Monday, 14 August 2017

cognition versus recognition

(Below, first draft of a section of my chapter for the Oxford Handbook of Philosophy and Psychoanalysis which edited volume is currently being compiled by Michael Lacewing and myself.)

Psychoanalytic psychotherapists are sometimes criticised for offering patients nothing but new just-so stories in the guise of applied science. These supposedly explain the origins of troubles in a manner which is either relieving because spuriously absolving (“it wasn’t you, it was your unconscious / your mum and dad / your past traumas…”, etc.) or because spuriously hope-engendering (the hope being that reflection on your unconscious motivation can somehow help change your mind’s functioning). The criticism continues that such a practice is: deluded since the alleged psychological causal stories we learn to tell about our symptoms are nothing but post-hoc fabrications; dependency-promoting; and largely ineffectual since it’s concerned with introspection rather than change. Psychotherapists’ responses to such critique vary from the bite-the-bullet it’s-all-just-a-story-anyway postmodernist option, to that of the scientist-practitioner who draws as far as possible on objective psychological knowledge whilst modestly refraining from offering anything other than flexible revisable hypotheses in a pragmatic fashion in his clinic.

A striking shared assumption of both the critic and the pundit is that the psychotherapeutic work of ‘making the unconscious conscious’ involves aiding a patient's arrival at new psychological knowledge of the history and current operations of his psyche. In what follows I suggest that this ‘applied science’ conception locates the therapeutic endeavour in the wrong conceptual context. In short it locates it within what we could call a descriptive psychology that treats of cognition, rather than a moral psychology that treats of ethical recognition. What follows provides the substance to my contrast.

By way of an example of a descriptive psychological treatment of cognition consider the following from a pundit and a critic of what the authors call ‘psychodynamic psychotherapy’. First the pundit (Cabaniss et al, 2013, pp. **-**):
A psychodynamic formulation ... is an hypothesis about the way a person thinks, feels, and behaves, which considers the impact and development of … thoughts and feelings that are out of awareness – that is, that are unconscious. … Thus, a psychodynamic formulation is an hypothesis about the way a person’s unconscious thoughts and feelings may be causing the difficulties that have led him/her to treatment. …. [H]elping people to become aware of their unconscious thoughts and feelings is an important psychodynamic technique. … Once we have a good sense of the problems and patterns, the next step in creating a psychodynamic formulation is to review the developmental history. … Having described and reviewed the patients problems and history the third step is to 'link' them together. [This provides the psychological 'hypotheses' which help the therapist to] construct meaningful interventions. …. These might include: … creating a life narrative … offering explanation and perspective throughout the therapy … consolidating insights…
Now the critic (Watters & Ofshe 1999, p. 204):
Psychodynamic therapists claim the ability to help clients connect current behaviors to long-past traumas in childhood, for instance, or to repressed fantasies decades in the patients’ past. … But … if [as they argue] we can’t trace the influence of simple actions and decisions to their correct sources, can we be expected to do better making etiological connections between complex current life and events or fantasies from our childhood? …[T]he vast number of psychodynamic schools of talk therapy appears as nothing more than a testing and breeding ground for these shared cultural narratives. Psychodynamic therapy offers a new and interesting world of possible narratives by which patients can come to believe they understand the origin of their thoughts and behaviors. These narratives become plausible in the patient’s eyes through the process of influence embedded in therapy.
 In both these cases the authors assume that making the unconscious conscious involves becoming cognisant of your own hitherto unconscious mental processes, rather as if the purpose of therapy were to learn to be a better psychologist at least regarding one’s own mental operations. In all this talk of becoming aware of - or developing bona fide knowledge or spurious belief about - one’s own mind, however, we meet with nothing in the patient that could itself be considered the existential shift of owning or appropriating one’s previously repressed attitudes. Furthermore in all this talk of a therapist learning to recognise (or at least develop ‘hypotheses’ about) a patient’s struggles we meet with nothing that could itself be considered an ethical attitude of her offering recognition to a patient in her difficulties. We are invited, that is, to see the task of therapy as the cognitively demanding but ethically null task of providing and enjoying a new reflexive transitive consciousness of our own attitudes. The task of offering recognition to a patient in her distress and his thereby recovering - not objective knowledge about his psychological performance, but rather, in his capacity to now enjoy intransitively conscious attitudes - his humanity, is not in view.[1]

The conception of making the unconscious conscious, or transforming id into ego, which has to do with ethical rather than scientific recognition starts by noticing the difference between a symptom being causally explained and a symptom dissolving into a living moment of a patient’s will and emotional expression. A patient presents as suffering from an affliction. They are having mental or bodily experiences which they do not recognise as part of who they are. For example they may experience compulsions, or have irrational fears, or hear voices, or feel demotivated and sluggish and weak despite not being poorly, or be enduringly sad and hopeless despite not being in mourning. They may wish for the psychotherapist to somehow ‘take these problems away from them’.

Needless to say, excision is not how psychotherapy works. Instead the psychoanalytic psychotherapist considers the patient’s difficulties under a different aspect. He considers them under the aspect of meaningful expression, emotional experience and the will, and responds to them as under-developed articulations of such functions. The point I wish to stress is not that he may (although he may not) have a psychological theory as to how such symptoms arose or are maintained. Instead I wish to point out that the therapist does not, in his therapeutic engagement, see the symptoms either (like the patient) as humanly unintelligible undergoings or (like the psychologist) as psychologically intelligible reactions; he sees them instead as incipient humanly intelligible actions and expressions. In a sense they are no longer symptoms, for what was previously seen as something undergone now becomes seen as an undertaking; a patient starts to become an agent; an event an action; a symptom suffered now itself becomes the suffering of something beyond itself.

Such recognition is not primarily of facts about the patient but rather a humane recognition of the patient herself in her suffering. If your friend dies and you are sad, I do not treat your sadness, your tears, your withdrawal, your pain, as symptoms. This is because they are instead the intelligible form of your humanity. I show you understanding, and offer you recognition, when I recognise your experience as a humanly apt mode of relating to the loss of your friend. I encounter you in your sadness; I do not see it as an affliction of you. You are not suffering from your sadness, but suffering from the loss of your friend: it is her death that afflicts you, not your feelings. Similarly, when a psychoanalytic psychotherapist shows her patient recognition his erstwhile presenting problems now become not symptoms or afflictions but intelligible actions and sufferings - not causally intelligible given his past or given his defence mechanisms, but the humanly intelligible anger or sadness or guilt or fear of a man in meaningful relationship with those who inspire such emotion in him.

The correlative of the therapist’s offering of recognition to the patient is, then, the patient appropriating his symptom and, in so doing, no longer having a symptom (and no longer being a ‘patient’) but rather having and expressing a human experience. It is not as I first thought that I love my child but have compulsive foreign symptomatic wishes to hurt her; rather I grasp that I have a humanly natural (if morally culpable) ambivalence towards her. (Perhaps I am envious of the comfort of her own childhood relative to my own. Perhaps I regressively blame her for the lack of time I now have to spend with my own friends.) The hallucinated voices I seem to hear can, post-appropriation, be acknowledged as my own thoughts. The depression that seemed to befall me was in truth me suppressing myself in my scarcely bearable feelings of sadness and/or anger on my friend’s death. And so on. After a helpful therapy the patient is now less ‘possessed by’ unintelligible afflictions; instead he is now achieves what we call ‘self-possession’. As such he needs rather less than before to have psychological knowledge about, or to be in some kind of comprehending relation to, himself. Being self-possessed means that he may now simply be in his emotional relations to the world – be in such relations as themselves provide the fundamental form of his comprehending encounter with it. In the popular terms bequeathed us by Martin Buber (****REF), the psychotherapist offers her patient not the ‘I-It’ relation of psychological cognition, but the ‘I-Thou’ relation of humane recognition. As a result he may now appropriate his symptoms into his self so that he no longer inhabits the self-estranged position intrinsic to being a psychological patient.


[1] Finkelstein (this volume) outlines the contrast between what I here mark as the transitive and intransitive senses of consciousness. Lear (this volume) outlines what I am here calling a broadly ethical reading of what it is for id to be supplanted by ego or for the unconscious to be made conscious.

Tuesday, 1 August 2017

formulation vs recognition

The rhetoric of the 'scientist practitioner model' we meet with in clinical psychology has for some time now found its way into psychodynamic psychotherapy. I'd like to reflect on some of its language and ask if it's really apt to the therapeutic task. I choose the following textbook at random. Cabaniss et al (2013) offer us their 'describe, review, link' model for creating a psychodynamic formulation: describe 'the patient's problems and patterns', review 'the patient's developmental history', and link 'the problems and patterns to the history using organizing ideas about development': 
'A psychodynamic formulation ... is an hypothesis about the way a person thinks, feels, and behaves, which considers the impact and development of unconscious thoughts and feelings.... Psychodynamic formulations do not offer definitive explanations; rather, they are hypotheses that we can change over time.' 
'One way of thinking about this postulates that these problems are often caused by thoughts and feelings that are out of awareness – that is, that are unconscious. This is called a psychodynamic frame of reference. Thus, a psychodynamic formulation is an hypothesis about the way a person’s unconscious thoughts and feelings may be causing the difficulties that have led him/her to treatment. This is important to understand, as helping people to become aware of their unconscious thoughts and feelings is an important psychodynamic technique.'

'When we formulate cases psychodynamically, we make hypotheses about how people develop their characteristic ways of thinking, feeling, and behaving. Thus, once we have a good sense of the problems and patterns, the next step in creating a psychodynamic formulation is to review the developmental history. The developmental history includes everything that happens during peoples’ lives that help shape their dominant patterns of functioning; that is, the way they think about themselves, have relationships with others, adapt to stress, think, and work and play.' 
'When we take a developmental history, we are guided by these principles:
  • include nature and nurture
  • relationships are key
  • trauma is critical
  • chronology is relevant
  • development is lifelong'
Having described and reviewed the patients problems and history the third step is to 'link' them together. This linkage provides the provisional understanding or 'hypotheses' which is to guide and inform the therapy. Here's an example: 
'How did Dr Z form this hypothesis? It was not magic. Rather, as she learned about Ms A’s problems and patterns, she asked herself a question: 
                  Why does this talented woman have such a low opinion of herself? 
Because she was thinking psychodynamically, she DESCRIBED Ms A as having difficulties with self-esteem regulation that likely reflected unconscious, overly critical perceptions about herself and her abilities. This gave Dr Z a partial answer to her question, but she knew that in order to develop a strategy for helping Ms A with her low self-esteem, she would need to understand how and why these unconscious, maladaptive self-perceptions had developed. To answer that, Dr Z REVIEWED Ms A’s developmental history and, among other things, learned that she had had a difficult relationship with her critical, dismissive mother. She then used an organizing idea about development – that maladaptive self-perceptions are often related to a person’s early relationship with a dismissing, critical parent – to LINK the pattern to the history. By describing, reviewing, and linking, she had formed an hypothesis about why Ms A had such a low opinion of herself – a psychodynamic formulation.'
Once we've got them 'Formulations help the therapist to 'construct meaningful interventions'. These might include: 
  • 'recommending treatment and setting early goals
  • creating a life narrative
  • offering explanation and perspective throughout the therapy
  • consolidating insights as a preparation for termination'

There is much we could take issue with in this. Even if it were clinically intelligible and possible it's hard for me to imagine it being therapeutically desirable. In particular I doubt that bringing such thought to bear on the patient in his presence is either of much therapeutic use or in line with the core values underpinning meaningful therapeutic - or for that matter meaningful human - encounters.

The word which comes to my mind is 'external': the authors' description of the relation of the patient's unconscious thought and feeling to her behaviour, and of the character of the therapist's appreciation of this, strips unconsciousness of its immanence in behaviour (inner causes, posits, etc). The requisite tentativeness of the therapist's suggestions is automatically equated with the therapist not losing sight of the thought that his or her suggestions about unconscious thoughts and feelings are hypotheses. The understanding which the clinician develops is construed as instrumental for his or her clinical activity. Finally the relation of the past to the present is also seen as an external relation between two different phenomena: a childhood trauma, an adult symptom; the clinician's hypothesising about this relation is facilitated by his knowledge of developmental and longitudinal studies.

But what might it mean to say - as I want to say - that a therapist and patient are, in potent analytic therapy, in some sense internally rather than externally related? What might it mean to say too - as I also want offer - that a patient's trajectory towards health is one from an external to an internal relation between himself and his own experience? Isn't all that a crazy mishmash of matters philosophical and matters psychotherapeutic? After all, in therapy we have two separate individuals in the room, etc etc...!

(That, I also want to say, is one of those philosophical reactions which is far too quick for its own good! Be patient!)

In therapy - and in much of interpersonal, moral, life - we have an essential need for recognition. The patient needs the therapist to be able to offer her recognition. Recognition in (and not just of) her distress. Recognition that ways of feeling and forms of behaviour which appear to the patient to be untoward, symptomatic, undesirable, foreign, forms which merely assail, are in fact intelligible moments in the living of a human life. To be honest the patient doesn't need to know that they are causally intelligible in terms of their traumata or what-have-you, although that may be interesting (perhaps too interesting...) or helpful. Such a form of explanation, in fact, still leaves the patient in an external, unassimilated, relation to her symptoms.

When I show you recognition, that is when my relation to you comes aptly under the concept of ethical recognition, then I take you and your experience and your action as humanly intelligible. Where by 'humanly intelligible' I mean: intelligible as such, being experiences that we 'get', that we can 'relate to' as meaningful in themselves. We can understand this immanent intelligibility best through examples. For example: you cut your finger and it hurts; your girlfriend leaves you and you are distraught; someone calumniates you and you are angry; someone praises you justly for what you and you are delighted. To react thus is to be living what we take to be a human life.

The patient however comes along with suffering which she does not understand. She perhaps hopes that the therapist will somehow help her get rid of it. The depressed person feels flat, unmotivated, suicidal, etc. The obsessional feels assailed by impulses that are not experienced as his own, ones he cannot endorse. The phobic feels scared of what she knows ought not to be scary to her (because it is not dangerous). And so on. The clinician may be able to understand how these developed - they may be able to understand the patient's symptoms - but in the sense I'm interested in here this does not mean yet an understanding of the patient. In the sense I reserve for it here, to understand the person is rather to offer an understanding of her symptom which restores human intelligibility to it. Not, for example, that we can understand the causal development of your obsession, but that it becomes once again something you understand as an expression of your will. This is what we call integration, and such integration (where id was there ego shall be - in Jonathan Lear's helpful take on Freud's dictum) is the correlative of another's recognition - recognising in the sense of acknowledging rather than identifying someone.

So this is one thing which it means to say that a patient's relation with her symptom is external whereas that with her emotional experience is internal. In the latter case the experience is her own not in the sense that it happens to her but that it is a moment of her agency. Therapy restores this internal of-a-piece-ness of the symptom with the patient's will; in this way they turn from patient to agent.

What about the apt relation between therapist and patient being, as I unperspicuously claimed, internal rather than external? Here my claim is that when we offer another recognition, when we encounter them as (we might say as) subject rather than object, our response to the other is an intimate corollary of them in their meaningful experience. The comparison here is between i) two independently crafted shapes that happen to fit together and (to borrow an example from Wittgenstein) ii) the inside of the black circle and the outside of this disk: O. If my will is internally related to my experiences in a way in which it is not related to that which befalls me, and if the therapist's recognition offers me a reacquaintance with what of myself is in truth immanent within my symptoms (where id was there ego shall be), then when the therapist offers an 'interpretation' what is happening is they have offered me an avowal. Offered something which can become a living moment of my will. When this happens the therapist and the patient are 'of one mind'. The therapist helps 'restore the patient to himself'. Le mot juste is offered to which the patient may say 'yes that's it!', pick it up, use it, and so on.

The clinical psychologist tends to portray the tentativeness of the apt therapeutic suggestion as making a statement in the form of an hypothesis rather than of a fact. I think this mischaracterises the relation between the imposing versus the respectful therapeutic word. (For example, sometimes the therapist might have to take a strong stand against the patient's defences, offering the mot juste in rather forceful terms. To do any less may be to fail to respect the patient as a locus of potential agency.) What is more to the point is the need to not impose one's will if one is to do anything that could even count as offering recognition. Thus if I tell you what you think I am not doing you justice. Since in telling I am claiming to speak from the phenomenon. Yet here I am making it part of my will, rather than allowing for you to own it within your own.

Finally, consider the difference between an understanding of a symptom as a present day causal product of a trauma (or what have you), something concatenated down and an understanding of it as the (until now disavowed) voicing of (say) a trauma. In the former case the two are related externally: one explains the other. In the latter it is internally related: one is of a piece with the other. We come to see what before was a mere symptom as the ongoing expression (in the sense of the pressing outwards, the very living enactment) of a humanly (not: of a psychologically) intelligible moment in someone's life.

Thursday, 27 July 2017

on psychotherapy

Psychotherapy is sometimes taught and conducted as an I-It relationship between a therapist and a patient's problems. It goes like this:
Patient presents with some problems.

Therapist inquires into the presenting problems, uses history-taking, and his or her psychological knowledge, to develop a linking formulation.

The formulation is applied by the therapist to the patient's problems by way of explanation of them or by way of a guide to something called an 'intervention'.
Now, if someone did that to me I'd be furious with them! There I was, hoping that I would be understood, and all we get is someone offering me a causal explanation of my problems. Jeez - thanks!

What do we really want from therapy? We want a relationship in which someone will treat us seriously as a person. They will be able to call us out on our unwitting bullshit, show us love, show us understanding when we lose perspective, help extricate themselves and us from the unwitting internal and relational habits we fall into, and offer us a few words to help us put ourselves back on a trusting open self-possessed footing. Sure, sometimes they may rely a little on hypothetically handled objective psychological knowledge of human subjects. But really what we want is someone who 'knows people', not someone who 'knows facts and theories, or who develops hypotheses, about people'.

What is it for someone to 'know people'? It's to know how to relate to the patient aptly and spontaneously, to listen and make room for the patient in his sui generic nature rather than project oneself into the patient's shoes, to oneself be geared up and fortified in the requisite ethical and emotional and humane resources, to be able to receive and not be closed to the patient in his distress.

Someone whose interaction is mediated by knowledge about people is, one imagines, perhaps not someone who really knows people at all!

(Just imagine if someone were to respond to what I've written by saying 'Well, perhaps that shows that this kind of (clinical psychological) psychotherapy is not for you?'! ... 'Richard: I don't like it when you punch me in the face.' 'Psychologist: Perhaps being punched in the face is just not for you'.)

Tuesday, 25 July 2017

explanation and understanding

Richard Bentall and David Bell have rather different psychodynamic theories of paranoia. Not just different theories of what causes paranoia, but different forms of theory - different ways of relating causes to effects - differences which, perhaps, could not unnaturally be said to spread into what is meant here by talk of a 'causal explanation'. I mark these differences with the terms 'empirical' and 'phenomenological'. In calling them that I'm not trying to categorise them in already understood categories, but just to advertise (prior to explicating) a conceptual difference that needs after all to be marked out by using some or other terms.

Thus Bentall the scientific psychologist wants to develop psychological hypotheses and test them. He wants to show us that paranoid people really do process information in the way that his theory suggests. By contrast it never seems to occur to Bell the psychoanalyst to derive general testable hypotheses about paranoia from his Kleinian theory. He proceeds instead by giving us formulations and examples. That is 'all' we get, and it seems reasonable to assume that it is all he takes himself to be required to provide. Why - the psychologist asks - is this? Is Bell a scientific failure - is he not schooled in actually substantiating his claims with empirical evidence? Not schooled in putting a question to nature so that she can as it were now answer all by herself? ... Well, I think not! Below I explain why.

Here is the general empirical method by which, as far as I understand it, Bentall the psychologist proceeds. Take a state: paranoia. Develop a measure of it. This state is our explanandum: it is what we want to explain. The kind of explanation we seek is: what in the individual's psychology makes her likely to experience paranoia? Next identify some external triggers, internal states and internal traits which may conceivably give rise to the paranoia. The latter two - the inner states and traits - are our psychological explanantia. Develop measures of these inner states (degree of implicit low self-esteem - how the person deep-down feels about herself; the quality of her underlying 'self-representations'; degree of explicit self-esteem - how the paranoid person consciously and explicitly represents herself to herself) and inner traits (habits of information processing such as having a bias toward making external and personal attributions for why the triggers obtained). Finally correlate the measures. If there is a positive relation between the measures of the explanantia (the degree of low self-esteem, the attribution bias) and the measures of the explanandum (the paranoia) then this constitutes evidence for the truth of the psychological model. The character of the theory might be summed up like this: paranoid people are people like this; it is in part because they are like this that they are now paranoid; the data we collect are empirical evidence for the truth of the theory.

By contrast with Bentall, Bell the psychoanalyst proceeds according to what I am calling a 'phenomenological' method. He too has an explanans (A = projection) for the explanandum ( B = paranoia), but he doesn't try to collect evidence of an increased level of projection leading to an increased amount of paranoia. A is not by him conceived of as a psychological trait; it isn't an independent phenomenon which throws up paranoia when triggered. It is rather a psychological process - a defence mechanism. Bell isn't saying that the paranoid person always deals with their distress through projection. He is saying that projection characterises the paranoid reaction to experienced threats to selfhood. (If we wanted we could say that the reference to projection is a way of understanding, rather than explaining, paranoia. What would be important, in saying this, is that we don't take ourselves to have done more than index the phenomenon - we haven't, simply by using this terminology, thereby either explained or understood it better.) What Bell offers us is a way of seeing paranoia: paranoia is, he suggests, the relocating of disturbing feelings from oneself into others-as-one-sees-them. Now, I'm not suggesting that it would be wrong to say that he sees paranoia as caused by projection, but it would be wrong to think of 'caused by' here as meaning 'precipitated by', and wrong to contrast it with 'characterised by'. Yet we might here still describe B as 'a function of' A. We could also, if we wished, describe the differences in terms such as: Bentall is on the whole trying to tell us more about what makes paranoid people vulnerable to paranoia; Bell is trying to deepen our understanding of what it means to be paranoid.

Now, Bentall's method runs into various self-confessed difficulties around testability (p. 339) - perhaps because it is (I suggest) hard to convincingly operationalise, or because it is (he suggests) hard to accurately test for, underlying as opposed to explicitly expressed low self-esteem. But I don't want to go into this here; instead I want to focus on another feature of his theory. This is that whilst his hypothesis-testing is geared up to assess whether paranoia may be an upshot of making external personal attributions when something triggers painful low self-esteem, nothing in his method allows him to test whether paranoia is motivated by the avoidance of painful low self-esteem. (NB I'm not saying that Bentall even thinks he's testing this aspect of his theory.) The method of taking measurements and making correlations does nothing by itself to establish the psychodynamic aspect of either his or Bell's understanding of paranoia, which understanding is of the motivation for the attribution bias / projection. And this is my central point: that the psychoanalytic model helps us understand paranoia - or at least certain forms of it - by seeing how it is motivated.

To see human behaviour (including inner behaviour - i.e. thought) as motivated is to see it as expressing intelligible desire. When we see it as such we do not do so by separately identifying the behaviour and the desire and then correlating or otherwise conjoining the two in thought. Instead the desire has its life within the action; it is not somehow stored up behind it; it is there in the action that we encounter it. The desire characterises the action, we could say, rather than having the action as its upshot. Imagine: you see someone withdraw her burning hand from a hot stove. You don't here separately identify her action and her desire to relieve pain, and then bring them together in your thought.

Naturally we may imagine strange cases (someone wants to burn his hand to win a dare, but he mindlessly withdraws it from the flame to scratch his itchy nose) but these do nothing to remove the default presumption that a hand withdrawn from the flame is, absent requisite strange defeating conditions, a hand withdrawn because of the burning or pain. And note, too, that we say all of this even if it so happens (Rundle) that the pain and the hand withdrawal are both effects of a common physiological cause (the burning), rather than the latter the upshot of the former. Our understanding that we are motivated to avoid pain is, then, not the understanding that avoidance is caused by pain. That we avoid pain and seek pleasure, rather than vice versa, is one could say not a contingent fact about our lives, and masochism must remain a special case on pain of unintelligibility. We are not to answer why we are motivated to avoid pain! Whilst we must be careful to avoid over-theorising the fact (a la 'simulation theory' etc), we understand the withdrawal of a burning hand from a flame in and by relating to the predicament: it makes immediate sense to us as such, and we are not left trying to make sense of one thing in terms of some other thing already understood. (The concept of 'immediacy' here is not temporal but instead has to do with the non-mediated nature of the understanding: we have here to do with something intrinsically intelligible (because it itself defines a form of intelligibility) rather than to something intelligible in terms of something else, or something made intelligible by doing something else. If it be insisted that we do it 'by empathic projection' (putting oneself in the shoes of another) then all that can be said is that this is: 'ok so long as our immediate grasp and our empathic projection are not to be thought of as two separate things, one done by means of the other'. No: 'empathic projection' is at best the form taken of this immediate grasp of motivational meaning.)

To return to paranoia: Bell aims at what I am calling understanding, whereas Bentall aims at what I've indexed with 'explanation'. But given that Bentall too clearly trades on our understanding what it is he is proposing but not demonstrating - that paranoia is motivationally explicable - then we do better to note that both Bell and Bentall aim at understanding, whereas Bentall aims in addition at explanation. If scientificity comes along with explanation then we may say that Bentall's account is the scientific one. But we cannot judge on that basis that Bell's account is un-scientific. All we may infer is that it is, on this rather limited criterion, non-scientific. And it is, in its reliance on our grasp of the intrinsic intelligibility of motivation, no less or more so than Bentall's. Bell isn't interested in noting how often paranoia is motivated, or in independently identifying features of paranoid people which appear to increases their likelihood of becoming paranoid. That just isn't his project. His project is instead to make the motivational forms of paranoia intelligible to us by providing us with a rich exemplary phenomenology - and what better method do we have for that than the case study? Bell's theory is not a scientific failure, but (I would argue) a successful attempt at providing the pre-scientific foundations for any meaningful understanding of paranoia whatsoever.

Wednesday, 14 June 2017

hallucination as unrelinquished anticipation

summary notes for talk this week: a phenomenological theory of hallucination 

Posted here to supersede and collate previous musings on hallucination.

1. ontological question of hallucination

What is it to hallucinate? What is the being of hallucination? This not an empirical question about psychological precipitants or associated neurological events.

2. against dualistic answers to the ontological question

If you espouse dualism of inner (mind/brain) and outer (world/body), then you hardly need a theory of the being of hallucination. Your conception of perception will likely already reference an inner mental item of some sort ('inner representation'/'percept'/'sense datum'/'idea'), so: hallucination becomes simply the inner item in absence of outer stimulus. (You'll also be likely to: take seriously the problem of constancy, be drawn to Helmholtzian theorising, talk of unconscious inferences etc; Gibson won't speak to you.)

But perception and experience are not just caused by their worldly objects; they take them in. Not hybrids of i) non-mental causal outer interactions with a world (the mechanics of vision and audition etc) plus ii) mental upshots of 'loud and glowing sense data' in an internal world. Instead perceptual experience is our openness to the world; it is 'originary transcendence'. In this sense of 'perceptual experience' a hallucination is precisely not a perception or experience; paradoxical/meaningless to talk here of 'an experience of a horse in the absence of a horse'.

'Inner representation', 'sense datum', 'inner image' etc are simply philosophical inventions which themselves cry out for explication before they themselves can feature in explanations. What use is a visual representation if one can't see it? Doesn't the concept of a 'representation' - e.g. of a picture - presuppose rather than explain the capacity to see what is thereby pictured? Such notions need explaining before being put to use to 'explain' perception. But why do we even need an explanation? The felt need had better not be a result of a theoretically contrived dualism between mind and world (the unnecessary explanation being of how it is possible for such an alienated subject to reach the world; ... dude, we're not world-alienated subjects, it's ok).


Non-disjunctivism says: the visual perception of a horse, and a hallucination of a horse, have something psychological/inner in common. 'Psychological': not just that they have in common the atemporal fact that the right way to describe their content is 'a horse'. Instead: they (allegedly) have in common something experiential and episodic. They are not just both experiences of horses; they are both - in some or other allegedly illuminating sense - experiences of horses. 


Disjunctivism says: it is no more illuminating to say this than to say that a real horse and a plastic horse are both horses, or that a standing bridge and a bombed out bridge are both bridges. We can say that a hallucination is a perceptual experience, just as we can also say that a bombed-out bridge is yet a bridge. But in both cases what is essential to the being of the perceptual experience (openness to the world) and the bridge (forging a connection between two sides of a river) has been lost. The reason why we identify the broken bridge as a bridge, the plastic horse as a horse, the hallucination as an experience, has to do with their ontological dependence on real bridges, horses, perceptions. We can call both veridical perceptions and hallucinations 'experiences', but this is not because they share something episodic in common, but instead merely because additive mention of all such phenomena gives us the extension of our broadest concept of 'experience'. 

3. differences to hallucinators of hallucinations and perceptions

Not elucidatory to say that in both real and hallucinatory cases it seems to us that there is a horse in front of us. For it may not seem to the hallucinator that there's a horse in front of her. Perhaps it seems to her that she's hallucinating a horse. 

Merleau-Ponty: examples of hallucinators being able to tell the difference between hallucinations and his perceptions. Early 20thC French and German psychiatrists playing tricks on psychotic patients with mock-ups of hallucinations, and reporting how taken aback the patients were, and how differently they related to their real and hallucinatory experiences with the same object.


Also: unclear what it means to say of someone who clearly sees a horse that it seems to him that he sees a horse. (And it may be true of someone who doesn't clearly see a horse that it seems to them that they see a cow.) This because part of the work that the concept of 'seeming' does is to distinguish between, for example, when something 'really is' the case and when something 'just seems' to be the case. To say that there is a 'seeming' alive in both cases sublimes the logic of 'seems'.


4. existential phenomenology - thinking form and content together

Value of existential-phenomenological theory is that it thinks hallucinatory form and content together. Dualistic theories, by contrast, typically chalk up form to neurological factors alone, and view content as epiphenomenal or to do with psychologically intelligible preoccupations, traumas, complexes, self-esteem, etc.

In thinking form and content together we also aid rapprochement of psychiatric understanding of form with psychoanalytic understanding of content.  (Thinking them together: we can ask: why would that be the content of a hallucination? The form of our embodiment is central to answering this.)

I will call hallucination: an embodied expectation of hearing (or seeing, being touched, etc.) uncancelled by (unrelinquished despite) the absence of a stimulus; a 'negative' (quasi-photographic) or 'anti-'experience, an ungraspable absence registered as a presence. This an existential-phenomenological characterisation, not a reductive explanation. Merleau-Ponty: We need to understand - to 'live' - hallucination without reductively 'explaining' or psychologically reducing it. 

Talk of 'embodied and cancelled expectations' is not straightforwardly perspicuous. We instead arrive at sense through analogies, disanalogies and examples. (Similarly for perception - to say it is our 'openness to the world', that it 'takes us out to the objects', that it involves an 'originary transcendence', hardly conveys positive information. Instead: what we have here are reminders not to make a travesty of our concept of perception by espousing dualism of inner mental domain enjoying merely external relation to an external world.) Of course one can have unrelinquished anticipations which do not constitute or coincide with hallucinations! I am truly aiming at an identity claim, but the particular meaning of 'unrelinquished' and 'anticipation' will emerge as we proceed.

5. hallucination as uncancelled anticipation

Hallucination: an embodied expectation of hearing, seeing, being touched, etc., uncancelled by the absence of a stimulus; a (quasi-photographic) 'negative' or 'anti-' experience; an ungraspable absence registered as a presence.

Anticipation: Merleau-Ponty follows Husserl in describing how perception has built into its structure a large array of 'promises' - if I move over there, and my vantage changes, or if I pick this up and turn it over, that I will encounter this or that. An interconnected protentive structure of experience constituting our normal perceptual world. Objects offer what Gibson calls sensori-motor affordances. M-P: 'I can feel swarming beneath my gaze, the countless mass of more detailed perceptions that I anticipate, and upon which I already have a hold'.

Merleau-Ponty on hallucination: 'The illusion of seeing is ... much less the presentation of an illusory object than the spread and, so to speak, running wild of a visual power which has lost any sensory counterpart. There are hallucinations because through the phenomenal body we are in constant relationship with an environment into which that body is projected, and because, when divorced from its actual environment, the body remains able to summon up, by means of its own settings, the pseudo-presence of that environment.'

Walk along - expect the floor to stay still. Get onto an escalator, expect it to move thus and so. Turn an object over in your hand: expect it to appear thus and so. Self usually rapidly and automatically adjust to various environmental changes. 

Selfhood and perceived object are two correlative moments in perception. What belongs to whom - this is what must be divvied up by the intentional arc which subtends and (at the 'chiasm') divides the two subject and object poles: e.g. is it that I've moved further away? Or that: it's got smaller / moved away?

Spinning: spin around a lot - then stop - the world appears to spin. You've set up certain expectations of self/world movement in your lived body. These expectations are not visually met with (because you stopped spinning). They're not immediately relinquished/cancelled. So then, instead, the world appears to move in opposite direction. In intoxication we have the same difficulty. Expectation and world are not so tightly coupled. Maximal grip is degraded.

Broken escalator: your body carries expectations of movement even if you can see escalator is static. Get on the escalator - it appears to lurch in the opposite direction. Your body stumbles. Why isn't it like getting on a normal staircase?!

Jewellery removed: take off a watch or bracelet before swimming or before doing the washing up. Normally you don't feel it there. But now you feel an anti-bracelet around your wrist!

Sensory deprivation: nothing to entrain the web of anticipations; nothing to cancel them (no staircase fully visible where a person would otherwise occlude it). Hallucinations spring up from fleeting unrelinquished sensory anticipations.

Phantom limb: the expectations that constitute the body schema can't be readily relinquished. 'Knowing that your limb is gone' is not a neurological unity - various disjunctive criteria for that, some of them verbal and some motor-habitual. (Harder to adjust if unconscious when amputation happened.) 

Rubber hand illusion: disturbance of sensory integration. Tickling of feather is not where body expects it when body takes rubber hand for own hand. So position of hand in body schema is adjusted. (Can cause OBEs in schizophrenics.)

Hallucinatory palinopsia: Wikipedia: "persistent recurrence of a visual image after the stimulus has been removed." The expectation is formed, yet not relinquished after the 'stimulus has been removed'  - so one has a 'recurring visual image'.


Ghosts: my beloved has died but this understanding has not propagated through my set of reactive dispositions. That is: I still expect her to come through the door. She does not. Yet the expectation does not immediately relinquish: instead I 'see' a 'negative' of her - I 'see' her 'ghost'.

Succubi, incubi, old hags, alien visitors: sleep paralysis undermines ability to update the body schema. Corollary discharge of the motor intention plus no change of retinal stimulation due to paralysis naturally gives rise to hallucinatory experience - projection of body image. Sense of evil - self-disintegration (terror - see below) and hallucinated body shape combine in the night terror. 

AVHs: perhaps not so easy to generalise to 'hearing voices'? The model would be: I have a latent anticipation of hearing my name being called. And in cases of mental illness, a latent anticipation (in the complexes) of receiving hostile criticism, of being talked about, etc. I do not manage to experience silence - in other words my latent anticipation is not relinquished. I then 'hear' an 'anti-voice' saying what I expect to hear. AVHs are auditory ghosts. Why expect criticism? This is the 'introjection of the bad object' to form persecutory superego.

Charles Bonnet Syndrome - visual hallucinations - in some of those with significant retinal damage - i.e. with partial blindness. Standard theory: impairment of normal visual stimulation unconstrains the brain from producing 'images' (of little people, of objects, landscapes, and repeating visual patterns). Alternative: hallucination here too is result of 'anticipations' uncancelled by normal sensory input. Question remains: why does person have such anticipations - of encountering people etc.? Well: of course we have expectations of encountering people, objects, landscapes, etc. And if we experience a little bit of a pattern it may be natural to expect this to continue as well (in the absence of the cancelling effect of regular visual input). Elaboration of a partial visual stimulus into a face, person, object, pattern ought to happen, and is what subtends normal protentive dimension of visual experience.

6. hallucination as failed grieving 

Failing to smoothly update body schema: caused by identificatory failures of mourning, by intoxication, by tricking the body (psychologist's rubber hand illusion etc), by schizophrenic fragility.

Easy to update, to 'grieve', when the lost phenomenon not really a part of who one is. 

Grieving: not an emotional experience that sits on top of the letting go of reactive dispositions to encounter the departed other / the amputated limb. Grieving is the embodied relinquishing of these expectations. Grieving tears at the fabric of our self, allowing it to adjust to new situation without the lost object. (You can't ask: 'why does mourning (letting go) involve feelings like that (grief)?' because the feeling is the experience of the adjustments within the mourning process.) 

Ghosts: intrinsically mournful phenomena. Beckon to the living from 'another world'. They still have something they want to say. They can 'haunt' - won't leave you or this world alone, trapped between the worlds. All of these properties in fact belong to the bereaved: it is we who can't let go of the beloved, we who want to say something to her, we who can't relinquish our expectations. The ghost is the reverse of these - rather than grieve we hallucinate. Ghosts - so-called presences - are, in fact, unmanageable absences.

This is not wish-fulfilment. It is a direct product of the non-relinquishment of the anticipations. It is no more wish-fulfilment than our lurch on the static escalator. 'Ghosts' are visual lurches on the static escalators of our animal souls.

7. the identity of hallucination

If one is reluctant or unable to relinquish the expectation of theorising hallucination in terms of 'inner images occurring in the absence of their normal cause' - if one is reluctant or unable to relinquish a conception of consciousness as an inner realm of inner representations - then the theory of hallucination as a failure of expectation will look unpersuasive.

One will be likely to think that a theory based on anticipation is either insufficiently sensory or is at best not an ontological account but instead merely a theory of what causes hallucination. The hallucination itself, one might think, will be an inner image upshot of the failure to relinquish the anticipation.

This is not our theory. It is one of the being of hallucination. If we have to think of hallucination in terms of 'images', then the claim is that the inner image is the anticipation unrelinquished despite the unencountered stimulus. However why think in terms of images at all? We have to see images (e.g. oil paintings or photos), and hallucination is not seeing. 

This talk of 'inner images' is a metaphor; one might as well say that auditory hallucination involves 'inner recordings', or that olfactory hallucination involves 'inner scratch-n-sniff cards'. Images, recordings, and smelly cards can all obtain in the absence of what the images depict, tapes record, and cards smell like - and hallucinations also obtain, of course, in the absence of that of which they are hallucinations! The theory of 'inner images' seems to suppose that because there is no outer stimulus in hallucination there must be an 'inner' one! (Error theory regarding 'inner image' talk proclivity.)

Someone might insist 'But at least the psychologist - i.e. the heir of the 18th century 'theory of ideas' pundit - has a theory of hallucination. It is a mental image. But what do you have? You talk of unrelinquished anticipations - but surely one can have an anticipation, including an unrelinquished one, without hallucinating anything?'

First of all I would like to question that it is all that obvious what a mental image is. I don't myself feel confident that I know this genus well enough in its own terms to then be able to allocate hallucination to it as a species. As I said above, it seems to me to be a mere metaphor.

Next I want to ask whether we always know what we are doing when we ask 'But what is X?' or 'But what is it to X?' The questions are so simple that it feels like we ought always be able to ask them. But my thought here is that it's not really so clear that the question has a proper place. For might we not just reply 'But don't you know? Surely you know what it is?' Imagine someone saying 'You keep talking about matter. But what is that, really?' One way of thinking about this riposte of mine is to question the idea that everything must be a species of some or other genus (rather than being a genus with only one species in, if you like). I should like to suggest that sometimes the 'But what is X?' question arises in a compelling way only because the questioner has herself already bought into a particular way of thinking about our mental life - perhaps in terms of a rather restricted set of categories like 'mental state, mental process, sensation, mental image' etc. Their 'But at least I've got a theory of X' comment now hardly looks so innocent. For it turns out that 'having a theory of what X is' presupposes what we might rather want to investigate - whether hallucination is, categorically speaking, sui generis, or whether it may be decomposed into or allocated to some other psychological phenomenon.

At this point, finally, I can imagine someone wanting to defend my position in the following way: 'But Richard you protest too much, since you do have a theory of what a hallucination is. It is, you said, an unrelinquished sensory anticipation obtaining even in the absence of sensory stimulation.' Well, that's very kind of you. However I don't think my 'account' is really in the same ballpark as the empiricist psychologist's account. I don't for a moment think that one could understand what it is to hallucinate simply through a grasp of how the terms 'anticipation' and 'relinquish' work in other contexts. For these anticipations are not any old anticipations - they have their being in the midst of our unreflective animate life. We have thousands of them every minute - if it even really makes sense to count them - and they are constantly relinquished by our sensorimotor contact with reality. I think there is a kind of 'leap' needed, a moment of sheer intuition, when one grasps how it is that a sensory anticipation that is unrelinquished despite not showing up in experience can constitute hallucination. This is why I used plenty of examples in section 5 above - my hope is that you will be able to just 'get' my thesis if you dwell on the examples and the theoretical claim in the midst of one another.

8. hallucination, terror and self-dissolution in schizophrenia

Self and perceptual object are correlatively enacted structures.

If we can't achieve self-world stability - grip (as in maximal grip) - then disintegrative terror looms. Not being able to attain object-stability is also disturbing. Because of their correlative enactment, not two alternative scenarios.

Schizophrenia - especially coenaesthopathic schizophrenia - involves a fragility to slippage of body schema - and by implication a vulnerability to disturbed self-world enactments (hallucinations, autoscopies, passivity experiences, coenaesthopathies, OBEs).

Parts of body schema become sheared off. Transitivism, appersonation, passivity experiences, alien hand, coenaesthopathies develop as body is no longer 'lived', alien invasions, electrical experiences, kundalini, etc.  Or displacement of point of perception - autoscopies, OBEs.

Terror is the experience (the undergoing - i.e. non-transitive experience) of self-dissolution. (The identity claim matters - now you can't say 'but Richard why is that so scary?') 

Delusionality: the relinquishing of the attempt to solve for self-world discrepancies, the retreat into autism / detachment from reality / disconnection of sensori-motor feedback cycles / diminished fonction du reél. Delusion is a way to not experience terror of self-dissolution (persecution is better than disintegration).

9. hallucination and therapy: between identification and grief

Compared to perception (reality contact) and self-world adjustment, hallucination is failure.

Compared to introjective identification with bad object, hallucination is a success!

That is: the hallucinator who 'hears' a persecutory voice is at least now not completely identified with it.

Hallucination can be seen like psychoanalytic symbolism (in dreams, images, preoccupations, obsessions, delusion-like ideas, etc): as a stage between illness and health. Both regressive and progressive moments possible. Recognition and encouragement of it's progressive dimension is the therapeutic task.

Therapeutic task is: relinquishing the anticipation! This may be updating the body schema with mirror boxes etc for phantom limb sufferer. It may be grieving the beloved, realising what one oneself wants to say to him or her, in those who see ghosts. It may be taking care to stabilise body schema, and sharing understanding about this, in schizophrenia.  

This contrasts with a conception of hallucinations as 'inner images'. On that conception we're likely to see them as psychologically unmotivated brain events, or as wishfully motivated (since imagination is often under control of the will). By contrast the anticipation account provides a clearer therapeutic direction.