Friday, 24 July 2015

delusions in philosophical psychopathology

A claim of philosophical psychopathology is that reflection on the nature of significant psychopathology can help us better understand the nature of sanity, of everyday mentality, of a mind functioning so as to be in touch with reality.

I happen to agree with this claim. However it is very often - perhaps most often - pursued in ways that strike me at least as deeply misguided, and which consequently obstruct rather than provide deeper understanding both of the presence and absence of reality-contact and of inner integration.

Here is a typical example. Someone is suffering from a delusional experience - an internal 'passivity' experience of the sort psychopathologists call 'thought insertion' or 'thought withdrawal'. This someone expresses herself by saying 'so and so is taking thoughts out of my mind' or 'dammit I have thoughts in my mind but they are not my thoughts, instead they're Geoffrey's thoughts'.

The philosophical psychopathologist then jumps from this to the claim that, although we've never had to think about or recognise this because we're on the whole sane and so it's all going mentally fine and we don't know any different, actually the normal having of thoughts involves a 'sense of ownership'. It is, he opines, this sense of ownership that the patient suffering thought insertion reveals - reveals in their lack of it that is.

We can then make the account even fancier by distinguishing between senses of ownership and senses of agency etc.: did I conjure the thoughts or merely house them? etc. By this stage the project of philosophical psychopathology will really seem to have got going. My claim is that this is (in a non-clinical sense) but a delusional project.

One way to get this delusional project going is to start by ignoring the strangeness of the psychopathology and taking it that we can simply understand what the patient is saying by gerrymandering some or other metaphysical conception of 'sense of mineness', 'ownership' etc. - whilst disagreeing with her judgement of course as to the origination of her thoughts! (If you want to get this going you'd do best to also falsify the phenomenology of thought insertion, claiming without undertaking any psychopathological research that the positive judgement that the thoughts in question are someone else's is based on an explanatory inference merely from a negative situation of a lack of a sense of mineness etc.) To act thus is, it seems to me, to radically fail the patient, there being little more alienating than someone else's pseudo-assimilation of the deeply strange within oneself.

So to start with, I suggest, we do a lot better to recover our sense of the deep strangeness of the passivity experiences - before we risk explaining it away with some conveniently-concocted-on-the-spot metaphysics of mind.

To find a way into this consider first how what I will (following Rupert Read) call [non-clinical] 'delusions of sense' arise. We have a conceptual metaphor of some sort - perhaps we depict time in spatial terms (backwards and forwards), or depict conversation as a conduit for the transmission of ideas (getting your point across), or we think of mood in positional terms (feeling up and down). But then we start to attribute to what Lakoff & Johnson call the 'target' domain of the metaphor further properties of the 'source' domain which are not contained within the original application. So, for example, we start to move from some basic entitative and spatial metaphors for talk of thoughts and minds ('I've got this thought in my head that I can't get rid of') to the idea of thoughts as objects that can be beamed into people's heads through something called 'telepathy'. Or we get carried away with talk of time in terms of motion and start to imagine that it makes sense to now talk of 'time travel' - as if time were some kind of landscape you can travel through. Or a mathematician might get carried away in thinking of numbers as knowable objects and start to imagine that mathematics is about discovery of hitherto unknown facts regarding the 'super-structure' of the universe.

If someone says 'please excuse me' and leans over and scratches our leg saying 'I have an itch there you know' we know they are being silly - pulling our leg, so to speak, by playing with our language. We know that this silliness is a mere pretend delusion of sense. But we've all met and been people who also get caught up in real delusions of sense - who move from talk of someone being or having a profound or kind soul to talk of their soul as a 'discarnate entity', who start telling themselves that 'time travel' is a real possibility, etc. Usually what has happened is that they've lost track of their conceptual metaphors and started imagining that the target domain enjoys substantive properties of the source domain for which no functional linguistic uses correspond. When we're not just joking about, we merely think we know what we are talking about when we talk in such ways. But in truth we're non-clinically deluded.

Wittgenstein rather thought that much of philosophy was like that: metaphysicians develop delusions of sense which it is the job of the real philosopher to dissolve. We 'take back words to their ordinary uses' - which is to say that we show the metaphysician that he is clearly a) not using the words in question in the ordinary way whilst b) simultaneously failing to provide us with the essential new paradigms for what is actually a new use, which he  merely thinks he is entitled to do because c) he has merely pretended to himself and to us that the use to which he is now putting them was all along contained within their old meaning. But enough about Wittgenstein - back to philosophical psychopathology and to thought insertion.

The patient says that she has thoughts in her head that are not her own but instead Geoffrey's. The philosophical psychopathologist of the ilk I am imagining says that our job is to show how this is an intelligible experience. He renders it putatively intelligible by positing various inner abilities which normally - unless we pay attention to what the psychopathology allegedly invites us to consider - we don't even notice as obtaining. But now the psychopathologist has ascribed to the patient what looks like mere mistake and not delusion at all. The patient has a disruption of inner sense, a disturbance in the presentation of their thoughts to themselves - so they mistake them for someone else's thoughts. So in this sense we lose the delusionality of the delusion, rather than make some headway in grasping their thought in its clinical delusionality. And at the same time we make not more sense of ordinary mindedness but rather foist on ourselves a delusion of sense - like the psychotic person we start to get carried away by the conceptual metaphors which structure the individuation and attribution of thought. Now we start to think of thoughts as things, things which are presented to us, things which have quasi-sensory ('phenomenal') properties, things which are 'taken up' by us in particular ways. The theorist's conception of thinking - the conception, that is, of a thinker's relationship to his thoughts - is alienated in a similar way to that lived by the patient.

At the end of all of this what we have is merely a philosophical delusion that we grasp clinical delusion. The metaphysician has, thankfully, merely lost touch with the ground in her theorising - unlike the patient who has lost touch with the ground, has become unhinged, in the midst of his everyday relationships. Louis Sass has drawn some nice analogues between the solipsist and the schizophrenic, analogies which help us understand schizophrenia to the extent that we can feel the pull towards asserting the nonsense that the solipsist spouts. But the philosophical psychopathologist from the stables I have been considering takes this a step further: she persuades herself that, for example, solipsism is somehow an intelligible if false possibility and then proceeds to depict schizophrenia as intelligible as the realisation of such a possibility (again, see Read 2003). But a clinician who heeds her call is likely to become nothing but smug, whilst his patient, in the derangement of her true delusionality, will be even more lost to any real grasp of her in the shattering and bewildering severity of her mental disturbance.

How then is it that philosophical pathology can help us better understand the nature of sanity and insanity? Well, consider again Louis Sass's above-mentioned project. He thinks we can grasp schizophrenic autism through seeing it as an embodiment of solipsism. Rupert Read disagrees. Because solipsism is what he calls a 'philosophical position' and because Read, like me, is being what I would call a 'good Wittgensteinian'(...), he urges that it is therefore simply nonsensical. But this leads him to erroneously state (2003 p. 136) that "Perhaps in contrast to Sass, there is then nothing [as regards helping us understand schizophrenia] special about solipsism: it is just one mode of presentation rather than another of the illusion that there can be philosophical positions." However this misses the point that it really is particularly the allure of solipsism for us, and not its (unreal - and in its unreality just as generic as any other bit of philosophical nonsense, as Read says) content, that is what helps us to better understand the schizophrenic. We understand something of the psychology of this allure - how we can come to develop delusions of sense best in certain circumstances (when we are staring, lying utterly still, feeling detached from our own bodies, not caught up in all that loop-y re-entrant causal nexus of body-world praxical sensori-motor interaction) - and we see how the clinical delusions then grow in the soil of someone whose 'maximal grip' or sensori-motor attunement - an attunement which constitutes their certainties-in-action that themselves constitute the bedrock of their knowing - is thus loosened. Thankfully the non-psychotic person entertaining solipsism can just snap out of it and like Hume go back to the billiards game. We are not all so lucky.

Wednesday, 22 July 2015

sacred, profane, neurotic, psychotic

In his chapter on 'the sacramental universe' Gordon Graham draws on Friedrich Schleiermacher and Mircea Eliade's thinking on the distinction between sacred and profane to articulate for us an idea of sacred time and sacred space and of their relation to the quotidian. 'Wisdom', Graham tells us, 'requires us to find some way of relating our finite lives to ... infinity...' But: how?

Many of us have moments in which we stop and think on how, in the scheme 'of things'  (as the idiom has it) we and our concerns are utterly insignificant. The resulting perspective can be positively awesome (the majesty of the vast night skies), simply terrifying (our life utterly contingent and counting for naught), or really rather comforting (looking out at the sea I grasp how, in the scheme 'of things', irrelevant are my anxious preoccupations). Veer too far one way and, lost thus to disproportion we become anxious over details that need not concern us, both since fate will in any case decide them for us and since we are at any rate more resilient than we fear. (We take ourselves to be less resilient than we fear because we have not known, or at least somehow not internalised, enough of that love which is another's faith in us - and so struggle to provide it for ourselves.) Caught up by the desire to assimilate and control, to preserve an existing inner order, we underestimate our own resources for accommodation, and overlook the possibilities inherent in such an accommodation which preserves us more authentically precisely in our adaptation. (Obsessional neurosis.) Veer too far the other way and, lost to the 'view from nowhere' of 'the scheme of things', perhaps even demanding the security of such an ultimate yet unforthcoming scheme, we detach from the admittedly contingent yet nonetheless essentially meaning-providing plots of our lives, lives which now of course seem void of purpose. (Depressive neurosis.)

'So teach us to number our days that we may apply our hearts to wisdom' says the Psalmist cited by Graham who also asks 'How, as Schleirmacher puts it, are we "to be one with the infinite in the midst of the finite, and to be eternal in a moment"?' One of the ways that religion achieves this, Graham tells us, is through ritual. A ritual renders sacred through sacramental acts: it instantiates the infinite in the finite and positions the finite within the infinite to give an apt proportion to our lives. Ritual calibrates our relationship with the infinite for us.  Properly understood the ritualistic action is not to be considered instrumental: it does not work to achieve an effect outside of itself. Rather, through our participating in it, we realise and enact our relationship to the infinite and eternal. Caught up in a superstitious religion we may try (p. 156) to 'encompass the infinite within the boundary of everyday life, by including "God" as one being (albeit the greatest) within the collection of all beings, for example, or treating the spiritual dimension of existence as a realm of "magical" power waiting to be harnessed, or replacing the "beauty of holiness" with a "holiness of beauty" in art or nature. [But to think thus is to be] the victim of delusion.'

Consider how ritual may relate profane to sacred temporalities. Profane time is datable, unrecoverable, ineluctable: we can never get back the minutes we spent in yesterday's pursuits. (Think of the first verse of R S Thomas' poem 'Vespers': 'Listen, I have a song / to sing that time will / punish you for listening / to and you will not know it.') By contrast, as Eliade (cited by Graham) says, 'sacred time is indefinitely recoverable, indefinitely repeatable.' Graham provides us with the analogy of a musical composition and its performance. The performance of the piece of music takes place in profane time: the concert starts at 7.30pm and the interval arrives at 8.40pm. However the piece of music has its own internal temporal order (introduction, development, finale etc.) and this order 'neither changes nor is exhausted'. Concepts like 'spring', 'summer', 'Christmas', 'Easter', 'Yom Kippur', 'Ramadan', 'Eid' are (159-160) similar: they can if you like be 'realised in' in profane time but they are not themselves spent when that time is gone: they come again every year.  (Similar distinctions between the sacred and the profane can be drawn in relation to space: consecrated space by definition partakes in a unique way of the infinite despite the churchyard still being aptly describable as round the back of Londis on Walton Street.) The sacraments are perhaps the clearest example we have of ritualised enactments of matters eternal in the present. Thus in the eucharist (holy communion) we have participation in the 'body of Christ' (which body presumably is infinite and eternal), a ritual which can be repeated (daily or weekly, say) endlessly.

I want to turn, now, in this rather recondite and rambling post, to psychosis, in particular to the experience of Morag Coate (which I've been documenting on my 'pain that breaks' blog). In Beyond All Reason (1964) Coate, an author who writes with profound and generous thoughtfulness of her own schizophrenic breakdown, describes the intimate connection between her religious preoccupations and her psychotic experience. The topic is interesting in many ways. For example a romantic Jungian might urge on us the idea that psychosis can result from a failure to bind the powerful energies of the spiritual life with an adequate framework of words and practices, or without an adequate guide (e.g. a psychotherapist qua shaman). A naturalistic Freudian might by contrast urge on us the idea that religion simply is psychosis. Avoiding these discussions for now I want instead to consider what psychotic ritual amounts to. Here is Coate (pp. 36-7):
    On arrival at the distant hospital, my first memories are of struggles and of forcible sedation. Soon afterwards I adapted myself to my new environment and acquired a different personality. My experiences were now filled with religious content, but of a kind quite different from what had occupied my mind over the previous half-year. I was submissive, pious, and at the same time elated. I was not concerned with understanding anything; I had been specially chosen to be a kind of star actress in a celestial mystery play. I accepted this unquestioningly and with delight, while at the same time never completely identifying myself with the role I played. At one time I took the part of the Virgin Mary, at another I was the boy David; sometimes I was an anonymous figure representing a boy and a girl at the same time. Always my point of reference and of distant veneration was the black-robed, sandalled figure who sat motionless for hours at a time at the end of the aisle of a cathedral. The building was long enough to fit in with this interpretation, and the tall windows were suitable, and the flowers were appropriate. The presence of beds there could be conveniently dismissed from mind. The black-robed figure was a priest, the head of a religious order, who represented and at times actually became Christ. At meal times we filed into an adjacent, circular building, the chapter house, in which the ceremony of the Last Supper was recurrently enacted. The priest-figure served out the food which I helped, with due reverence, to carry round. Then, after seating myself at one of the wooden trestle tables, my duty was to see that the salt was passed up and down and especially from one side to the other. This was vitally important, for the two sides were not, as it seemed, a mere arm's length apart. The opposing rows of people seated there were really in far different places and in different centuries as well. Space and time converged here to make a meeting point.
    I awoke one day, as my normal self, to the consciousness that I had recently been mad.
Consider first the sane version of that sacrament described here - i.e. the eucharist (holy communion). In this sacramental context, to engage in the rite of the bread and wine is to partake of divine life - to partake of 'the body of Christ'. The eucharist, which itself takes place in a sacred place,  further births the sacred into the profane; the ritual sanctifies or, if you like, 'dignifies' the wine and wafer, and taking them then dignifies the communicant. There is a sense in which we don't do well to see the wine and wafer as mere symbols of something else since this misses their full enactive potency. And there is something daft about the idea that talking of eating or drinking the literal body or blood of Jesus Christ. Not, I think, because that would mean to talk of cannibalism (since, after all, presumably his physical body went the way of all flesh), but rather because it's really not clear either what it would mean to talk of metaphor here either (and how could we have one without the other). (Sometimes people seem to think that the physical body is the literal body, or even more generally tie talk of literality to talk of physicality. But, well, why on earth would we want to do that? That would be like saying that the genuineness of a bank note was a function of its composition rather than of its origination - in a place 'dignified' as 'the royal mint'.) We're clearly in a spiritual context, so the only relevant philosophical question here is 'what is it here to, what does it mean here to, 'eat the body of Christ'?') A Catholic friend of mine once told me that transubstantiation was like buying a pint in the pub: it changes ownership utterly when you hand over the dosh, but none of its molecules change. (I didn't grasp that at the time but it seems obviously helpful now as an analogy.) Put a wedding ring on before you get married or put it on during the ceremony: it matters when you do it! Putting the ring on enacts the marriage: we don't do well to divorce the meaning of marriage away from the ritual, and say that the ritual merely points beyond itself, that the ring is 'just' a symbol.

Anyway. Here's the idea. The psychotic state obliterates in particular regions of experience the distinction between imaginary and real, between metaphorical and literal, between symbol and symbolised, between ritualistic and instrumental, and also between sacred and profane. Reality contact consists in having a mind which sensitively instantiates such distinctions (and the instantiation manifests itself primarily in praxis rather than in disengaged reflection). Psychosis also obliterates the distinction between eternal and temporal, infinite and bounded, ordained and unordained. Religious psychosis is, one might say, a particularly tragic form of idolatry. Coate delusionally believes that she is carrying the host about the place, that the cafeteria is a sacred space, etc. It is not that she's made any kind of mere mistake about these things, since such an empirical possibility would itself presuppose rather than negate the idea that she enjoys reality contact. It is rather than she has abraded the distinction between sacred and profane. The meaning of the sacred therefore gets debased. She lives deliriously now in mere shadows of meaning. A true ritual would, e.g., help mediate the relation of finite and infinite for us; Coate's pseudo-rituals instead collapse them, just as a symbol and what it symbolises are collapsed in the psychotic mind. She has escaped the terrible mundane but ended up in the void.

The neurotic bends the rules but the psychotic stops playing; she 'loses touch with' 'reality'. Only when one's feet are on the ground is it possible to embed a distinction in one's mind of the imaginary from the real. (This is often written of as 'tell the difference, at some or other juncture, between the imaginary and the real'. But this puts an ontological point in an epistemic mode, and so not only invites us to adopt a criterion of insanity which would diagnose most people as often temporarily insane (since we may often make mistakes without being mad), but also makes it sound like we're supposed to be in the business of standing behind our own minds looking in on what is found within, as it were, and correctly ascertaining where it came from!) My point in this somewhat chaotic post is that this distinction is no less apparent in the domain of the sacred than within the domain of the mundane. Psychiatrists sometimes fret over how to diagnose religious delusions, and may end up settling for a flaccid pragmatism which says 'well if its not interfering with the patient's ability to work and play then it's all fine'. Let's not go there. First off, unless we take for granted an alienated conception of work or a hedonistic conception of play (and why on earth would you want to do that?) it's surely evident that we only really work or truly play when we have reality contact. Working is about thought-in-action; playing is about imagination-in-action. Pass a religious Turing test and so what? To have one's spiritual feet on spiritual ground is rather, I am suggesting, not a matter of being able to do anything, but of having the distinction between sacred and profane embedded in one's mind. To be simply ignorant of it, or to radically lack spiritual sensibility, is of course not to be deluded: it is to have no spiritual beliefs at all, delusional or otherwise. Religious delusions though obtain for those who do have some such a sensibility, but one that is disintegrating.

Saturday, 18 July 2015

love, depression, psychotherapy

According to ISTDP (instensive short term dynamic psychotherapy) the transformative 'breakthrough' moment of therapy is the derepression of unconscious rage and guilt towards loved-yet-hated attachment figures.

According to RGTG (me!) the transformative breakthrough in therapy involves a reconnection with what I will for want of a better term call the 'idea of love'. Primarily a form or mode of experiencing rather than a thought, the 'idea' involves the rediscovery or re-entry to a lost garden of the heart, exile from which has been unwitting yet calamitous. 

In the barren landscapes of a loveless world the maladies of the soul proliferate. Without the light from the sun to animate them, creatures instead cannibalise one another for energy. Projective identification for evacuation and control becomes ascendant. Melancholic darkness descends.

The reason I call it an idea of love, rather than simply love, is that the entry ticket to this garden need not be a current loving relationship. A memory, or an upsurge of feeling towards an absent beloved, may do just as well. The important thing is for the memory, current experience or imagined encounter to be experienced fully; a memory that one has or has been loved, a merely entertained thought that one could, will not do, and this is not what I mean by talking here of an 'idea'. There is however something of the generality of love that makes apt here the idea of an 'idea'. Love, of course, is not an abstract matter: it is always and everywhere deeply personal, yet for all that is not something restricted to any one relationship.

Living within the balm of your love I can relax. Light and life bubble up, now, spontaneously from within. I need no reason to live of the sort sought and not found by the depressive. I'm living in the garden once again; what use have I of reason? Once again night and day, dreaming and waking, fantasy and reality, separate out from one another. The animal sleeps and is rested, wakes and can work or play; it knows without thought when it is time for what, it knows without thought how to move on, where to go.

An occurrent experience of the idea of love is the moment of transformational bliss. Underneath the pain and shame and betrayal and woundedness of unmet need and dashed confidence and rejection lies a yet-beating heart. Peel back the scar tissue and listen to it. Treat it carefully: it is very fragile. It takes time for it to grow in strength, time to learn who to trust, time for the courage to remain thus 'wounded' when out and about in the rough and tumble of the world. 

A striking thing that we encounter in psychotherapy is that it is precisely when the idea of love becomes thinkable that neurotic symptoms become intelligible to the patient. What the therapist has been saying, if they've been on the right lines, now makes sense. The transference interpretations no longer feel persecutory; instead they feel apt and thoughtful.

Christians identify God with love, and claim to enjoy a loving relationship with Him. They are preoccupied with forgiveness, they meditate on Christ's wounds. The person of Christ becomes a bridge between unthinkable eternal love and the worldly historical particular. 

Now the theological register does not really speak to me. But the religious idea of culturing a reconnection with Love is surely not too far from what I'm talking about. (I've capitalised 'Love' here to emphasise again that I'm talking about something which, whilst always deeply personal (i.e. necessarily involving particular objects), is yet a form or mode of experience which can take in different objects.)

A chance moment may reanimate this 'idea' in us. A patient of mine recently witnessed an ordinary moment of loving care between a parent and adult child: this was for a while enough for him to re-enter the garden, before the inexorably exiling mists of the latent expectation of non-recognition came rolling in again.

Here, to end, is the wonderful Morag Coate, sometime schizophrenia sufferer and author of Beyond All Reason, telling us (pp. 119-122) of the experience of going to see the film David and Lisa,
a film that tells the story of a mentally sick boy and girl in a school for severely disturbed adolescents. ... The central characters were presented with a reality that struck me as perfectly authentic, and with a sympathy that implied absolute acceptance. So, by involving myself in their experience as I did, I was not only accepting my past sickness, but feeling it accepted too. ... 
[Afterwards she] walked slowly along the river bank, and let the chattering groups pass me by. The black waters of a big river at night are threatening when seen in the context of insanity; I was not troubled by them now, but awed a little, certainly impressed. And a planet shone out in the clear sky above, as piercing in its light as a single sharp note of music, and the lights on the far bank were gay with a warming brightness, and I myself was feeling human and humane. 
My involvement in the film brought home to me how sick I had been in my past life at times when I had outwardly seemed well. I saw with sudden insight the relevance of minor neurotic symptoms, and I remembered the terrors of infancy which had been revived for me in my last time in hospital. I began to reach down towards the roots of a forgotten fear of absolute destruction and annihilation. 
I got home ... I was thinking of [my psychotherapist] ... in spirit I took him by the hand with the same confidence and comfort that a child holds someone's hand when retracing their steps to the place where they have had a terrifying accident. I pressed down into the darkly bright intensity of my hidden life and broke through to the perilous secret that my adult defences had guarded me from coming near. Dammed up and firmly sealed off down inside myself my primal, urgent need was still intact. And somewhere, in the uncharted time of early infancy, I had given myself and taken in return; I had needed and enjoyed and later felt that I had lost a mother's love. The sudden, living sense of need and loss came upon me so strongly that I wept. And then, refreshed as by a sudden storm of rain, I fell asleep. 
[Coate goes on to provide a moving description of her psychotherapy. Later her] sense of an urgent, overwhelming need for the doctor whom I freely loved and trusted subsided gradually as I worked through and left behind my childhood terrors.... Once that phase was over I could return to the interests and joys of normal adult life. But the personal relationship remained, giving a deep, warm sense of security that enriched all aspects of my life. Mind, body and spirit were now at peace with one another. I had been made whole.

Friday, 3 July 2015

ryle's rabbits

The following clip tickles me endlessly. Especially at around 50 seconds when Gilbert Ryle is talking about a rabbit whose limited cognitive repertoire constraints the kinds of emotions he may feel (e.g. indignation is apparently not an option) although perhaps he 'could feel anger of a sorts...  if another rabbit was going orf with his wife or something of the sorts...'

One can understand Ryle's inclination to think indignation a richer affect than anger, hence one not so readily ascribed to the not-so-behaviourally-and-culturally-well-endowed lowly bunny. But it occurs to me, when I put my mind to the task of discerning rabbit affectivity, that I can rather more easily imagine rabbit behaviour that seemed expressive of indignation than I can of anger. I can imagine a rabbit becoming aggressive, for example - perhaps when fighting, but would I really think it angry? However, without pretending to any ethological prowess, I can I think imagine something at least akin to a snooty, shunning, rabbit taking offence.