Saturday, 30 November 2019

the danger of wonder

We're sometimes invited to philosophise in a mood of wonder. Heidegger does this; Wittgenstein occasionally does something similar too. Now I've no wish to dismiss wonder, but I want to express a concern about it, or at least about what can easily be taken for it.

St Augustine
Take Augustine's question "What then is time?" which he follows with "If no one asks me, I know; if I want to explain it to a questioner, I do not know." (Both Heidegger and Wittgenstein were concerned with this remark, and admired, if with reservations, Augustine's treatment of time.)

What I'm imagining is someone taking himself to understand Augustine's words, taking himself to understand the question "What is time?", and agreeing with the idea that, in some sense, he "knows what time is" if nobody asks him but not if they do ask him. If I put myself in this imaginary situation, I find myself starting to wonder at time; "How extraordinary!" I interject. It seems utterly mysterious what it is. A simple philosophical question seems to take something we all rather took for granted, something into which we're all unreflectively sunk, something which our thought and action rely upon - and turns it into a thematic object of investigation. And a sense of something at least rather like wonder is surely attendant on this. "Time!" we gasp, wondering at it, stunned that this marvel which seems to outstrip our reflective comprehension was all along under our noses.

But what concerns me here is that Philosophy ( - in what follows I shall pretend that 'Philosophy' is the name of the person drawn to making the philosophical move I wish to expose - ) has mistaken its own capacity to confuse itself for the extraordinariness of nature. For Philosophy here takes a question - "What is X?" - a question which we know how to handle in various contexts ("What is the atomic number of mercury?", "What is a dodecahedron?", "What is a carburettor?") and now substituted for "X" (not "mercury", "dodecahedron" or "carburettor" but) "time". After it has done this, Philosophy takes itself to be asking a genuine question with "What is time?" There being no ready answer, a sense of something like marvel or wonder springs up. "Time: how extraordinary!"

Yet what Philosophy has done nothing to show is the intelligibility of its own question. After all, why on earth should we expect to get a sensible question out of "What is X?" regardless of whichever noun we substitute for "X"? Why should that be a good question in more than a certain range of cases? Why should it be any more prima facie intelligible what is being asked when someone says "What is time?" than when, taking "Y" not as standing for "a piece of string" but rather for "a prime number" or "the colour yellow" they say "How onerous is Y?"? 

The "What is X?" question certainly has a clear role in articulating a certain kind of puzzle about certain substances and (what we might cautiously call) various abstract phenomena (insolvency, arrogance, woke culture, aluminium, plate glass); it works for the whole range of ordinary objects too if we put an 'a' or an 'an' in it too. But so far as I can tell it just isn't obvious what's being asked by "What is time?"

Someone might reply "Well talk of Augustine's knowing what time is so long as nobody asks him must just be another way of saying that he knows how to tell the time, knows how to use the word 'time' in sentences like 'The time is 3.30pm', etc." OK. I'm fine with that. But I don't see a way to preserve the sense of wonder generated by "What is time?" if it is taken to mean "How is the word 'time' used?" For the answer to that question is not in any sense mysterious. It involves pointing to clocks and stopwatches, rehearsing the tenses, explaining how the day is divided into hours and minutes and seconds, etc. etc.

Now I've no wish to deprive anyone of genuine wonder. All I wish to point out here is that we're capable of generating apparent senses of awe and wonder by asking questions the sense of which is unclear when this unclarity goes unrecognised by us. We ask "What is time?" and then rather than continue with "Hang on, what am I even asking here?" instead go on with "How amazing, I talk about it unreflectively every day, but it radically outstrips my reflective purchase and I simply don't know what it is!" That, I suggest, is not a sense of wonder worth having, and philosophy pursued under its sign is nothing but arrogant hubris - the arrogance here being the presumptuous opinion that the putative question on Philosophy's lips had any meaning in the first place.

Rather than wonder, then, the affective sign under which we most often do well to pursue philosophy is, I suggest, humility.

Saturday, 21 September 2019

psychotherapy as internal relation

(notes for a talk at Confer, 21st Sep 2019)

Abstract 

Describing psychotherapy as a method of treatment is expedient in healthcare settings, but it would take a tin ear to not baulk at it as a characterisation of the therapeutic experience. To unpack our intuition that ‘treatment’ talk fails us, we may use Wittgenstein’s distinction between internal (constitutive) and external (two-part) relations. Psychotherapeutic work embodies, and develops the patient’s capacity to enter trustingly into, mutually implicating (i.e. internal) relations with others – whereas treatment requires only that people are merely externally related. Then again, psychotherapy is also in the business of helping patients separate out from others. This togetherness-in-difference has a name: it’s what we call ‘love’.


Introduction - Grammatical Notes

The question I was invited to address by the organisers of this conference was 'Is psychotherapy a treatment or a relationship?'

Now I take it that this isn't a straightforward question like 'Is animal X a cat or a dog?' For there's as yet too little context, around the mere question, for us to have a sense that the two terms (treatment and relationship) are being used in a sense which excludes one another. Thus perhaps we should want, and do well, to say that psychotherapy is both a relationship and a treatment.

Now there's a trivial sense in which 'psychotherapy' can't easily be taken as the name of a relationship, since psychotherapy is - like 'treatment' but not 'cure' - the name of an activity, and activities are not relationships even when they're done together with someone else. 

And there's also a trivial sense in which nobody shall deny that psychotherapy involves relationship, since even those behaviourists who think of the therapeutic relationship in merely instrumental terms - i.e. merely as a means to an end - as merely a delivery mechanism if you like - will not deny that it involves two or more individuals in cooperative interaction. A pizza (the end, as it were) is delivered by a delivery man (the means, as it were). The delivery man himself, though, is not the dinner (unless you’re a murderous cannibal).

Having got these trivia out the way let's move straight on to examine the key issues.

Instrumental vs Non-Instrumental Understandings, and Versions, of Psychotherapeutic Relationships

Now, what contrasts with a merely instrumental conception of the psychotherapeutic relationship is one in which it is in the relating itself that therapeutic change is taken to occur.

Consider that Judith Beck tried to take a stand against those who accuse cognitive therapists of ignoring the importance of the therapeutic relationship by insisting that cognitive therapy

requires a good therapeutic relationship. Therapists do many things to build a strong alliance. For example, they  work collaboratively with clients . . . ask for feedback . . . and conduct themselves as genuine, warm, empathic, interested, caring human beings.

To this the psychoanalytical psychotherapist Jonathan Shedler responded 

This is the kind of relationship I would expect from my hair stylist or real estate broker. From a psychotherapist, I expect something else. [Beck appears] to have no concept that the therapy relationship provides a special window into the patient’s inner world, or a relationship laboratory and sanctuary in which lifelong patterns can be recognized and understood, and new ones created.

Against this response I only note that Shedler’s optimism regarding his barber or estate agent perhaps warrants some of what a CBT therapist would call 'cognitive restructuring' - although maybe here we meet also with the different cultural expectations and practices of the two sides of the North Atlantic...

Now, working 'in the transference', as they say, provides a good example of what I'm here calling a non-instrumental use of the therapeutic relationship. Let's now spell this out using a comparison of, rather than a remark on the disanalogy between, behaviour therapy and psychoanalytic therapy. (I probably got this analogy from Leigh McCullough's work on 'affect phobia'.)

So consider first that in behaviour therapy it isn't imagined that one shall overcome one's dog phobia, say, merely by talking about dogs. Instead, real encounters with dogs must be suffered, and a 'response prevention' (i.e. evasion prevention) protocol be implemented. In this way one learns - or is re-conditioned - directly from within a transformative experience (of a non-devouring dog).

Similarly when it comes to reconditioning our fundamental, conscious and unconscious, affectively charged expectations of how others will treat us: what's important is not that we (I’m here the therapist, you the patient) simply talk about what happened to you in your childhood, or about what's currently going on at home, but rather that the fearful expectations are directly met with within, because they've been activated bythe intimacy of the therapeutic relationship itself

When the transference is activated and these fearful expectations are alive between us, we now stand a chance of truly learning the difference between the malevolent pit bull (in the negative transference) or the impossibly ideal golden retriever (in the positive transference) the therapist is imagined to be - and the, say, slightly up tight but nevertheless caring and discerning labradoodle he really is (in the real relationship).

As well as this transference work we also have the fundamental work of therapy to install a 'good internal object' and challenge self-criticism, which process we may think of as an internalisation of the therapeutic relationship. Here too the good therapeutic relationship is not merely instrumental – it’s not merely a precondition for the effective deployment of this or that technique, not merely a way to make someone receptive to the actual treatment - but it is itself the substance of the therapeutic process.

We might sum up these reflections by saying that, far from treatment and relationship being antithetical, meaningful therapeutic treatment will itself take the form of a relationship.

Disanalogies

I now wish to turn to ways in which talk of a 'psychotherapeutic treatment' may be considered oxymoronic - or, in other words, to think about what it is in our concept of 'treatment' that can strike a bum note when we're thinking of applying it to the case of psychodynamic and person-centred psychotherapy. And I think the bum note rings out most clearly when we consider such uses of the word 'treatment' as 'Dr Gipps was treating Megan for her depression' - i.e. when the treatment is something done by one person (the therapist) to the other (the patient). This is the sort of thing which may be useful to write on an insurance report or in an NHS case file, but the 'treatment' concept does, I think, risk doing an justice to our sense of the therapeutic process.

To get at this I will borrow a concept from Wittgenstein's philosophy - that of an 'internal relation'. We might define this abstractly - as a conceptual or a constitutive relation - rather than a relationship between discrete, separable, entities - but I think that what it is will come out more readily with an example.

So, imagine first a child's toy in which various shapes (stars, squares, circles, etc) are to be posted through variously shaped holes. Here the holes and the shapes are two separate phenomena. We can say what they are without referring to the other. We can tell a meaningful story about what allowed the one to fit so well through the other (it was made to the same specifications, the craftsman was very skilled, etc). Here we meet with phenomena that are externally related one to the other: they don’t each take their shape from the other.



And now imagine that we meet instead only with a circle drawn on a piece of paper. Someone may come along and ask 'How is it that the white disc in the middle fits so well into the black circle around it?' But now we'd have to explain to the person that they’ve made a mistake. These are not really two separate phenomena, but just one phenomenon. The outside of the white disc is defined by its black perimeter, so there can be no question of one thing fitting another. The white disc and the black circle are internally related to one another: they take their shape from one another.


O

Now what I propose is that talk of 'treatment' is best understood as talk of something that's done by one individual to another separate individual. As such it is a paradigm of an external, causal relationship between discrete beings. 

The individuals in question may of course be very intimate, but the idea of a treatment going on does not in itself presuppose this intimacy. And it is because treatment talk has these external connotations that we should reject it for an apt description of the work of psychotherapy if we want to understand what psychotherapy essentially is. (You and the pizza delivery man may be lovers, but the pizza he brings is (presumably) extrinsic to your lovemaking.)

The question remains, though, as to what it means to describe what are after all the two separately identifiable participants in a therapeutic relationship as 'internally related'? And clearly the answer will be that, to the extent that the relationship stands a chance of being therapeutic, there is some sense in which the participants cannot be considered entirely separate. And yet clearly the last thing we want from a therapeutic relationship is that the participants become somehow merged with one another. Indeed it may be because of problems with her ego boundaries, or because she suffers a want of self-possession, that the patient comes to therapy in the first place. 

In what follows I shall look first at the internal relatedness required in a truly therapeutic relationship and then consider the significance of our human recognition of separateness, finally tying both of these points to the bum note struck by 'treatment' talk.

Internal Relations

The predicament we're often in when we go to therapy may I think be put like this. (I'm now going to tell you some things that I hope you'll agree we both already know.) So (you’re the patient again): you've suffered a partial developmental failure. You're unclear or doubtful in your heart about whether you're truly lovable as you are and about whether other people are truly to be trusted. To manage these concerns you erect a set of defences and develop a pseudo-adult carapace or persona through which you now engage with the world.

Certain others you do 'let in'. Even here however this goes smoother if first you idealise, have a 'love-in' with, identify with, these others, doing your best to overlook or 'forgive' (which is not real forgiveness) their all-too-human sides, all this happening under the aegis of a positive transference. All the other others, however, you 'keep out'; you engage in politeness, decorum, and all the panoply of those forms of latent human shunning or failures of openness that go to make up 'civilised life’. But whilst these defences help manage your anxiety they also create what we call 'symptoms' and thwart your development. Why is this?

They thwart development because it's only when we let others in that we can grow. The child needs a trusting intimate connection with others in order to get anywhere in life. Before he can become a separate being with a character which is more than a congeries of defences, he must be able to find his sense of himself in his relations with trusted others. Only out of this togetherness may true individuation proceed. I think that the quality of this experience of the child is best summed up by the Christian use of the word 'parrhesia', which in the Catechism is described as "straightforward simplicity, filial trust, joyous assurance, humble boldness, the certainty of being loved".

So: when I trust you, and let you in, I take your reaction to me as a true indicator of how I really am in myself. I cannot, despite the seductive illusions of omnipotent narcissism, truly achieve this calibration for myself. I can only achievemy self-esteem andcalibratemy moral sensibility (i.e. my conscience) through a close trusting relation with you. I find myself in you.

In such trust I allow myself to be calibrated by you - this is the sense in which a close trusting relationship, especially of a parent-child sort, involves a relationship that is partly internal. My self-becoming and your sense of me are not now two quite separate matters.

Now - not globally but at this specific juncture of our connection - we're related not as two separately-shaped phenomena which happen to coincide, but instead as the edge of the white disc to the inside of the black circle which defines it.

My self-esteem - which is simply the confident untrammelled bodying-forth of myself - can now grow. It grows, in particular, to the extent that I get a sense (now I’m the patient or child, you’re the therapist or adult) that you love me - by which here I mean, you want the best for me- with the stress both on 'the best for'and on the 'me'I can now grow as I step forward confidently into my life. My sense of forgivableness - my sense that I shan't be sent into exile when I make mistakes - and my sense of the valuedness of my own love - is also now increased. Because of all this I can allow myself to form valuable and close relationships with others.

One way we might articulate all this is by distinguishing two different senses of 'recognition'. In the one – let’s call it ‘empirical recognition’, as when I recognise that bird over there as a green woodpecker - we meet with something that may intelligibly be described as correct or incorrect. In the other – let’s call it ethical recognition, as when recognition is what you offer me - you affirm me in my essential character. This is what Rogers called 'unconditional[,] positive regard' - which, incidentally has got nothing to do with a regard that is unconditionally positive (since otherwise how could it begin to cohere with anyone but the sappiest therapist's congruence), but everything to do with being treated as an 'end in oneself', to borrow the Kantian terminology. You welcome me in; you show an openness to me as I am. When I trust in this recognition, then I and you are one, not simply in the coincidence of the content of our beliefs, but in a moment in which who we are is jointly enacted and thereby constituted. Now, just at the meeting point between us, we are one another, just as the white disk and the black circumference are of a piece - although, and of course, there are myriad other junctures of our lives where we are not so mutually implicated.

Now this, I think, is what it is to be internally related to one another in psychotherapy. It is only by presupposing a relationship with such a feature that, say, meaningful work in the transference can ever occur - otherwise why should I – I’m still the patient - ever trust your interpretations? It is this quality of the work, this inner involvement and implication, that - I think - explains why talk of ‘treatment’ just doesn't cut the therapeutic mustard. 

And, for that matter, it is this intimate recognition which is rightly described in terms of love, and which prompts the observation that decent psychotherapy is necessarily informed by love.

Separateness

Having described our togetherness in a meaningful love-structured therapeutic relationship, I now turn to the equally important matter of our separateness and the recognition of it. The important question here is how to think both of these together. 

In a paper called 'The Sublime and the Good', Iris Murdoch writes:

Love is the perception of individuals. Love is the extremely difficult realisation that something other than oneself is real. Love ... is the discovery of reality. ... the apprehension of something else, something particular, as existing outside us. The enemies... of love...are... social convention and neurosis. ... Freedom is exercised in the confrontation by each other, in the context of an infinitely extensible work of imaginative understanding, of two irreducibly dissimilar individuals. Love is the … respect for, this otherness.

I present this here because with its talk of recognising otherness it can seem to give us a very different picture of what intimate connection is than the conception of self and other as internally related provides. 

And I take it too that a lot of therapy is about helping the patient separate out from, and recognise the independence from him of, his significant others. 

Therapy is partly - and it's an important part - about the growth of self-possession. In psychodynamic psychotherapy this occurs, we believe, partly through the interpretation, and thereby the dismantling of, the transference. A precondition of this is that the therapist can offer that unconditional positive regard to the patient which itself stems from a recognition of his independence from her. But what we were talking about before was the need for patient and therapist to join together in a moment of internal relatedness, mutual implication, or conjoint constitution. And this seems now to put us inquirers at theoretically odds with ourselves, to have us searching for both identity and disunity at the same time.

The answer to this puzzle is that that recognition which makes for an internal relation between self and other isn’t a kind of identity. What you offer recognition to is: me in my distinctive selfhood. In my particular character. This particular character is thereby acknowledged as an intrinsically valid way of being human. This is what it is to offer me positive, unconditional, regard. And I gain my sense of myself and the comfort to body forth as myself under your loving gaze. Despite how different I am from you, you recognise my character as a viable form of human selfhood. By loving me you acknowledge me in my utter otherness to you, as Murdoch states. Yet when I in my self-understanding meet you in your recognition of me, there we are at one, and there I can flourish.

Individuality, Psychotherapy and Treatment


Now it’s sometimes said, by psychoanalytic psychotherapists seeking a quick-and-easy response to the challenges of empirical research pundits, that it's wrong to make use of intrinsically generalist evidence-based treatment research because patients are all individuals.

If what this means is that patients all have different characters, then it's obviously wrong to some degree, and right to some degree. In some ways we are really rather like one another, and psychoanalysis has even contributed to our understanding of this. Whether or not one patient with, say, OCD, is sufficiently similar to another to make a research-derived psychotherapy protocol viable is, we might then think, surely an empirical matter, not something to be pronounced on from an armchair.

But this all makes me wonder whether there might not be another way to take what the psychoanalytic psychotherapist says from her armchair by way of reply to the scientist practitioner. And the way I suggest is what’s already been offered above: we're to treat our patient as an individual not in the sense that he has a unique character profile, but in the sense that he has a way of being human that (underneath the destructive defences he deploys) is to be accepted as is

It’s in his way of being human that we offer him recognition. This is not about our empirically recognising his characterological distinctness, but ethically recognising him in his distinctness. (And so we use his name and not a number; we treat him as an intelligible object of love; if he dies we don't treat him either as a dead animal or as a piece of rubbish, and when we grieve him we grieve not our loss but him. If we wrong him then we feel bad - not for having broken some moral law, but because we've hurt him

So the reason why it may not be apt to apply an evidence-based protocol to our patient, then, is not because he has a rare character profile, but because in a therapeutic relationship we specifically encounter him under the description 'human being' rather than, say, ‘homo sapiens’. This requires recognition - not of the empirical but of the ethical, offered, sort. The point isn’t that he’s not an instance of a type (presumably he is) - but rather that a relationship structured by that idea could never itself be a therapeutic one. 

To suppose that it is would make no more sense than someone saying 'I love my husband because he's 6 foot tall, has a handlebar moustache, is a clever clogs, and has large biceps'. One may certainly 'love' (qua greatly enjoy) those things about him, but truly loving him has no because - or, if you enjoy circular explanations, has no ‘because’ other than that in 'I love him simply 'because he is he''. Our patient has struggled with receiving recognition, has erected defences against being met with as a person, may have been judged in his core being, may have been projected into or neglected or used or smothered or spoiled or indulged by those who were instead supposed to care for him by honouring him, offering him recognition, treating him as a moral subject, one capable of wronging and being wronged. This is what we must undo, as we now express our willingness to meet him as a human being.

Conclusion

I began by getting a clear non-instrumental sense of the therapeutic relationship on the table. I then stressed that we can use the idea of 'internal - mutually implicating - relations' to characterise the kind of relationship we find in a therapeutic relationship. When we are open to one another in such a way as to make ourselves visible to the other's ethical recognition of us, then we are related internally and then the transformative work of therapy may begin. Now we take the other's reactions to us as providing more than information about ourselves. Rather it's in your true pity that I find myself; in your moral challenge to me that I understand my thoughtless selfishness; it's here that I can now become myself. Yet whilst this relationship between us is internal in form, like the black circle to the white disc within, it's not one of identity. Far from it: to be real your loving recognition of me must honour me as truly separate from you - as a being with his own character, own inner life, own needs, own form of experience.

And all this, I suggest, helps us grasp what it is that 'treatment' talk misses by way of an apt characterisation of the essential form of a therapeutic relationship. It tends us toward supposing that we and the patient do well to both direct our attention to something extrinsic to the therapeutic relationship, to something called 'the problem', 'the illness', 'the symptom'. But the very 'symptoms' that bring patients to psychotherapy are a product of a failure of personal being - a failure to receive, or a chronic shying away from receiving, recognition. And it's in providing the requisite recognition that we meet our patient, and its in this recognition that he meets himself and so may now pick up afresh the task of being a person in the world. It is, we might say, precisely in our treating him as a human being that the lie is given to the idea that what he needs is something called treatment.

Monday, 1 July 2019

just published



Previous multi-author collections of English language essays in phenomenological psychopathology include Rollo May, Ernest Angel and Henri Ellenberger (1958) Existence: A New Dimension in Psychiatry and Psychology; John Cutting and Michael Shepherd (1986) The Clinical Roots of the Schizophrenia Concept: Translations of Seminal European Contributions; and Matthew Broome, Robert Harland, Gareth Owen and Argyris Stringaris (2013) The Maudsley Reader in Phenomenological Psychiatry. Unlike the Maudsley Reader, which is the only other collection still in print, the Oxford Handbook of Phenomenological Psychopathology is a 98 chapter collection of newly written essays, covering a wide variety of topics.
  1. The 23 essays in its first section cover the history of phenomenological philosophy (Husserl to Levinas) and phenomenological psychopathology (Jaspers to Laing).
  2. The 7 essays in section two consider the meaning of taking a phenomenological approach and its relation to other approaches.
  3. Section three consists of 12 essays on key concepts of phenomenology such as the self, emotion, and various of what Heidegger called the existentialia (essential dimensions of human existence).
  4. Section four comprises 15 chapters on descriptive psychopathology, chapters which amongst other things consider the psychopathology of the various existentialia.
  5. The 8 chapters of section five look holistically at the different life worlds of persons with different conditions (schizophrenia, mood disorders, hysteria, BPD, addictions, autism, eating disorders).
  6. Section six entitled ‘Clinical Psychopathology’ contains 9 essays on different aspects of (mainly) psychotic experience.
  7. Finally section 7 contains 13 chapters on the relationship between phenomenological psychopathology and other disciplines from neuroscience to psychoanalysis.

1: Introduction, Giovanni Stanghellini, Matthew Broome, Anthony Vincent Fernandez, Paolo Fusar Poli, Andrea Raballo, and René Rosfort

Section One: History


2: Edmund Husserl, Roberta de Monticelli

3: The Role of Psychology According to Edith Stein, Angela Ales Bello
4: Martin Heidegger, Anthony Vincent Fernandez
5: Jean-Paul Sartre, Anthony Hatzimoysis
6: Merleau-Ponty, Phenomenology, and Psychopathology, Maxine Sheets-Johnstone
7: Simone de Beauvoir, Shannon M. Mussett
8: Max Scheler, John Cutting
9: Hans-Georg Gadamer, Andrzej Wiercinski
10: Paul Ricoeur, René Rosfort
11: Emmanuel Levinas, Richard A. Cohen
12: Critiques and Integrations of Phenomenology: Derrida, Foucault, Deleuze, Federico Leoni
13: Karl Jaspers, Matthias Bormuth
14: Eugène Minkowski, Annick Urfer-Parnas
15: Ludwig Binswanger, Klaus Hoffmann and Roman Knorr
16: Medard Boss, Franz Mayr
17: Erwin Straus, Thomas Fuchs
18: Ernst Kretschmer, Mario Rossi Monti
19: Hubertus Tellenbach, Stefano Micali
20: Kimura Bin, James Phillips
21: Wolfgang Blankenburg, Martin Heinze
22: Franco Basaglia, John Foot
23: Frantz Fanon, Lewis R. Gordon
24: R.D. Laing, Allan Beveridge

Section Two: Foundations and Methods


25: On the Subject Matter of Phenomenological Psychopathology, Anthony Vincent Fernandez and Allan Køster

26: The Phenomenological Approach, Dermot Moran
28: Genetic Phenomenology, Anthony Steinbock
29: Phenomenology and Hermeneutics, René Rosfort
31: Phenomenology and Cognitive Science, Shaun Gallagher
32: Phenomenology, Naturalism, and the Neurosciences, Massimiliano Aragona
33: Normality, Sara Heinämaa and Joona Taipale

Section Three: Key Concepts


34: Self, Dan Zahavi

35: Emotion, René Rosfort
36: The Unconscious in Phenomenology, Roberta Lanfredini
37: Intentionality, Joel Krueger
38: Personhood, René Rosfort
39: Befindlichkeit: Disposition, Francesca Brencio
40: Values and Values-based Practice, KWM (Bill) Fulford and Giovanni Stanghellini
41: Embodiment, Eric Matthews
42: Autonomy, Katerina Deligiorgi
43: Alterity, Søren Overgaard and Mads Gram Henriksen
44: Time, Federico Leoni
45: Conscience, Marcin Moskalewicz
46: Understanding and Explaining, Christoph Hoerl

Section Four: Descriptive Psychopathology


47: Consciousness and its Disorders, Femi Oyebode

48: The Experience of Time and its Disorders, Thomas Fuchs
49: Attention, Concentration, Memory, and their Disorders, Julian C. Hughes
50: Thought, Speech and Language Disorders, John Cutting
51: Affectivity and its Disorders, Kevin Aho
52: Selfhood and its Disorders, Josef Parnas and Mads Gram Henriksen
53: Vital Anxiety, Maria Inés López-Ibor and Dra Julia Picazo Zapinno
54: Hallucinations and Phenomenal Consciousness, Aaron Mishara and Yuliya Zaytseva
55: Bodily Experience and its Disorders, John Cutting
56: The Psychopathological Concept of Catatonia, Gabor S. Ungvari
57: Eating Behavior and its Disorders, Giovanni Castellini and Valdo Ricca
58: The Phenomenological Clarification of Grief and its Relevance for Psychiatry, Matthew Ratcliffe
59: Gender Dysphoria, Giovanni Castellini and Milena Mancini
60: Hysteria, Dissociation, Conversion and Somatisation, Maria Luísa Figueira and Luís Madeira
61: Obsessions and Phobias, Claire Ahern, Daniel B. Fassnacht, and Michael Kyrios
62: Thoughts without Thinkers: Agency, Ownership and the Paradox of Thought Insertion, Clara S. Humpston

Section Five: Life Worlds


63: The Life-World of Persons with Schizophrenia (considered as a Disorder of Basic Self), Louis Sass

64: The Life-World of Persons with Mood Disorders as Disorders of Temporality, Thomas Fuchs
65: The Life-World of the Obsessive-Compulsive Person, Martin Bürgy
66: The Life-World of Persons with Hysteria, Guilherme Messas, Rafaela Zorzanelli, and Melissa Tamelini
67: The Life-World of persons with Borderline Personality Disorder, Giovanni Stanghellini and Milena Mancini
68: The Life-World of Persons with Drug Addictions, G. Di Petta
69: The Life-World of Persons with Autism, Francesco Barale, Davide Broglia, Giulia Zelda De Vidovich, and Stefania Ucelli di Nemi Translated by Martino Rossi Monti
70: Eating Disorders as Disorders of Embodiment and Identity, Giovanni Castellini and Valdo Ricca

Section Six: Clinical Psychopathology


71: First Rank Symptoms of Schizophrenia, Lennart Jansson

72: Schizophrenic Delusion, Arnaldo Ballerini
73: Delusional mood, Mads Gram Henriksen and Josef Parnas
74: Delusion and Mood Disorders, Otto Doerr
75: Paranoia, Paolo Scudellari
76: Auditory Verbal Hallucinations and their Phenomenological Context, Matthew Ratcliffe
77: Affective Temperaments, Andrea Raballo and Lorenzo Pelizza
78: Schizophrenic Autism, Richard Gipps and Sanneke de Haan
79: Dysphoria in Borderline Persons, Mario Rossi Monti and Alessandra D'Agostino
80: Psychosis High Risk States, Luis Madeira, Ilaria Bonoldi, and Barnaby Nelson
81: Psychopathology and Law, Gareth S. Owen
82: Atmospheres and the Clinical Encounter, Cristina Costa, Sergio Carmenates, Luis Madeira, and Giovanni Stanghellini
83: The Psychopathology of Psychopaths, Jerome Englebert
84: A Phenomenological-Contextual, Existential, and Ethical Perspective on Emotional Trauma, Robert D. Stolorow

Section Seven: Phenomenological Psychopathology


85: Phenomenological Psychopathology and Neuroscience, Georg Northoff

86: Phenomenological Psychopathology and Qualitative Research, Massimo Ballerini
87: Phenomenological Psychopathology and Quantitative Research, Julie Nordgaard and Mads Gram Henriksen
88: Phenomenological Psychopathology and Psychotherapy, Giovanni Stanghellini
89: Phenomenological Psychopathology and Psychiatric
90: Phenomenological Psychopathology and America's Social Life-World, Jake Jackson
91: Phenomenological Psychopathology and the Formation of Clinicians, Giovanni Stanghellini
92: Phenomenological Psychopathology and Psychiatric Classification, Anthony Vincent Fernandez
93: Phenomenological Psychopathology and Clinical Decision Making, Eduardo Iacoponi and Harvey Wickham
94: Phenomenological Psychopathology and Psychoanalysis, Federico Leoni
95: Phenomenological Psychopathology and Autobiography, Anna Bortolan
96: Phenomenological Psychopathology, Neuroscience, Psychiatric Disorders and the Intentional Arc, Grant Gillett and Patrick Seniuk
97: The Phenomenology of Neurodiversity, Marco O. Bertelli, Johan De Groef, and Elisa Rondini
98: The Bodily Self in Schizophrenia: From Phenomenology to Neuroscience, Francesca Ferri and Vittorio Gallese

Friday, 7 June 2019

shades of gaslight

Notes for a talk on narcissistic abuse.

i. introduction

The 1938/1940/1944 play/film Gaslight gave rise to the pop-psychological term 'gaslightling'. To cite Wikipedia:
Gaslighting is a form of psychological manipulation that seeks to sow seeds of doubt in a targeted individual or in members of a targeted group, making them question their own memory, perception, and sanity. Using persistent denial, misdirection, contradiction, and lying, it attempts to destabilize the victim and delegitimize the victim's belief. Instances may range from the denial by an abuser that previous abusive incidents ever occurred up to the staging of bizarre events by the abuser with the intention of disorienting the victim.
The reality of narcissistic abuse has come out of the shadows in the last 10 years, mainly thanks to the internet. Isolated victims struggle by themselves to gain or regain any meaningful perspective on their experience, in no small part because of the manipulation of their self-esteem and self-understanding by the narcissist. But now we have available the ideas of 'empaths' and 'codependents' and 'echoists' and a new rhetorics of manipulation: 'hoovering', 'enablers' and 'flying monkeys', 'scapegoating', 'going gray-rock', strategies of 'divide and conquer', 'fauxpologies', 'smear campaigns', etc. We know something too of the lifetime prevalence of NPD (apparently around 1%), prevalence in the population (apparently from 1% to 6%), and in clinical populations (apparently 2%-16%). The strategies of isolating victims from other sources of support, spreading lies about the victim's alleged difficulties to others, love-bombing, projective identification of vulnerabilities into the victim, are becoming well-known.

Even so the focus on 'incidents' and 'events' in the above quote encourages us to think that what's most at stake in gaslighting is our perception of  facts that are determinate and concern external reality - whether or not something really happened, whether or not what someone said is a misrepresentation, a lie, etc. This, after all, is what happens in the play/film: the evil protagonist persuades his victim that she must be hallucinating and otherwise imagining things (that the gaslight is dimming, footsteps sounding, objects not going missing, etc). With this talk of 'external reality', determinacy, and facts, I mean to elicit a contrast with three matters: matters of the inner life (especially moral motivation), indeterminate matters, and matters of meaning. But I also want to highlight something about the way the narcissistic manipulation intended by talk of 'gaslighting' has its effects: not so much by persuading us to doubt what we perceive and understand, but by bending out of shape our very perception, understanding, moral emotions, and the fabric of the self.

Sam Vaknin, a writer on narcissism and himself an NPD sufferer, talks helpfully here of
ambient abuse as the stealthy, subtle, underground current of maltreatment that sometimes goes unnoticed even by the victim herself until it's too late. Ambient abuse penetrates and permeates everything, but is difficult to pinpoint and identify. Gaslighting is vigorous, equivocal, atmospheric and diffuse, hence its insidious and pernicious effects. It is by far the most dangerous kinds of abuse there is. ... Ambient abuse yields an irksome feeling, a kind of disagreeable foreboding, a premonition, a bad omen; it's in the air. In the long term such an environment erodes the individual's sense of self-worth. 
The ambient abuse may result in a feeling of walking on eggshells, being constantly on edge, feeling like you ought to apologise for no particular reason, like there's something wrong with your own moral character that you didn't previously realise, all of this for no very obvious reason. It is the nature of such 'ambient, atmospheric' abuse that I want to focus on today.

ii. omission

Acts of omission are rather more subtle and pernicious than acts of commission, usually because they can go unnoticed or can be more easily denied. Here's a rather obvious example:
When I was in my late teens, my mother had about 10 of her closest friends over for a party right after Christmas. I was sitting among them (the only one of my mother's children present) enjoying the banter when all of a sudden, my mother grabbed everyone's attention and asked "would you all like to see what my children gave me for Christmas?" They all chimed in "absolutely"!! And I knew she was about to pull one of her classic gaslighting moves as she's done it so many times. She doesn't realize she has a tell (a certain tic in her facial muscles) when she's about to go full on narc. She walked over to the tree and grabbed two gifts - the one my brother got her and the one my sister got for her. She showed both as her friends ooohhhhed and awwed over them, and then she went and put them back under the tree. Her two closest friends' eyes got very wide and puzzled but neither would look over in my direction. I did not take the bait. I knew she wanted me to spout off so that she could humiliate me in front of the group and say she just forgot about my gift - I guess she forgot she has 3 children. It was beautiful though the way her move completely backfired as everyone got very quiet and uncomfortable as I sat completely silent. I'm almost certain that her best friend railed her when she got her alone as their relationship went quickly south after that. But that goes to show you how sinister and calculating these people are and the damage they do to their children is so unnatural. [by kris777]
Other cases are more subtle. Think of how long someone takes to reply to a message, how often they forget to reply, how often someone keeps you waiting, how often someone 'just doesn't hear' what you say to them, says very little to you compared with to another, or how someone doesn't reply to a verbal question and then - if you ask why not - will tell you 'I was thinking'. Even a slight pause in a conversation, or heeding only part of a call, can manifest a narcissistic temptation to put someone else on the back foot.

iii. defeasibility and plausible deniability

Here I stress two things. First, that none of the above behaviours are criterial of narcissism. They're only expressive of it in particular contexts, when engaged in above certain frequencies, as part of a general pattern, etc. The criteria for narcissism, we might say, are defeasible. In various contexts the above-described behaviours could all be perfectly normal and morally innocent. In this they share a key feature of psychological concepts quite generally: the absence of any one to one correlation between behaviour and mental attribute. Such attributes are only ascribable in particular historical and social circumstances. And what shall count as the right circumstances against which to read any particular stretch of behaviour as expressive of this or that feeling or tendency or characteristic is always a matter of judgement. What is the context in which that raised eyebrow shall count as non-accusatory surprise, or as an unwarranted accusation, or as a warranted accusation? Second, that this lends to them all a degree of plausible deniability; contrast a flat-out lie.

iv. indeterminacy

As well as the heavily contextual nature and defeasible character of the ascription of psychological qualities there's another quality of psychological and moral life which adds to the possibility of spurious plausible deniability exploited by the narcissistic abuser. This is the constitutive indeterminacy of the mental and moral. When it comes to various physical qualities (height, weight, etc) and other qualities (e.g. quantity measured by integers), indeterminacy in our measurements can by and large be eradicated through the use of more refined measures or more clearly specified questions. How many elephants are there in the room? Well, four but one's on his way out with his arse still sticking through the door. So, ok, we ask 'How many whole elephants are there in...?' But when it comes to certain moral or mental matters there need - so the thought goes - be no such agreement even amongst perfectly competent psychological and moral judges. There can occasionally be expressions which to one person looks to be of annoyance, to another of mere indifference, and for which consulting the subject in question may provide no clear answer. We may take ourselves to be motivated by entirely selfless ambitions; another may find a sliver of selfishness there - and there be no fact of the matter as to who is right. Was he being annoying or just insistent? Was it thoughtless or merely casual? Uncertainty here can be "constitutional. It is not a shortcoming. It resides in our concepts that this uncertainty exists, in our instrument." (Wittgenstein, Remarks on the Philosophy of Psychology, vol II, 657)

In our everyday life we do well to accommodate to this indeterminacy by attempting to err on the side of thinking the best of one another. Even so many of us suffer sundry 'attribution errors': we tend to overstate the significance of personal as opposed to situational variables in determining others' unfortunate behaviour, and to understate the significance of personal as opposed to situational variables in accounting for our own unfortunate behaviour. Amongst us depressives are the least vulnerable to the fundamental attribution error. It is not then surprising that they (in the guise of empaths, echoists and codependants) are the most vulnerable to abuse by narcissists who are the most vulnerable to, or exploitative of, the fundamental attribution error. The narcissist reads every encounter in such a way as to sap the presumption of moral decency from his victims and accrue it to his own ledger. S/He can do this, in part, because of the constitutive indeterminacy of the mental and because of the contextually situated defeasibility of behavioural criteria for mental states.

v. co-enaction of conscience and sense of being wronged

Matters of conscience are often portrayed in entirely inward terms. And of course there's much right about this: you can't outsource your voice of conscience. Someone else may recall you to your morally better self, thereby reawakening your inner moral voice, but they can't take the place of that inner voice itself. (This is just a 'grammatical remark'.) Nevertheless our sense of what is right and wrong - what is deserving of reproach or praise - in our behaviour and in the behaviour of others with whom we interact is itself something which emerges in the context of certain relationships. The sense of conscience and the correlative sense of being well or badly treated by another, arise (are enactively constructed) in the context of those close relationships in which they're worked out. And this, I suggest, has something to do with what it means to even be in a close relationship.

A close relationship, of a recognisable and important sort, involves trust and attachment. One might say that letting someone in involves in part, and in certain contexts, partly giving over one's judgement to them. But we might put that better: usually the starting point is of them already being ‘in’, in there with us, here where we co-constitute one another, and what we don’t do is take the artificial step of keeping them out. You found what I said hurtful; I wasn't sensitive enough - I don't judge entirely for myself now whether this is or is not true, but in part take you at your word. I allow – or don’t take the unnatural step of preventing – my moral sense to be part-calibrated by you. To not do this would involve not being in the kind of relationship which here I'm focusing on. Later in life deep friendship and committed romantic relationships have this quality. Our happiness may be one another's but, as well, our sense of our own decency and desert is partly given over to the other. In this way a close friendship or deep romantic relationship recapitulates the structure of a young child's relationship with her primary care-givers. And it is here that her conscience, sense of self-worth and sense of justice are typically formed. And the two of these - knowing that I've wronged another, my sense of my worth - are typically corollary. We might call this the non-autonomous character of conscience's ongoing (re)formation (i.e. of its enaction). Important to this enaction is that my sense of your moral worth and my sense of my own moral worth are constant corollaries - they are a function of one another - since the fabric of moral sense - of conscience - is itself enacted in the context of this relationship.

vi. bending the soul out of shape

So long as the other is well-formed and well-motivated the partial giving over of one's moral self-definition, this trust, is all well and good - in fact constitutive of forms of relationship we particular treasure. But along with the defeasibility and indeterminacy of the mental, this trust leaves one open to narcissistic abuse. Leaves one open to abuse by those who will urge on one a sense of one’s own badness - of responsibility for a relational badness that has come up between us - and thereby spuriously exculpate themselves. What I in particular want to make clear is the difference between i) somebody pretending to someone that matters are other than they are, when the first person has a well-developed and autonomous conscience and sense of self-worth into which is simply fed, for a moment, misleading data, and ii) the case where someone's very sense of worth and conscience is being consistently bent out of shape, perversely enacted, by a consistent skewing or queering of the pitch of the allocation of blame and reward in the relationship. An image may help here: in the one case a point is misplaced on a graph. In another the 0 axis itself becomes shifted. It is this more fundamental matter of this shifting of the axis of one's morale and moral sense - the disturbance to the formation of the faculties of judgement and not to this or that judgement - to which I'm here drawing attention. In the second diagram below I, the narcissist, have perverted the co-enaction of sense of guilt and being wronged in such a way that we both now allocate to you more moral culpability for certain unhappy incidents that occurred between us.

The narcissistic abuser does what she can to make unavailable to her victim other sources of recalibration. The victim is no longer able to meet with his friends, is ostracised from his family. The victim's friends are fed lies or spurious concerns ('oh his mental health is playing up at the moment so he can't come out'. 'Oh, did you hear what he said about so-and-so, how he treated so-and-so; he's in the dog house at the moment') so they don't make themselves available as aids to help recalibrate the victim's sense of self-worth. Duped 'flying monkeys' and pseudo-friends keep alive the narcissist's image of moral worth and reinforce the victim's sense of low self-worth. Word salad is used to confuse the narcissist’s victim, to get the upper hand, to provoke a preoccupation in the victim of regaining a sense of meaning, as an obfuscating shield, to provoke helplessness, to disturb the sense of the reliability of memory, to control the conversation. Body language and verbal tone is used which in itself may be easily deniable (compared to explicit verbal content) but which serves to queer the moral pitch of the interaction and leave the interlocutor feeling on the moral back foot. At stake in all of this is a distortion of the very moral fabric of the self of the victim. The sense of blame, desert, self-worth and admiration of the other are all thereby skewed.

vii. ontological depths of enactive perversions of conscience

In distinguishing between perversions of the scale itself - the scale which we are in ourselves (an ontological matter), which scale constitutes our sense of self-worth that provides the backbone of our character - and perversions of the perception of the placement of individual points of data on the scale (a merely epistemic matter) I don't mean to invoke an everywhere firm distinction. No doubt the one blends into the other in the way that the conceptual and the empirical do more generally, but most always they exclude one another. But by making the distinction we can preserve the former from being described only in terms appropriate to the latter, and thereby preserve it from being trivialised. This is akin to the importance of preventing delusion from being theorised in terms which are only appropriate for false atypical intransigent belief – i.e. in representational terms. In this way we prepare the way for a phenomenology of the depths of narcissistic abuse, of the way it affects the entire being of the victim, how it spreads out into their entire sense of their own value compared with that of others (in particular that of the narcissist), how it affects their ability to make moral judgement, take apt (not too much) responsibility, allocate blame appropriately (not too little). We can start to understand how someone can really come to think that of course they deserve it if their partner is having another affair, or how someone can come to be so skilled at walking on eggshells without even realising that they're doing so, or what it's like to endlessly receive devaluing disrespectful comments and to be ignored in such a way that one habituates to it so that it becomes the new normal, a new placement for the 0 of the X axis, a new 'normal' which also involves cutting the narcissist far more moral slack than would normally be tolerated.

The narcissist’s tricks work to detach her victim from moral reality and from sources of morale. She degrades the very fabric of his moral being. For when the enaction of the moral subject is perverted in this way, it is not merely prone to mistakes, but prone to distortions which are so off they’re not even wrong. One’s whole moral sensibility thereby gets bent out of shape and meaninglessness starts to take shape in the heart. The black emptiness inside the narcissist inevitably finds its complement. The inhumanity of the narcissist thereby infects the victim who now loses his sense of self, the backbone of his morale; he falls apart, becomes mentally and physically ill, shows signs of trauma. Again it is not simply the victim’s judgements that become skewed, but his very ability to make moral judgement: judgements like 'this treatment is wrong', 'I'm not a fundamentally bad person', etc.. They are in a trance state, a delusion, one that is necessarily blind to its own conditions, conditions which here are being twisted out of shape.

viii. conclusion

Let’s summarise the main points:

Gaslighting does not simply mean making someone feel crazy by lying to them a lot.

It involves a disturbance not only to representation but also to the enaction of morale and the moral sense.

This enaction can be carried not simply by the verbal content of what's said, but by variously subtle or unsubtle communications - the use of silence, selective memory, world salad, paralinguistic communication (an intake of breath, a raised eyebrow) - by forms of communication which provide the embedding sense-providing background to explicit verbal communication. This is 'ambient abuse'.

There are special features of the mental – indeterminacy, particularism, defeasibility, and co-constituted intersubjectivity – which enable the narcissist to gaslight.

The enaction of moral selfhood is co-enaction: who’s to blame for this upset we’re now in? is the fundamental relational question asked in a row, rows which the narcissist will provoke, the normally shared premises of which they will try to pervert.

Narcissism is ontological – it runs deep in the narcissist and its effects run deep in his victim – since it affects the enaction of the very axes of that moral graph, the enaction of the moral spine of the subject, her sense of worth and justice and culpability, and not merely the placement of this or that judgement upon it.