|ok... an ox not a horse...|
Today I read this in Wittgenstein's Culture and Value:
I sit astride life like a bad rider on a horse. I only owe it to the horse's good nature that I am not thrown off at this very moment.
Now if such a sorrow, such painful knowledge or reflection, is so harrowing that it becomes positively unbearable, and the individual would succumb to it, then nature, alarmed in this way, seizes upon madness as the last means of saving life. The mind, tormented so greatly, destroys, as it were, the thread of memory, fills up the gaps with fictions, and thus seeks refuge in madness from the mental suffering that exceeds its strength.The position, as Brook and Young ably describe, is fundamental to Freud in Neurosis and Psychosis (1924), and intuitively compelling to boot.
In regard to the genesis of delusions, a fair number of analyses have taught us that the delusion is found applied like a patch over the place where originally a rent had appeared in the ego’s relation to the external world. If this precondition of a conflict with the external world is not much more noticeable to us than it now is, that is because, in the clinical picture of the psychosis, the manifestations of the pathogenic process are often overlaid by manifestations of an attempt at a cure or a reconstruction.
we have a general undirected feeling of fear. Later on we have an experience which makes us say, "Now I know what I was afraid of. I was afraid of so-and-so happening". Is it correct to describe my first feeling by an intransitive verb, or should I say that my fear had an object although I did not know that it had one? Both these forms of description can be used.And, to help us grasp the legitimacy of this latitude, he invites us to 'examine the following example':
It might be found practical to call a certain state of decay in a tooth, not accompanied by what we commonly call toothache, "unconscious toothache" and to use in such a case the expression that we have toothache, but don't know it. It is in just this sense that psychoanalysis talks of unconscious thoughts, acts of volition, etc.
Now is it wrong in this sense to say that I have toothache but don't know it? There is nothing wrong about it, as it is just a new terminology and can at any time be retranslated into ordinary language. ... But the new expression misleads us by calling up pictures and analogies which make it difficult for us to go through with our convention. ...
Thus, by the expression "unconscious toothache" you may either be misled into thinking that a stupendous discovery has been made, a discovery which in a sense altogether bewilders our understanding; or else you may be extremely puzzled by the expression (the puzzlement of philosophy) and perhaps ask such a question as "How is unconscious toothache possible?"
You may then be tempted to deny the possibility of unconscious toothache; but the scientist will tell you that it is a proved fact that there is such a thing, and he will say it like a man who is destroying a common prejudice. He will say: "Surely it's quite simple; there are other things which you don't know of, and there can also be toothache which you don't know of. It is just a new discovery".Here Wittgenstein is offering a deflationary answer to the question 'Are we right to talk of 'unconscious fears and desires'?' We feel an undirected sensation of fear or longing. If you ask us 'What of or for?' we may either reply i) 'of or for nothing' or say ii) 'I don't know what of or for'. Wittgenstein invites us to draw an equivalence between these utterances: we can say what we like, although it's best of course if we don't then go on to mislead ourselves about what we mean by what we say.
You have a new conception and interpret it as seeing a new object. You interpret a grammatical movement made by yourself as a quasi-physical phenomenon which you are observing. ... But there is an objection to my saying that you have made a 'grammatical' movement. What you have discovered is a new way of looking at things. As if you had invented a new way of painting; or, again, a new metre, or a new kind of song.-This takes us closer to the idea that we cannot easily and without loss translate psychoanalytic discourse into ordinary language in the way that the comparison with unconscious toothache suggests. Freud is indeed wrong to think that he has discovered that emotion may in fact be unconscious, rather than discovered how driven we are by what we may call 'unconscious emotion'. In this sense psychoanalysis really is 'a new kind of song'. Yet if we accept that it truly is 'a new way of looking at things' (or an alternative set of 'rules of representation') we risk succumbing to another temptation - the temptation to imagine that the 'things' looked at can readily be specified independently of this 'new way' (or of the 'rules') - as if we are here looking at the same things (x, y, z) in different ways.
A psychodynamic formulation ... is an hypothesis about the way a person thinks, feels, and behaves, which considers the impact and development of … thoughts and feelings that are out of awareness – that is, that are unconscious. … Thus, a psychodynamic formulation is an hypothesis about the way a person’s unconscious thoughts and feelings may be causing the difficulties that have led him/her to treatment. …. [H]elping people to become aware of their unconscious thoughts and feelings is an important psychodynamic technique. … Once we have a good sense of the problems and patterns, the next step in creating a psychodynamic formulation is to review the developmental history. … Having described and reviewed the patients problems and history the third step is to 'link' them together. [This provides the psychological 'hypotheses' which help the therapist to] construct meaningful interventions. …. These might include: … creating a life narrative … offering explanation and perspective throughout the therapy … consolidating insights…Now the critic (Watters & Ofshe 1999, p. 204):
Psychodynamic therapists claim the ability to help clients connect current behaviors to long-past traumas in childhood, for instance, or to repressed fantasies decades in the patients’ past. … But … if [as they argue] we can’t trace the influence of simple actions and decisions to their correct sources, can we be expected to do better making etiological connections between complex current life and events or fantasies from our childhood? …[T]he vast number of psychodynamic schools of talk therapy appears as nothing more than a testing and breeding ground for these shared cultural narratives. Psychodynamic therapy offers a new and interesting world of possible narratives by which patients can come to believe they understand the origin of their thoughts and behaviors. These narratives become plausible in the patient’s eyes through the process of influence embedded in therapy.In both these cases the authors assume that making the unconscious conscious involves becoming cognisant of your own hitherto unconscious mental processes, rather as if the purpose of therapy were to learn to be a better psychologist at least regarding one’s own mental operations. In all this talk of becoming aware of - or developing bona fide knowledge or spurious belief about - one’s own mind, however, we meet with nothing in the patient that could itself be considered the existential shift of owning or appropriating one’s previously repressed attitudes. Furthermore in all this talk of a therapist learning to recognise (or at least develop ‘hypotheses’ about) a patient’s struggles we meet with nothing that could itself be considered an ethical attitude of her offering recognition to a patient in her difficulties. We are invited, that is, to see the task of therapy as the cognitively demanding but ethically null task of providing and enjoying a new reflexive transitive consciousness of our own attitudes. The task of offering recognition to a patient in her distress and his thereby recovering - not objective knowledge about his psychological performance, but rather, in his capacity to now enjoy intransitively conscious attitudes - his humanity, is not in view.
'A psychodynamic formulation ... is an hypothesis about the way a person thinks, feels, and behaves, which considers the impact and development of unconscious thoughts and feelings.... Psychodynamic formulations do not offer definitive explanations; rather, they are hypotheses that we can change over time.'
'One way of thinking about this postulates that these problems are often caused by thoughts and feelings that are out of awareness – that is, that are unconscious. This is called a psychodynamic frame of reference. Thus, a psychodynamic formulation is an hypothesis about the way a person’s unconscious thoughts and feelings may be causing the difficulties that have led him/her to treatment. This is important to understand, as helping people to become aware of their unconscious thoughts and feelings is an important psychodynamic technique.'
'When we formulate cases psychodynamically, we make hypotheses about how people develop their characteristic ways of thinking, feeling, and behaving. Thus, once we have a good sense of the problems and patterns, the next step in creating a psychodynamic formulation is to review the developmental history. The developmental history includes everything that happens during peoples’ lives that help shape their dominant patterns of functioning; that is, the way they think about themselves, have relationships with others, adapt to stress, think, and work and play.'
'When we take a developmental history, we are guided by these principles:
Having described and reviewed the patients problems and history the third step is to 'link' them together. This linkage provides the provisional understanding or 'hypotheses' which is to guide and inform the therapy. Here's an example:
- include nature and nurture
- relationships are key
- trauma is critical
- chronology is relevant
- development is lifelong'
'How did Dr Z form this hypothesis? It was not magic. Rather, as she learned about Ms A’s problems and patterns, she asked herself a question:
Why does this talented woman have such a low opinion of herself?Because she was thinking psychodynamically, she DESCRIBED Ms A as having difficulties with self-esteem regulation that likely reflected unconscious, overly critical perceptions about herself and her abilities. This gave Dr Z a partial answer to her question, but she knew that in order to develop a strategy for helping Ms A with her low self-esteem, she would need to understand how and why these unconscious, maladaptive self-perceptions had developed. To answer that, Dr Z REVIEWED Ms A’s developmental history and, among other things, learned that she had had a difficult relationship with her critical, dismissive mother. She then used an organizing idea about development – that maladaptive self-perceptions are often related to a person’s early relationship with a dismissing, critical parent – to LINK the pattern to the history. By describing, reviewing, and linking, she had formed an hypothesis about why Ms A had such a low opinion of herself – a psychodynamic formulation.'
Once we've got them 'Formulations help the therapist to 'construct meaningful interventions'. These might include:
- 'recommending treatment and setting early goals
- creating a life narrative
- offering explanation and perspective throughout the therapy
- consolidating insights as a preparation for termination'
Patient presents with some problems.Now, if someone did that to me I'd be furious with them! There I was, hoping that I would be understood, and all we get is someone offering me a causal explanation of my problems. Jeez - thanks!
Therapist inquires into the presenting problems, uses history-taking, and his or her psychological knowledge, to develop a linking formulation.
The formulation is applied by the therapist to the patient's problems by way of explanation of them or by way of a guide to something called an 'intervention'.