Tuesday, 10 April 2018

imaginary friends

It's easy to knock the imaginary friend (IF). The knocking takes its lead from the idea of the value of the IF as wish-fulfilling substitutive pseudo-satisfaction. This IF fills a gap but through desire's self-deceiving palliation rather than through desire's genuine satisfaction. It takes us further away from reality; it entrenches a self-deception. This IF doesn't help us accommodate, doesn't help us face the world in an honest way, doesn't help us tackle our loneliness, but encourages a drifting away into the pallid shades of faery.

What that critique of the IF misses is a deeper understanding of loneliness as existential state. What if what we are really at risk of is not the pain of missing actual others, or the painful longing for friendship one doesn't have, but a loss in one's sense of self as lovable, an unwitting voiding of that inner echo chamber where the You and the I may hear one another, where both meeting and missing take place? An unexperienced loss of warmth, of sense of inner warmth and inner value, an unwittingly traversed loveless wasteland?

On this more fundamental understanding, the function of the IF isn't to conjure an imaginary companion for such wanderings in the void. It's rather to keep alive the axis of relatedness in our inner life, an axis which provides warmth to our heart and opens us to meaning and value in our relations. Such an IF, far from being a salve for everyday loneliness, may even function as its condition of possibility. What I mean is that without that axis being energised by the relationality cultivated by the IF, perhaps we might lose relationality altogether, and thereby lose the possibility of enjoying or missing the company of others.

Might God - the God of love, that is - be the supreme IF? And, if so, might He fulfil a function really quite other than any mere wish-fulfilment? Might praying to Him keep us alive to relatedness at times when otherwise we may drift off into depression's drifting void? Perhaps such prayer not only staves melancholy or apathy but also, through keeping us alive to what is met with in relatedness - through disclosing the other to us in her otherness under the aspect of love - keep us on the moral ball. Keep in check our centripetal disposition to self-centredness; keep alive our centrifugal disposition to caring connection.


Theological afterword: I'd be disappointed to be read as implying that God is an imaginary as opposed to a real Being! Whilst I know what it is to distinguish between a real childhood friend and an imaginary childhood friend, I don't think I know what it is to distinguish between (to pick a common understanding of God) a Ground of Being which is Love that is real and one that is imaginary. Do many of our concepts of 'God' really make room for an imaginary/real contrast - any more than, say, those of 'space' or 'time' do? We may ask whether a certain space is real or imagined, but space itself? (It's not as if the concepts of 'space' or 'God' do their work by 'referring to' or by 'picking out' something.) What notions of 'real' and of 'God' are we working with if we ask whether or not God is but an imaginary being or instead has a real existence? (They don't seem to be the ones met with in religious texts. So why use them?)

Monday, 19 March 2018

changing to stay the same

There's a strange passage in Wittgenstein's Zettel:
37. (At the beginning of a piece of music it says crotchet = 88, written there by the composer. But in order to play it right nowadays it must be played crotchet = 94: which is the tempo intended by the composer?)
I find it hard to know quite what Wittgenstein here had in mind. But perhaps (to recall some suggestions from members of my reading group) it no longer sounds right at that speed on modern instruments. Or perhaps the cultural times have changed - 'speeded up' as we might put it - in such a way that the emotional experience of this music played at 88 just would now feel lugubrious when before it wouldn't have. (The remark is, incidentally, in parentheses.) I suspect that the important work the remark does it to open up the question, to get us thinking about what doing justice over time to an original meaning consists in.

There are easier examples. Currency inflation makes for a rather obvious case: in order for a house to remain the same value it must increase in price. Or, to take a simpler musical example: if you change the key of a piece of music, to now sing the right note at the start of the fourth bar you must sing not what was originally written, a C sharp, but a D sharp. Yet such examples may be rather too easy in that with them we can appeal to a singular criterion to justify our choice of revision, and I suspect all the interesting cases are ones in which that won't be available. 

There's a kind of cultural illness we often meet with which pretends to be a friend of conservativism - conservativism in the sense of: valuing the preservation of what is of deep value in our cultural and environmental legacy - yet which betrays itself by insisting that in order to remain the same you just gotta remain the same. The idiocy of this position shows itself in how it never stops to ask what it is to remain the same when so much around is changing. The result is a fetishising rather than a preservation of the past. The past no longer lives in this tradition, but instead merely serves the function of quelling current obsessional anxieties. ('We'll be ok so long as we keep on doing just what they used to do.') When the world has changed key we find this faux conservative coming in with the C sharp, a C sharp which now but clangs.

The effects are striking when we turn to religion. Orthodox practitioners are perhaps the most often guilty of practices which corrupt the original meaning of belief and ritual by keeping it 'the same' despite the new context. The Word now risks being reduced to an idol. The faux conservative wants to substitute the grasp we have of the meaning of scripture which comes from something like the application of a criterion for the grasp we enjoy which comes from our living faith. In non-scientific ages it was natural for faith to be expressed in ways which to us now seem almost incomprehensible (e.g. that we always have an angel standing over us; I don't deny the fact but ask what today, given our best understandings of how the world works, it could even mean to assert this). When the range of conceptual distinctions available to us was not so great - for example, in times before reflective thought was even alive to the conceptual/empirical distinction - it made sense to simply proclaim all sorts of beliefs which now, said like that, are surely just incredible.

Which is the tempo intended by the composer? What would the Christ or Prophet have us do today? What is it now for that spirit to live? In answering this you can't read the scripture the way one reads an instruction manual. For the scripture might say 'play it at 88 Joe' whilst today, to really hear The Word, you gotta play it at 94. And how do you know that 94 is the right tempo? Through prayer; through listening to your heart; through talking it over with others; through weeding out the egoism of fetishistic idolatry within oneself; through imagination. What, you wanted it easy? What, you'd forgotten that the whole point was to encounter not the world but the living spirit? You really thought that to be informed by The Word you could just comprehend the words? Really?

Sunday, 18 March 2018

how to live with a personality disorder

I continue to be struck by how my 'personality-disordered' patients ruined their lives by damaging their relationships through what we could call the breaking of promises. This promise-breaking rarely happened explicitly. It happened, rather, through an erosion of human trust: by the largely unacknowledged changing of tunes over time; by the insistent and too-convenient use of excuses; by doing too much of what they momentarily felt like and too little of what was the right thing to do; by insisting, when others tried to hold them to what they said in the past, that these others were taking their past declarations too seriously - whilst getting annoyed if they weren't taken utterly seriously in their current declarations; by tacit attempts to gain others' pity; by excessive invoking of illness or disability as moral get-out-of-jail-free cards; and, at worst, by emotionally abusive, conscience-overriding, efforts to project guilt and shame and inadequacy feelings into others (i.e. trying actively to make others instead of themselves feel like the morally bad one), efforts which become a vicious cycle when what also now has to be defended against is the guilt about being emotionally abusive in this manner.

In such ways the 'personality-disordered' adult has, despite much intellectual development, remained in their heart and morals a toddler-teenager. They have not developed that self-sameness over time, in the form of being a word-keeper, which is essential if there can be something in us in which others can meaningfully be said to trust, something which allows them to then come to know and love us.

Before continuing, let's be clear: everyone has some degree of 'personality disorder'. (The concept of a morally mature adult is an 'ideal type', it is not something which many of us manage to completely realise all the time.) But the degrees vary widely!

Sometimes I met with someone who in their heart knew full well what they were doing, and so who  understood that those they called friends really either merely tolerated them or had fallen for their charms and excuses perhaps because they, the friends, tend to see the best in people or tend depressively to see the worst in themselves. But often I met with people who seemed puzzled and hurt by the chaos they created, perhaps because their projections against overwhelming unbearable moral emotions really did succeed in ridding them of a sense of their guilt and shame, i.e. ridding them of a sense of what they had done to deserve their shunning.

Here I share my thoughts as to what someone might do if they find themselves spoiling their relationships in the above ways. 

a. Bring to mind a clear sense of what the right thing for anyone to do in any situation is, and always act only according to this general understanding. In this way you can align yourself with the good rather than only with what feels comfortable or rewarding to you. You can then also reap the rewards within yourself of what we call 'adult dignity' - i.e. feeling good because what you're doing is the right thing to do - and can leave behind the childish form of satisfactions which come from getting your way or getting out of something unpleasant. Dignity is not often talked about today, but in truth it is the only valuable form of self-love. The dignified person can feel good in herself because she knows she is living according to what is right, and this provides the deepest nourishment that the self can have outside of the love of another. The ambition of living a dignified life also helps with what to do when there's not much joy to be reaped in life. It has us ask: well, what can I do, today, to use my talents well, to help somebody, to grow, to discharge my responsibilities; what meaningful options are open to me? So long as we do what we can then, even if there's not much we can do, even if nothing goes our way, we can feel good in ourselves, so long as we are organised by dignity. By living a dignified life we also reap the rewards of the genuine love and respect of others.

b. Be honest with yourself in acknowledging that whilst there are no criteria for what count as: a reasonable or an unreasonable excuse, a legitimate or illegitimate changing of one's opinion or values, respectful or disrespectful talk, etc, in no way does this mean that it is up to you to say what is and isn't reasonable in your own actions! To think in that way - to think that we have some kind of privileged position from which we can inwardly know about the reasonableness or genuineness of our excuses, and some right to insist on what is thereby true of us - is to be what clinically is called a 'narcissist' - i.e. is to adopt the moral stance of the defensive teenager. (To put it philosophically, our first-person authority is a function of the expressive transparency of our avowals to the thoughts and feelings thereby avowed; it is not a function of our being better informed than others about what we think and feel.) The discernment of what is and isn't reasonable cannot be done in a defensive state of mind; it comes along in life as one develops a mature moral sensibility.

c. Develop a moral practice in which you learn to tolerate and even cherish your guilt and shame and feelings of inadequacy. If this doesn't happen then those awful defensive spirals, in which you keep needing to bolster the lie or the denial of blame and to try to push it into others, thereby alienating them and destroying friendships, will flourish. The person with a 'personality disorder' has got stuck in a moral universe in which admitting blame feels dangerous or seems to make one vulnerable in a potentially devastating way. This is after all how it may seem if you were raised by a 'personality-disordered' parent: your guilt will not be forgiven but held against you as a weapon, and so acknowledging guilt will be felt to be foolish, leaving you open to attack. Well, you can choose to stay in such a moral universe if you want, or you can choose to cultivate a different way of moral being, a way of moral being which is compatible with having genuine friends. In a morally mature universe others respect and forgive you precisely when you make genuine apology, and it is in the genuine apology and the forgiveness that proper relationship can be restored and nourished. Moral maturity consists in learning that such vulnerability to being seen as blameworthy is an essential part of friendship. (Going to confession is an example of a moral practice of this sort.) I said 'cherish your guilt and shame'; what I mean is: come to cherish your conscience which gives you such feelings. (I'm not talking about the bogus neurotic versions of depressive guilt and shame, but the genuine articles!) Your conscience is your friend because it helps you know when you've done things wrong; it enables you to rebuild and deepen your friendships. And your vulnerability is your friend because it is the condition of possibility of you having meaningful human relationships at all.

Saturday, 10 March 2018

senses of presence

In a previous post I proposed a theory of hallucination as a particular kind of anticipation or readiness - what I called a 'bodily anticipation' - of right now having a sensory experience of someone coming down the stairs, which anticipation is unrelinquished (for when it is relinquished, the hallucination of someone coming down the stairs ceases) despite it being unfulfilled (nobody is seen to come down the stairs - since there is, let's imagine, nobody coming down the stairs). This power of updating or relinquishing through sensory engagement with the environment is, I think, of a piece with what we call 'reality contact'. I wrote there too that the idea of the 'inner image' is hopeless as part of the explanation of hallucination; naturally, though, I have no objection to the use of the term as merely another way to referring to an hallucination. But if to form a mental image of a cat is either to imagine looking at a cat or to imagine looking at a picture of a cat, then it could be misleading to talk of hallucinating a cat as having a mental image of a cat. To be sure, we might say of someone who hallucinates a cat that they are unwittingly imagining looking at a cat, but a risk of talking that way is that one thereby fails to distinguish hallucinating from daydreaming.

As against my understanding of hallucination, it could be said that one of the things which hallucination at least often-times shares with perception is a sense of the presence of the hallucinated or perceived object. But an anticipation by itself hardly constitutes a sense of presence. So don't we need to add something to unrelinquished anticipation to arrive at the sense of presence which hallucination shares with perception? Perhaps what we need to add is - heaven forbid - an inner image! It is, perhaps, the image which at least is 'present to the mind'. And perhaps such an image is also, in its way, the fulfilment of the anticipation.  

By way of answer I want to press the question what is really meant here by this notion of a 'sense of presence'. For there is a standard use of that term which itself implies something unshared by hallucination and perception, but instead indicates something which only obtains when we don't perceive something. So let's avoid the risk of misleading ourselves by getting that use clearly on the table first, before rushing on too quickly with the discussion.

So, we do sometimes talk about 'sensing the presence' of something or someone; we may even talk about sensing 'a presence', 'presence' now being another term for ghost or spirit. I suggest that the logic of this talk of 'presence' is best understood by comparison with our talk of déjà vu. An experience of déjà vu is properly articulated with a phrase like 'it is for me just like I had already experienced this very same thing happening.' Such uses of words defines the experience in question. However we have gazillions of experiences every day which we have had before - walking down the same corridor to our office, using the same toilet, drinking from the same coffee cup - and these precisely do not engender an experience of déjà vu. So in a sense the experience of déjà vu is precisely not like an ordinary experience of encountering something again. What this goes to show, I think, is that we are here using the phrase 'as if I had already had this experience' in what Wittgenstein called a special 'secondary sense'. We are drawn to use just this phrase; that we are so drawn is criterial for the experience in question; yet the use is not to be taken as justified by the current experience having something in common with the perfectly ordinary experience of encountering something which one had previously encountered in just the same way. (It is neither justified nor unjustified; that's just not how it works.)

What I am claiming is that the ordinary use of 'sense of presence' is, just like that of déjà vu, a secondary sense application of the term. We precisely do not mark with it something which is shared by both hallucination and perception. But perhaps, the objection goes, this is not the sense of 'sense of presence' which is relevant here. Sure, there is such a sense which applies specifically to hallucination, but what is relevant here is rather the (...alleged...) sense that (...allegedly...) applies to the case of the perception of objects. When I ordinarily see an object I ordinarily have a sense of the presence of the object (...so the argument goes....). And this same sense of presence can obtain in at least some hallucinations. Thus one might use, in both hallucinatory and perceptual cases, sentences like 'It is for me just as if I were actually seeing the cat' to emphasise the same point.

As against this I want to ask just what is meant here by a 'sense of presence' in the non-hallucinatory case. For example, does the person who says that when I actually see a cat I have a sense of the presence of a cat mean more by this than that they are, er, seeing a cat? If so, what? I see a cat and in seeing this cat most often can also be said to see that there is a cat there on the mat. This however is precisely not shared with hallucination: when I hallucinate a cat I precisely do not see that there is a cat there on the mat. ('Seeing' and 'Seeing that something is there' are what we call success verbs/clauses. Hallucination is not successful or unsuccessful seeing!) Or is it that when someone sees a cat and hallucinates a cat it can seem to them that they see a cat? Is the 'sense of presence' a 'seeming' of some kind? But then, well, honestly, it is rather hard to know what is being done with the phrase 'it seems to me that I see a cat' when used by someone who straightforwardly, in a situation which wasn't anticipated by them to be one of deception (for we do use it as an expression of hesitancy when we're not sure if we should believe what we see, even when we are in fact undeceived), does see a cat. The concepts of appearance (seeming, etc.) gain their sense in virtue of the distinction they draw between the case of the seeming and the case of what is.

Now, it may be that there is some use being envisaged for 'sense of presence' which has not yet been spelled out. A use which is shared by both hallucinatory and perceptual cases. I however have not had it introduced to me, nor have I yet been able to pull it out of my own noggin. So, well... I'm waiting.

What however is also interesting to me is that we do use this notion of a 'sense of presence' to describe cases of hallucination.  I think it is worth pondering why this should be. (And when we think on the 'why' here I think we should make sure that we don't automatically start to look for a justifying reason, rather than an elucidatory cause, for our talk.)

On my understanding of hallucination it involves a form of anticipation of right now perceiving something which is unrelinquished despite the fact that one also has no experience of this anticipation being confirmed. Despite, that is, one not perceiving whatever is presently anticipated. This leads us to use the word 'presence' in the spooky, secondary sense, manner. 'I sensed the presence of my dead grandma' or 'I felt her presence' is what we are spontaneously drawn say. Despite her manifestly not being present: if she were actually present then we precisely wouldn't have that experience which we call the 'experience of her presence'. So, my question is: why are we drawn to use this locution? I take it that the question is the same as that which attends the use of 'déjà vu': why do we use this phrase to describe an experience which is precisely not like the gazillions of experiences we have everyday for the second or third or millionth time? 

Well, the reason (in the sense of cause that moves us, not in the sense of that which I could give as my reason) why we use the notion of 'presence' is, I think, because we have here to do with an unrelinquished anticipation. In this way it, the hallucination, is similar to a fulfilled anticipation (i.e. to a perception) since in the hallucinatory case there is no cancelling of the anticipation despite the manifest absence of what is anticipated. And in the perceptual case it is also not cancelled since it is instead fulfilled, and now has its life immanently within the perception itself. In short, this is what both perception and hallucination have in common: the continued life of the bodily anticipation. 

Similarly with déjà vu. It is not really that I seem to remember having had this conversation or visual experience before. We've all done that, all the time, and it doesn't amount to déjà vu. We don't reach for that description because it is part of the content of the experience; we are not justified, not even seemingly, in using the 'as if I've done this before' locution. Something in the temporal structure of the experience has instead gone awry. Something like the registering of the newness of each experience through time has failed, thereby constituting a distinctive dissociation. We want to say something like 'It is as if this very stretch of experience - not simply its content, but it in its temporally individuated identity - had happened before.' But that of course is nonsense, since what it is for the experience to be this one, when we are thinking not about its content but about its temporally indexed identity, is precisely for it to not be any previous experience. And yet we want to say what we say, and that we want to say just this is criterial for the experience being what it is. It's notable that with both déjà vu and hallucination we necessarily encounter a form of dissociation or trance or loss of reality contact - not necessarily any global state of such within the individual, but within the experience itself, as an essential part of its form.

Tuesday, 20 February 2018

moral character, illness, and the mind

What is it that makes for illness? In trying to answer this question we are perennially tempted to look toward the causes of illness - diseases for example - and away from the work that the concept does for us. In what follows I pay closer attention to that work by relating the concept of illness to that of character. The discussion also considers the question of what we are to make of the concept of mental illness and how it relates to physical illness. I shall both draw on and dispute a claim of Wittgenstein's and a claim made in a paper by T S Champlin. The remark from Wittgenstein is (Culture & Value p.54) 'Madness need not be regarded as an illness. Why shouldn't it be seen as a sudden - more or less sudden - change of character?' First however I turn to Champlin's paper.

Champlin is amongst those who consider the concept of 'mental illness' to be derived from 'physical illness' or, more perspicuously, from what, before the concept of 'mental illness' was invented, was simply called 'illness'. Unlike those (like Neil Pickering) who consider 'mental illness' a conceptual metaphor, Champlin considers it formed by 'secondary sense' and offers an analogy to help us grasp this. The analogy suggests the model of a 'rhyme for the eye' which stands to a 'rhyme for the ear' in the same kind of relation as 'mental illness' stands to 'physical illness'. So just as we may call the end of two lines of poetry which look the same even if sounding differently (...he'd read quite enough / ...of The Golden Bough) a 'rhyme for the eye', so too we may talk of an 'illness of the mind' even when we don't have to do with such features as are essential to illnesses 'of the body'.

But what is it that grounds (by way not of justification but of inspiration) the extension? Champlin suggests that 'the counterpart to position at the end of the line which facilitated the extension of the word 'rhyme' to cover rhymes for the eye but not the ear was that, typically, the mentally ill have in common with the physically ill the fact that they behave in ways similar to the physically ill. They often look ill and fail to carry on with their normal lives and need to be cared for by others.' Well, I don't buy this. For those who are mentally ill often don't look ill, they may never really have had normal lives or may be carrying on with what for them is a normal life in a mentally ill way, and they may not need to be cared for by others to a greater extent than the rest of us. These consequential difficulties do not take us into what it is for the mind to itself become 'ill'. So I suggest we keep the analogical idea - mental and physical illness needn't share something in common in virtue of which they are both illnesses; instead of something in common we need to look for a counterpart - but think again about what the counterpart is.

Wittgenstein asks - in what was presumably intended as a rhetorical question, although I shall treat it otherwise - why we don't talk not of mental illnesses but of sudden changes in character. The remark does the helpful work it does by virtue of shaking us out of the idea that we could, with our concept of 'mental illness', meaningfully be said to here have hit upon 'the right concept'. (We play the language game, and that's enough.) It also helpfully brings the concept of 'illness' into relation with that of 'character'. But what I want to suggest is that the whole point of the concept of 'illness' is that, precisely, we don't sanction an inference to the idea of a change of moral character, and that the whole point of 'mental illness' is that we may continue to draw on such exculpatory benefits in cases where the attribution of a character change is even more tempting.

Here's my main claim: Illness essentially involves changes in personal disposition which would, unless we reference that defeating condition which is the illness ascription itself, be seen as constituting a decline in moral character. Thus when we are ill we are disinclined to work, to take care of our responsibilities to others, to exercise our talents, to enjoy our appetites for life, to cultivate and spread hope. We are instead inclined to withdrawal, sloth, pessimism, self-preoccupation. Were such changes to happen to someone in the absence of disease we should say of that person that they had developed a poorer character. Such habits essentially find a negative moral evaluation, but thankfully we may be excused by being ill! The concept of 'illness' allows us to keep our virtues intact, if you like. In this way the concept of 'illness' does important work in regulating our social and occupational interactions. We cut the ill person some moral slack, discharge them of responsibilities, give them a sick note, do not hold them accountable for incompetencies to the same extent, etc. That the concept should be open to abuse by the pity-seeker or the work-shy is an important part of it. But another important part of it is that the mentally competent adult who is ill is able to acknowledge that he is ill. That he can do this is also an important part of our not ascribing character change to him. He himself offers illness as a legitimate excuse.

Now what about mental illness? What I suggest is that the excusing function of the concept of 'illness' is also central to the identity of 'mental illness'. And the person we call 'mentally ill' also starts to do things which would, were it not for the leeway we afford her, be judged as showing failure of moral character. She becomes preoccupied with herself, she stops respecting the shared norms that constitute conversational sense, she shows failures in courage and resolve, she shows less solicitude with others and does not make genuine heartfelt emotional contact with them. In short she demonstrates what looks to be a deficiency of humanity. Were it not for our saying of her that she is mentally ill then we should say of her that she was not being her better self, and if the difficulties were enduring then we should say that she had a change of character for the worse. However, the person who is the paradigm of the mentally ill has 'lost touch with reality'. Unlike the physically ill adult, she does not say of herself that she is ill. She may have moments of insight and during those say that she is unwell at the moment. Or she may look back at her past thoughts and deeds and say 'I was really ill during that time'. But in the moment of mental illness itself she does not say of herself 'this is illness'.

It is this, I am suggesting, which discriminates the mentally from the physically ill. In both cases the positive functioning of the concept is to defeat a moral judgement to do with bad character. In the physical case it works through citing bodily ailment: the person, we now allow, has the same good character, it is just that his character enactment is currently blocked by his bodily infirmity. In the mental case we also find the same helpful defeating function, and here we also say that the person is 'not herself' rather than that she has succumbed to vice. And we do this even though she in her adult self is not willing to say 'I am ill'. She 'lacks insight' and this lack is constitutive of her illness being a mental illness; she suffers a detachment from reality i.e. a foundational disturbance in her reason (notice I do not write: 'in her reasoning').


Addendum: The above discussion aims to discern some underlooked necessary, although not of course sufficient, conditions for talk of illness. I thought just append here what seems essential to me in illness generally and mental illness in particular. Whilst we may have what today we call a disease without feeling dis-easy, we become ill when we are, for example, overwhelmed by a disease. When you get the flu, for example, your body is overwhelmed. For a while you might have been 'fighting off' the virus. But then it gets to a point when your usual homeostatic mechanisms that maintain ordinary energy and balance collapse. You get a temperature, can't muster energy, feel hot and cold and achey all at the same time. Your health has broken down.

In mental illness you also suffer a 'break down'. The breakdown here is of the normal processes which keep you from being overwhelmed by painful emotional experience. Normally we find ways to deal with shame, grief, guilt, envy, fear, anxiety, and anger. We symbolise them in words and encase them in narratives, we take appropriate assertive action, we take time out to grieve i.e. to accommodate to loss. When this doesn't work we sublimate or repress. But when even these defences break down we become overwhelmed. This, I believe, is the basis of the use of illness talk when it comes to the mind. What we analogise between is the overwhelm of the normal self-regulating mechanisms in the case of bodily illness and in the case of emotional experience. The person who breaks down is no longer able to cope with reality. In the case of mental illness it is because what we call 'symbolisation' breaks down (i.e. the ability to put as yet inchoate affect into thinkable form is overwhelmed). In the case of physical illness it is because the regulation of appetite and energy provision and temperature breaks down. The analogy is so natural that it is surprising that the concept of mental illness didn't become more widespread earlier than it did.