Towards Therapeutic Event Scores

Key Signature:

Healing does not occur in the abstract, sterile space of medical terminology or diagnostic coding; it happens in the concrete, everyday performance of living.

I have recently been working through numerous cases that share the following attributes: 

• Extensive diagnostic history from multiple institutions that frustrate the client and make clinical imagination-conceptualization work quite hard.
• For example: over 20 years, a person has accrued the diagnoses of Bipolar, Borderline Personality Disorder, PTSD, OCD, and ADHD. Is this picture accurate? If it’s accurate, what does that mean in terms of this person’s moment-to-moment lived experience?
• Existing on “the spectrum” has been a core phenomenological experience for the clients, but much of the medication prescribed to the clients aim for acute symptom management and abandon the neurodiverse dimension. 
• These clients have routinely felt dismissed, disempowered, and ignored by providers. They are hesitant to raise their voice within the Doctor-Patient power dynamic, and yet not raising their voice has led to protracted but unhelpful medication regimens and long stretches of emotional and psychological distress 

In reference to Ludwig Wittgenstein, I call diagnostic pictures like this one “a fly-bottle inside a fly-bottle.” Famously, Wittgenstein wrote that the aim of philosophy is to show the fly out of the fly-bottle. By this, I believe he meant that philosophers and non-philosophers alike have become trapped within language-based prisons that end up defining the boundaries of the thinkable. Translating the thought into the therapeutic register, I believe that when people become patients who acquire diagnostic labels, they find themselves caught within a fly-bottle insofar as, from the time of diagnosis on, they can only function within the terms applied to them by psychiatric discourse and “evidence-based” therapeutic practices intended to treat illnesses outlined in that discourse. Even in cases when patients learn to perform well within such confines, they will eventually leave that fly-bottle and re-enter the other one, the fly-bottle of society where language and spectacle and validated behavioral scripts compel a second performance. 

Working with people who share this kind of experience has motivated me to clarify my theory of therapy, which I now identify as performance philosophy therapy. That title presents the basic picture: I believe psychoanalysis, performance in everyday life, historiography (a la Foucault), and philosophy (e.g., Wittgenstein) can come together to produce an experiential and relationally focused therapy that forwards the client as the producer of change. 

Recently, I’ve returned to the work of Fluxus artists because their experimentation also blends the same elements as my performance philosophy therapy. I am working on a “non-workbook” called Therapeutic Event Scores that offers “event scores” to clients along with analysis of the Fluxus works that served as motivation. A walk through a city street, an unscripted conversation, a deliberate pause, or an intentional relational gesture are not mere background noise to clinical intervention; they are the primary sites of therapeutic potential. When we approach these mundane moments through an experiential, score-like framework—drawing on the minimalist tactics of Fluxus Event scores—we begin to treat daily existence not as a static diagnosis to be managed, but as an ongoing, immersive performance.

I use the phrase “micro-practices of presence” to name the mode of attentiveness required to shift from “stuff I do” to “event.” I can talk to myself and just let that be that. But I could also invite people to my home for a 20-minute window while I perform the mundane task of talking to myself. The shift from occurrence to event requires an artistic and philosophical shift in perspective, and once this shifted perspective supports a daily practice of attentiveness, “event scores” can function as non-pharmacological therapeutic interventions. The aim is not to elide the difference between being and performing; rather, the aim is to make visible the sparks of tension between being and performing so as to describe them and see what they illuminate. Furthermore, these scores do not attempt to fixate on abnormality or fix reality into a universal index, but instead invite therapy seekers to experiment directly with new ways of inhabiting space, time, and relationship. By framing pedestrian actions as minimalist performances, these score-like experiments re-sensitize us to the richness of the present moment. In doing so, they actively counteract the emotional flattening, somatic alienation, and system-wide dampening that so often accompany chronic medication use and manualized psychiatric protocols.

By turning the mundane into an Event, the problem does not simply receive a new label; rather, in the true Wittgensteinian sense, the problem vanishes as we act otherwise.