Does Philosophical Practice Help?
An Inquiry through a Philosophical Dialogue in Medical Settings
Flavia Baldari
Tokyo College, The University of Tokyo

Abstract: The question surrounding the role of philosophical practice is often whether
or not it can be considered a helping profession. Practices held in medical contexts
are particularly subjected to this inquiry because of their delicate situations and the
expectations participants might have. This paper addresses this question through thecase study of OncoloCafé, a café philosophique designed for cancer patients,
survivors, patients of intractable diseases, their families, and medical professionals.
The paper first explains how to approach this setting (the illness and its experienceby the participants) and then clarifies how philosophy can intervene. Finally, thepaper attempts to answer the extent to which philosophical practice can “help”
patients by emphasizing the goals and the processes at the basis of the practice.

1. Introduction
Questioning the purpose of philosophical practice inevitably envisions an end of it, an
end that means, as the double meaning of the word suggests, both the actual
termination of the practice and an expected result. Whether the hope for an expected
result is justified or not is a topic open to debate: does philosophical practice aim tobe some help for those who decide to try it? This issue elicits other essential aspects
that concern the evaluation of the practice and the interrogative about good practice.
Is a practice good when it reaches some outcome? Is it good in the way it tries to reachthem? Is it in its process? Is it in the person who facilitates the practice? How do weunderstand the results?
This paper gives a perspective on the role of philosophical practice using thehealthcare context as an example. This setting is particularly interesting because it
raises the question of whether this practice can be helpful, in some ways therapeutic,
or at least as beneficial as other helping professions. By anticipating the conclusion,
because of its transformative character, philosophical practice can be beneficial in theDoes Philosophical Practice Help?
sense that it can produce beneficial effects for those who undergo a philosophical path.
However, it cannot be therapeutic if we understand its meaning as “relating to thetreatment of disease or disorders by remedial agents or methods” or, generally, tofeeling “healthier”, in the short period of time. The goal1 of a philosophical practice– even considering the differences among the numerous types (for instancephilosophical counseling, philosophical café, P4C, Socratic dialogue) – is, rather, tothink together, to clarify our thoughts and narrations, or in other words, to try tounderstand and make sense of our lives and experiences. In this sense its aim cannot
be that of addressing and resolving immediate problems, particularly if related to
one’s health, but addressing the way of staying in the problem, the way of seeing the
problem. This paper discusses these issues, presenting them through a case study: thedialogues at OncoloCafé. Because of its specific target, OncoloCafé is a particularkind of café philosophique designed for cancer patients, survivors, their families,
persons with intractable diseases (ALS in particular), and medical professionals. Its
target and the fact that it creates a closed group of people raise the question of “support”
or “help” in a more decisive way than in other contexts. This paper offers a definitionof philosophical practice that accepts the helpful effects of the practice without
expecting or looking for these immediate results, as in the case of a helping profession.

2. Philosophical Practice in Healthcare Setting: Approaching the Illness
In this paper, we inquire the extent to which philosophical practice can help those who
try this path. The case study of OncoloCafé will guide the discussion. It is a thoughtprovoking case because of the group members’ situation, the urgency they may feelto share it, and the need to understand themselves in facing their illness and its related
concerns. Before touching on the dialogues at the café, it is first necessary to linger
on how to approach philosophical dialogues in healthcare settings.
When we think about how to design activities in a context that deals with illness,
intractable conditions, and healthcare in general, the first thing to reflect upon is how
to approach the disease the participants are experiencing. The most important thing isto acknowledge the subjective and personal experience of the disease. Cancer and
ALS, to list two, are part of the life experience of a person (as well as of the family
members, physicians, nurses, and all those who are close to someone experiencing the1

Because claiming that the practice has no expected end does not mean to claim that is has
no goal.

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disease), and the meaning they give to their experience cannot be generalized or taken
for granted. Particularly, when the dialogue participants are physicians, patients, andfamily, the gap in their definition of the illness can be substantial. In this sense,
phenomenology is a good framework we can use to approach the dialogue.
The illness of the body cannot be considered as something exclusively organicand isolated from the rest of the person who is suffering. Our body is the medium
through which we experience the world, meet other people, feel, live. It is the door to
our experiences and our possibilities. Far from Cartesian mind-body dualism, ourbody, our feelings and thoughts, and the “outer” world exist in an inseparable dynamicthat creates our existence. “The lived body needs to be thought from the movement of
the existence” (Costa, Cesana 2019, 35) without being separated or evicted as aseparate entity. Lived Body is an expression created by Husserl, according to him:
The Body is, in the first place, the medium of all perception; it is the organ ofperception and is necessarily involved in all perception . . . the bearer of thezero point of orientation, the bearer of the here and the now, out of which thepure Ego intuits space and the whole world of the senses. Thus each thing thatappears has eo ipso an orienting relation to the Body, and this refers not only
to what actually appears but to each thing that is supposed to be able toappear. . .
Now the processes of perception, in virtue of which one and the same external
world is present to me, do not always exhibit the same style; instead, there are
distinctions which make themselves noticeable. At first, the same unchanged
Objects appear, according to the changing circumstances, now this way, now
in another way. The same unchanged form has a changing appearance,
according to its position in relation to my Body (Husserl 2000, 61–64)
And again
The appearing external world shows itself as relative not only to the Body but
also to the psychophysical subject as a whole. Hence a distinction is made here
between the identical thing itself and its subjectively conditioned modes ofappearance, i.e., its subjectively conditioned features which persist in relation
to me, my Body, and my soul (ibid., 80).

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Therefore, the meaning of an illness also varies according to how it is experienced,
and often “there is a decisive gap between the patient’s experience of illness and how
physicians think about it in terms of disease”, writes Toombs (Toombs 1987, 220) andcontinues “the patient [. . . ] focuses on a different ‘reality’. He does not ‘see’ his
illness primarily as a disease process. Rather, he experiences it essentially in terms of
its effects upon his everyday life” (ibid., 222). We can add the obvious remark that
this gap also exists among patients who describe their encounters and life with thedisease in numerous ways. It is Husserl again who writes that through our body, we
access the intersubjective world, a world that he calls lifeworld (Lebenswelt) in which
we act, confer meanings, and are motivated by our experience (an experience that
affects not only the causes of our actions but also our judgments). According to
Husserl, while being intersubjective and a place where embodied subjectivities are
related to each other, the world is for me, in a way that its perception is different
according to the perceiver, and so are the ways of experiencing this world. In thissense, every event or significant change (and illness is a dramatic change in the life of
someone) produces a transformation in the attribution of meanings and theinterpretation of one’s reality.
We cannot separate from this reality in which we are born; we are always
within the world. Now, Heidegger can help us describe how the discovery of theillness dramatically changes the established perception of one’s reality. If we borrowthe lexicon of Heidegger, the subject who is in the world is called Da-sein (Being
there), and it understands itself “with regard to its being-in-the-world” (Heidegger
1996, 81). The focus of the understanding is the existence of the Da-sein and thepossibilities it has while it is being-in-the-world. Heidegger writes, “As an existential,
possibility does not refer to a free-floating potentiality of being [. . . ], Da-sein has
always already got itself into definite possibilities” (Heidegger 1996, 135). Therefore,
understanding one’s existence is necessarily related to the possibilities they have.
Heidegger calls the existential structure of the understanding “projection”. Projection
does not mean creating a project for oneself practically. It is the understanding of the
Da-sein itself, an understanding that is reached in relation to its possibilities. Thesepossibilities are limited, for the Da-sein exists in the world for a limited time.
Approaching the illness and its experience according to this framework means
understanding it from an existential point of view. It means to consider the disease as“the encounter with a possibility of the existence” (Costa, Cesana 2019, 88), an
encounter that – if we follow Heidegger’s reasoning – affects the understanding of the
Da-sein, so the person as a whole. When a person discovers themselves to be ill, have

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some condition or disease, the understanding of themselves undergoes a radical
change. They need to reframe themselves according to their new possibilities, which
can mean rearranging their relationships, duties, and free time. A patient’s relationshipwith the world is altered, and their projection, that is, the understanding of themselves
according to their possibilities, is “destructured by the illness” (Costa, Cesana 2019,89).
Therefore, the illness affects not only the organic body but the person’s whole
existence. In a sense, it is their identity until that moment and the meaning they gaveto their life that comes into crisis. Philosophical practice acts in this kind of situation,
considering all the aspects of one’s life that can be affected by the occurrence of an
illness. It digs into understanding the person’s situation and, using Heidegger’s words,
their possibilities. The first definition of philosophical practice given by Gerd
Achenbach describes the practice precisely as a process of understanding. He writes:
In Philosophical Practice, people [who] show up [. . . ] don’t just want to live
or to get through but rather want to give account of their lives and who wantclarity about their lives shape, the from-where, in-what, where-to. Theirdemand quite often is to reflect upon the special circumstances, the peculiar
entanglements and the somehow ambivalent course of their lives. In short: they
visit a Philosophical Practice in order to understand and to be understood. [. . .
Philosophical practice] gives weight to our life, importance to our being andmeaning to our presence. (Achenbach 1999)
For Achenbach, philosophical practice (Philosophische Praxis) is a dialogue between
two people: the guest and the philosopher. However, we think that the above definition
can be extended to the wider umbrella of practices that have been already mentioned
at the beginning, so that the process of understanding seems to be the focus ofphilosophical practice, but how does this happen?

3. How does Philosophical Practice Intervene?
Philosophical practice is essentially dialogue. It can be between two people if it is aone-on-one activity or among more than two people if it is a group dialogue. As the
Italian practitioner Neri Pollastri points out, “Not all dialogues, however, are the same:that of philosophical practice is a philosophical one. It means in the first place that inSpecial Theme: Philosophical Practice110

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it, the two (or more) dialoguers have equal rational dignity, therefore also [equal]
human and ethical [dignity]” (Pollastri 2020, 43). In a group dialogue, which is thecase of this paper’s case study OncoloCafé, where patients and physicians join thediscussion, there is no hierarchy, and “it does not matter whether one of them is moreeducated or more experienced in conceptual processing and whether the other is ineven quite serious personal difficulties or expects the former to have answers”(ibidem)—in the dialogue they are equal. In that sense, the main goal of OncoloCafé
is to deepen everyone’s introspection and to reflect on everyone’s thoughts andopinions through dialogue. It is a group dialogue, so exchanging ideas with otherparticipants is essential to the practice. Through listening to one another, participants
can also discover something about themselves. It is not supposed to be a support groupin the strict sense, nor a place to ask for advice or answers. It is a place whereparticipants think together.
The content of the dialogue in a philosophical practice can vary according to
the needs of those who want to undergo a philosophical path, and it can vary according
to the context. It can be mainly theoretical, or it can be heavily grounded in the life
experiences of the participants. In general, we think that philosophical practice,differently from academic philosophy, tries to constantly shift from a practical to atheoretical level, to correlate the living experience with the theoretical analysis of theconcepts at stake. However, some contexts or needs require plunging deeper into thenarration of the life experiences of the participants, and one of these contexts is
precisely the healthcare setting, which is the focus of OncoloCafé.
It is an essential first step because it gives voice to the participants’
individuality; it values their subjective definition of their illness and its context, whichmeans how it affects their relationships with their families, acquaintances, workplace,etc. Narration, mainly biographical narration, is not something unique to philosophicalpractice; indeed, it finds use in psychiatry, psychology, narrative medicine, and soforth. The way narration is approached by philosophical practice does not necessarily
differ from these other disciplines. It is not something new, but nonetheless it is an
essential part of this practice because it is the most direct way to approach theparticipants’ experiences. The importance of narration lies in the nuances given to themessage the speakers want to convey; it is not the simple “fact” that they express it,
but how they explain it, the universe of concepts and values that inform the narrationand lead to the interpretation of the facts themselves that is of interest. Narrationencompasses all these aspects, but they are destined to remain primarily implicit if thenarration is considered a simple transmission of an event. Within philosophical

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practice, narration is only a starting point; it is a necessary step to introduce what is
important for the person who is narrating, but it is not the end of the practice. The
practice aims to reflect on one’s narration. The shift between narrating and reflecting
on what one has said can occur multiple times. Depending on how the dialogue
develops, the dialogue can return to a narrative level and then shift once again to amore theoretical one. The crucial aspect is “how the dialogue developed, producing aseries of small variations in understanding and meaning until the generation of a new
macro-establishment of the overall worldview” (ibid., 98).
When someone recalls an episode and tells it to the counselor and, in case ofgroup dialogue, to the other participants, the logic of the thoughts can be blurry, theepisode and the thinking about it can be full of meanings between the lines, and thenarrators themselves at times may be unsure about where they are going with theirnarration. Moreover, something that is not emphasized enough is that it is not always
easy to narrate. Thinking about something and choosing the words to say is a processthat can be easy for someone but extremely difficult for others. “What do I say?” and“How do I say it?” can be common concerns because being able to narrate something
about oneself is an activity that takes time to learn. However, once the narrating flow
starts, it is clear that it is something incredibly generative. Even if still at an implicit
level, the concepts and the values that constitute the narrator’s worldview are alreadythere. In that sense, the narration is a first step, a propaedeutic for a second one, thatof reflection.
Reflecting does not produce a mere increase in knowledge [...]. To reflect
means to set our eyes on what we already know, but precisely because it
directly affects us, is not as clear as we can sometimes imagine. [...]To reflect is to see ourselves in a broader perspective, to make our own a moregeneral point of view, to incorporate the gaze of the other. Thanks to this, we
can evaluate, value and, if necessary, transform what we do and say and theway in which we do it. (Contesini, 2016).
Here is the shift from a practical and narrative level to a more theoretical andconceptual one. Here is the beginning of the dialogue. The counselor, the facilitatorof the group dialogue, does not interpret the narration alone because the dialogicalprocess implies the participation of the narrator and the other members (in the case ofa group practice). It is crucial to stay in the narration, stay in the problematic situation
exemplified in the episode, and reflect upon it. One important step is clarifying what

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was implicit or blurry in the narration or checking the meaning of the words used toconvey the episode. Particularly in group practice, everyone needs to be on the same
page regarding the meaning of the words the group uses. Understanding what
everyone means through their remarks is important to avoid misunderstandings. This
process can sometimes be tiring, or it can, for a moment, result in the group taking adetour from the discussed topic. However, clarifying the misunderstandings about
concepts, words, or others’ standpoints is crucial for the discussion. Exchanging
opinions about the use of words, the concepts that they subsume, is, in fact, closely
bonded to how the participants relate the words to their experience.
Misunderstandings are also valuable for confronting problematic issues and contributeto creating a common ground of understanding without which the dialogue could not
be unfruitful.
The shift from plain narration to dialogue makes the practice philosophical. As
Buber writes about dialogues, “Two men bound together in dialogue must be turned
to one another, they must therefore—no matter with what measure of activity or
indeed of consciousness of activity—have turned to one another” (Buber 2004, 9).
This is “easier” in a one-on-one experience, where the counselor is actively engaged
in the dialogue with the consultant, but it is indispensable also in a group activity.
Every participant should be turned toward and actively listen to others’ remarks. A
philosophical dialogue is not a collection of unrelated monologues; the goal is to think
together, which means to engage and be engaged by others and give one’s insights
concerning the subject matter in a word contributing to the dialogue. As mentioned,
if the dialogue starts from a narration of someone around a topic and the episodebecomes the focus of the dialogue, everyone should contribute to a more profoundunderstanding of it. That can lead to connecting it to others’ narrations which can becomplex, but at the same time, can broaden the group’s horizon and suggest something
new. The role of the facilitator is to help the participants connect their remarks andexperiences by playing catch, referring to one another, and making the group think
together.
OncoloCafé is a philosophical activity designed for a medical setting. Despite
the target and the setting, it is not a support group intended as a place for participants
to gather practical information or give advice to one another about what worked forthem in a particular circumstance related to therapy or their condition in general. It isa safe place (something in common with support groups) where those who join think
together about a topic that is not directly related to their medical condition. It is apractice that aims to lead to a more conscious awareness of one’s situation. Dialogues

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can touch on many different topics related to different aspects of the participants’ lives.
By putting their thoughts into words and reflecting upon them, the understanding ofthemselves can become deeper and clearer and highlight different perspectives thathave not previously been considered. Let us consider the activity in a more detailed
way to try to give some answers to the questions posed in the introduction.

4. A Case Study: Dialogues at OncoloCafé
As introduced at the beginning of this article, OncoloCafé 2 is one example ofphilosophical practice in healthcare. It was created by Nakaoka Narifumi and Sano
Keiko and “opened” for the first time in 2016 at the Osaka University Hospital. It is aphilosophical café even if the topic of the day is mainly decided by the facilitator, apractice that differs from the cafés designed by Marc Sautet (Sautet 1995).
A typical session is organized as follows.
1) Simple Self-introduction: the participants can use their names, but they should alsofeel free to use a nickname they would like to be called by the others.
2) The Facilitator introduces the “topic of the day”, but if the participants want topropose a different topic they would like to discuss, it is also perfectly acceptable.
3) Participants try to describe what comes to mind when they hear the theme. The goalof the dialogue is to proceed by playing catch, referring to one another while
participating.
4) Participants are free to enter and leave the room during the session without asking
permission.
5) Everyone should listen carefully to others’ observations and remarks and try to findwords that come from within themselves. No one has to speak if they cannot find theirwords immediately. They may find them after the dialogue is over, or even a week
later when a word may come to them.
6) Silence is also important in dialogue. There is no need to rush to speak.
7) The content of the dialogue is to be kept for the occasion only and is to be kept
confidential.

2

In the number 5 volume of Tetsugaku, Nakaoka Narifumi already mentioned the activity of
OncoloCafé.
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8) Participants are encouraged to find their answers, but the goal is not to draw any
conclusions about the topics discussed, and there is no need to reach a sharedconclusion during the dialogue. The process of dialogue itself is fundamental.
One aspect that is important to underline is the choice of topics. Topics at
OncoloCafé are not directly related to the participants’ medical conditions. To givesome examples: “What is happiness?” “Relationship”, “Reliability”, “At the critical
moment”, “What does it mean to do your best?” and so on. The choice of topics
unrelated to illness wants to emphasize that it is crucial to embrace the participant asa person, not as a patient. The narration of the illness, its discovery, how it affected
their life, and similar aspects take a big part of the dialogue, ça va sans dire. However,illness is not the focus. The focus is always on the person and their experience; illness
is only a part of their life experience. In this sense, dialogues at OncoloCafé aim tobreak down the healthy-ill dualism which tends to be created in this kind of setting.
Since 2020, all activities have been held online because of the COVID-19
pandemic.
We discussed above the role of dialogue in philosophical practice, thephenomenological approach towards the experience of the illness, and theunderstanding of a person according to their “being-in-the-world” and their
possibilities. How do these translate into practice at OncoloCafé?
The primary aspect that became evident during the numerous dialogues withpatients is how the illness affected their understanding of themselves. Previously, we
briefly touched on Heidegger’s definition of projection and the suggestion of Costa
and Cesana that the illness destructures the understanding that the person had ofthemselves before. A huge divide between the before and the after of the illness isundoubtedly common among those who experienced some kind of disease, curable ornot. Some participants noticed a sense of loss after the shock following its discovery;
one participant T., said once, “I felt a void inside”, a void which indicated not only
the sense of fear for what to expect but also the impossibility of recognizing the personthat existed before. On a different occasion, T. also remarked, “All footholds I used
before make no sense now”, expressing the different meaning that reality gained. The
same feeling was expressed by another participant, Y., who once said, “I am reborn,
but in a negative way”. In this last case, the participant not only expressed that it was
hard to get the sense of this new reality but added another crucial aspect: theimpossibility of using words to express it. It was something that could be understoodby those who had the same experience because they did not need words to explain

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something that was a shared experience. However, the challenge was to let those who
did not have the same experience understand this new feeling and sense of discomfort.
Because of the participation of medical professionals and family—who have different
experiences of the illness—this was a difficult challenge.
As pointed out above, every experience is singular and subjective, so noteveryone feels the same way in every circumstance. The job-related conversation isanother delicate topic for most of the participants at OncoloCafé. Disease andtreatment can cause fatigue and result in the impossibility of working at the same pace
as before. Some people need to take time off, which can abruptly interrupt one’s career
and the future they have imagined for themselves. Furthermore, the disclosure of one’s
condition at the workplace sometimes negatively affects the relationships one has withcoworkers. In such a case, it can make them feel the stigma of being ill. The experienceof loss can manifest, therefore, as the loss of one’s place in the world, where they do
not feel recognized as the same as before and are not given the same confidence andtrust.
The illness affects not only the organic body, but the person as a whole since
every single experience, public or private, is re-signified under the shadow of thedisease. In this sense, illness destructures the person and their understanding ofthemselves and their reality. The possibilities they have are not the same since a
dramatic change occurred, and with it, one can no longer read and understand theirreality with themselves in it. “Who am I?” The person’s identity, their relationshipwith the illness, and the process of coming to terms with their new situation areimportant and profound questions that can be discussed in philosophical dialogue.
The questions to answer on this occasion are how philosophical dialogue proceeds
and, by understanding the process, clarifying whether or not it helps in the recovery.
From a philosophical standpoint, staying in the conversation concerning the loss of
meaning is essential. This practice aims to create a more profound awarenessconcerning that specific topic and the participants’ worldviews, as we alreadymentioned. Worldview is also the conceptual framework that Ran Lahav uses to
identify philosophical counseling. He writes:
A worldview is [. . . ] an abstract framework that interprets the structure andphilosophical implications of one’s conception of oneself and reality; a systemof coordinates, so to speak, that organizes, makes distinctions, draws
implications, compares, confers meanings, and thus makes sense of one’s
various attitudes towards oneself and one’s world (Lahav 1995, 7).

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In order to succeed in being aware of one’s worldview, philosophical dialogue
encourages one to clarify one’s statements and remarks through examples of everyday
life. When the topic is highly abstract and finding an example is not simple, the inquiry
can require quite a bit of effort. However, once the example is found, it helps inclarifying one’s position or thinking patterns. The case mentioned earlier about being“reborn but in a negative way” was obscure for both the participants and the person
who said it. It took time to find a fitting example that could explain, even if partially,
what they wanted to convey. In the beginning, as mentioned above, the example wasdifficult to explain with words rather than difficult to be found. It was as if there were
no words to give voice to a new situation to the extent that the language they used
could not explain this radically new experience. However, when grasped, the example
can also help clarify the meaning of the words used. It makes the implicit suggestionsof the narration explicit for everyone in the group. Furthermore, the passage from astill blurry and abstract thought to a practical example at the level of everyday life
often sheds light on the thought that was obscure until that moment. As Lahav states:
The subject matter of philosophical counseling is not the processes which
presumably occur inside the counselee, but rather the construction of a world
through philosophical (logical, conceptual, existential, ethical, aesthetic, etc.)
considerations. Thus, the counselees’ conception of reality as expressed intheir way of life and developed through philosophical reflection is what
counseling conversations are about (ibid., 12).
At OncoloCafé, it is often the passage to a new “conception of reality” and a new“way of life” that constitutes the subject matter of the dialogue.
If, according to the approach proposed in this paper, a medical condition is anencounter with the different possibilities of one’s experience, the goal of the dialogue
is to discuss how the participants’ “conceptions of reality” changed, how this change
is “expressed in their way of life”, and how to make some sense of it by giving somemeaning to what seems to be unthinkable—such as the example given just before. Resignifying the new reality confers meaning also to oneself, allowing oneself to makesense of one’s identity, which is in the making.
Dialogue, it bears repeating, is a process of understanding. In a group dialogue,
as OncoloCafé is, every member interacts with each other adding a piece to a dialogue
they are building together. When we do philosophy in a group, it is not only the

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consultant and the counselee, but also other people who are listening and challenging
the remarks one decides to share. Everyone in the dialogue needs to be open: those
who narrate something about themselves must be willing to discuss it with everyone,
accept others’ respectfully3 challenging comments, questions, or interpretations, andbe open to the fact that everyone is contributing to discussing something that can bevery personal; those who listen need to listen to the other participants carefully andrefer to one another while narrating or remarking on something in return. This is the
only way to avoid a collection of monologues and create a dialogue in which we canthink together. As Hannah Arendt remarked, something new can emerge throughspeech—an activity that can exist only among people because plurality is its conditio
sine qua non (Arendt 1958). By challenging one another and going deep into theanalysis of words and expressions, a more profound awareness can be reached, newmeanings can come to the surface, and a “macro worldview” can be generated.

5. Is Transformative Practice comparable to a Helping Profession?
In this particular setting, the dramatic change and the difficulties in coping and dealing
with it are a considerable part of the practice. Participants have to face numerous
challenges concerning how they see themselves and their reality. As has become clear,these concerns regard their identity and their need to reframe it, to understand it inlight of the new condition that life has created for them. The process of understanding
activated by dialogue can bring to the surface the ways they conceptualize theirsituation and the universe of values at the base of their thoughts, which can lead to resignifying their reality and giving new meanings to something which seemed to makeno sense at all. This elaboration of the new reality and the process of its realization
are indispensable to (re-)learning to navigate it, finding new footholds to orient
oneself, and, finally, repositioning oneself into this new reality.
This process is what makes philosophical practice a transformative activity.
By “transformative”, we mean to become aware of one’s process of thoughts, of one’s
scale of values—not necessarily rearrange them. In this sense, philosophical practice
can be beneficial for those who decide to undergo this path, for they can understandsomething different or something more about themselves. Ran Lahav uses the3

Dialogue is not a debate we aim to win. Everyone should respect others’ standpoints andviews, and everyone can express a different opinion and challenge others’ opinions while
always motivating their reasons respectfully.
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expression “transformational philosophers” to introduce thinkers who “envisioned apersonal transformation through philosophical reflection”, and he writes:
Included in this list are thinkers such as Plato, the Stoics, Plotinus, Spinoza,
Rousseau, Nietzsche, Emerson, Bergson, Marcel, Buber, and many others.
Interestingly, these thinkers belong to very different schools of philosophy,
have different theories about life and use radically different concepts. And yet,common to all of them is the vision of self-transformation: They all note that
normal life is limited and superficial, controlled by constricting mechanisms
and influences, but that we are nevertheless capable of overcoming theselimitations and of transforming our lives towards a deeper, fuller, truer, moremeaningful way of being (Lahav 2013, 86).
In the sense suggested by Lahav, philosophical practice helps the counselee reachsome understanding that can improve their condition. It helps them to face theirdistress and to feel better about it. The first example he mentions right after the above
quote is, in fact, Plato’s allegory of the cave: only the slaves who decide to leave thecave “can learn, through a long and difficult process, to see the true reality outside”(ibidem). Their understanding is transformed, it becomes deeper and fuller.
We explained before that at OncoloCafé, participants examine the reality they
are facing through philosophical dialogue, and sometimes their identity is at stake.
However, reaching a better understanding of oneself and one’s position within one’s
current reality does not necessarily mean feeling better; actually, digging for a senseof self in the mud of our beliefs and feelings can be an unpleasant journey.
Notwithstanding, because of the practice’s primary concern of looking for andhopefully making sense of our reality, it is undeniable that philosophical practice canhave beneficial effects even if we do not consider “feeling better” its main purpose
and, furthermore, we do not necessarily expect a change in the short period.
At this point, it is important to clarify a central aspect of this discussion. Mostof the arguments concerning the practice being therapeutic generally refer tophilosophical counseling intended as a counselor-counselee relationship,4 not grouppractices. Does this mean that the group dialogue and the so-called philosophicalcounseling differ in their goals and intent? This is a question that concerns the identity
4

These discussions also consider the complex relationship with psychotherapies, their sharedaspects, and their differences. See, for instance, Lahav 1995, Lahav 2013, Mills 2013, andPollastri 2020.

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Flavia Baldariof philosophical practice itself. Despite the noticeable differences, namely the
progression of the dialogue, the dynamic between two persons vs. that of a group, thepossibility to focus on one person’s needs, a more ludic atmosphere, and so on, we
argue that the central core of a philosophical practice does not change among thevarious forms of the practice itself. Of course, in the counselor-counselee practice, thefocus of the discussion is centered on what only one person wants to discuss, on one
person’s problem. However, the élan towards the thinking process (and—in a sense—
towards a kind of research), the desire for a more profound understanding, and thedesire to do it together are shared in every type of philosophical dialogue. The goal of
the practice is the process of understanding the problem—and the understanding of
the person in relation to the problem—and not how to directly solve it. Therefore, if
the new understanding that emerges has a therapeutic effect on the person andphilosophical practice begins to look similar to a helping profession, it is mostly in an
indirect fashion.
In a recent panel discussion titled “Philosophical Practice in Healthcare
Settings” held on September 1, 2022, Professor Nishimura Takahiro (University of
Fukui) questioned the “necessity” of philosophical practice in this particular context.
He thought particularly about patients with terminal diseases or other delicate
circumstances and stated that philosophical dialogue, which encourages one to rethink one’s values, can be “violent” towards the people involved and force the realityof death in front of their eyes. This remark questions the necessity (or not) ofphilosophical practice in medical settings and the harm the practice can inflict. This
is why we said above that knowing something more about oneself and understanding
one’s thoughts and values more profoundly does not necessarily lead to feeling better.
Thinking and saying the thoughts aloud and listening to others’ challenging comments
can be painful. Staying on the problem and analyzing it can be painful. However, thedialogue in most cases starts from the narration of the participants, it starts from where
the person wants to start, from what they want or are ready to share, and what theywant to think. It can be painful, but it is not violent in the sense that it is not imposing
a process that one does not want to undergo or challenging the thoughts to the pointthat it becomes harmful. Philosophical practice aims to offer a different approach for
those who have questions that philosophy can help analyze. However, even if thinking
can be painful in every context, it is important to keep this point in mind in a setting
where suffering is more visible than elsewhere.
Philosophical practice can be a valuable tool in medical contexts. It can be
useful for those who have tried other paths that did not work out or for those who do

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Does Philosophical Practice Help?
not want to try the canonic helping professions. Philosophy encourages questioning;some people want to think about the existential questions they face more deeply 5
without necessarily thinking about solving them. As Jeanette Bresson Ladegaard
Knox writes, “understanding the existential implications of surviving cancer and of
having a palpable sense of temporality and mortality awakened in oneself can informthe cancer care programs that intend to target long-term survivors’ well-being” (Knox
2020, 704). In philosophical group practice, as stated above, the group dialogue cannot
consent to really focusing in on the immediate problem of every participant. In order
to interest and engage everyone, the starting point of the discussion is always quite
theoretical, and the effort to try making sense of a new reality, usually takes a longtime, as they address their beliefs and values, rather than focus on the immediateproblem that the participants face. However, as a way of understanding, it is precious
for the person and their well-being. The participants at OncoloCafé have expressed
multiple times the helpful effects that dialogue and thinking together have had on them.
Knowing different perspectives and worldviews allows them to discover their biases
and question their assumptions, and whether this affects their well-being is for themto judge. A practice reaches its goal when its participants can uncover their biases andclarify their thoughts and values. That is, undoubtedly, a helpful tool for the person’swell-being. In this sense, the relationship between philosophy in its practical use andhelp remains complicated, and, at times, it is difficult to separate the two. The line
separating the indirect effect from the practice can be blurry. However, the helping
process is something we believe the practice can activate even if solving theimmediate problem is not its primary goal. It is only after carrying out the practicethat participants can tell what to do with their new understanding, with theirdiscoveries, the clarifications of assumptions, and whether these are instruments that
can help in any way with the immediate problems they are facing.

5

See the opinion A., one participant at OncoloCafé who first participated in the practice
precisely because “The first thing that made me happy when I joined the OncoloCafé was that
here I could think as much as I wanted [. . . ] I was allowed to think about it until I was
satisfied, and it became easier as if a weight had been lifted”. https://oncolocafe.com/私にとっておんころカフェ/

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Flavia Baldari
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