Monday, 28 December 2015

on why it matters, to me, that psychoanalysis not be relentlessly portrayed as science

I've been thinking over why it matters to me that, say, explanation should not be taken as the fundamental entry point of the concept of 'the unconscious'. Or why I do not always find it helpful to characterise psychoanalysis as a science. I suspect my reasons are not the standard ones. Those include such concerns as that psychoanalysis treats of meanings or reasons rather than causes (assuming the former are not the latter), or a vaunting of the natural sciences or of laws of nature as paradigms of science or of scientific knowledge (which psychoanalysis and social sciences cannot hope to emulate). I'm not troubled by the idea that psychoanalysis may be pursued as science here or there, that we might find some criteria that go beyond mere 'body of knowledge' (history surely isn't allowed to count as science) but stop short of some deductive-nomological structure or what-have-you. It's rather all got to do with fundamentals. My claims is that, at its root, psychoanalysis is not to be taken as a science.

The logic of the point is quickly if admittedly without argument put. Science involves us putting a question to nature which we allow to answer in ways that may surprise us. (The answer cannot already be contained in the concepts in terms of which the question is put.) Whilst we may do this at local junctures here or there (we might not know yet if Geoffrey is repressing anger towards his father; the answer might surprise us), we cannot, I suggest, articulate even the being of the fundamental explananda without already deploying a psychoanalytic sensibility. What transformations in psychoanalytic theory, in the explanantia, involve, it seems to me, are fundamentally transformations in sensibility, transformations in ways of seeing. Such refinements and variations of sensibility can be found in stages of Freud's work, but also in the developments in object relations and Kleinian theory-and-practice. The new sensibilities open up for us new domains of emotional experience as objects to be known and negotiated. The grasp of the concepts for these domains presupposes the flourishing of the requisite sensibility. Expression, evocation, metaphor, etc. are often fundamental to opening up and attuning such depth psychological vision. Disagreements between schools are often, I suggest, rooted in different sensibilities, or the attempt to grasp a new theory without also changing the sensibility into which it is grafted.

At any rate, I'm not going to press the above here. My claim is just that those who suggest that psychoanalysis is a science often overlook the extent to which the sensibility makes available the facts and can either downplay or ignore its fundamental role in making available psychoanalytical knowledge. Psychoanalysis, I want to say, is importantly more revelatio than scientia. This leads me straight back to why it matters to me that psychoanalysis not be portrayed as fundamentally a (social) science or as fundamentally in the business of explanation. It is because such approaches are, I believe, misguided in the way that they ignore the fact of their own revelation and the change of sensibility required to see what is revealed, and say to us too: hey, you too can get here where I am just by using empirical knowledge and right reasoning. (The Alpha Course provides a parallel example in relation to evangelical Christianity: it's all portrayed as so-very-sensible that one wonders: why bother; give me Kierkegaardian absurdity any day over this...) And, here's the thing: there's nothing more annoying than someone trying to pass off their own unarguable revelation as something to be arrived at through evidence and reason. It is a form of narcissism and a failure of dialectical responsibility and ethical recognition. Show me how you see things, yes, draw my attention to this or that, draw out what may already be implicit in my experience, evoke and express and poetise. But, please, do so with an open heart; do not try to force your revelation on me by tacitly pretending or forgetting that you never had it, or by making out that it can be grounded in what can anyway be ascertained independently of it.

Friday, 25 December 2015

on the alleged explanatory necessity of our concept of 'the unconscious'

One reads, I read, not infrequently, the suggestion that the concept of 'the unconscious' is forced upon us if we are to make explanatory sense of a significant range of human phenomena. We meet with this first in Freud - in his suggestion (in the Introductory Lectures and elsewhere) that the phenomena of post-hypnotic suggestion are unintelligible except on some such explanatory posit.

If we are to deny this - and dammit I do wish to deny it - it may seem that we are committed to the preposterous idea that there are no unconscious mental states; that we can do without the concept; that we can do justice to the phenomena which prompted the development of the concept without such a concept. And, well, I've already said that that such an idea (a la William James perhaps - see ch. 2 of Donald Levy's marvellous little book) seems to me to be preposterous. (And thank God for that, really, or I'd most likely be out of a job...)

The distinction I wish to invoke at this point is one between invoking a concept to offer, or by way of offering, acknowledgement to a phenomenon and invoking a concept by way of explaining a phenomenon. It is the latter claim which we meet with in the literature I'm carelessly recollecting here. (We do not serve ourselves well, I believe, by responding to my initial suggestion already with something like 'well, I'm just not going to join you Richard in making any such distinction between, as it were, descriptively acknowledging the being of some phenomenon on the one hand and properly explaining some already-acknowledged phenomenon on the other' - because the fact is that we do make such distinctions, and failing to make them risks both emasculating our concept of 'explanation' in ways which deprive it of its scientific potency and hyperbolically inflating our ability to recognise the life of the unconscious in our everyday interactions and reflections.)

Consider then Freud's claim that the phenomenon of post-hypnotic suggestion obliges us to wheel out the concept of the unconscious. The hypnotist puts the patient in a trance, and instructs / suggests to him that on awaking, when the hypnotist goes to leave the room, the patient will come and open an umbrella over his head before exiting the building, and the patient will yet remember nothing of this suggestion. All this goes down as suggested, and the patient, on being asked why on earth they've opened the umbrella, at best comes up with some absurd rationalisation like 'well I thought it might be helpful to you as you are about to go outside'. Doesn't this force us, Freud says, to deploy a concept like 'unconscious motivation' to explain the behaviour in question?

Well. No. It doesn't. Because explanation just isn't what we need here. What we need is rather to acknowledge the extraordinary fact of the phenomenon itself. This shit happens. That's what's incredible (to the person who's not yet (allowed themselves to have) met with it). That's what 'necessitates' the concept.

What, I think, stops us from even really seeing this, from being able to offer it due wondering acknowledgment, from accepting it, is i) an unhelpful and unwarranted and unargued epistemological conception of consciousness and unconsciousness, and ii) a correlative entified ontology of our thoughts feelings and intentions. Such ii) thoughts and feelings and intentions are thought of as inner objects that, perhaps, cause our actions. And to have unconscious feelings etc is supposed to be a matter of i) having feelings to which we don't have the normal inner epistemic access. Once that dose of double trouble is ingested, the explanatory conception of the work that the idea of the unconscious does for us will seem an inevitability. It will look as if we are required to posit an intention that the patient is not aware of - whatever that means - in order to make sense of why he acts as he does. And if now we start to push that 'whatever that means' scepticism, a la James or Sartre perhaps, it will look like we've just got our head in the sand, and that the only proper way with us will be one of impatience.

So let's back up. Let's just remind ourselves of the phenomena. Sometimes we meet with someone who, when asked why she does something, can do what we call 'giving us her reason'. Sometimes we meet with someone who cannot do this. Sometimes what she does is a matter of fulfilling an instruction given earlier. In the normal 'conscious' case, the two phenomena come together: the person both acts on the instruction and offers acknowledgement of this. In the case of an unconscious intention the person cannot offer such an acknowledgement. Nothing in this necessitates that her inability to offer the acknowledgement is based on a failure of acquaintance with her own intentions. Nothing necessitates the epistemic take. Nothing necessitates the idea, either, that the intention is an object with which acquaintance could be made. By contrast, what it is to intend to do something is to be disposed to do that thing, to be disposed to state it as a reason, etc. And what we mean by an unconscious intention is one which the subject is not thus disposed to state as a reason. Here we are stating matters of meaning; we are articulating the being of the phenomena; we have said nothing at all about explanation or about positing or about access or about inner awareness (whatever that is).

Once we've thus grasped the meaning or being of the unconscious, the idea that we require it to explain what the hypnotised subject is doing will rightly show up as hyperbolic. Now we can see clearly how, instead, our deploying the concept is itself nothing more than our offering the phenomena due recognition; it provides no kind of getting behind them. We can ditch the confusing 'inner access' model of conscious feeling. We can accept that our normal intentions and wishes are not merely contingently conscious; accept that consciousness is not best thought of as some kind of optional extra that we can enjoy if we are lucky enough. A conscious desire is not a desire we are conscious of - if by that we mean that it is a kind of transitive object of our consciousness just like sheep and goats are the transitive objects of the perceptual consciousness of someone walking through a farm; it is rather one that may be voiced, not one which has its only life in desirous motion. There is, though, no 'because' here: we don't voice it because we are conscious of it. That, once again, is but pretension.

A Cartesian conception of mind supposes that our capacity to avow our mental states is grounded in a kind of inviolable inner inspection of them. An anti-Cartesian conception of the unconscious supposes that our incapacity in avowing our repressed mental states is a function of an inability to thus inspect them. What I have been suggesting here is that this anti-Cartesian conception has a lot more in common with the Cartesian conception than it wants to acknowledge. In particular it has this idea of inner objects of inner inspection in common. If instead we get going with a Wittgensteinian conception of dynamic unconsciousness a la Elder and Finkelstein, the being of the unconscious can simply be located in the very phenomena that, according to the Cartesian, the unconscious is instead supposed to explain.

Thursday, 24 December 2015

efficacy and outcome

Sitting in the pub the other night a friend invited me to consider that we don't ever really know whether we psychotherapists have helped our patients. (Curious how this kind of sentence only really works to convey its allegedly valid point if we put the 'know' in italics.) A desire for modesty, and reflection on the self-serving confirmation bias of therapists - reflection on how easy it is to tell a post-hoc narrative in which the good outcomes are a result of the therapy, the poor ones the result of the psychopathology or life circumstances, incline me to agree with him. (He told me too of a patient who shared with him the priceless 'When I'm doing better my psychiatrist tells me it's his drugs working; when I'm doing worse he says it's something I'm doing wrong. I can't win!' ) And yet...

The question touches for me on two other concerns. The first has to do with interventionism in the philosophy of science. The second to do with a distrust, by psychoanalytical psychotherapists, of outcome research, a distrust which often seems poorly reasoned but which yet may, I suspect, sometimes be on to something.

So here is a way of looking at therapeutic efficacy and outcome which sustains the idea that we don't really know whether we've helped someone. It is one in which the interactions in the consulting room - actually it really works best, for reasons that will become clear, if we call them 'interventions' - and the emotional relief of the patient - and it works best if this is thought of as an 'outcome' - are thought of as 'distinct existences'. Distinct existences that, we will now want to describe as, either actually or merely apparently in relation to one another. Now it becomes clear how we can get going with a picture of emotional therapeutics which renders its impact beyond anything that could safely, non-arrogantly, be said to be known.

So, yes, if we have to do with distinct causes and effects - with something brought by the therapist which is the intervention, and something now felt in and by the patient which is the effect of the intervention - then the appeal of maximal epistemic modesty - 'we can't ever really know whether what we do really helps them' - 'we can't ever really know whether or not our intervention works' - becomes evident.

But why would anyone think that that's (the 'workings of interventions') a good way to characterise the therapeutic encounter? It might ally nicely with a medical model (does the drug work or not?), but does it ally with what any of us really experience as patients of psychotherapy?

Actually there are situations in which something like this characterisation does seem apt. The occupational/behavioural therapy of a depressed person is an obvious example. 'Do you know, I really do feel better just going out and getting on with some work; I really didn't expect what she said to help but I do find myself feeling a lot better'. Even here, however, we have two things going on which I think need teasing apart. One is the non-psychotherapeutic boon of the recovery of self-sustaining meaning-making through work, world-engagement, etc. Good old behavioural recovery. Nothing to do with the unity of subject and subject in a therapeutic relationship, this. Rather the transmission of a guiding idea from the one to the other. The other is an existential and emotional shift - a recovery of trust in the cogent solicitude of the other (of the therapist that is) implicit in this situation of which the patient's mind is a part: the patient allows himself to hear what she is saying to him. And a recovery of trust in his own mind - a recovery in his ability to show himself meaningful solicitude.

On the whole, however, and especially when what we have to do with is psychotherapy proper, the medical model - by which I mean a model framed in terms of the distinct existences of intervention and outcome - hardly seems applicable. A better model would, I suggest, be face painting. Someone wants to get their face painted. So they go to a face painter. Here it would be daft to call the face-painting the intervention which has the effect of the person's face now having paint on it. The cause and the effect are not here two separate things: the cause is the painting on the face which is the same thing as the face being painted. Imagine someone saying 'But do you ever really know that it's your face-daubing that causes the face-being-daubed-ness of your client?' The correct answer is 'Yes mate I kinda do, but your talk of "causing" is flagrantly hyperbolic'.  

'But', it will be objected, 'psychotherapy is hardly as sure an art as face painting'. 'It is this uncertainty, this difficulty, that gives our thoughtful scepticism its point'. Well. Yes. But. But we mustn't generalise from the difficulty of significant emotional change relative to facial hue change to the idea that when emotional change does happen it happens in a way that can be aptly modelled on the idea of interventions leading certainly or uncertainly to outcomes. Might it not rather be like going to see a dyspraxic face-painter? Four out of five attempted daubings miss their target, but the one that does: there's no question for this one that it might not be the daubing that causes (better: constitutes) the being daubed. No question of being immodest if we pretend to knowledge here.

It seems to me that it is perfectly clear enough, and no kind of unsafe inference - no kind of inference of any sort, for that matter - clear to both therapist and patient, when a therapy is alive, when it truly is functioning as a therapy. My patient is defended, emotionally cut off, irritable, stuck in his depressed or anxious state - and I make various attempts to 'get through to him'. And many of these backfire. But then I do - there we go - now he has that rush of tears, that relinquishment, that flowing up and out of openness, he settles into a meaningful relief or sadness, or he allows himself to feel his anger, his envy, his guilt. He relinquishes the suppression or involution of his anger. There is this lifting of his depression, in this moment. This cessation of depression now is not the cause of its ongoing cessation over the week. We're not inferring from one thing to another thing here either. To borrow an analogy from Squires' (1969) brilliant critique of causal theories of memory: the curtains being indigo today is not the cause of their being indigo tomorrow; it's just that nothing has intervened in the meantime. In this moment of therapeutic action both therapist and patient know perfectly well that this therapy, here, now, is working.

None of this is to say that outcome research is invalid. By all means find a description of therapist actions and beneficial patient reactions under which they manifest as external relata, and then ask about how consistent such relations are for this or that therapist, or perhaps even across therapists, for those using this or that model of therapy for example (although I think this is much harder to think sensibly about). We would be crazy to go and see a therapist whose outcome data, measured thus, was effectively at a chance level - who offered therapeutic relationships in which therapeutic moments were no more frequent than in any other waking hour of their patients' lives. But we would also, it seems to me, be crazy to try to use such outcome research to guide us in our practice - at least to the extent that it inclined us to a mode of therapeutic action which was all about doing things to our patients. We already know what is therapeutic. Sometimes we need to take courage. Sometimes we need to get better at challenging defences, discerning the extent of a patient's identification with his defences. Sometimes we can fail in our compassion. (Not fail in a technique of showing compassion, whatever that would be - but just fail ethically to meet our patients as people. We do this, sometimes, because we are human. And if you do it a lot you don't need a better model of therapy but rather something like a call to conscience, or some more therapy yourself to help with your projections.) But we do know, often enough, when it is working, that it is working. We were there. Not there as witnesses to an unsafely-inferred two-place relation, but participants in the midst of this unitary unfolding of the patient's emotional restoration.

Wednesday, 23 December 2015

ism

Interventionism is a doctrine in the philosophy of science which tells us that what it is for x to cause y is for an intervention on x to impact also on the happening of y.

Since it uses concepts like ‘intervention’ and ‘impact’ it is not to be read as attempting to analyse causation in non-causal terms. It is not attempting to provide a reductive analysis.

But then, well: what is it trying to do? We can’t really be expected to be taken all that seriously if we answer ‘well duh it’s trying to provide a non-reductive account or analysis of causation’ or some-such, since it is now far less obvious what ‘account’ or ‘analysis’ means here, in this new context – certainly far less obvious than, say, what ‘cause’ means.

It seems to me, on rather minimal acquaintance, that the interventionist project really arises from grappling with a certain puzzle – of how to distinguish causes from coincidences. As is usual when philosophical research projects arise in such a way, the question principally comes up for someone who is contemplating a rather detached and unusual scenario, someone not concurrently engaged in a situation in which they directly know of the causal relation between two things conjoined in a single event, as when I myself push or pull or cut something, pick up the cat, pick my nose. But rather a situation in which they witness two things or events obtain and wonder if they are causally or merely coincidentally arising. Perfect examples to sustain what we could call the ‘imaginary’ of the problematic will therefore probably be ones in which a switch is pressed over there, a trigger pulled over here, a boulder set rolling up here – and then a light comes on, a pheasant falls down dead, a landslide gets going, down there.

What I want to suggest here is that this particular juncture of perplexity is essential to the apparent intelligibility of the interventionist research project. I also suggest that if we start from here, in the quest to reflectively respect the being of causality, and try and come up with some criterion which will help us here to distinguish coincidences from causes, we will never get anywhere. Saying it that boldly is not of course something that could be written in a philosophy paper, but this is a blog post, ok (so eat it).

Such a situation is readily familiar to us from other philosophical contexts. Hence the arising of the Gettier problem. Someone tries to understand knowledge by starting from something potentially less secure, more abstracted – starting from ‘mere belief’ that is – and wonders what more we must say, on top of, conjoining, logically or causally related to the belief – in order to ascend our way to knowledge. Or we try to work out what must be added to mere intrinsically non-world-involving ‘internal representations’ for them to help them ascend to genuine cases of accurate memory or perception or belief. Or we start from an alienated conception of the lived body – as a juncture of mere movement – and wonder what must be added to arm raisings for them to ascend (no pun intended) to the status of arm risings. This attempt to distinguish causes from co-arisings through providing a marker of some sort to be added to the latter - haven't we seen it before in, for example, attempts to say what makes for the difference between those perceptual appearances which are mere, and those which are revelatory? (It's hard to even put this question out there without already deploying the question-begging non-disjunctivist conceptualisation which would have it that there is some thing in common between mere and revelatory appearances - i.e. the appearance - when, from what I take to be a more epistemically respectable disjunctivist perspective, the terminology of appearance is best left to do its duty precisely in its contrastive application with bona fide perceptual reality-contact.) Interventionism is, one could say, a kind of non-disjunctivist account of causality which wants to present the basic situation to us in terms of a common co-arising which in some instances inflates to causality. 'But how?' is the allegedly respectable journey it invites us all on.     

Now the elucidatory context is clear, and we start to get a good sense of what it is to be an ‘analytical philosopher’ who is ‘currently working on’ (ugh) ‘the [putative] problem of’ (double ugh) causality / perception / knowledge / etc. First you start from a disengaged uncertain spectatorial take on a phenomenon, you wonder then how to get from this to something with the life-blood world-involvement of knowing and seeing and doing and causing pumped back into it, and then you get busy proposing theories, and when someone then comes along with inevitable counter-examples, you think ‘oh goodie a research project’ and set to ‘work’.

Back to interventionism. Start from a case in which it is not already evident that we have to do with causality. Not a case of you squashing a spider – where there is one clear event in which your toe with squidging squelching inevitability causes the spider’s loss of three dimensionality. But rather a case of you pressing a switch, and something happening somewhere else – a buzzer sounds perhaps, and this often or usually or always happening when you press this switch, and then us wondering if here we have to do with causality or coincidence. And then we start to hunt around for a principle to distinguish between the two cases. The general tack is clear: start with mere happenings, and see if we can ascend to bona fide causings.

The principle that interventionism cites is: your pressing of the switch can be considered the cause of the buzzer sounding iff intervening on your pressing of the switch intervenes on the occurrence of the buzzing. That seems like just the ticket. We seem now to recover the certainty and pulsion we feel our use of the concept requires not by thinking instead of those engaged contexts of pushing and pulling but rather by adding a counterfactual principle of the ‘were it not for this, then not that’ sort.

And yet the problem that immediately arises is we start thinking of cases in which the that would have occurred even if the this which, undisputed cause as it nevertheless was, hadn’t obtained. Or, relying now on a particular use of the concept of cause which essentially pits it against matters agential, we imagine a case of my periodically pressing a switch and some perverse little bugger in the next room always watching me and then of his own free and devious will pressing the button that causes the buzzer to sound. (‘He’s the real cause’, we say.)

Rather than put her hands up with a ‘you got me guvnor’ gesture, the temptation for the philosopher who likes a ‘research project’ will now be to come up with a further set of criteria. So perhaps it is said that if someone now intervenes on that Z which would as it happens have caused X to happen had not Y caused it – which Y is subject to our imaginary intervention – and X does not now happen, then Y can be said to cause it. Or they say that the relevant concept of causality is not to be pitted against matters agential so that the little bugger’s actions are properly to be thought of as caused by our actions. Well, that certainly hypes things up a bit. But where does it really get us? Now we are to get our causings out of our happenings in the following way: X happening is the cause of Y happening if stopping X stops Y and if a load of other possible stuff that could have meant that Y happened anyway doesn’t happen. The difficulty for such a treatment will still be, I propose, that a niggling doubt in us is never quite sated that we still here just have events hanging in the air next to one another, that we might just meet with friends rather than with relatives, thereby failing to attain the bite of bona fide causality. Might not God have arranged the world so that some stuff only happens in constant conjunctions but yet there still obtain no causal relation between the conjuncta? (Perhaps He’s decided to take a leaf out of Jung’s book on synchronicity.) Or maybe that doesn't really make sense. But it's hard to know. My point is really just that it's not yet obvious that we can ascend to causality from conjunctions plus conditions. 

But it's also not obvious to me why I should ever want to try this - unless for some reason I've started my whole investigation of the being of causality by contemplating e.g. cases of action at a distance, cases in which we can't just swallow in one mouthful the fact of the causal relation itself. Why try to get to causings by adding things to happenings? (As the Irishman asked in Cork how to get to Dublin said: ‘well don’t start from here’.) We know from the start that we aren’t going to get a marvellous reduction of causality – since we’re using concepts like ‘intervention’ to get this whole thing going. We know too that we might have to specify a possible infinity of defeating conditions on all the other exceptional things that might yet have caused Y to happen even if X hadn’t happened. And most importantly we know we’re still going to be left with this strange sense of it all somehow still hanging in the air. That, however, is surely an artefact of the original problematic – this attempt to get the meat of causality out of the veg of co-incidence. Why even ask ourselves ‘But what is it for X to cause Y?’ I mean: what a funny question! How about, instead of answering that with a theorem, we instead remind ourselves of where we ordinarily encounter the meat of causality – not in cases of action at a distance – the flicking of switches, the firing of bullets – but in the slow squishing of that spider under your callous toe. Now you remember ‘what causality is’. Don’t you?


Tuesday, 22 December 2015

suffering made possible by solicitude

John is back in the clinic. He's sunken into despair, enmeshed in hopelessness, racked with desperation. I ask 'what's wrong John?' He replies:
I am—yet what I am none cares or knows;
My friends forsake me like a memory lost:
I am the self-consumer of my woes—
They rise and vanish in oblivious host,
Like shadows in love’s frenzied stifled throes
And yet I am, and live—like vapours tossed
Into the nothingness of scorn and noise,
Into the living sea of waking dreams,
Where there is neither sense of life or joys,
But the vast shipwreck of my life’s esteems;
Even the dearest that I loved the best
Are strange—nay, rather, stranger than the rest.
I long for scenes where man hath never trod
A place where woman never smiled or wept
There to abide with my Creator, God,
And sleep as I in childhood sweetly slept,
Untroubling and untroubled where I lie
The grass below—above the vaulted sky.

We've seen him in this state before. It besets him repeatedly; it courses through his mind and body, colouring the whole horizon of his understanding of self and world.

'Loneliness', he sometimes thinks, 'I'm lonely': the thought is itself a small achievement, a passing condensation of some small nugget out of the gloam. Again, and like the thought about loneliness, the words in the poem start to bring some small relief. A little space is created, between himself and his feeling; yet the relief is so little, so very little.

What has happened to John? All of us get lonely, feel saddened, dejected, rejected. Yet such states normally rise and (after a good while) vanish in the midst of our ongoing everyday lives; they don't give rise to such melancholia as afflicts John. With John the desolation spreads out to frame the entire horizon of his lived experience. The feelings, we could say, now become moods; they become fundamental modes of world-encounter. Every thought he now has is constrained by this horizon; he cannot escape it. This inescapability is what constitutes his depression as such - it is what makes for the hopelessness. His feelings are no longer within the Lichtung; rather they frame its perimeter. Their host, that is, is now oblivion itself. Rather than - rather than what?

The answer I want to give is: rather than a containing sense of self which is constituted by a sense of lovableness and of possibly being in the loving presence of the beloved other. I've called this 'the idea of love' at other times. It needn't imply the actual presence of a beloved. There need not even be one now alive. But there must be a background sense - not a mere thought, not something held onto as a mere fact - of one's own value, lovableness, goodness. It is this background sense of lovableness that makes for the possibility of a meaningful, particular, experience of unlovedness. It is only against the background of the former that the latter can be properly felt, suffered. This is why solicitude makes for suffering and, at the same moment, for its eventual release.

How can John achieve it? Let's be clear - his difficulty is not that his actual friends have deserted him. Doubtless they have - his self-involvement is too much for them. And doubtless too it did not help - all that brief fame he achieved, his celebration in literary circles, his being dropped again, the blow of being unable to marry his beloved Mary - all of this helped precipitate his psychotic depression, his compensatory wish-fulfilling delusions of being Shakespeare and Byron. It is not that his actual friends have deserted him - it is that the possibility of friendship has deserted him; the 'idea of love' - this is what is lost. The 'idea' that he can be known, met, as he is, that he could be cared for, as he is - not with compensatory fame, unreal manic celebrity, and so on. That he may love and be met with in his love. Not with Mary perhaps, sure, but with someone, somewhere, should he ever meet her. Instead of that poor John longs for the peace of a place where man and woman has never trod or wept - the peace of nirvana, the chilling silence of the death drive.

But how can he achieve it? One question for the clinician - the one I want to focus on here - is: How can we help John to know himself in the right way? We can see that his mind is trying to frame his emotional experience. Thus the poem comes forth, but it sputters - it does not get to the root. It is, rather, still a complaint. It is still only like the relief got from picking a spot: a relief from the pressure or itch, but the structure of the spot remains and it comes up again. John's complaint only voices the pain of the depression; it does not yet know of or voice the pain of those feelings - the actual disappointments, say - that throw up the depression. It does not allow these feelings to be felt, to be known.

So how can he come to the relief of knowing of himself that he is experiencing unlovedness? It will not help him if we introduce him to this as a fact. First off, this time he must come for regular therapy. The regularity of meeting with me will start to contain, make thinkable, his feelings. It starts to inscribe in his mind a psychic structure, a container, the idea of a place where caring accepting attention can be directed towards his hurt, can foster the idea of tending to the suffering, knowing it as such, seeing it as a worthwhile moment of the living of a human life, as a part of that life, as something tolerable, as something that can be borne with care. It may come about as he starts to talk with me in his mind, as he takes in not just the possibility of attention that comes from the therapeutic space, the consulting room, the function of attention, but also the possibility of tending that comes from the therapeutic meeting with me, of my hearing him, not shirking him, not interfering with him, not intruding with my own analogical experiences, not trying to help him out of it, not trying to overcome it. The trust that gradually grows as he comes to know that the feeling is part of what it is to be him, this man, this gentle genius with his frailties, his sensitivity, his human culpabilities, his gifts - this is the trust which comes from an approach that refuses to help him out of his experience, which instead allows him to master the terrible art. The terrible art, that is, of suffering the losses and disappointments of a human life.

Over time John comes to understand this. He knows now that he has experienced unlovedness and rejection. The unlovedness comes into the Lichtung - it no longer frames it, no longer spreads out as unloveability - instead he can have an actual emotional experience of it in its particularity. The loss of a specific hope becomes thinkable; hopelessness recedes. No longer the relentless insoluble inevitable hopelessness of the unlovable. John comes to know of and then accept his hurt feelings about Mary. He gives up his compensatory Byron delusion. His living and loving fit within the shape and frame of his actual life. He can do this because we helped him to suffer, to smile gently on that suffering, to take courage in it. He comes to trust again in the love of those dearest he loved the best; he lies troubled rather than untroubled, but he soothes his troubles. He comes back to life.

Wednesday, 9 December 2015

on 'what makes correct' an interpretation - coda on self-alienation

I find myself still perseverating, if now with diminishing spasms, on the issue of what makes correct a particular psychoanalytic interpretation. Having disposed of answers to that question which legitimately but - so far as scratching my itch goes - irrelevantly frame it as an inquiry into apt technique or into the criteria for this or that unconscious thought or feeling, the question still remains.

It remains, in particular, as a friend recently suggested, for the analysand who is mooting his analyst's offerings, perhaps taking them away with him, wondering something like 'but does this really apply to me and, if so, how do I know it is true?'

My suggestion, now, is that the question is unanswerable because it arises, in its most important and compelling if nonsensical form, only within an as-yet unacknowledged state of self-alienation.

If, that is, I am still in the business of asking this question of myself, then I am not yet of an unalienated piece with that which forms the content of the interpretation. Even if we  believed it true it would still not be something we could speak from. We could only speak about it. In this predicament we are yet treating ourselves like a second or third person.

Compare situations in which the question does not come up. You ask me 'It's getting late - are you hungry?' I say 'fo'shizzle ma dizzle, I'm ravenous'. There is, here, no question of my being correct or incorrect about my hunger, nothing which makes this avowal right or wrong. It is true, since it truly reports, whilst I truthfully propound, the fact of my hunger. I avow the hunger directly, and do not get into the business of, say, expressing a belief I have about myself. Lazily, we might say of ourselves here, 'I just know' that I'm hungry. That'll do fine, so long as we don't take ourselves to have thereby opened up an intelligible 'how (do you know)?' question.

And now compare such situations as those that prompted the question. I am left pondering my analyst's remark. Clearly, I want to say, the pondering obtains because the interpretation did not yet prompt my acknowledgement of my still-unconscious thought or feeling. I may be able to contemplate, in a theoretical mode, whether I have such a thought or feeling. But if I am doing that, and if it is true that I do have the thought or feeling in question, it is analytic (in the philosophical sense!) that my defences are still up. By contrast, if I could now simply avow the previously unconscious thought or feeling, it is not clear what the question would be asking. Now I know it in the way in which I know that I'm hungry. (Here my talk of 'knowledge' just means: 'shut up, you, you with your mis-placed disrespectful 'how?' questions...')

....

In other news, but relatedly: sitting in the pub after our seminar on Monday a psychotherapist described how she encouraged her patients to think of their emotions as providing them with information. As signals, if you like - as clueing them in to the obtaining of something significant in their life. Not to be ignored or wished away. It's a way of cultivating a friendly relationship with one's feelings: they have a meaning, one wants to say; they're important! Take note!

That is something I sometimes say, too, but I've noticed I do it rather less these days, and I want to think about why in the terms provided by the above blogpost. I think it is because if what we have to do with is normal ('conscious') emotional experience, the idea that our feelings convey information to us is misplaced. You do something spiteful to me. I am angry at you for it. Does my anger here carry information for me about the significance of what you have done? - Well: isn't that a bit of an estranged way of thinking about the relationship between myself and my anger? For surely it is in my anger itself that I know you've wronged me.

In the normal case the intentional content is not sheared away from the affect; they are of a piece. When we are estranged from ourselves, then we may do well to attend to our feelings, to see them as signals, as carrying information for or to us. But when we are of a piece with our feelings, then they themselves are our recognition of the significance of our interpersonal interactions. They don't clue us into grasping that something is up for us - rather they themselves are already of a piece with that grasp.

This, then, is the reason why I am less likely, these days, to urge the patient to view her feelings as carrying information for her. It can, to be sure, be a valuable half-way step towards integration. But since it is integration we are aiming at, I would these days be more likely to explore the situation in which the affect arose, to encourage the patient to think about its meaning, to ask at select times how she now feels towards the person the encounter with whom she is describing - which all aids in the development of conscious affect about which the question 'what does it mean?' does not arise.

Wednesday, 25 November 2015

on 'what makes correct' an interpretation

We're in the clinic. A psychoanalytical interpretation hits the spot. We might find ourselves wanting to ask: 'What makes it, in virtue of what is it, a correct interpretation?'

Before rushing to answer let's consider, first, how we might take the question.

1. One way of handling the question would be to quickly resolve it into a request for an explication of the being of unconscious thought. 'The patient's psychology is what makes it correct' - so goes the obvious answer. And then we might give an example of, say, Geoffrey's projection of his unconscious guilt into Margery, and elaborate the markers of that - his tetchy heightened need to blame her when he comes near anything which, as we see it, risks revealing to him his own blameworthiness, his mood, his shiftiness, etc. This way of taking the question sees it as a way of asking 'What is it to be labouring under what the interpretation interprets as obtaining?' It doesn't, say, take the raising of the question to be inspired by anything peculiar to the clinical situation of the patient's uptake of the interpretation. For sure, the criteria for unconscious guilt differ from those for conscious guilt, but the form of the question is the same in both cases, and spelling out the general similarities and differences in his or her dispositions etc. will answer the question understood thus.

2. Another way of handling the question reads it as an inquiry into correct psychoanalytical technique. 'What makes it the clinically correct thing for the analyst to say, here, now?' And here we would make reference to matters of timing, the defences not being too high for it to be meaningful to the patient, etc. - Geoffrey can now say 'Oh, God, yes, I can see now just how unfairly I've been treating Margery, and this guilt, yeah, it feels truly dreadful, how can I make it right?'. Perhaps we could even gloss 'correct' as 'that which enables the defence to be withdrawn'.

Such interpretations of the interpretative act are fine as far as they go, and so long as we keep saying what we mean and meaning what we say then we can of course say what we will. But there's a real question, for me at least, of whether they really get to the bafflement and unease that threw up my question for me. Perhaps they've merely temporarily gated the irritation of the real itch by scratching at a different point on the conceptual body.

3. At any rate, here is a different juncture where I am inclined to ask the original question. (But what do you think? Was this your predicament?) So, I am imagining an analyst making an interpretation to the patient, and the patient taking it up to avow his own feelings, or not. And I start to worry about how I can distinguish between the patient inauthentically receiving a mere suggestion and his now authentically avowing his inner experience.

One way forward I should now like to offer proceeds by first stepping back and reminding us of something about avowal. Avowal of one's feelings is not itself an act which it makes much sense to describe as correct or incorrect. Geoffrey's avowal of his guilty feelings is not the expression of his judgement that he has feelings of guilt. He is, if he truly is avowing, speaking from his guilty feeling itself. He is not, that is to say, avowing a belief that he has guilty feelings, but instead, now, avowing his guilty feeling itself. The avowal ('I feel guilty') can (unlike a mere  animal expression) accordingly (when it truly is an avowal of what it voices) be true or (if someone is lying or in denial) false, but is not helpfully described as correct or incorrect. (A fortiori there are no criteria of correctness for avowals.) (Acknowledgement of one's guilt itself is, however, at least often equivalent to avowing a belief that one is guilty.)

One way we could understand the analyst's interpretation is as the offering of a possible avowal to and for the patient. Seemingly aware of the instantiation here of the criteria for unconscious guilt, the analyst offers Geoffrey an opportunity of criterionless avowal, a chance at ownership. Nothing makes Geoffrey's avowal correct - for it neither is nor isn't. And what is it that makes the analyst's interpretation correct? Well, here, we can say various different things - we said some of them above already remember? - but - as it seems to me - what these would all do would be to tacitly - and perfectly respectably - specify what 'correctness' would actually amount to here.

Now we could also say 'It is Geoffrey's avowal (of his feeling of guilt) that makes the analyst's interpretation (about his guilty feeling) correct'. Wittgenstein wanted to say something like that. I think we can see what is being got at here, and not need to disagree with it, nor disagree with the idea that it is an apt answer to the question, whilst yet insisting that it only really works by stipulating one thing that 'correct' could amount to in this context.

4. However at this point my original bafflement and unease still rears its head. Sure, Geoffrey may take up the analyst's interpretation and use it now in avowal, but is he correct to do so? And what if he doesn't do so - must the analyst's interpretation now be seen as necessarily incorrect? On the one hand, I want to say, we don't want the correctness of the analyst's interpretation to be left hanging on Geoffrey's say-so. On the other there is a kind of infallibility which we don't do well to offer to the patient especially in such situations.

I think we can answer these concerns though, and show how Wittgenstein's suggestion can be taken up. This works through uncoupling the idea of a conceptual relation between analyst's correctness and patient's avowal from an epistemic idea about how can we tell that a voicing of what was previously unconscious really obtains. The point cannot be that whatever the patient offers by way of an avowal constitutes the truth of what is avowed. For we may not yet be 'in touch with' the feeling in question, or we might be offering a hysterical narrative about our feelings rather than really voicing our feelings themselves. The point is just that when someone is now speaking from his thoughts and feelings, and has taken up his analyst's interpretation to do so, then there is no further question of the correctness of the interpretation.

5. There is a perennial temptation when thinking philosophically about the mind to try to attain a kind of certainty in or guarantee for (what I will here describe whimsically as) the passage from delusion to truth. The question is in fact often posed in terms of what must be added to delusion for it to become truth. We see this in 'theories of' perception: what must be added to a mere inner image for it to become a veridical perception? (Cue: wild goose chase for causal mechanisms between objects and inner impressions of objects.) We see it in 'theories of' knowledge: what must be added to mere belief for it to become bona fide knowledge? (Cue: wild goose chase of attempts to solve the Gettier problem.) Or in 'theories of' action: what must be added to arm raisings to get arm risings? (Cue: quickly invent some inner acts called 'volitions'.)

My suggestion is that the current question ('What makes correct the analyst's interpretation?') springs forth, in my own case, from some similarly disturbing and disturbed territory. I would, as it were, like to be able to think my way to sanity and insight. That is the fantasy I think I'm labouring under. I would, it seems to me, like to be able to start with an interpretation-taken-up-or-not-in-avowal that yet may or may not be correct, and then to ask what it is that makes it correct in a certain instance. To borrow McDowell's terminology of 'disjunctivism', such an approach takes interpretations to be 'non-disjunctive': that they (like the putative 'volitions' in action and in mere tryings, or the putative 'inner images' in both 'veridical perceptions' and hallucinations) are to be thought of as  fundamentally self-same regardless of whether they happen to be correct or incorrect, and that their rightness or otherwise is something that can be spelled out in addition to their content.

Against this picture I will now stress again the significance of avowal itself. In avowal proper I am not talking about my thoughts and feelings. So we do not in our own case meet with a speech act - an avowal - which may or may not hit its target. Rather: if I truly am avowing my thoughts and feelings, there is no target to be hit: the arrow made of my words is being fired forth from the thought or feeling; it is not directed at them by mind. There are of course moments - hysterical moments, say -  when I simulate avowal. How can I tell the difference between these? Well, we already know this - we must just look out for the markers of, say, hysteria.

6. To recap: I don't have or need reasons to believe that, when I am speaking from my own thoughts or feelings, this is what I am doing. Given this we may say, when offered the question 'What makes the analyst's interpretation as taken up by the patient correct?', 'Well, nothing really' or 'The patient's use of it in avowal'. We can't just blankly say 'The patient's say-so' as a general rule since that would overlook those cases in which the say-so is not genuine, ill-considered, too based on positive transference; and we also have to consider those cases when the patient doesn't have the ears to hear what the analyst is saying. Or we may of course offer the criteria for the unconscious feeling in question, or refer back to matters of correct technique.

What we ought to recall though is that There are no criteria for authenticity! There are criteria for delusion and for belief; there are criteria for action and for mere movement; there are criteria for hallucination and for perception. However there aren't criteria for the genuineness of perception, criteria that can, as it were, be added to those for hallucination to get to the real deal. That's an ass-over-tit approach to the grammar of psychological predication.

One difficulty with a suggestion that 'what makes correct the analyst's interpretation is the analysand's say-so', is that it yet risks sanctioning the hunting around for something, some criterion, which certifies for us that we're living an authentic life, that we're authentically in touch with the feeling ascribed to us by the analyst. But this is daft because the whole premise of psychoanalysis is that we unwittingly yet motivatedly make shit up; that we defend against the truth of our feelings; that we tell ourselves untrue stories about what we feel.

This kind of answer reminds me of the idea that the absence of surprise is the criterion which distinguishes arm raising from arm rising. It's not a bad idea in itself. However it speaks past the motivation underlying the question about how to distinguish the two. So too with a suggestion like 'what makes an avowal true is the absence of self-deception'.

7. My analyst offers me an interpretation. It's a good'un. I now take it up as my own speech act. It is a new moment in my self-becoming, a new bodying forth of uncovered thought and feeling. But what makes it right? Oh come on! It isn't wrong or right: it isn't a judgement.

The above concerns may also be articulated in the language of 'fit'. We may raise these questions too for 'tip of the tongue' phenomena: 'What makes it the case that this is the word I was looking for?' is the question we may sometimes feel compelled to ask. We want to say that the new word fits the shape of the gap at the end of my previously thwarted self-expression.

In both cases, though, there is nothing which makes this utterance the right one. If we are forced to give an answer we might say 'It is my say-so that makes it right', but this puts the point rather poorly. Rather: avowal, speaking from my thoughts, faltered... and then it re-started. We would do better to say 'Nothing made it right; it's just that nothing spurious was added, I didn't change the subject'.

Geoffrey fluently says to Margery 'I was hoping we'd first have time to go home and pick up those cufflinks you got me'. What makes 'cufflinks' the right word to help express the thought he had? The question is absurd: the thought and its expression are, to borrow the idealist idiom, 'internally, not externally, related'. But then we put a hiatus in the sentence: the word 'cufflinks' won't come to him. But then Geoffrey recovers it spontaneously, or perhaps Margery, intuiting what her husband was wanting to say, supplies it for him.'Yes, pick up those cufflinks you got me!'

Now, why should the pause make us think the relation between the thought and its expression is any less internal? The thought is still that which is expressed thus. Similarly, I suggest, for the relationship between the analyst's interpretation and the patient's voicing of her own thought. The defences create a hiatus in our lives. The interpretation undoes the hiatus. Now life, thought, feeling, can go on.




Sunday, 15 November 2015

thwarts and splits, depletion and ambivalence

In what follows I use 'thought' a les philosophes - i.e. not to denote thinking as opposed to feeling or willing, but to denote any 'intentional attitude'. So here I include emotions - I'm happy to be going back to KPax but angry John tickled my iguana - and desires - I want to go once more round this mulberry bush - and beliefs - I reckon the moon is mightily gibbous of late - as thoughts. Intended thus, 'thought' can be reflective or unreflective; in this context it is not essentially cogitative.

(Needless to say, by talk of 'unreflective thought' I've not accidentally become a cognitive psychologist: I can think of no reason to think that understanding must proceed from conscious or subconscious cogitation. Or: the only way I can get to a felt need for such a reason would be if I unwittingly started off with a conception of action and gesture and speech as intrinsically uncomprehending or non-intentional, which activity then would need supplementation with cognition for it to ascend to the dizzy heights of being seen, as we naturally do, as expressive of thought. But, well, yeah: let's not start from there. An utterance expresses thought if its shape and circumstances are in order, not if it proceeds from cogitation.)

Kicking off now: It's helpful to be able to think - to be able, that is, to come to understand what's going down. It helps me accommodate to changes whilst remaining self-same. Well, I can put it better: it is the form that accommodation to change whilst yet remaining self-same takes.

Sometimes its hard to think. We can't get to grips with what's going down. Perhaps we're tired or drunk. But sometimes we're troubled, and that's why.

As I think, my grasp of my situation organises itself from nothing through to something rudimentary through to something more nuanced. Our thought becomes more structured or 'articulated' as I will say here. (By 'articulation' I don't mean: the voicing of something pre-existing; I mean the developing of structure itself.) Discourse is, on the whole, the condition of possibility for thought's finesse.

But sometimes I'm troubled. Accomm-odation in one direction would make for the articulate formation of such and such a desire, belief, affect. But such a structuration of thought could push against the formation of some quite other thought which also - to metaphorically represent the potential as actual - calls us forth, pulling us towards it. So we're stuck. A little like Burridan's ass (but without the rationalism).

The situation is tense. I can't accommodate; I don't know 'how to go on'; perhaps I go blank. Perhaps I get a headache.

We can depict it thus. Here is a depiction of a thought in formation - our dawning grip, our increasingly articulate stance, on our situation.
 * a→aaaa

So, great, all going well we get from the first stirrings of accommodation (*) on the left to the real deal on the right. But let's imagine that the situation also provides a pull in the other direction, and that if I develop articulate thought in one direction I am damaging my accommodative potential in the other direction.
-a-a-a-a-a←-a *

Either trajectory by itself would be just fine. But put them together, try to do justice both to a and to -a, we get in trouble:

….-a-a←-a * a→aa….

To make it a little more concrete: my mother and I have had a certain difficult exchange. The exchange, to a disinterested spectator, could readily be seen as one inspiring both love and hate. In the immediacy of the exchange I am pulled in two different directions. I don't expand enough to accommodate the growth of both feelings. Rather I go blank and start to feel anxious.

So one possibility here is that the individuation of my thought is thwarted. I never develop any. Like my non-reflective version of Buridan's donkey I just starve to death. An analogy could be a ball bearing poised between two opposing magnets. Each repels it towards the other - and it just hovers tensely in the middle. If it could go in either direction the tension from the push of one of the magnets could be gladly alleviated. But then one just encounters even more so the push of the other. So the ball goes nowhere and, by analogy, the thought goes nowhere too. Not only do I not have two unconscious occurrent thoughts, but it's not obvious either that I have two unconscious dispositional thoughts either. The predicament is: thought cannot here yet be born.

One possibility at this point is that I 'split' and develop two thoughts at roughly the same time but in different states of mind. In one frame of mind I develop my love. In another I develop my hate. Yet now I am no longer a self-identical subject. This itself is a radical failure of accommodation. But I do yet develop somewhat articulated thought. These two 'parts' of me must now, of course, not come too close together. It is not possible now that I be truly accountable. We might metaphorically depict this as the two parts not 'knowing' about each other - but it's important to me to note that I'm speaking here of the being (ontology) of the self and of our thought, and not of our knowing (epistemology) what we ourselves think. (I don't think we need second-order intentional attitudes of knowing here yet - that just complicates the story that can so-far be told at the first-order level of the forming of the relevant attitudes.) Half of a ball bearing goes in each direction.

Another possibility is that I become radically depleted. (Think: negative symptoms of schizophrenia.) One of the magnets is turned off. I live a half life, subservient, say, to my mother, with no hate on the scene because there is now no self to feel the hate. (It can be frightening to be with such a patient since we end up with the praecox gefühl which, often enough, surfaces like a shimmering atmosphere of murderous rage.)

Another is that I 'project' half of that part of myself in this interaction into the other. (Think: borderline personality disorder.) The imminent feeling now takes its shape in the mind of the other.

What is the best option? The best option is I believe what has been called 'metastability' and healthy conscious ambivalence. I am able to remain self-same because I come to accommodate within the same breast both my nascent love and my nascent hate. I understand more clearly what I love, and I understand more clearly what angers me. This understanding is the growing, the structuration, of my love and hate. I can hold onto both of these by developing a more finessed articulation both of myself and of my mother. Both 'a' and '-a' are made space for. They no longer struggle for pole position. As my ego capacity is enlarged I can both love and hate the same object without needing to split in two. The ball bearing swells to include the magnets within it.

Why am I going on about all of this? Why not just help myself to a notion of 'unconscious thought' and be done with it? "It's not about thought formation Richard; it's about thought registration." Well, that's the point really: to see if we can get by without 'positing' anything obtaining unbeknownst to us 'in the unconscious' - without feeling that we must construct a structural picture of the mind as composed partly of an unconscious part 'invisible' to us, without feeling that we must abandon a purely enactivist conception of mindedness. What I've not done is said that all anxiety arises from conflict between articulated yet 'submerged' thoughts. I've tried to keep our conception of a thought closer to something which is itself an accommodative dispositional stance, rather than the theorist's inner state behind such stances causally explaining their adoption by the subject. You might not be as troubled as I am by a somewhat Sartrean disquiet with the very idea of unconscious thought. But, like me, you may feel that whilst psychoanalytic phenomenology - the details of our struggling meaningful lives - is the best on offer, the metapsychology - the theorist's positings (of unconscious thought etc.) - risks being a  conjuring trick we play on ourselves at our peril.

Tuesday, 10 November 2015

unconscious emotion

A patient appears highly anxious; she herself acknowledges a little anxiety. We find that she has suffered an encounter which would leave most of us angry; she herself reports no anger when asked. Perhaps a little sadness.

Let's avoid thinking we know what we're saying with 'she is out of touch with her feelings' or 'she is alexithymic' or 'she is not aware of what she feels'. Instead of (allegedly) knowing things let's think about them.

What would be the criterion for unconscious anger? It is all well and good to say 'we posit the unconscious anger as part of an inference to the best explanation for such action and conscious feeling as we do encounter'. That might be just fine. But in order to understand our own explanation to which inferences are made we will have first to understand what it is invoking. So what is (it to feel) an unconscious emotion?

A neuroreductionist answer might be: to be in a certain state of brain activation common to that of conscious anger but which yet obtains regardless of the disposition to avow anger. Hence Panksepp"The core of the RAGE system runs from medial amygdaloid areas downward, largely via the stria terminalis [a bundle of nerve fibers] to the medial hypothalamus, and from there to specific locations within the PAG [periaqueductal gray] of the midbrain." That's fine too, but doesn't help us here: we'd wanted, I imagine,  an answer which explained whatever is going on in psychological terms - i.e. in terms of the emotional content. For someone to be angry is no more for them to be in a certain brain state than for a car to accelerate is for more fuel to enter its carburettor. Such empirical conditions of possibility are not constituting criteria.

The Rat Man kicks a stone out of the road lest it derail his girlfriend's carriage, but then finds himself annoying and returns to replace it. Why did he do this, rather than just leave it there? The psychoanalytic answer: he had unconscious anger at his girlfriend; this caused a wish to harm her; the kicking it out the way was a defence against this wish; the moving it back was an expression of the wish. Ok. But what is it to have this 'unconscious anger'? 

Perhaps: to be unconsciously angry is to behave in aggressive ways, and to show expressive signs of anger, but to be undisposed or unable to verbally avow it. Not a bad suggestion, perhaps, but it doesn't really capture the situation. The unconsciously angry person does not behave in the same way as the consciously angry person minus the avowal. If she did then she would be hard-pressed to deny her anger. 

Her anger is more likely to show itself in 'passive' than overt aggression. She is more likely to be anxious, tetchy, self-thwarting, passive-aggressive, etc. By 'passive-aggressive' acts I mean: antagonistic acts that are marked by not doing something, rather than by doing something actively aggressive. Also she feels a non-specific inner tension.

Does such a 'syndrome' amount to unconscious anger? We can say this if we like. But we may also want to take into account the resolution of the syndrome into anger. What may make us say of this person that they are 'unconsciously angry' is that this state can resolve into 'conscious' - i.e. standard issue - anger. 

Why do these conceptual issues matter? Well, perhaps they don't matter terribly. But, clinically, the value may consist in their helping us to manage the question of helping the patient 'recognise that they are angry'. The patient is not aware of being angry. And we don't do well, either phenomenologically or conceptually, to construe emotions as the objects of feelings - i.e. we don't do well to construe 'he was angry but he wasn't feeling this anger' along the model of 'he was sitting next to his wife but not aware that his wife was next to him'. We do not perceive our emotions; we have them! To help the patient 'recognise' her anger is not so much to help her become aware that a pre-existing emotion obtains, but rather to help her own or acknowledge her anger at someone. And this involves a new relationship of comprehension between the patient and the person she is angry with: it involves her coming into a different kind of relation to him, one that she can express, one in which his wronging of her can be articulated.

The principal boon, though, as it seems to me, is the way it helps the clinician and the patient out of the inauthentic predicament of the patient feeling the therapist is trying to tell her something about herself, or can see or thinks he sees something in her, that she cannot tell herself. That predicament is fraught with intrusion for the patient and smugness for the therapist. Elaborating what yet is but latently and nascently present within oneself - this, here, is what 'acknowledgement' of one's own feelings amounts to. The therapist as non-leading handmaiden to that process: now that's a more comfortable role for both parties.

Sunday, 1 November 2015

the symbolic meaning of delusional thought

First bash at a chapter in a book I'm very slowly writing on the intelligibility of schizophrenic thought...

a. Introduction

The upshot of the critical investigation of cognitive theories of delusion in chapter 1 was that, regardless of the possible reasoning or perceptual deficits of schizophrenic subjects, meaning cannot be usefully retrieved from their delusional discourse by treating the latter as expressing intelligible mistakes of reasoning or perceptual judgement. Schizophrenic persons may suffer at times from aberrant perception or faulty reasoning but, as Jaspers insisted, what is explained in terms of such failures is not delusion but merely erroneous belief. Delusion proper implicates a far more fundamental disturbance in what we call ‘reality contact’ than the accumulation of hallucinations and/or errors of judgement: in fact, one might say, an intelligible description of someone as, regarding some subject matter, truly capable of ‘making mistakes’ about it presupposes, rather than contradicts the assumption, that they are here fundamentally ‘in touch with reality’.

A suggestion frequently made in the psychiatric and psychological literature is that delusions can be understood if we treat them as enjoying that form of intelligibility manifest by metaphors or symbols. The appeal of the idea is clear: that we can find meaning in psychotic thought by ‘decoding’ it – by looking beyond its apparent surface meaninglessness to a meaning buried within. ‘Our task in everyday psychiatry is to decipher the meaning of these [disguised memory fragments]. This is comparable to solving crossword puzzle clues…’ is how one psychiatrist put it (using an uncharacteristically glib simile) (Lucas, 2009, p. 307). The underlying aspiration here is, by thus ‘decoding’ the psychotic subject’s utterances, to bring him or her back within the fold of intelligible humanity.

In what follows I first explore the idea that delusions can be understood along the lines of metaphors – i.e. as attempts to communicate truths using non-literal language. This approach however soon runs into difficulties, difficulties that necessitate the making of two fundamental distinctions. The first is between such symbolism as presupposes a mind capable of thinking about some matter yet which intentionally makes play across conceptual categories to communicative ends (i.e. metaphor – symbolism as an intentional rhetorical act), and the different form of symbolism of a mind not yet capable of tolerating representational thought about some matter, where the conceptual miscegenations it manifests are symptomatic of this inability (i.e. psychological symbolism – symbolism as a psychological process). The second is between two uses of psychological symbolism. One of these has to do with the nascent capacity to represent the facts in the progressive service of reality contact and acknowledgement of and accommodation to the sometime painful absence of what is desired (in psychoanalysis this is called either ‘symbolisation’ or ‘thinking’). The other has to do with the regressive denial of need and the provision of substitutive, imaginary, satisfaction for unmet needs (‘wish-fulfilment’ and delusion). Quite different forms of understanding and intelligibility are applicable to metaphor and psychological symbolism, and a central aim of this chapter is to make these clear so that explanations of the latter, primarily provided by psychoanalysis, will not be judged as deficient by those who have available to them only such standards as are relevant to the assessment of the former.

To understand psychological symbolism it is essential to appreciate the frame of mind in which it takes place. This is especially so when it comes to grasping the regressive, wish-fulfilling, reality-denying uses of symbolism as makes for much schizophrenic delusion. Without appreciating how different the psychotic mode is from that which constitutes reality contact, delusions may hastily and unhelpfully get treated (by cognitive scientists, for example) as if they were essentially mistaken uncommon beliefs, and the quite distinct intelligibility they do enjoy is overlooked whilst a form of everyday meaning is ascribed to them that, precisely, they do not in fact enjoy. The distinction here is between the recovery of speaker’s meaning in a mind enjoying reality contact versus the appreciation of the emotional and motivational causes of delusional thought in a mind partly insulated from reality. This insulation takes the form of psychic retreats (Steiner 1993) or, in the term’s original sense, autism (Bleuler, 1911). A key contention of this chapter is that it is only once the distinction, which receives its fullest treatment from phenomenological psychiatry, between autism and reality contact is appreciated, that the distinctive intelligibility of psychological symbolism, as elaborated by psychoanalytical psychology, can be reflectively understood. (A fuller explication of autism must however wait until chapter 4.) The merits of taking a psychoanalytical approach – an approach that understands the forms of mental disturbance as resulting from motivated attempts to manage intolerable emotional pain – are several. They extend considerably beyond the formulation of delusion in terms of symbolism, inter alia into theories of paranoia, bizarre delusions, delusional perception and mania in terms of ‘splitting’, ‘projection’, a failure of ‘alpha function’ and ‘omnipotence’.  But even when we restrict ourselves (as in this chapter) to matters of symbolism, the merits of a psychoanalytic over a cognitive approach include the ability to account for the typical (paranoid, megalomaniacal, erotic) forms of delusional belief, and also to explain the relation of psychotic experience to psychotic thought without falling back on the cognitivist’s implausible model of the latter as resulting from attempts to make rational sense of the former.

b. Delusion as Metaphor

We’ve all had the experience of being baffled by what someone says only to realise that we had taken literally what needed to be taken metaphorically. Perhaps – so the thought goes – we can find relief from our bafflement by delusions in the same way. It is important then that we first get clear on what is meant by a metaphor; two essential aspects bear mention. First, metaphor involves a mapping across conceptual domains, from ‘source’ (e.g. weather) to ‘target’ (e.g. emotional expression) domains (‘she gave him a frosty smile’), and often involves the use of physical state and event terms to betoken psychological and relational properties. Second, the concept of metaphor belongs to the ars rhetorica: i.e. it essentially describes a technique used by a speaker or author to encourage a particular understanding of what is being talked about – e.g. to enhance the listener’s grasp of speaker’s meaning. Thus we may hear of someone uncritically accepting what someone else says, but by using gustatory metaphors - ‘He had her eating out of the palm of his hand’; ‘She was lapping up / swallowing everything he said’ – we are provided with a more potent sense of the power relations at play, of how the eager listener’s loss of self-possession and willing neediness figures into the readiness with which what is asserted takes root in her mind.

An important precondition for the intelligible ascription to a speaker of metaphoric talk is that he grasp the distinction between source and target domains. If he thought that to swallow or lap something up always meant to accept it uncritically, and had no understanding of its literal gustatory sense, then we should not yet talk of him as speaking metaphorically. Not only does the concept of the metaphorical presuppose the concept of the literal to which it is internally (through contrastive application) related, but the idea of someone speaking metaphorically requires that the speaker can acknowledge that he is not here to be taken literally.

As applied to the understanding of delusion, the promise of the concept of metaphor is that, whilst delusional utterances remain unintelligible as literal assertions, they may perhaps yet be grasped if interpreted as metaphorical. Consider the following: before I trained as a psychologist an eccentric woman who visited the drop-in centre where I worked in Oxford told me that she had recently been released from Belsen (the German concentration camp which had been closed for 60 years). I was confused but, from what she was saying, I understood that she had probably been discharged from the local psychiatric hospital. Naïve to the nature of schizophrenic delusion, and attempting to retrieve meaning in her utterance, I therefore interpreted it as a metaphor and offered her a reworking into a simile: ‘Ah, you mean, being at the Warneford was like being at Belsen?’

What was wrong with my response is what is wrong with a theory of delusion as metaphor. The woman looked baffled and, now a little disturbed, said with hesitation: ‘It was Belsen’ – before changing the subject. Whilst taking what she said as a metaphor would be an obvious avenue for retrieving sense in it, that sense is yet dependent on her intending her statement as metaphor. Without that intention the sense-recovery operation fails since the disturbance in intelligibility has just, as it were, been shunted from her failure to advertise, to her failure to appreciate, that she is not to be taken literally. What we really encounter here is not a speaker who deploys the conceptual resources of the metaphorical and the literal to map from one domain to the other, but rather a speaker whose thought and utterance simply collapses the source (Belsen) and target (Warneford) domains.

Two rescue strategies now present themselves (these are taken from Rhodes & Jakes, 2004). The first locates the making of the metaphor at a time before the psychotic collapse of the source and target domains sets in. To borrow a clinical example taken from Rhodes & Jakes (2004), a patient at first seemed to use a concept of devil possession in a non-literal way – perhaps to describe her experience of being out of mental control - but then became psychotic at which point the metaphor collapsed into the literal locution. In this approach the decoding or retrieval it is incumbent on us to do involves the back-extrapolation to a time before delusionality became ascendant: Whilst she may not now be saying something intelligibly taken as metaphor, what is said yet carries the trace of a metaphor she once used in her own thinking. We thereby retrieve a genuine meaning in her pre-psychotic life.

One difficulty with this proposal is that, regardless of its adequacy in meeting its own ends, it does not of course help us with our end of retrieving the delusional speaker’s meaning; in fact it asserts that what is now being said is not now to be found intelligible as metaphor. The second is that it is hard to evaluate since it postulates a pre-psychotic state of a respectably metaphoric use of the notion later crystallised in the delusion – and this state and use will often be irretrievable in anamnesis. Furthermore many delusions involve figurations that do not precede the psychotic state (Rhodes & Jakes, 2004). This is particularly the case when we have to do with the delusional perception found in schizophrenia – i.e. when someone looking at the cross suddenly sees that he is Jesus, looking at the dog raise its leg sees that the Kaiser has a special message for her, etc. The principal objection is not to the content but to the scope of the rescued metaphor theory: that in saving intelligibility by invoking pre-delusional metaphor use, the theory does not yet help us grasp a sense in which delusional figurations can themselves, whether or not historically preceded by metaphoric thinking, be understood symbolically. It also provides no understanding of why the patient is here so selectively disturbed in her grasp of the distinction between the metaphoric and the literal.

The second rescue strategy follows Lakoff & Johnson (1980) in removing the concept of metaphor from the home ground of intentional human agency. No longer treated as intentional human action it becomes instead a merely causally specified psychological process. Since we are now no longer to appeal to what someone intends in making their utterance we must also forego specifying what counts here as ‘source’ and what as ‘target’ in terms of the intention of the speaker; perhaps these become specified post hoc by the theorist. This metaphorical use of the concept of metaphor in effect reduces all metaphor to the level of the dead metaphor, the life provided by the ars rhetorica having been taken from it. But whilst there is nothing wrong with consciously using the concept in this way, we must now guard against unwittingly attempting to both have and eat our epistemic cake. That is, we must not imagine that treating delusional utterance as metaphor in this merely causal rather than intentional sense allows us to still retrieve speaker’s meaning from it. For when we consider what it is for someone who says ‘I have just been in Belsen’ to be referring to a stay in a psychiatric hospital they found dehumanising, terrifying and soul-destroying - rather than to have, for example, made a mistake about its name – we make essential appeal to her intention-in-utterance (she meant to describe how awful it was there), to the clarifications she would offer if pressed (‘I mean it was like…’), and to her assent to or dissent from clarifications offered (‘No I mean it was Belsen.’) As we will see below none of this means that what she says does not provide us with important information about her psychology, but it does mean that we cannot take what she says as meaningful in that sense of ‘meaningful’ which adverts to what she intends to communicate.

The hope of recovering a speaker’s symbolic meaning in delusional discourse simply through treating it as expressing metaphor fails. It fails because whilst promising to help us grasp a meaning for delusion it helps itself to the notion of an as-yet-unexplicated form of speaker’s meaning. If we are yet to find some sort of meaning in delusional discourse, we require some means other than a reference to speaker’s intention for distinguishing between what here counts as symbol and what as symbolised. Psychoanalysis provides this with its theory of psychological symbolism and its understanding of the motivational and emotional dynamics underlying the formation of psychological symbols. This will be described below, but first it is essential that we grasp something of the constitutive and embedding state of mind in which symbolism obtains.

c. Schizophrenic autism

Textbook definitions of delusion make it sound as if it were all simply a matter of stubbornly entertaining mistaken or impossible or atypical beliefs. But [cf ch 1] as Jaspers (1963, pp. 93ff) – who himself introduced such criteria – noted, to say this is but to provide a ‘superficial’, ‘vague’, merely ‘external’, and ‘incorrect’ account of the delusionality of delusion – which instead must be understood for what it is in terms of such deep alterations in the fabric of the personality (by ‘personality’ Jaspers means individual selfhood or personhood; he’s not referring to someone’s introversion or extroversion etc.) as ramify into the character of that personality’s meaningful experience of the world. These alterations were mysterious to Jaspers (p. 96: ‘a clear presentation is hardly possible with so alien a happening’), and much of the work of phenomenological psychiatrists since his time has been to elucidate them in a meaningful way (see ch. 4). Since the time of Bleuler (1911) this altered form of selfhood has been known as ‘autism’ – not to be confused with the developmental condition of ‘autistic spectrum disorders’ for which Leo Kanner redeployed the term in the 1940s.[1]

The Greek term ‘autós’ means ‘self’, and Bleuler’s use of the term refers to an inner retreat into the self away from the world:

The most severe schizophrenics, who have no more contact with the outside world, live in a world of their own. They have encased themselves with their desires and wishes (which they consider fulfilled) or occupy themselves with the trials and tribulations of their persecutory ideas; they have cut themselves off as much as possible from any contact with the external world. This detachment from reality, together with the relative predominance of the inner life, we term ‘autism’. (Bleuler, 1911/1950, p. 63)

He goes on to note (ibid, p. 63, note 19) that:

In essence the term, autism, designates in a positive way the same concept that Pierre Janet formulated negatively as “the loss of the sense of reality.” … [But the] sense of reality is not entirely lacking in the schizophrenic. It fails only in relation to matters threatening to contradict his complexes. Our relatively advanced hospital cases can very correctly comprehend and retain such detailed anamneses which turn out to be quite correct. In short, they show daily that they have not lost their sense of reality, but that this capacity is inhibited or falsified in certain connections…

Autism, then, involves a disconnection from reality and into a ‘world of one’s own’. But what this means is not easy to say; it is tempting – although also unhelpful to a project of critical reflection – to gloss this as ‘living in an imaginary world’, or as ‘imagining one’s wishes or fears fulfilled’, or to say that ‘delusional utterances refer not to our consensual reality but to the states and events of an inner private world’. Although such phrases are not exactly wrong, in truth they too – like the word ‘false’ in the phrase ‘delusions are false beliefs’ – carry a meaning special to their psychiatric context, a meaning which now needs reflective unpacking rather than assuming. Bleuler, not being a philosopher, is not going to help us with this. But nearly as soon as he introduces us to autism he does provide a clue in writing not about the different possible contents or rationality of thought but of its different possible forms:

realistic and autistic thinking which exist side by side in the same patient. In realistic thinking the patient orients himself quite well in time and space. He adjusts his actions to reality insofar as they appear normal. The autistic thinking [however] is the source of the delusions, of the crude offenses against logic and propriety, and all the other pathological symptoms. The two forms of thought are often fairly well separated so that the patient is able at times to think completely autistically and at other times completely normally. (67).

We get our best clue as to the nature of this distinctive form of thought by reflecting on what is wrong with formulae like ‘living in an imaginary world’. Thus sometimes when we talk of (i) ‘imagining’ we mean ‘wrongly envisaging or expecting’, a passive and dispositional use of the term not far removed from that of ‘(usually falsely) believing’. This sense of ‘imagine’ helps us not at all here, since it does nothing to help us achieve what we want from a concept of ‘autism’; definitions drawing on this sense of ‘imagine’ effectively ignore or presuppose – rather than establish – the sense of the delusionality of psychotic thought. To see this, consider how Bleuler often gives examples of what he calls ‘double-entry bookkeeping’ to explicate the character of autistic thought. In these examples a patient professes one attitude in the delusional mode (I am the king of Denmark) whilst at the same time manifesting dispositions that signal reality contact (it is my job to scrub the kitchen in the hospital). It is here just this absence of the normal dispositions in which false belief is manifest which marks delusion as such and which accordingly makes such a concept of (i) imagining in-apt to its explication.

At other times we mean by ‘imagining’ not a passive expectation but rather (ii) an intentional action, as when I intentionally ‘picture something in my mind’s eye’. This is the most distinctive and potent sense of ‘imagining’ we possess, and is explored at length by Sartre and Ryle. It however is essentially connected with my understanding of the imagined object’s absence: I am, that is, precisely not at such times trying to see something but rather to visualise something that I understand is not there to be seen. Here therefore imagination presupposes – in my grasp of the object’s absence – intact reality contact, and this too makes it in-apt for present purposes – since delusions are believed in by delusional subjects.

We get closer to an apt sense of ‘imagining’ when we consider (iii) those uses of the term that are synonymous with ‘dreaming’ or ‘fantasising’. When (non-lucidly) dreaming we are not aware that we are doing so – we are lost to the dream, so to speak, and accordingly are not in touch with reality; such imagining is not intentional action but unintentional activity. (It is not insignificant that psychosis has often been described as a ‘waking dream’.) Yet this sense does not collapse us back into the first dispositional sense of ‘imagine’ since when daydreaming we do not at such times believe that what we daydream is or isn’t the case; the whole point of this mode of thought is, after all, that ‘reality testing’ is put off-line.[2]

 In this (iii) sense of ‘imagine’, we meet not with a retreat into imagination qua visualisation, but rather with a breakdown in the distinction between either visualising or envisaging and veridically perceiving or believing. As Freud describes, ‘an uncanny effect is often and easily produced by effacing the distinction between imagination and reality’ (1919 p. 396). What makes for the distinctive nature of (ii) imagination as a non-reality-oriented intentional action, i.e. that it yet preserves reality contact, is what is definitively lost in this conception of (iii) imagination as dreaming.

On this understanding autism amounts not to a retreat into active imagination but rather into a state of mind in which the distinction between imagining and reality contact is selectively effaced. The sensori-motor cycles which embed us in our worlds and which form the causally-constraining foundation of reality-oriented thought are disengaged here. Instead the shape taken by this dreamlike thought becomes governed by inner association: one dream image sparking another, the shape of associative pathways primed by recency, emotional valency, habitual preoccupations, self-soothing potency, etc. The person in an autistic state of mind is not so much, for example, actively imagining their wishes fulfilled. Rather they are indulging or suffering a form of thought in which the distinction between wish or fear and its fulfilment is effaced. The form of autistic thought does not therefore amount to an unambiguous triumph of the imagination over the real. If we are to speak of triumph here it is one of a triumph of the need to manage intolerable mental pain over the integrity of both imagination and reality contact. Laing (Div Self, p. *) describes well how autistic thought is the very erosion of both inner and outer experience in his patient Julie:

‘Reality did not cast its shadow or its light over any wish or fear.’ ‘Every wish met with instantaneous phantom fulfilment and every dread likewise instantaneously came to pass in a phantom way. Thus she could be anyone, anywhere, anytime. ‘I’m Rita Hayworth, I’m Joan Blondell. I’m a Royal Queen. My royal name is Julianne.’ ‘She’s self-sufficient,’ she told me. ‘She’s the self-possessed.’ But this self-possession was double-edged. It had also its dark side. She was a girl ‘possessed’ by the phantom of her own being. Her self had no freedom, autonomy, or power in the real world. Since she was anyone she cared to mention, she was no one.’ ‘I’m the prairie. She’s a ruined city.’ ‘She’s the ghost of the weed garden.’

[The hungry infant who, in the absence of breast or bottle makes suckling gestures and appears calmer, is no better described as satisfying their desire for food through a fantasy of feeding than they are as engaging in activity which dismantles their desire. (Jim Hopkins’ term ‘pacification’ works much better than ‘fulfilment’ here.)] The psychotic does not so much fool himself that his desires are fulfilled – as enter into a state of mind in which both the desire and his appreciation of the object in its absence is trashed.

d. Metaphor, Imagination, and the Pre/Trans Fallacy

Delusions have typically been understood either as false (and atypical and stubbornly maintained) beliefs (DSM-5), or as derivations of metaphorical thought (Rhodes & Jakes 2004) or imaginings mistaken by the delusional subject for bona fide literal beliefs (Currie 2002). The approach taken here is rather different: delusional thoughts must be understood as such in terms of that alteration in the personality which makes for the autistic enclave wherein such thoughts obtain. And autism is not to be understood as a retreat from reality contact to imagination, but as a local collapse, or defect in the formation, of the constituting oppositionality of these two modes of thought. To make clear the difference between the current approach and cognitive psychological approaches it will help us to have an error theory of the latter.

When reality-testing (the capacity to perceive and understand independent reality as independent) is insecure or fragile – as it may well be in infancy for example – there is as yet little meaningful distinction to be made, regarding the subject’s thought, between the metaphorical and the literal, imagination and perception, sacred and profane, playful and serious, wishing and doing, inner and outer, etc. To say this is not to make an epistemological observation about a subject’s ability to correctly apprehend the categorical nature of her own mental activity, but an ontological observation about the as-yet categorically inchoate nature of such activity itself. As a subject develops in her reality-testing she may more robustly be described as now believing and now imagining. Later on, as she develops even further and such categorical distinctions can be reliably and aptly applied, she may start to knowingly make play across the categories of the real and the imaginary, the inner and the outer, to make for more vivid and expressive (i.e. poetic) communication. Such pre- and trans- states may however superficially resemble one another and – and this is our error theory – psychological theorists may conflate them on this basis. This conflation has been dubbed the ‘pre/trans fallacy’ by Wilber (1982) who describes, for example, how Freud sometimes reductively deflates mystical ego-transcending states into the pre-ego states of infantile oceanic bliss, or how Jung can romantically and unrealistically inflate the pre-ego states of infancy and psychosis into those of ego-transcending mystical experience.

Applied to delusion the moral is that the use of a term that presupposes a collapse of target and source domains (pre) cannot be equated to a metaphorical use that depends on intentional play across the domains (trans). Only the latter provides the conditions for the retrieval of speaker’s meaning from the expression. Delusion may look superficially like either false belief or imagination, but this is only because none of these states involves veridical belief. We so habitually read one another against the tacit background assumption of reality-testing being in place that we find it hard to suspend such an attitude even in outré cases. Yet in the case of delusion and the autistic state of mind in which it obtains the distinction between the real and the imaginary has been deleteriously effaced. Such cases are to be distinguished either from misfiring efforts in the real (delusion as false belief) or cases of its artful suspension in the imaginary (metaphor, imagining). To add an extra level of sophistication to one’s account of delusion – suggesting it is the result of mistaking one’s own imaginings for beliefs (Currie 2002) – is to attempt to make good an error by compounding it further; what is required is not uncommonly sophisticated if awry epistemic self-relation, but simply degraded ontological self-constitution.

e. Psychological Symbolism

What remains is to trace the distinctive meaning of symbolism and the logical character of its apt comprehension when what we have to do with is schizophrenic delusional thought which of its nature necessarily obtains in an autistic state. What follows draws on the clearest theoretical explication we have of symbolism, namely the ‘Freudian Broad’ theory of symbolism of Petocz (1999 ch. 10), but in turn broadens it. Petocz’s theory is, in its exclusive focus on drive-based conflict and wish-fulfilling substitutive satisfaction as the motors of symbolism, rather more Freudian than Freud himself, and in what follows I consider also such uses of symbolism as facilitate accommodation to the pains of real life (to be called symbolisation) rather than merely promote their evasion. Jungian approaches to schizophrenic symbolism sometimes attribute more progressive purpose and meaning to the unconscious and its symbolic productions than is naturalistically plausible; Petocz’s drive-based Freudian account steers us away from this but, I suggest, errs in the opposite, regressive, direction by ignoring the use of symbolism in serious play to facilitate the tolerable knowing of one’s privations, wounds and losses. Segal’s distinction between ‘symbolic equation’ and ‘symbolism proper’ is another important contribution to the theory of psychotic symbolism. In what follows however I carve up the conceptual animal differently and call both of these ‘psychological symbolism’, and distinguish between progressive uses of it in the depressive mode (‘symbolism proper’) and regressive uses of it in the paranoid-schizoid mode (‘symbolic equation’).

Carl Jung was the first to apply the insights of psychoanalytical psychology to psychotic thought. Jung believed that delusions were the product of unconscious material breaking through the resistances against it into consciousness; that this material was expressed in ‘the language of the unconscious’; and that some of the outré forms taken by delusion resulted from those psychological processes - identical to Freud’s dream-work - of condensation, displacement, and negation by which the content and character of feelings and impulses could be simultaneously expressed yet smuggled past the resistances (Jung, 1914/1991 [on the importance of the uncs in psychopathology] p, 209). That delusion formation is so similar to dream formation is another reason why, from a psychoanalytical point of view, psychosis can be considered a waking dream.
Symbolisation here means the dream-work – the creation of a substitute image for a feeling that cannot be straightforwardly owned. Consider the following example from Jung’s time at the famous Swiss psychiatric hospital known as the Burghölzli (Jung 1907/1991); the patient is a poor dressmaker who:

fell ill in 1886 in her 39th year – on the threshold of the age when so many dreams are brought to naught’. [She has sat] like an “imbecile” [for twenty years in her asylum workroom, mechanically darning her linen and occasionally mumbling a few apparently meaningless phrases. Jung listens to her and discovers various fixed delusions (pp. 173-177) – amongst them that she is] ‘The Banknote Monopoly, Queen of the Orphans, Proprietress of Burghölzli Asylum.’ … ‘Naples and I must supply the whole world with macaroni’. … She was Socrates…. ‘I am the finest professorship and the finest world of art.’ ‘I am the Lorelei … Switzerland … a crane … Schiller’s Bell … Hufeland … the master-key …’ She is the owner of a distant island with silver mines, ‘the mightiest silver island in the world’… the ‘greatest orator’ possessing the ‘highest eloquence’. … she is not only the honoured earthly queens Mary Stuart and Louise of Prussia, she is also the Queen of Heaven, the Mother of God, and at the same time the Godhead. … she chose three husbands from the best families in the town and her fourth was the Emperor Francis. From these marriages sprouted two phantom children, a little boy and a little girl.

The patient’s illness, lack of educational and marital and family success, etc. are devastating to her, and several of her delusions symbolically represent her desire to be free of such impediments. Many of her desires can find expression only because their character is greatly distorted – many are, for example, represented as fulfilled (she has money, is a professor, etc.) and hence as tolerable. At other times her delusions involve role-reversals: she is proprietress and not patient of the Burghölzli. In her autistic world her wishes are not separate from their realisations. To translate the delusional symbolism here is to track back the wishful fantasy to the intolerable thwarted desires from which it springs.

Another Burgölhzi clinician, Marguerite Sechehaye, later developed a theory of ‘symbolic realisation’ as the therapy for schizophrenic patients. (The therapy consisted in sensitively understanding the symbolic meaning of the patient’s delusions and then, rather than confronting the patient with her painfully unmet needs, first meeting the needs in symbolic form. The Autobiography of a Schizophrenic Girl, co-authored with her patient Renee (actually one Louisa Duess, who recovered and later became a psychoanalyst herself) describes this in moving detail.) Her works provide careful descriptions of her patients’ delusional wish-fulfilments [A New Psychotherapy in Schizophrenia 1956 p. 69], such as that of:

a young man, neglected by his mother because of a congenital physical malformation, who sought tenderness in young girls. Unfortunately, the rejection of his tentative amorous advances reactivated the initial privation and precipitated a psychosis. After a short agitated phase, he fell into a long dream-like state offering everything hitherto denied by reality. During a period of improvement, questioning revealed that he had at last found happiness, as he believed himself the son of a powerful royal couple who adored him and granted his every request. He was an Arabian prince, handsome and fabulously rich, living in a harem surrounded by a bevy of women, each more beautiful than the other, who fought for his favour. His conquests were numberless; he was a veritable Don Juan. The shame, the bitterness and distress of his mother’s neglect and his amorous disappointments had disappeared, to be replaced by an exuberance of power and pride, unhappily at the expense of mental equilibrium. [note to self: sort out the original from my summaries in this]

Such examples might lead us to assume that symbolism is always a function of repression and substitutive satisfaction.[3] Certain extant frustrated drives and conflictual desires are too painful to be consciously entertained; they therefore are repressed, subject to displacement, then to a regressive substitutive gratification. This however misses the connection between psychological symbolism and a still more basic function we can call psychological symbolisation. The latter relates not to the substitutive wish-fulfilling satisfaction of extant desires, but rather to the condition of their initial structuration. The clearest example here is provided by play therapy: the child often cannot at first give form to certain latent fears and wishes; instead they spontaneously act out scenes with e.g. dolls which scenes the clinician can understand as expressive of their own immanent affect. The model here is not necessarily ‘It is not I who am angry with my father; it is my doll who is angry with his doll father’. It is rather one of an as-yet inarticulable ripening yet unpicked anger at father nevertheless finding its initial articulation in an analogue situation.

What makes for inarticulation in the first-person case need not here be understood solely in terms of repression, but rather and also in terms of an excessive proximity. Too closely caught up in a conjoint world of me-and-you, I cannot yet develop thought about or feeling toward you. Here I do not know enough of you in your otherness and me in my separateness to feel love for you in your goodness, or anger at you in your hurting of me, or guilt in my wronging of you. The emotions that constitute our object relations are achievements of individuation, that basic drive to differentiate from and thereby come into comprehending relation with the reality of others and of our situations. Such individuating is fraught, it may be shirked; affect may not be borne, and contact as opposed to fusion with reality may not be successful. Symbolisation is the process and motor of such dis-identification and differentiation: an inner movement of mind through which selfhood, otherness, and the thought that constitutes the relation between self and other become possible.

In practice the distinction between symbolism and symbolisation may be narrow. Difficulties in individuation will often result from inner conflict. Yet development contains imperatives other than conflict resolution, imperatives such as accommodation to loss, change, privation and difference. Whether or not we have to do with a symbolism that compounds reality-avoidance through the elaboration of autistic enclaves in which symbol and symbolised are equated (‘symbolic equations’ in Hanna Segal’s terms), or whether we have to do with a symbolism that facilitates a true emotional accommodation to reality through an act of serious play in which a template for individuation is first laid down in relation to analogue situations, may depend more on the surrounding interpersonal and intrapsychic context than on facts internal to the psychological processes.

Consider the following from the teenage hospitalised Renee/Duess (Sechehaye 1951); we hear Renee’s voice here; her psychoanalyst Sechehaye is ‘Mama’ (pp.71-79):

Mama brought me a gift – a little plush monkey of which I was at once afraid. When he had his arms up, I was anxious lest he hurt me; and then, he had a most shockingly unhappy expression. Oddly, at that very moment, I felt the impulse to strike myself. I realized full well that my own arms were delivering the blows, still I was sure the monkey was attacking me. Nonetheless I did not know that he was a symbol of myself, nor in any case should I have known what that meant.
I said to myself, “I am I and he is he and there is no relationship between us;” however the confusion as to who was who was complete. He had the same troubles as I and moreover he wanted to hurt me, to destroy me, and I dreaded him without holding it against him for I realized it was not his fault. …
The monkey was very unhappy because he had nothing to eat; everything was forbidden him except apples and spinach. So I went to the orchard to gather an apple or two from the tree; these I ate voraciously. In taking these apples, I had no sense of guilt for the tree was part of my country, the land of Tibet I called it, of which I was queen. …
Mama bought me pounds of magnificent apples. But I could not touch them, for I was allowed to eat only my own apples still attached to their Mama-tree. I should have liked so much to have Mama give me apples, real apples I called them.
But alas, Mama did not understand….
[Later, after a severe crisis, the following exchange takes place.] while in my heart I was outraged that Mama too wanted to force me to eat, my eyes fell to her bosom, and when she insisted, “But why don’t you want the apples I buy you?” I knew what I was yearning for so desperately and I was able to bring out, “Because the apples you buy are food for grown-ups and I want real apples, Mama’s apples, like those,” and I pointed to Mama’s breasts.
She got up at once, went to get a magnificent apple, cut a piece and gave it to me, saying, “Now, Mama is going to feed her little Renee. It is time to drink the good milk from Mama’s apples.” She put the piece in my mouth, and with my eyes closed, my head against her breast, I ate, or rather drank, my milk. A nameless felicity flowed into my heart. It was as though, suddenly, by magic, all my agony, the tempest which had shaken me a moment ago, had given place to a blissful calm; I thought of nothing, I discerned nothing, I revelled in my joy.

Here the monkey is a symbol for Renee – specifically for her infantile self and its unmet needs and hostile urges. Apples are symbols for Mama’s breasts; Renee’s inarticulable desire for the comfort of maternal feeding and care is displaced onto the monkey and apple symbols. Analyst and patient come to understand this together and Renee’s healing is set underway.[4] Is it the case that Renee had clear desires and feelings the owning and content of which had to be displaced onto the analogue objects, or instead that she is only able to give shape to such desires in the first place through such objects? It is neither evident which answer one should give nor that an answer must be given. The question is the same as that which asks whether an unconscious desire is extant yet unknown, or whether it is rather immanent, inchoate, potential? Empirical evidence – e.g. of reaction time differences, dispositions to particular perceptual distortions etc. – will not help us decide this conceptual question, since it does not tell us whether such evidence itself pertains to extant and merely unavowed affect or to a sub-affective disposition. In some cases we may be drawn in one, in others in another, direction. This conceptual question is supplemented by a theoretical question, which has to do with whether what we meet with here are the delusions of an attachment- and reality-shirking autism or the creative propositions of a tentative other- and reality-embracing accommodation to the facts of life. A delusion about apples becomes, in Sechehaye’s careful hands, a creative steppingstone to the comfortable owning of deep personal needs.

So far we have considered wish-fulfilment and the expression of needs as two forms [?] of symbolism lying behind schizophrenic thought. A third form concerns the bare fact of disturbed self-experience. The schizophrenic process of self-dissolution is terrifying, and is typically articulated in terms of either a bodily or an external situation – this is the ‘delusional atmosphere’ surrounding the incipient schizophrenic, an atmosphere that condenses out into those metaphysical delusions pathognomic of schizophrenia. Following Merleau-Ponty, Louis Sass [Phenomenology as Description and as Explanation: The Case of Schizophrenia. in Gallagher & Schmicking (eds) Handbook of Phenomenology and Cognitive Science] has described such delusions as expressing or emblematizing – expressing in a concrete form – the self-disturbance of the schizophrenic process. Classic examples are delusions of being controlled by an influencing machine; being constantly recorded by video cameras; of the world coming to an end; of a great flood of water sweeping everything away; of a great heat or cold suffusing everything. As Sechahaye writes (p.63 of the new psychotherapy book), such delusions represent ‘an alteration of the “being-in-the-world”; in other words, the condition of psychotic disintegration in the schizophrenic. … Kunz … declares “What is expressed in primary delusion is not related to complexes but to existence and its alterations. The delirium [the translator really means delusion] is a part of the very alteration of Dasein and is a particular expression of it.”’

The expressive depiction in the delusion of the state of self-disintegration often projects it outwards, as the prodromal terror (the ‘trema’) resolves (in the ‘apophany’) into a clearer delusional articulation. It is not hard to understand how, despite the terrifying situation that is depicted, the dual emblematization and projection yet serves an anxiolytic purpose. The first anxiolytic moment is the very symbolising of the psychotic process: the sufferer is no longer simply shaken to his core since he can begin to articulate this: the process of symbolising articulation is itself a process of disidentification – the creation of a non-trauma-ridden vantage from which the self’s trauma can be articulated. The second is the projection outwards: living in a world that is persecuting or about to collapse is terrifying but less so than being a self that is self-hating or collapsing. We see examples of both moments in Renee’s case: (p. 64): ‘Renee, at the beginning of her illness, complained of the “terrible fear” constricting her. But soon she lost consciousness of her own fear, projecting it outside. “It is the wind,” she said, “howling in anguish across the desolate steppes”; later, the wind, the messenger of a great calamity, portended the end of the world.’

f. The logic of the symbolic understanding of delusional content

It is common to understand the idea of psychological symbolism through discursive metaphors. Thus Petocz (1999) first distinguishes between conventional and non-conventional (i.e. psychological) symbolism as follows: ‘Non-conventional symbolism differs from language and conventional symbolism in that the non-conventional symbol is not used primarily to refer or to communicate. Rather, it is a substitute produced via displacement, and can be used normally or pathologically, consciously or unconsciously. It includes no just isolated entities, but actions, events, and complex combinations.’ (p. 232). (In the previous section I have questioned whether the products of symbolisation are always best understood in terms of substitutes produced via displacement.) However she then goes on to say, of non-conventional (psychological) symbolism, that ‘the theme of the symbol as defensive substitute produced via the conflict-repression-substitution ‘formula’ [is] central’. Petocz is speaking metaphorically here of production according to formulae, and so no fallacy is committed, as it would be if she were attempting to speak literally. But the quote still illustrates a perennial temptation, found mainly in Jungian thought – that mythology, imagistic thought, symbolism, fantasy, etc. form the ‘natural language of the unconscious’. In the Jungian project the metaphorical nature of this ‘language’, and therefore too of the different form of understanding that must be brought to bear on it, is typically left implicit. Such inexplicit metaphor is perhaps one reason for the temptation to construe delusion as metaphor. But what must in particular be acknowledged is the fact that there is, for delusion, no translation of what is said into what is intended, no communicational intent that serves to specify meaning, and in fact no speaker’s meaning (beyond what is actually said) to be recovered. The symbol does not here stand for the symbolised, at least not when ‘standing for’ is understood as doing communicational duty.

The duty done by psychological symbolism is not to the needs of conversants but rather, if we focus on symbolic substitution and emblematisation, to the anxiolytic needs of the delusional subject. The meaning of delusion understood as symbol is accordingly a function not of the individual intentions or social rules behind its deployment – for talk of deployment (and a fortiori of intentions and rules) is not apt here – but rather of the empathically graspable human intelligibility of that which it replaces or nascently articulates. The meaning of such symbols may be usefully compared to cases such as ‘smoke means fire’, ‘2 stripes on the pregnancy test means you’re pregnant’, ‘the bus being delayed means I will be late for work’, ‘a red sky at night means a dry day tomorrow’. Such ‘natural meaning’ (as Grice (****) calls it) is not simply a function of the causal relations involved (fire causing smoke etc.) but in particular of the prior significance to us of the upshot or cause of the signs of smoke, stripes, delays, red skies etc. Lateness, good weather, pregnancy and fire matter to us – and so the non-conventional indicators or signs of them now also possess a derivative meaning (unlike the infinity of other causes and upshots around about us which matter not a jot). Thus it may be that I’m caused to dream of violence by eating mustard before bedtime, but it would be odd to say that my murderous dreams mean or signify mustard – and this is because mustard is a condiment rather than a predicament. What it means to talk of something in a dream or of a delusional idea as symbolising such and such, or as having a ‘natural meaning’, is for it to advert to a cause that has its own significance as a human predicament. Delusional utterances have their symbolic meaning partly in virtue of the clue they give us as to the intolerable complexes of the delusional subject that throw them up – their conflicts of identity, their unmanageable loves and hates.

To understand delusional utterance, we might say, is not to understand what is intended by the delusional person, but rather to understand his psychology. To view a psychological perspective as straightforwardly allowing the recovery of human intelligibility in delusional discourse is in this respect naïve. For not only do we not thereby recover meaning in its rational intelligibility but, by looking to the speaker’s psychology, we go further and thereby preclude treating what is said as a rational expression of intention. Delusions possess us, but only the self-possessed can be rational; we suffer from delusions in a way which we cannot be said to suffer from rational beliefs regardless of the pain the latter cause us: delusions afflict, whereas rational beliefs are of, us.

Delusions obtain, of necessity, in an autistic enclave, and understanding this is the first step towards grasping what the form of understanding is that must be brought to bear on delusion. Autism, I have claimed, is defined by a disruption of reality-contact and the consequent collapsing of the imaginary into the real.[5] It is this collapse, and not any degree of falseness or lack of inferential probity, that makes for that deep form of irrationality we call delusion. But the delusional discourse of a schizophrenic subject does yet reveal him to us in his human intelligibility, if we have the ears to hear. We do not grasp what he is trying to tell us, but rather what he is trying not to tell himself. We hear not his rational intelligibility nor his communicational intent, but rather the strains of the pain driving the delusions’ formation. We understand the delusional symbolism when we understand what is causing the delusion formation and how it serves its anxiolytic purpose – its purpose of binding a terror that is shaking the self apart. (‘like a patch where originally a rent had appeared in the ego’s relation to the external world.’ (Freud 1924 p. 151).) The patch, the binding, is a quick fix – it is not part of the fabric of ‘secondary-process’ thought and understanding; it is not accommodative; it is for when the accommodative project of establishing reality-testing is unendurable. In this chapter on the symbolic understanding of delusion I have however also described cases of symbolisation as well as defensive symbolism. Such symbolisation involves a tentative step in putting a need or feeling into a verbal or pictorial or active form. Whether or not such a symbolisation becomes taken up into autistic world-avoiding delusion, or whether it becomes a transitional step towards accommodation to inner and outer reality, will depend on various intrapsychic factors – such as courage, integrity, ego capacity, amount of envy and hate. But it will also depend on interpersonal factors – in particular, on how it is received by the listener, on whether it can be understood and handled without the incurring of shame.[6]

To wrap up let's consider again the woman in the homeless shelter who told me she had just been liberated from Belsen. She found it hard to acknowledge that she had recently been so mad that she had to be sectioned. Having just been at the psychiatric hospital was, we can readily imagine, overwhelmingly shameful for her. She may also have found the hospital to be inhumane and degrading - perhaps because it sometimes was, and/or because she projected such qualities into it. She thereby came upon the delusional notion that she had been in Belsen, a terrible place in which one could be incarcerated not because of anything wrong one had done, but because of others taking a dislike to who one is. This is the patch over the rent in her ego - the 'solution' to the problem of her terror and shame. Now the shame of being in an institution is lessened - the problem lay in the prejudice of others not in the collapse of her mind. Now the cause of her sense of threat lies outside and not inside her mind. (Here lies the fragment of truth in the cognitivist's notion that delusions are attempts to 'explain experience': she has an experience of terror and confinement which is rationalised by reference to the idea of being in Belsen. If she were in touch with reality however no explanation would required: the fact is that she was terrifyingly insane and confined in in the Warneford psychiatric hospital. We do not recover meaning in her delusion by seeing it as an attempt to explain or render intelligible or make sense of her experience, but rather as an attempt to provide a comforting illusion of sense - comforting merely in terms of its affective congruence with the unforgettable terror.) Belsen, here, is a psychological symbol of the Warneford. In understanding this we grasp something of the cause of the delusion: the displacement, the motivating drive. In understanding this we do not retrieve what she is trying to tell us, but rather what she is trying not to tell herself. But whilst we do not recover meaning in her talk we do yet recover something of her humanity that has become obscured to her: we understand her in her very human struggles to be a self-possessed subject, we can see why she is motivated to form delusions, see something of the emotional pressures she is labouring under. When thinking of whether the psychological symbol of Belsen functions as a symbolic equation that merely substitutes for healthy reality contact, or whether it is a stepping stone of symbolisation towards accommodation to the painful emotional facts, much will depend not merely on her - but on how what she says is received and treated by us.   





[1] Psychoanalysts (Lucas, 2009; Grotstein, 2009, ch. 6; Jackson & Williams, 1994) often follow Bion (1957) instead of Bleuler and refer to ‘psychotic and non-psychotic’, rather than ‘autistic and reality-oriented’, parts of the personality. However the different terminology ought not to lead us to the mistaken view that the ‘concept of psychotic and non-psychotic parts of the personality in the individual, introduced by Bion, provided a new perspective to the understanding of psychosis’ (Jackson & Williams, 1994, p. 196); the distinction pre-dates Bion by a good 50 years.

[2] ‘Reality testing’ is not to be confused with hypothesis testing. Hypothesis testing presupposes contact with reality – when we test mere hypotheses we enjoy basic reality contact and are asking whether some entertained possibility is or is not actual. Reality testing refers to a more primordial mental function; autism refers to its preclusion.

[3] Petocz’s (1999) thinking on symbol formation tends in this direction. Klein’s (1930) The importance of symbol-formation in the development of the ego might lead one to a different yet similarly limited view – of symbol-formation arising solely through an iterative process of hate displacement. At first hating the unavailable or pain-providing breast, the child displaces this hatred onto a substitute (to save himself from the breast’s feared retaliations), and this process continues as the imagined retaliations of each substitute become feared in turn. It is hard to see how symbolisation in Klein’s sense could have anything much to do with the establishing of healthy reality contact; it seems rather to be solely a motor for the formation of paranoid worlds. 

[4] Here symbols are somewhat akin to Winnicott’s transitional objects, but since the important theory of transitional space has many complex and debatable theoretical tenets it is not elucidatory to appeal to it here.

[5] Segal distinguishes symbolic equation from symbolism in terms of what the symboliser feels to be the case. [find ref] The subject making a symbolic equation between playing the violin and masturbating feels that the two are identical; the subject symbolising the latter with the former does not. This is not wrong, but it is unclear, since the notion of what someone ‘feels to be the case’ is itself unclear. In this chapter I have suggested that it is the mode of thought (and not a feeling per se) in which symbolism obtains that makes for its delusionality or otherwise. [or I could say: we can understand what this feeling is in terms of the distinction between autism and reality contact. We can explicate Segal’s distinction. Nb the distinction between paranoid-schizoid and depressive positions, in which symbolic equations and symbolism proper obtain, is also significant here. The subject in the depressive position is able to move between different relations to the same symbolisation. Or I could put it differently or better: that we sometimes have to do with symbolisation and sometimes to do with symbolism. We have the latter, and its more progressive accommodative possibilities, when the symbol helps him make comprehending contact with his feelings for his beloved. The former obtains when we have substitutive satisfaction – and this is what drives Segal’s ‘feeling of reality’. I need to figure out how to clearly distinguish: symbolism/symbolisation - autism/reality – paranoid-schiz/depressive – etc. how far do these distinctions map onto each other, and how much cut across each other?

[6] Cf Lars and the Real Girl  - a film in which a sex doll forms a transitional object for a man struggling to relate to women in an adult way – and in which the community supports him in this until he is able to relinquish it.