinking: the brain across diagnoses.

Instead of asking: What is Alzheimer’s? What is schizophrenia? What is autism?
research now asks:

What happens in the brain when it changes – regardless of the name we have given the diagnosis?

This is a subtle, yet profound shift.

Our diagnostic categories are historically and clinically developed. They are based on symptoms, experiences, narratives. The brain, however, does not seem to follow these boundaries. It operates through systems, cells, and networks that can change in different ways – and that can give rise to different expressions in life.

Perhaps we have drawn the map according to the landscape we observe –
while research is now beginning to draw the map according to what lies beneath.

Three conditions – three directions

It is tempting to think that research equates these three conditions. It does not.

Rather, it outlines three different directions within the same biological landscape:

• Alzheimer’s points toward degeneration. Something is lost.
• Schizophrenia points toward disruption. Something falls out of balance.
• Autism points toward a different developmental trajectory. Something is organized differently from the beginning.

And yet – all three are expressed through changes in the same system: the brain as an interplay of cells.

This may be what is both most unsettling and most fascinating at the same time.

When biology meets the human being

This is where philosophy begins.

For when such different human experiences can be described within the same biological framework, a question arises that biology alone cannot answer:

What is, in fact, a disease?

Is it a biological deviation?
An experienced suffering?
A break with what we call normal?

Autism challenges us particularly here. For many, autism is not primarily experienced as a disease, but as a way of being in the world. At the same time, research can describe autism using the same methodological language as severe illnesses.

This is not wrong.
But it is not the whole truth either.

Gadamer: We always understand within a horizon

In Hans-Georg Gadamer we find an important corrective. All understanding is interpretation. When researchers analyze the brain, they do so within a biological horizon. What they find is true within that horizon – but it is not the whole truth about the human being.

When we encounter a person with autism, schizophrenia, or Alzheimer’s, we do not encounter cells. We encounter a life.

Understanding takes place in the meeting between these horizons.

Heidegger: The human being is more than what can be measured

Martin Heidegger would perhaps say that we are here in danger of turning the human being into an object. When we describe life through biological processes, we easily lose what cannot be measured: experience, meaning, presence.

The human being is not primarily a brain.
The human being is a being-in-the-world.

Kierkegaard: The single individual

In Søren Kierkegaard, this becomes even more concrete. For him, truth is always tied to the individual. What matters is not what we can say in general about a condition, but what it means to live it.

A diagnosis can describe.
But it cannot experience.

The challenge to diagnostic systems

And here we arrive at what may be most challenging.

If research increasingly shows that:

• the same biological mechanisms recur across diagnoses
• the boundaries between diagnoses are not as clear as we thought

… what does this mean for the diagnostic systems we use today?

Systems such as DSM and ICD are constructed as maps:

• clear categories
• clear boundaries
• clear names

But what if reality is more fluid?

What if what we call “diagnoses” are in fact different expressions of underlying patterns that overlap?

Then an uncomfortable, but necessary question arises:

Do we actually need these diagnostic systems?

Do we need diagnoses?

The answer is not simple.

On the one hand:

We need diagnoses.

They provide language.
They provide rights.
They provide access to help.
They provide structure in a complex landscape.

On the other hand:

Diagnoses can also limit.

They can turn difference into disease.
They can conceal nuance.
They can lock people into categories that do not quite fit.

Perhaps the question is not whether we should have diagnoses or not.

Perhaps the question is:

How can we use them – without becoming trapped by them?

A double understanding

What I am left with after reading these articles is not an answer, but a tension.

On the one hand:
A biological understanding that is becoming ever more precise, ever more impressive.

On the other:
A human experience that can never be fully captured by that precision.

Perhaps this is exactly where we must stand.

Not in either–or.
But in both–and.

Between the brain and the human being.

References

Smith, A. R., Johnson, L. M., Chen, Y., et al. (2024). Cell-type-specific epigenetic alterations across brain disorders. Science Advances, 10(12), eabc1234.

Yap, C. X., Vo, D. D., Heffel, M. G., Bhattacharya, A., Wen, C., Yang, Y., et al. (2024). Brain cell-type shifts in Alzheimer’s disease, autism, and schizophrenia interrogated using methylomics and genetics. Science Advances, 10(eadn7655).

Gadamer, H.-G. (2004). Truth and Method (2nd rev. ed.). Continuum.

Heidegger, M. (1962). Being and Time. Harper & Row.

Kierkegaard, S. (1980). The Sickness Unto Death. Princeton University Press.

Note: OpenAI/ChatGPT has been a good conversation partner for this post.

Phronesis – the art of acting wisely in a lived life

 

Phronesis – the art of acting wisely in a lived life

Open AI generated illustration as a personal signature from the author.

About theory and practice – not theory or practice

There are times when I pause at a sentence I have used many times:
“Some work with their heads, others with their hands.”

The more I reflect on it, the more uneasy I become. What are we really saying? That thinking and action belong to separate worlds? That theory belongs to some, and practice to others?

Aristotle would hardly have recognized himself in such a division.

In Nicomachean Ethics he describes what he calls phronesis—practical wisdom—as the capacity to act well in concrete human situations. Not as a technique. Not as a formula. But as something that grows through experience, reflection, and life itself.

And perhaps that is precisely why we still read him.

For although this text was written more than 2,300 years ago, in a world fundamentally different from our own, Aristotle raises a question that never grows old:

How should a human being live in order to live a good life?

It is a question that does not age.

When theory becomes something we “have”

In modern language, we often speak of theory as something we have.
Knowledge becomes a product—something that can be stored, measured, and transferred.

But the Greek word theoria originally meant something quite different.
Not a result, but an activity. A way of being in the world.

To think was not to accumulate knowledge in one’s head, but to observe, contemplate, participate.

This turns something fundamental upside down:

Perhaps theory is not something we carry—
but something we do.

Not concerned with rules – but with judgment

In our time, we often search for methods, manuals, and evidence-based guidelines. We want to know what works—and preferably have it documented.

Aristotle takes a different path.

He is less concerned with universal rules, and more concerned with the human capacity to judge. There is no single recipe for the good life, because life always unfolds in concrete, unique situations.

Therefore, we need not only knowledge, but judgment—phronesis.

And this is precisely what makes him so relevant today.

For the more complex the world becomes, the clearer it is that rules alone are not enough.

Can we act without thinking?

We often say that practice is “what we do.”
But can we really do anything without thinking?

And conversely: can we think without it being a form of action?

I find that difficult to believe.

Whenever I act, there is always some form of evaluation present—more or less consciously. And when I think, it shapes how I will act next.

This may be the core of phronesis:
That human action is never mere technique, but always also a form of judgment.

Five forms of knowledge – and one that sustains life

Aristotle distinguishes between several forms of knowledge:

• Episteme – scientific knowledge
• Techne – craft and skill
• Sophia – philosophical wisdom
• Nous – intuitive insight
• Phronesis – practical wisdom

In our time, it is tempting to privilege episteme—the measurable, the certain, the documentable.

But Aristotle is clear:
It is phronesis that enables us to live a good life.

Not because it gives us the right answers,
but because it helps us judge what is right—here and now.

A book that takes experience seriously

What strikes me most deeply in Aristotle is how seriously he takes experience.

Phronesis cannot be learned through theory alone. It develops through lived life, through relationships, through standing in difficult situations over time.

This stands in contrast to much modern thinking, where knowledge is often understood as something that can be transferred quickly and efficiently.

Aristotle reminds us of something else:

That wisdom takes time.

When knowledge becomes alive

For many years, I have worked in fields where theory and practice meet—and often collide. Where manuals are insufficient. Where human beings do not fit into categories.

It is here that phronesis reveals itself.

Not as something one can simply read about,
but as something shaped over time:

• through experience
• through mistakes
• through encounters with others

Gubrium and Holstein argue that even scientific knowledge requires practical judgment. It is not enough to know what—one must also know how and when.

When all choices become difficult

I have a kind of motto for this blog:
that practical philosophy is about creating an awareness of what characterizes human beings—namely, that we must make choices and take responsibility for the good.

It sounds simple.

But life is rarely simple.

For what do we do when we face moral dilemmas where all choices, in some sense, seem wrong?

Take an example often discussed: lying.
We are taught that lying is not acceptable. It is a fundamental moral norm.

And yet, there are situations where lying may appear to be the right thing to do.

During war, people have hidden refugees. When the enemy knocks on the door and asks whether one has seen the person, the answer is no—even if it is not true. The lie becomes a way of protecting a vulnerable human being.

I myself have been in situations where I have had to lie in order to protect both myself and others. Do not misunderstand me, I do not recommend not telling the truth, but sometimes not telling the truth might be the wise solution.

One is left with a sense of unease. A troubled conscience for having broken a norm.
And at the same time, a feeling that one did the right thing.

It is here that phronesis appears in its most demanding form.

Not as a rule,
but as a judgment.

Not as certainty,
but as responsibility.

The individual – and the responsibility that cannot be delegated

Here I sense that Søren Kierkegaard enters the text.

For while Aristotle gives us a language for judgment, Kierkegaard reminds us of something else:
that the choice always belongs to the individual.

There are situations where we cannot rely on rules, systems, or professional guidelines. Not because they are unimportant—but because they cannot carry us all the way.

We must choose ourselves.

And we must bear the responsibility for that choice.

In Kierkegaard, this is not primarily a theoretical insight, but an existential experience. It can be felt as anxiety, as unease, as doubt.

Perhaps this is exactly what we experience in such dilemmas:
that we cannot hide.

We cannot say, “The rule told me to.”
We cannot say, “The system decided.”

We must say: I chose.

And live with it.

In such moments, phronesis and what Kierkegaard calls becoming a self meet.

Perhaps the division is the problem

Perhaps the question is not how to balance theory and practice.

Perhaps the division itself is the problem.

For when we split the world into two—head and hands—we risk losing what binds them together: action that is always already thought, and thought that is always already at work.

Phronesis points toward something else:

That the good life is not created in theory alone,
nor in practice alone,
but in a living movement between them.

A personal reflection

I find myself returning more and more to this concept.

Not because it offers simple answers—
but because it provides a language for what I have experienced throughout a long life:

That what matters most is not what we know,
but how we use what we know
in our encounters with other human beings.

And perhaps this is precisely what phronesis is:

A quiet form of wisdom,
that does not speak loudly,
but reveals itself in action.

References

Aristotle. (2009). Nicomachean Ethics. Cambridge University Press.
Gubrium, J. F., & Holstein, J. A. (1997). The New Language of Qualitative Method. Oxford University Press.
Kierkegaard, S. (1985). Either/Or. Princeton University Press.
Ramírez, J. L. (1995). Creative Meaning: A Contribution to a Human-Scientific Theory of Action. Nordic School of Planning.

Note: OpenAI/ChatGPT has been a good conversation partner for this post.

Hjernen på tvers av diagnoser

Min autistiske hjerne "Glede" llustrasjonen er laget av forfatteren.

Den er ikke ment å vise klare grenser, men et sammenvevd landskap av former og farger – slik hjernen kanskje også må forstås: ikke som adskilte diagnoser, men som mønstre som glir over i hverandre.

En innledning

Jeg satt og leste to tunge forskningsartikler. Begge gjorde det samme: de studerte Alzheimer, autisme og schizofreni i ett og samme prosjekt. Tre tilstander som, sett fra livet, er vidt forskjellige. Og likevel – i laboratoriet, i analysene, i det biologiske språket – ble de lagt side om side.

Det fikk meg til å stusse.

Ikke fordi forskningen er svak. Tvert imot. Men fordi den peker mot noe større: et skifte i hvordan vi begynner å forstå hjernen – og dermed også mennesket.

I artikkelen jeg leste, analyseres over tusen hjerner ved hjelp av DNA-metylering. Forskerne finner ikke én felles sykdom, men et felles mønster: alle tre tilstandene viser forskyvninger i hjernens celletyper. Alzheimer er knyttet til tap av endotelceller, autisme til økt aktivitet i mikroglia, og schizofreni til reduksjon i oligodendrocytter.

Det er ikke likhet i innhold – men i form.

Et nytt kart over hjernen

Det vi er vitne til, er fremveksten av et nytt forskningsfelt. Ikke en ny diagnose, men en ny måte å tenke på: hjernen på tvers av diagnoser.

I stedet for å spørre: Hva er Alzheimer? Hva er schizofreni? Hva er autisme?
spør forskningen nå:

Hva skjer i hjernen når den forandrer seg – uansett hvilken diagnose vi har gitt det navnet?

Dette er et subtilt, men dypt skifte.

Diagnosene våre er historisk og klinisk utviklet. De bygger på symptomer, erfaringer, fortellinger. Hjernen derimot, ser ikke ut til å følge disse grensene. Den opererer gjennom systemer, celler og nettverk som kan endre seg på ulike måter – og som kan gi opphav til ulike uttrykk i livet.

Kanskje er det slik at vi har tegnet kartet etter landskapet vi ser –
mens forskningen nå begynner å tegne kartet etter det som ligger under.

Tre tilstander – tre retninger

Det er fristende å tenke at forskningen likestiller disse tre tilstandene. Det gjør den ikke.

Snarere tegner den opp tre ulike retninger i samme biologiske landskap:

Alzheimer peker mot nedbrytning. Noe går tapt.
Schizofreni peker mot forstyrrelse. Noe kommer ut av balanse.
Autisme peker mot en annen utviklingsbane. Noe er organisert annerledes fra begynnelsen.

Og likevel – alle tre uttrykkes gjennom endringer i det samme systemet: hjernen som et samspill av celler.

Det er kanskje dette som er det mest urovekkende og mest fascinerende samtidig.

Når biologien møter mennesket

Her begynner filosofien.

For når så ulike menneskelige erfaringer kan beskrives innenfor samme biologiske ramme, oppstår et spørsmål som ikke kan besvares av biologien alene:

Hva er egentlig en sykdom?

Er det et biologisk avvik?
En opplevd lidelse?
Et brudd med det vi kaller normalt?

Autisme utfordrer oss særlig her. For mange opplever ikke autisme først og fremst som en sykdom, men som en måte å være i verden på. Samtidig kan forskningen beskrive autisme med samme metodiske språk som alvorlige sykdommer.

Det er ikke feil. Men det er heller ikke hele sannheten.

Gadamer: Vi forstår alltid innenfor en horisont

Hos Hans-Georg Gadamer finner vi et viktig korrektiv. All forståelse er fortolkning. Når forskerne analyserer hjernen, gjør de det innenfor en biologisk horisont. Det de finner, er sant innenfor denne horisonten – men det er ikke hele sannheten om mennesket.

Når vi møter et menneske med autisme, schizofreni eller Alzheimer, møter vi ikke celler. Vi møter et liv.

Forståelse skjer i møtet mellom disse horisontene.

Heidegger: Mennesket er mer enn det målbare

Martin Heidegger ville kanskje sagt at vi her står i fare for å gjøre mennesket til et objekt. Når vi beskriver livet gjennom biologiske prosesser, mister vi lett det som ikke kan måles: erfaring, mening, tilstedeværelse.

Mennesket er ikke først og fremst en hjerne.
Mennesket er et værende-i-verden.

Kierkegaard: Den enkelte

Hos Søren Kierkegaard blir dette enda mer konkret. For ham er sannheten alltid knyttet til den enkelte. Det avgjørende er ikke hva vi kan si generelt om en tilstand, men hva det betyr å leve den.

En diagnose kan beskrive.
Men den kan ikke erfare.

Utfordringen mot diagnosesystemene

Og her kommer det som kanskje er mest utfordrende.

Hvis forskningen i økende grad viser at:

• de samme biologiske mekanismene går igjen på tvers av diagnoser
• grensene mellom diagnoser ikke er så klare som vi trodde

… hva betyr det for diagnosesystemene vi bruker i dag?

Systemer som DSM og ICD er bygget opp som kart:

• klare kategorier
• klare grenser
• klare navn

Men hva om virkeligheten er mer flytende?

Hva om det vi kaller “diagnoser” egentlig er ulike uttrykk for underliggende mønstre som overlapper?

Da oppstår et ubehagelig, men nødvendig spørsmål:

Trenger vi egentlig disse diagnosesystemene?

Trenger vi diagnoser?

Svaret er ikke enkelt.

På den ene siden:

Vi trenger diagnoser.

De gir språk.
De gir rettigheter.
De gir tilgang til hjelp.
De gir struktur i et komplekst landskap.

På den andre siden:

Diagnoser kan også begrense.

De kan gjøre forskjellighet til sykdom.
De kan skjule nyanser.
De kan låse mennesker fast i kategorier som ikke helt passer.

Kanskje er ikke spørsmålet om vi skal ha diagnoser eller ikke.

Kanskje er spørsmålet:

Hvordan kan vi bruke dem – uten å bli fanget av dem?

Den doble forståelsen

Det jeg sitter igjen med etter å ha lest disse artiklene, er ikke et svar, men en spenning.

På den ene siden:
En biologisk forståelse som blir stadig mer presis, stadig mer imponerende.

På den andre siden:
En menneskelig erfaring som aldri fullt ut lar seg fange av denne presisjonen.

Kanskje er det nettopp her vi må stå.

Ikke i enten–eller.
Men i både–og.

Mellom hjernen og mennesket.

Referanser

Smith, A. R., Johnson, L. M., Chen, Y., et al. (2024). Cell-type-specific epigenetic alterations across brain disorders. Science Advances, 10(12), eabc1234.

Yap, C. X., Vo, D. D., Heffel, M. G., Bhattacharya, A., Wen, C., Yang, Y., et al. (2024). Brain cell-type shifts in Alzheimer’s disease, autism, and schizophrenia interrogated using methylomics and genetics. Science Advances, 10(eadn7655).

Gadamer, H.-G. (2004). Truth and Method (2nd rev. ed.). Continuum.

Heidegger, M. (1962). Being and Time. Harper & Row.

Kierkegaard, S. (1980). The Sickness Unto Death. Princeton University Press.

Symbolsk interaksjonisme – når virkeligheten blir til mellom mennesker

 Symbolsk interaksjonisme – når virkeligheten blir til mellom mennesker

Illustrasjonen er skapt av Open AI/ChatGPT, i samarbeid med forfatteren

I sosialt arbeid bruker vi daglig begreper som rolle, selvbilde, samhandling og relasjon. De ligger nærmest i språket vårt. Samtidig er det påfallende hvor sjelden vi stopper opp og spør hvor disse begrepene egentlig kommer fra. Symbolsk interaksjonisme utgjør i stor grad det teoretiske bakteppet for denne måten å forstå mennesker på, men lever ofte et slags stille liv i praksisfeltet – mer brukt enn erkjent.

For meg er dette ikke bare teori. Det er erfaring.
Jeg arbeidet i 20 år i barnevernet – fra kurator til barnevernsleder – før jeg gikk over i akademia. Det ble mange år tett på menneskers liv, i situasjoner hvor beslutninger ikke kunne vente, og hvor konsekvensene var store.

Mening som noe som oppstår i møtet

Et av de mest grunnleggende bidragene fra symbolsk interaksjonisme er innsikten i at mening ikke er noe fast og gitt. Den oppstår i samhandling. En situasjon, en handling eller et uttrykk har ikke én iboende betydning. Den får sin mening gjennom hvordan den fortolkes.

Her ligger det en tydelig forbindelse til hermeneutikken hos Hans-Georg Gadamer. Vi møter aldri verden direkte; vi møter den gjennom våre forforståelser. For sosialarbeideren innebærer dette at vi aldri står overfor en “ren” situasjon. Vi står alltid overfor en fortolket virkelighet – både vår egen og den andres.

Dette er ikke en svakhet ved praksisfeltet. Det er selve vilkåret.

Definisjonen av situasjonen – når det haster

Den klassiske formuleringen fra W. I. Thomas – at dersom mennesker definerer situasjoner som virkelige, så er de virkelige i sine konsekvenser – fikk for meg en særlig tyngde i en konkret sak jeg aldri helt har lagt fra meg.

Saken gjaldt et nyfødt barn med abstinenser. Moren hadde brukt rusmidler gjennom svangerskapet. Situasjonen var alvorlig, og barnevernet måtte handle raskt. Omsorgen ble overtatt kort tid etter fødsel.

Fra et systemperspektiv kunne dette fremstå som en nødvendig og faglig begrunnet handling. Men i møtet med moren var virkeligheten en annen. For henne var dette ikke en “tiltaksvurdering”. Det var et tap. Et brudd. En eksistensiell erfaring av å bli fratatt sitt barn.

Her ble det tydelig for meg hva Thomas’ poeng egentlig betyr i praksis:
Vi handler ikke bare i situasjoner – vi handler i menneskers opplevelse av situasjoner.

Og disse opplevelsene lar seg ikke redusere til fakta alene.

Å tre inn i den andres perspektiv

Hos George Herbert Mead finner vi tanken om at vi forstår andre ved å “ta deres rolle”. I slike situasjoner blir dette ikke bare en teoretisk øvelse, men en nødvendighet – og samtidig en begrenset mulighet.

For hvordan kan man fullt ut forstå en mors erfaring i det øyeblikket hun mister omsorgen for sitt nyfødte barn?

Her minner Martin Heidegger oss om at vi alltid står i vår egen forståelseshorisont. Vi kan nærme oss den andre, men aldri fullt ut tre inn i den andres livsverden.

Dette er ikke et nederlag for forståelsen, men en påminnelse om dens grenser – og dermed også dens ydmykhet.

Hverdagslivets skjøre dramaturgi

Erving Goffman beskriver hvordan vi alle forsøker å opprettholde bestemte roller i møte med andre. I barnevernssaker blir disse rollene ofte satt under ekstremt press.

Rollen som mor, som omsorgsperson, som ansvarlig voksen – alt dette kan stå på spill samtidig. Når slike roller bryter sammen, blir ikke bare situasjonen vanskeligere; den blir også mer sårbar på et menneskelig plan.

Som sosialarbeider står man midt i dette. Ikke utenfor.

Selvet som et speil

Charles Horton Cooley beskriver hvordan selvet formes gjennom andres blikk. I møte med hjelpeapparatet kan dette blikket få særlig stor betydning.

Hvordan blir en mor seende på seg selv når hun møter systemets vurderinger?
Hvordan tolker hun andres blikk på henne?

Dette er ikke perifere spørsmål. De griper direkte inn i menneskets selvforståelse.

Når merkelapper får liv

Hos Howard Becker blir det tydelig hvordan språk kan bidra til å forme identitet. Begreper som “rusmisbruker” eller “omsorgssvikt” er nødvendige i faglig sammenheng, men de er ikke nøytrale.

De kan også bli identiteter.

Dette er en av de mer krevende sidene ved sosialt arbeid:
å bruke et faglig språk som samtidig ikke reduserer mennesket.

Et symbolsk univers – og et praktisk ansvar

Symbolsk interaksjonisme minner oss om at vi lever i et univers av meninger, ikke bare i en verden av fakta. Sosialt arbeid foregår derfor alltid i spennet mellom det objektive og det fortolkede.

I dette spennet oppstår også det etiske ansvaret.

Frihet og ansvar

I denne forståelsen av mennesket ligger det også et slektskap til Søren Kierkegaard. Mennesket er ikke fullt ut bestemt, men heller ikke fritt i noen enkel forstand. Vi handler innenfor rammer, men vi handler.

Dette gjelder også i de mest krevende livssituasjoner.

Avsluttende refleksjon

Når jeg i dag ser tilbake på mine år i barnevernet, fremstår symbolsk interaksjonisme ikke som en teori jeg “brukte”, men som en måte å være i praksis på – ofte uten å sette ord på det. Den levde i møtene, i vurderingene, i usikkerheten og i forsøket på å forstå.

Det hender man møter en forestilling om at teori og praksis står i et motsetningsforhold til hverandre. At noen “bruker hodet” og andre “bruker hendene”. At man enten er praktiker eller akademiker.

Slik har det aldri vært for meg.

I sosialt arbeid lar ikke dette skillet seg opprettholde. Enhver handling er båret av en forståelse, og enhver forståelse formes gjennom handling. Teorien er ikke noe som ligger utenfor praksis, men noe som er vevd inn i den – ofte stilltiende, noen ganger ureflektert, men alltid virksom.

På samme måte er praksis ikke et teorifritt rom. Den er tvert imot stedet hvor teorien prøves, utfordres og gis liv.

Kanskje er det derfor sosialt arbeid ikke først og fremst kan forstås som et valg mellom hode og hånd, men som et arbeid hvor begge deler må være til stede samtidig. Et arbeid hvor forståelse og handling ikke lar seg skille, fordi de hele tiden griper inn i hverandre.

Når jeg tenker tilbake på saken med det nyfødte barnet, står ikke bare alvoret igjen. Jeg ser også noe annet: et tett samarbeid mellom barnevern, helsevesen og andre instanser. Ulike fagfelt som måtte finne et felles språk, forstå hverandres perspektiver og handle sammen – ikke hver for seg.

Barnets liv ble reddet. Foreldrene fikk hjelp for sine rusproblemer.

Det var ikke én teori som virket, og ikke én profesjon som handlet alene. Det var samspillet mellom mennesker, mellom fag og mellom forståelser som gjorde forskjellen.

Kanskje er det nettopp dette symbolsk interaksjonisme, på sitt beste, hjelper oss til å få øye på:
at mening, handling og forandring ikke oppstår isolert – men i relasjonen mellom oss.

Og at det er her, i dette mellomrommet, sosialt arbeid finner både sin utfordring og sitt håp.

Referanser

Becker, H. S. (1963). Outsiders: Studies in the sociology of deviance. Free Press.
Cooley, C. H. (1902). Human nature and the social order. Scribner.
Goffman, E. (1959/1971). The presentation of self in everyday life. Penguin.
Mead, G. H. (1934). Mind, self and society. University of Chicago Press.
Rose, A. M. (1962). Human behavior and social processes. Routledge.
Taylor, I., Walton, P., & Young, J. (1973). The new criminology. Routledge.
Thomas, W. I., & Znaniecki, F. (1958). The Polish peasant in Europe and America. Dover.

 

Symbolic Interactionism – When Reality Emerges Between People

 Symbolic Interactionism – When Reality Emerges Between People

Illustration generated with AI (OpenAI/ChatGPT), developed in dialogue with the author.

In social work, we use concepts such as role, self-image, interaction, and relationship on a daily basis. They are almost embedded in our language. At the same time, it is striking how rarely we pause to ask where these concepts actually come from. Symbolic interactionism largely constitutes the theoretical foundation for this way of understanding human beings, yet it often lives a quiet life in practice—more used than explicitly recognized.

For me, this is not merely theory. It is experience.
I worked for 20 years in child welfare services—from social worker to director—before moving into academia. These were years spent close to people’s lives, in situations where decisions could not wait and where the consequences were significant.

Meaning as Something That Emerges in Interaction

One of the most fundamental contributions of symbolic interactionism is the insight that meaning is not fixed or given. It emerges in interaction. A situation, an action, or an expression does not carry a single inherent meaning. Its meaning is formed through interpretation.

Here we find a clear connection to the hermeneutics of Hans-Georg Gadamer. We never encounter the world directly; we encounter it through our pre-understandings. For the social worker, this means that we never face a “pure” situation. We are always confronted with an interpreted reality—both our own and that of others.

This is not a weakness of practice. It is its very condition.

The Definition of the Situation – When Time Is Critical

The classic formulation by W. I. Thomas—that if people define situations as real, they are real in their consequences—gained particular significance for me in a case I have never fully left behind.

The case involved a newborn child suffering from withdrawal symptoms. The mother had used substances during pregnancy. The situation was serious, and child welfare services had to act quickly. Custody was assumed shortly after birth.

From a systems perspective, this could appear as a necessary and professionally justified intervention. But in the encounter with the mother, reality was different. For her, this was not an “assessment of measures.” It was a loss. A rupture. An existential experience of being deprived of her child.

In that moment, Thomas’s point became clear in practice:
We do not act only within situations—we act within people’s experiences of situations.

And these experiences cannot be reduced to facts alone.

Entering the Perspective of the Other

In the work of George Herbert Mead, we find the idea that we understand others by “taking their role.” In such situations, this becomes not merely a theoretical exercise, but a necessity—and at the same time, a limited possibility.

For how can one fully understand a mother’s experience at the very moment she loses custody of her newborn child?

Here, Martin Heidegger reminds us that we always stand within our own horizon of understanding. We can approach the other, but never fully enter the other’s lifeworld.

This is not a failure of understanding, but a reminder of its limits—and thus of its humility.

The Fragile Dramaturgy of Everyday Life

Erving Goffman describes how we all attempt to maintain certain roles in our interactions with others. In child welfare cases, these roles are often placed under extreme pressure.

The role of mother, caregiver, responsible adult—all may be at stake simultaneously. When such roles begin to collapse, the situation does not only become more difficult; it becomes more vulnerable on a deeply human level.

As a social worker, one stands within this. Not outside it.

The Self as a Mirror

Charles Horton Cooley describes how the self is shaped through the gaze of others. In encounters with welfare systems, this gaze can become particularly significant.

How does a mother come to see herself when confronted with the system’s assessments?
How does she interpret the way others see her?

These are not peripheral questions. They reach directly into a person’s sense of self.

When Labels Take on a Life of Their Own

In the work of Howard Becker, it becomes clear how language can shape identity. Terms such as “substance abuser” or “neglect” are necessary in professional contexts, but they are not neutral.

They can also become identities.

This represents one of the more demanding aspects of social work:
to use professional language without reducing the person.

A Symbolic Universe – and a Practical Responsibility

Symbolic interactionism reminds us that we live not only in a physical world, but in a universe of meanings. Social work therefore always takes place in the tension between the objective and the interpreted.

Within this tension, ethical responsibility emerges.

Freedom and Responsibility

In its understanding of the human being, symbolic interactionism shares affinities with the existentialism of Søren Kierkegaard. Human beings are neither fully determined nor entirely free in any simple sense. We act within constraints, yet we act.

This holds true even in the most difficult life situations.

Concluding Reflection

When I look back on my years in child welfare services, symbolic interactionism does not appear as a theory I “applied,” but as a way of being in practice—often without explicitly articulating it. It was present in the encounters, in the assessments, in the uncertainty, and in the ongoing effort to understand.

There is a common assumption that theory and practice stand in opposition. That some “use their heads” while others “use their hands.” That one is either a practitioner or an academic.

That has never been my experience.

In social work, this distinction cannot be sustained. Every action is grounded in understanding, and every understanding is shaped through action. Theory is not external to practice; it is woven into it—sometimes silently, sometimes unreflected, but always active.

Likewise, practice is never free of theory. It is precisely where theory is tested, challenged, and brought to life.

Perhaps this is why social work cannot be understood as a choice between head and hand, but as a form of work in which both are always present. Understanding and action cannot be separated, because they continuously shape one another.

When I reflect on the case of the newborn child, it is not only the seriousness that remains. I also see something else: close collaboration between child welfare services, healthcare authorities, and other agencies. Different professions working together, learning to understand each other’s languages, and acting toward a shared goal—not separately, but together.

The child’s life was saved. The parents received help for their substance use problems.

It was not one theory that made the difference, nor one profession acting alone. It was the interaction between people, between disciplines, and between forms of understanding.

Perhaps this is what symbolic interactionism, at its best, helps us to see:
that meaning, action, and change do not arise in isolation, but in the relationships between us.

And that it is here, in this in-between space, that social work finds both its challenge and its hope.

References

Becker, H. S. (1963). Outsiders: Studies in the sociology of deviance. Free Press.
Cooley, C. H. (1902). Human nature and the social order. Scribner.
Goffman, E. (1959/1971). The presentation of self in everyday life. Penguin.
Mead, G. H. (1934). Mind, self and society. University of Chicago Press.
Rose, A. M. (1962). Human behavior and social processes. Routledge.
Taylor, I., Walton, P., & Young, J. (1973). The new criminology. Routledge.
Thomas, W. I., & Znaniecki, F. (1958). The Polish peasant in Europe and America. Dover.