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.