Monday, 3 December 2018

"i'm dead"

An unintentionally humorous passage from Kurt Schneider's Clinical Psychopathology has it that 'complaints of cyclothymic depressives or schizophrenics that they are no longer alive should not be taken literally.' (p. 121).

The passage - less amusingly - continues: 'The very statement presupposes an experience of existence, dulled though this may be. Sometimes there is actual (nihilistic) delusion present. Distressing changes in bodily sensation or hallucinations may give rise to these utterances.'

Could someone literally believe that she had died? Does, say, the Cotard delusion sufferer literally believe that she has died? ... Surely anyone who answers either 'yes' or 'no' to such a question has quite a bit still to learn about severe psychopathology. (I'm not suggesting that Schneider would answer 'yes' or 'no'! He knew more than I about psychopathology...)

Does the schizophrenic intend her own words metaphorically? The new question is surely no better. When what we have to do with is delusion then we're dealing precisely with such thought as can no longer carry descriptions of it as either metaphorical or literal. (We must learn to hold our peace. To not do so is to insist that the mad be sane, and that is to fail to meet them where they're at.)

What for that matter would it mean to 'believe that one is alive'? At best, perhaps, that one knows how to use the word 'alive'?

To the extent that Schneider's passage means anything, I propose that he's wrong. He's wrong if he thinks that we may safely infer from this patient having a 'dulled experience of existence' to her meaning her 'I'm dead' complaint metaphorically.

'Perhaps the patient thinks he's died and is now in the afterlife?' Oh please! Enough already! Learn this: madness breaks the mind and, therefore, along with it, the language which expresses this mind's broken thought. But this provides no occasion for us to take empathic leave of the patient. It's in his broken language that we encounter him in his brokenness.

What in us is an apt registration of schizophrenic brokenness? A respectful silence? Heartbreak?

Friday, 23 November 2018

hinges, again

Today I've been rethinking what I recently wrote contra Bardina, Campbell, my earlier self, on delusions as hinge propositions. I think I need to own that I failed to do justice to the good intuition lying behind their nevertheless peculiar suggestion.

The suggestion was that we can shed light on delusions, in their defining peculiarity and intransigence, by construing them as alternative hinges. For like those hinges which constitute our sanity or 'reality contact', delusions truly are reasoned from and not about; they are the still points around which investigations are to turn. The thought here is that, despite the fact that delusions and hinges are chalk and cheese - hinges necessarily being paradigms of meaning and truth, delusions being paradigms of the opposite of these - they nevertheless share something of a functional role. It now seems to me that this comparison does real work: it explains or at least makes it clearer why a delusional person is so sure (lacking in doubt) in her delusion, why she can't be reasoned out of it. It offers a deeper characterisation of this intransigence than we had before.

To try to do justice to both the similarities and the differences, I begin by remarking on the fact that hinge propositions are never articulated outside of philosophy classes, whereas it is nearly always outside of philosophy classes that delusions are articulated. Hinge propositions are rather contrived verbal formulations of certainties which really have their life in our active habits - they are forced articulations of lived certainties.

In truth we don't so much pivot around hinge propositions - we instead pivot around the unreflective lived certainties of our worldly engagements (nb Wittgenstein's 'certain things are in deed not doubted' (OC 342)). One could equally say: we pivot around features of the world. For the point of the 'hinge' metaphor is that, at the point of the hinge, thought and world are not two different matters. Thought, here, is not a matter of representation of something other than it; it's not a matter of representation at all. Rather, thought here is what it is because of how the mind is directly conditioned, in-formed, by the world.

But next, note, the delusional person does, or at least can readily, articulate their delusions. They do not so much here have a lived sense-defining certainty - after all they have, in their delusion, lost contact with reality, whereas the person who is in touch with reality is so in virtue of being hinged to it in their praxis.

What I'm getting at is that the delusional person relates to their delusion thought somewhat as the sane person relates to their world.

How are we to make sense of that?

The literature contains two suggestions. The first is phenomenological, and finds (an albeit unhappy) expression in Spitzer's idea that the delusional certainty is helpfully modelled on the certainty of psychological first-person authority. The real point is: the delusional person has (necessarily, in this domain) lost reality testing. Where 'reality testing' means: enjoying thought of a form which instantiates an appearance/reality distinction - thought of which we (the observer) can meaningfully say 'it is imagination, or, it is world-directed'. (It's so hard to resist - even though we must - putting this in what I've been calling a 'cataphatic' mode - i.e. to resist offering an explanation of it, e.g. by wanting to understand delusion better by saying of what other psychological genus it's a species!)

The second is psychoanalytic, and is there in all the major psychoanalysts who've worked with psychotic patients. It is that delusions do work for the patient, binding fragmentation, providing stabilisation - and are in this sense motivated. This gets misarticulated in the cognitivist's view that true delusions are attempted 'explanations' of bizarre experiences - but we can see why one might be tempted to put things like that (that irresistible 'cataphatic' impulse again...) whilst also finding ways to do better justice to the underlying intuition.

The position we arrive at might be summarised like this: A delusion is akin to a hinge certainty in that it plays an analogous role in the 'economy' of an individual's thought. Both stabilise, both manifest an unchallengeable certainty.

But whereas the certainty of the hinge comes from our allowing the world to be sovereign in our thought, the certainty of the delusion comes from our attempting to usurp this role. The result is incoherence: the meaningful coherence of the mind depends on resisting the allure of psychotic omnipotence, and in trusting in - settling down into - the necessarily worldly foundations of any genuine thought.

Sunday, 11 November 2018

contra bardina

In a recent paper Svetlana Bardina (2018) attempts defence of the view that delusional utterances may be understood as hinge propositions. (John Campbell (2001) first suggested this; the idea has since been flirted with by others including myself (Rhodes & Gipps, 2008) and Naomi Eilan (2001), and argued against by Tim Thornton (2008) and Rick Bellaar (2016).) She lists Danielle Moyal-Sharrock's (2004) six features of hinge propositions (they are: indubitable, foundational, nonempirical, grammatical, ineffable and enacted) and shows how delusions also embody these characteristics, or at least a good portion of them.

Despite these analogues or identities, the general claim strikes me (now) as utterly wrong; Thornton's arguments against Campbell, by contrast, appear to me to stand firm. For whilst Moyal-Sharrock's six features may be necessary, they are surely not sufficient, conditions on hinge propositions. Even if they tell us a lot about what makes for the hinge nature of certain propositions, they don't tell us what makes for their propositional nature. What the conditions all presuppose is that what is being said makes sense. And the definitive, paradigmatic thing about definitive, paradigmatic, expressions of delusions is: they don't make sense. Furthermore, it is definitive of hinge propositions not merely that they make (qua constitute) sense but that there is here no distinction between their meaning and their truth. 'These are my hands' said waving one's hands about: a truth of meaning at least as much as a truth of fact. So hinge propositions are, as such, truths! But: delusions are nearly always false. So it's utterly unclear how their articulations can really be said to be hinge propositions.

At this point someone may be tempted to relativise the hinge proposition, or meaning itself, to the delusional subject. 'It makes sense to him (at least, while he's in his delusion, if not later on)!' someone might say; 'It functions as a hinge proposition for him!' But what does this mean? For something to actually make sense to someone it is not enough for him to not be puzzled by it! Just as for many dream thoughts, what we have in the paradigmatic clinical cases are (what Cora Diamond calls) but illusions of meaning. But the concept of the role played in our life by the beliefs expressed in hinge propositions is the concept of a semantic role - the concept of a role that could only be played by something meaningful. It must be the case, then, if delusional utterances are to be seen as playing the role of hinge propositions, that there is in play here a distinction between something being meaningful and something seeming meaningful to the delusional subject. But it is hard to see how we can reconstruct that essential distinction if we go down the 'meaningful to him' line.

What has gone wrong? How could my earlier self, or Bardina, or Campbell, have defended this suggestion in the face of the stark delusionality, the un-hinge-dness, of psychotic belief? I suggest it comes in part from a lack of attention to the real phenomena - both to the nature of true delusion and to the nature of real clinical reason. Telling markers of this in the cognitive science literature are its runaway focus on really rather obscure delusional conditions (the standard Cotard syndrome and Capgras delusion cases), as if even these could be understood for what they are in abstraction from the delusional life of the patient (that's the wishful thought of those who try to step-wise theorise mental illness on the basis of 'monothematic' delusions) rather than any actual engagement with the kinds of psychotic thought met with in clinical practice (the delusional perception, mood, experiences and beliefs found in schizophrenia providing the best examples). (In the Bardina paper, for example, it's also telling that she speaks of 'the Cotard patient' (sic) who now  'pretends' (sic) that he's dead - clinical reality now being just miles away.) It's not as if there isn't a wealth of readily accessible first person clinical material out there to really get grounded in before risking theorising in this domain; the fact that theorising happens in abstraction from it may therefore indicate a phobic flight from delusional instabilities into the security of philosophical reason. But I think it's not just a failure to engage with real clinical narratives, as opposed to brief mentions of a psychiatrist's micro-summary of a patient's delusional content, but also a detachment of philosophical reason from the grounds of its own thoughtful praxis, that's at fault. For here philosophical thought has itself started to ape that of the schizophrenic (à la Minkowski and Sass): it takes on a life of its own, forgetting its debt to, and loosing its anchorage in, discursive life. In this way it somehow starts to seem intelligible to suppose that so long as a delusional utterance embodies Moyal-Sharrock's six features of hinge propositions, then it too may be treated as such. (The same can be said for Spitzer's suggestion that the indubitability of delusional utterances can be modelled on the indubitability of avowals of mental states.) That hinges provide paradigms of sense, and delusions paradigms of nonsense, suddenly gets quite lost from sight.

Now perhaps it is said that whilst we can't truly say that delusional expressions function as hinge propositions for the delusional subject, she yet treats them as if they do. This 'treating them as' would then be what is supposed to be illuminating in the appeal to hinge propositions. To which I want to respond: let us agree that whilst chalk is not cheese, someone may yet treat it as such: they may, if they are so inclined, wrap it up in clingfilm, put it in the fridge, stick it between slices of bread - or for that matter may also smear cheese on the blackboard, etc. But what of it? Nobody ever doubted that the delusional patient doesn't question, takes as axiomatic, reasons not to but from, his delusional beliefs. To note that non-delusional people also don't question, and also take as axiomatic, some of their sane beliefs - i.e. those which are articulated in framework propositions - doesn't help us understand what it is to be delusional.

It's not surprising that it's tempting to theorise the delusional mind as not merely unhinged but as hinged otherwise. Tempting because we may then take ourselves to be able to offer a paradigm of intelligibility - a way to make sense of an aspect of what has gone on here for the delusional person in her delusion. (She is atypically treating treating certain atypical propositions as hinge propositions.) Tempting, perhaps, because we thereby find another way to avoid having to tolerate the dementing strangeness of a door of the mind no longer hinged to the doorpost of the world. Find a way, that is, to avoid staying with a mind now quite lost in that phantasmic, devitalised and denatured world of faery - where to think, fear or wish something can no longer be distinguished from taking it to be so - so that the terrors of a shattering contact with reality may be safely left out of consideration.

Sunday, 28 October 2018

obe

How can we understand out of body experiences? There on the divan lies Geoff, mid-psychotic episode, or whacked out on drugs, or just dreamy, or an 'astral projection' pundit, and he's taking himself to be floating on the ceiling looking down at his own body. What's going on? Is this pure hallucination? Is it some kind of projection?

My guess is that it's neither. So, I predict that it can't happen if your eyes are shut, and that you can't 'travel' to parts of the room that you haven't been able to see. If I'm right about that then I think that any simple hallucination theory is already scotched. As for projection: well, that's just a 'made up' explanation, since we don't have any clearer an idea of what is meant by 'projection' here than we do of what is meant by 'OBE'. Three more predictions: that what is seen in OBEs are static scenes (even as the 'perceiver' moves about them), and that who has OBEs are people (who are actually) lying still, and that the 'hovering perceiver' of the OBE is experienced not as static but as, even if but a little, moving ('flying') around the room as he 'looks down' on his own body and its environs.

So what are they? How can we understand OBEs within a purely naturalistic framework? I propose we think of it like this. Every perceptual act enacts a differentiation of a a body subject from a perceived object. Normally the lived body synthesises these so that the body subject pole remains self-same over a whole variety of transforms. The perceiving pole is therefore anchored in the body, and the perceived pole shifts depending on what is seen. This enactive differentiation of body-subject and its intentional object is at the very same time a perceptual act: the cat is constituted as object of my perception, I am constituted as body subject in this chair, the perceptual relation unfolds between the two of us, with the direction of the intentional perceptual relation manifesting in the content: it is, here, I who see the cat, and not the sleeping cat who sees me. What is it, for any experience, that determines which pole shall be which? Well presumably the brain's integrative function sorts out which are to be the variances and which the invariances amongst a whole bunch of ongoing sensorimotor enactions, at the same time over different senses, over time within the same sense, and so on. Presumably the simplest solution to the differential equations which the brain has, as it were, here to solve is usually the one which drops the body out of the content and relegates it to the transcendental from-where of the experience. But when you have an OBE the simplest solution changes. The sensorimotor body is no longer tightly self-integrating over time, so the only two options are for a shifting visual scene to be constituted despite the variety of cues that suggest its stasis, or instead for the subject pole and the intentional object to switch position in the constitution of the intentional arc. Usually we take for granted the constitution of the body subject and so imagine that the only sensorimotor task confronting the brain is determining whether an alteration is due either to the subject (Geoff moves his head) or to the object (the cat moves). But this ignores the need to also determine the polarity of the intentional arc.

Why is it hard to grasp this? I think it is because we are, even today, relentlessly attracted to representationalism in our theories of vision. So we think of perception as reception of information from the environment; we take for granted the constitution of the subject; we imagine that in perception visibilia are simply presented, re-presented even, to a pre-constituted body subject. Or we imagine that the fact that the constitution of the body subject is transcendental somehow makes it not a part of the world, not a co-constituted, constantly re-enacted, empirically ascertainable fact. We relentlessly take the constitution of the subject for granted. (This explains, too, why we are constantly drawn to misunderstand psychosis in merely epistemic terms - as if it were simply a matter of a self-same subject making mistakes in his perception and in his belief.)

Wednesday, 3 October 2018

wittgenstein's dreams

Sometimes Wittgenstein records his dreams in his diaries. And sometimes they're funny. For example when repeatedly calling a particularly stubborn mule he was talking to 'Inspector', then deciding to call all horses 'Inspector', only realising on waking that perhaps this was all rather odd. (There's far more to the dream, as it happens, than the pleasing oddness of it, but we may still enjoy that about it.) But more often they are deeply sad. I think they are sad in ways that Wittgenstein himself is unable to appreciate. I might put that differently though: if Wittgenstein were able to appreciate their sadness, and take care of himself in his sadness, then I don't think he'd have had them to begin with.

Here's the first dream I want to consider. Note how much he talks of realising that the feeling of dread in it has significance, and yet how little he understands of that significance.
Cumaean Sibyl 
Last night I awoke with dread from a dream and I suddenly saw that such dread means something after all, that I should think about what it means. The dream had so to speak two parts … In the first someone had died, it was sad and I seemed to have conducted myself well and then as if upon returning home someone, namely a strong, old rural person (of the sort of our Rosalie [a beloved family maid, apparently, not his sister]) (I am also thinking of the Cumaean Sibyl) gave me a word of praise and something like: “You are someone, after all.” Then this image disappeared and I was alone in the dark and said to myself – with irony “You are someone, after all” and voices shouted loudly around me (but I saw no one shouting) “the debt must yet be paid” or “the debt is yet unpaid” or something like that. I awoke as from a dreadful dream. (Hid my head – as since childhood I have always done in this case – under the blanket and dared only after a few minutes to uncover it and to open my eyes.) As I said I became conscious that this dread has a deeper significance …. that is, the capacity to feel dread is to mean something for me. Immediately after waking, in dread, I thought: dream or no dream, this dread means something. I did something, felt something, after all, whatever my body was doing in the meantime.That is, the human being is capable of such dread – And this means something. [Diary entry 12.10.1931] 
It is reasonable, and straightforward, to interpret the dream. The Wittgenstein children were not well loved; Brahms talked of finding an atmosphere as of being at court in their family home; three brothers suicided. Ludwig was anxious, aloof, needy of others' affection, desperately fearful of not receiving it, seeking positions of invulnerability and solitude, sometimes desperately lonely, fearful of madness. In the dream someone has died, and Wittgenstein says straightforwardly: 'it was sad and I ... conducted myself well'. He is able to experience appropriate sadness on someone's death, he is able to 'stay in touch with' his feelings. And then a mother figure (Rosalie that is; there's too many meanings of the Sibyl of Cumae for us to even guess at his associations) tells him that he is someone. Here he is someone not because he's 'made it big' but rather simply in his capacity for ordinary humanity. For here he can feel healthy feelings, he can be receive ordinary recognition, care, love. But then something terrible, something spoiling, comes crashing in. The dynamic is echt Wittgenstein: ordinary love cannot be held onto inside; it is not safe, secure, enough; he cannot rest easy with, cannot trust in, ordinary affection's reliability. It becomes an unpaid debt, not a gift freely given. The healthy 'you are someone' gets ironically parroted by a mocking internal object. Wittgenstein's habitual dynamic of vanity and self-loathing for that vanity - a dynamic that drives his inner loveless loneliness toward a sense of insanity - then comes into play.

A natural interpretation of a second dream hangs together with the above:
I stood with Paul [brother] and Mining [elder sister]… as if on the front platform of a streetcar …Paul told Mining how enthusiastic my brother-in-law Jerome was about my unbelievable musical gift; the day before I had so wonderfully sung along in a work of Mendelsohn …. it was as if we had performed this work among ourselves at home and I had sung along with extraordinary expressiveness and also with especially expressive gestures. Paul and Mining seemed to completely agree with Jerome’s praise. Jerome was said to have said again and again: “What talent!” … I held a withered plant in my hand with blackish seeds in the little pods that had already opened and thought: if they were to tell me what a pity it is about my unused musical talent, I will show them the plant and say that nature isn’t stingy with its seed either and that one shouldn’t be afraid and just throw out a seed. All of this was carried on in a self-satisfied manner. – I woke up and was angry or ashamed because of my vanity. … May I not become completely base and also not mad! May God have mercy on me. [Diary entry 28.1.1937]
The under-loved Ludwig dreams wishfulfillingly of praise from his brother-in-law. (Recall the family atmospherics; recall Paul coming in from the room where he was practicing piano into Ludwig's room exclaiming that he couldn't play when Ludwig's scepticism toward him was seeping in from under the door. Recall Ludwig's combined intensity and awkwardness of expression.) To achieve its effect, to push past the doubt and competition, it takes an extreme form. Everyone 'completely agrees'. But then - a withered plant, black seeds in a pod. A symbol of life and generation and of free and easy expression (throwing out a seed without inhibition) is already stifled, blackened, withered. Doubt is kept at bay through self-satisfaction. And then, well, the dynamic we know so well - the vanity and the shame at the vanity, the self-excoriation, the fear of madness. Nowhere do we find a jot of ordinary healthy self-sympathy. Nowhere, even, do we find acknowledgement that such apt sympathy is missing.

The well-loved E E Cummings can write 'i carry your heart with me (i carry it in my heart)'. He knows his mother's love, he carries it inside him, and it spills out in his love of, especially, women and nature/God. He has something good in him and can rest easy with it, reasonably fearless of its being taken away. Wittgenstein, though, struggled either to find the necessary self-solicitude for life, or even to know it for missing. He remains something of a mystery to himself. The result is not an ordinary self-understanding and ordinary fluctuation of emotion; it's a feared incipient madness. His 1930s diary entries show this - show how caught up he is in but the distal products of a dynamic that itself remains unconscious, a dynamic substituted for by cruel vacillations of pride and shame. An unconscious dynamic of something so ordinary, simple, valuable - care, trust, value, gentleness - being needed, wanted desperately - but feared in its possible, in its likely, unavailability - then mocked, then naturally compensated for with conscious vanity, a vanity in turn consciously despised. (The perverse and painful comforts of self-reproach.)

Loneliness comes in different forms. The term covers what psychically are near antonyms, marked as common only by their both being un-easy reactions to solitude. In a healthy loneliness one knows one misses the kind of loving connection with others which one also knows, for oneself, is truly possible and realistic. One can feel, in a healthy sense, 'sorry for oneself'. One can know it's time to seek out a friend, or to take especial care of oneself if a friend is currently unavailable. One can suffer properly, meaningfully; one's feelings make natural sense to one, are to be expected, are tended to. In dreadful and largely 'unconscious' loneliness there's no realistic sense of the self as lovable and of others as loving. (Ordinary friendly gestures are looked on with suspicion; Wittgenstein is acutely sensitive to the issue of the friendliness of others toward him.) The sufferer tends to retreat into a world of one; into solipsism; into a mountain hut; he seeks to become independent of fate. But the real feeling of loneliness is, if you like, 'repressed'. To put it otherwise: there is within what still remains of the human soul a drive to connection, and this drive, when unsatisfied, will now be diverted, into dreams, into symptoms, into madness; it cannot take shape as ordinary loneliness, it cannot be 'suffered' (in a 'suffer the little children...' sense) but will instead lead to psychic 'constructions' (Bion: suffering vs constructing an experience). The dread of being abandoned, lost, becomes nameless; it becomes something that feels significant but can't really be grasped. The dreams are necessary because the loneliness cannot be tolerated, known of, accepted, cared for; they (and the correlative neuroses) are necessary because Wittgenstein so struggles to, in an ordinary way, for long, carry the heart of another securely within his own.

To end, one further short dream. In the dream Wittgenstein 'arrived at a sentence which upon awakening I still vaguely knew:'
Baron Munchausen's
remarkable feat
“But let us talk in our mother tongue, and not believe that we must pull ourselves out of the swamp by our own hair; that was – thank God – only a dream, after all. To God alone be praise!” [11.4.1937].
Here he finally finds the way out, and remarkably he finds it even in the dream itself. We do not need to try and be our own source of nourishment, have one hand give another a gift and for that to somehow be meaningful, define the terms of our own introspective language so that we cannot go wrong but yet somehow supposedly yet go right, tell our height by putting our hand on top of our head, secure the hands of a clock to the dial, push on the dashboard to try to make a car move forward, get ourself and our horse out of the swamp by pulling on our own hair like Baron Munchhausen ... Wittgenstein's metaphors for the perils of this fruitless backfiring solipsistic desire for self-sufficiency, and his experience of the nightmares that then ensue (when we are cut off from external nourishment), are legion. What we must do, instead, is talk in that language which is not of our own making, which is a good-enough mother; we must talk in our mother tongue; give up the narcissistic ambitions and instead give our praise to God; find the courage to have trust in this mother tongue God; forgo the frictionless ice that takes us nowhere; and then we can walk the rough but serviceable ground, stumbling a little but, by the grace of God and nature, not too much.