Saturday, 21 November 2009

why psychology is a bit rubbish really

Er... a shamelessly hyperbolic and attention-seeking title I know. Anyway, I thought I (a psychologist) would spend a few moments clearly specifying why it seems to me that psychology is a rather limited discipline when it comes to understanding psychopathology. Of course I'm playing rather fast and loose with what is to count as the extension of 'psychology' but I hope my caricature will at least be recognisable.

Psychology today tells us about - to use a shorthand - what happens 'in minds'. That's just what psychology is. It tells us about what people think and feel and intend and will and 'represent'. And as well as telling us about what representations are in the mind, it tells us about how people think and feel and... We have 'mental states' and then we have the 'mental processes' that link these states together.

The natural deployment of this framework in psychopathological contexts suggests that in psychopathology people's representations of others or themselves or their worlds are faulty in content (a faulty 'what'), or there are faulty links between these representations (a faulty 'how'). Perhaps someone's feelings are out of proportion to a situation; perhaps their beliefs are inaccurate; perhaps they are jumping to conclusions, etc. It is either mental states that are disturbed, or mental processes that are breaking down. And that is the sum of it, of what it means to 'do the psychology' of psychopathological conditions or states, on the story I'm telling.

The problem is, however, that most of what we recognise as proper psychopathology is not at all aptly characterised as due to a faulty contents or broken processes. What most frank psychopathology involves is not a failure in the mind's mirroring capacities, a failure of what is in the mind (states or processes), but rather in the structuration of the mind itself.

By structuration I do not mean 'stage of development' or 'degree of complexity'. That, it seems to me, is (in this context alone) another psychologist's red herring. I have in mind rather the way in which the faculties dialectically unfold into their mutually constituting yet opposing domains. To understand this we need the conceptual resources not of psychology, which can only tell us about what's happening within minds, but rather of existential phenomenology, which tells us about the essential character of mindedness itself.

Here's a rather daft pictorial way of demonstrating what I'm getting at. First we have a picture of a normal mind doing its normal job. (It's not supposed to instantiate a valid faculty psychology, just to help me make a theoretical point!)

Here we've got someone looking at a dog, recognising what to call it, laying down a memory, shutting their eyes and drawing on their memory to call up an imaginary dog, etc. We have a mental process of perception leading to a mental representation etc. etc.

Now we imagine someone suffering from some deficits in their mental states and mental processes. Here's one possible result:

What we have here are a whole host of different difficulties: a faulty perceptual processes leading to the internal representation of the dog being somewhat truncated; dodgy memory processes such that we have a lack of laying down of new memories, and a knackered verbal recognition ability such that the term 'hog' comes to mind instead of 'dog'.

Such a way of depicting matters comes fairly naturally when we are thinking of specific brain injuries or fairly localised dementing processes. What I want to claim is that, despite the ambitions of cognitive clinical psychology or cognitive neuropsychiatry, it just won't do at all when we try to grasp the essential character of psychopathological conditions such as OCD or psychosis.

The essential character of such conditions, I want to suggest, lies in the fact that, under certain pressures and in certain contexts, we have a failure in the structuration of the faculties and of the very mind itself. This is difficult to represent pictorially because another claim on the table has is that to the extent that we have deviation from that structuration which separates what is inside the mind from what is outside, or which separates the imagination from memory or from perception, we have a loss of mindedness itself. I've tried to represent this in the following picture by showing how, when we have a movement of the boundary of the faculty, we simultaneously and necessarily also get a loss of that very boundary:

Our ability to really talk about distinct faculties, to place a representation within one rather than the other, starts to blur. It may become hard to say where the self ends and the world begins (witness the intruding dog). Yet this is simultaneously to say that it starts to become hard to talk about distinct selfhood at all, since self and world-as-experienced-and-understood just are mutually yet opositionally defined. Whether we have to deal with a memory or an imagination or a perception becomes unclear. Verbal recognition starts to intrude into perception. Again, it's not just that, say, something within the mind gets mislocated, or mental processes mediating representations between faculties become impaired. (That's the standard cognitive psychological model of mental disturbance.) Rather, the very possibilities of making coherent distinctions between imagining and seeing starts, especially in particular affectively significant contexts, to fall apart.

Cognitive models of obsessive compulsive disorder tell us that 'everyone gets intrusive thoughts. It's just that the person with OCD wrongly perceives the significance of these, taking themselves to be responsible etc.' To my mind this radically misunderstands the nature of both intrusive thoughts and of obsessional responsibility-taking. The obsessive person 'takes responsibility for' things that it doesn't even make sense to take responsibility for. I mean that quite literally: pushed to an extreme we start to lose track of what it even means to say that they are 'taking responsibility' in these situations. We can have some kind of a psychodynamic understanding of this: faced by an intolerable self-shattering anxiety they enact self-constructions which distort the relation between self and world so that a damaged self can take itself to have more agency and therefore control over the unpredictable beyond than it makes sense to have.

Now normalising is often very laudable, and clinically this seems to be a useful strategy, but phenomenologically speaking it's mighty suspect, and I can't help entertain the thought that, like several cognitive interventions, what is helpful in aiding the patient to return to some kind of relative stability may get in the way of deeper restructurations of the self. One could even say that normalising is the precondition of (im/possibility of) the whole psychological project, since psychology, restricted to talking about what is happening within minds and faculties, simply lacks the resources of existential phenomenology for theorising the character of deep disturbances of mindedness and faculty divisions themselves.