Sunday, 1 June 2008


In this post, as in several other recent contributions, I should like to do two things. One: offer a perspicuous overview of a clinical topic which is seldom addressed. Two: provide a perspective which demonstrates the contributions of philosophical as well as psychological reflection to unpacking the phenomenon in question. A third issue I ought to mention is that the post is rather autobiographical, tracing a difficulty which appears not only in clinical material but also in the act of writing about it (in a blog, for example). (One of my principal motivations in writing this blog is to cure myself of certain pathologies of the writing process.)

The phenomenon in question, here, is scope. I have in mind the simple fact that several disturbances of intentionality have, at their heart, a failure of a certain kind of intuitive appreciation of scale and relevance. Sometimes the mind gets anxiously lost in particular details, unable to 'see the wood for the trees'. Activities become unconstrained by general goals, but seem instead to pathologically generate their own momentum, leading to a lack of progress. At other times the mind constantly and depressively drifts to the bigger picture, paralysing the ability to get on with the particular, unable to 'see the trees for the wood'. Once again the general goals are not met through particular actions.

The lack of balance which comes from a disturbance of scope in either direction demonstrates a key principal of understanding mental health. This is that the balance in question is not a static poise, but rather a way of handling a dynamic equilibrium. The equilibrium is that between a general goal and the specific tasks which would jointly constitute its fulfillment. Further, the lack of balance is not one which can be proscribed by means of a universal formulae. It must be reworked and regrasped intuitively rather than rationally. That is, our capacity to appreciate what the 'relevant' scope is is, I suspect, ultimately unformulable.

A patient with obsessional difficulties may get particularly bogged down with a hundred details. The anxieties of success and failure make it hard to simultaneously hold in mind the general goal whilst performing the task that would lead to it. Activity takes over, develops a seeming momentum of its own, which takes one further away from fulfilling one's now-ignored goals. A hundred other details appear to require her urgent attention.

Another patient with depressive difficulties finds themselves preoccupied by the bigger picture. By remaining at this general level they find it impossible to enter into the moment. Action seems futile since no particular action they engage in will ever enable them to realise their more global desires. A lack of activity takes over, a gloomy paralysis in the eternal.

The above remarks are, I take it, best understood as psychological rather than philosophical. True, they are not empirical but theoretical; nevertheless they can be grasped by a purely psychological sensibility. This sensibility allows us to simply employ psychological notions, without thereby demanding a self-conscious reflection on what could be called their 'limiting conditions' or 'conditions of impossibility'. The significance of the philosophical, in the sense I wish to develop it here, comes out when we consider the psychoses.

Take schizophrenia. Schizophrenia involves a particularly radical disturbance of scope, where particular activities become significantly unconstrained by general goals. An activity may be repetitively engaged in, remaining uncancelled even when what we might have imagined was the original goal was achieved. But what is significant with this degree of a failure of 'scope' is that we start (or ought to start) to feel reluctant in our ascription of the goals in question. The very idea that someone may have a genuine goal, yet radically fail to stop trying to achieve it when they have already done so, seems to stretch the concept of goal-directed activity too far. We do not know whether to call a putative desire 'satisfied' if an action which would normally be seen as achieving its satisfaction is not consequently inhibited.

Some measure of what I am calling 'scope', then, is constitutive of intentionality itself. Radical failures of scope are failures of intentionality, and disturbances of sanity. We talk of the 'neuroses' when we remain fairly comfortably within the limiting conditions of the concepts of general goal and particular activity. We talk of 'psychoses', on the other hand, when the bounds of sense are stretched, when we can no longer achieve confidence in the application of the concepts in question.

Achieving 'scope' is often (I find) a difficult business. It may be tempting to try and find a formula to help us keep the right balance, a formula which prescribes and proscribes the 'right' amount of metaphorical distance we must take from the individual metaphorical trees in order to make our way through the metaphorical forest. Yet discerning whether this formula is itself apt or useful and how often it should be applied will itself depend upon further scope. If we remain in reflective thought we will limit our ability to engage in the praxes which individually partially embody our goals. Some degree of unreflecting trust must also, then, be shown - in ourselves, in the process of living out our goals, in the trustworthiness of our environments to not thwart our efforts to realise our own ends.