Sunday, 31 January 2016

qualitative research in psychology

I don't know about you but it often strikes me that most of the qualitative research one finds in clinical psychological doctoral dissertations and in psychology journals is without scientific merit. This demerit, it seems to me, has nothing to do with the researchers failing to do what quantitative researchers try to do. (Quantitative research is often without merit for quite different reasons.) If anything - and this is what I elaborate below - it comes from the qualitative researchers themselves asking questions and approaching their topic in a manner far too close to the forms of thought constituting and driving quantitative investigation. If one complains to such a researcher 'Oh but you'd need a much bigger sample to establish that with any reliability', the researcher will retort 'but I'm doing qualitative research, I'm here to build, rather than test, a model; I'm trying to develop valid concepts not to assert reliably true generalisations; please stop trying to foist your quantitative prejudices onto me'. To which the only apt response, often enough, is 'Well please stop framing your questions and answers in such a way as that only a quantitative approach could really do justice to them.' 

We do of course at other times meet with unthinking positivist critique of good qualitative research. I remember how, at a journal club meeting at the Institute of Psychiatry in London about thirteen years ago, in which we discussed an excellent qualitative paper by Josef Parnas on the essential structure of pre-schizophrenic self-disturbance, a young professor (who shall remain nameless) scoffed that the sample size of about seven people made rather worthless Parnas' investigation. It was embarrassing and demoralising how many of the students in the room tittered. Parnas who, despite being even grumpier than me, is a very perspicacious Danish psychiatric researcher, has not only published profound work on self-disturbance in the schizophrenic prodrome, but also extensive quantitative statistically rigorous research on diverse developmental, genetic, and neurological psychiatric concerns. The then head of the Institute (who shall also remain nameless) professed himself unable to grasp Parnas' phenomenological work but, given his knowledge of the quality of Danish scientist's rigorous quantitative research, could at least own that his failure to understand the value of the qualitative research may be his own.

To return to my theme: it seems to me that there really is a clear possible value to qualitative research, which is that it can help us reflectively unearth and articulate - give a voice to - what is otherwise the merely pre-reflectively grasped being or character or significance or meaning of some phenomenon. Imagine that we have an implicit grasp of the significance of something, or an implicit grasp that certain phenomena which looked at in various ways appear disparate nevertheless share something central. We might think this of schizophrenic symptomatology: looked at through the conceptual lens of a Mary Boyle or a Richard Bentall, one which accepts a phenomenological reduction of the condition into allegedly independently assayable behavioural and cognitive signs and symptoms - i.e. one which sees the concept of schizophrenia as a construct - the phenomenon falls apart and one now naturally questions whether or not 'schizophrenia' really means anything in particular. Nevertheless our intuition that here we meet with phenomena that are in some as-yet-unarticulated sense fundamentally alike might instead push us to reject the phenomenological reduction and instead pursue a qualitative investigation which would (a la Parnas) develop quite different terms with which to articulate the unitary lived character of schizophrenic experience. 

To develop my theme: For a qualitative investigation into the character of some phenomenon to be worthwhile, it must be the case that a) we actually do have to do with a phenomenon, of which b) we have an implicit grasp. The research makes the implicit grasp explicit. (It may also occasionally be more revolutionary than this, inviting us to question our unreflective grasp, suggesting a diversity which had previously been obscured by and assimilated in our thinking. I will leave this aside for now.) Essential to qualitative research, then, is that a) we do actually meet with phenomenon. But this is the first hurdle at which most qualitative studies that I've seen fall. They claim to be developing 'a model of' some or other phenomenon, but when you look at what this alleged phenomenon is it is something like 'the experience of being a nonagenarian insulin user' or 'the experience of visiting a relative in hospital' or 'the experience of being a gay Asian man in a European city' or what have you. And here it is not in the slightest bit obvious that we have here to do with any phenomenon at all. For why on earth should we imagine that there is any such thing as the experience of being a nonagenarian insulin user? Why should we even imagine that there is any such thing as the experience of being a nonagenarian, or the experience of being an insulin user? Maybe there are as many such experiences as there are nonagenarian insulin users - or perhaps even more than that, given the different experiences the same person may have on different days, and the different things that can be meant by that vaguest of terms 'experience' even on the same day. 

At this point the qualitative researcher may say 'Well actually Dr Gipps I'm precisely not assuming that there is an experience that I'm investigating. If you look properly at my title you'll see that I'm undertaking at 'a qualitative investigation into the experiences of relatives attending a hospital for psychiatric patients'. At this point, however, I want to say 'Ok but, aside from the question of whether this really counts as scientific research: if we can all be fairly sure from the get-go - just from our ordinary experience and understanding of what it is to live a human life - that people will be having different experiences here - why are you looking at the experience of just seven people?' Once again, there is no phenomenon being studied here. There are instead a variety of different experiences of a situation. The unity resides in the object (the hospital) not in the experiences of the object. In fact, given that this object is where the only unity lies, we ought to note as well that the abstract titular talk of 'a hospital' is itself misleading. There is nothing in the research which suggests that the experiences of these visitors can be generalised to other hospitals, and nothing that suggests that it is distinct to this hospital either. What the 'research' paper ought to be called is 'An inquiry into what seven people who visited relatives in St Barts hospital on 7th November 2009 were inclined to say on that day about how they found coming to St Barts.' The only thing still wrong with that title is the word 'inquiry' which is better suited, I would suggest, to legal, journalistic or scientific contexts rather than to unstructured interviews. (When a journalist or lawyer conducts an inquiry into something, it really is just into that one thing - in particular when we are asking ourselves 'what actually did go wrong here?')

I just mentioned generalisation, and ought to immediately acknowledge that qualitative research is not, or at least ought not to be, itself in the business of generating generalisations. Someone might say 'I'm just generating some nicely fleshed-out concepts, you quantitative researchers can now go off and find out how widely they are instantiated in reality'. However this once again, I believe, just misunderstands the criticism. The criticism is not that qualitative research ought but fails to generate generalisable claims. It most certainly ought to be in the business of investigating the being of some phenomenon, and not be considering how widely that phenomenon obtains. The criticism is instead that, given that we don't have an intuition that we meet with a phenomenon here, but instead are looking at a tiny sample of a range of different phenomena which are only contingently related through sharing, in the vaguest possible sense, the same object, the only possible way in which what is being done could be of interest or have significance would be if it were reliably generalisable. 

Why is this? It is because knowledge, and not only understanding, is sometimes useful. Qualitative research at its best develops understanding for us. It isn't in the business of delivering knowledge of what happens to obtain, but rather helps us better grasp what we already know to obtain. But in the contexts considered above, in which we are given an insight into what a few people's experience of visiting the hospital was like, any new understanding we develop is probably irrelevant - unless we were, say, doing therapeutic work with that individual - and the only thing that would here be relevant would be knowledge.

By all means, please have a look at the experience of visitors to your hospital, and listen to what they say, and make your service better given that feedback. That is highly important work. It may be more valuable than doing research. But - it is not research. There's no honest reason to dress it up as 'An investigation into the experience of visitors to a day hospital': that's just hyperbole, the driver of which is probably the misperception of the desirability of scientific over non-scientific ways of spending one's time and developing as a professional.

Finally a comment on the idea of 'developing a model of...'. The word 'model' is not clearly defined and so I don't want to get stroppy about it. However in the qualitative arena I'd rather go with 'an understanding of...' since the word 'model' often carries connotations of either a prototype or of a representation of how something works. Qualitative research, however, gives us 'whats' and 'whys', not 'hows'. Talk of models by qualitative researchers is, it seems to me, yet another way in which they too closely ape the procedures and forms of representation of quantitative research and, in the process, make themselves vulnerable to losing sight of what can be of real and distinctive value in the process of trying to grasp the qualities that make a phenomenon what it is.

Thursday, 21 January 2016

spring

Spring. In a couple of months it will be spring again.

Waking I think 'Is it really nearly a year since last spring? Must time march on so? My end draws nearer yet.' I feel despair.

Here I'm clinging onto life, try to take a portion of it for myself. It's me against time, me against fate.

Or:

I wake and think 'How wonderful: spring will soon be here; yet another chance to experience its joys.' I feel happy, grateful.

Here I'm alive to grace: life now is 'gift'. I arise and pass within time; how good to have this repeated glimpse at all.

These two visions of spring are, in the facts they survey, precisely equivalent.

..... And now imagine what you would want to say to someone who voiced the banal 'That's just the difference between a glass half empty and a glass half full.'

Tuesday, 19 January 2016

beck on free association

I've recently been writing and talking about Aaron T Beck's origination of cognitive therapy as a reaction against an odd and counter-therapeutic version of psychoanalytic psychotherapy which he and doubtless others practiced in 1950s America. Along the way I've tracked peculiarities in his psychoanalytical understanding of dreams, depression, and the transference. In this post I want to focus a little more just on his understanding of 'free association' and the 'fundamental rule'.

Beck's understanding of free association and the fundamental rule can be read and heard in various places, but the one I want to consider is available here. To quote:
I was seeing a patient named Lucy. She was on the couch, and we were doing classical analysis. She was presumably following the "fundamental rule" that the patient must report everything that comes into her mind. During this session she was regaling me with descriptions of her various sexual adventures. At the end of the session, I did what I usually do. I asked her "Now, how have you been feeling during this session?" She said "I've been feeling terribly anxious doctor". 
...I said "It's very clear why you've been feeling anxious. You have these sexual impulses which are threatening to burst forth. Since your sexual impulses are unacceptable they cue off anxiety." I said "Does that sound right?" She said "Oh yes, you're right on target." I said "Do you feel better now that you know this?" She responded "No, I feel worse". I replied "Thank you for being frank. Can you tell me a little more about this?" She responded "Well actually, I thought that maybe I was boring you, and now that you said that, I think I really was boring you." I asked "What made you think that you were boring me?" She replied "I was thinking that all during the session." I said "You had a thought "I am boring Dr Beck", and you didn't say it?" She replied "No, I never thought to say that." I said "You had that thought just this one time, right?" She responded "Oh no, I always have that thought". I said "Oh that's really strange. How come you never reported this before?" She responded "It just never occurred to me that this would be the sort of thing you would be interested in." I asked "Did you have any feeling when you had this thought?" She replied "Well this is what has made me really anxious". I asked "Do you ever get this thought when you're not in the session?" She replied "Oh, I get it with everybody. I'm always very anxious because I think that I'm boring people."
Beck starts by telling us that Lucy was 'presumably following the 'fundamental rule''. We then learn however that she was doing no such thing. As Jonathan Lear has stressed, to follow the fundamental rule is impossible. It is in the nature of being analysed that one very often does not say what is on one's mind. One may take oneself to be doing that at the time. But then, when the session's over, one thinks: 'Oh, how come I never voiced that worry about what my therapist would think of my saying this or that? The worry was there all along!' (Beck himself was in analysis for a few years. How come he never realised this himself?!) This tells us something really interesting and important about the nature of the unconscious: how the image of repression as obscuring and burying what is on one's mind is not quite right. What is repressed is in fact known perfectly well, yet peculiarly 'un-thought' as Christopher Bollas calls it. (Sometimes I think that what is repressed becomes like a default tacit framing assumption: something that is rather imagined to go without saying. Both the patient and the analyst 'know' that the patient is basically boring - this much is already down - so let's not state the obvious and instead keep what would be a painful thought unconscious - in the curiously too-well-known-and-yet-thereby-not-known-at-all miasmic sea in which the analytic relationship floats.)

Anyway, Beck's therapy with his patient gets better when she stops trying to meet his needs and starts addressing her actual worries. It gets better, one could say, when she starts 'complying' better with the fundamental rule. Then the two of them can work through her transference worries. Beck calls these worries her 'negative automatic thoughts', and implies that they are only incidentally ignored by her, and that she just needs training to look at them. I would suggest, however, that the connection between her not voicing the worry that she was boring him, her belief that she ought to be saying things interesting to him even though it's her therapy, and her fear of boring him are clearly connected! Their connectedness forms the flesh of the motivational dynamics of the internal world, a world on which Beck effectively turns his back as he turns his back on the transference and develops instead a coaching relationship.

Here, however, let's just note the vast difference between saying whatever it occurs to you to say, and saying whatever is actually on your mind. Beck seemed to have no sense, in his analytic work, of this difference. He seemed to have no idea that if someone really could comply with the fundamental rule then they wouldn't need to be coming to  psychoanalysis!

Why is it hard to grasp the meaning of 'free association' - 'frier Einfall' Partly the term itself I'd suggest (I'm following Guy Thompson on the fundamental rule). It is in one sense neither 'free' - because as Thompson notes psychoanalysis is governed by a constraining ethic of honesty (you really gotta try to share stuff you donna wanna share). Nor is it about associating a la associationist psychology - since one can just as well associate away from one's real emotional preoccupations as towards them (as Jon Frederickson describes in his books on therapy). Rather it's all about actually sharing what is actually on your mind - which is so much more readily known than thought, and which we are in any case so often reluctant - even instinctually, unreflectively reluctant - to do.

Monday, 18 January 2016

evidence and outcome in psychotherapy

So you want to learn to paint do you? Vast powerful oil paintings a la Jenny Saville - so that's your thing?

Well, I ought to tell you first that, sadly, there just is no very good evidence linking the using of different types of brushstrokes to producing a powerful picture. Sure, certain ways of doing thing were haphazardly handed down from practitioner to apprentice over the years, but the amazing thing is, no one ever stopped to evaluate them properly.

However in the last few years we have been lucky enough to start to benefit from an intrepid range of painter-researchers. The way they've done it: they've strictly manualised the techniques for making certain brushstrokes and they've also devised an operationalised scale of painterly success.

Sadly we still have very little evidence concerning the rest of the brushstrokes - more research is always needed don't you know? - but I can say that, for a well-researched select few, the initial data are rather promising. (In all honesty though I ought to acknowledge that these techniques have so far only been shown to work when producing still lifes.) 

What's that? You're citing some evidence from ages ago, carried out in some other alleged research tradition, that the type of brushstroke makes little difference to the quality of the painting? Well, that all sounds a bit unfocused to me. And what's this vague idea you're touting now, something to do with the importance of cultivating the artist's nascent sensibility? Well, I wouldn't know about that. And this idea that different artists have different things to say? Or that different collectors are drawn to different styles? I have to say, this all sounds terribly unscientific. And, what's that: why am I focusing on brush strokes anyway!? Well, I'm really not sure I can help you if that's the way you're going. 

Right, I'm off to polish my hammer now, which is the only tool I've ever found myself to need. Good luck to you and all that. I have to say, though, it's getting mighty tiresome living in a world in which people keep imagining themselves to encounter things other than nails.

Sunday, 17 January 2016

beck on psychodynamic psychotherapy - engagement, getting better, and 'what works'

In a brief clip on Youtube an elderly Aaron Beck talks of his historic disillusion with psychodynamic psychotherapy.

What he says is instructive, I believe, for what it tells us about poor psychodynamic practice. I make no claims here about whether such practice is the norm. I think we can all recognise it. Perhaps we (psychoanalytically-minded psychotherapists) have all slipped into it. Perhaps we've even been schooled in it. Hmm.
In this post I want to think about what makes this kind of psychotherapy a poor thing. And how this poverty relates to something else Beck says - namely that 'this was not a very efficient way of doing things. The patients did not get better the way they should... it didn't work.' (The connection I wish to draw between the therapy being poor and the therapy not working is not the obvious one... which is why I'm gonna write this post!)

Beck is talking of how,
when I was doing psychodynamic therapy... the patient would come in, and you'd say 'what's on your mind today?', and then they would talk and you'd keep them going. And then you'd kind of look for the themes. And they'd talk about a movie they'd just seen, and then about a relationship they just had, and some thoughts they had while they were driving, and maybe a recent memory they had. And then you'd say, 'well you see you can dissect, you see this little theme, the theme is that you've been the underdog, and it comes out in each one of these circumstances, but you're not really aware of that'. And then the patient would say 'You know doctor you're right, you've hit it on the head'. But what I found was that this was not a very efficient way of doing things. The patients did not get better the way they should. We were both intrigued by what was happening. [laughter] And it was very, very satisfying. It was the most satisfying experience I had, being kind of a detective and showing how smart you are. But it didn't work. I thought it worked, but when I switched to cognitive therapy which was more directive .... then the patients started to get better much sooner. So I had to be practical. 
What strikes me about this (parodic) description of therapy is what I will call the 'external relation' it posits or presupposes between a therapeutic method and a therapeutic outcome. The patient does one thing - allegedly saying what's on his or her mind. (I say 'allegedly' because Beck often acknowledges that his analytic patients actually weren't following the 'fundamental rule' of psychoanalysis, but were leaving very significant background thoughts - the ones he called 'negative automatic thoughts', ones which unsurprisingly pertained to the transference - unshared.) The therapist encourages this to continue for a while. Then the therapist does another thing: describes the patterns he or she finds in his or her patient's sundry musings. The patient then agrees or not. And finally another thing happens: the patient does or doesn't get better. The phenomena are, that is to say, not of a piece with one another; they are separate and merely causally related; the logic is that of applying a procedure to a process which should, all going well, practice going as theory suggests, result in a product. One could say that, in this scenario, the therapist and the patient too are, in their supposedly therapeutic encounter itself, here themselves merely externally related to one another. The result is a depiction of therapy as technique, as parlour game and, I believe, as facile and auto-parodic. And the result of this game is, naturally enough, merely intellectual insight; the patient's deeper emotional difficulties remain.

Now Beck's transition to cognitive therapy can be described in several different ways, but one of the best is, I believe, in terms of an increased engagement between himself and his patient. This can be seen in different ways - for example in what he describes as his asking 'a key cognitive therapy question, namely ''what are you thinking right now?'' It can be seen in the collaborative focus that the therapy takes. It can be seen too in the abandonment of the floaty parlour tricks of the putatively analytic technique. It can be seen in his direct and honest challenging of his patients' beliefs. Against the backdrop of the merely intellectually curious procedures of his psychodynamic practice what can one say apart from 'hooray for cognitive therapy!'?

As engagement increases in this way, what is in and on the patient's mind, what is happening in the room, what is happening in the mind of the therapist, become much more of a piece with one another. We have, one could say, an increase of the internality of their inter-relations. They become more of a piece with one another since they all partake in and of the interaction between the therapist and the patient. (I would say that, if only Beck had grasped the significance of the transference, he could have arrived at a still more intimately engaged and valuable therapy.) But in the psychodynamic therapy parodied or confessed by Beck we see little of that. The patient waffles on, not actually sharing her transference thoughts despite supposedly following a rule to say what is actually on her mind. (The pivotal case Beck provides is of a woman who fails to share her omnipresent worry that she is boring Beck.) The therapist encourages this waffling and, sitting back, makes theory-guided links between different things that are said leading, at best, to intellectual insight. (At worst, since the patient isn't really sharing her true preoccupations, we don't get any insight at all.) There is no very live connection between patient and therapist. The patient says stuff, the analyst says stuff; the latter ('interpretations') are somehow supposed to have an effect on the psychopathology which inspires what the patient says; unsurprisingly Beck finds that they don't.

What strikes me the most, then, about Beck's early psychoanalytic work is how distant it all is. We have a push button (an interpretation) over here, and a bell (the patient's feelings) over there. It is easy to see in such a setting how to pose a question 'does pressing the button cause the bell to ring?' - 'does this procedure (intellectual interpretation) lead to an effect (emotional relief)?' We can separate out the cause and the effect in such a way as to pose a question about whether such an such an intervention really does lead to such and such an outcome. But consider now situations in which we don't have to do with such a distance of cause and effect. Rather than press a button we go and gong the bell ourselves. Is it now so obvious what it would mean to ask  'does your gonging the bell cause it to ring or not?' The gonging and the ringing are internal to one another: the cause and the effect are of a piece and are unified by the action. Similarly, I suggest, with engaged therapeutic action. If I and the patient are truly engaged then when I offer not some remote intellectual 'interpretation', but rather say something which truly breaks through her defences, there will be no question of its therapeutic efficacy.

My claim, then, to take us back to the beginning, is that to the extent that it makes sense to ask whether a therapy 'works' or not, we probably have to do with a poor therapy. And this is not because good therapies always work, but because the concept of 'working' doesn't gain respectable application when we have the real deal. Beck talks of how psychodynamic interpretation, as he practiced it, 'was not a very efficient way of doing things. The patients did not get better the way they should... it didn't work.' My point here is that if we in the game of thinking of whether a therapy 'works' or not then we are in the game of something we should avoid. (Sometimes trainees say to me: 'With this patient I've done and said all of these things in my therapy book, but none of them seem to work!' I always feel like saying: 'So stop trying to doing things to your patient!') For what we want is for the patient to 'get better the way they should'. If we break through the defences, then the defences - which by definition are what stop the patient from truly getting over their disappointments, from truly overcoming their fears, from mourning their losses - will stop plaguing the patient. You don't need an outcome study to tell you that: you just have to learn the discourse of psychotherapy. If the patient is not getting better then this is because they are still really defended, or because you're not really engaging with them - i.e. with how they unconsciously feel in themselves.

Does making the unconscious conscious succeed as a way of making the unconscious conscious? It's a daft question. Does painting a picture work as a way of getting a successful picture painted? Well, doesn't it just depend on how artistic you are?

causing, again

Imagine this: you go and bash the bell of a doorbell with your hand hard enough for it to ring forth. But then some philosopher comes up to you and says 'Ah, but do you really know it was your bashing that caused the ringing? Might this not just be one thing being correlated with another but not being caused by it?' My question today is: How does one get to be such a philosopher? What must have gone wrong with the bent of her thinking such that questions like these start to seem sensible to her?

Well: now imagine that you only thought of cases like the above after first having considered wireless doorbells. The postman comes with a parcel. He presses the button. The bell rings inside. But later your neighbour presses the button and the bell doesn't ring. What's going on? You realise that the receiver was tuned to the wrong frequency and in fact, when the postman came, it was the coincidental pressing of another neighbour's button, to which your receiver was accidentally tuned, that caused your bell to ring when it did.

Consider, then, that your philosophical thinking about causality was itself fundamentally conditioned by such cases in which we have to try to distinguish causes and coincidences. To get this thinking off the ground you'll need to make sure you have a fairly alienated set of cases to work with. You'll want your causes and your effects to very much be 'distinct existences'. We won't want to be thinking of cases like squishing an egg in your hand or crushing a nut with your teeth. We'll want to be thinking of cases like bells and buttons. We will want cases in which there is necessarily a mechanism involved. Not cases in which we have to do with the workings of proximal components of the mechanism - which presumably, on pain of infinite regress, do not always have their own linking mechanisms.

When you think about it, the same kind of set of examples are required here as in any other situation when we want to get a philosophical problematic off the ground so we can set to important 'work on' it. First ignore the engaged human being living effectively and spontaneously as part of her proximal environment itself containing objects in proximal relations to one another. Instead sit back and go for the disengaged perspective, contemplating objects which themselves may or may not really be engaged with one another. Hive off, at least for a while, your understanding of the being of causality from your living encounter with your environment, imagining that it is some kind of an open question whether what you take yourself to encounter really does instantiate causality. (If you want you can console yourself with the notion that you can always plop causality back in later with a transcendental argument or some other train of thought borrowed from transcendental idealism. Causal animation might not be encounterable in nature: never mind - just animate nature with the form of your own thought!)

In this way you can happily start to make engagement, relatedness - be it causal, intentional, or rational  - seem somewhat unsafe, happenstance. Start with the uncertain cases: start with mere correlations, belief, arm risings, appearances - and then ask yourself what your warrant is - since if you start from there you can be sure that warrant will be required - to ascend to causes, knowledge, arm raisings, realities. Now you can start too to think that causality must always be realised in a mechanism - since mechanisms are required when we have two distinct things that require linking up. Your alienated perspective on the natural world is now pretty much complete. And now you can start to feel confident that you've got enough of a rationale to start developing 'theories' to help us all distinguish between causes and mere correlations. That distinguishing, you now urge, not being something we ought to have allowed ourselves to do with such blithe confidence beforehand. Now it's obvious that 'how do you know that x caused y?' is not just sometimes, but always, a good question to ask. Estrangement now being secured, the grant application can go in in good faith and one can once again sit comfortably in all those oddly decontextualised locutions like 'the theory of x' and 'the problem of y'.

Thursday, 14 January 2016

lonely, part i

We all feel our loneliness is caused by there being no-one there for us. By our being alone, by our being left behind. But we all know too that this isn't really quite right. Isn't it rather something like this: we become lonely when we've left ourselves behind. We become lonely when we denude ourselves of our hope and happiness and place these outside, place them in someone else. Then, like a bee trying to reclaim its lost sting, trying to reclaim this essential part of its own body, we hover hopelessly around the other's shadow. We become lonely when we have, as it were, 'fallen in love'. This has nothing to do with a healthy wish to see our friends, a healthy wish to share of our good experiences, or to receive solace for and in our troubles. It has nothing to do with missing someone. Perhaps that - missing someone - provides the most important contrast for loneliness. When I miss someone they are on my mind. I long to see them. But when I am lonely it is myself who is on my mind. Loneliness: when we're lonely we don't want comfort from others for some particular pain we have. Rather: we want them to help relieve us of our loneliness itself. The truth is: We become lonely when we leave ourselves behind in others, but always-also when we've left others behind. The lonely no longer stand before one another in their humanity. The other is idealised but also, and because of the idealisation, not met with by us in herself. The call, here, the call against loneliness, is not a call to be sufficient unto ourselves. That's not possible or desirable; that itself conjures loneliness. It is rather a call to be ourselves (perhaps to forego 'projective identification'), to carry within ourselves our own sadness and fear and delight, and to bring these to one another, and to seek others' own sadness and fear and delight there - there where they are.