Friday, 31 May 2013

thinking about suicide

At the university counselling service I work in we sometimes have to be mindful of the impact of the deaths by self-killing of some students on others of the university members. To this end the manager of the service must announce these deaths - which are only occasional, and not in greater number than would be expected for this age group nationally - to the staff group. When this happens we don't seem to know what to do with what we are told. I recently tried to explain why I thought this was to my colleagues, but did so in a rather desperately unhelpful manner. So I now want to get some clarity on this here.

Here is the feeling I encounter in the meeting: that the fact of the death of a student sits there like a huge dead fish in the middle of the meeting, with us all staring at it in its gloaming palor, not knowing what to do with it. It sits there like a kind of inert body. We all know, in some way, that it is an unspeakable tragedy. But our lack of speaking does not reflect this unspeakableness. Rather it reflects a kind of stuckness.

And here is my diagnosis of the stuckness: It is hard to think about, we get stuck, because we live in a world largely dominated by a particular Gestell or episteme or enframing. We know that death is hard to think about, but this, I want to say, is because it is hard for us to know how to think about the significance or meaning of a death - that meaning being of course the meaning/s of the life that preceded it. And why is it hard to think about the meanings of a life? Heidegger's idea is that we are enframed by something he articulated in terms of technology, but which has more to do with a splitting of the living of a life into two components: our actions themselves, and the meanings of them which are now unhelpfully located in a future beyond the actions themselves. All has become instrumentalised, everything done for the sake of something else, the meaning of things always being located supposedly outside of and in front of them.

Examples of this, I think, are all around us. They infect my profession when it gets sucked into a utilitarian ethics in which therapy or mindfulness or whathaveyou is done for the sake of increasing the sense of wellbeing of the patient. They affect the workplace, where we end up 'working in order to live', or in order to play, or in order to earn money to go on holiday with - rather than working for working's sake, rather than work itself being a spontaneous playful intrinsically meaningful rewarding activity. We start to take it for granted that alienation from our labour will always be status quo. Rather than the meaning or purpose of activities being inside themselves, they are located elsewhere. We therapists are alienated too from the means of production - and sometimes unwittingly end up working to meet the agendas of the government's latest thinking about mental health, or the suggestions of NICE, or to meet the needs of the service or our boss, or to meet our own needs. We find ourselves talking too in nonsensical ways about 'suicidal ideation', 'cognitive restructuring', 'positive and negative thinking', 'managing your anxieties' and so on. These terms aren't describing the living of a life, the meaning and value immanent within it - they are technologised and alienated descriptions of a life lived at odds with itself.

The result of this, I suggest, is a kind of splitting of the living organism - the now inert body on the one hand, leached of its value and meaning, and on the other the now imponderable meanings of its life endlessly deferred into a future (into 'happiness', into 'holidays', into 'my salary / my pension', into 'quality of life' defined in hedonistic ways). We then get brought up against a fact of self-killing, and find ourselves blundering about almost not really knowing what to say - and start thinking in platitudinous terms like 'well they will get through this and then they'll be so grateful they didn't do it because now they're enjoying their life again', or what have you. We go mute at biological death because we're already muted and capitulated to existential death - the death of self-becoming, of living loving connecting intrinsically valuable relating open raw fragile vulnerable passionate frightened bold courageous quivering humanity. We capitulated thus by our unwittingly being caught up within the 'technological' Gestell, within the instrumentalised world in which value is located outside of the current moment of self-becoming. And we disguise from ourselves our awareness of our own existentially impoverished grasp of the meanings of dying and living through letting ourselves be taken up primarily with the trivial anxieties du jour - with the loft conversion, with the difficult colleague or neighbour who raises our hackles or ruffles our feathers, with the totally unfair rate at which we're paid, with the difficulties of managing risk, with the waiting list and reports to be written, and so on.

What do we do about this? Well, what do we do with the suicidal patient? Do we get caught up in trying to manage their risk? Perhaps a little of this is sometimes a good thing. But what we mainly need to do, surely, is good old fashioned psychotherapy, which attends to the felt and true risks of being - and of not being - existentially alive, rather than to the distracting risks of self-killing. Which attends for example to intolerable hatred 'turned against' the self; which itself takes the risk of making real, vulnerable, contact with the patient in their emotionality - contact between the patient and with who one is in oneself, that is, and not between the patient and some model or theory or technique or instruction we've inserted between us. The real risk, after all, is that our patient never comes alive - that we collude with their inner death through ourselves getting caught up in being nice or safe or jolly or banal - and not that they kill themselves. Existential suicide and infanticide are all around us; we are run through with it. What are we going to do about it?

Thursday, 30 May 2013

even if it's sunday may i be wrong

Consider e e cummings' passionate prayer:
e e cummings
may my heart always be open to little
birds who are the secrets of living
whatever they sing is better than to know
and if men should not hear them men are old

   
may my mind stroll about hungry
and fearless and thirsty and supple
and even if it's sunday may i be wrong
for whenever men are right they are not young
 
and may myself do nothing usefully
and love yourself so more than truly
there's never been quite such a fool who could fail
pulling all the sky over him with one smile

Here a hungry and supple loving openness to living the spontaneous song of life is pitted against something called 'knowledge', pitted against something to do with 'being right', religiosity, utilitarianism.

So what's the pitting? Is it fair; are the contrasts meaningful? Considered as conveying psychological wisdom the poem's message is perhaps apt, yet basically dull: May I be without fear, flexibly minded, not get caught up with needing to be right, not cleaving too firmly to received beliefs, etc.... Right, but poetically boring. And also, for such a reading we have the question: What's all that stuff about age, singing versus knowing, not being useful, pulling the sky over oneself with a smile? Have we just caught the most always romantic e e cummings in one of his more exuberant soppy moments?

So instead let's have a look through a philosophical lens. The one I'm shuffling into my scope right now is perhaps borrowed from Heidegger, but let's not be fussed with Heidegger exegesis here (this is just a blog post, ok). Here's a distinction to get us going: between originary discourse, in which the 'being' of things is disclosed to us, and representational discourse, in which a grasp of 'being' which has already been disclosed is now simply redeployed in a description.

A function of poetry on the one hand is to reveal things in their sui generic being to us. The poet intones 'A' and brings the being of A alive for us; the A-ness of A is evoked by her words; metaphors used here will be live ones. Poetic thought, furthermore, is thought to no purpose beyond itself. Poetry which descends into point-making, like some conceptual art which serves only to convey ideas which could equally be expressed in language, denatures itself as art.

A function of representational and technological thought, on the other hand, is to tell us which, of various already-grasped options, we have to do with in a particular case. The scientist says 'A is a case of F.' Any metaphors deployed here will be essentially dead. Here we have to do with thought not as originary evocation, but instead as a re-presentation of something already cognised. We don't give voice to phenomena, but instead merely talk about them.

An important theme in Heidegger and elsewhere is the way in which the very fact of the prior disclosure of Being in representational discourse is lost on us. The very fact of disclosure itself is lost on us, and because of this we are condemned to tacitly reiterate pre-understandings of Being which are only part of the story of what is, and try then through our metaphysics and epistemology to find ways to accommodate certain of the manifest facts about ourselves to a universe which has been pre-understood in an impoverished way.

Anyway, what about Cummings' poem? Well seen through the lens just offered I think a fuller range of its meanings become immediately available. Anyone who has listened to the song of little birds will, I suggest, find it baffling that they are just singing, that its not obvious that any why can or should be offered as to their singing exactly this, then, now, etc. (Though we can of course offer evolutionary and ecological explanations of their having and manifesting the ability to sing.) They are, as it were, pure expression, pure self-becoming, in their singing. Hearing this singing, being alive to the un-representing spontaneity of their singing, is better than any amount of 'knowing' or representational thought. Being 'right' too is a matter of representational matching. Better to be 'young' - to be close to the evocative pulse of life rather than stifled by unwittingly adopted dead metaphors - than to be one who is 'right'. And utility, too, is a matter of non-poetic thought: A is done for the sake of something outside of itself; it is not true to say of what is 'useful' that it is done 'for its own sake'; we are instead always thinking of doing A to meet end B. The image of 'holy' fools who fail (who are not in the business of representational fitting, success, aiming at extrinsically defined goals, but who instead are just pulsing with love and life) is, finally, one familiar to many of us in religious literature.

Another prayer of Cummings, this time of thanks rather than petition, ends:
(now the ears of my ears awake and
now the eyes of my eyes are opened).
A sui generic sensibility awakens to sui generic stimulation: here there's no danger of closed, old, correct, knowing hearts at all.

Thursday, 23 May 2013

on the compatibility of the different ways of understanding and not understanding schizophrenic delusion

As ought to be well known, psychologists are prone to conflate various different senses of the verb 'understand' when considering the question of the intelligibility of schizophrenic delusions. I'll outline a few forms and then consider their in/compatibility.

Thus we have an ordinary sense of 'understand' where I come to fathom what someone says or does in coming to see their reason for thus saying or doing - the end (Aristotle's 'final cause'), say, at which that speech or activity aims. It is this kind of understanding, surely, which Jaspers has in mind in talking of the un-understandability of the primary delusions of the schizophrenic person. Try as I might I can't make the reasons they proffer my own.

And we have another kind of 'understand' in play when I grasp, if it were as much as possible to do so, what neuropsychological mechanisms had temporarily become disturbed when someone is deluded. Perhaps in offering a causal explanation of this kind I can be said to be fathoming the 'material' or 'formal' causes of the change in psychological functioning that constitutes or underpins delusionality.

A further kind of 'understand' is in play when we think of how, say, a paranoid delusion may bring at least initial relief to its sufferer, by systematising, concentrating and (in an unhelpfully vague use of this term, which is at least a little less misleading than the 'explaining' function which the cognitive psychologist often posits as the cause of delusion formation) 'rationalising' the unbearable antecedent psychotic terror. It isn't exactly obvious to me which level of explanation this form of understanding is best pegged to. For example should we think of it as primarily referencing the subject's motivation - that the subject's forming and maintaining their delusion is motivated by a drive to reduce selfhood-disrupting terror? Or should we think of it in terms of the subpersonal lure of, as it were, an 'attractor basin' in the systemic dynamics of the brain's function - a replacement form of inner equilibrium which can kick in when equilibrium becomes hard to come by in the context of what might normally be those sustaining reality-contact-promoting brain-body-world-other-afferent-and-efferent feedback loops (certain of which have for the delusional subject become radically destabilised) - a replacement form, that is, characterised by an intra-neural short-circuit. Or perhaps those are two different levels of explanation of the same phenomenon?

Another kind of 'understand' is in play when we grasp how the delusion emerges out of prodromal disturbances of selfhood - of the sort that Louis Sass and Josef Parnas and Giovanni Stanghellini - i.e. phenomenologically minded psychiatrists and psychologists - are so good at characterising. Sometimes, as Sass suggests, this emergence may itself thematise aspects of the character of the prodromally psychotic mind - I think that it is following Heidegger (or Merleau-Ponty?) that Sass calls this 'emblematisation' (in the sense of 'emblems of someone's Being' (emblems of their form of Existence / being-in-the-world)).

And then we have yet another kind of 'understand' that comes into play when we grasp the 'symbolic content' of the delusion - in the way that psychoanalysts shed light for us on psychotic aspects of mental function. This, I suspect most important, sense of 'understand' concerns us with a particular mixture of causal and motivational factors that also reference a different ('autistic' or 'psychotic') mode of functioning (i.e. 'formal cause') of part of the self (nb when psychoanalysts talk about 'mind' they refer, it seems to me, to what most psychologists instead refer to by 'self': thus ego, id, superego are parts of the self, not of the information processing mind). Understanding delusions in this sense of 'understand' involves us in 'reading' them according to a certain pattern: as ways the patient is trying to meet their own libidinal / object-relational needs through a kind of surrogate and narcissistic/omnipotent formation. Coming together here, then, are factors about i) a particular (omnipotent/autistic) mode of function, ii) motivational dynamics and the defence mechanisms (projective identification etc.) used in attempts to meet, deny or destroy the emotional needs, and iii) association-governed 'symbolic' connections to provide a substitute content.

There are undoubtedly other forms of understanding too that can be brought to bear on the question of the formation or of the being of delusion. Many of these will be hybrid in character. For example, if I am to grasp the significance of a delusion of world catastrophe, I will first need to understand how aspects of the subject's selfhood and self-experience have become detached from the ('external') world, resulting in an 'autistic' or 'primary narcissistic' or 'omnipotent' mode of being. And then I will need to think of how what has now become the world (i.e. this subjectivised version of worldhood which is all that the schizophrenic person, in the delusional aspects of their being - i.e. in the ambit of their core psychotogenic complexes - has left to them) is experienced as ending. Thus we can say that the delusion of the ending of the world is the emblematisation of the destruction of the self, perhaps projected safely into the future (think of Winnicott on what one fears as already having happened).

But, yes, my main point here is that many of the forms of understanding we bring to bear on delusion are precisely not compatible with the form we started with - with, that is, the kind of understanding which, if I am right, Jaspers is referring to as being impossible with schizophrenic delusion. I cannot grasp a delusion as the product of to-me intelligible-to-hold beliefs and desires (Davidson's so-called 'primary reasons') or in terms of the ends or the facts or purported facts (which are what we normally mean by actual talk of 'reasons') proffered by the delusional person. If I could, then, (the standard interpretation of) Jaspers' story goes, we simply would not here have to do with delusion in any case. But also in the very bringing to bear of some of these other forms of understanding on the delusional beliefs we are, I want to suggest, already consigning them to the category of the un-understandable (in the ordinary, initial, sense). To offer, say, a defensive-motivational understanding of someone's believing what they do is to assert that an ordinary reason-giving explanation will not cut it here. As to which forms of understanding are and are not compatible with maintaining the propriety of the initial everyday-reason-giving form, well, try it out yourself using different examples. Even at the neurological level, whilst it is clear that ordinary believing will necessarily be subtended by any number of diverse neurological processes, if we are looking at accounts of neurological dysfunction, given that such function or dysfunction must itself surely be defined relative to (say) the reality contact or otherwise of the patient, the possibility even of such 'merely causal' forms of explanation will itself, it seems to me, impugn the sane status of the person in their believing what they do when they cleave to what are to be identified as delusions.

And, just in case its not obvious, why am I going on about this here? Well, psychologists are apt to say something like 'oh that terrible Jaspers, he said we couldn't understand delusions, make them intelligible, but this was to give up on the psychotic person and to fail to reach out to them as a sense-making subject'. My point would be that the ways in which we can and do understand delusion in fact precisely also implicate the delusional subject in a form of senselessness, in a failure of everyday meaning. Far from bringing a greater degree of interpretative charity to bear on the psychotic subject, the psychologist just described succeeds merely in muddying the psychopathological waters - as well as in missing the depth of psychotic damage and, one suspects, the terror attendant on it.