When the Human Being Cannot Be Fully Measured

On Science, Experience, and Mental Health Work

There are fields of practice where theory is never merely theory. Mental health work is one of them. Here, knowledge meets human lives. Concepts meet pain, unrest, anxiety, grief, shame, hope, and the longing to be understood. Here, a word can open a door, but it can also close one. A diagnosis can provide help, but it can also make a person smaller than he or she is. Research can bring necessary clarity, but it can also become too narrow if it forgets that it deals with lives lived from within.

This is why mental health work can never be reduced to technique. Nor is it enough to say that it is based on research. The decisive question is what kind of research, what kind of knowledge, and what kind of view of the human being are allowed to shape practice. When we say that mental health work should be science-based, we must also ask: What kind of science? What understanding of the human being lies beneath it? Do we see the human being as body, biology, and behavior? Do we see the human being as story, experience, and meaning? Do we see the human being as a free and responsible person? Do we see the human being as shaped by society’s forms of power, language, and institutions? Or do we see all of this at once, in a fragile and demanding whole?

It is easy to wish for one answer. One system. One theory that can put everything in order. One method that can tell us what works. But human life is not like that. The human being is not a simple object. A person cannot be understood only from the outside. Nor can a person be understood only from the inside. There are measurable aspects of life, but life itself is more than what can be measured. There are biological processes, but a human being is more than biochemistry. There are symptoms, but symptoms may also be expressions. They may be a language when words are no longer available.

For this reason, mental health work is a field where philosophy is not decoration. Philosophy is not something added afterwards, when the practical work has been done. Philosophy is already present in practice. It is present in the way we ask questions. It is present in the way we listen. It is present in the way we distinguish between normality and deviance. It is present in the way we understand responsibility, illness, freedom, and dignity. It is present in the gaze with which we meet the other person.

A person who suffers mentally is not merely a case. Not merely a diagnosis. Not merely a problem to be solved. He or she is a human being already in the world, with a history, a body, a family, a language, a culture, a hope, a shame, a despair, and a possibility of change. Mental health work therefore does not begin with theory alone. It begins in the encounter.

But the encounter is not without theory. We never come empty-handed to another human being. We come with our concepts, our habits, our education, our institutions, our prejudices, and our expectations. This is not necessarily wrong. It is human. But it must become visible. For if we do not know which lenses we are looking through, we may come to believe that we see reality as it is, while in fact we see it through a particular professional and cultural filter.

This is especially important when we speak of normality and deviance. Few words seem more innocent than the word normal. It can mean what is usual. It can mean what is healthy. It can mean what is morally acceptable. It can mean what is statistically average. It can mean what is socially desirable. But behind the word there is always an evaluation. The normal is never merely a neutral fact. It is also a norm. It does not only describe how people are. It also suggests how people ought to be.

Statistical normality may seem the most objective. One measures, counts, and calculates. The normal becomes what lies close to the average. But even here there are hidden choices. What is to be measured? Who is to be measured? Where should the boundary be drawn? How much deviation do we tolerate before we call it illness? The numbers may be precise, but the decision about what the numbers should mean is not merely mathematical. It is also social, moral, and political.

The medical understanding of normality has its own strength. It can identify illness. It can relieve suffering. It can provide treatment, medication, and protection. It can save lives. It would be both irresponsible and unscientific to reject medical knowledge in mental health work. The human being has a body. The brain matters. Biology is not the enemy of humanism. But the medical model can become dangerous if it becomes sovereign. When illness becomes the only language, life experience can become invisible. When treatment becomes the only answer, meaning may disappear. When the suffering person becomes only a patient, the human being may lose his or her agency.

There is a paradox here. To be defined as ill can be a relief. It can free a person from guilt. It can give the right to help. It can create order in chaos. But it can also make the person less responsible for his or her own life than the person actually is. It can make the other passive. It can lead to people being treated as objects of intervention rather than as persons in a process. The person who is made entirely non-responsible may at the same time be deprived of agency. And the deprivation of agency is always a danger in systems of help.

This does not mean that responsibility should be used harshly or moralistically. The worst thing one can say to a person in mental distress is: Pull yourself together. That is brutality disguised as reason. But the second worst thing may be to say: You can do nothing. You are only ill. Between these extremes lies the difficult and humane path. There we must hold on to both suffering and possibility. Both vulnerability and dignity. Both help and agency.

This is where different views of science have practical significance. The mathematical and natural-scientific view of knowledge seeks explanations through measurement, observation, hypotheses, and verification. It has brought enormous progress. It has taught us to be cautious about pure speculation. It has taught us that claims must be tested. It has taught us that what we believe works does not always work. It has taught us humility before facts.

But this view of science also has a limit. It can describe aspects of the human being, but not the whole human being. It can measure sleep, but it cannot fully understand the unrest of the night. It can register behavior, but it does not necessarily grasp the meaning of that behavior. It can measure symptom reduction, but it does not automatically understand what it means to regain one’s life. It can count relationships, but it cannot know loneliness from within.

The humanistic view of knowledge begins elsewhere. It does not ask first: What can be measured? It asks: What does this mean for the person who lives it? It does not seek only explanation, but understanding. It listens to the story. It is concerned with what is particular, personal, historical, and meaningful. It tries to understand the human being as a person living in a lifeworld, not merely as an object in an external world.

Lifeworld is an important word. It points to the world we already live in before we begin to analyze it. It is the world of everyday life, the world of relationships, memory, body, shame, and hope. For the person who struggles mentally, the lifeworld may be threatened. What was once safe may become strange. What was once simple may become impossible. A room may feel too narrow. A sound may become too strong. A conversation may become a trial. A glance may feel like a judgment.

If we do not understand the lifeworld, we may misunderstand the person. We may interpret withdrawal as lack of motivation, when it is really about being overwhelmed. We may interpret anger as hostility, when it is really about anxiety. We may interpret silence as resistance, when it is really about the absence of words. We may interpret symptoms as isolated signs, when in reality they belong to a lived life.

Hermeneutics gives us a language for this. It reminds us that understanding always takes place through interpretation. We never understand from a zero point. We always have a pre-understanding. We carry with us experiences, values, professional theories, and personal reactions. We meet the other with a horizon. The other meets us with his or her horizon. In conversation, these horizons may either collide or expand.

This is what makes conversation so demanding and so important. A good conversation in mental health work is not merely the gathering of information. It is not simply a technique for filling out forms. It is a movement between part and whole. A single event may shed light on a life. A whole life may shed light on a single event. A symptom may gain meaning when it is seen in relation to family, loss, body, work, shame, or loneliness. But the whole may also change when we understand the symptom in a new way.

This movement is never finished. Experiences change meaning over time. What was once only pain may later be understood as a turning point. What was once explained as weakness may later be understood as survival. What was once silence may later find language. Therefore, the person who works with human beings must be able to tolerate that understanding changes. One must not lock the other person in too early.

Here there is also an ethical demand. The person who has the power to define must be careful. Diagnoses, records, and professional assessments have consequences. They follow people. They can open rights, but they can also close possibilities. They can provide help, but they can also mark a person. For this reason, professional language must be used with humility. Whoever writes about another human being is not merely writing about a case. One is writing into a life.

Existentialism brings in another kind of seriousness. It reminds us of freedom, choice, responsibility, and anxiety. The human being is not only determined by causes. A person is also a being who must relate to himself or herself. Even when life is strongly limited, there is often a space, however small, in which a person must choose how to carry what cannot be chosen away. This is not an easy message. It must never be used to place the burden back on the person who is already lying down. But it points to something deeply human: that we are not only what has happened to us. We are also our way of responding to what has happened.

In mental health work, this means that therapist and patient do not stand on opposite sides of human life. They share basic conditions. Both are mortal. Both know vulnerability. Both live with choices, losses, mistakes, and hopes. The professional has a responsibility, a role, and a knowledge that the other does not have. But the professional is not a human being without anxiety, without history, without pre-understanding. This matters. For when the helper pretends to be only method, the encounter may become cold. When the helper, on the other hand, uses himself or herself without reflection, the encounter may become unclear. Between coldness and confusion lies the professional personality: a human being who knows something, is able to do something, but also knows that he or she is present.

The personal element is therefore not an addition to professionalism. It is part of professionalism. Not as private confession, but as maturity. The helper’s voice, gaze, patience, courage, caution, and judgment cannot be separated from the help that is given. One may know the theories and still not be able to bear the human being in front of oneself. One may master the methods and still not be present. One may have read about empathy and still not listen.

This is why tacit knowledge is so important. Michael Polanyi’s phrase, that we can know more than we can tell, reaches deeply into the field of practice. The experienced practitioner often sees something before it is formulated. She notices when a conversation changes character. He senses when a person disappears behind the words. She knows when it is right to ask more, and when it is right to wait. He knows when a rule must be followed strictly, and when the situation calls for another kind of wisdom.

This is not mysticism. It is experience that has become embodied. It is knowledge that resides in the way one acts. It cannot always be reduced to procedures, but neither is it arbitrary. It develops through practice, reflection, mistakes, supervision, and long-term responsibility. It is competence in performance. It is the creative side of professional action. In every encounter, knowledge must be applied anew, because the situation is never exactly the same.

Yet tacit knowledge must not be romanticized. Not all experience is good experience. Not all practice is wise practice. One can also develop bad habits, cynicism, blindness, and institutional arrogance. Therefore, tacit knowledge must be brought into conversation with theory, research, and critique. It must be open to challenge. An experienced practitioner may be wrong. A young student may see something that the experienced practitioner has stopped seeing. A service user may understand the effects of the system better than those who work within it. Professional maturity does not consist in escaping criticism, but in being able to endure it.

Critical theory reminds us that mental health work does not take place only between the individual and the therapist. It takes place in a society. Suffering is not only internal. It may also be socially produced or socially intensified. Poverty, exclusion, discrimination, loneliness, unemployment, violence, and lack of belonging settle into human beings. The person who looks only for causes inside the individual may fail to see the world that hurts.

Here mental health work also becomes social critique. Not in the sense of party politics, but in the sense of being awake to power. Who is allowed to define what is ill? Who is allowed to define what is normal? Who is seen as in need of treatment, and who is seen as troublesome? Who receives help, and who is controlled? Which forms of suffering fit into the system’s categories, and which fall outside them?

Foucault’s analyses of madness, institutions, and the history of knowledge remind us that what we today take for granted has not always been taken for granted. Every age has its forms of understanding. Every age has its ways of ordering what is disturbing, frightening, and deviant. Psychiatry has helped many people. But the history of psychiatry is also a history of power, confinement, discipline, and silence. Both must be said. A field that cannot tolerate its own history becomes dangerous.

Postmodern critique may at times become too dissolving. If everything is only construction, we lose our grip on real suffering. Anxiety is not only language. Psychosis is not only society’s definition. Depression is not only a story imposed on us by others. Human beings truly suffer. They truly need help. But postmodern critique still has a necessary point: the way we describe suffering is never innocent. Language creates room for some experiences and closes room for others.

Constructivism points in the same direction, often in a more practice-oriented way. It reminds us that people live in systems. Family, work, school, neighborhood, welfare services, and culture are all part of human life. What appears to be the individual’s problem may be part of an interaction. Deviance cannot always be understood in isolation. A child’s restlessness may be a language for the family’s unrest. A young person’s resistance may be a response to a situation no one has understood. An adult’s breakdown may be the result of long-term pressure in relationships, work, or social hardship.

Systemic understanding does not mean that the individual disappears. It means that the individual does not stand alone. Human beings become themselves in relationships. We may be harmed in relationships, but we may also be healed in relationships. Therefore, mental health work cannot be only individual treatment. It must also include milieu therapy, social training, network work, family therapy, care work, supportive conversations, and practical help. Sometimes the most therapeutic thing is not an interpretation, but a safe rhythm in everyday life. A meal. A walk. An appointment that is kept. A person who returns the next day.

This brings us back to the diversity of practice. Mental health work includes medical treatment, medication, psychotherapy, psychoanalysis, group therapy, family therapy, milieu therapy, Gestalt therapy, body-oriented therapies, care work, and social training. This diversity may seem confusing. But it also corresponds to the diversity of the human being. Some people need medication in order to have enough calm to live. Some need conversation in order to understand their story. Some need community. Some need bodily grounding. Some need practical help in order to manage everyday life. Some need, first of all, time.

Psychoanalysis has its place in this history because it took symptoms seriously as carriers of meaning. It argued that deviant behavior is not only something to be removed, but something that may be understood. The symptom may have a history. It may point backwards, toward conflicts, longings, traumas, or unconscious patterns. One may disagree with much in classical psychoanalysis, but its great contribution was to insist that the human being is not always transparent to himself or herself. What we do may mean more than we know.

At the same time, every depth understanding must be held together with help here and now. It is not enough to explain a person’s suffering in an elegant way if the explanation does not help the person move forward. Diagnoses and theories are meaningful when they open possibilities for treatment, change, and better lives. When they only organize the language of professionals but do not improve people’s everyday lives, they become poor.

The decisive question, therefore, is not which theory alone is right. The question is how different forms of knowledge can be held in fruitful tension. Mental health work needs measurement, but must not become the worship of measurement. It needs diagnosis, but must not become diagnostic language alone. It needs biology, but must not forget the lifeworld. It needs conversation, but must not become blind to body and medicine. It needs critique of power, but must not lose the ability to help concretely. It needs theory, but must not look down on experience. It needs tacit knowledge, but must not become immune to research.

Science is not one single thing. Research has many faces. Some knowledge comes through controlled studies. Some comes through qualitative interviews. Some comes through historical analyses. Some comes through practice-near reflection. Some comes through the lived experiences of service users. There is no simple road from research to practice. But there is a demand: making practice more scientific should lead to better practice. If knowledge does not make us wiser, more humble, and more helpful, we must ask what kind of knowledge we are cultivating.

For students and practitioners in mental health work, this means that education cannot only be about learning methods. It must also teach critical thinking. Students must learn to question the practice they encounter. Not arrogantly, but responsibly. They must be able to ask: What view of the human being is present here? Who has power in this situation? Which voices are heard? What do we overlook when we use this method? What happens to human dignity in this institution? What do we do when our theories do not fit the person in front of us?

This is practical philosophy in mental health work. Not philosophy as an abstract system, but philosophy as wakefulness. To work with human beings is to stand in a field where explanation and understanding meet, where theory and practice must correct one another, where the measurable and the meaningful both demand attention. It is to know that the human being can never be fully captured, but still not to give up the attempt to understand.

The good helper must therefore be both professional and human. She must be able to read research, but also read a face. He must be able to use theory, but also tolerate silence. She must be able to act decisively, but also wait. He must be able to make a diagnosis, but also see the person who is more than the diagnosis. She must know that sometimes medication is necessary, and that at other times the most important thing is a community that does not give up. He must know that a person can be ill without being reduced to illness, and responsible without being guilty.

In this lies a deep respect for human dignity. Dignity does not mean that the human being is always strong, functional, or rational. Dignity means that the human being, even in breakdown, is more than the breakdown. Even in confusion, more than the confusion. Even in addiction, anxiety, psychosis, or depression, there is a human being who must be met as a Thou, not merely as an It.

Perhaps this is where mental health work receives its deepest ethical meaning. It should help people return to some form of agency, but without despising their helplessness. It should relieve suffering, but without turning the human being into a passive object. It should use knowledge, but without believing that knowledge owns the person. It should dare to explain, but also dare to listen to what cannot yet be explained.

When the human being cannot be fully measured, this is not a weakness of the field. It is a reminder of what kind of field this is. Mental health work takes place in the most demanding landscapes of human life. There are body and language, biology and history, society and soul, freedom and coercion, hope and defeat. No theory can carry everything alone. No method can replace judgment. No diagnosis can contain the whole human being.

This is why we need an understanding of knowledge large enough for the task. Large enough for research. Large enough for experience. Large enough for critique. Large enough for story. Large enough for tacit knowledge. Large enough to see that mental health work is not only about repairing what deviates, but about meeting people where life has become difficult to bear.

It is in this encounter that the field is tested. Not first in the definitions. Not first in the theories. Not first in the methods. But in the question: Does the help we give make the human being more seen, more understood, more agentic, more alive?

If the answer is yes, theory has found its practice. If the answer is no, we must think again.