Friday, 23 May 2008

Listening to Paranoia

So (an imaginary case): my client tells me that the SAS are always after him, that the royal family are plotting against him, that everyone is involved in a conspiracy against him, that everything that goes on around him goes on 'somehow for him'. What am I to make of it?

What I know is that he does not mean these things 'in the same way' as someone who is not paranoid. The clue comes in the way in which these things go on 'somehow for him'.

He might sometimes talk, of course, as if this was all meant in the normal way. But then at other times he makes it quite clear that it isn't to be understood in the normal sense.

Yet it is true too that he is not talking in metaphors. If anything, his ability to make the metaphor / reality distinction has become a little hard to hold on to.

And yet it is also true that it doesn't seem right to say that the words themselves have a different meaning. At least, it is not as if we have here something which makes perfect sense yet which is just making a different sense than normal.

My struggle is that I don't know how to listen to him. I easily get caught up with taking what he says as a literal normal truth, or as a metaphorical expression. Neither of these helps him to feel heard, to feel understood.

And perhaps I say that the 'Background' (cf John Searle on the Background) to his belief has changed. And this is surely right. The difficulties he experiences are not psychologically explicable, in the sense of explicable as consequences of unusual belief contents. But even so: How can I listen to him?

The question matters to me because I conceive of therapeutic listening as constituting a bridge between where the client is at, and where reality is at. The act of listening is the forming of this bridge, the making safe of the passage across it. It is through the connection that both understanding and healing occur. But how to connect?

Louis Sass gives us the best answer we currently have. He compares paranoia with solipsism. The solipsist 'believes' that she is the only person, only consciousness, there is. All experiences, all life, is theirs alone. (Solipsism is the reductio ad absurdum of empiricist theories of mind...) Words gain their meaning by referring to what is evident only to the solipsist herself, in her own experience.

The paranoid person is like a solipsist. Yet rather than coming to these views in philosophical reflection labouring under certain reflective presuppositions about the nature of experience, they arrive at them spontaneously. Their experience is solipsistic through and through; their (delusional) belief is merely an outgrowth of this.

But as Rupert Read discusses, following on from James Conant and Cora Diamond's 'resolute' readings of Wittgenstein's Tractatus, what the solipsist says is meaningless. It grabs us, it pulls us in, we engage with it, but we do wrong to take it 'seriously'. When we talk metaphysically we are acting without the constraints of everyday grammar, making distinctions where none can be sustained, held captive by pictures.

So too, what the paranoid person says is, sensu stricto, meaningless. That feels like a harsh thing to write, and I want to make clear that in declaring it thus I am not advocating not listening to it, not engaging patiently with it. That is precisely what I want to find: A way to listen to it.

Wittgenstein talks intriguingly about finding a way to bring words back to their ordinary meanings. The cure for the solipsist is patient reminders of how we normally use words. Words are brought back from 'holiday' through these patient reminders, these assemblies of cases.

What doesn't help is to argue against the solipsist, to put forward empirical evidence, and so on. And this is because every piece of evidence can just be caught up within their solipsistic system.

When we offer reminders as to the uses of words, we are not simply trying to get them to acknowledge that what they have been saying is meaningless. That would leave them with their experiences which they are trying to describe in solipsistic language, and yet without the language to so describe them. The attempt to engage with the solipsist is an attempt to help them shift the very structure of their experience.

How this happens remains to be understood. What is clear is that, in the process, they are brought back within the fold of our common humanity. All of this makes me wonder what would be the equivalent for the person with paranoia. What kind of 'reminders' would be apposite when it comes to his solipsistically structured (and hense sensu stricto nonsensical) belief that the SAS are always after him, that we are all plotting against him?

One kind would be 'reminders' which re-engage him with his life. Or which acquaint him with the operations of the SAS: a day-trip to SAS headquarters perhaps? These are not suggested as ways to help him test his belief, but rather as ways of returning his belief to the domain of the testable (i.e. non-solipsistic).

It escapes me, right now, how to fully learn Wittgenstein's lessons regarding the solipsist, and how to apply these to paranoia. I shall start by reading up on his actual encounter with solipsism.