Sunday, 21 May 2017

wittgenstein, self-knowledge, sensations

Philosophical Investigations paras 246-7 has it that
...If we are using the word "to know" as it is normally used (and how else are we to use it?), then other people very often know when I am in pain. - Yes, but after all not with the certainty with which I know it myself! - It can't be said of me at all except (perhaps as a joke) that I know I am in pain. What is it supposed to mean - except perhaps that I am in pain?
Other people cannot be said to learn of my sensations only from my behaviour,—for I cannot be said to learn of them. I have them.
The truth is: it makes sense to say about other people that they doubt whether I am in pain; but not to say it about myself.  
"Only you can know if you had that intention." One might tell someone this when one was explaining the meaning of the word "intention" to him. For then it means: that is how we use it.
(And here "know" means that the expression of uncertainty is senseless.)
I heard it said yesterday, at a conference, in the context of a discussion of John Hyman's analytical-philosophical 'account' or 'conception' (i.e. that project of answering the question 'what is something?' by citing general sufficient conditions or general proper definitions) of knowledge that p as having an ability to use (or be guided by) the fact that p as a reason (for doing or saying something), that Wittgenstein did not in fact give us reasons for thinking that 'It can't be said of [myself] that I know I am in pain'. And in the context of that discussion I took it that Wittgenstein was - aside from some possible face-saving reconstruction by Anthony Kenny - being taken to be failing to offer something which anyone, including Wittgenstein himself, might have thought sensible to offer - namely for him to say to us 'here is my general positive conception of knowledge, and behold, here we see that the alleged first person case of knowledge does not fall under that conception.' (... The point being that, by contrast, on Hyman's general 'account' of knowledge the person who says 'I know I am in pain' is perfectly entitled to say this since they may of course use the fact of their being in pain as a reason (why didn't you play badminton this week? I had a pain in my elbow).)

Yet one of the things which is clear from 247 is that Wittgenstein is not in fact always shy of letting us know what he takes 'know' to mean. ('And here "know" means that the expression of uncertainty is senseless.') And, in fact, given that this remark occurs in the very passage after the one in which he says that it can't be said of myself that I know I am in pain, the situation is really rather curious. After all is he really saying that it can't be said of myself that an expression of doubt by me regarding my sensation is senseless? That in fact would seem to be rather the opposite of what he is claiming!

What is going on here? First of all, why can't it, joking aside, be said of me that I know that I am in pain? Second, how can it be true that this can't be said when in the very next paragraph we are offered a use for 'know' which looks like it makes for the possibility of what was denied in the previous paragraph?

The trick to answering or perhaps, better, dissolving these questions is to note that Wittgenstein is not interested in providing general sufficient conditions. Nothing in what he says about our life-with-language would lend support to the idea that he thought that an intelligible philosophical project. He is at times (as in 247 concerning know and intention) happy to provide contextually situated sufficient conditions ('And here 'know' means...'), but nowhere does he defend the (to me intuitively implausible - but you might have other ideas!) notion that language is trans-situationally decomposable. As if, for example, one might intelligibly imagine someone who went through his earlier life never hearing the word 'know' used, but being perfectly proficient in understanding and deploying facts as reasons, could then be inducted into our knowledge talk at one fell swoop. (One natural thought is: might we not expect to encounter analogues of Gettier-type problems for Hyman's non-belief-involving account of knowledge? That is, cases of being 'guided by' facts in offering reasons, or however exactly the proposal is to be cashed out, which don't amount to knowledge or which tacitly and illegitimately build in a reference to knowledge in order to secure their fix on their target.)

But then, it might be suggested, the problem with 246 is not just that no general account of knowledge is given, but that we don't even have a specific account of what talk of 'knowledge' in the context of sensations would be. But then that seems absurd too. After all, if Wittgenstein had such a specific account then he could hardly go on to say that it is nonsense to talk here of knowledge! So what does he mean? What I propose (in a 'new Wittgensteinian' spirit) is that, far from saying that something in our general concept of knowledge rules out a coherent application of it to cases of my own relation to my own sensations, he is saying that nothing here has yet been 'ruled in' (as it were). That is, he is claiming, there is no obvious use to talk here of 'knowing that I am in pain', nothing that comes to mind when we try to imagine here what those words are supposed to be doing, no obvious contribution they make to our conversations, nothing they add to my merely saying 'I'm in pain'. 

Is Wittgenstein trying to say that we can't imagine uses for 'I know I am in pain'? In fact I think we can imagine uses for that sentence. For example you might be quizzing me about my grasp of the concept 'pain' and I kick myself and say to you 'I know I am in pain'. It's a bit odd, perhaps, but it seems to me not unimaginable. (We might also imagine someone insisting, to someone who is wrongly trying to generalise a situationally unhelpful conception of reason-giving to argue down someone who tries to appeal to their pain as a reason not to go into work, that they know they are in pain. Again, it's a bit odd, but I think we can probably get there!) Here I have made sense of the idea of knowing I am in pain by imagining a possible situationally specific use of the sentence. And surely - and this is the general 'new Wittgensteinian' point - nothing stops us from developing uses which, so long as we demonstrate them, show the contributions they can make to our conversations, are perfectly and (as it were) unaccountably fine. What he was disputing was not that we can't ever imagine helpful deployments of  'I know I am in pain' but that, in the context of our relation to the fact that I am in pain, talk of 'knowledge' seems to have yet no clear work to do. 

But, you know, feel free to invent some such a purpose. Wittgenstein surely wouldn't want to stop you! After all, he's got no general account to get defensive about.








Saturday, 20 May 2017

self-deception

An akratic gambler says (again) that he wants to quit gambling. For example, if you ask him this is what he will tell you. We might also say that it is what he 'says to himself'.

But then he starts to think of himself 'empirically' rather than 'practically'. He says 'ok, so this is what I intend, but what actually am I likely to do?' He then reasons 'in the past I haven't quit, therefore I probably won't quit.'

There are also many occasions when the gambler still wants to go gambling. (This, indeed, is what gives point to our talking here of addiction, of commitment to quit, etc.)

Richard Moran offers this:
For the gambler to have made such a decision is to be committed to avoiding the gambling tables. He is committed to this truth categorically, as the content of his decision; that is, insofar as he actually has made such a decision, this is what it commits him to. For him his decision is not just (empirical) evidence about what he will do, but a resolution of which he is the author and which he is responsible for carrying through.
What this made me think of is a predicament that can arise in psychotherapy. A patient says that he or she wants to overcome some problem, to quit a certain habit of thought or action. And he then engages the psychotherapist in a discussion the form of which is supposed to help him tackle this disposition within himself.

The patient is at war with himself. The therapist is engaged as collaborator with the patient to help him take a stand against himself. Hmm.

It all looks so reasonable.

Perhaps sometimes it is.

However there is I think also something disquieting about the way the patient moves into the 'empirical' rather than 'practical' stance. That very stance, I want to say, is already one which prescinds from the commitment to give up their addictive or other behaviour. After all, if he really has made up his mind, then what is the possible relevance of looking at past evidence? Acts of self-determination are precisely that.

But because the patient appeals to something which these days is a paradigm of reasonableness - namely an empirical, evidence-taking stance - we may be encouraged to overlook his irrationality in deploying it in the present case.

 Why is he irrational?

It is irrational not because it ignores evidence. It is irrational in the way that Moore's paradox is irrational. ('I believe it is raining but it is not raining'.) In effect, one feels, he is saying 'I make up my mind to not do this, but probably my mind isn't made up'.

If I make up my mind to do something, then I am committed to doing something. To be committed to doing something means to follow this through so long as the opportunity remains.

Now a further question might be thought to coherently arise. That question is 'ok, but might not the opportunity here include the absence of overwhelmingly compelling urges to gamble?'

But what is being said here? Is the idea that the person, in committing to stopping gambling, is really saying 'I now commit to giving up gambling, unless of course I have compelling urges to gamble'? Yet this is absurd - it seems to reduce a commitment to a wish. Or is he saying 'Despite and in truth because of the compelling urges to gamble I experience, I now commit to put this behaviour behind me'? Hopefully the latter if we're not to waste our time in listening to him.

The rationality-defeating narcissism in the akratic gambler's appeal to empirical considerations about his past behaviour consists in his overvaluation of what he says to himself or to us when he takes himself to be making a commitment. The irrationality is partly obscured from us because the word 'says' or 'tells' in the first paragraph has two meanings - to utter and to commit, and we flit between them without realising.

Thursday, 4 May 2017

not defensive

Why can it be hard to 'get in touch with your feelings', to 'feel what you need to feel'?

Psychodynamics offers one answer: it's because we don't want to feel pain, and so shy away from painful emotion and from the anxiety it causes.

No doubt that's sometimes true. However I've described before how it seems to me that what can make for the difficulty is not so much the pain, but the shame, of feeling. Or at least, that what makes for the difficulty is not having a sense of an other who will accept one in it. That, I believe, is not so far from a difficulty in 'mentalising' one's emotions, so long as one resists the temptation to construe that phenomenon in a merely cognitive manner.

But something else that needs to be considered is the intrinsic difficulty of transitioning between states. Being in an emotional state is being in a self-maintaining auto-enacted attractor basin of affect, thought, activity, etc. It is being in a mode which is itself one way of 'making sense'. My hypothesis is that it is simply difficult to move between states. You have to escape the self-maintaining attractor dynamics of one state, move over a threshold, and enter another state.

Moving between solitude and co-presence is a good example. Getting in touch with your latent anger when you are happy is another. We aren't obliged to think of this difficulty in motivational terms.

Often enough we are, when we arrive there, perfectly happy to be angry or sad or what have you. It was the transition, not the destination, that was troubling. Or, sometimes, not even troubling, but simply difficult.

So what we need to do is to cultivate our ability to move across thresholds between emotional states. We need to develop rites of passage. Micro-emotional forms of what anthropologists note regarding major transitions in life.

Some of these are simple. For example, we have rituals for saying hello and saying goodbye. These enable us to move between the radically different modes of being of solitude and company.

Moving between states can be troubling. I propose that 'anxiety' is the name of the stateless in-between, the state of upheaval we feel when we move out of one unanxious known into another such - but, since we must reconfigure ourselves - or better, since we must be reconfigured - in transit, we have to go through discombobulation. But, once again, I'm not proposing a psychodynamic theory - i.e. it isn't that we don't want to feel the anxiety - although that too may well sometimes be true. It is that we are designed to keep being pulled into the prior steady states. It is anxiogenic to get in touch with uncommon emotions, on this model, not because we don't want to be in the latter state, but because the process of auto-reconfiguration we must go through to get there is intrinsically jarring. But, again, it's not  necessarily that we act to avoid the anxiety, so much as that we get auto-configured by the attractor basin of the original affect state.

It's not that we don't want to travel, but just that having a home is having a place we are pulled back to. When we get there, finally, we're usually happy enough.

Wednesday, 3 May 2017

hate has to come first

In The Divided Self chapter 10 Laing makes extensive effective reference to a paper by Hayward & Taylor (1956) called 'A schizophrenic patient [Joan] describes the action of intensive psychotherapy'. The following caught my eye:

Laing: The main agent in uniting the patient, in allowing the pieces to come together and cohere, is the physician's love, a love that recognises the patient's total being, and accepts it, with no strings attached.
Joan: Hate has to come first. The patient hates the doctor for opening the wound again and hates himself for allowing himself to be touched again. The patient is sure it will just lead to more hurt. He really wants to be dead and hidden in a place where nothing can touch him and drag him back.
The doctor has to care enough to keep after the patient until he does hate. If you hate, you don't get hurt so much as if you love, but still you can be alive again, not just cold and dead. People mean something to you again.
The doctor must keep after the patient until he does hate, that is the only way to get started. But the patient must never be made to feel guilty for hating. The doctor has to feel sure he has the right to break into the illness, just as a parent knows he has the right to walk into a baby's room, no matter what the baby feels about it. The doctor has to know he's doing the right thing.
The patient is terribly afraid of his own problems, since they have destroyed him, so he feels terribly guilty for allowing the doctor to get mixed up in the problems. The patient is convinced that the doctor will be smacked too. It's not fair for the doctor to ask permission to come in. The doctor must fight his way in; then the patient doesn't have to feel guilty. The patient can feel that he has done his best to protect the doctor. The doctor must say by his manner, "I'm coming in no matter what you feel."
It's hellish misery to see the breast being offered gladly with love, but to know that getting close to it will make you hate it as you hated your mother's. It makes you feel hellish guilt because before you can love, you have to be able to feel the hate too. The doctor has to show that he can feel the hate but can understand and not be hurt by it. It's too awful if the doctor is going to be hurt by the sickness.
What is striking about Joan's description of her state and its apt therapy is how replete it is with moral tension. Laing tells us that is the doctor's love that cures. Joan tells us all about her hate, and her need for the doctor to engage in a non-collaborative self-assured tolerant manner. The manner, i.e. the form of the relationship, a form Laing calls 'love', is all.

What today is called 'clinical psychology' can, I believe, often-enough almost be defined as an attempt to approach psychological suffering and treatment in descriptive/psychological rather than moral/evaluative terms. To the extent that it succeeds in its attempt, to that extent does it damage the patient and impede true recovery. Joan needed a therapist who could be morally assured and bold. She did not ask for a moral relationship defined merely as a collaborative willingness to do work which itself could be understood non-morally (merely epistemically, for example). Instead she asked for what she essentially needs - a transformative moral relationship, the therapist's containment and metabolism of her hate, a stance which from the standpoint of the defences amounts to intrusion, a stance which is nevertheless in the service of recognition of the patient's actual and potential humanity.

Psychologists are today so apt to disaggregate and deconstruct schizophrenia into this or that symptom which supposedly warrants treatment. Laing takes a different route - he reaggregates the symptoms into an understanding of predicament - the schizoid and schizophrenic predicament and struggle with the courage to be, to be in relation to fate and to the passing of time, and particularly the courage to be in relation to others.



Saturday, 22 April 2017

cmt

Joe Weiss
I've been looking at a little of the writing on Control Mastery Theory - the approach to psychotherapy developed by Joseph Weiss, later in collaboration with Harold Sampson, and disseminated by Alan Rappoport, George Silverschatz and others. It's a simple model (ugh, that word 'model' that hides so many conceptual sins in clinical psychology) and, if we are to have a simple model, it surely describes better than most any other some of the central features of the psychotherapeutic process.

And yet I find myself reading through Frank Cioffi's eyes. (Cioffi, the marvellous critic of Goffman and Freud, with the keenest of eyes for, and wittiest of pens for recording, the latently pseudo-empirical.) For CMT, it seems to me, offers much by way of 'posits', but provides little sense of what it would be to confirm or disconfirm these. So we're left wondering if what we meet with here are really hypotheses, or axioms, or what.

The real worry I have is that they are axioms masquerading as hypotheses. And that's a real worry because such masquerading is typically cultish, because it shrinks one's sense of the possible, and because it bamboozles natural human communication.

Frank Cioffi
(I'm not trying to overlook the benefits of having a simple system to organise one's thought and experience and interaction. Perhaps some people really would be better off with such a system? (Rappoport, for example, tends to write as if therapists will be lost without a system which provides a far greater degree of reduction than I could ever find comfortable.) Maybe I'm naive in believing most of us can outgrow such needs and return to a richer, more diverse, more fluid encounter with our own and one another's minds.)

The main move in CMT that interests me is a tendency to offer something we can all recognise as sometimes done or occurring, in psychotherapy, as if it were always done or occurring. Because the normal criteria for that something are clearly not going to be present all the time, the tendency can be to suggest that this is because the something is unconscious. Yet it confuses matters to use the concept of the unconscious thus. Not because we cannot find very decent uses for it. But because, if we want to know what it can mean to say that A is Xing even when A is not aware of or disposed to avow that he is Xing, it does not help us to say that A is Xing unconsciously. Sure, fine - but what are the criteria, the ascription conditions, for that? What counts for and what counts against ascribing X to A?  Unless you can give us some kind of answer to that question then it's not clear to me that you're really yet saying anything in maintaining that A is Xing. (Explanationism, in the philosophy of psychology, suffers the same lacunae: we are told that an unconscious or subconscious Xing is the best explanation of the consciously available behaviour Ying, and that's all very well but gets us nowhere until we are told what it is to un/sub-consciously X. It won't do to be told 'well, it's the same as to consciously X except the subject is not aware of it!' For what it is to 'consciously X' is in part to avow that one is Xing etc etc.)

You've been owed an example for too long. Here's something from the San Francisco Psychotherapy Research Group Website:
Control Mastery Theory embraces the idea that patients consciously and unconsciously regulate their own treatment. They work in therapy to disconfirm their crippling pathogenic beliefs. Patients are made miserable by these beliefs and are highly motivated to disconfirm them. Patients think unconsciously about their problems, and make and figure out plans for disconfirming these beliefs. Symptoms such as compulsions or inhibitions can now be understood as efforts to avoid dangers foretold by the pathogenic beliefs. One way that patients work to disconfirm their pathogenic beliefs is by testing them in relation to the therapist. This is a way for patients to reevaluate the reality upon which the dangers predicted by the pathogenic beliefs are based. In testing, a patient acts in accordance with his pathogenic belief. Patients engage in testing behaviors in order to ascertain if conditions of safety are sufficient enough for making their beliefs conscious.
Now how would we distinguish whether that, or the following, was right?
Out of Control Theory embraces the idea that patients come to therapy with emotional pain, anxiety and behavioural dysfunction which they either can't understand or can't control. They have a range of unconscious, semi-conscious and conscious pathogenic beliefs, sets of expectations, complexes, schemata, phantasies and wishes in terms of which we can understand their habitual thoughts, feelings, fantasies, behaviours, and relationship patterns. Because patients are often not adequately aware of their mental states,  and/or because they may not recognise their possible falsity, they typically enact them unintentionally in the therapeutic relationship. Yet so long as the therapist pays attention this is all super grist to the therapeutic mill. What keeps the therapeutic work in the zone of the complexes is not, since he is unaware of them, the patient's drive to test them out, but rather the therapist's skill in noticing and drawing them out, the absence of small talk, the activation of the transference, the closeness of the therapeutic relationship, etc. Fostered by his own reflection on unexpected experiences in and out of therapy, fostered by the therapist's transference interpretations, and fostered by the therapist's love and care, the patient increasingly recognises that he has latent fears and wishes and that they are not as inevitably sound as he expects. Because of all this the patient comes increasingly to acknowledge some of his own unrealistic desires for control and mastery, both of his emotional experiences and of his relationships. Sometimes he takes a punt on his expectations being unfounded or merely self-fulfilling, and risks a new way of relating to his therapist or to other significant others. If things go well he comes to be able to tolerate more of his diverse drives and wishes, acknowledge his all-too-human failings, withdraw his projections, be more vulnerable and loving, make reparations when required, notice and desist from his self-thwarting depressive and avoidant defences, man up, etc. Sometimes the all-too-human therapist gets in the way of this progress, but when therapy goes well he can be a helpful aid, confidant, testbed, reality check, support, recognition provider, confessor, and caregiver.
We all recognise, I think, that patients do sometimes test their therapists. But CMT invites us to think that this is the form that many or most interactions in therapy take. And it invites us to think that progress is made when therapists pass tests. But what about all the times when patients don't test their therapists? And what about the times when the testing is itself pathogenic? When testing needs not to be passed but to be called?

'Oh', the CMT therapist might say, 'calling someone out on their testing is just another way of passing the test. The test was whether you would take a stand against such behaviour. This is what we call 'passive into active' testing. The patient is behaving badly, but what they are hoping is to learn how to resist such bad behaviour as they themselves were subject to.'

But what are the grounds for saying that the patient was testing the therapist in their behaviour? It won't do to move straight to 'well, this explains really well why they are doing it', for explanations are only good to us if we understand them, and it is an understanding of what it means, here, to talk of testing that we are after.

There is a use of 'test' or 'try' - as in 'trying/testing my patience' - which is largely non-intentional. It is one which would fit the situation just envisaged (when the patient projects guilt into the therapist, for example). But it is not one which fits the CMT therapist's model - since it is, qua test if not qua evacuation, non-intentional. We are not here after evidence; we are after an understanding of what the evidence is said to be for. And none is forthcoming.

I'm not trying to say that we can't think of myriad instances in which a child or a patient benefits, calms down, feels safe, when their boundary-testing and omnipotence is successfully stood up to, when their bluff is called. But is this really going to provide the general framework for psychotherapy in general? Nobody, and certainly not the CMT therapist, thinks that.