Sunday, 15 April 2012

What is Madness? 11
Language and Influence in Schizophrenia

Chapter 4 of Darian Leader's rather interesting new book on psychosis begins with a kind of explanation of feelings of influence in schizophrenia - which explanation seems to me to be a paradigm of a stretch of reasoning that I, unlike (presumably) the author, cannot (yet) recognise as such. I don't know what to do about this other than to document it, so here goes.

Leader is interested in the feeling and belief in schizophrenia that the intentions and thoughts of others can enter one's own mind and body, controlling one's own mind from without. He suggests that our identity is partly constituted by our acts of refusal (e.g. rejecting further food - we assert our own desires). Language, however, is learned, and so language and that internalised language we call 'thought' is also derived from (mainly) our parents. We must take from them (i.e. internalise knowledge of word meaning) in order to express ourselves, and cannot therefore only assert ourselves against them.

I'm not sure what to make of this. After all, we can refuse to say certain words, and we do also learn a variety of actions from observation. We can also verbally subvert the parental order of meaning. And, most importantly, we can - and children very often do - say 'no!' - using language learned from the parent to refuse the parent's entreaty. The contrast between doing and saying is not clear to me - or more honestly, I just don't see that there is one.

At any rate, Leader then cites Freud on Tausk on the experience of influence in schizophrenia. Freud says 'the 'infant's conception that others knew its thoughts has its source in the process of learning to speak. Having obtained its language from others, the infant has also received thoughts from them; and the child's feeling that others know his thoughts as well as that others have "made" his language for him, and along with it his thoughts, has, therefore, some basis in reality'. As a schizophrenic woman said, when she was younger her father could hear her thoughts and, quite rightly, took them away from her' (p. 95).

First of all, I'm not sure if we are trying to explain delusions of thought insertion, thought control, mind reading, or what. The Freud quote and Leader's rider don't seem to match up.

Second, I don't yet see any legitimate inference from 'obtaining language from others' to the idea of 'receiving thoughts [and, I am assuming, motor commands] from others'. We do, to be sure, 'receive' all sorts of thoughts from others when we listen to the thoughts they express in their talk. Furthermore we may pick up, consciously or otherwise, a variety of perspectives which are more implicitly immanent within their talk than explicitly avowed by it. And also, to the extent that language is the vehicle of thought, and we learn language from others, we develop our capacity to have our own thoughts by learning the language of others. All of this is fairly obvious. But none of it is what is meant by the schizophrenic subject complaining of 'made' or 'passivity' actions, impulses, and feelings. They aren't complaining of being able to understand other people(!), or of having been influenced by the propaganda of others. They are complaining of, here and now, as a living experience, having others directly affect the initiation and direction of their feelings, thoughts, and behaviours.

Contra Freud, there is I still believe no obvious 'basis in reality' for the phenomenon in question. Reflecting on the way in which we learn language doesn't seem to even begin to help us understand made phenomena. But then again, Leader and Freud offer their reflections as addressing precisely this issue. And then Leader writes that 'As a schizophrenic woman said... her father could hear her thoughts and... took them away from her'. But where on earth does the 'as' come from? How is this sentence any kind of further exemplification of what has gone before?

So I'm stuck. The text is offering me sentences which have the form of thoughts, but I cannot see how to receive these thoughts, to let my mind begin to be influenced by them. In the normal sense of those terms, that is. I am left to conclude that what passes as thinking for someone else is not what passes for thinking amongst myself and I suspect those who trained me. It is, for me, as if Leader had conflated associative word-picturing with the generation of thoughts. That is exceedingly ungenerous of me, but I just don't yet know what else to do with what he writes here.

Leader goes on to describe how as children we may often think that our parents know what we think (without us telling them), hence the importance of learning to lie (cf Winnicott...), which is described by Leader as escaping from the parents' dominion.  'In schizophrenia, however, this dominion is not always broken, and it can affect both the body and the mind' (p. 96). Well yes, but are we just being offered a regression hypothesis without independent evidence of regression, or is the idea that the maturation of the schizophrenic adolescent up till their breakdown is a pseudo-maturation?

Leader goes further: 'This apparent absence of will [ - the schizophrenic experiencing themselves as the plaything of a powerful Other] is linked to the question of language. [What the question is that Leader has in mind here is left unarticulated.] In schizophrenia there is a permeability to language, as if words and images had a direct effect. Some schizophrenic subjects will obey any command or suggestion coming from the outside, and this is one reason why it so often seems that their childhoods were happy and uneventful. ... Words are followed like instructions' (p. 96). Further examples of suggestibility are given. And here we have a curious feature of Leader's text that I am beginning to notice. The fact that, say, instructions are verbal is taken to mean that their linguistic nature is significant to their occurrence and should accordingly feature in explanations of it.

Leader says 'In schizophrenia there is a permeability to language, as if words and images had a direct effect.' What he appears to me to be is talking about are the kind of command automatisms one may sometimes find in schizophrenia. But isn't this (well - to me it is - how about to you?) a strange way of putting matters: a 'permeability to language'. This way of articulating it makes one think that there is something about the subject's relationship with language that has gone awry. But is that true? Rather we have the fact that such people seem to have lost their capacity for self-initiated action but instead may follow the instructions of others without thinking. Describing this as a 'permeability to language' is simply far too general and vague to count for me as an elucidatory reference.

Here's another example: 'If the symbolic hasn't separated child from mother, they will remain included in her. As one patient expressed it, 'I look at my arms and they aren't mine. They move without my direction. Somebody else moves them. All my limbs and my thoughts are attached to strings and these strings are pulled by others' (p. 98).

Here is what I think is happening in such vague descriptions. On the one hand the vagueness defeats the possibility of there being any genuine explanation here. On the other hand it is only because we have such vague, eliding, language that we even seem to have explanation at all. Leader is tying together, in an admittedly very intriguing way, a child's initial partial un-differentiation from their parents with the schizophrenic's experience of being invaded by the will of the other. But what we now need to actually know, be given details of, is how this tying together is supposed to work. It is not as if the child is normally to be described as suffering from passivity experiences, and not as if the schizophrenic typically experiences their parents as the invasive forces - instead it is just 'somebody else' who moves their limbs and thoughts.

Nobody has ever doubted that we have, in such schizophrenic cases, to do with transitivistic phenomena; that such phenomena can be described as a disturbance of ego boundaries; that the development of ego boundaries is a core task of childhood and adolescence etc. But what we find in schizophrenia is not a simple failure of differentiation, but an actual experience of invasion: they precisely do have an 'ego boundary' in place, a boundary which they experience as being transgressed by the alien other now located inside their body. And it is precisely this that we need explaining. 'Failure of differentiation from the mother' by itself just isn't, it seems to me, up to the explanatory job for which it is being proffered. Not only do we need to hedge it (by explaining how they functioned non-transitivistically when pre-psychotic) but also we need to supplement it - by explaining how we don't, in fact, have to do with any simple absence or weakness of boundary - but with a delusional experience which has, impossibly but actually (as it were), the Other represented as being within one's own sensori-motor domain.

Leader writes: the child's body is payed a lot of attention to by its caregiver/s when young. 'Both external and internal processes will be linked to this Other' (p. 98) [ - ok, vague ('linked' etc.) but lets go with it - ] 'The sensation of hunger, for example, is inseparable from the caregiver's will: if we are hungry, it is not just because we don't have food, but because the Other hasn't fed us. ' [ - ok, good example, makes it less vague -] 'The Other is thus intimately linked to our actual body, both inner and outer, so that what happens inside depends on them. This fact must be of special importance in schizophrenia, due not only to the bizarre bodily sensations we find there but also to the ascription of such feelings to external influence' (p. 98). -- Whoa - this is the connection that we are waiting to have explained to us! And must the fact be of special importance? Might not the passivity experiences have a different origin (e.g. a neurological disturbance)? Just because the child experiences hunger and 'links' this to the caregiver's lack of care, why should this have anything to do with a schizophrenic person experiencing invasion of another person into their internal world? The only way I can make that work is if I take 'internal world' and 'linked' in one sense, then take them both in another sense, then make a (pseudo-)inference in which I switch the senses of the terms half way through the discussion.

postscript: I've noticed that there's something extraordinary about the way in which Leader's text both fascinates and frustrates me. The frustration consists in the way in which language is used which I find to be too vague to be genuinely communicative, in the way in which thoughts and theories are presented which I can't recognise as such. I feel like I am caught up in shadow boxing - that certain moves are being made but that the normal connections between words and world are often not happening. But then again Leader has some genuinely interesting things to say, and we really do need further psychoanalytic accounts of psychosis - to supplement and challenge what in the UK at least are the far more readily available Freudian and Kleinian options (Freeman, Bion, Segal, Jackson, Lucas etc). My feeling, that I don't yet trust, is that there is something to Leader's working out of the meaning of the Oedipus complex that genuinely does contribute to a different understanding of psychotic conditions. As I write about his text, though, I find myself getting cross and often having to go back to my posts later to edit out my frustrated jabs and jibes that get past the censor at the first and second pass. This sets me a task for further postings: to try and achieve a greater degree of measured owning of my feelings and open mindedness.