Tuesday, 30 May 2017

merleau-ponty on hallucination

Image result for phenomenology of perceptionMerleau-Ponty's principal treatment of hallucination comes pp. 334-345 of Phenomenology of Perception. So far as I know we yet lack a comprehensive exposition of it (cf Romdenh-Romluc 2009; Benvenuto 2015). Here at least are the main themes as I understand them:

a. The hallucinator can often tell the difference between his hallucinations and his perceptions. Merleau-Ponty gives dozens of examples of this - which basically seem to involve a bunch of early twentieth century French and German psychiatrists playing tricks on their psychotic patients with mock-ups of their hallucinations, and reporting how taken aback the patients were, and how differently they related to their real and hallucinatory experiences with the same object.

b. Hallucinations cannot be understood using either intellectualist or empiricist philosophies. Intellectualism: hallucinations are faulty judgements. Response: no, they're not. The hallucinator may or may not judge that their hallucinations are veridical experiences, but the hallucinations themselves are not judgements.

c. Empiricism: the mind relates to the body as follows. Physical stimuli affect the sense organs, give rise to neural excitation, this travels to the cortex, and then at this distal end arise sensory experiences, sense data. Hallucinations are the inner sensory experiences without their normal causes. Response: no, they're not. As in a. above, the hallucinator often readily distinguishes the two.

d. We need to understand - to 'live' - hallucination without explaining it, where by 'explaining it' he means reducing it to further items (e.g. to judgements or to sensory experiences which simply happen to obtain in the absence of their typical objects).

e. Genuine perception has built into its structure a large array of 'promises' - here Merleau-Ponty seems to draw on Husserl - that if I move over there, and my vantage changes, or if I pick this up and turn it over, that I will encounter this or that. This interconnected protentive structure of experience constitutes our normal perceptual world. Real objects also offer us what Gibson later calls sensori-motor affordances. Contrast hallucination, where there are not the same expectational pathways leading from the hallucinatory experience to other real or delusional experiences, and not the same affordances for action provided. 'I can feel swarming beneath my gaze, the countless mass of more detailed perceptions that I anticipate, and upon which I already have a hold'.

f. So, following Minkowski: 'Hallucinations are played out on a stage different from that of the perceived world'. 'The world has lost its expressive force, and the hallucinatory system has usurped it.' They 'lack the fullness, the inner articulation which makes the real thing reside 'in itself', and act and exist by itself. The hallucinatory thing is not, unlike the real thing, packed with small perceptions which sustain it in existence. It is an implicit and inarticulate significance.'

g. 'The illusion of seeing is ... much less the presentation of an illusory object than the spread and, so to speak, running wild of a visual power which has lost any sensory counterpart. There are hallucinations because through the phenomenal body we are in constant relationship with an environment into which that body is projected, and because, when divorced from its actual environment, the body remains able to summon up, by means of its own settings, the pseudo-presence of that environment.'

h. In real experience, the perceptual landscape 'opens on to a geographical world and tends towards absolute plenitude. The normal person does not find satisfaction in subjectivity, he runs away from it, he is genuinely concerned with being in the world, and his hold on time is direct and unreflecting, whereas the suffered from hallucinations simply exploits his being in the world in order to carve a private sector for himself out of the common property world, and constantly runs up against the transcendence of time.'

i. Underlying our experience of the world is a 'momentum' or 'faith' or 'primary opinion'. This deeper functions gives perception its reality quotient. The schizophrenic lacks this. So too is this faith insufficiently established in the child who 'attributes his dreams, no less than his perceptions, to the world ... he believes that the dream is enacted ... at the foot of his bed'.

j. 'the illusory thing and the true thing do not have the same structure, for the patient to assent to the illusion, he must forget or repress the true world, and cease to refer back to it, and retain at least the ability to revert to the primitive confusion of the true and the false.'

Sunday, 28 May 2017

why voices?

So, I'm wondering how much mileage I can get out of my theory of hallucination as constituted by latent un-cancelled lived-body expectations in perception, expectations not met by their objects yet nevertheless not quelled, resulting in an experiential (quasi-photographic) 'negative' of the perceptual object. What follows is sometimes speculative.

The theory seems to makes sense of 'seeing ghosts', and we can I think readily grasp a failure of complete mourning as the reason for the 'negative perception' of the deceased beloved. It ties the visual cases nicely to the haptic or vestibular cases (that odd jolt on embarking on the static escalator) - our lived body expected movement but met with none, giving rise to a kind of reverse experience of movement because of its own now otiose compensation.

But what about 'voices' (AVHs)? Can 'spirit beings' that one 'hears' be naturalistically understood to arise in the same manner as 'spirit beings' that one 'sees'? The theory will have to be something like: the patient is in some or other latent manner primed to receive auditory stimulation, yet receives none whilst that priming is yet uncancelled, and so they 'hear' a 'negative' of what they latently expected. But why would they be primed to receive something, not receive it, not have this non-reception cancel the priming, and so then inverse-hear what they were primed for, and what on earth is inverse-hearing?

Well, consider the commonest AVH: hearing your own name being called. Aren't we all maximally subconsciously primed for encountering our own name being called? This call on our being, this fundamental human address - isn't it inscribed in the latent body of our subjectivity? (NB I'm not talking here just of our disposition to mis-hear ('mis-interpret' as we incautiously say) other sounds as our own name, or as our infant's cry, though presumably that too is a function of the same priming. I'm simply talking about the priming.)

We can apply to hearing the general sensory formula: personal-level hearing equals subpersonal-level expectation minus subpersonal-level stimulation. One of the most significant sources of expectation will be sensory changes due to bodily movements and sounds. (Remember that at the subpersonal level we don't do well to talk of 'self-generated movements and sounds'. Selfhood and perception are co-constituted equiprimordial personal-level phenomena. Cognitive models typically disrespect these distinctions and presuppose rather than derive selfhood in their accounts. Not that selfhood is to be explicated experientially - precisely the opposite in fact. Transcendental selfhood is to be explicated precisely in terms of that which renders experience possible yet is precisely itself not experienced. It is the co-constituted 'from where', not the 'object', of experience.) The other source will be due to past sensory stimulations in the environment in question. (These two come together when the bodily movements in question are the efferent stimulations by the brain of the outer hair cells in the cochlear.)

Having no sensory stimulation (e.g. when dropping off to sleep) will, then, lead to an experience of hallucinating your own name being called - if the underlying readiness for receiving the sensory stimulation met with on someone calling one's name is not cancelled by afferent sensory stimulation. Experiencing silence is an achievement, if you like: it's the result of the successful cancelling of sensory anticipations by sensory input.

So, mightn't it be something like this (excuse the anthropomorphism; it's a metaphor, ok, I'm not setting out to commit the mereological fallacy!): one part of the brain is all excited, thinking 'ooh, maybe I'll hear my name called!', then the null sensory input comes in and tells that part 'calm down dude, nobody's interested in you'. The result is silence. (The deaf person does not live in silence.) And what makes it possible for me to hear meaningful speech is that such parts of the brain are all excited and kinda expecting them. Only if a spotlight is dynamically swooping back and forth across the courtyard can the absence of intruders be registered; a stable stasis presupposes an underlying medium in a dynamic equilibrium. These are the shaped holes in the mind all prepared for the distinctively shaped sensory inputs. When the null input is received, the anticipatory firings get cancelled. But when the null input is not received, then the anticipatory firings result in what I'll call an anti-sound. Such anti-sounds, I suggest, are AVHs.

We often talk to ourselves in foro interno. We say something and perhaps even respond to it. There are those who, in my view convincingly, think that much of what we mean by the act of 'thinking' (if not by the logical category of 'thought') is to be understood thus. This involves activation of parts of the cortex also involved in speech production. Thereby there is also, I imagine (yes, this is all 'armchair neuroscience' - or better, it is preliminary reflection on the form best taken for interpreting the deliverances of actual neuroscience), a readiness generated for the sensory stimulation arising from actual vocalisation; the readiness may extend all the way out to the cochlear, or may remain within the cortex. Yet there is, in the normal case, also a cancelling of the neural activation subtending such readiness - through the null sensory input, or through an absence of the typical feedforward from the motor cortex, etc.

World-disengagement (i.e. schizophrenic autism) is particularly important for voice-hallucinating. Voice 'hearers' do so far more in silence - whether we have to do with hypnopompic hallucinations, situations of sensory deprivation, or with schizophrenic voices. In world-engagement we have in place the range of sensori-motor feedback loops which maintain the normal updating of anticipations regime, along with those fulfilments of anticipation we call 'perceptual experiences'. Abstract oneself from this maximal grip, lose 'reality contact' or 'fonction du réel', and the conditions are perfect for the neurological activation underlying sensory anticipation to come adrift and give rise to auditory ghosts.

We may contrast the above theory with the cognitivist account. I find it impossible to state the latter without committing the mereological fallacy,  so built into the explanatory framework appears to be this assumption which yet vitiates it, but here goes: inner soliloquy is generated, there is no feed-forward so it is not inwardly expected, yet nevertheless it is inwardly encountered, and so is now taken as ego-alien. My phenomenological theory, by contrast, simply references the uncancelled subpersonal anticipations of sensory voice input themselves constituting the personal level AVH

Saturday, 27 May 2017

essences and family resemblances

don't gotta have a 'fro to be a jackson
(but it helps)
Investigations 65-71 introduce us to the concept of 'family resemblances'.

Wittgenstein in effect points out that for many concepts there aren't context-independent jointly sufficient conditions to be had, yet we operate with these concepts well enough. (This much is surely on target.)

However he voices this point in a particular way, saying things like: the range of phenomena that fall under a concept do not all have 'something in common'.  He implies that they may not share 'an essence'.

Instead the commonalities are like (likenesses of faces in a family, or) threads within a cord that run together for a stretch, but with no single thread running the whole length of the cord.

The idea that there may not be an essence ( = no general sufficient condition or conjunction thereof = no one feature in common to all the faces in a family (the big nose, the brown eyes are over-represented but not always all instantiated)) is taken by some cognitive psychologists and linguisticians and philosophers of language to invite the creation of the notion of a 'family resemblance concept'.

I realise I find this all a bit peculiar.

First off, it seems to take rather (too) seriously the idea of non-contextually-situated sufficient conditions. But how many of our more fundamental concepts could realistically be thought to work like that in any case?

Sure, technical concepts are often introduced through definitions. (f=ma, v=w*a, etc.) They are, if you like, pre-operationalised.

And other concepts may also be definable in terms of yet other concepts. (I've no idea but perhaps the concept of 'game', since it isn't all that fundamental to our conceptual scheme, can be reduced, through the provision of universal sufficient conditions, to other more fundamental concepts. (Rule-bound play, or something like that?))

But, I suggest, this isn't all that typical.

If we could provide sufficient conditions for many of our concepts it would make us wonder what the point of language was. As if life only had a smidgen of sui generisity to it, as if we only needed a few basic concepts and could build the rest out of these ('logical simples').

But language isn't like that - is it? We grasp the meanings of words - we grasp when it is correct and when it is incorrect to use them - we grasp their normative character - not, typically, through learning rules for their use. Such rules as obtain are often rather post factum, only apply to a degree, are hedged with defeating conditions, etc etc. Instead we just 'get' or 'grasp' the meaning; we take some examples and 'run with it'. This applies particularly to all the more fundamental concepts in our lives.

Or perhaps I'm cheating here, since what it might be to be a 'more fundamental' concept is to be a concept which is not to be defined in terms of other concepts and which in turn is used to define other concepts which we shall call 'less fundamental'.

Yet, well, at any rate, my question is: must we understand what it is for there to be an 'essence' of something in terms of that thing having sufficient conditions? I don't see why - it seems a very linguistic, rule-based, conception of 'essence'. My feeling, this morning, is that perhaps even Wittgenstein - but certainly those who have taken his ideas to warrant talk of types of concepts called 'family resemblance concepts' - stray too far towards equating essences and necessary/sufficient conditions. Just because various instances of a phenomenon may have no one thing in common apart from their being instances of that one phenomenon - no one further thing in common, one might say - does not, I contend, imply that the phenomenon has no essence. (I can't help but think that the difficulty here is related to Wittgenstein's not-always-so-helpful invocation of the normativity of rules to explicate the normativity of language.)

Dictionaries are 'rough and ready' only because, or in the sense that, for want of space, for want of a world beyond the page, they tell rather than show.

It goes like this: First off there's an unhelpful conception of essence in terms of sufficient condition. Then there's a discovery that many concepts aren't bound with sufficient conditions. Then there's a replacement of sufficient conditions with family resemblances. So we end up with the suggestion that we should do away with essences, acquiesce in the sometime unavailability of a supposedly helpful rule, and make do with mere family resemblances in our understanding of language. (Contrast Heidegger on the being of language.)

Sunday, 21 May 2017

wittgenstein, self-knowledge, sensations

Philosophical Investigations paras 246-7 has it that
...If we are using the word "to know" as it is normally used (and how else are we to use it?), then other people very often know when I am in pain. - Yes, but after all not with the certainty with which I know it myself! - It can't be said of me at all except (perhaps as a joke) that I know I am in pain. What is it supposed to mean - except perhaps that I am in pain?
Other people cannot be said to learn of my sensations only from my behaviour,—for I cannot be said to learn of them. I have them.
The truth is: it makes sense to say about other people that they doubt whether I am in pain; but not to say it about myself.  
"Only you can know if you had that intention." One might tell someone this when one was explaining the meaning of the word "intention" to him. For then it means: that is how we use it.
(And here "know" means that the expression of uncertainty is senseless.)
I heard it said yesterday, at a conference, in the context of a discussion of John Hyman's analytical-philosophical 'account' or 'conception' (i.e. that project of answering the question 'what is something?' by citing general sufficient conditions or general proper definitions) of knowledge that p as having an ability to use (or be guided by) the fact that p as a reason (for doing or saying something), that Wittgenstein did not in fact give us reasons for thinking that 'It can't be said of [myself] that I know I am in pain'. And in the context of that discussion I took it that Wittgenstein was - aside from some possible face-saving reconstruction by Anthony Kenny - being taken to be failing to offer something which anyone, including Wittgenstein himself, might have thought sensible to offer - namely for him to say to us 'here is my general positive conception of knowledge, and behold, here we see that the alleged first person case of knowledge does not fall under that conception.' (... The point being that, by contrast, on Hyman's general 'account' of knowledge the person who says 'I know I am in pain' is perfectly entitled to say this since they may of course use the fact of their being in pain as a reason (why didn't you play badminton this week? I had a pain in my elbow).)

Yet one of the things which is clear from 247 is that Wittgenstein is not in fact always shy of letting us know what he takes 'know' to mean. ('And here "know" means that the expression of uncertainty is senseless.') And, in fact, given that this remark occurs in the very passage after the one in which he says that it can't be said of myself that I know I am in pain, the situation is really rather curious. After all is he really saying that it can't be said of myself that an expression of doubt by me regarding my sensation is senseless? That in fact would seem to be rather the opposite of what he is claiming!

What is going on here? First of all, why can't it, joking aside, be said of me that I know that I am in pain? Second, how can it be true that this can't be said when in the very next paragraph we are offered a use for 'know' which looks like it makes for the possibility of what was denied in the previous paragraph?

The trick to answering or perhaps, better, dissolving these questions is to note that Wittgenstein is not interested in providing general sufficient conditions. Nothing in what he says about our life-with-language would lend support to the idea that he thought that an intelligible philosophical project. He is at times (as in 247 concerning know and intention) happy to provide contextually situated sufficient conditions ('And here 'know' means...'), but nowhere does he defend the (to me intuitively implausible - but you might have other ideas!) notion that language is trans-situationally decomposable. As if, for example, one might intelligibly imagine someone who went through his earlier life never hearing the word 'know' used, but being perfectly proficient in understanding and deploying facts as reasons, could then be inducted into our knowledge talk at one fell swoop. (One natural thought is: might we not expect to encounter analogues of Gettier-type problems for Hyman's non-belief-involving account of knowledge? That is, cases of being 'guided by' facts in offering reasons, or however exactly the proposal is to be cashed out, which don't amount to knowledge or which tacitly and illegitimately build in a reference to knowledge in order to secure their fix on their target.)

But then, it might be suggested, the problem with 246 is not just that no general account of knowledge is given, but that we don't even have a specific account of what talk of 'knowledge' in the context of sensations would be. But then that seems absurd too. After all, if Wittgenstein had such a specific account then he could hardly go on to say that it is nonsense to talk here of knowledge! So what does he mean? What I propose (in a 'new Wittgensteinian' spirit) is that, far from saying that something in our general concept of knowledge rules out a coherent application of it to cases of my own relation to my own sensations, he is saying that nothing here has yet been 'ruled in' (as it were). That is, he is claiming, there is no obvious use to talk here of 'knowing that I am in pain', nothing that comes to mind when we try to imagine here what those words are supposed to be doing, no obvious contribution they make to our conversations, nothing they add to my merely saying 'I'm in pain'. 

Is Wittgenstein trying to say that we can't imagine uses for 'I know I am in pain'? In fact I think we can imagine uses for that sentence. For example you might be quizzing me about my grasp of the concept 'pain' and I kick myself and say to you 'I know I am in pain'. It's a bit odd, perhaps, but it seems to me not unimaginable. (We might also imagine someone insisting, to someone who is wrongly trying to generalise a situationally unhelpful conception of reason-giving to argue down someone who tries to appeal to their pain as a reason not to go into work, that they know they are in pain. Again, it's a bit odd, but I think we can probably get there!) Here I have made sense of the idea of knowing I am in pain by imagining a possible situationally specific use of the sentence. And surely - and this is the general 'new Wittgensteinian' point - nothing stops us from developing uses which, so long as we demonstrate them, show the contributions they can make to our conversations, are perfectly and (as it were) unaccountably fine. What he was disputing was not that we can't ever imagine helpful deployments of  'I know I am in pain' but that, in the context of our relation to the fact that I am in pain, talk of 'knowledge' seems to have yet no clear work to do. 

But, you know, feel free to invent some such a purpose. Wittgenstein surely wouldn't want to stop you! After all, he's got no general account about which to get defensively protective.

Saturday, 20 May 2017

self-deception

An akratic gambler says (again) that he wants to quit gambling. For example, if you ask him this is what he will tell you. We might also say that it is what he 'says to himself'.

But then he starts to think of himself 'empirically' rather than 'practically'. He says 'ok, so this is what I intend, but what actually am I likely to do?' He then reasons 'in the past I haven't quit, therefore I probably won't quit.'

There are also many occasions when the gambler still wants to go gambling. (This, indeed, is what gives point to our talking here of addiction, of commitment to quit, etc.)

Richard Moran offers this:
For the gambler to have made such a decision is to be committed to avoiding the gambling tables. He is committed to this truth categorically, as the content of his decision; that is, insofar as he actually has made such a decision, this is what it commits him to. For him his decision is not just (empirical) evidence about what he will do, but a resolution of which he is the author and which he is responsible for carrying through.
What this made me think of is a predicament that can arise in psychotherapy. A patient says that he or she wants to overcome some problem, to quit a certain habit of thought or action. And he then engages the psychotherapist in a discussion the form of which is supposed to help him tackle this disposition within himself.

The patient is at war with himself. The therapist is engaged as collaborator with the patient to help him take a stand against himself. Hmm.

It all looks so reasonable.

Perhaps sometimes it is.

However there is I think also something disquieting about the way the patient moves into the 'empirical' rather than 'practical' stance. That very stance, I want to say, is already one which prescinds from the commitment to give up their addictive or other behaviour. After all, if he really has made up his mind, then what is the possible relevance of looking at past evidence? Acts of self-determination are precisely that.

But because the patient appeals to something which these days is a paradigm of reasonableness - namely an empirical, evidence-taking stance - we may be encouraged to overlook his irrationality in deploying it in the present case.

 Why is he irrational?

It is irrational not because it ignores evidence. It is irrational in the way that Moore's paradox is irrational. ('I believe it is raining but it is not raining'.) In effect, one feels, he is saying 'I make up my mind to not do this, but probably my mind isn't made up'.

If I make up my mind to do something, then I am committed to doing something. To be committed to doing something means to follow this through so long as the opportunity remains.

Now a further question might be thought to coherently arise. That question is 'ok, but might not the opportunity here include the absence of overwhelmingly compelling urges to gamble?'

But what is being said here? Is the idea that the person, in committing to stopping gambling, is really saying 'I now commit to giving up gambling, unless of course I have compelling urges to gamble'? Yet this is absurd - it seems to reduce a commitment to a wish. Or is he saying 'Despite and in truth because of the compelling urges to gamble I experience, I now commit to put this behaviour behind me'? Hopefully the latter if we're not to waste our time in listening to him.

The rationality-defeating narcissism in the akratic gambler's appeal to empirical considerations about his past behaviour consists in his overvaluation of what he says to himself or to us when he takes himself to be making a commitment. The irrationality is partly obscured from us because the word 'says' or 'tells' in the first paragraph has two meanings - to utter and to commit, and we flit between them without realising.

Thursday, 4 May 2017

not defensive

Why can it be hard to 'get in touch with your feelings', to 'feel what you need to feel'?

Psychodynamics offers one answer: it's because we don't want to feel pain, and so shy away from painful emotion and from the anxiety it causes.

No doubt that's sometimes true. Yet other factors suggest themselves. Thus what can make for the difficulty may not be so much the intrinsic pain, but the secondary shame, of the feeling. Or at least, what can make for the difficulty is not having a sense of an other who will accept one in one's feeling. That, I believe, is not so far from a difficulty in 'mentalising' one's emotions, so long as one resists the temptation to construe that phenomenon in a merely cognitive manner. Shame and acceptance enter into the heart of self-understanding; thus you enter into the ontological heart of I.

But what else needs considering is the intrinsic difficulty of transitioning between states. Being in an emotional state is being in a self-maintaining auto-enacted attractor basin of affect, thought, activity, etc. It is being in a mode which itself is one way of 'making sense'. My hypothesis is that it is simply difficult to move between states. Where by 'simply' I mean: not because of the pain of the shift, despite the shift being painful, but because we don't know our way around. You have to escape the self-maintaining attractor dynamics of one state, move over a threshold, and enter another state.

Moving between solitude and co-presence is a good example. Getting in touch with your latent anger when you are happy is another. We aren't obliged to think of this difficulty in motivational terms.

Often enough we are, when we arrive there, perfectly happy to be angry or sad or what have you. It was the transition, not the destination, that was troubling. Or, sometimes, not even troubling, but simply difficult.

So what we need to do is to cultivate our ability to move across thresholds between emotional states. We need to develop rites of passage. Micro-emotional forms of what anthropologists note regarding major transitions in life.

Some of these are simple. For example, we have rituals for saying hello and saying goodbye. These enable us to move between the radically different modes of being of solitude and company.

Moving between states can be troubling. I propose that 'anxiety' is the name of the stateless in-between, the state of upheaval we feel when we move out of one unanxious known into another such - but, since we must reconfigure ourselves - or better, since we must be reconfigured - in transit, we have to go through discombobulation. But, once again, I'm not proposing a psychodynamic theory - i.e. it isn't that we don't want to feel the anxiety - although that too may well sometimes be true. It is that we are designed to keep being pulled into the prior steady states. It is anxiogenic to get in touch with uncommon emotions, on this model, not because we don't want to be in the latter state, but because the process of auto-reconfiguration we must go through to get there is intrinsically jarring. But, again, it's not  necessarily that we act to avoid the anxiety, so much as that we get auto-configured by the attractor basin of the original affect state. We know our way around when we are in a steady affective state. That state reveals the world to us (as Heidegger contends regarding mood). We don't know our way around when we are transitioning between states. We lack an inner seer, an inner shaman, an inner spirit guide, to take us from one world to the next.

It's not that we don't want to travel, but just that having a home is having a place we are pulled back to. When we get there, finally, we're usually happy enough.

Wednesday, 3 May 2017

hate has to come first

In The Divided Self chapter 10 Laing makes extensive effective reference to a paper by Hayward & Taylor (1956) called 'A schizophrenic patient [Joan] describes the action of intensive psychotherapy'. The following caught my eye:

Laing: The main agent in uniting the patient, in allowing the pieces to come together and cohere, is the physician's love, a love that recognises the patient's total being, and accepts it, with no strings attached.
Joan: Hate has to come first. The patient hates the doctor for opening the wound again and hates himself for allowing himself to be touched again. The patient is sure it will just lead to more hurt. He really wants to be dead and hidden in a place where nothing can touch him and drag him back.
The doctor has to care enough to keep after the patient until he does hate. If you hate, you don't get hurt so much as if you love, but still you can be alive again, not just cold and dead. People mean something to you again.
The doctor must keep after the patient until he does hate, that is the only way to get started. But the patient must never be made to feel guilty for hating. The doctor has to feel sure he has the right to break into the illness, just as a parent knows he has the right to walk into a baby's room, no matter what the baby feels about it. The doctor has to know he's doing the right thing.
The patient is terribly afraid of his own problems, since they have destroyed him, so he feels terribly guilty for allowing the doctor to get mixed up in the problems. The patient is convinced that the doctor will be smacked too. It's not fair for the doctor to ask permission to come in. The doctor must fight his way in; then the patient doesn't have to feel guilty. The patient can feel that he has done his best to protect the doctor. The doctor must say by his manner, "I'm coming in no matter what you feel."
It's hellish misery to see the breast being offered gladly with love, but to know that getting close to it will make you hate it as you hated your mother's. It makes you feel hellish guilt because before you can love, you have to be able to feel the hate too. The doctor has to show that he can feel the hate but can understand and not be hurt by it. It's too awful if the doctor is going to be hurt by the sickness.
What is striking about Joan's description of her state and its apt therapy is how replete it is with moral tension. Laing tells us that is the doctor's love that cures. Joan tells us all about her hate, and her need for the doctor to engage in a non-collaborative self-assured tolerant manner. The manner, i.e. the form of the relationship, a form Laing calls 'love', is all.

What today is called 'clinical psychology' can, I believe, often-enough almost be defined as an attempt to approach psychological suffering and treatment in descriptive/psychological rather than moral/evaluative terms. To the extent that it succeeds in its attempt, to that extent does it damage the patient and impede true recovery. Joan needed a therapist who could be morally assured and bold. She did not ask for a moral relationship defined merely as a collaborative willingness to do work which itself could be understood non-morally (merely epistemically, for example). Instead she asked for what she essentially needs - a transformative moral relationship, the therapist's containment and metabolism of her hate, a stance which from the standpoint of the defences amounts to intrusion, a stance which is nevertheless in the service of recognition of the patient's actual and potential humanity.

Psychologists are today so apt to disaggregate and deconstruct schizophrenia into this or that symptom which supposedly warrants treatment. Laing takes a different route - he reaggregates the symptoms into an understanding of predicament - the schizoid and schizophrenic predicament and struggle with the courage to be, to be in relation to fate and to the passing of time, and particularly the courage to be in relation to others.