Thursday, 25 August 2016

callanish

This morning I walked amongst the standing stones at Callanish. I was struck by the impression they made, and by the disjunct between that and what was on the information placard. Not that the information qua information was in-apt, but that what was striking and valuable to me about the stones was not something well articulated by the provision of such historical information and anthropological conjecture. (My observation was a variation on Wittgenstein's animadversions on Frazer.)

We call them 'standing stones'. It's worth noting this, I think. We don't say 'upright' or 'upended' stones. It doesn't capture the mystique. They are standing and in this, I believe, we see them under the aspect of the gravity-defying power of the animal. And because of their shape we spontaneously relate them in particular to one kind of animal: a human being. 'They stand there', one wants to say, 'like watchful sentinels'.

We may be drawn into speculating on the ritual uses of such stones, their alignments with celestial objects, etc. But much of what takes us even there is the impression they more directly make on us. They are like human sentinels, standing there - and yet they are of stone. They are of the mineral body of the earth itself, not subject to illness or pain or rash desire. They have this perpetual perdurance about them. About all this there is something comforting yet awesome, something which makes the vagaries and vicissitudes of our animal and social life more bearable, something quietening.

They are still and they point upwards to the sky above. Just through their shape - and let's leave aside speculation about the conscious intentions of their makers - and their circular arrangement they fulfil a 'sacred' role: to link the temporal and the eternal orders. They bring the balm and awe that comes when we see our lives sub specie aeternitatis. In this they are like vast columns in the nave of a cathedral, or the ancient sequoia of Yosemite. (But unlike the former are not man-made nor under a roof, so can link the resonant observer more directly with the cosmos; and unlike the latter are not subject to the vicissitudes of the living.)

You can't see it in my photo, but on the hilltop the stones are hemmed in by a sheep fence, and this automatically depletes their impact. Yet impact they still have, especially when seen against the hills and under the shifting skies, or when your body wanders amongst theirs, moving through whilst they stand there stock still.

Tuesday, 23 August 2016

platitudes, pleonasms and the present moment

I was chatting about mindfulness meditation at a wedding the other day. My interlocutor said she found the practice helpful to her, and from how she talked about it it was clear that this was true. It seemed it helped her stop catastrophising, become more realistic, become calmer, able to think 'what's the worst that can happen?', take stock, take a moment, show herself some encouragement and kindness, regain self-possession, and so on.

But what struck me was how the words she used to express how helpful it was often seemed to me, as is often the case in talk about mindfulness, fairly 'nonsensical'. At best they sometimes appeared to amount to little more than tautology, at worst to a metaphysics of the philosophically disreputable sort. And yet, such phrasing came naturally and seemed important to the 'sell'; what was going on?

The kinds of phrases I'm thinking of are: The past and future don't actually exist. All that exists is the present moment. Only the now is real. In the present moment nothing bad is actually happening. So attune with this present moment and you can be ok. (It doesn't matter what she actually said; here I'm interested in the kinds of things one generally finds oneself hearing or saying when talking about mindfulness meditation.)

First off: it's surely metaphysical blah to say that whilst the present exists the past either does or doesn't exist or that the future either does or doesn't exist. Of course if by 'exist' you mean 'exist now' then by definition only the present 'exists'. But how are we to get comfort from a mere definition?

And if not 'exist now' then what? We do - let's recall - have a language-game in which we talk of whether something did or did not happen, actually, as a matter of fact. We distinguish between 'imaginary' or 'fictitious' and 'real' in relation to past events. We don't use present tense verbs to talk of past tense events - that's just to mis-speak. But we do actually and properly say of a purported past event that it did or did not actually happen. So to the extent that it means anything to talk of existence or obtaining in relation to past events, then it can be referring either to events non-actual or actual. Similarly for the future: something either will or won't happen. By definition it isn't happening now, but it is nevertheless a fact that it will or won't happen later. There are, one could say, facts about the future. (You can say what you like as long as you make it clear what you're talking about ... and hopefully don't saddle us with a 'metaphysical theory' of 'future facts' or some such...) The facts just are those which will actually obtain.

Now the mindfulness practitioner as I'm caricaturing him or her here perhaps draws comfort from the fact that the feared phenomena are not happening now. The fear is merely about what might happen. But the phrases offered us here are either grammatical truisms or flagrant nonsense. What then is the relation between the genuine comfort and the pleonastic platitudes?

Well, perhaps it's this. That although the phrase 'all that exists exists now' is platitudinous or nonsense if we take it as aiming to communicate a fact, it is yet helpful if we see it as the right words to shake someone awake who has fallen into a dream. Being in a trance or in a dream they have lost 'reality testing'. By this I mean that they have stopped instantiating in their mind the distinction between now and then, or between here and there. The platitude does not provide information, but instead it prods us awake. It reminds us of the fact that there is a distinction between now and then that we can make and that we've stopped making. Catastrophic fantasy can be separated from tractable reality, and one can align oneself with the latter. (You're frightened of the monsters in the dark; but then your mum comes into the room with all her bustle and life and 'reality' and the fear dissolves. Later: you just turn the light on. Later still: you know full well what's just 'in your mind' and what's (not) in that cupboard in the corner of the room.)

I suggest that the platitude might also 'help' (pacify) in soporific self-deceiving ways. That is, we might say 'oh well the bad thing I fear will happen is not happening right now, and life is only ever a series of right-nows, so I don't need to worry because I can always live in the right-now.' Well, that's kinda dumb because the thing I fear might happen and then it would be correct to say, at that time, that it is happening right now, and this future possibility is what right now in the present time I'm worried about. I'm not, in this imagined scenario, worried about it happening right now: I'm worried about it happening in the future.

But leaving that aside the value of the phrase is, I suggest, that it helps the anxious mind reinstate a distinction between now and then which, in its anxiety, it had lost. Whilst it can sound rather metaphysical, or be presented as if it's some kind of positive realisation into the nature of existence or time or facts, really it is just a wake-up call for the anxiously somnolent to start functioning again. For when my anxiety is such that I fail to distinguish the possible and the actual, I get caught in runaway fears. Worry about the future is fine: it can help me face up to what will happen, or to take steps to prevent what might happen, etc. But some kinds of worry stop the mind from working and from doing precisely that. I panic because, losing sight of the distinction between the present and the future, or between what is likely to happen and what is the worst that can happen, I lose sight of, e.g., the possibility of taking this time to make sensible plans to avoid possible mishaps.

Here's where I'm arriving at: that something that sounds like the worst kind of metaphysics is actually a non-information-carrying device to help us put our feet back on the ground. It's tempting to imagine that the phrase works by speaking some kind of truth or expressing some kind of thought. It's tempting to imagine that it carries its effect through a cognisable propositional content. Through some truth one might come to realise or see. But that's not it. It's rather that it has an effect on the form - and not on the contents - of the mind. It recalls us to ourselves. In this respect what it offers is less like something to be understood or grasped, and more like ECT.

Now: that this can happen: that is an interesting thing! That is to say: we utter the words that make a conceptual distinction between here and there, now and then, present and past or future. And then the mind recalls itself to itself, becomes able to reinstantiate this distinction in its form, so that we can emerge from trance into this unhypnotic bliss. It risks too metaphysical an inquiry but I'm yet tempted to ask into the conditions of possibility ( - ask 'what the mind must be like for this to be possible? '- ) of the bliss-bestowing possibilities of mindfulness.

Thursday, 18 August 2016

i and thou

Martin Buber with his wife Paula
What's the deal with Buber's I & Thou?

The deal can be understood in terms of the defining difference between a) I-It and I-You relations - and also in terms of the relation between b) relationship itself and the individuals related. That much is common wisdom.

A quick note on b). Buber has it that relationship precedes the individuals in it. But surely that's sensu stricto nonsense. (The concept of a relation presupposes that of relata.) Just as much nonsense as the idea which he is challenging - that the individuals precede the relationship. What in any case I suspect he really meant to say was that, a la Heidegger, they are equiprimordial. I'll take it that this is what b) is all about: that I am the person I am in my relationship to you, and our recognition of one another partly constitutes us; I do not obtain independently of my relatedness. In the rest of this post I'll focus on a).

In an I-It relationship I approach the other as an object. OK, but what does that mean? It's not good enough to rely on a flabby pre-understanding of 'object' vs 'person', or of en soi vs pour soi, or of 'intersubjective' vs 'subject-object relations', to get us into Buber's categories. Surely we want instead to take something back from his thought to enhance our reflective understanding of, just, what is most helpfully meant by encountering someone as either an object or a subject. And in any case, Buber's Thous pertain not just to people or subjects of experience but in some sense, he tells us, to cats and trees as well. Or can I rely on something I read in Kant: that to relate to another as to a You is to see her also as an end in herself and not just as a means to an end of my own? This I think comes closer to it, but doesn't capture all that much of the meaning - and there'd be no point to the Buber if we could just rely on the Kant. Similarly we definitely don't find in Kant a conception of the human subject which is equiprimordial with that of the relationship - so the other (b) relational aspect of Buber's I-Thou is off the table there. (We definitely don't want to end up thinking that to understand an Other as such is to see her as importantly like Me!) Furthermore: sure, I grasp that you have your own ends, and I don't subordinate you to mine. But: what is the essential form taken by an encounter with a being with her own ends which encounter itself recognises just that about the other? That's what we want to know.

Here's a first distinction which looks psychological but which I think can also be grasped in an ontological register: that between being touched or moved by something and that of having a thought about something. I'd also now like to put another couple of contrasting pairs of terms on the table before moving on to the discussion. The second, owed to Piaget, is the distinction between assimilating in judgement something encountered to something already understood, and accommodating the shape of one's understanding to something new. The third, owed to Heidegger, is that between a conception of truth as adequatio or correspondence of judgement and object, and truth as alethia or truthful expressive revelation.

Here is one way to encounter, say, a tree. I go for a walk in the woods, and find a good one. I measure how tall it is, how broad it is. I estimate its age. I identify its species from its leaves and fruits. I perhaps think of what use it could be put to as timber, or as a tree house, or as a shady spot for a picnic. In these ways I encounter the tree as an It, and - let's be clear - there's nothing wrong with that.

But then I get chatting to a deep ecologist. (A 'deep ecologist' is not a profound biologist but someone who thinks of the natural world as possessing sui generic (non-instrumental) value.) And I learn from him that the tree is scheduled to be cut down because it is in the way of someone's building project. I feel sad because I won't be able to show it to my daughter, we won't be able to build a treehouse there, we won't be able to go on picnics under its boughs. He however feels sad that the tree is going to be cut down - punkt. This magnificent tree, this majestic tree, with its age and dignity, the life it has 'led' intersecting and making possible and itself being made possible by all the insects and algae and bacteria and birds and plants that live in and around its roots and branches, this dignified tree that has 'stood' here quietly, solidly, through the ages, this lively tree which pulses in its leaves and fruits with the cycles of the seasons... He lists such properties of the tree not because any of them make the tree valuable - as if the value lay more in the properties than in their bearer - but because, he tells me, he is trying to paint a picture which will help me, impoverished instrumentalist aspirant that I am, see the tree under the aspect of a being with intrinsic value.

Let's suppose he succeeds. Now I start to look at the tree differently. Regarding the tree I wake to wonder. I thereby become open to what we can call its Being. ... Wait - don't get put off by talk of wonder and 'Being'; instead let's understand together what's being talked about. ... Let's consider for
example the different state of mind of someone who is painting an expressive picture of the tree, or who is writing a poem about it. It is possible to do a semblance of either of these activities in an I-It mode: you are commissioned to write a poem about the tree, you putatively discharge your commission by finding some pithy observations and fragments of science and natural history and folklore that can be wrapped up in words that scan and rhyme. Or, you paint a picture which is a near-perfect 'photographic' resemblance of the tree. In neither of these activities do you give the tree a voice. You use your own voice to talk about it. But this isn't poetry or art. We (the reader, the viewer) are not yet addressed by the tree in the art. You (the wannabe artist) have just expressed yourself; you haven't yet expressed the world - or, better, allowed yourself to function as expressive mouthpiece for the (Being of the) tree.

This is the distinction I'm getting at: between me having a thought about the tree - making a judgement of some sort, assigning a species to a genus or a truth value to a proposition - the sense of which proposition is intelligible independently of an encounter with that which the judgement is about - and giving voice to the tree, allowing myself to be touched by it, allowing the weft of my mind to accommodate to the tree's presence, resonating to that presence, being informed by rather than about it. The tree poet is not expressing judgements about the tree, but rather voicing the encounter with it. He is not offering representational truths about it - his propositions are not independently intelligible and then made true or false depending on whether things are the way he suggests (adequatio). Instead he truly expresses the tree, becoming its mouthpiece, accommodating himself to its Being, receptive to its distinctive nature (alethia). (Buber called this 'inspiration'.) Here truth is like the 'truth' of a completely straight line: his words are true in the sense that a tight string is true. When we meet here with a failure of truth we don't meet with inaccurate representation but with a distorted voice, a defence mechanism, disingenuity, false consciousness, a kink in the line.

The person who avows a desire is not reporting their desire but expressing it. They may offer a pretend avowal though, or their avowal may partly distort the desire which finds its way to the verbal surface in garbled form. So too someone who 'avows' the being of tree - someone who invokes it through alethic poiesis - is not issuing a report of their findings, but instead letting the tree speak. The poet may fail in her poetic task, but this failure will not be a matter of false representation but rather of some kind of an intrusive narcissism which distorts the simplicity of avowal with something sentimental or hyperbolic which comes not from the tree's nature but from their own. As Buber has it, their voicing of the tree offers us a revelation of its presence or, as Heidegger might put it, an unconcealment of its Being.

I-It relations are far easier. We are less vulnerable in them. We can just stand back and speak about, rather than lean in in openness and be affected. We can impart or gather information about, rather than ourselves becoming in-formed by, the other.

If we are in an I-It relationship with another we are not vulnerable to intrusive projective identification and comparable enactments. That vulnerability is constitutive, I believe (but what do you think?), of the possibility of real I-You relating, but it's also an openness and vulnerability, a primal wound that lets in both the light (love) but also the darkness (gaslighting, projection, etc.).

Monday, 15 August 2016

on 'how psychotherapy works'

One effect of our sciencey psychological zeitgeist is to make various questions appear far more innocent and straightforwardly intelligible than really they are. 'How does psychotherapy work?' is one of them. It looks like someone asking how a process works... with an answer to be given in terms of causal mechanisms. Thus perhaps we could look at different therapists'  accounts of what makes for mutative therapy and then pursue empirical investigation (e.g. a 'component analysis') to assess the truth of these accounts.

For example, someone who claimed that what really did the work in CBT was changing pathogenic beliefs might be confounded by a study which showed the relevant changes in mood occurring after the behavioural activation phase, but before the cognitive restructuring phase, was introduced. ... In fact, once you start thinking and talking in the inhuman way I contrivedly did in the previous sentence, the idea of empirical research into 'how it actually works' starts to seem perfectly straightforward. What might not be straightforward is the answer, or the methods needed to reach it - but the question, that at least, supposedly, is perfectly clear.

Well, I don't think it at all clear. I think the appearance of clarity to be an illusion undergirded by latent conceptual confusion. In this post I spell out why I think this. My claim will be that for the question to find intelligible application we must surely be able to separately specify process and product. But when it comes to psychotherapy - in fact, when it comes to most everything of interest in psychology - we can't actually do this. Sure, we can create impoverished measures of success which don't make explicit reference to the therapeutic process, or banal measures of the process which don't make explicit reference to the product. However these, I claim, only give us the appearance of the kind of externally related relata which can cogently function as independent variables in a causal explanation. (Just because you give a rather thin description of something which doesn't overlap with another rather thin description of what is only allegedly a separate thing doesn't mean that you can then intelligibly relate the two through a causal explanation.)
Example. Marjorie's existence is misery-saturated. What does this misery consist in? When we and she get to know her better what we both come to understand is that she rather moralistically doesn't allow herself certain of her ordinary human feelings. Feelings of illness are morally judged as indulgent and as in any case unsafe to acknowledge since they may betoken serious unmanageable disease. Feelings of both her reasonable and her somewhat childish anger are tacitly judged as simply too shameful; no understanding is shown towards herself in them. Her hopelessness is a function of her sucking the imaginary poison out from fate's sting before the real, and inevitably more benign, deal comes anywhere near her. And so on, you get the picture. In all these ways she suppresses herself, offers herself no understanding or encouragement, and takes no courage in facing the challenges of life without having first denatured life in her imagination. Her misery is a function of this unwitting auto-restriction of her life-energy and her hope and her spontaneous emotionality. 
Marjorie's therapy looks like this. When she automatically acts in one of the above self-defeating ways in the therapy session, or when she reports having thoughts and feelings during the week which, on reflection in the therapy session, can be seen to be fit one of the above self-defeating ways, then the therapist gently and firmly calls her on it. Then Marjorie can see what she has been doing. But this isn't just a bit of intellectual self-knowledge that she gains. It is itself a liberatory experience: in being called out for her relentless fusion with her miserabilist superego, she experiences emancipation from it. She de-fuses from it. If she didn't de-fuse from it then she wouldn't be having a living understanding of what was being talked about. She would just be knowing that a sentence composed of certain words was true of her, without really understanding their significance for her. (Sometimes this pseudo-knowing is called 'intellectual insight'; my own view is that there is no such thing as merely intellectual insight.) 
Do these de-fusings take? Does Marjorie come to fully internalise her therapist's way of relating to her (Marjorie's) feelings - and thereby cultivate a more benign and unstressy superego? Well, let's suppose, to some degree: yes they do, yes she does.
Now, what would it mean to question, here, how the therapy works? What we'd need to do, to get our question off the ground - if, that is, we're pursuing it in a hypothesis-testing mode - is to parcel off our understanding of therapeutic action from our understanding of therapeutic boon. Thus we could think of the therapeutic action in terms of a 'therapeutic intervention' (the word 'intervention' is already nice and causal-sounding; that should rhetorically help the cause-effect game get into play), and we could also think of the therapeutic boon as a remission of 'depressive symptoms' (the word 'symptom' is already nice and distal-sounding, just ripe for taking the place of a product, an effect, of some otherwise-to-be-specified cause). We could measure these therapeutic 'interventions' (for example, we could count the number of interpretations that are offered!) and these depressive 'symptoms' (using the BDI, for example). And then we could see if these 'interventions' and these 'symptoms' are correlated. And if they were correlated then we could posit a causal relationship between them. ... ... ...

But why on earth would we want to do any of that - apart from to try and ape the procedures of natural science? For we already know full well that life isn't in any way like this. We know that it isn't the quantity of the interpretations given which makes them mutative. I can take in what you say to the degree that I can trust you, to the degree that I'm prepared to risk climbing out from under the thumb of my superego, to the degree that I can be touched and moved. This can sometimes take a long time to develop. It can take patience, perseverance, and courage. Sometimes the less you 'interpret', the more effective you are - it depends on what's live in the relationship between the two of you. But the point of what I'm saying is not to plead for complexity - not to say 'but there's all these other factors we will need to take into account in the causal model'. It is rather to question the very idea of the intelligibility of a causal model of therapeutic action. What I am saying is: the only meaningful description of the so-called 'intervention' is of a therapist saying something that actually touches the patient in such a way that they do start to see things differently, do step outside of their enmeshed relationship with their own inner critic, etc. And the only meaningful description of a life without depression is of a life without these vitality-stultifying defences ruling the interior roost. After all, life can be hard, painful feelings need to be felt, losses mourned, hopelessness endured. It's not the affects but the defensive relation to the affects which matters in stepping outside of depression and into authentic relationship with whatever is in the offing in one's inner and outer life.

I don't really expect to convince anyone with this post. My purpose in writing it has however been to start to articulate a very different vision of what it might mean to ask 'how does psychotherapy work?' The answer we can give which is actually intelligible is, I believe, one which includes within it an apt characterisation of the nature of the problems the patient faces, and includes within it a characterisation of the nature of the relationship with the therapist within which understanding is reached. Here understanding does not mediate change - for understanding is change. (If I truly come to understand myself anew, this is itself always-already transformational - and there's no need to hold onto a here-inappropriately third-person-type conception of understanding or knowledge as extrinsic to the being of that which is understood or known. 'Know thyself' is not an instruction to accumulate more true beliefs about yourself! It's already a matter of not being alienated from yourself, already about becoming more self-possessed.) The therapeutic relationship - i.e. the therapeutic aspect of the relationship between therapist and patient - is also not a vehicle for or mediator of change, but rather its locus. Being touched by the therapist, internalising (not, nb, learning facts from!) what she is saying, this is 'therapeutic action'. And in therapeutic action we don't have a cause followed by an effect. We have a transformational moment within a relationship.

Sure, it's important to go to therapy. But going to therapy does not by itself cause therapeutic improvement. You can go to therapy all you like and not get anything out of it. Once again it would be meaningless to correlate going to therapy with going better and say that the former must have caused the latter. We already know that going there isn't going to do anything except accidentally ('behavioural activation' or 'getting off your arse'). For you have to engage with the therapy. You can't have a change of heart unless your heart is in it to start with.

So, as I see it, the question 'how does psychotherapy work?' does not receive an empirical answer - it turns out to not have been an empirical question. At the end of our quest we might reach a better phenomenological explication of just what therapy is. That I'll take any day. But the component analysis or what have you - that we can hand back to the natural scientist.

Saturday, 13 August 2016

the case of m

Aaron T Beck
When recounting the history of his clinical disillusion with psychoanalysis Beck describes the reactions of two patients. One - the women who generously regaled him with stories about her sex life but whose transference was yet latently dominated by worries of being boring - I've written about before. But the story of the other patient - M - in 1956 - is perhaps less well known. (It gets told in Aaron T Beck. 1993. Cognitive Therapy of Depression: A Personal Reflection. Aberdeen: Scottish Cultural Press.) It seems to me that, despite it forming a lynchpin of Beck's turning away from psychoanalysis, it really cries out for  psychoanalytic treatment. To pre-empt my conclusion, I shall argue here that what Beck was really reacting to was a clumsy form of ego psychology; that cognitive therapy was a better bet in theory and practice than the (ego-psychological) form of psychoanalysis he was trained in; but that a version of psychoanalysis which pays proper attention to the complexity of unintegrated internal object relations is a better bet still. Further, that whilst the task of psychotherapy is integration, there are aspects of Beck's theorising of the mind which work against this. (I know it must seem like I'm trying to give this guy a hard time! But, really, it's not that - I suspect he was a much better and more creative psychotherapist than many of his analytic colleagues, and I value the pragmatism of his approach. It's just that I feel he also did psychotherapy a disservice when he threw the object-relational baby out with the ego-psychological bathwater.)

m

M was a depressed male patient in psychoanalysis who according to Beck followed the fundamental rule - 'of reporting everything that came to his mind. He had learned not to censor thoughts that he was concerned about and not to leave anything out.' M spends much of a session angrily criticising Beck. 'After a pause, I asked him, going according to the book, what he was feeling. He repeated he felt guilty.' Beck surmises that M 'was feeling angry, he expressed anger, and the anger itself evoked the affect of guilt. That is, hostility led directly without any intermediary variables to guilt – one emotion to another.' 'But then the patient surprised me with an observation... that the whole time while he was criticizing me, he was generally aware of another [un-expressed] stream of thoughts such as, “I said the wrong thing … I should not have said that … I’m wrong to criticize him. I’m bad… I have no excuse for being so mean.”'

Beck remarks several times on how surprised he was by the fact that his patient was, in effect, not actually following the fundamental rule. 'This incident constituted my first surprise and also presented me with an anomaly. If the patient was actually reporting everything that came to mind, how could he have experienced a conscious flow of associations and not report it? Further, how could two streams of thought [one conscious, the other preconscious - consisting of what Beck called 'automatic thoughts'] occur simultaneously?'

To conclude, Beck formulates that 'M’s self-critical thoughts were an intermediate variable between his angry expressions and his guilty feelings. The angry feelings did not directly activate guilty feelings but led to self-critical thoughts. ... This notion was contrary to my erstwhile understanding of the psychoanalytic dictum that anger leads directly to guilty feelings. Later, I was to discover that self-critical thoughts could lead to guilty feelings/sadness without there being any preceding anger.'

About this I offer three considerations:

the fundamental rule

There is one rather peculiar feature to Beck's description of the fundamental rule and free association. That is, he tells us that the patient was following it... but also that he wasn't following it. We now know the story: the thoughts the patient struggles to attend to are preconscious and are 'automatic'. According to Beck the difficulty in attention to them comes from the fact that they are fleeting, are on the fringe of consciousness, and that patients are not accustomed to verbalise them.

Well, yes, but... But psychoanalysis has always had a story to tell about why this is. Which is that the patient struggles to attend to such thoughts, or even to allow them to develop into fully fledged conscious thoughts, because they cause anxiety. The ignoring of them is not accidental but rather motivated - by the avoidance of anxiety, shame, guilt, awkwardness, etc.

I return below as to why M would be defended against such anxiogenic thoughts.

intervening variables

Beck tells us that in his opinion M's self-critical thoughts were an 'intermediate variable between his angry expressions and his guilty feelings' and that this was 'contrary to my erstwhile understanding of the psychoanalytic dictum that anger leads directly to guilty feelings'. 

First off, I think we can be confident that Beck didn't believe that anger led to guilty feelings for no reason. It is obvious why someone feels guilty on getting angry: they either realistically or neurotically take themselves to be unreasonable in this. I think we can also be confident that no psychoanalyst has ever thought that hostile feelings lead to guilt feelings for no meaningful reason, but just as a brute reflex.

Michael McEachrane
Second, isn't it just such takings that are given expression in the second stream of thoughts Beck describes? Here we need to remember to distinguish two senses of 'thought' - one is akin to 'belief', another to 'occurrent cogitation'. When someone says 'I think that...' they are probably reporting a belief - i.e. something with a primarily dispositional character; when they say 'I was just inwardly rehearsing what I'd say if...' they are talking of a more Jamesian stream of consciousness. (Michael McEachrane does a super job of showing how these two senses get conflated in CBT to the detriment of the theory.) Here it is surely M's belief that he has traduced Beck that is being expressed in M's semi-conscious inner chatter.

Yet whilst we do well to distinguish two senses of thought, we don't ordinarily do so well, I believe, to distinguish thoughts and feelings. If we take thoughts as merely bits of inner verbiage, and feelings as akin to sensations without any intrinsic intentional content, then we can push ourselves into thinking of them as needing bolstering from one another to make viable contributions to our inner life. But there's no need to take them in such reductive ways. M actually feels bad about his hostile treatment of Beck. There is a unity to this feeling. Defence mechanisms may sever the unity; they need no further help in doing this from a phenomenologically misguided cognitive theory.

internal object relations

What struck me the most on reading Beck's description of M was M's difficulty in managing ambivalence and how this difficulty relates to the structure and task of an analytic session. On the one hand M was angry with Beck (we don't know why); on the other he felt guilty about this. But up till this point in the session he didn't admit (to Beck certainly, but perhaps also to himself) that he felt the guilt. The fundamental rule, I surmise, gave him a novel kind of 'permission' to voice all his angry feelings - that, after all, is 'being a good analytic patient'. But actually he doesn't manage to be a 'good patient' - not because he has been angry, but because he has not also confessed to his guilty feelings. M's mind is not integrated. He can either have one or the other. If both come together - that's when he'd feel too anxious, and, I suggest a la analytic theory, defend against the anxiety by splitting into either his guilty or his angry self.

When M is out in the world, busy being depressed, we may imagine that often he is just aware of the guilt. When he is in the clinic, busy telling Beck with impunity just what he thinks of him, then he will just be aware of the anger. Neither are very helpful by themselves. What is required is integration. Let's assume for the sake of the discussion that Beck didn't really deserve M's anger. (It seems a reasonable assumption!) So now what we are arriving at is an understanding that M perhaps has some natural narcissistic difficulties (i.e. he struggles with not having his 'infantile' needs met in the way he feels entitled to), and that hitherto the only response to the anger that he feels has been an unsympathetic self-berating. 

M has, as yet, nowhere to turn. The situation is familiar to all of us on either side of the couch. He can either identify with his anger, and cut off from his guilt. This is all very well but hardly makes for being an integrated individual. (We all know the kind of spoiled unpersonable scold who is made for by the kind of pseudo-therapy which urges such an affective exchange.) Or he can identify with his guilt and cut off from his anger. Which is also all very well but is a surefire recipe for being a uncongenial depressive miserabilist. (The extreme Calvinist solution, perhaps.) These different positions are characteristically embodied in different internal object relations - either I cow-tow before a nasty superego or I become an all-id sociopath. The significance of the talk of complex object relations here is that we acknowledge the different uncomplementary positions which M is forced into and the relations between these in his psyche which make for associations either of the one stream or of another (which is different than saying simply that some of M's thoughts are best understood as conscious and some as subconscious, and that M just needs attentional training to report the latter), and the need for him to cultivate more benign relations (which means the same as 'integration') between these intrapsychic self-stances.

therapy

At this point what I believe M needs is ... therapy. By 'therapy' I mean, here ... an inwardly transformative encounter with a loving judge. I mean: an experience of engaging with someone who can smile kindly on his anger, know the distress it comes from, know how hard it is to not have what you want, not dismiss or disallow the anger, but yet not thereby condone or give it full rein, not exculpate yet not castigate. As M internalises this relationship he will himself become able to smile on his perfectly human impulses and reactions, engage in a more kind (which is not to say 'more permissive') inner dialogue, allow himself to suffer the pains of not having his needs met without devaluing them, face life with honesty and fortitude and forbearance, forgive himself whilst learning from his mistakes, and learn to shape such of his anger as is valuable into a fruitful assertiveness. That way we find ego where id was; that way M can cultivate a more benign superego, avoid the unenviable choice of being a brat or a misery guts, and grow as an integrated person.