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.