Tuesday, 30 September 2008

Psychosis, Humanity, Dialectics



I've been struck recently, in my clinical work, by the way in which psychosis both:
  • Challenges the humanity of the sufferer
  • Reveals the sufferer at his or her most human
often at one and the same time. Further, or so I want to suggest, only a properly dialectical understanding of selfhood allows us to appreciate just why this is so. So - first - what do I mean by dialectical?

Let's start with what I don't mean. There are, it seems to me, many conceptions, or concepts, the meaning of which can be understood simply by virtue of their place in a differentiated web of other such conceptions. Leaving aside spurious metaphysical notions of self-identity, identity conditions are typically given by "différance". Left is what is not right, right is not left, and the meaning of a term is at least in part a function of the differentiating work that this term carries out within the web of signifiers. Such meaning is not however, by itself, dialectical in the sense I wish to indicate here. For whilst we must understand what 'right' means in order to understand 'left', this is an exclusory understanding: right is just not left.

Dialectical conceptions, however, work differently. A dialectical condition cannot be comprehended simply through a grasp of the differentiating play of signifiers. It is, rather, necessary to comprehend it in terms of an irresolvable tension, back and forth, between two opposed conceptions. Dialectical conceptions really do hold us in a tension; they are necessarily undefinable; and we can find no resting place within them. They do not repose at one juncture, one antithesis, in the way that non-dialectical concepts do.

'Self' and 'other' are concepts which are defined through their mutual opposition - but this in itself does nothing to make them 'dialectical'. The dialectical character of selfhood comes out, I want to claim, in an ongoing and unresting play between identification and differentiation. But let's consider first the most famous example of dialectical comprehension provided by Hegel - in his discussion of the relations of masters and slaves - sufficiently gripping and sufficiently near the beginning of the Phenomenology of Spirit for readers (like me) who never got round to reading the whole thing to pretentiously wield around the place as if they knew what Hegel was generally all about. (Not as bad as clichéd references to Proust's madelaines (they crop up near the beginning of volume 1 of In Search of Lost Time, if my rememberances serve me right, which is also as far as I - and I suspect many others - got with that work) but, well... nearly...) As John Elster summarises the discussion in his super little book - An Introduction to Karl Marx (p. 37) -
The contradictory desire Hegel finds in the master is the desire for a unilateral recognition. The master wants to be recognized by the slave, but he does not want to recognize the slave in return. This constellation of desires is contradictory because recognition, to be worth anything, must come from someone who is worth recognizing. ... To be recognized by someone whom we pay to lavish us with praise can at most give a fleeting satisfaction; it is like transferring money from one pocket to another [cf Wittgenstein's examples in the Investigations of giving a gift from one hand to the other], not like receiving an additional income. Although strange, such strivings play an important part in human behavior.
To be recognised as a master, I must also confer recognition to the slave - otherwise they cannot count as a meaningful recogniser. But how much is enough, and how much too much? There is no answer to this: the social contract must be continually negotiated, fought over, redefined.

So too, I want to claim, with selfhood more generally. What is dialectical comes out not in the fact that 'self' and 'other' must be defined in relation to one another; there's nothing dialectical about that per se. Rather it comes out in the process by which we comprehend one another as distinct selves - which process necessarily involves identification.

To recognise the other as other, we must acknowledge their separateness, their difference from us. But to recognise them as an other self, we must be able to identify with them. Such identification demands a capacity to relinquish separation or difference. And in order to genuinely relate to others as others, we must oscillate between the two, constantly back and forth. There is no pre-defined mid-point or definition of a balance between the two extremes of an isolation which denies oneself the possibility of achieving recognition, and an identification which risks losing one's selfhood entirely in the other.

This dialectic has varied forms. Some of them are largely embedded in our self-understandings, implicit or explicit. A 'dialogical' approach is offered to us by the Lysakers in their important new book Schizophrenia and the Fate of the Self. It is important to note that by 'dialogical' they do not mean 'dialectical' (purely verbal modes of engagement), and they are concerned largely with our ability to sustain and move between various different positions of self-in-relation-to-others. Nevertheless it would be fair to say that theirs is largely a more discursive approach than is found in other psychiatric/phenomenological theories, which provide a primarily sensori-motoric or principally non-verbal affective understanding, where the principle 'positions' one is able to occupy are not those sustained through discourse-involving practices, but rather through postural, proprioceptive and exteroceptive, motoric-interactive engagements. But regardless of the particular medium, my claim here is that the condition of psychosis, perhaps in particular psychosis as it occurs in the 'schizophrenic' disorders, is precisely due to struggles with such dialectical processes. Throwing ourselves into this dialectic, we risk losing ourself in the other, being taken for granted, being the object of transference or projection, being strung along, for the sake of a chance at being and becoming. (I'm dramatising here to make the point: much of the dialectic is doubtless sustained and modulated by automatic neurobiological processes.) Removing ourselves from the dialectical process we keep safe at the expense of existing (since existing is being-in-the-world).

This, then, is why I believe that psychosis often strikes me as both a challenge to the humanity of the sufferer, and also as itself a window into what is most human about him or her. It is in our attempts at, or our preconscious capacities for, managing our dialectical encounters that we are engaged most fully on the pursuit of being human. And it is due to a great fragility in the capacity to sustain a sense of self-in-relation-to-others that the person with schizophrenic psychosis is so vulnerable to alienation and deadening on the one hand, or to the processes which Laing so aptly characterised of implosion or petrification or engulfment on the other. If the pursuit of our own humanity - our ongoing management of our self-in-relation-to-others - were not a dialectical affair, then psychosis would simply present as a diminishment of humanity. But it is a dialectical concern: being human is not a matter of approximating to some one stable standpoint, but of continually negotiating a balance between identification and differentiation. To this extent, then, the sufferer from psychosis is not, as Sullivan had it, just 'more simply human than otherwise'.

Addendum

The Frankfurt School were suspicious of non- or anti-dialectical stances in critical thought. This, it might be suggested, is what led core members to withdraw support from Fromm's increasingly non-dialectical, ego-psychological, potentially-mythologising thought. That at least is how Martin Jay seems to understand it, in his book on The Dialectical Imagination (on the Frankfurt School). He quotes from Fromm's The Heart of Man:
This duality [of death and life instincts] is not one of two biologically inherent instincts, relatively constant and always battling with each other until the final victory of the death instinct, but it is one between the primary and most fundamental tendency of life - to persevere in life - and its contradiction, which comes into being when man fails in this goal.
Here we do not have the human condition being (partly) defined through a shifting tension between two opposites. Rather, we have one tendency posited as primary (to persevere in life) and a contrary tendency (towards death) emerging only secondarily. This is nothing to do with dialectics proper, it seems to me. Whatever one thinks of the notions of the death drive and eros, thinking which draws upon them enjoys the possibility of sustaining dialectical tensions and not slipping into mythocentric psychologised religion. (It is just this insistence on the ubiquity of the tragic, and on the sui-generis character of aggressive drives, which marks out Kleinian as opposed, say, to Fairbairnian, thought as containing the greater ethical and intellectual potential and promise (whatever the actual ethics and understandings on offer in dominant Kleinian paradigms.))