Saturday, 26 November 2016

trust and the transference

Here is just about the key question for the patient in psychotherapy: How can you tell if your apparently unhelpful therapist is truly unhelpful or is a victim of your negative transference? (If you're not asking this question then maybe you're avoiding it, taking refuge in a positive transference?)

There he sits, all self-satisfied, telling you what he thinks of you, infringing your agential sovereignty, failing to offer meaningful recognition, smug and far too comfortable in his therapist's chair, intrusive with his interpretations.

Or: There he sits, trying to understand you, doing his best, occasionally clumsy but on the whole well-meaning, respectful, interested, in this for you not for him, willing to take back and own his errors, with useful things to say, things which might go against one's first thought as to one's motives or feelings or thoughts but which might be all the more valuable for that.

The thing is, from within the transference - and where else can you reside? - we can never test the issue. Matters feel the way they feel: here one sits, and one can do no other.

But here is the juncture for an 'existential' or 'moral' moment. This moral moment is what I will call trust. A moment  not for residing somewhere, but for taking a step of faith. The kind of trust I have is not of the earned, reasoned, evidenced, warranted sort. Yet neither is it helpful to frame it in terms of the negations of those qualities - in terms of something unearned, irrational, unwarranted. Such epithets still make it look like we're playing the pre-moral-moment game. As if we're still supposed to be residing rather than leaping somewhere, sitting on the throne of our extant reactive dispositions, reading the other just as we would normally read him.

This moment of trust itself amounts to a lowering of defence, an opening of the 'front door' of the house of the self. (ISTDP talks of a front door and a cellar door, the former being interpersonal defences, the latter defences against the repressed material kept in the unconscious. I think, though, following the psychoanalytic understanding that in nuce all mental-emotional disorders are at root personality disorders, that they're one and the same.) For the patient it's a leap into the unknown; it feels unsafe. For the therapist it can feel difficult too: a moment in which one actually asks something from the patient.

I'm writing about this moral moment because we tend to overlook it. How often does the therapist hide behind mere descriptive interpretations, or behind mere kindnesses? How often do they issue a call to courage in trust? And how often does the patient take it spontaneously? Well, in my experience, sometimes they do. And those moments, they can be the most transformative in the whole of a therapy. Post-leap the world looks different, the other trustable, the other someone who cares, the other someone whose care can be internalised, someone with whom one can share one's troubles, someone who can through his sheer ongoing presence disconfirm the lurking-yet-warded-off suspicion that one is, as one is in oneself, unlovable.

Friday, 25 November 2016

what are 'voices'?

We get this question a lot, don't we? The schizophrenic subject - and others too - have an experience which it often comes naturally to them to describe as 'hearing voices'. What is that? Lots of not-very-illuminating answers flood in: they are auditory-verbal hallucinations; they are more like inner musings mistaken as being externally produced; they are inner musings occurring within a subjectivity the fundamental structure of which has been altered, so that what ought to be a live subjective moment of thought becomes an intentional object of a self-alienated consciousness; they are the irruption of superego dictats and id impulses into the conscious part of the ego; they are actually perceptual illusions / misperceptions. Etc. Matthew Ratcliffe raised the question again recently, and aptly questioned many of the above options, but hasn't yet given us his own answer.

Well, I want an answer! So I'm gonna try make one up. What follows rambles; it'll do for now.

How does our hearing of actual voices work? I've got no idea. Presumably what we most need to steer away from, in our theorising, is any primitive conception of a sequence of energetically defined 'auditory stimuli' being transformed into a genuine 'auditory experience'. That way lies mere cognitive psychology and the mess it makes of relating physical to psychological as one of relating
outer to inner. ... But way back to the Gestalt psychologists we already had in play some more intriguing ideas of figure and (back)ground, and a little more recently we have the important but difficult ideas of correlative constancy and transformation (e.g. from Gibson).

Kohler's Ghost
Let's start with the not very illuminating but somewhat unassailable notion that sometimes we hallucinate what we expect to hear. The mother 'hears' her crying baby. You 'hear' your name being called in the street. This particularly tends to happen in hypnopompic and hypnogogic states. Waking up, 'clear as a bell', your friend is calling your name. (Except she's not.) But... so far so nothing. This is mere observation; it's not any kind of theory. For: why should we hear what we expect to hear? Anyone who's had this experience will know that it really isn't just a matter of misinterpreting auditory stimuli. (Yeah, I know, that whole idea that perception is a matter of interpreting auditory stimuli is in any case just a cognitivist's confused fantasy... But my point here is just to make clear that: the hallucination of your name being called or your baby crying really can just happen when there's no actual vaguely similar sound going on at all; it can happen in total silence.)

The answer I've touted before (here and here - mainly about visual and movement hallucination) is that a hallucination is a 'negative of an expectation'. You approach the static escalator. You know it's static (in the sense that you would say 'it isn't moving' if someone asked you), but yet in your lived body resides an expectation of movement from the escalator, which expectation manifests itself in your still habitually and automatically readying yourself for it by pushing yourself forward more than normal - so as to join in the forward movement in a smooth way (so in this sense you don't know it isn't moving). One might say: the static escalator seems, for a moment, to be moving backwards.

This example is supposed to help us grasp how what one might think is rightly described as a total
Gibson's Ghost
absence of stimulus can yet manifest as an experience which is the negative of an expectation. You expect - in your lived body if not in your noggin - the escalator to move forward. It doesn't. Yet you ready yourself habitually - and this results in an hallucination of backward movement.

How might this kind of conception translate to the 'hearing voices' experience? Well, my proposal here is that whereas the 'opposite' of an experience of movement in one direction is an experience of movement in the other direction, the 'opposite' of an experience of an embodied you calling my name is ... an experience of a disembodied you calling my name.

All of this involves the mark of the ghostly. Ghosts are, I imagine, psychological anti-matter - the negatives of our thwarted expectations.

When we are sane, grounded in reality, we rapidly and automatically adjust our lived expectations of sensory stimulation depending on the sensorimotor feedback we get. This is entrainment: the automatic update of those lived expectancies only ever against which sensory stimulation makes for experience. But there are moments in our lives - hypnopompic moments, psychotic moments - when we are not thus looped into the habitus. Moments in which the lived expectancies can't update so flushly. And then what we meet with are 'ghosts' - these negatives of our latent expectancies. This is the mark of the ghostly, whether we're talking about the 'cold touch' on our arm, the empty spectral outline we see, the oddly loud yet somehow also oddly internal or unlocalised voice calling our name when we wake, and so on. When our expectancies are not super-rapidly pulled into line through sensorimotor entrainment, we naturally get flashes of psychological antimatter, ghostly presences, these un-sights and un-sounds that more than anything else we're drawn to calling 'visions' and 'being spoken to'. We're loopy to the extent we're unlooped.

Voices can be oddly internal because they're not a part-function of a rich domain of sensory stimulation which, to lazily lapse temporarily into cognitivism, 'provides information about' relative location etc. ... It is not impossible for us to expect to be addressed from over here or over there, but it is more likely that a standing expectation of address is non-localised.

And why do we go round expecting, primed for, our name to be called? Well, often we don't. But we do when, roughly speaking, we think we are - or the person calling our name is - in trouble. We're in our own world, and the person calling our name is addressing us, pulling us for some reason into a shared space. ... This too is what the baby's cry achieves. It's an address which pulls us into a zone of responsibility. ... And this too is why the accounts of voices 'emanating from the superego' have applicability - the superego being precisely the intrapsychic domain of accountability.

Ratcliffe's Ghost
And what do we make of the phenomenological inner objectification theory? Well, as Matthew Ratcliffe points out, the theory may get a little carried away with itself, conflate different senses of 'object' and pass way too quickly over decent sceptical questions regarding what it could even mean to 'morbidly experience one's thoughts as objects'. (These theorists just tend to say this stuff, about basal hyperreflexivity, or about automatic self-presence, in a kind of authoritative manner, like we ought just accept that it's obvious that something rather than nothing is here being meant!) But their idea that the form of consciousness we meet with here is dirempted, and not merely the content, does seem helpful to me. ... Sure, we don't need a phenomenological theorist's spurious fantasy providing an explanatory theory of hallucination. And there's an important sense in which we really don't want a psychologically explanatory theory at all; psychological explanations - explanations which presuppose the intact applicability of concepts like 'experience' and 'experiencing subject' and 'object of experience' - will I believe self-defeatingly presuppose the core sanity of the psychosis sufferer. We genuinely need to understand diremptions in, and not somehow presuppose the operation of, subjectivity. (What I'm saying is: such phenomenological theories are, despite themselves, perhaps as unhelpfully homuncular as cognitivist theories.) BUT the idea that psychosis is to be understood in terms of ontological form and not merely content or putative psychological mechanisms - and that we essentially meet with a background unworlding in the psychotic, an unworlding which is a condition of intelligibility of psychotic symptoms as such - this seems super-helpful to me. The other answers (from the first paragraph) seem less likely: saying that voices are AVH's is I believe at best rather tautologous, and only looks helpful to the extent that we somehow wrongly imagine we already understand what an auditory hallucination is. And the cognitivist' idea of the hallucinator mistaking an inner musing as externally produced is also either merely a gauche definition of the phenomenon, or a corrupt source-discrimination theory which just mushes together matters psychological and neurological in the groaningly obscurant manner we've all come to expect. (I mean, come on, no one else after all is talking to you, so in one sense of course you're 'talking to yourself without realising it'!)

Wednesday, 23 November 2016

philosophy: why you gotta be anxious

Here I want to set down my understanding of Martin Heidegger's understanding of how Angst is essential to philosophy.

Take a traditional philosophical problem: how do I know other minds / the external world? Sceptically phrased: how do I even know they exist?

Heidegger's idea is that this question will only seem intelligible to someone mired in forgetfulness and taking-for-granted-ness.

His thought is: We've become inured to the contingency and vulnerability and dependency of our lives. Of our sanity. Of our bodily continuity. Of our capacity to think.

And when we are forgetful in these ways we tend to imagine that we are not dependent creatures.

And then we think that we can, all out of our ownmost noddles, raise (what are actually insoluble - but thankfully also misguided) questions about the obtaining of an external world and other minds.

The tacit move is: having forgotten how dependent what's in our noddles is on a world - this world of language, communication, embodiment, friends, teachers, tools, culture, history, society - how dependent the intelligibility and purport of our discourse is - discourse including our philosophical questions themselves - we imagine that we can take for granted the intelligibility of unanchored, free-floating philosophical questions about an 'external world' or 'other minds'.

We take our philosophical questions too seriously because we've narcissistically overlooked our dependency.

If we hadn't lost sight of our essential en-world-ed-ness, it wouldn't have occurred to us to (try to) raise questions about 'how' or 'that' at such an essential juncture. The questions would rightly look both dumb and pretentious.

Put it this way: if our contingency and dependency and embeddedness is grasped as a condition of possibility of our having intelligible thought, then the idea of asking such philosophical questions will come to seem like an absurd scandal.

Yet it's really not easy for us to hold on to the fact of our dependency. We like to think of ourselves as self-contained and invulnerable. We like to imagine we can guarantee our sanity or knowing from within, from an invulnerable procedure of 'pure reason' or from the self-ratification of Cartesian self-presence. We don't like the fact of our dependency - because it makes us angsty.

This, then, is the value of angst. It keeps us on our existential toes. Angst discloses the fundamental condition of personhood as Dasein. The condition - to put it gnomically - of being-here which is being-there.

We philosophers like to think we are bravely asking about intelligibility, about how to secure it, how to achieve it, how to ground it. And all along what we're doing is presupposing that the mind which questions intelligibility can quite happily and intelligibly ask its own philosophical questions. We arrogate to ourselves an extraordinary and utterly unrealistic degree of intellectual sensibleness. We are Humpty Dumpties imagining that our words mean just whatever we want them to mean. What hubris!

Acknowledging our contingent enworldedness is both terrifying and wonderful. We wake to wonder as we acknowledge our smallness, vulnerability, mortality. We wake to gratitude when we acknowledge our dependency. We come to an apt humility, but also to an apt platform - one resting in the midst of our historical-bodily-social lives rather than on a fantasy of a ground beyond them - for exercising in a real, rather than phantastic, and responsible way the power we actually do have.

Angst, I believe, is the flip-side of narcissism. Neither, it seems to me, is necessary (here I depart from many an existentialist),  but both are fairly inevitable. In living our lives we tend to unwittingly accrue comforting yet delusional narcissistic certainties. But their smugness keeps out not only the darkness but also the light. Hence the move to humility and wonder, to love and meaning, and to the inevitable angst that comes from relinquishing the narcissistic phantasy.

Wednesday, 9 November 2016

anxiety - dynamic, existential

How do existential and psychoanalytic understandings of anxiety interact? Are they in competition? Are they complementary? If the latter: do they provide complementary perspectives on the same, or on a different, phenomenon?

Both theories distinguish between anxiety and fear. They do so in different ways. Psychoanalysis considers fear to be of an external (a tiger), whereas anxiety relates to an internal (an emotion), noxious stimulus. Existentialism tells us that fear is of a specific phenomenon in life (a tiger) whereas anxiety is a recognition of a fundamental fact of life (our contingency, mortality, ungroundedness).

They also have different understandings of anxiety. Psychoanalysis tells us that it arises out of intrapsychic conflict. Some (affect phobia) theorists have it that the conflict is between the self and a feared emotion. Thus I fear being angry with you since I am troubled by the prospect of jeopardising our fragile relationship. I fear to hate you: this fear is itself the anxiety. Other theorists view it as a function of a clash between parts of the self; in short, the superego is shouting at the ego or at any collusion between ego and id. Other theorists view anxiety as the experience of conflict between different incompatible emotions. Thus I love you and I hate you. It's not so much that I fear the hate, but that the emotions are simply incompatible and so start to shake apart the ego without sufficient capacity. ... Straighten out terminological and theoretical imperfections and these (self-emotion and self-self and emotion-emotion) views will probably collapse together quite happily. ... One of the things which will need to be thought about here is the intentionality of anxiety. Fears have intentional objects (tigers), whereas the 'of' in 'anxious experience of conflict between love and hate' may not denote intentionality but rather identity. (When I have an experience of happiness I am not having an experience with happiness as its object! I'm having an experience which is happiness!) My own suspicion is that the 'affect phobia' view is too intentionalistic. ...


Existentialism tells us that anxiety is the experience of our recognition of our ungroundedness, contingency, mortality, abandonableness, dependency, vulnerability to illness, vulnerability to insanity, etc. The mood of anxiety, Heidegger tells us, is what reveals to us the true character of human life - it is the essential revelatory clearing for the existential analytic of Dasein. And we shy away from anxiety - we lose ourselves in the banal chatter of the They, or we lose ourselves out amongst the objects and tasks and projects we are embarked on. We don't ask about the meaning or mattering or intelligibility or availability of these - and so we are not cognisant of the contingency (non-necessity, arbitrariness, vulnerability) of these projects. (I will come back later to the intelligibility of this question of intelligibility.) But pause for a minute, pull back from the They and from the World, inquire into the possibility of our having a World, and do so in seriousness, and we will get in touch with our anxiety.

One essential point is that for the psychoanalyst anxiety is something to be overcome. Sure, we cannot escape the miseries of life, but the miseries of inner conflict can at least be overcome through a growth in ego capacity. For the existentialist anxiety is inevitable: it is the inevitable character of an authentic recognition of our finitude. The abyss is ever-present, even if most of the time we avert our gaze. What we can do is to meet it with courage. This is the examined life.

So how do these views intersect? Are they compatible or incompatible? Sure, they may sound incompatible - to be different theories of anxiety. But perhaps, say, we can solve this as simply as by saying that the existentialists are theorising Angst, whereas the dynamicists are theorising Anxiety. After all, the thought goes, there's no reason why you shouldn't have both inner conflict and existential alertness. ... This compatibilist project reminds me of Dreyfus's brilliant paper on the unconscious in Freud and Merleau-Ponty and Heidegger. Dreyfus accepts the value of a Freudian depth unconscious, but proposes that we also think about a breadth unconscious - which has to do with what gets lodged in the structuring apparatus of the clearing itself, rather than to do with what shows up or doesn't show up within it. ... But to my mind Dreyfus's account is too friendly to Freud, and would be better cast as a better way of theorising the phenomena which get mis-theorised by the misleading metaphors of inner blindness which permeate the Freudian depth unconscious. 

The main objection I have to compatibilism here is that: it - is - boooorrring. (In the same way that the biopsychosocial model is boring. One wants to say: if that's the nature of reality then, well, I give up! Show me to the abyss!) The suggestion pursued here instead, in the spirit of thinking them together, constitutively or competitively and not simply alongside one another, is whether they may be better understood as windows into different aspects of the same phenomenon, or as competing theorisations. How would this work? 

So, imagine: I love you - and right now I also hate you. You were selfish earlier and it angers me. But I struggle to allow myself a conscious experience of this hate. Perhaps I repress it. Perhaps I do so by depressing myself: I lower myself, painting myself as deserving of your actions. I shy away from my intrapsychic conflict and I shy away from conflict with you. So far so psychodynamic.

But let's think a bit about what real love involves. To do so I will draw entirely on the unsurpassed thought of Joel Backström. Love for the psychodynamicist is an inner intrinsically possessive force of attraction and attachment. But that is hardly the only conception available to us - in fact it is a rather impoverished conception. On a more let's-call-it-Christian take, love involves a real desire to know and be known by the other, to be open to her; it is a longing for togetherness with him. 

To be open in love to the other is to be in a state of existential vulnerability. My love may not be reciprocated. Or you may die or otherwise leave me. The openness of love, the forging of value in love, can be frightening. And then, yes, we have this falling out. I'm angry at you for, as it seems to me, being selfish earlier. This brings me closer to my existential anxiety in the relationship. Closer to the fact that I cannot take for granted my own goodness. Or yours. It is destabilising. But note - and here I want to stress that I really am borrowing straight from Backström - that this is not particularly aptly described as a conflict between love and hate. For one thing I only hate you because I love you. If I didn't love you then there would be at most a mild annoyance - your selfishness wouldn't matter to me because you wouldn't matter to me. In my desire to keep on good terms by squashing my anger I am really showing a failure of love. I am no longer staying open to you, wanting to know and be known by you. 

In this working through of the example what we have is something which looked 'intrapsychic' (whatever that really means) - a putative conflict between love and hate - being analysed into something existential. My baulking at my anger amounts to a failure of existential nerve - to a failure of love or openness itself, not really a conflict between love and hate. In fact that way of putting it will most likely only occur to us if we have already pulled away from the other such that we confuse love with lust or some other self-interested emotion. But keep true to an existential conception of love as openness to the other, and the psychodynamic theorisation of the conflict may start to look as defensive as the conflicted individual.

This is one example, and I may have become over-organised by it. I leave that for another day, but turn back now to the question of the existentialist's consideration that anxiety is inevitable and inexorable and that it is the disclosing window for an adequate explication of human nature.

Consider first the soothing effect of standing on a mountain top or staring out to sea. We become helpfully small. Our own troubles seem insignificant, pared down. At such moments our contingencies and mortality don't seem to matter half so much! And it's not at all clear that this is because the mountain perspective defends against anything. 

Perhaps, I suggest, our lostness in our projects and in the They may not be simply a defence against our terror at the abyss, but also the condition of possibility of that terror. What I'm suggesting is that existential anxiety may not be an inevitable truth-telling mood which comes whenever anyone considers the basic facts of the human condition. Rather, perhaps death only becomes quite so fearful when we've dealt with the more tractable anxieties of our lives with a set of narcissistic defences. These give a false sense of comfort and 'necessity' by a spurious arrogation of control to the person and a deficient sense of control to the other, to nature, etc. But if we align our will with that of God/fate/nature, if we practice Gelassenheit (the releasement from self-aggrandising will), the existential predicament appears not half so bad. 

The question then arises as to whether anxiety really does provide a better window for an existential analytic of Dasein, or rather whether it just provides the person who is otherwise lost in narcissistic defences a better such window on their own defences. Taking up our place within the natural order, and in this sense being non-defensively lost in one's projects: anxiety now hardly seems so revelatory. Perhaps other moods may now also be allowed to do their revelatory work. Joyful wonder for instance. Yet perhaps what they reveal is not anything so theoretically general as 'the' nature of human life - but instead some of the ways we struggle to live a life which in its plenitude and diversity can never be pinned down by any 'existential analytic'.