Saturday, 26 July 2008

Reading Read Reading Sass Reading Schizophrenia

Applying WittgensteinRupert ReadIn Part 2.2 of his splendid new book Applying Wittgenstein, Rupert Read develops his 'new Wittgen-steinian' reading of psychosis. (See also his document Sass Corrected, and commentary paper On Delusions of Sense.) In particular he develops the idea that we shouldn't make 'too much sense' out of what is said by someone suffering schizophrenia when what is said is disturbed in some of the ways characteristic of extreme forms of that disorder. And this is because there may not be, contrary to some of our expectations - even our philosophically or phenomenologically sophisticated expectations - no 'what' to 'what is said' which requires further interpretation. What we do need to try to come to see is when our understandings run out, when cases of psychosis subvert or exceed our automatically-deployed sense-making disposition. In what follows, exposition precedes critique.

Exposition

Read's understanding of schizophrenia is developed against Louis Sass's brilliant analysis. Let us recall briefly some of its key details: Schizophrenia may best be understood as a disease of hyper-rationality, of thinking too much about what is normally taken for granted; as with philosophical scepticism, then, it may incoherently bring into question the pre-reflective foundations of human understanding, undermining its own intelligibility in the process; and as with philosophical solipsism, which also imagines that thought can obtain for a solitary unworlded subject, the schizophrenic person may, with affective and bodily and intersubjective detachment, attempt to think their way to, rather than prereflectively reside within, a coherent grip on the world.

Consequently, as with philosophical solipsism, their thought may develop in extraordinarily self-contradictory ways at the very same time. The self may become all (everything is subjective) whilst also becoming nothing (the contrast between self and other having been cancelled by the solipsistic process, selfhood collapses into objective reality), either simultaneously, or in an oscillating fashion. Hence certain delusions may, in an internally contradictory manner. be entertained as both true only of oneself, but also as true statements about objective reality. (In order to appreciate this fully it is necessary to first explore Wittgenstein's philosophical therapeutics of solipsism. Peter Hacker's is a good place to start on a task which won't be considered further here. Only to say that the solipsist, and the schizophrenic judge Schreber, act as if they might measure their own height by placing their hand on top of their head. The requisite independence of a measuring system from what is measured is not respected, and consequently we only have a shadow-talk of measuring here.) Whilst the philosopher 'entertains' her sceptical or solipsistic thoughts in disengaged moments of study, and then like Hume returns to the non-sceptical world of the billiard table, the schizophrenic 'lives out' the sceptical scenario.

Now Read is much taken (as I am) by Sass's reading of schizophrenia (which was one of the greatest contributions - regardless of how satisfactory we ultimately find it to be - to phenomenological psychopathology of the second half of the twentieth century). But as I wrote above, Read questions whether in central, severe yet prototypical, cases 'schizophrenia' can be read at all. Just as Diamond, Conant et al want to get us to see the early Wittgenstein as (albeit deliberately) talking nonsense in the Tractatus (to effect a Zen-like therapeutic end), rather than as gesturing towards ineffable truths, so Read wants us to see what the schizophrenic says as inviting a reading which nevertheless does not count as a reading. For what Read is primarily interested in, in his book, are the ways in which what we say (especially but not only when we are doing philosophy) exceeds what we can imagine. Or to put it differently, how what we imagine we can imagine exceeds what we can really imagine. (It is just this which Wittgenstein meant by 'getting held captive by a picture'.). So p. 72:

I want to suggest that we have not been given good reason to think that there can be any such thing as understanding an actual person who is thoroughly in the grip of such absurdities as Sass describes. To do so, to be able truly to understand a lived solipsism, would be somewhat like understanding 'logically alien thought' - but the point, as Wittgenstein was the first to argue, is that there isn't any such thing as (what we will in the end be satisfied to call) 'logically alien thought. (A fortiori, there can't be any such thing as understanding 'it'.)

Just as there cannot be any such thing as 'thinking' solipsism - no such thought to think - so too there cannot be any such thing as 'living it out' in schizophrenia.

What we are left with, then, is an acknowledgement that one of the best understandings we have of the nature of schizophrenic thought (i.e. Sass's understanding) is not so much an understanding, but itself a self-deconstructing picture which has deployed a 'picture' to take us beyond what can coherently be said. Like Wittgenstein's ladder in the Tractatus (p. 77), we are ultimately compelled to throw Sass's account away (pp. 74, 75):

'Quasi-thought', thought or talk in the nowhere 'beyond' the limits of thought, consisting of quasi-thoughts which are, roughly, 'logically alien', which canonly be mentall compassed through an overly hopeful and presumptuous process of analogy, or through imaginative mental projection of quite dubious status, is 'simply' not, strictly speaking, to be regarded as comprehensible. As Wittgenstein once remarked, indiscussing the related problem of 'private language': "I cannot accept his tesetimony because it is not testimony. It only tells me what he is inclined to say" (PI 386).

We have no criteria via which cognitively to evaluate [cases of severe mental illness], and so whatever we attempt to say of them by way of affirmative characterization will be arbitrary, and in a way quite misleading.

So, summary over. Let me say: I find Read's reading of Wittgenstein and of Sass compelling, and hence am convinced that he is right to question whether Sass, or anyone else for that matter, can provide us with a coherent positive account of the nature of schizophrenic experience. But, nevertheless, I am troubled. And perhaps it is the clinician in me, rather than the philosopher, that is primarily troubled. So I shall now try to spell out what my troubles are.

Critique

First, Read is careful to limit his critique to what he calls 'severe' or 'chronic' cases of schizophrenia. These however are surely different designators (when I think of 'chronic cases' I think mainly of so-called 'negative symptoms' lasting for a long time, cases in which delusions may have long been given up (in which delusions may even be signs of mental health), whereas when I think of cases of extreme schizophrenic delusion of the sort which necessarily present challenges to the understanding of the sort envisaged by Read, I am not thinking of something that may never remit). Further, it seems that, despite the disclaimer, his critique is really directed at Sass's account in toto - whether or not it is being used to describe more or less severe cases. It is not as if - surely - a solipsistic reading might really 'work' for someone with only mild or transient delusions? (Further, it is important to distinguish between the person with schizophrenia and their schizophrenic thoughts. Much of what the person says will be entirely sane, and remains uncontaminated by their delusional thought.)

Second, however, I can't help but feel that some subtle and unintentional injustice is being done to the sufferer from schizophrenia by Read (and perhaps by Sass too?). I am unclear quite how to articulate this, but I'll risk the following here. What I would like to distinguish between is: i) my understanding of what the person with schizophrenia says, and ii) my understanding of the person with schizophrenia. My idea is that my discomfort comes from the way in which these two are brought together by Read (e.g. p. 71: 'understanding schizophrenia, understanding the people who suffer from it'). In the process it seems to me that difficulties in coming to understand what the person says are automatically taken to be difficulties in coming to understand the person who is doing the talking. And the problem with this is that the clinical encounter seems in danger of being robbed of one of the ingredients which makes it therapeutically valuable, namely, the clinician's humane understanding of their patient (and not simply their explanation of their symptoms).

Now it would be daft of me to suppose that the two concepts are not internally related. My understanding of what you say and do is partly - but not entirely - of a piece with my understanding of you the person. But it is important to notice the different forms of understanding that abound in this territory. Thus we could distinguish between:

  • Understanding what you say (grasping the propositional content).
  • Understanding why you say it (what you are trying to achieve by saying it).
  • Understanding what motivates your saying this (for example, unconscious wishes).
  • Understanding what is expressed by what is said (for example, the affects that permeate the words).
  • More vaguely, understanding 'where you are coming from'.
  • Being understanding towards you (empathy).
  • Acknowledging what you say, in the ethical sense of offering you (and not just your words) recognition.
  • Being able to identify with you when you say or do this or that in such and such a situation.
  • Understanding your rendition of a piece of music.
  • Understanding why the composer modulated into G minor at that point.
  • Understanding why this wine goes with this, but not that, food.
  • Understanding when someone says that tuesday is thin whilst wednesday is fat.

Rationalistic analytical philosophy often pushes us towards accounts of understanding which reduce it's forms to the schema of the first in the above list. As if all understanding were a matter of seeing what is being said and how it is rationally related to what else the person may say or do. I'm not accusing Read (unlike many of the theorists of the 'propositional attitude') of falling into this rationalism. But it's worth taking a short detour to set the scene.

What is missing when we take it that understanding involves just the grasping of the reasonableness of what is said is, I believe, a sense of understanding which speaks more to our capacity for identification with our interlocutor. When I say 'I can see why you felt like that' it may have nothing to do with my having discerned (or even have rendered myself responsive to the) rational relations between the feeling and the person's other beliefs or experience of the situation they are in. Perhaps the rationality of what is said does not come into it. Rather I simply find myself feeling the same feelings when I imagine the situation. And even more so, I may find that, having pursued this exercise of rather involuntary imagination, I have shifted or developed my set of expectations regarding what you might say or do or think or feel next which, it turns out, tallies rather nicely with what you are yourself disposed to say or do or think or feel.

Recall Wittgenstein's invitation to consider understanding as an ability, an ability which has me now being able to 'go on' in the manner deemed apposite. It is just one such ability that is often essential when I am with my clients who are suffering from schizophrenia. They may start to articulate what comes naturally to them to say, and I may, by allowing myself to be held captive by the solipsistic picture, come to be able to take part in this conversation. What is said may not articulate a real possibility. Nevertheless it is predictable, and furthermore it connects up in non-rationally-yet-nevertheless-anticipable ways with emotional and interpersonal experiences which are themselves fully intelligible.

There are, I believe, a variety of understandings that I can offer my client, ways of showing him understanding, even when what is said when he articulates his delusion is incoherent. Some of this understanding may involve a grasp of why delusional 'pictures' can be alluring replacements for unbearable affects. Some of it may come from letting the same cogs idle in my mind and noticing their shadow play on the wall of my imagination. Identification does not presuppose a rational appreciation of the merits of the beliefs of the person with whom we are identified. I may be able to imagine wanting to say or do the same things as my interlocutor even whilst I fully appreciate their intrinsic irrationality. The causal workings of my brain take care of the identification for me!

By way of developing this a little further, perhaps it would help to take note of all the ways in which our everyday understanding of ourselves, one another, our minds, our worlds, can rely on little more than 'what we are [groundlessly] inclined to say'. Lakoff and Johnson, for example, radically extend Wittgenstein's notion of secondary sense by cataloguing the 'conceptual metaphors' which constitute vast swathes of our discourse. The very idea of 'mental illness' has itself been argued to be one such example of secondary sense (standing to 'physical illness' as a 'rhyme for the eye' (words at the ends of the poem's lines look similar) stands to a 'rhyme for the ear') (Champlin, 1997).

None of this is intended as a critique of what Read primarily says, for what he offers is a sensitive, nuanced, intelligent reading of Wittgenstein and of Sass. It is intended, rather, primarily as a reflection on what he does not say, and on how much more could be said than he appears prepared to say, regarding our capacity to understand the person who is struggling to be a person in the ways characteristic of schizophrenia.

Wednesday, 23 July 2008

Saying Too Much

There are all sorts of junctures in philosophy and in psychopathological theory when we find ourselves wanting to say too much. To offer reasons when reasons have run out. To offer a theory when what we 'need' to be able to do is instead come to accept the facts as they are - and understand better what stops us from reaching this acceptance and instead leads us to pursue theory. In this post, which I hope to update whenever the chance arises, I want to begin to catalogue some of these ways in which we unwittingly transcend ourselves, and explore some of the reasons why this happens.

1. Feeling unsure, unsafe, anxious, we look for a justification of our point of view, even when our 'point of view' is actually 'bedrock' - i.e. is the kind of everyday common sense which does not offer an account of what we find in our experience, but is itself the articulation of that experience. The 'groundlessness' of our existence is not a metaphysical surprise - since its opposite is strictly speaking unintelligible (recall the myth that the world rests on an elephant, and that rests on a turtle, and after that it's turtles 'all the way down' ('down to where?!' is the operative question!)). Nevertheless when feeling destabilised we seek grounds and certainty. Perhaps we have been taken out of (our) context. What we ought to do in these situations is to wait for things to settle down, for patterns of habit and reason to gradually solidify and emerge around us, to provide workable pathways through the conversational contexts of our everyday lives. Instead we get out a shovel and start digging to to find a mythical super-hard path that is allegedly buried beneath.

2. Relatedly, someone - a sceptic for example - starts to (try to bring into) question our everyday beliefs. Or perhaps they start first of all by characterising certain statements we find ourselves wanting to say in the face of sceptical doubt ('here is one hand') as the expression of beliefs. And feeling on the defensive, we lose confidence in simply sticking with our original assertion, and feel the need to say more. The sceptic has invoked a question-and-answer game which, to be sure, has its rightful place at certain junctures in our lives. And being caught on the back foot, we fail to inquire whether there really is the room for playing that game here, and instead take up the challenge, and try to counter their moves in the usual way. (Imagine: Someone lays out the chess pieces on a board which has (if we only stopped to look) irregular black-white square patterning, or which has too few squares, and insists quite forcefully that we play. And caught up in this we now start to take our inability to now know what to do with our knight as some kind of lacuna in our ability to play chess.)

3. Or we come to this situation of wanting to dig below bedrock, wanting to play a game when there is no space to lay it out, because we have become inwardly alienated from our own lives, and project a mental shadow of our discursive practices back onto them. Let me spell out what I mean. First: The kinds of philosophical situations in which we are 'saying too much' are, here, cases in which we are wrongly inclined to philosophically explain our everyday capacities - to speak a language, to speak our minds, to see where others are coming from. To say what these 'consist in'. Second: Here's an image: I am engaged in a certain kind of pattern play in the world. I can imagine, now, pausing for a moment and recreating this pattern play 'in my mind'. Perhaps I get quite familiar with this mental pattern play, engaging in it without any external support. So familiar, in fact, that I now start to presuppose that any worldly pattern play must, to count as genuinely an intelligent, meaningful, activity, be some kind of outward expression of the inner ersatz. And I embark on a question to find out how the inner pattern play creates what is alleged to be its external correlate. All of a sudden there seems to be a 'how' question that demands to be answered - how do I think, talk, listen, understand, write, grasp. It seems there must be some story to be told about how the intentionality securely possessed by the inner ersatz finds its way into the world of praxical endeavour.

4. The question of whether a response, justification, theory, explanation, is or is not called for in any particular instance is not one which can be settled in advance by reference to a criterion, rule, algorithm. This is a 'standing issue'. I'm thinking here in particular of reasons for actions. Whether or not my having said or done x is something for which a reason, an exculpation, a justification can intelligibly be offered will depend upon the context in which x is done. And no simple dividing line can be given to distinguish between these different context. In fact, given the hermeneutic character of our everyday (non-philosophical) engaged discernment of such contexts, the very acts of everyday sense-making, context-discrimination, etc. cannot be considered purely reflective and descriptive of a first-order domain of contexts of reason provision or abstention. Rather, the discernment itself feeds the unfolding of the practice. Yet, despite this, there remains the possibility of error. However better or worse judgement are to be individuated we do find ourselves, against our better judgement, making mistakes about which context we are in and accordingly with whether an explanation is or is not called for. To err is human.

5. We can want to say too much when we want to connect. I'm thinking in particular of how we can want to say too much about what someone else is saying or doing, when we want to find it intelligible - but it is not. This is a standing difficulty in encounters with people suffering from psychosis, or even in trying to make sense of our own idiosyncrasies or madnesses (psychotic or otherwise). It sounds like it ought to be intelligible. The words in another context may very well be. So we start to import one context after another. But then the next sentence, or sentence fragment, would need a different context for it to be understood. And we just can't reconcile the contexts. (This is how thought falls apart in thought disorder: the background contexts slip and slide. They don't stay still enough for us to find our feet with whatever is said.)

6. We can say too much when we follow the track set by the source of a conceptual metaphor into aspects of the target domain for that metaphor which are not in fact constrained, are not part of, the metaphor. So we presuppose that there will be a greater conceptual determinacy to be found than is in fact the case in the language game in question. Perhaps we get carried away by some spatial metaphors which constitute our discourse around time, and end up just taking it as obvious that 'time travel' is an intelligible possibility. (I don't mean to say that there isn't indeed something we might want to call 'time travel' - only to say that we shouldn't take it as obvious that we understand what is meant by such a term simply on the basis of our application, in temporal contexts, of the notions of before and after, in front and behind, long and short, etc.)

7. We may so utterly take for granted - without thinking about them, without realising their significance - the contexts of intelligibility we inhabit, that we fail to notice when we have abrogated, stepped outside of, their guiding influence. We then take it that the set of concepts operative within such contexts are available for theoretical deployment (for making explanatory theories, or just for everyday sense-making) in contexts which themselves involve a degrading of the structures of intelligibility. I'm thinking in particular here of two mutually reinforcing fallacies operative in psychopathological theory. On the one hand: psychological concepts are imagined to be far more free-standing (non-background-dependent) than they are. We fail to notice the necessity of background regularities for their coherent deployment. On the other hand: psychopathological conditions are treated as if they are puzzles to be made sense of, and the ways in which they themselves involve degrading of contexts of intelligibility is overlooked. Accordingly, the tacitly de-contextualised everyday psychological concepts are deployed in pseudo-explanatory theories, or sense-making endeavours, of psychopathological material.

Friday, 18 July 2008

Miracles of Expression and Understanding


"Language is Miraculous."

This is a claim at once absurd and viable I wish to develop a little further. I should say in advance that the development is speculative, metaphorical, under-theorised. I've been in too good a mood recently to have any decent thoughts. And perhaps the pull of the attractor basins of more workable understandings in our common conceptual currency will be too great to allow for the requisite patience for such ill-formed thoughts to be entertained by any sensible reader.

It is tempting to develop the miracle claim by comparing expressive with descriptive language. By, that is, describing the contrast in such a way as the miraculous character of the expressive can be compared with the banal character of the descriptive. But in the sense in which it is miraculous, descriptive language is no less expressive than expressive language. It is the 'expressivity' of all language which is miraculous. Which is, in a way, not to draw a real contrast, and so to risk not saying anything, or to risk mystical Tractarian posturing about showing instead of saying something. I mention these concerns because, well, because they have occurred to me along the way, presented themselves as more viable opportunities for the development of the putative thought than they were.

It is tempting to think that language, spoken or written, has a function. Of course we use this or that bit of language for a thousand functions. But these functions are defined internally to the uses of language; they are not determined from outside. So, yes, it is tempting to think that language has some overall function. To 'represent reality' perhaps. To 'convey information'. To 'convey ideas'. To 'describe'.

But in the relevant sense, language tout court has no purpose. Or better, it makes no sense to ascribe an overall purpose to language use. Our life with language is the field in which purposes are opened up as possibilities; what sense then to ascribe a purpose to discourse per se?

But then in what sense is language 'miraculous'? I think it seems miraculous when, at least, we approach it from an already crumbling instrumentalist perspective. When we had imagined, in our phantasy, that we somehow typically stand behind, stand back from, our language and put it to use. And then we realise that it can't be like that. I don't mean to say that this is the only perspective from which it seems miraculous; I shall return to this below.

Heidegger wrote that language speaks us, we do not speak it. (See Charles Taylor on 'Heidegger, Language, Ecology'.) In saying this he was speaking nonsense in order to remove a narcissistic prejudice. For whilst of course language does not literally 'speak us' (that doesn't mean anything!), and whilst of course we speak a language or a sentence and not language per se, to the extent that (as it were) it is (which it is not) true (rather than just meaningless) to say that we don't speak language, then to this extent it is true to say that language speaks us. But a better way to put it would be to acknowledge that 'we' and 'language' are internally related - whilst remembering that the former (if we take 'we' in a royal sense) has been around for a good deal less time than the latter. (Hence Heidegger's phrasology, or so I'm supposing.)

We start life by grunting, and gradually this grunting richens itself into discourse. Wittgenstein's developmental parable (Investigations, para 244) about the development of first-person sensation language works not just by countering an 'inner description' myth with a story about expression or avowal. Rather it works by reminding us of the ongoing immediacy of the relation, or better the non-relation, of the grunt to the sensation.

How do words refer to sensations? -- There doesn't seem to be any problem here; don't we talk about sensations every day, and give them names? But how is the connection between the name and the thing named set up? This question is the same as: how does a human being learn the meaning of the names of sensations? -- of the word "pain" for example. Here is one possibility: words are connected with the primitive, the natural, expressions of the sensation and used in their place. A child has hurt himself and he cries; and then adults talk to him and teach him exclamations and, later, sentences. They teach the child new pain -- behavior.

We do not (typically) feel a desire to grunt and then grunt; we do not find we have something to grunt about and then grunt. We just: grunt. Grunting is where we are at that moment. We are grunting. And so too with discourse. (cf Schreber's bellowing miracle. Perhaps what made Schreber's bellowing seem miraculous to him was that it refused to fit the dominant psychotic phantasy that he was instrumentally reesponsible for his own expression.)

"It is miraculous that we 'express our thoughts' in language." "It is miraculous that we 'understand' each other's utterances." This understanding is no less immediate (except when we don't at first understand - of course!) than the grunting. We are "there with each other" in language. We are born into it, we live it, it lives us. From the perspective of narcissistic instrumentalism, understanding comes to look like sense-making, sense-finding, interpretation, decoding. But that is what is 'so miraculous': this (apart from in all the interesting exceptions themselves proving, relying on, the rule) just doesn't happen. Understanding is there. You speak, I carry on. 'A packet of crisps please'. 'That will be 40 pence'. There: understanding, speaking; no thinking. This just does happen.

Or, if there had been thinking, then the very occurrence of that thinking - without prior thinking - would be - is - 'miraculous' in just the same way.

If it is almost sensible to speak of 'miraculous', this is because there is one very good sense in which it is impossible, senseless, to try to explain how we speak or how we understand. And it seems particularly miraculous because it comes all too naturally to take up a perspective from which it seems that some such explanation really ought to be forthcoming here. That perspective is the one from which we are, as it were, 'behind' our language, the instrumental narcissistic homuncular user of our language.

It is senseless, in this one very good sense, to ask or answer how we speak or understand, when that question is asking for an explanation of how thought or intention gets put into language, or how it gets read off from it. Attempting that quite general explanation once again quite gets the cart before the horse or, more absurdly yet justly put, gets the horse before itself. Augustine imagined that learning a first language was like learning a second language (Investigations para 1). The thing is, though, that in the relevant sense in which we might be inclined to say how we learn our first language: There isn't a how. Again - there are a thousand hows for a thousand specific questions, questions that arise within the life of the language user, but to think about those parts here is not to accept the dubious global invitation that philosophy is holding out for us.

A change of tack.

"Neurosis results from attempts to speak (or not speak) speech, to perform (or not perform) actions, to feel (or not feel) feelings." That is a bold claim, but I believe it is just. It helps explain, amongst many other things, why neurosis never 'works'. We try to speak our lives, but our symptoms just start to speak us. Neurosis is a fear, a hopeless flight from, the miraculous.

ACT, amongst other new-wave CBTs, asks us to accept our thoughts as just that, and to 'defuse' from them. (In fact it (rather incoherently) seems to go one step further, and views thoughts as private verbal events. But clearly a thought is not that, for we can have private verbal events which are not thoughts but which are, say, our inner soliloquising rehearsal of our lines for a play.) It encourages us to 'comprehensively distance ourselves' (defuse) from our thoughts, to stop treating them as necessarily reflecting the way things are, and to see them for what they are - i.e.: thoughts.

It occurs to me that, by encouraging a 'noticing' relation to own's own thoughts, we might run the risk of encouraging neurosis. That kind of self-alienation - in which one starts to exist in a cognitive or quasi-perceptual relation to one's own thought - in which the idea that one is one's thoughts - is just what neurosis amounts to.

So is there another way to describe what ACT is doing? Well, I think there is. It is - building acceptance of the occurrence of these thoughts, accepting that they occur, that they are moments of us - removing the instrumentalist control agendas that we neurotically develop in relation to our thoughts and feelings.

The relevant de-fusion is between thought and world, not between thought and self. Through this defusion, the thoughts are (as Richard Wollheim would say) 'brought under the regulative concept of' 'belief'; they are owned as such. And belief is a cooler place to stand than in the heat generated by the knowledge and delusion driven by desire.