Sunday, 27 August 2017

now i know what i feared

In The Blue Book (dictated 1933-34) Wittgenstein notes that whilst we sometimes feel afraid of something particular ('transitive' fear), at other times we may just feel afraid full stop ('intransitive' fear; I suspect this is essentially the same as 'anxiety' - the distinction between fear and anxiety will become important later). In considering an example of the latter he asks whether we do well to represent it to ourselves with 'I am afraid of something, but I don't know of what?'. 'Consider this case', he says (25-6):
we have a general undirected feeling of fear. Later on we have an experience which makes us say, "Now I know what I was afraid of. I was afraid of so-and-so happening". Is it correct to describe my first feeling by an intransitive verb, or should I say that my fear had an object although I did not know that it had one? Both these forms of description can be used.
And, to help us grasp the legitimacy of this latitude, he invites us to 'examine the following example':
It might be found practical to call a certain state of decay in a tooth, not accompanied by what we commonly call toothache, "unconscious toothache" and to use in such a case the expression that we have toothache, but don't know it. It is in just this sense that psychoanalysis talks of unconscious thoughts, acts of volition, etc.
Now is it wrong in this sense to say that I have toothache but don't know it? There is nothing wrong about it, as it is just a new terminology and can at any time be retranslated into ordinary language. ... But the new expression misleads us by calling up pictures and analogies which make it difficult for us to go through with our convention. ...
Thus, by the expression "unconscious toothache" you may either be misled into thinking that a stupendous discovery has been made, a discovery which in a sense altogether bewilders our understanding; or else you may be extremely puzzled by the expression (the puzzlement of philosophy) and perhaps ask such a question as "How is unconscious toothache possible?"
You may then be tempted to deny the possibility of unconscious toothache; but the scientist will tell you that it is a proved fact that there is such a thing, and he will say it like a man who is destroying a common prejudice. He will say: "Surely it's quite simple; there are other things which you don't know of, and there can also be toothache which you don't know of. It is just a new discovery".
Here Wittgenstein is offering a deflationary answer to the question 'Are we right to talk of 'unconscious fears and desires'?' We feel an undirected sensation of fear or longing. If you ask us 'What of or for?' we may either reply i) 'of or for nothing' or say ii) 'I don't know what of or for'. Wittgenstein invites us to draw an equivalence between these utterances: we can say what we like, although it's best of course if we don't then go on to mislead ourselves about what we mean by what we say.

How might we mislead ourselves if we talked in one or the other way? Well, we might think that i) and ii) contrast in that the fear of i) supposedly has no object, whilst ii) supposedly has an unknown object. When we consider the toothache analogy, however, we're not drawn to think that there is any difference between there here being what we call 'unconscious toothache' and 'tooth decay but thankfully no toothache'. And we can then usefully extend our grasp of this to the case of not knowing what we fear.

The analogy is unfortunate if pushed in an unhelpful direction. One unhelpful direction is that which makes objects (the intentional objects of intentional attitudes - fearing etc.) equivalent to causes. What causes toothache is tooth decay; toothache is not about or of tooth decay. What causes my fear may however be pretty much of a piece with what my fear is of (a tiger's chasing me, say, and a tiger's biting me). Yet there's no reason to push it in that direction, and every reason to think that Wittgenstein would not have wanted us to do that.

We may also distinguish between two forms of undirected feelings of fear. In one case I later discover that earlier I had, say, unwittingly ingested a large quantity of caffeine. In the other case I later 'have an experience which makes [me] say, "Now I know what I was afraid of. I was afraid of so-and-so happening".' The first of these cases provides a cause but no object for the undirected fear. The latter case may make us want to revise our description of undirectedness ... but, nota bene, this would be a non-compulsory decision on our part.  For we could, after all, equally say that an undirected feeling of fear which yet had a certain cause but no object has turned into a directed feeling of fear where the object now coincides with the cause.

This provides one way in which we may after all want to talk of a non-equivalence between there being nothing which a fear was of and someone not knowing what particular something he was afraid of. By this I mean: we could use our distinguishing between such cases to give life to a distinction between not knowing something and there being nothing to know. And not: we can use an already-intuitively-grasped distinction between knowing and there being nothing to know to accurately depict such cases.

We would not want to talk of knowing what we were afraid of in the caffeine case; instead we would just talk of knowing what made us afraid. However this is not to disagree with Wittgenstein's important suggestion that knowledge and what is known are not here, in the case of unconscious fear, to be understood along the model of knowing or not knowing that there is, say, a tiger chasing you.

What are the conditions of intelligibility for talk of having had an experience which we are happy later to further describe with "Now I know what I was afraid of. I was afraid of so-and-so happening"? I propose that we can only understand this as recovery from an agnosia or as de-repression. In proposing that we can only understand objectful yet object-unavowable fear as agnosia or repression I intend a conceptual, not an empirical, thesis. The claim is that it's unintelligible to suggest that one had a feeling with an 'unknown' object unless one's prepared to posit a mental blockage of a neurological or psychodynamic sort. Absent such a defeater on an ascription of the capacity to avow the object and the claim that there was an object all along, and not simply a cause, becomes - I'm claiming - unsustainable.

Consider the difference between the caffeine case and the repression case (my fear with repressed 'knowledge of my fear's object'). In the former case our understanding does not belong to psychology in the sense that it is not to be understood in terms of my psychology. There is nothing about caffeine which scares me - which is not to say that it does not have specific chemical properties which cause me to become anxious. There is however something about my boss walking in with that de haut en bas expression on his face which freaks me out. Unpacking this aboutness necessarily invokes mention of my distinctly psychological states: thus he reminds me of my beloved yet infuriatingly haughty father. Our understanding of my reaction is of a sort which belongs uniquely to the intelligibility of our human lives; it makes human sense to you why I reacted as I did.

Without my fear belonging in this way to my psychology, without it being the kind of thing to which meaningful understanding may be brought to bear, it is - I suggest - impossible to sustain a meaningful distinction between it and objectless anxiety. This marks an important difference between repression and agnosia which explains why, in the case of agnosia, the decision to speak of a 'fear with an unknown object' truly does seem as optional as the decision to talk of unfelt tooth decay as 'unconscious toothache'. Whilst we are not compelled by the facts to talk of recovered repression cases as involving a fear of something we know not what rather than as involving a fear which only becomes objectful at the moment of de-repression, we are yet surely more moved to talk here in the former way than we are in the case of the agnosia. In the agnosic case it seems truly arbitrary to us whether we talk of our intention as having or as not having an object.

Wittgenstein, I think, here and elsewhere tends to underestimate the conceptual significance of denial (and motivational dynamics more generally) for the logic of psychodynamic forms of unconsciousness. None of this is intended to contradict his apt deprecation of an assimilation of the logic either of the knowledge or of the objecthood of unconscious emotion (emotion with an unconscious object) to such cases as our knowing what's in the cupboard. Instead it's intended as a protest at his assimilation of the logic of the dynamic unconscious of psychoanalysis to the merely descriptive unconscious of psychology, an assimilation which disguises the way in which reference to disavowal as opposed to disability motivates us in an inclination to preserve the objecthood and not merely the causality of such unconscious emotion.

Ten or so years after he dictated The Blue Book Wittgenstein completed part 1 of the Philosophical Investigations. In sections which bear comparison to his earlier offerings (except for being about a 'visual room' rather than 'unconscious toothache') he has it that (401):
You have a new conception and interpret it as seeing a new object. You interpret a grammatical movement made by yourself as a quasi-physical phenomenon which you are observing. ... But there is an objection to my saying that you have made a 'grammatical' movement. What you have discovered is a new way of looking at things. As if you had invented a new way of painting; or, again, a new metre, or a new kind of song.-
This takes us closer to the idea that we cannot easily and without loss translate psychoanalytic discourse into ordinary language in the way that the comparison with unconscious toothache suggests. Freud is indeed wrong to think that he has discovered that emotion may in fact be unconscious, rather than discovered how driven we are by what we may call 'unconscious emotion'. In this sense psychoanalysis really is 'a new kind of song'. Yet if we accept that it truly is 'a new way of looking at things' (or an alternative set of 'rules of representation') we risk succumbing to another temptation - the temptation to imagine that the 'things' looked at can readily be specified independently of this 'new way' (or of the 'rules') - as if we are here looking at the same things (x, y, z) in different ways.

Freud did not just invent a new way of talking, nor merely make empirical discoveries about the causes of certain behaviours and illnesses. To change the object for our metaphor of a 'new kind of song' away from the psychoanalytic discourse to the unconscious itself: Freud provided for us a new way of listening, a way of listening which enables us to hear a song we've sung for a long time, yet a song to which we've previously been so habituated that we couldn't distinguish it from silence.

Monday, 14 August 2017

cognition versus recognition

(Below, first draft of a section of my chapter for the Oxford Handbook of Philosophy and Psychoanalysis which edited volume is currently being compiled by Michael Lacewing and myself.)

Psychoanalytic psychotherapists are sometimes criticised for offering patients nothing but new just-so stories in the guise of applied science. These supposedly explain the origins of troubles in a manner which is either relieving because spuriously absolving (“it wasn’t you, it was your unconscious / your mum and dad / your past traumas…”, etc.) or because spuriously hope-engendering (the hope being that reflection on your unconscious motivation can somehow help change your mind’s functioning). The criticism continues that such a practice is: deluded since the alleged psychological causal stories we learn to tell about our symptoms are nothing but post-hoc fabrications; dependency-promoting; and largely ineffectual since it’s concerned with introspection rather than change. Psychotherapists’ responses to such critique vary from the bite-the-bullet it’s-all-just-a-story-anyway postmodernist option, to that of the scientist-practitioner who draws as far as possible on objective psychological knowledge whilst modestly refraining from offering anything other than flexible revisable hypotheses in a pragmatic fashion in his clinic.

A striking shared assumption of both the critic and the pundit is that the psychotherapeutic work of ‘making the unconscious conscious’ involves aiding a patient's arrival at new psychological knowledge of the history and current operations of his psyche. In what follows I suggest that this ‘applied science’ conception locates the therapeutic endeavour in the wrong conceptual context. In short it locates it within what we could call a descriptive psychology that treats of cognition, rather than a moral psychology that treats of ethical recognition. What follows provides the substance to my contrast.

By way of an example of a descriptive psychological treatment of cognition consider the following from a pundit and a critic of what the authors call ‘psychodynamic psychotherapy’. First the pundit (Cabaniss et al, 2013, pp. **-**):
A psychodynamic formulation ... is an hypothesis about the way a person thinks, feels, and behaves, which considers the impact and development of … thoughts and feelings that are out of awareness – that is, that are unconscious. … Thus, a psychodynamic formulation is an hypothesis about the way a person’s unconscious thoughts and feelings may be causing the difficulties that have led him/her to treatment. …. [H]elping people to become aware of their unconscious thoughts and feelings is an important psychodynamic technique. … Once we have a good sense of the problems and patterns, the next step in creating a psychodynamic formulation is to review the developmental history. … Having described and reviewed the patients problems and history the third step is to 'link' them together. [This provides the psychological 'hypotheses' which help the therapist to] construct meaningful interventions. …. These might include: … creating a life narrative … offering explanation and perspective throughout the therapy … consolidating insights…
Now the critic (Watters & Ofshe 1999, p. 204):
Psychodynamic therapists claim the ability to help clients connect current behaviors to long-past traumas in childhood, for instance, or to repressed fantasies decades in the patients’ past. … But … if [as they argue] we can’t trace the influence of simple actions and decisions to their correct sources, can we be expected to do better making etiological connections between complex current life and events or fantasies from our childhood? …[T]he vast number of psychodynamic schools of talk therapy appears as nothing more than a testing and breeding ground for these shared cultural narratives. Psychodynamic therapy offers a new and interesting world of possible narratives by which patients can come to believe they understand the origin of their thoughts and behaviors. These narratives become plausible in the patient’s eyes through the process of influence embedded in therapy.
 In both these cases the authors assume that making the unconscious conscious involves becoming cognisant of your own hitherto unconscious mental processes, rather as if the purpose of therapy were to learn to be a better psychologist at least regarding one’s own mental operations. In all this talk of becoming aware of - or developing bona fide knowledge or spurious belief about - one’s own mind, however, we meet with nothing in the patient that could itself be considered the existential shift of owning or appropriating one’s previously repressed attitudes. Furthermore in all this talk of a therapist learning to recognise (or at least develop ‘hypotheses’ about) a patient’s struggles we meet with nothing that could itself be considered an ethical attitude of her offering recognition to a patient in her difficulties. We are invited, that is, to see the task of therapy as the cognitively demanding but ethically null task of providing and enjoying a new reflexive transitive consciousness of our own attitudes. The task of offering recognition to a patient in her distress and his thereby recovering - not objective knowledge about his psychological performance, but rather, in his capacity to now enjoy intransitively conscious attitudes - his humanity, is not in view.[1]

The conception of making the unconscious conscious, or transforming id into ego, which has to do with ethical rather than scientific recognition starts by noticing the difference between a symptom being causally explained and a symptom dissolving into a living moment of a patient’s will and emotional expression. A patient presents as suffering from an affliction. They are having mental or bodily experiences which they do not recognise as part of who they are. For example they may experience compulsions, or have irrational fears, or hear voices, or feel demotivated and sluggish and weak despite not being poorly, or be enduringly sad and hopeless despite not being in mourning. They may wish for the psychotherapist to somehow ‘take these problems away from them’.

Needless to say, excision is not how psychotherapy works. Instead the psychoanalytic psychotherapist considers the patient’s difficulties under a different aspect. He considers them under the aspect of meaningful expression, emotional experience and the will, and responds to them as under-developed articulations of such functions. The point I wish to stress is not that he may (although he may not) have a psychological theory as to how such symptoms arose or are maintained. Instead I wish to point out that the therapist does not, in his therapeutic engagement, see the symptoms either (like the patient) as humanly unintelligible undergoings or (like the psychologist) as psychologically intelligible reactions; he sees them instead as incipient humanly intelligible actions and expressions. In a sense they are no longer symptoms, for what was previously seen as something undergone now becomes seen as an undertaking; a patient starts to become an agent; an event an action; a symptom suffered now itself becomes the suffering of something beyond itself.

Such recognition is not primarily of facts about the patient but rather a humane recognition of the patient herself in her suffering. If your friend dies and you are sad, I do not treat your sadness, your tears, your withdrawal, your pain, as symptoms. This is because they are instead the intelligible form of your humanity. I show you understanding, and offer you recognition, when I recognise your experience as a humanly apt mode of relating to the loss of your friend. I encounter you in your sadness; I do not see it as an affliction of you. You are not suffering from your sadness, but suffering from the loss of your friend: it is her death that afflicts you, not your feelings. Similarly, when a psychoanalytic psychotherapist shows her patient recognition his erstwhile presenting problems now become not symptoms or afflictions but intelligible actions and sufferings - not causally intelligible given his past or given his defence mechanisms, but the humanly intelligible anger or sadness or guilt or fear of a man in meaningful relationship with those who inspire such emotion in him.

The correlative of the therapist’s offering of recognition to the patient is, then, the patient appropriating his symptom and, in so doing, no longer having a symptom (and no longer being a ‘patient’) but rather having and expressing a human experience. It is not as I first thought that I love my child but have compulsive foreign symptomatic wishes to hurt her; rather I grasp that I have a humanly natural (if morally culpable) ambivalence towards her. (Perhaps I am envious of the comfort of her own childhood relative to my own. Perhaps I regressively blame her for the lack of time I now have to spend with my own friends.) The hallucinated voices I seem to hear can, post-appropriation, be acknowledged as my own thoughts. The depression that seemed to befall me was in truth me suppressing myself in my scarcely bearable feelings of sadness and/or anger on my friend’s death. And so on. After a helpful therapy the patient is now less ‘possessed by’ unintelligible afflictions; instead he is now achieves what we call ‘self-possession’. As such he needs rather less than before to have psychological knowledge about, or to be in some kind of comprehending relation to, himself. Being self-possessed means that he may now simply be in his emotional relations to the world – be in such relations as themselves provide the fundamental form of his comprehending encounter with it. In the popular terms bequeathed us by Martin Buber (****REF), the psychotherapist offers her patient not the ‘I-It’ relation of psychological cognition, but the ‘I-Thou’ relation of humane recognition. As a result he may now appropriate his symptoms into his self so that he no longer inhabits the self-estranged position intrinsic to being a psychological patient.

[1] Finkelstein (this volume) outlines the contrast between what I here mark as the transitive and intransitive senses of consciousness. Lear (this volume) outlines what I am here calling a broadly ethical reading of what it is for id to be supplanted by ego or for the unconscious to be made conscious.

Tuesday, 1 August 2017

formulation vs recognition

The rhetoric of the 'scientist practitioner model' we meet with in clinical psychology has for some time now found its way into psychodynamic psychotherapy. I'd like to reflect on some of its language and ask if it's really apt to the therapeutic task. I choose the following textbook at random. Cabaniss et al (2013) offer us their 'describe, review, link' model for creating a psychodynamic formulation: describe 'the patient's problems and patterns', review 'the patient's developmental history', and link 'the problems and patterns to the history using organizing ideas about development': 
'A psychodynamic formulation ... is an hypothesis about the way a person thinks, feels, and behaves, which considers the impact and development of unconscious thoughts and feelings.... Psychodynamic formulations do not offer definitive explanations; rather, they are hypotheses that we can change over time.' 
'One way of thinking about this postulates that these problems are often caused by thoughts and feelings that are out of awareness – that is, that are unconscious. This is called a psychodynamic frame of reference. Thus, a psychodynamic formulation is an hypothesis about the way a person’s unconscious thoughts and feelings may be causing the difficulties that have led him/her to treatment. This is important to understand, as helping people to become aware of their unconscious thoughts and feelings is an important psychodynamic technique.'

'When we formulate cases psychodynamically, we make hypotheses about how people develop their characteristic ways of thinking, feeling, and behaving. Thus, once we have a good sense of the problems and patterns, the next step in creating a psychodynamic formulation is to review the developmental history. The developmental history includes everything that happens during peoples’ lives that help shape their dominant patterns of functioning; that is, the way they think about themselves, have relationships with others, adapt to stress, think, and work and play.' 
'When we take a developmental history, we are guided by these principles:
  • include nature and nurture
  • relationships are key
  • trauma is critical
  • chronology is relevant
  • development is lifelong'
Having described and reviewed the patients problems and history the third step is to 'link' them together. This linkage provides the provisional understanding or 'hypotheses' which is to guide and inform the therapy. Here's an example: 
'How did Dr Z form this hypothesis? It was not magic. Rather, as she learned about Ms A’s problems and patterns, she asked herself a question: 
                  Why does this talented woman have such a low opinion of herself? 
Because she was thinking psychodynamically, she DESCRIBED Ms A as having difficulties with self-esteem regulation that likely reflected unconscious, overly critical perceptions about herself and her abilities. This gave Dr Z a partial answer to her question, but she knew that in order to develop a strategy for helping Ms A with her low self-esteem, she would need to understand how and why these unconscious, maladaptive self-perceptions had developed. To answer that, Dr Z REVIEWED Ms A’s developmental history and, among other things, learned that she had had a difficult relationship with her critical, dismissive mother. She then used an organizing idea about development – that maladaptive self-perceptions are often related to a person’s early relationship with a dismissing, critical parent – to LINK the pattern to the history. By describing, reviewing, and linking, she had formed an hypothesis about why Ms A had such a low opinion of herself – a psychodynamic formulation.'
Once we've got them 'Formulations help the therapist to 'construct meaningful interventions'. These might include: 
  • 'recommending treatment and setting early goals
  • creating a life narrative
  • offering explanation and perspective throughout the therapy
  • consolidating insights as a preparation for termination'

There is much we could take issue with in this. Even if it were clinically intelligible and possible it's hard for me to imagine it being therapeutically desirable. In particular I doubt that bringing such thought to bear on the patient in his presence is either of much therapeutic use or in line with the core values underpinning meaningful therapeutic - or for that matter meaningful human - encounters.

The word which comes to my mind is 'external': the authors' description of the relation of the patient's unconscious thought and feeling to her behaviour, and of the character of the therapist's appreciation of this, strips unconsciousness of its immanence in behaviour (inner causes, posits, etc). The requisite tentativeness of the therapist's suggestions is automatically equated with the therapist not losing sight of the thought that his or her suggestions about unconscious thoughts and feelings are hypotheses. The understanding which the clinician develops is construed as instrumental for his or her clinical activity. Finally the relation of the past to the present is also seen as an external relation between two different phenomena: a childhood trauma, an adult symptom; the clinician's hypothesising about this relation is facilitated by his knowledge of developmental and longitudinal studies.

But what might it mean to say - as I want to say - that a therapist and patient are, in potent analytic therapy, in some sense internally rather than externally related? What might it mean to say too - as I also want offer - that a patient's trajectory towards health is one from an external to an internal relation between himself and his own experience? Isn't all that a crazy mishmash of matters philosophical and matters psychotherapeutic? After all, in therapy we have two separate individuals in the room, etc etc...!

(That, I also want to say, is one of those philosophical reactions which is far too quick for its own good! Be patient!)

In therapy - and in much of interpersonal, moral, life - we have an essential need for recognition. The patient needs the therapist to be able to offer her recognition. Recognition in (and not just of) her distress. Recognition that ways of feeling and forms of behaviour which appear to the patient to be untoward, symptomatic, undesirable, foreign, forms which merely assail, are in fact intelligible moments in the living of a human life. To be honest the patient doesn't need to know that they are causally intelligible in terms of their traumata or what-have-you, although that may be interesting (perhaps too interesting...) or helpful. Such a form of explanation, in fact, still leaves the patient in an external, unassimilated, relation to her symptoms.

When I show you recognition, that is when my relation to you comes aptly under the concept of ethical recognition, then I take you and your experience and your action as humanly intelligible. Where by 'humanly intelligible' I mean: intelligible as such, being experiences that we 'get', that we can 'relate to' as meaningful in themselves. We can understand this immanent intelligibility best through examples. For example: you cut your finger and it hurts; your girlfriend leaves you and you are distraught; someone calumniates you and you are angry; someone praises you justly for what you and you are delighted. To react thus is to be living what we take to be a human life.

The patient however comes along with suffering which she does not understand. She perhaps hopes that the therapist will somehow help her get rid of it. The depressed person feels flat, unmotivated, suicidal, etc. The obsessional feels assailed by impulses that are not experienced as his own, ones he cannot endorse. The phobic feels scared of what she knows ought not to be scary to her (because it is not dangerous). And so on. The clinician may be able to understand how these developed - they may be able to understand the patient's symptoms - but in the sense I'm interested in here this does not mean yet an understanding of the patient. In the sense I reserve for it here, to understand the person is rather to offer an understanding of her symptom which restores human intelligibility to it. Not, for example, that we can understand the causal development of your obsession, but that it becomes once again something you understand as an expression of your will. This is what we call integration, and such integration (where id was there ego shall be - in Jonathan Lear's helpful take on Freud's dictum) is the correlative of another's recognition - recognising in the sense of acknowledging rather than identifying someone.

So this is one thing which it means to say that a patient's relation with her symptom is external whereas that with her emotional experience is internal. In the latter case the experience is her own not in the sense that it happens to her but that it is a moment of her agency. Therapy restores this internal of-a-piece-ness of the symptom with the patient's will; in this way they turn from patient to agent.

What about the apt relation between therapist and patient being, as I unperspicuously claimed, internal rather than external? Here my claim is that when we offer another recognition, when we encounter them as (we might say as) subject rather than object, our response to the other is an intimate corollary of them in their meaningful experience. The comparison here is between i) two independently crafted shapes that happen to fit together and (to borrow an example from Wittgenstein) ii) the inside of the black circle and the outside of this disk: O. If my will is internally related to my experiences in a way in which it is not related to that which befalls me, and if the therapist's recognition offers me a reacquaintance with what of myself is in truth immanent within my symptoms (where id was there ego shall be), then when the therapist offers an 'interpretation' what is happening is they have offered me an avowal. Offered something which can become a living moment of my will. When this happens the therapist and the patient are 'of one mind'. The therapist helps 'restore the patient to himself'. Le mot juste is offered to which the patient may say 'yes that's it!', pick it up, use it, and so on.

The clinical psychologist tends to portray the tentativeness of the apt therapeutic suggestion as making a statement in the form of an hypothesis rather than of a fact. I think this mischaracterises the relation between the imposing versus the respectful therapeutic word. (For example, sometimes the therapist might have to take a strong stand against the patient's defences, offering the mot juste in rather forceful terms. To do any less may be to fail to respect the patient as a locus of potential agency.) What is more to the point is the need to not impose one's will if one is to do anything that could even count as offering recognition. Thus if I tell you what you think I am not doing you justice. Since in telling I am claiming to speak from the phenomenon. Yet here I am making it part of my will, rather than allowing for you to own it within your own.

Finally, consider the difference between an understanding of a symptom as a present day causal product of a trauma (or what have you), something concatenated down and an understanding of it as the (until now disavowed) voicing of (say) a trauma. In the former case the two are related externally: one explains the other. In the latter it is internally related: one is of a piece with the other. We come to see what before was a mere symptom as the ongoing expression (in the sense of the pressing outwards, the very living enactment) of a humanly (not: of a psychologically) intelligible moment in someone's life.