Tuesday, 19 October 2010

identification, projection and interpersonal understanding

Peter Hobson's chapter on Emotion, Self-/Other-Awareness, and Autism: A Developmental Perspective in Peter Goldie's (Ed) Oxford Handbook of the Philosophy of Emotion posits identification as a core driver of our developing understanding of one another. Against simulationists he holds that imagination, as it is normally understood, is not what it takes for us to grasp another. It is not that we understand one another because we imaginatively project ourselves into their shoes. Importantly, it is not as if we start with a viable understanding of ourself, and then go on to make use of this in understanding other people. Against simulationist's main rivals, the theory theorists, he holds that the relevant abilities are far more developmentally primitive and non-cognitive than the idea that they are a function of deploying a tacit theory would suggest.

And that all sounds very attractive. But what is identification, and how does it help us to make sense of one another? Well, I suspect the latter part of that question may be badly put - in so far as it suggests that we know what it is to understand one another but are just unsure about the route we take to come to this understanding. At any rate, here is my answer to the question.

First, understanding someone is here not something other than being able to unreflectively anticipate their next gesture or movement or utterance. This pre-reflective non-predictive expectation is what it is for us to be able to find our feet with one another, to be able to 'make sense of' how someone is behaving.

Next, emotions are object-relations, where these intentional relations are primitive forms of social understanding. When I feel hurt, this feeling is my grasp of your hurtfulness, your slight of me. The emotion discloses to me the social meaning of your action. Emotion is a window onto the social world, and emotion - in all its own dispositional glory - is an embodied action-guiding grasp of others: without it there is no such thing as true social understanding, since this more cognitively elaborate forms of this understanding are always embedded on the most primitive emotional form.

It is true that to understand your anger I need not myself be angry. More likely I will be afraid. It is in my fear that your anger is disclosed to me. So there can be no straightforward story about identification leading to similar emotional experience leading (somehow) to understanding. That way of thinking about it in any case is highly external - once again we have the identification leading to understanding, rather than being part of its very form.

So what is it for me to be able to 'feel' or 'come to know' your anger? It could be that you remain blankly on the outside of my understanding, as may be the case for the autistic child. For this coming to know to obtain, two processes must, I believe, take place.

First we have the identificatory entering into the space of shared experience. This is a kind of loss of self, a merging. Your arousal becomes my arousal at this point. Identification is in a sense a pre-psychological process - part of something which makes for a psychological experience of understanding, but not itself something which is a psychological experience. (It doesn't happen within a psyche, one might say, to borrow the Cartesian spatial metaphor: rather it structures the psyche itself in a part of itself.)

Second we have the differentiating 'cut' of self and other, in which the directionality of emotion is registered. For example, your arousal is directed outwards rather than inwards: you are angry rather than fearful. In the conjoint intentional field, the reinstating of self-other differentiation leads to me feeling afraid. My fear is my recognition of your anger.

I've talked about 'first' and 'second' here, but I suspect that we don't have to do with two temporal segments of experience, but rather two merely-formally-separable aspects of interpersonal understanding.

Of course identification need not be accompanied by differentiation. For example, the little boy does the things his father does, adopts his mannerisms, all quite unconsicously. What it is to pattern yourself on someone in this pre-reflective manner is to allow your neurological system to reverberate with theirs. Well, actually the difficult thing is preventing this from happening, rather than allowing it: identification usually happens automatically. This is a powerful learning mechanism, but it does not come with understanding unless we also have the cut of differentiation.

Yet of course the cut can be drawn in the wrong place. Where it is drawn - how the arousal in the interpersonal sphere comes to be divided into the complementary doublets of anger and fear, for example (or sadness and pity) - will depend not only on the identifier but also on the identified-with. Forms of emotional micro-interaction can affect, skew, the placing of the 'cut' (or the 'chiasm' as Merleau-Ponty calls it). Hence we get projective and introjective forms of identification, where I take in some of you or lose some of myself in you. The placement of the chiasm is also, as we know all too well in therapy, under largely unconscious motivational control.

And we have the work of therapy itself where I manage, metabolise, and then reflectively or otherwise feed back your projections into me.

Tuesday, 24 August 2010

OC and OCD

evocative image borrowed with thanks from http://www.addictionrecov.org/paradigm/P_PR_F99/piacentini.htm
Ludwig Wittgenstein
Wittgenstein's On Certainty contains a wealth of references to the 'madness' or 'insanity' or 'dementia' one would have to suffer from in order to not insincerely come out with the kinds of things that otherwise only the philosophical sceptic wants to say. Within the text the appeal is made from an intuitive understanding of what it would be to be 'mad' to an explication of the logic of the non-epistemic foundations of our negotiations (epistemic and otherwise) with others and with our environments. Perhaps that serves well the philosopher's purposes but, from a psychopathologist's point of view, what is more interesting and more illuminating is the tracking of the phenomenological implications in the reverse direction. What, that is, does the account of the character of our 'lived certainties' - which it makes no sense to talk of doubting or believing or justifying (or perhaps even 'knowing') - tell us about the foundations of our sanity? And what, by implication, does it tell us about the primitive location of the deficit in psychosis: a disturbance not in inference making (and in this sense not in rationality), nor in 'mistaken' perception, but rather in our embodied, embedded, (logically, not developmentally, speaking) pre-rational and pre-reflective coping and comportment. (See Rhodes & Gipps (2008) and Gipps & Rhodes (2008 & 2011) for development of this idea.)

In this post, however, I want to start to explore another way in which On Certainty provides rich phenomenological pickings for the psychopathologist. This time my focus is not on psychosis but on obsessive compulsive disorder. Whereas in delusion and psychosis the focus is on what is believed, here the focus will be on what is doubted.

Cognitive models of OCD (see e.g. chapter 9 of Wells' Cognitive Therapy of Anxiety Disorders) would have us believe that the psychopathological action is to be located in the character of the patient's meta-cognitive relationship with their intrusive thoughts. To take a typical example: Mary finds thoughts of her son being run over coming unbidden into her head. She also worries that the having of such thoughts betrays a wish she has, or in some other way may magically bring about the feared outcome. Delighting as they do in reinventing the psychoanalytical wheel, cognitive theorists since Rachman have relabelled 'magical thinking' as 'thought-action fusion'. The relevant confusion in the mind of the OCD patient that 'thought-action fusion' betokens is thought to be a meta-cognitive one:  thoughts are meta-cognitively taken to cause actions or events and/or to signify the likelihood of having actually performed the terrible action which the thought is taken to betoken.

This location of the mental disturbance at a 'meta' level fits well with the 'You're alright Jack' normalising ambitions of the practice of cognitive therapy. "There's nothing wrong with your thoughts themselves - everyone has lots of strange or unpleasant thoughts all the time don't you know. The problem lies only with how you are appraising these thoughts. That's why you think you're going mad, etc. You are taking yourself to be responsible for the having of your thoughts, whereas in fact the mind just likes to churn them out; the only difference between you and someone without OCD is that they don't take much notice of their similar thoughts since they don't assume that they betoken intentions or veridical memories." The cognitive theory is, one might say, almost a direct inversion of the psychoanalytical one - the latter viewing the obsessions as expressions of intolerable and ambivalent wishes which, because of their intolerable nature to the patient, are expeirenced as foreign and intrusive - and because they cannot be assimilated and the ambivalence tolerated, retain such constant anxiogenic power. Whereas the cognitive practitioner tells the young mother 'Of course you don't really want to stab your baby; you are probably only having this intrusive thought because it is the worst thing you can think of and because you are trying not to think of it' ( - like trying not to think about a pink elephant, you're just onto a loser with such attempts at mind-control, especially if you think that there's something intrinsically evil or dangerous about thinking about pink elephants), the psychoanalytic practitioner wants to explore the possibility that it might be quite natural for the young mother to sometimes want to stab her baby, and to pursue the thought that perhaps such anger is better assimilated rather than split off (none of which is to say that she is any more likely than normal to actually stab her baby).

Now I have no wish to bluntly undo the 'you're not mad' message of the cognitive therapist for the OCD patient. (In fact we don't need the normalising theory to achieve this, since it is usually already contained in that which differentiates OCD from psychosis: namely the patient's own insight-ful and at-least-occasional appraisal of their own thoughts - and of their own compulsive rituals which are designed to reassure them and alleviate the anxiety caused by the obsessions - as irrational. 'I am performing this compulsion mainly to reduce my anxiety, regardless of whether the obsession is actually true'.) Therapeutically, however, normalising can come at quite a cost - when it tacitly indicates an unwillingness in the clinician to tolerate and contain the 'mad' parts of the patient. But, therapy aside, it is the viability of the psychopathological theory which concerns me here.

Here are the questions I wish to ask: 1) Is it the case that the patient with obsessive rumination is best understood as having normal first-order thoughts which are being meta-appraised in an irrational way through the lens of a hyper-responsible attitude? Or is it the case that what we have are rather first-order thoughts which, as part of their very own form, encourage an elision of the distinction between the real and the imagined? What could help us decide between these two formulations? 2) Further, if we opt for the latter, what are the key characteristics of the obsessional mind?

Shortly I will draw on Wittgenstein's On Certainty to describe what I take to be (2) some of the key features of obsessionality. But to consider questions (1) first: It is certainly true that the patient is able, in the clinic, at calmer times, to occupy a meta-perspective on their own thoughts - to see that they are being irrational when they are caught up in their anxious rumination and compulsion. Yet, at the time, what seems rather to characterise the obsessional struggle is not so much a being-pulled-between two opposed meta-attitudes (one saying: thoughts are causally inert; the other saying: I am now responsible if what I think happens) to first-order thoughts, but rather amounts to a being-pulled-between a) ordinary propositional attitudes and b) structurally degraded propositional attitudes.

Children sometimes show a form of thought which, especially if it became prevalent in adulthood, would be deemed obsessive-compulsive in character. The idea of the possibility of magic (action at a distance, mind reading, etc.) has not yet been fully overcome; the distinction between what is 'inside' and what is 'outside' the mind has not fully taken form. And this failure occurs in particular when the child is anxious - anxiety destabilising the intentional field (the field within which thought separates off from the world into a domain which can then be said to represent facts which are other than it itself). It can take the reassuring presence of the mind of another to allow the child to gain that composure required for going-on-being in the face of anxiety which otherwise overwhelms and undermines the very possibility of (the essential intentionality of) true thought. (By 'intentionality' I mean: thought's directedness at a world independent of it.)

And, to recap, my thought is here that what the anxiety makes for is not the presence of false meta-cognitive appraisals of first-order thoughts, but rather of structurally degraded first-order thoughts themselves. The child is going into a kind of altered state in which their thought itself is falling apart, failing to cling on to that separation from its objects which gives it the right to its title of 'thought'. In this magical thinking state, which is (more) aptly (than the cognitive theorist realises) called 'thought-action fusion' (since the thought is no longer comprehending itself as such), the child gains (in phantasy!) the ability to magically mend mind-splitting terrors, but also, and terrifyingly, a felt vulnerability to the terrors which their imagination, now failing to maintain its separation from reality-oriented thought, presents as if real. In describing this phantasy-ridden magical thinking state we naturally slip into the vocabulary of thought, imagination, understanding, etc., and find ourselves forced, if we are stick with this vocabulary of the 'propositional attitudes', to describe the patient's obsessional thoughts as such - as thoughts - and then to locate the pathology at what could now only be a metacognitive level. Rather, that is, than acknowledging the glimmering quasi-psychotic character of this aspect of the patient's mental function (which is not to say that, unlike the actually psychotic patient, they are unable to take insightful perspectives onto the contents of this mode of functioning, in particular when disengaged from the fearful phantasy state. I will say a bit more below about what makes OCD non-psychotic).

I want to turn now to the other question (2), namely the core characteristics of the obsessional mind and, here, to begin to make use of OC to theorise OCD. The feature I shall focus on is obsessional doubt. An important strand of On Certainty is Wittgenstein's diagnosis of the way the sceptic, in formulating their doubts, 'sublimes the logic of our language'. Doubts, Wittgenstein notes, are necessarily localised matters, arising as they do within the context of this or that enquiry. As such they presuppose a background framework of certainties. To attempt to raise a doubt outside of such a framework, or regarding the very framework, is precisely to obviate the essential preconditions for, well, for intelligible thought (including doubting thought) itself. By comparison we might imagine someone trying to make the car go faster by pushing on the dashboard, or someone trying to use a lever without a fulcrum (or with only a simulacrum of a fulcrum which nevertheless remains of a piece with the lever or with that which is to be levered), or someone trying to pull themselves up by their own bootstraps. The doubting operation takes place in a particular context and requires the doubter to stand firm on general issues before they can raise an intelligible question regarding some specific detail. (Just as the 'private linguist' in the Investigations (mis)takes themselves to be able to generate genuinely normative distinctions (the 'private' intra-subjective definitions) whilst nevertheless remaining within a domain of subjectivity (which, qua subjective domain, is defined precisely through the absence of normativity); they fail therefore to gain the necessary traction for talk of wrong or right uses of a term to mean anything.)

A second feature of doubt and its relation to certainty that receives treatment in OC is the sceptic's tacit misrepresentation of the character of the certainties we everyday enjoy. For the sceptic these are to be treated as propositional in character: beliefs to which we can rightly feel ourselves entitled, which we can readily justify or which are otherwise self-revealing in their ownmost indubitability. Earlier in OC Wittgenstein introduces the idea of a 'framework' or a 'hinge' proposition: propositional beliefs which are the lynchpins of our whole 'enquiry', propositional foundations for our practices of believing and doubting. Later, however, Wittgenstein stresses the more primarily praxical character of such foundations: the certainties I enjoy are certainties in acting. Well-grounded belief gives out in belief that is not grounded (OC253), which requires no grounds, but which also is not obviously propositional in character. I am certain of what will happen next, of the solidity of the ground under my foot, of the progression of the day into night, that the waves will continue to lap against the shore, that my mind will continue to function, that I will not forget how to speak, that I will be able to understand what people say to me enough of the time. And these certainties consist neither in beliefs which have an actual propositional articulation, nor are derived from their potential propositional articulability, but consists rather in the lived animal dispositional praxical retentive protentive habitual visceral character of my going-on-being.

And how to theorise OCD in such terms? Well, first we note that the person with OCD has some degree of weakness within particular aspects of their praxical bedrock of lived certainty. This I believe, admittedly without compelling research grounds for doing so, often stems from an insecure attachment relationship in childhood, sometimes along with over-protective forms of parenting. (The point being that the child does not internalise enough certainty that the world and their mind will continue to function as anticipated, and that they will be able to cope with such variation as there is.) This weakness is not as radical as in psychosis, and certainly does not prompt the reorganisation of the substructure of the intentional field that we find in the neurological systems of persons, systems which solve for foundational anxieties by radically restructuring the structure of the world. Furthermore, the diathesis often remains largely unactivated due to absence of significant stressors.

Second, when the diathesis is activated, the obsessional person is disposed to use reason to attempt to solve for their uncertainty. They try to find reasons for believing in the health of their body and mind. They attempt to justify to themselves their actions. They attempt to check, verify, double-check, prove, logically ascertain their veracity in their belief that their doubts are unfounded. Yet, whilst temporary relief may be obtained by such methods, the underlying pre-reflective doubt - in particular, the diathesis - remains intact. Once it has been unhelpfully raised to the level of a reflective question, the way it invites its own repose is by means of attempts at reflective answering. And these may indeed settle the question for a time. But because the foundations of our certainty are pre-epistemic, not themselves well-founded (or ill-founded, for that matter - but rather, non-founded and in principle not intelligibly founded at all), the questions which arise regarding their validity can only really be silenced rather than answered. Sometimes the entire charade of question and answer will bubble up and settle down, anxious certainty replacing anxious doubt for a while, until the next tranche of worries rises to the surface. Wittgenstein's text helps us understand why obsessional strategies of resolving obsessional doubt are doomed to failure. Once doubt has arisen at bedrock and cracked it, it will not help us to attempt to dig below bedrock in order to found it: the digging exercise will, in the end, only unseat us further.

What does this imply about the therapy of OCD? Well, first that CBT therapy is on the right lines, despite the inadequacy of its theory. For what it encourages in its behavioural component is an exposure and extinction (through response-prevention) attitude to obsessional anxieties - and it explicitly proscribes reassurance provision. And second - if my aetiological speculations are right - that the therapeutic action will take place at the pre-reflective level, whereby the therapist provides, in and through the manner of their own comportment in relation to the patient's worry, a reassuring pre-reflective sense that going-on-being is possible, that the world and the mind are enduring and stable enough to be born, that they will survive.

---------------------------
On Certainty
246. "Here I have arrived at a foundation of all my beliefs." "This position I will hold!" But isn't that, precisely, only because I am completely convinced of it? - What is 'being completely convinced' like?


247. What would it be like to doubt now whether I have two hands? Why can't I imagine it at all? What would I believe if I didn't believe that? So far I have no system at all within which this doubt might exist.

248. I have arrived at the rock bottom of my convictions. And one might almost say that these foundation-walls are carried by the whole house.

249. One gives oneself a false picture of doubt.

250. My having two hands is, in normal circumstances, as certain as anything that I could produce in evidence for it. That is why I am not in a position to take the sight of my hand as evidence for it.

251. Doesn't this mean: I shall proceed according to this belief unconditionally, and not let anything confuse me?

252. But it isn't just that I believe in this way that I have two hands, but that every reasonable person does.

253. At the foundation of well-founded belief lies belief that is not founded.

-------------------------

Postscript.

I notice another nice parallel reverse use of Wittgenstein's intuitive reaching towards psychopathological forms of life to explicate philosophical points in 433 of the Philosophical Investigations:

When we give an order, it can look as if the ultimate thing sought by the order has to remain unexpressed, as there is always a gulf between an order and its execution. Say I want someone to make a particular movement, say to raise his arm. To make it quite clear, I do the movement. This picture seems quite unambiguous until we ask: how does he know that he is to make that movement? How does he know at all what use he is to make of the signs I give him, whatever they are? Perhaps I shall now try to supplement the order by means of further signs, by pointing from myself to him, making encouraging gestures, etc. Here it looks as if the order were beginning to stammer.
OCD is to thought partly what stammering is to utterance. Embarked on a regress, thought or language splinter and fall apart. The stammerer struggles to speak - instead they are left caught up in trying to speak. They are separated from their own life-with-spoken-language, standing outside of it, trying to instantiate it. How can they once again become linguistic beings?

Sunday, 15 August 2010

but is it rational?

In a recent literature review (forthcoming in Current Opinion in Psychiatry) I criticised the view - which might perhaps be ascribable to Tim Thornton - which equates understanding something with appreciating its rationality. Whilst one of the aims of understanding might be rational comprehension, I argued, what about other such forms - such as making something empathically intelligible, or symbolically (in the psychoanalytic - displaced association - sense) or emblematically (in the phenomenological - ontical emblem of an ontological disturbance - sense) intelligible? Might these not still be available to us - when we are trying to make sense of psychotic delusion - even when the project of rendering a delusion rationally intelligible has given out? Might not the equation of rationality with understanding amount to a prejudice of analytical philosophy, rather exclusively concerned as it is with rational argument; might we not have here a kind of illicit projection of philosophy's own methods back onto its subject matter, and an exclusive if unwitting focus on its own parochial concerns?

Whether or not my critique was apt will turn, I suppose, on a) just what we (are prepared to) mean by 'rational', and on b) whether I was correctly tracking such meaning/s as 'rational' enjoys. What I think I was imagining is that, to call something 'rational' we ought to be able to view it as supportable by reasons - as something which could be justified. But this, surely, is far too strict, for it immediately leaves out all of those claims we make which themselves exemplify, or paradigmatically instance, the rational, for which there is no (need or possibility of a) further justification. Inductive claims, I believe, work like this: Our long-standing experience of social or natural regularities does not stand to our belief that things will carry on as before as its reason or justification. Rather, to expect things to carry on as before just is what counts as 'rational' here: there is no room for a 'because' when we are already at the 'beginning of the language game'. (What I would need a reason for is if I were to maintain that something different was going to happen next time.)

So let's embrace the inductive not, to be sure, as a species of reasoning, but nevertheless as paradigmatically rational. The question remains: do we have grounds for completely equating the rational order with the intelligible order? Well, there are surely cases in which we may find ourselves wanting to use the term 'understanding' in which talk of what is 'rational' comes a little less naturally. Take, for instance, our non-intellectual understanding of a piece of music - how it can just 'make sense to us' that the tune should end like this, and not like that. More closely inviting of the 'rational' appelation are cases of skill learning (e.g. plastering a wall), where my 'getting', 'grasp', 'mastery' or 'understanding' of the requisite technique is not something other (even if not reducible to) my now being able to aim successfully at the goal which the skill itself aims to achieve (e.g. getting the wall plastered). I understand the reason why it is good to work the plaster like this or that, not merely when I intellectually grasp the benefits of doing so, but also when I incorporate the skill into my repertoire which itself has the telos of getting the wall nice and flat. And then too we have the kinds of cases with which, in the actual practice of philosophy, we are all too familiar: coming to understand, as I think we would often want to put it, why someone says what they are saying even though what they are saying isn't rationally defensible ('ah, an understandable mistake!' we say).

What about cases of secondary sense? This is a topic addressed here and here by Tim Thornton. Here are the relevant passages:
Neil Pickering ... criticise[d] a view he ascribed to Richard Gipps that mental illnesses are illnesses merely in secondary sense. His argument certainly helped to make that idea seem a desperate move. I’ll have to remind myself of what the argument for it might be. But one comment he made seems interesting. With the background thought that secondary sense is distinct from metaphor or simile because there are no shared features that justify it, he commented that a secondary extension of the use of a word is under no rational obligation.

That seems right, in the context of the contrast with simile, but less so without a codification of rationality. Isn’t it rational for those with minds like most of us to rebel against the substitution of synonyms in poetry, to treasure the picture of one’s beloved and so forth? I’m not sure. (I’m also not sure because a firm criterion here - ruling those out as instances of rationality - might come back to bite in the context of what following a rule isn’t: ie being gripped by a self-interpreting interpretation of a general rule.)
And:

Richard seems here to be probing the same issue I have become interested in. The appropriateness of the use of words in secondary sense seems to play a constitutive role in individuating experiences such as that the world feels unreal. The experience is the experience it is because of the appropriateness of using this set of words. This is how Wittgenstein describes it (RPPI:§125).
The feeling of the unreality of one’s surroundings. This feeling I have had once, and many have it before the onset of mental illness. Everything seems somehow not real; but not as if one saw things unclear or blurred; everything looks quite as usual. And how do I know that another has felt what I have? Because he uses the same words as I find appropriate.
But why do I choose precisely the word “unreality” to express it? Surely not because of its sound. (A word of very like sound but different meaning would not do.) I choose it because of its meaning.
But I surely did not learn to use the word to mean: a feeling. No; but I learned to use it with a particular meaning and now I use it spontaneously like this. One might say--though it may mislead--: When I have learnt the word in its ordinary meaning, then I choose that meaning as a simile for my feeling. But of course what is in question here is not a simile, not a comparison of the feeling with something else. §126. The fact is simply that I use a word, the bearer of another technique, as the expression of a feeling. I use it in a new way. And wherein consists this new kind of use? Well, one thing is that I say: I have a ‘feeling of unreality’--after I have, of course, learnt the use of the word “feeling” in the ordinary way. Also: the feeling is a state.
But despite the fact that just these words are the right words (I think that ‘right’ is the right word), they are not used in the standard, primary sense. And hence Richard’s twin utter propriety and yet strict meaninglessness.

Now, however, what seems interesting to me is that there seem to be cases where such a spontaneous use is shared. One might reply: I know exactly how you feel. But what of cases where the use is not shared? What happens if one simply cannot do anything with it? In a paper I wrote some years ago I pushed the line that the only criterion we have for secondary sense is such shared reactions. What I meant was that there was no content to the claim that there was any kind of sense to it once that broke down (by the way: I’m not naturally a communitarian Wittgensteinian). Now whilst I do not wish to say that that’s false it seems to be much less interesting. It is a kind of surd fact that we have no reason to call such a case ‘sense’ rather than a fact that might helpfully explain anything else.

But that still leaves the
issue that Neil Pickering raised a year ago: does secondary sense ever impose a rational obligation? Is ‘right’ right?
First, the idea of mental illnesses being illnesses in a 'secondary sense' is owed originally to Champlin. It isn't prima facie obvious that a 'mind' can be ill in the same way that we can be ill in our bodily being. And so perhaps, he suggests, we could think of mental illness as standing to bodily illness like a rhyme for the eye (two lines of poetry looking the same at the end) stands to a rhyme for the ear (two lines of poetry ending with similar sounds). 'Rhyme' and 'ill' are used in a secondary sense in the latter cases to meet certain purposes - in the psychiatric case, for somewhat 'political' purposes to help ease the application of medical (and hence hopefully humane) rather than moral (and hence potentially punitive) approaches to people whose behaviour may be challenging of the social order. (The argument is worth making just to provide a contrast to standard anti-psychiatric polemic. Thomas Szasz now looks, not so much as if he had made a mistake of reasoning but, as if he mainly has a tin ear...)

Next: Tim makes clear one way in which an argument against equating rationality with understandability might start off on the wrong foot: if it started by wrongly assuming that rationality was codifiable, and then urged that certain codifications were lacking in the present instance. But still, I think we can reasonably ask whether anything is being said if our practice of kissing the photo of a departed beloved is described as rational or irrational. It isn't irrational, since it isn't that I kiss the photo because I have mistaken it for her. Yet it is also neither something for which further reasons could be given, nor - I think - exactly a paradigm of what it means to here act rationally. We might want to describe it as a constitutive behaviour of missing and honouring - 'to be so disposed just is what it is to miss and honour her' - and it is certainly a behaviour which can be described as intelligible - but, I submit, we don't have any clear use for talk of 'rational' here.

The quote from Remarks on the Philosophy of Psychology was delightful - I never knew, or had completely forgotten, that Wittgenstein himself applied the secondary sense idea to the unreality experience. Tim's remarks on shared and unshared secondary sense reactions are however puzzling. He tells us that he is interested in cases of shared dispositions to use words other than in their primary sense, and that (by contrast with this interest?) the idea - that what makes it the case that a particular non-standard deployment of a term is an instance of secondary sense rather than of mere senselessness is a function of whether a disposition to deploy it thus is shared within the relevant linguistic community - is much less interesting. (But why? I'm not trying to defend a communitarian view of secondary sense, since I suspect that it would be no less dubious than communitarian views of primary sense (and that both originate when we are alienated from our life-with-language, and as a result split it into inner and outer aspects that we then struggle to rejoin).) Then Tim says 'It is a kind of surd fact that we have no reason to call such a case ‘sense’ rather than a fact that might helpfully explain anything else.' I go along with the surdness of the fact (since the idea that it is non-surd seems, as just suggested above, to be born of an alienated stance towards our life-with-language that then seems to beg an explanation of us), but why shouldn't the fact, however surd, itself be deployed in explanations of this or that other matter? (Tim - What is going on here?!)

What I find interesting is what the pressures of thought are that might impel us to a communitarian view of secondary sense. But first, let's return to the question: what makes something a case of secondary sense, rather than just gibberish? What comes to my mind is that the term's deployment is most paradigmatically an instance of secondary sense when it is part of a somewhat structured language-game (shared by however many, as with primary sense discourses). Various inferences may - in the secondary language game - be licensed, inferences which map the structure of some of those in the primary discourse. (So with emotions, feeling 'up' is contrasted with feeling 'down', moods may rise and fall, we can feel 'high' and 'low' too, etc.) The more one-off a use of secondary sense is, the fewer other similar things one wants to say in the conceptual neighbourhood, and the more, er, semantically embarrassing the term's deployment seems to be.

Second, I'd want to suggest that, as with metaphor, users of secondary sense ought to have some awareness that they are doing so. Consider Wittgenstein's derealisation feeling: he finds himself wanting to use the term. We are unlikely to understand him unless we have had a similar experience, part of which experience is the disposition to use the same ('unreal') description. But when someone uses the term fully in the throws of delusionality - when they start to believe that nothing is real - their praxical grasp of the difference between secondary and primary senses breaks down. (That, I believe, is what really constitutes psychosis proper: a disturbance in what is unhelpfully called 'reality testing' which, put better, amounts to an inability to keep apart the orders of i) the metaphorical / symbolical / secondary / imaginary and ii) the real / primary. The failure is not so much one of self-knowledge (i.e. not so much one of knowing what order one is in), but rather of one's experiences or thoughts (however selectively) to themselves sustain relegation to one or the other domain. (Contra Sass, I suggest that such a 'regressive' disturbance is precisely of a piece with hyper-reflexive world-disengaged thought.))

The temptation to communitarianism with primary sense arises when in the grip of a certain picture of language. The theorist starts alienated from their life-with-language (i.e. with the inner and outer aspects of language having come quite apart, with a conception of language as consisting not of living exchanges but of discarnate signs awaiting animation from without), and then asks 'What makes it the case that rule 'xyz' has the extension it does?' Depending on one's metaphysical leanings, the temptation is (as Tim documents in his book) to rejoin the two halves of language by an appeal either to inner acts of interpretation, or to the linguistic behaviour of the community (both of which, as Tim shows, are hopeless strategies). And (as Tim also documents) the real trick is not to cleave our life-with-language in the first place - to view it as animated expressive behaviour through and through.

So: what is it that makes a certain putatively secondary use of a sign a genuine, meaningful, use? Well, what I find myself wanting to say is: why should we take it to be in the predicament of needing to be made meaningful? I suspect that it looks like this if it is being approached from the outside, as a non-participant might approach it; when we wonder whether this is a practice in which we can share, whether it might not just leave us cold, wondering if it is we who are unimaginative or our interlocutors who are self-deluding.

But isn't that precisely, so often in particular in matters aesthetic, precisely our predicament? Well, yes it is, so often. Stanley Cavell makes a similar, related, point about matters psychological - how that which intellectually gets 'deflected' and generalised into an epistemological discourse about scepticism actually (or: so he tells us) begins life as a perfectly unavoidable, natural, existential uncertainty about the inner lives of others. Others can, it just must be admitted, be enigmas to us at times, be frighteningly baffling, impenetrable, suddenly alien. Often enough they are not, and that they are not is the transcendental precondition for the language games of the inner. (Consider too D Z Phillips' claims about what the most profound form of scepticism amounts to (in, but not restricted to, the philosophy of religion): not a denial of the possibility of knowledge, but an expression of a struggle to find one's feet with, to make any sense of, the discourse (e.g. talk about God) in question.)

But note that there are two different concerns here. One is that we share enough by way of our linguistic dispositions to get the (primary or secondary) language game off the ground. This however is not to provide a communitarian answer to the second, and misguided, question 'What makes it the case that 'xyz' means xyz?'' What makes it possible that we can play a particular primary sense language game is - platitudinously (in the same sense in which 'meaning = use' can be taken as platitude rather than as dubious metaphysics) - that we are wired for it. For secondary sense the question is - are we game for letting that semantic organ - our brain - spin playfully out of gear for a time? Are we prepared to submit ourselves to the requisite aesthetic education (as is most strikingly necessary before one can learn to play the language games of psychoanalysis, musical appreciation, wine tasting, and literary criticism)? We move to the misguided question out of anxieties regarding our ability to answer the first question.

I once performed an ad hoc survey of people's dispositions to classify Tuesday or Wednesday as fat or thin. The one reaction I still remember (apart from the anticipated preponderance of fat Wednesdays) was from someone who became quite agitated. 'I don't like things like that' he said, revealing not a blank disengagement or puzzlement, but a powerful defensive hostility which was a function of no other aspect of the social encounter other than the asking of precisely that kind of question. It wasn't its silliness, either, he explained; something about what I was asking him to do made him deeply uneasy.

My tentative theory would be that a willingness to (as it were) play the secondary sense game is of a piece with the ability to play (in Winnicott's sense) simpliciter - to let the mind idle and function symbolically without fear of thereby losing the plot (i.e. the neurotic fear of psychosis). Hannah Segal's paper on the difference between symbolism and the symbolic equation seems to the point here: symbolism involves the ability to take things for other than they are. If we want meaningful lives we must harness forces which also have the possibility of making for psychosis. Symbolic equation, by contrast, means getting stuck with the symbolic relation: not being able to play.

Is play rational? Not: is it rational to play (it may or may not be, depending on the circumstances) but: are the forms of play forms of rationality? I suspect that there is simply no answer to this question. That, if we wanted an answer, we would need to invent one, and add nuance to the language-game of 'rationality' that is not currently there. As with play, so for secondary sense: I can, when I find my feet with someone using a word in a new (playful, secondary) way, find it within myself to say: 'Now I see how to go on like you' even when it would feel excessive to say 'Now I see why you went on thus'.

the value of quietism

Wittgenstein's grave; identity of cat: unknownThe approach to which I seem to be drawn, in philosophical psychopathology, is typically a Wittgensteinian one, and as such tends towards quietism. Which is to say, it tends towards a non-theory-providing, mere-undoing-of-mistakes, content-less, activity at the end of which, one might want to say, one is 'no further forward' than when one started. But what, then, is or could be the value of that? How are we then better off than the (pictured) cat, lying inert on Wittgenstein's grave?

Well: to render latent nonsense patent, however merely destructive, is at least a means to stop us wasting time pursuing (pseudo-) explanatory agendas which, previously unbeknownst to us, have started off on the wrong foot. On this understanding of quietism, philosophy prepares the ground for genuine empirical enquiry in psychology, once the houses of cards of only
misbegotten psychological theory have been cleared away. And that may surely be of value. Minimally, it is better to lie on one's back than to break it in pointless labour. If philosophy cannot itself engender theory then, well, at least we will be spared the embarrassment of kidding ourselves that we are up to something of cognitive import when we are not.

That however all sounds a bit depressingly paltry to me. In place of this vision which only has philosophical deconstruction and theory-building on its menu, I want to suggest a richer diet which would include something called 'phenomenology'. In particular, it would include a dialectic of phenomenological and quietistic understanding.

Heidegger
By 'phenomenology' I mean simply the rich description and expression of the diverse facts and experiences and their place in our world. Philosophy can help in this project of unconcealment by showing negatively how phenomena may be covered over both by being assimilated to other phenomena and through being recruited merely to bogus explanatory projects. (For one thing is sure - as I once noted in an introductory article on theory of mind research in autism: those theorists who eschew the unedifying edifice of the 'theory of mind' and inferentialist projects regarding others' minds are precisely those able to pay best attention to the diverse reaches and characters of our mindedness.) Phenomenology by contrast is the articulation (either expressive or descriptive) of these facts in all their unconcealed sui generis glory. By moving back and forth what we gain is the world in all its richness - where 'the world' includes, importantly, one another.

Adorno and Horkheimer
Does this richer description of the world - in particular of those corners of it which have become obscured to us because we have recruited the light of our understanding into a focal spotlight, shone elsewhere, to enact mere fantasies of penetration - constitute real advance or progress? The attraction of the enlightenment idea of a mass of scientific knowledge and understanding moving forward is that it enables us to think of our contribution as adding up to something solid which will outlast us and our generation. Once the knowledge and the explanations are generated, then they are 'there forever'. Quietism might seem to have a more modest goal, and will always be parasitic upon the presence, within contemporary understanding, of misguided metaphysics and its pseudo-explanatory epistemological products.

Yet this also sells quietism short. For over time we gain clearer understanding of the diverse (but often related) ways in which we contrive to misunderstand ourselves and our worlds. This is understanding that can, at least for a while, be 'banked'. And in any case, the belief that the explanation of the world is to be preferred to the capacity to encounter it fully is itself a parochial value of the enlightenment. Perhaps our emancipation from that set of goals as the only viable set of intellectual goals could start right here, with questioning such values (and defences - against the fear of death, for example) as lie hidden within it.

Thursday, 12 August 2010

recap and recant

N's latest couple of posts made me think both that I hadn't quite properly expressed myself and that some of the thoughts I properly expressed were improperly formulated, in my previous post. But also I (someone whose Zen meditation cushion still looks rather tellingly unworn) want first to risk a comment on the koan analogy proffered by N.

N suggests - rightly I think - that trying to get from a delusional to a sane experience can be like trying to solve a koan. Let me conflate Wittgenstein and Zen a little (as Canfield and Gudmunsen and Huntingdon have taught us to do (cf also, though, Magliola on Derrida and Nagarjuna)) and suggest that what is needed in relation to the koan is not a solution but a dissolution. Within the terms of reference that the koan sets there is no solution; the dissolution comes from rejecting its tacit premises.

So, to take one koan with which I'm a little familiar: A master says (something a bit like this) to his students: 'If you say this is a stick, I will hit you with it. If you say it is not a stick, I will hit you with it. What do you say?' Predictably, all the students get hit right and proper. There is no solution in the terms offered. But, the further thought goes, why should we buy into this bit of demandingness? What we - the novices - do in so buying is accept the presupposition that we must answer the master's puzzles. We accept the power dynamic, we maintain - by remaining caught within - the bubble of the transference relationship. Better by far to grab the stick and give the old goat a thwack, or just chuck it away. That would show an emancipation from the terms of the argument. (I once had a similar experience on a training week at the Tavistock Clinic: the group leader (twice per day, 90 minutes per session, for 5 days) acted like a complete bastard, sighing and hurrumphing and interrupting and generally being very 'rude', throughout all the sessions. It wasn't until the end of two days of getting furious with him, or profoundly doubting whether my experience could really be veridical, that I realised instead his real lesson, which was: Why on earth would I be giving him, a complete stranger, such power to affect how I am left feeling during and after the session?)

If such a dissolutive rather than solution-based deconstruction of the koan is (in the analogical context) a matter of using thought to reconnect with reality after being caught within the purview of a phantasy/delusion, then I will happily accept this use of 'thought'. (What I meant in the post by (the need to abandon) 'thinking one's way to reality' really only referred to attempts to solve, rather than dissolve, the delusional experience - or, by analogy again, to try to disprove the justifiability of scepticism whilst accepting its tacit premises about the world-independence of the mind. When it comes to a thoughtful dissolution or deconstruction, however, then: bring it on!)

So to put better what I was previously saying: it is not that I want to urge that we would be misguided to provide ourselves with "reasons for returning from the study to the billiards table". The main such reason is the fruitlessness of attempting to arrive at veridical perceptions by supplementing inner experience with (epistemology-provided) causal or justificatory connections to reality. But start where the sceptic starts and remain there (despite all the thinking in the world); question his tacit non-disjunctivist premises, and (only then) abjure his problematic. (N's playful embracing/negating of the epistemological enterprise (toward the end of the 'part ii' post) thus seems to me de trop.) Hume found himself untroubled by his sceptical doubts when engaged in the game. Augustine found himself untroubled about the nature of time when taking it or giving it to someone. What got them into their respective puzzles was not, I submit, anything about time or experience per se, but rather, time or experience already refracted through misbegotten prior assumptions about the way that the respective language games work.

Where does this leave the discussion of schizophrenic experience? Here I want to clarify something I wrote before and to register what I think is a disagreement with N: Whilst I think it is entirely wrong to blithely accept that we know what is meant when someone tells us, or we tell ourselves, that we have had the experience or thought that (e.g.) nothing is real, I really can't accept that what is actually happening is that the someone in question is having a particular experience that they merely happen to thematise (narrativize) in this manner. As N says, the question then remains as to why it is so entirely natural for the someone to thematise it thus. (And here we are back in the territory of my earlier 'talking teapots' post.) What I would rather urge is that the content of the experience is given precisely through that avowal of it which makes use of the notion of 'unreality'.

But yet, or so it seems to me, this need not cause us to become complacent in assuming that we (could) know (that there could be such a thing as knowing) what it would mean to talk of an experience (as) of everything being real or unreal. We know what it is for a dollar or a smile or a problem to be real; do we really - really - understand what it would mean for the world to be real or not? Isn't "the world" precisely that within which discriminations of the reality of this or that are made? Isn't the world a transcendental precondition for necessarily localised talk of 'reality' or 'unreality'? Isn't it to 'sublime the logic of our language' - to ignore the necessary background context within which the concept of 'real' operates and to try to use it about the context itself - to carry on in this way?

One aspect of the model I would, then, use for making sense of the twin utter propriety and yet strict meaninglessness (although is it really right to call it 'meaningless'? I have a feeling that doesn't quite make the point I'm aiming for) of talk of depersonalisation or derealisation is secondary sense. We are drawn to using the terms in the ways we do by the experiences we have. That we are so drawn is not something which could be justified by reference to the content of the experiences; rather, our being-thus-drawn is the 'beginning, and not the end, of this [particular] language-game'. It is the condition of our finding it intelligible. Wednesday is fat and Tuesday is thin; happiness is up and sadness is down; sopranos are high and basses are low; anger is red and envy is green; and so on. We know how to use the relevant terms in their everyday deployments, and then we redeploy them spontaneously and groundlessly to express or report such further experiences and phenomena. I know how to talk about unreal diamonds, and then I find myself using the same word to characterise the very being of others. The logic of my language is sublimed (I cannot - however hard I try, with however much sincerity - mean it in the way I normally mean 'real'). But, damn it, that really is the only way to describe the experience!

Wednesday, 11 August 2010

against non-disjunctivism in the
philosophy of psychiatry

Non-disjunctivist conceptions of mind are presented blithely throughout the corpus of philosophical psychopathology, as if we could and should just take it for granted that they are the only show in town. I don't want to - don't know how to - don't really know what it would mean to - argue against them here, only to point out the different direction that a disjunctivist conception takes us. (I say 'don't really know what it would mean to...' because, to be honest, I don't really think that disjunctivism and non-disjunctivism are best understood as two opposing philosophical positions about the formal character of experience. Rather, I would posit disjunctivism as a non-position, a grammatical reminder which somewhat exceeds itself, still slightly under the sway of the (very idea of the meaningfulness of the) metaphysics that at best it aims to 'cancel' rather than oppose.)

Recall what the non-disjunctivist says about perceptual experience (I take (rather from memory), as my source, John McDowell's paper Criteria, Defeasibility, and Knowledge - although it should be noted that McDowell doesn't actually talk about 'disjunctivism' per se): that the possibility of my not being able to distinguish, on occasion, whether I am hallucinating from whether I am having a (so-called (by philosophers)) 'veridical perception' entails that the two cases have some 'highest common factor' (e.g. an inner experience, a sense datum, a mental image) in common. Against this the disjunctivist insists that in 'veridical perception' (let's just call it 'perception' shall we!) - in perception - the content of my experience is no inner proxy, no half-way-house-to-the-object, but rather: the object itself. When I see my cat, that is what I do - I do not need to be presented more 'proximally' with a visual image, a sense datum, an inner experience, of a cat. I've got the damn thing itself right in front of me, thank you very much. (So there is a 'disjunct' between the two cases - no common item of an inner cat image in cat hallucinations and cat perceptions.)

Now the kind of non-disjunctivism I have in mind in the philosophy of psychopathology is not simply that contained in the typical empiricist's (non-disjunctivist) conception of hallucination (although that is widespread enough). It is rather an analogue of this in a wider range of psychotic phenomena. What makes it analogous is the similar philosophical inventing of a whole class or form of (parts of) experiences, a class which is posited so that it can do apparent explanatory work (but which putative work will only itself seem to be required on the basis of some rather non-disjunctivist-like conceptions of experience itself...).

Take Zahavi- or Frith- or Graham-esque conceptions of self-consciousness. Here it is typically assumed that - from the fact that the patient experiencing passivity experiences has an experience as of, or just: of, someone else thinking my thoughts, putting thoughts in my mind that are not my own, extracting them, moving my body instead of me moving it - the non-patient must normally be having contrary (albeit subliminal) experiences of being the agent of their own thoughts/actions. Failures of this agency can then be appealed to in an alleged explanation of the psychopathological phenomena. But I can see no more evidence for this everyday tacit 'ipseity'-sense, for this automatic experience of myself as the agent of my own actions, than I can for the presence of sense data in the case of genuine perception.

I want to leave those examples for now, and turn instead to depersonalisation and derealisation - experiences of the self or the world as being unreal. From the presence of these we have the common inference that we must normally have some belief or experience or sense of the world or the self as real, genuine, objective, independent. It is then suggested that it is to some kind of failure in this mechanism of providing a sense of the real that we owe the psychopathological phenomena. (I seem to recall Matthew Ratcliffe arguing in a similar way - that we have some normal feeling of this or that facet of being-in-the-world which feelings of being (or 'senses of reality') can be disrupted in psychopathological self-disturbances.) But I see no reason why such putative normal senses of reality should be posited. Just because I may sometimes have a feeling of unreality does not entail that I normally have a feeling of reality that has been supplanted. (I may sometimes feel hungry. This does not mean that, when I don't, I always have a feeling of fullness, or just a feeling of satiation (although perhaps I might, after a nice meal). Rather I just don't feel hungry when, well, when I don't feel hungry.)

The extra explanatory potency of the 'non-disjunctivist's' conception should be clear: by positing a 'feeling of reality' I can 'explain' feelings of unreality as due to the breakdown of some normal part of our affective relating to the world. But, honestly, this seems just far too 'neat'. First, I'm not aware of any such feelings of 'reality' in the normal case (what would be the point of them anyway?). Secondly, it just won't do to invent explanantia for the job when confronted with puzzling explananda. Thirdly, just why is it that I take myself to be in need of some such explanation? Fourth, aren't we being misled by the psychopathology, asked to buy into the very conditions of (im)possibility of psychotic experience that it is precisely part of its pathologicality to tacitly posit?

Er, I think I ought to explain what I mean. So, compare the unreality experience to the sceptic's predicament. With everyday being-in-the-world, I need no 'feelings of being' to sustain my living conscious engagement with my surroundings and with others. I just, you know, get on with it. But in psychosis existential terror throws me out of this; and with scepticism, in an intellectual rather than lived register, I also stop viewing my understanding as, necessarily, always-already, embedded in a world. The mind now understands itself as a self-contained inner domain. It will now seem that there ought to be thoughts or feelings which bridge the gap between mind and world. A feeling of reality would do the trick nicely, where a feeling of unreality has come on the scene and threatens to unseat one's whole grasp of what is true, meaningful, real. But from within this 'sceptical' construction the fly cannot escape from the flybottle: once the seed of sceptical doubt has found fertile ground, there is nothing that can stop it growing and growing in the mind - not all the epistemology in the world can have the desired effect of intellectually sanctioning what is so valuable about Hume's walk to the billiards table from the study.

We might compare the predicament here with that of someone living under, or in the sway of, an unconscious phantasy. An existential-phenomenological recasting of such phantasy has it that something (some emotional understanding) which would ideally be revealed within 'the clearing' (in the 'intentional field') has now become part of its very structure. I inhabit an atmosphere which, in its all-pervasiveness, is peculiarly transparent to me (if not to the perceptive other). Attending from this phantasy, rather than to what would normally be its worldly contents, throws up a set of concerns for me, into consciousness, which concerns are actually irresolveable (and I am left simply with an unconscious 'compulsion to repeat' (actually, as Lear points out, it's not a compulsion to repeat - just a non-satiated compulsion to do that-which-is-repeated)) within this framework. Within the phantasy all the fly can do is bounce around the bottle; it takes a particularly skilled Wittgensteinian entomologist to show him out, not by solving the presenting puzzle but by untying the underlying phantasy.

Let me wrap up a little. What I have analogically been calling the 'non-disjunctivist' conception of psychotic experiences such as depersonalisation has it that these are on a par with putative normal experiences of 'personalisation' or 'realisation' (as it were) - that they represent a subjective registering of the breakdown of those faculties which allegedly normally give rise to the alleged sane varieties of affectively toned everyday encounters. What this theoretically presupposes is, I believe, an analogue of that conception of the mind presupposed by the non-disjunctivist about perceptual experience: some kind of 'inner world' or domain of 'sense data / phenomenological items' present in both hallucinatory and non-hallucinatory episodes as a common inner currency. The epistemological task now becomes that of finding one's way out of this inner landscape. The problem is that this is an impossible task. Rather than look for ways out (causal links of the 'right kind' etc.) of the inner world, we would do better to question its very premises. So, too, I have been suggesting, (semi-)psychotic experiences of derealisation might invite us to understand them as just further contents of consciousness, contents perhaps standing on a par with alleged other such contents (such as alleged feelings of 'reality'). But, I want to suggest, the decisive trick has taken place further back in the mind - not in what contents present themselves to consciousness, but rather - in the structuration of the field of experience which gives rise to the abnormal sensings. Because this field is something which can only be inhabited, not itself experienced, the fact of its distorted involution cannot be registered. Trying to 'think' one's way out of it - give oneself reasons for returning from the study to the billiards table - will inevitably be a doomed enterprise.

Those who move swiftly to explanatory theories of psychotic experience have, it seems to me, often failed to take in, in a first phenomenological sweep, just how very odd such experience is. 'Oh yes, depersonalisation, that happens in x % of people, is characterised by xyz, etc etc.' Hang on a minute, just listen to what you're saying! De-person-alisation! De-real-isation! A sense of the self or world as being unreal! What could that possibly be! I'm not trying to question the disturbing fact of the experience, only to invite us to linger a little longer over the idea that it is in any way obvious what its content is. Such a failure to linger and a flight to explanation sits well with that kind of (non-disjunctive) conception of the mind - as a domain that might quite naturally be populated by feelings of either reality or unreality - tacitly on offer. But wait! Are we really confident that we have either any clear sense of what it would be for an experience to be of something - or myself - as real or as unreal? Sitting with the bare thought of it, it can start to look like a strange philosophical joke. Deja vu is not dissimilar in this respect: the feeling presents itself as an uncanny feeling of having seen something or been somewhere before which we believe we haven't seen or been. But it isn't as if we have a quite general normal experience of having seen something before (is it?), or as if we don't in fact very often take ourselves to recognise people or places who or which, in fact, we had not previously encountered. Such formulations far-too-quickly invite us to reduce the uncanniness of the experience to the contradiction between 'I have' and 'I haven't' seen her or it before. Far from taking us nearer to the bizarreness of the experience, we are left - by the too-quick acceptance of how the psychotic experience articulates itself - further and further away from it.

Monday, 9 August 2010

what might philosophy be?

The enlightenment is so very seductive. Better and greater understandings of the universe without. And - in philosophy of mind, or in psychology - deeper and richer, more empirically informed, more theoretically developed, understandings of the universe within. Making slow progress on the big problems. Yada yada yada....

What if the philosophy of mind came to look more like psychotherapy? Where psychotherapy itself looked less like an enterprise of education or growth, but more like - say - merely the ego's growing acknowledgement, tolerance, of the id. (Desires to be a certain kind of desiring creature giving over, at some point, to acknowledgement of the desires one actually has.) Or like - say - the manifest content coming to approximate the latent content of a dream.


What if the philosopher came to see himself - not as the foundations man, or as the ideas man, but - as a therapist for a particular vein of society's repressed desire? As a therapist who aimed to simultaneously increase our 'ego strength' (our capacity to tolerate understandings of ourselves which might not fit so well with our current manifest image?) whilst increasing, through an analogue of interpretation, our knowledge of the availability of other such understandings? Understandings which were all along part of our implicit self-conception, understandings which - if we could only allow ourselves to help ourselves to them - would enable us to breathe more comfortably?


If such understandings were made therapeutically available, they could help forestall manic attempts to build our way out of conflict zones which will always remain such given their narcissistic, omnipotent, foundations. We might find we do have the resources to live on the rough ground after all - rather than, fearing we do not, attempting to maximise the use of a few intellectual resources within the confines of some shiny narrow urban centre.


Each age will have its own self understandings and self misunderstandings. And within the conversation of mankind we will always find other variants - the pulls of idealism and realism, conventionalism and platonism - in a range of sub-localities. Our work will be cut out for sure.


It seems less impressive though, doesn't it? The business of 'merely' making available to the social patient the self-understandings they already have (somewhere)? The therapist as a more lowly profession than the scientist. One swimming forward, the other happy to help the patient happy to tread water, to help them understand that they can be happy where they are, that there is plenty to see and do there, that the sea monsters there are really not quite so scary as to devour one, that there will be other monsters in other places too, that the frantic efforts to move forward are really just doomed efforts at escape.


Can that be enough? Can we philosophers value the therapist role model as much as the scientist role model? Well, perhaps that revaluation could itself be part of a recovery of values and self-conceptions lurking somewhere within. Perhaps that recovery is itself the first job - of making philosophy content with a now-manifest image of itself as a 'merely' humanistic discipline, as just perpetuating and enlivening the conversation of mankind. Of coming to value ourselves a little more - coming to value an interest in ourselves couched in terms which are uniquely and intimately our own.

Sunday, 25 July 2010

back again

I've just been roused from my non-blogging slumbers by a post from the author ('N') of the Ruminations on Madness blog which is helpfully critical of some of my own previous contributions. What follows is an attempt at a defense of what I wrote before.

In 'Talking Teapots' I considered some dis/analogies between psychosis and imaginative make-believe. N aptly summarises some of my views and then quotes me as follows, and continues:

“The pre-reflective cogs which bind the mind to reality are disengaged, and it idles, spins in fancy.” This is nothing like anything I have ever experienced—indeed it sounds a hell of a lot more amusing and enjoyable than anything I have ever experienced! Instead, precisely the difficulty of operating within a psychotic space is, for me, the fact that so many choices must be made, that I must constantly navigate between consensus reality and its epistemological strictures and—like it or not, Gipps—another “reality.” That I am at every moment forced to make choices about which path to follow—and, indeed, how to construct, spatialize, and thematize that path. Constructing a delusion is, in my mind anyway, an extremely–even acrobatically–creative (and also terrifying) endeavor.
I would agree that spinning in fancy is not a good description of the operations of the delusional mind - in point of fact I think I was using this phrase to describe the mind imaginatively engaged with a fairytale (and I continued 'In psychosis there is not this element of ... playfulness.'). But N's point is mainly about the relation of choice to delusion-formation, and I had suggested that there is no role for choice in the entering into of delusional modes of thought. (Depending on what we count as volitional, this claim of mine is surely wrong: we can readily recall patients who seem to 'choose' their delusions, with convenient contents, at convenient times, for particular emotional purposes, etc. But we can also recall many who seem simply lost in, and lost to, modes of experience which are not reality oriented.) What I want to suggest, as a compromise, is that the delusional subject cannot simply choose to engage in delusional thought any more than the sane subject (and the psychotic subject in non-delusional times) choose to engage with many mundane matters. Our sane existence is characterised by being-in-the-world - which is to say that we do not approach our environments from the point of view of a disengaged hypothesis-former, but rather are always-already engaged in and through our interactions with a pre-understanding of the meanings of our situations.

If however psychosis leads to (or, better, is itself understood as) the partial loss of being-in-the-world, then the subject is indeed now forced to confront his or her environment as a radical chooser. Thought - thought which is no longer utterly pre-inflected through that tacit world-engagement constitutive of sanity - must be called on to arbitrate between a thousand possibilities, choices must be made: the cognitive load must often be overwhelming. Constructing a delusional system to make sense of the chaos of noise which results when the situations around us no longer call to us with their familiar cries would, I imagine, seem to be pretty much a survival necessity.

N and I clearly disagree about the helpfulness of describing the delusional subject as occupying 'another reality'. This is a huge question which can hardly be settled here. What I would be concerned to combat is any of what Hamilton, following Squires, calls the 'lost tribe romantic' view of schizophrenia. This view has it that the interpretative task of the person who wishes to understand the experience of the psychotic subject (and that task may very well be one for that subject him or her self, as well as for their clinical interlocutors) is akin to that of the anthropologist encountering an exotic tribe. On such a view, the task is to suspend one's everyday understanding and enter into a different reality, with different rules, structures of meaning, forms of experience, etc.

A cheap way to spell out this view would be to deploy some kind of degraded Kantian scheme-content dualism - and imagine that the person with psychosis is thematising the content of their experience with a different scheme of conceptual categories, and that entering into that world requires us to learn such categories. (I say 'degraded' because Kant would presumably have thought that the very categories challenged by psychosis (time, space, etc.) were constitutive of any possible experience whatsoever.) This strikes me as unpromising - basically because such dualism is so philosophically unpromising, but also because I think that Kant was right about the necessary ingredients of bona fide, paradigm case, genuine articles of experience. Sure, let us acknowledge the profundity of the psychotic break by acknowledging the breakdown in such structures. Let us willingly abandon the normalising attempts of the CBT pundit for just this reason (see N's nice post on this issue here). Let us acknowledge too what might metaphorically be called the attempts at world-making of the subject suffering such a break. But none of this means attributing any ontological parity between psychotic and everyday experience, nor acknowledging that psychotic experience reveals another world.

N continues:

Next, “sanity is synonymous with meaning”…? Delusional realities are only metaphors…? I think I have an even harder time wrapping my head around this one. Metaphors are not meaningful? And “sanity” is, what, consensual reality? And consensual reality is…what precisely? Are mystical experiences part of consensual reality? Buddhist satori? Dreams? Where does consensual reality begin and end?
So, er, yes: metaphors are meaningful. We have a meaningful metaphor when we talk of 'delusional realities'. But this does not mean that the delusional person's delusional claims have either a metaphorical or a literal meaning. They are not metaphors (although the claims often 'behave' like metaphors. (Basically, I believe they are not metaphors because a) the appearance/reality distinction has collapsed, and because b) the subject does not treat them as metaphors.)) The meaning attaches to the classification, not to what is classified.

And to talk of 'consensual reality' is, I believe, misleading, since it seems to reduce the question of what is real to the question of what a certain group of people say is real. What seems wrong about that, to my mind, is not that it contradicts some fancy metaphysical doctrine of Realism that I set out to believe in. (Not my style, being a hopelessly Wittgensteinian kind of chap.) To be sure, we need to look to our diverse language games to be able to appreciate the different kinds of reality enjoyed by economic crashes, motor cars, algebraic solutions, mood swings, etc. (The kind of thing which would mark the distinction between a genuine versus a false motor car or solution or mood swing is quite different (and this is a semantic, and not an epistemological, point).) What seems wrong with it is that it risks a conflation of the idea that what we say/think/do determines what is real with the idea that what we say/think/do determines what is called 'real' here or there.

Contrast conventionalism with Wittgensteinianism about logical necessity. The conventionalist says that the statement "2+2=4" is true because of how we go on in our mathematical language-games. The Wittgensteinian says that the statement "2+2=4" is how we go on in our mathematical language-games. The former invites us towards constructionist formulations of the character of meaningful experience - invites us towards the idea that we are all engaged in world-making exercises. And following from that we can readily imagine that different groups of people are engaged in different world-making exercises. (And just around the corner from that is the relativistically-minded subject's outrage along 'how dare they tell me/us what is and is not real!' lines...) The latter platitude encourages little other than philosophical quietism...

So, to return my wandering mind to what N actually wrote(!), no I wouldn't want to start talking about 'consensual reality' since it implies a relativism or constructionism about reality that I don't relate to. I think there are different 'criteria' (as the Wittgensteinian unpromisingly puts it) as to what is to count as real, actual or true (as opposed to unreal, fake, illusory, wrong) in diverse language games, and there are of course such diverse language-games regarding medium-sized dry objects as well as dreams, numbers, mystical experiences, miracles, scents, fashion items, wishes, stamps, etc. (One of the philosophical sins I'm trying to wean myself of is that of talking about some putative super-object called 'Reality' which is the putative object of all these diverse language-games. I confess I still commit this sin all too often though...)

N next writes:

Finally, I have a hard time understanding why it matters whether a given delusional statement is “correct” or not (when is anything ever absolutely and definitively “correct”?)… I’m also very unsure as to what Gipps means by a “rule of representation,” though I take it to mean that there would need to be (but why?) some kind of external criteria (that could be applied to delusions, or rather to individual’s delusions qua explanations of an anomalous experience) if we were to want to make some kind of evaluative judgment of them. Now, since the delusional experience is, certainly, deeply idiosyncratic and personal, I don’t see how this could happen. But isn’t the same true for much of normal human experience? Do we have “rules of representation” for the veracity of any given emotional or affective response, for example? For dreams? Day-dreams? Hopes? Desires?
This I think involves a (perfectly understandable) misunderstanding of my intent, and I would agree with much of what N writes. My concern was with whether we can say that a delusional subject's expressions of their inner experiences are or are not correct. For example, when someone says that someone is having an experience of (or, prodromally perhaps, as of) thoughts being taken out of their head, or inserted, can we say that they have given a correct description of their experience? I do not believe that we can, but I certainly don't think this knocks any spots off the delusional subject, since - yes - this is equally true of any avowal of subjective experience.

What I wrote in 'talking teapots' was that it seemed to be that there was no such thing as the delusional subject being correct or incorrect in their descriptions of their own experience. Why this matters? Well, it was all part of my critique of the adequacy of 'romantic' and 'psychiatric' approaches in psychopathology which either think that the meaning of delusional utterances can be recovered through interpretation, or think they can be seen to be meaningless because they can be shown to fail to describe something properly. I think that both approaches try to say too much, and fail to 'sit with' the delusional experiences themselves.

I turn now to N's comments on the 2nd of my ridiculously-titled 'aporiae of apophany' pieces. N worries that I am considering thought disordered thought to be thought which qua thought starts to unravel - or that I am considering delusions to be beliefs which begin to be damaged as beliefs. I plead unrepentently guilty to both charges. Next N worries that I'm


not proposing some kind of equal-but-different status for delusions, but, whether he means to or not, seems to be devaluing (how, after all, can a meaningless experience have value?) them...
Well, I'd agree with the not equal-but-different status bit (I don't think for example that delusional beliefs are, say, just different ways of understanding 'the world', that the delusional subject is just occupying a different 'framework', etc...). But I'm not so sure about the devaluing bit. I guess it depends on the context of the valuation. What I'm reminded by is what Wittgenstein said about the nonsense that metaphysicians unwittingly proclaimed, that the production of (what is in fact) nonsense can be very important, and that we should pay attention to it. Just because delusions are, I believe, not meaningful in the final analysis, does not mean that they are not revelatory and important, nor that it is fruitless (for patient and clinician alike) to engage with them. (A delusion may be meaningless but may reveal something of my state of mind, for example. Or it may have fragments of meaning that can be worked with and, through the gradual re-establishing of the relational terrain of meaning, be developed in meaningful directions.)

Perhaps, however, on this last point, what I ought to own here, as something I would maintain about the values and meanings of lives not exclusively my own, is my belief that such meaning and value arises in the midst of our relationships with: others, work, craft, our humbling private or relational attempts at supercession of our own narcissism, etc. Not all relationships are meaningful, by any means, but I do consider all meaning to be 'relational' - and I do consider solipsism and narcissism ('narcissism' in the psychoanalytical sense) to be the death of meaning - to harbour merely the ghost of living meaning.

N goes on to find a (putative) self-contradiction in what I say about there both being no such experience of having thoughts removed from one's mind, and yet urge that precisely this is the content of the delusional subject's thought (er, when it is...). I don't think this is quite such a mad thing to say, though: they are having an impossible experience which is individuated through what they are inclined to say about it. By an 'impossible experience' I do not mean to say that they do not have an experience which is best described as of having thoughts removed from one's mind, only to note that there is no such thing as having thoughts removed from one's mind, and nothing that that is like. Secondary sense is, I believe, the way to make sense of such contents of thought or experience. (Also, it is not, as N suggests, that I am sceptical of verifying the accuracy of the delusional subject's claims about their inner experience; rather I am sceptical that it even makes sense to talk of doing this. Verification doesn't seem to have a meaningful place in the inner - and this I believe is an 'ontological' rather than an 'epistemological' truth.) Further, I'm certainly not claiming this is true of all delusions, only making a point about delusions of 'inner sense' (inner passivity experiences etc.).

Should we (N's final point) resist attempts at explanation or understanding of delusions? I believe that we should not resist attempts to explain them (for example, to understand their origination). As for attempts to comprehend them (i.e. understand their meaning, rather than discover their causes), I would want to say the following: We would do well to try and understand what it is that delusions may betray about the subject's mind. For example, their themes may symbolically (in the psychoanalytical, somewhat associationist, sense of 'symbolise') represent a significant emotional theme. Or they may 'emblematise' (as the phenomenologists have it) an ontological sense of self-dissolution which, e.g., either gets projected onto the world or which get reduced to a merely empirical posit about something within the world being destroyed. But just as importantly, I want to urge that we pay attention to the way in which we may 'over-understand' delusions, in our haste to make psychotic thought more comfortable, in our desire to avoid sitting with terrifying affects of self-and-meaning-dissolution. How we - doctors, patients - may accordingly 'romanticise' what are either actually forms of world-disintegration or 'psychic retreat'-like modes of world-evasion.