Thursday, 24 November 2011

therapy as ethics: from intervention to recognition

I've recently come to the end of a three year post as a clinical psychologist working in an NHS primary care service. And have been looking back over my clinical notes and teaching session notes from this time. Much has changed me in the last couple of years, including my experiences with the 150 or so patients that have graced my consulting room.

What I notice, when I look back, is a significant change in my clinical understanding and clinical practice. It would be too easy to gloss this at the level of the 'model' I most typically deploy - having moved from a mainstay use of cognitive-behavioural, ACT, solution-focused, narrative, and schema-focused modes of formulation, towards something best characterised as psychodynamic. But characterising the move in that way, on the basis of the model used, misses - in fact it seems to me it covers over, obscures - what I now feel to be what is essential to the change. I shall call that, instead, a change from 'intervention' to 'recognition', and will now try to spell out what I mean by that.

When I started out I think I took myself to be in the business of formulating the patient's difficulties, and then - either from within my own expertise, or in closer proximity to the patient's own comprehension and wish - developing and deploying an intervention. The intervention might, for example, have involved exploring with and explaining to the patient the disorder-maintaining function of certain 'safety behaviours', and inviting them to relinquish these in the knowledge that anxiety is self-limiting. Or it might have involved asking them a series of 'solution-focused' questions designed to elicit an anti-depressive sense of self-efficacy and possibility. Or it may have involved formulating the patient's emotional difficulties as the product of certain habitually deployed 'defence mechanisms', and trying to push through these defences; to intervene in, or disrupt their hold on, the patient's emotional functioning.

I think it is still true that the above are what I do much of the time. And perhaps that is often-enough not such a bad thing, even if I suspect that intervening is too often something I do out of laziness or defensive omnipotent narcissism. And I think it is true, too, that no doubt certain skills get 'internalised' and so I have come to automatically, unreflectively, deploy therapeutic skills. But what I want to resist here is the idea that the growth of the therapist away from a conscious deployment of 'interventions' is best explicated in terms of an internalisation, automatisation, of such therapeutic knowledge, models, and skills. That is the tempting but banal thought; a thought which, I believe, it takes philosophical reflection to 'undo' (hence this post appearing in this blog).

One way of describing part of the difference in me over that time makes reference to becoming, rather than delivering, the therapy. What I mean by this is something like: rather than providing 'psychoeducation' to the patient at an explicit, conscious, level - about the nature of anxiety for example - this learning is instead something which gets embodied at an implicit, unconscious, level in the therapeutic interaction. The patient comes gradually to automatically, unreflectively, internalise my own tolerance of, and capacity to carry-on-thinking in the midst of, anxiety. And this happens in and through my own non-intervention-driven interactions with the patient in the room. What I am claiming, that is, is that this really isn't primarily a matter of my automating my interventions. What matters is not whether I have an automatic capacity to draw on a piece of knowledge, but whether I can automatically 'contain' their anxiety, keep on thinking, non-reflectively metabolise their projections, and the like. This is not a matter of intervening on my part, automatically or not, but a matter of being able to continue relating to the patient as to a person, despite their defensive (fear-motivated) evasions of their own personal being - their unconscious evasions and distortions of their autonomy, responsibility, agency, and inner integrity.

I don't mean to suggest by this that skill and knowledge are not needed on the part of the therapist who practices therapy as 'ethics' rather than as 'intervention'. They surely are, but it seems to me that the real skills are often not in knowing what interventions to perform how on whom, but rather in explicitly or tacitly recognising such forms of disturbance as may otherwise lay latent within, and prove disruptive for, the therapeutic process - recognising them so that the helpful recognition-providing conversations can continue, unabated, un-derailed.

http://www.carolcamfield.co.uk

Tuesday, 5 July 2011

psychological vs neurological

So I'm wondering if it's possible to do better, when unpacking the distinction between psychological and neurological forms of mental health problems, than:

a. Psychological problems are psychologically caused; neurological problems are neurologically caused.

The problem with this is surely that

b. Since all psychological factors are realised in the brain, and since there just isn't any substantial paramechanical psychological domain which causally impacts on the brain, and since talking therapy can affect brain function and neuroleptic therapy can affect psychological function, the very distinction - neurological / psychological - looks to be otiose.

It seems so very tempting to suppose that b. must be true - to suppose, say, that the very idea of distinguishing between neurological and psychological disorders reflects adherence to an unthinkingly dualistic metaphysics.

One salvaging move at this point might be to recast the distinction along structural / functional lines: neurological disturbances being disruptions in the 'hardware' of the brain, psychological disturbances being disturbances in the software being run on the neurologically intact system. That distinction might itself break down if we take too fine-grained a look at the hardware - i.e. at the level of the software implementation, but on the whole seems to work well enough. But still, construing the psychological / neurological distinciton in such terms might easily be seen more as a case of changing, rather than elucidating, the subject.

Despite the above problems, I want to make a case that the psychological / neurological distinction is well worth preserving. Why it should be preserved is, I think, an object lesson in the philosophy of psychiatry. The basic idea is that we do better to consider how these terms ('psychological', 'neurological') are actually used in clinical practice, rather than impose decontextualised meanings onto them from within philosophy's own metaphysical preoccupations. What I want to claim is that psychological disturbances are those mental disturbances which are a function of an individual's self-understanding; neurological disturbances are not. 

This approach is metaphysically neutral about minds and brains, and about the ultimate causal origins of psychological disturbance (perhaps one particular psychological disturbance was originally caused by a one-off quirky mishap in the prefrontal cortex). What makes for its psychological character, however, is its having been caught up in the self-creating ongoing dynamics of a subject's self-understanding. Psychological disorders are, in this way, disturbances of inwardness: disturbances in aspects of those processes by which we become characters and steer ourselves around the interpersonal world.

A neurological disturbance is not first and foremost a disturbance in self-understanding. It may give rise to such disturbances, but the idea of the fundamental disturbance ought not to make mention of them.

Another way to try to make the distinction between psychological and neurological is on the basis of intelligibility: neurological disorders are intelligible only in the sense that the pattern of breakdown in a causal mechanism is intelligible given what we know about its mode of functioning. Psychological disorders, however, can be thought of as humanly understandable, in that kind of a way that someone's reasons for acting may be intelligible. Intelligible by being placed in the human order of rationality, that is, rather than merely in the natural order of causality.

In itself that seems just fine to me. What is perhaps less desirable is a commonplace way of spelling out what the basic ingredients of an intelligible response might be. The cognitive behaviour therapist, for example, tends to find distorted beliefs or thoughts underlying the psychological disorder. But whether the distorted forms of understanding are really captured, in anything other than a rather loose metaphorical way, through such notions as 'false or unhelpful beliefs', 'automatic thoughts', etc., is I believe doubtful; this is simply too intellectualist a form for the understanding to take. (The analyst's 'unconscious phantasies' seem closer to the mark, although this notion also risks conjuring up the idea of hidden occurrent imaginings, rather than of disturbed living dispositions.)

On the other hand it would not do to take too general a notion of disturbed understanding - to look, for example, for the kinds of 'understanding' that are contained in every unreflective perceptual act. For then, once again, we struggle to maintain our distinction between the neurological and the psychological. What gets lost here is what I believe is the essential reference to a disturbed self-understanding - a disturbed self-understanding which gets inscribed and reworked in the heart of the psychological disturbance.

I notice, to finish, that the notion of 'psychological disturbance' that I have arrived at is not very dissimilar to the old fashioned notion of a 'neurosis'. It occurs to me that this might not be such a bad thing, and I wonder whether that concept has simply gone 'underground' for a while, still shaping and unifying our conceptions of disorders from beneath whilst being temporarily erased from our reflective clinical consciousness.

Friday, 17 June 2011

Review

John Heaton: The Talking Cure: Wittgenstein’s Therapeutic Method for Psychotherapy - Draft of a review for the British Wittgenstein Society

 Wittgenstein, Philosophy, and Psychotherapy

In considering Wittgenstein and psychotherapy in the same breath, our first thoughts naturally go to Wittgenstein’s use of the metaphors of (mental) ‘illness’ and its ‘therapy’ or ‘treatment’ to characterise the intent and manner of his engagement with philosophical questions. The central idea of the analogy is by now clear (thanks to Fann, Cavell, Fischer, Petermann et al.). Unbeknownst to himself the metaphysician is held captive by a ‘picture’ which unconsciously influences and thereby distorts his thinking. He then consciously attempts to articulate the resultant perplexities and doubts into clear questions; the hope is that such perplexities and doubts can be relieved by developing theories and explanations which answer the questions. In doing so, Wittgenstein contends, he is much less like a scientist providing us with global or foundational knowledge, and much more like a neurotic, than he realises.


The obsessional neurotic, for example, struggles to habituate to her underlying anxieties and accept her losses; instead they are deflected by being articulated into obsessional questions or forged into intentions. The underlying anxieties may then be quelled when the questions and intentions are compulsively answered or acted on. But because the questions and intentions do not truthfully articulate the underlying anxiety, the resolution of the anxiety is only temporary and it soon rears its head again. Thus the obsessional often presents to her doctor hoping for a better, more conclusive, answer to her doubts.


So too the epistemologist wants a better, more conclusive, explanation of ‘the mind’s’ relation to the ‘external world’; the ontologist wants a better account of the fundamental nature of ‘reality’; the metaphysician wants to develop a comprehensive theory explaining how mental events ‘cause’ bodily movements. In each case the Wittgensteinian treatment is the same: rather than trying to answer our philosophical questions and develop more secure knowledge, we are to unearth, clarify and undo the underlying deflections. Whether such philosophical deflections are best grasped i) cognitively – as resulting passively from the distorting influence on thought of tacit conceptual metaphors (Fischer), or ii) psychoanalytically or existentially - as actively if unconsciously motivated by a wish to avoid intolerable anxieties (Cavell) – is still a matter of debate. What is shared by all sides, however, is the idea that we do well to direct our interrogation not to philosophical answers but to the philosophical questions themselves.


Considered against the backdrop of this debate, John Heaton has written a surprising book. Rather than enter into the debate, or pursue distinctly philosophical scholarship of any sort, he instead takes back Wittgenstein’s distinctive clarificatory methods for psychotherapy. The form of therapy which results – which is clearly the method Heaton himself espouses – gets called the ‘talking cure’. Along the way he provides what I found to be a fascinating and really rather compelling account of emotional disturbance and the therapeutic resolution provided for it by the ‘talking cure’, and a somewhat uncharitable and less compelling critique of psychoanalysis, cognitive therapy, and psychiatry. I will now consider the therapy and the critique in turn.


The Talking Cure


Heaton’s vision of psychotherapy is modelled on Wittgenstein’s practice, but its value does not consist in its faithfulness to Wittgenstein’s philosophy (how could it?), nor in the evidence gathered for it (for how does one evidence a vision?). It consists rather in its capacity to make clear to the clinician what she already tacitly knows, to open up new insights, and to provide a sometimes radically alternative articulation of the character and goals of therapy, all in a form uncontaminated by pre-existing theories and their over-theorisations of the phenomenological facts of therapeutic interaction, misleading analogies and unhelpful ideologies. If I were to locate him on a pre-existing map I might describe Heaton as an unusually tough-minded, psychodynamically-inflected practitioner of Rogers’ Person Centred Counselling, or as a rather sophisticated exponent of Hobson and Meares’ Conversational Model. The transformative power of an honest and thoughtful encounter between two people is held up as important, rather than the doctor doing something (e.g. applying expert knowledge) to a patient.


But rather than continue to describe Heaton’s therapeutic method in relation to other therapies, or in terms of his fidelity to Wittgenstein’s philosophical method, it will be more instructive here to let it speak for itself; in this way the reader can arrive at her own judgement. Let us first consider Heaton’s characterisation of the nature and origins of psychopathology. In ‘neurosis and psychosis’, he writes, ‘there is an inability to speak of experiences that were traumatic or important but ‘unspoken’ … The victim [accordingly] is … not able to understand the reasons for her unhappiness …’. (ix) Misleading ‘pictures and analogies … hold our thinking in a cramp and stand in the way of our recognising the extraordinariness of the ordinary. The particular pictures that we fix on are rooted in our human way of life and culture, and therefore connected to our desires, fears and aspirations. They may be the expression of a wish to control the seemingly arbitrary world, especially if our childhood experiences were chaotic and unjust.’ (10)


It is part of Heaton’s understanding that the ways clinicians try to explain mental conflict often renders them ‘caught in a confusion whose character is not transparent to us. We are driven by a wish to find an explanation for the conflict, as if that will enable us to cure it. But this search for an answer is also the driving force in the conflict; we need to be liberated from the persistent inclination to seek answers to all questions. It is the conditions in which conflicts emerge, and the confusions which arise, that need attention.’ (10) The following provides an example of the kind of confusion Heaton has in mind. Someone ‘gave an account of his childhood, which was a variant of the ‘wicked stepmother’ theme. When he finished he turned to me and said, ‘ I suppose it was all inviteable’. (146). ‘[W]hen he said ‘inviteable’ truthfulness spoke, in that it showed he was trying to live as if the inevitable could be invited – a confused relationship between freedom and necessity, a compulsive attempt to live a life without suffering. He was saying something that cannot be meaningfully said as he was trying to live something that cannot be lived.’ (148)


This vision of what counts as worth attending to in the clinic entails certain goals for the talking cure. If someone is in ‘the grip of a problem’, what matters in therapy ‘depends on his free acknowledgement … If he does not agree with an elucidation, the appropriate expression has not been found. … This contrasts with much psychotherapy which is addressed to the problem as diagnosed by the therapist rather than the grip of the problem on the individual.’ (56). ‘By revealing themselves to some other person who they trust’, the patient ‘may come to see creative possibilities, differences and similarities they had not seen before. So they may realise that things need not be as they thought they must be, or that things may be as they imagined could not be.’ Elucidating the grip of unconscious pictures, rather than ‘being told what to do, or being interpreted in terms of a theory’ allows the patient to move on ‘spontaneously’ (94). Such elucidation is not to do with correcting mistakes, but with a more fundamental shifting of the way things are seen; it is to do with releasing us from captivity by a picture, rather than replacing one picture with another.


How does this elucidation and freedom to flourish spontaneously proceed? Not by ‘learning new facts, explanations and theories’ but rather through ‘reminders of what we have overlooked’ (ix) and by ‘attending to possibilities’ (209). Pyrrhonian scepticism provides an ideal: ataraxia (peace of mind) is ‘not achieved by cognitive accomplishment, attaining knowledge or insight – but rather by putting down dogmatic beliefs, by ceasing something’ (24). Therapy involves the patient finding their own voice. Free association is used to this end, not (as in psychoanalysis) to allow unconscious determinants come to the fore, but because it breaks up static language use, allows in chance and promotes different ways of seeing (140-1).


The patient’s movement from picture-engendered confusion to authenticity calls for a commensurate ‘response from the therapist… [whose words are] ‘simple, and … ideally spoken without a touch of ill-feeling, contempt, arrogance, bias, frivolity, jargon or word intoxication.’ (31) The therapist is required not just to help us relinquish the grip of pictures, but also to ‘support the [emerging] sense of our own experience. To listen to an expression of despair with a bored, all-knowing expression deprives the words of sense in a person who is unsure of herself. It is the involvement of others in our words that constitutes a condition of their meaningfulness, and which helps to bring order to our confusions.’ (97) The practice of elucidation and the provision of genuine rather than ersatz recognition involves spontaneous action by the therapist ‘and not the application of a theory or technique... Spontaneous action allows the subject to unfold out of itself the richness of meaning.’ (210) The psychotherapy adequate to this task is accordingly ‘a motley of techniques and practices… [using] pictures, analogies, metaphors or humour’ to develop the patient’s thinking (52). The psychotherapist is, unlike (say) the clinical psychologist who styles herself as a ‘scientist practitioner’ applying general scientific knowledge to the particular case, more like the ‘parrhesiastes’ of Ancient Greece: they must possess ‘virtuous knowledge’ – an individual, personal and practical ‘knack for acting’ (15).


In the above I have let Heaton speak for himself regarding his talking cure. As a vision of therapy I found it, as I said, compelling. What is not so clear to me is that it adequately captures the entire ground or field of either extant psychological distress or of apt psychotherapeutic practice. As I understand it, Heaton conceives of his own practice as a better way of doing therapy than that encouraged by cognitive or psychoanalytical approaches. I shall now therefore turn to his critique of these alternative theories and methods, and spell out some of my misgivings.


The Critique of Psychoanalysis and Cognitive Therapy


Throughout his book Heaton contrasts his talking cure with the theories and practices of psychoanalysis and CBT. He takes these therapies to task for their imposing on us: a vision of our mindedness as the possession of an inner realm of mental entities; a conception of neurosis as a quasi-mechanical disturbance in this realm; a version of the discipline of psychopathology as the causal explanation of such inner disturbances; and an account of therapy as theory-driven intervention in the internal world to undo the disturbances generated there. The question that continually recurred for me was whether it is primarily the therapies Heaton criticises which are to be taken to account for their mechanistic and objectified account of our mental life, or whether instead it is Heaton’s reading of the idioms such therapists deploy in their theoretical work which should be taken to account for its literalism.


As I read it, there are two related aspects of Heaton’s work which contribute to its unpersuasiveness as critique. One is its eschewal of the academic methods of philosophical, psychological or literary scholarship ; another is its running together – despite its oft sensitivity to precisely the same distinction – of matters ‘grammatical’ and empirical.


There are several ways in which the non-scholarly nature of Heaton’s text is a bonus rather than a detraction. In particular it makes for a refreshing directness of communication and a greater expressive force. Nevertheless it also means that there is no significant engagement with other attempts to read psychoanalysis and Wittgenstein together – which engagement, had it occurred, may have provided a better balance to his work. Take, for example, Charles Elder’s book The Grammar of the Unconscious, which makes its way into Heaton’s bibliography, but not into his discussion. The merit of Elder’s curiously disjointed book is its determination to read the intension of psychoanalytic discourse out of its extension – its meaning out of its use, as one might say – rather than out of its explicit (and readily criticisable, naturalistic and scientistic) metapsychological self-understandings. At times one may suspect Elder of an overly liberal application of the principle of interpretative charity. Heaton’s reading of psychoanalytic texts, by contrast, reminds one of the tendency of (say) physicalists to read religious or human science texts as if they were to be judged and understood according to the epistemic and semantic standards of the natural or physical sciences – from which such texts may nevertheless metaphorically extrapolate some of their terms.


I will consider this further in the following section, but first wish to document the other difficulty caused by Heaton’s otherwise pleasing scholastic restraint. This is his offering of unsubstantiated opinion, rather than hermeneutically or empirically evidenced argument, regarding the clinical practice (and not simply the theoretical apparatus) of psychoanalysis and of particular psychoanalysts. I will now – hopefully, thereby, avoiding the charge of hypocrisy – illustrate this with a wide range of examples:


Freud ‘did not distinguish the use of language, on a particular occasion, to describe how things are, from the more therapeutic use of clarifying how expressions are being used.’ (p. 1) [We are not given illustrations.] ‘He treated the patient as an evidence-exhibiting body – rather than a speaking human being.’ [No biographical data are provided.] ‘Psychoanalytic interpretations and CBT … are not based on a fixed truth about reality. [The meaning of the philosophical expression ‘fixed truth about reality’ is not explicated.] The analyst is not in a position to observe reality and put it into words without representing it. Although he should strive to be just, he is not neutral. [No detailing of psychoanalytic discussion about what clinical neutrality might and might not amount to is provided.] ’ (p. 10). In psychoanalysis, the ‘patient is instructed to speak freely but the analyst interprets dogmatically according to a rule. [No evidence of this dogmatic practice is provided.] He assumes that any deviation in free associations is caused by unconscious processes in the mind. [Whether analysts actually practice like this – or whether this is just a working assumption regarding material important for the business of psychoanalysis – is not explored.] He ignores the influence of external and physical factors.’ [No evidence is given.] (19).


‘In analytic circles no other self-analysis is authentic if it differs in any significant way from Freud’s ‘discoveries’. It is therefore discouraged. Experts know best.’ [Again, the alleged attitude of un-named psychoanalysts is stated but not evidenced – nor is contrary evidence investigated.] (26). ‘The psychoanalyst has an external relation to her patient. She aims to extract from the individual his inner subjectivity through a particular technique and the subject is supposed to interiorise the norms imposed upon him. … Instead of throwing light on the person’s confusions, it creates theoretical chatter behind their back.’ [We are not told what psychoanalysts would make of this accusation.] The ‘traditional description of speech by analysis breaks it into units that are static, discrete, and context-free. The theory of meaning that underpins psychoanalysis is that these units are combined by a finite set of rules which give structure to our speech.’ [No evidence is given for their being any such underpinning theory of meaning, or for the idea that psychoanalysis even needs a theory of meaning to underpin it.] (45) ‘Much theory in psychotherapy answers questions posed by the theorist rather than the patient. Instead of thinking through the problem together with the patient, the therapist takes the easy way, bypassing the problem by appealing to theories.’ [No evidence is given.] (53).


‘The technical language of psychoanalysis encourages us to believe that we know what we are resistant to, that is, our unconscious sexuality and ‘primitive instincts’. Human vanity and self-deception are not mentioned.’ [Heaton does not investigate what psychoanalysts have to say about narcissism.] (54). Saying ‘to people that they ‘have’ a phobia or depression can cause them to think they have something in them they need to get rid of. It distracts us from the fact that it is they that have become lost, not their mind or brain.’ [The clinical literature on the benefits and the pitfalls of the use of externalisation is not considered.] (139). ‘The not yet expressed is ultimately an expression; however; it is not an object co-existing with the expressed, such as a complex in the unconscious, as Freud’s subjectivist conception of expression would have it. The appeal to the unconscious takes away our responsibility to make sense. It is nihilistic in that it separates freedom from necessity, suffering from living.’ (149) [How this connects with the analytic goal of increasing freedom and responsibility by ‘making the unconscious conscious’ is not considered.] ‘The confusions generated by the picture of the inner world can be illustrated by the Freudian and Kleinian belief that there is a death instinct that is opposed to the life instinct in the inner world … But death is not an entity.’ (170) [Heaton does not give examples of any such curious psychoanalytic texts which presuppose that death is ‘an entity’. The clinical uses of the concept of ‘death drive’ are not discussed, nor is the considerable intra-psychoanalytic controversy regarding the cogency and value of the very idea.]


For this reviewer these hermeneutic deficiencies made for an uncomfortable reading experience. Let me be clear: I sometimes found myself sympathetic to the points of view expressed. Yet the text itself did not show me why I should believe what it claimed, and I found myself thinking that if I had started off with a different point of view I may have become more rather than less reactively entrenched within it by the end of the book.


The Conceptual and the Empirical


Whilst Heaton frequently joins Wittgenstein in urging us to distinguish between the conceptual (or ‘grammatical’) and the empirical orders, a similar conflation seemed to me to crop up when he criticises therapists for not having reflective, conceptual clarity regarding the nature of their and our terms – as if this was a criticism of their theories or practice. That is, he seems to suggest that tacit philosophical beliefs may underpin or underlie (and hence, when the beliefs are confused, undermine) therapeutic practice. Thus the following: ‘differentiating between logical propositions and ordinary empirical ones is vital in psychotherapy but they are often confused. Thus most psychoanalysts and CBT practitioners assume the uniformity of propositions. Their scientism and psychologism lead them to this. Reality as described by science is the only true reality; there is an a priori structure of the world which science describes. The specific features of a person’s language must be reduced to the ‘neutral’ descriptive language of science. Thus expressions of love may be reduced to ‘attachment’, or the sexual instinct, for these lend themselves more easily to empirical explanations.’ (121) And this: ‘The confusion between concepts and objects is endemic to psychoanalysis, CBT and neurosis. Perhaps this is most clearly seen in such notions as that there is an internal world containing internal objects and that thinking occurs in our heads or brain.’ (123).


The alternative suggestion – that psychoanalysts may deploy concepts to perfectly good effect as tools in their clinical work (to organise their intuitions, guide their interventions, and inform their discussions with colleagues), whilst yet often unsurprisingly failing in a separate philosophical task of achieving a second-order clarity in such beliefs as they do have regarding the character of their own concepts – is not pursued.


On this alternative – and what we might reasonably think of as a more faithfully Wittgensteinian – reading, conceptual confusion shows up in clinical theory and practice not when psychoanalysts unwittingly engage in bad philosophy, or use terms which invite the unwary or uninitiated into asking and attempting to answer misguided questions, but rather when in-itself innocent talk about ‘internal objects’ or ‘mental representations’ or ‘transference’ or ‘projection’ gets recruited to pursue explanatory agendas which only find a clear application regarding the objects of the roots of the metaphors (i.e. only regarding actual physical objects, images of such objects, and the movements of the objects or the images). Whether this muddle based on a conflation of the logic of categories takes place in any given instance cannot, I submit, be assessed at a general level but only at the level of a detailed investigation of particular cases. Heaton, however, talks as if the very ideas of a ‘transitional object’ or of ‘transference’ or of ‘projective identification’ or of a ‘mental apparatus’ are impossibly contaminated by conceptual confusion, and his disagreements with psychoanalysis are accordingly pitched at this (arguably far too abstract) level.


For example, Freud is taken to be radically confused as to the nature of mind and of his own (alleged) discoveries because ‘he thought that we only know of the existence of others by inference … But does the mind consist of things and processes that are present to be discovered by inference?’ (28) This leads the way into a series of claims regarding how psychoanalysis ‘conceals human dignity … removing the personal from itself … removes the dignity of self-understanding’ etc. But these (self-understanding, the recovery of dignity, the acknowledgement and growth of the personal sphere), as any examination of a modern textbook of psychoanalytical psychotherapy will reveal, are precisely the goals of psychoanalysis. Just because psychoanalysis deploys a vocabulary, derived by metaphorical extension, of inner objects in causal interactions, need not mean that we have to read the ‘logic’ or ‘grammar’ of this in terms appropriate to the roots of the metaphors. The misreading, to my mind, appears to be Heaton’s, and not (on the whole) that of psychoanalysts.


To exemplify this consider the following: ‘People having only one perspective that are unable to cope with changes in it have difficulty in placing their feelings and emotions in a context. They have difficulty with propositional attitudes and tend to think in a primitive causal fashion about their feelings and thoughts – ‘that’s to blame’ – instead of being able to reflect on the context and their relations to others that enables propositional attitudes to develop. It is this primitive seeking for an immediate cause that psychoanalysts conceptualise as using mental mechanisms such as projection and introjection. These theorists, however, are as mechanical as the people they seek to understand. They assume that there is an entity, the mind, so there is an inner world and an outer world, and as such beliefs must be either ‘inner’ or ‘outer’, introjected or projected’ (90-91). As can be seen, the actual grammar – the logic of the living use of terms such as ‘projection’ and ‘introjection’ in clinical thought – does not get a look in. It is what we might call this ‘sociological’ aspect of Wittgenstein’s project – investigating the uses to which terms are actually put in diverse clinical language games – that receives the barest attention by Heaton.


As a final example, consider this: ‘[The] theoretical concept of transference is confused due to false analogies and a language myth… It assumes that there is a speech circuit that involves the transfer of the speaker’s thoughts and feelings across to the hearer. … Meaning is thought of as some kind of entity which we can take into ourselves, by introjection, and then discharge it, by projection, into other people. … This is a muddle. In transference the person is not introjecting a thought or projecting one; thoughts and meanings are not entities in the mind or head that can be transferred.’ (176) Once again the living meaning of ‘transference’ – in particular, its use to describe the rich undertow of affect in the therapeutic encounter, or its more nuanced use to describe the ways in which a patient may unconsciously re-enact past relationships in the present – is neglected, the unsubstantiated argument instead being prosecuted at the level of a putative and general entification of meaning by psychoanalysis. Psychoanalytical language games (of transference, projection and introjection) are described as if they involved subscription to false theory about reality; the nature of the language games remains obscure.


Dogmatism and Dialectics


Throughout his book Heaton tends to deploy various self-coined or Wittgensteinian mantras as if they were transparent condensations of prĂȘt-a-porter arguments to be wielded against the alleged tacit conceptual confusions of psychoanalysts and cognitive therapists. I found the results of this strategy to be mixed. At times it provided a helpful shortcut, but at times I was left either confused or with the impression that an at best optional interpretation of Wittgenstein was simply being foisted onto me.


A recurrent claim which just confused me was the idea that people cannot be explanatorily subsumed within their own theories. Example: Psychoanalysts or cognitive therapists tend to assume that phantasies or cognitive schemas drive pathology. But both ‘forget that in any empirical theory the one who makes the theory is necessarily outside it. We … make theories for various purposes but we cannot be subsumed under them. Whenever there is a representation of the world in propositions, there is a subject who is in a position to say ‘I think…’ This applies as much to the patient as to the therapist. Everyone measures the world. To subsume a particular group of people under a theory is to impose a measure on them, to fail to recognise their humanity and to fail to have an unconstrained relation to them.’ (96). The idea sounds intriguing, but further developments of it fail to shed further light on its possible content. Thus the next page has it that the idea of an inner world standing in a representational, mirroring, relation to an external, independent a-priori-ordered-and-structured reality ‘is a functionalism that has thinking as irrelevant to what is thought.’ This is said to be ‘based on the confused notion that there are facts, ‘external and internal reality’, which serve as a standard against which we judge whether our propositions make sense. … We make theories for various purposes; to identify with a theory results in our being used by it, acting as if it were true.’ (97).


Those familiar with Wittgenstein will recall his frequent insistence on not conflating empirical and grammatical statements or, to put it in other words, on not conflating representations with rules for the deployment of representations. We may also recall his diagnosis of the confusion of conceptual ‘sublimation’: when we take a term like ‘real’ which has respectable deployment within various linguistic practices (e.g. real versus fake money or paintings, real versus imaginary scenarios or numbers, real versus pretend smiles or love) and then hold it over and above such discourses, with an ambition – diagnosed by Wittgenstein as disreputable – of asking if they themselves correspond to anything ‘beyond’ them ‘in reality’. It may be something like this which Heaton is aiming at in the above, but his use of phrases such as ‘thinking as relevant to what is thought’ or ‘identifying with a theory’ was to me more confusing than clarificatory.


Furthermore, Heaton himself often lapses into dressing such grammatical insights in a troublingly epistemic garb – that is, in a manner which has recently received much critical attention from Wittgenstein scholars. What in particular I have in mind is the critical attention which the very idea of limits or bounds of sense of thought has received from recent Wittgenstein scholars (e.g. Kuusela). On one understanding, our rules of grammar which as a set constitute the domain of the thinkable, act as some kind of constraint on our thought, or mark out certain ideas as unthinkable, at least for us. Against this idea the New Wittgensteinians in particular have urged the function of grammatical rules as ruling in, rather than ruling out, certain uses of sentential forms. The problem for particular usages of English, including those which pepper the pages of many philosophy books, is not that they contravene what can be thought, but that they are tacitly undetermined or unstably vacillating in their applications. Nonsense characterises words without a use, not words with, as it were, an inadmissible sense (cf Diamond).


Heaton, however, appears to me both to sublimate and to lapse back into the idea of limits of thought, when he offers us such sentences as: ‘The [pyrrhonian] sceptic relies on what seems to him to be the case, while he suspends judgement on how things are ‘in reality’, that is, the fantasy that we can know the essence of things beyond what can be expressed in human language.’ (24) ‘Much of Wittgenstein’s writing was concerned with studying our limits and showing the incoherence of attempts to describe anything beyond them.’ (28) ‘For Wittgenstein, therapy should help us to see that the world does not present itself as a collection of objects to be known, possessed or rejected. We have no direct access to the world. For us humans, thinking involves language.’ (60) ‘Both the Tractatus and Philosophical Investigations were crafted by him at length and painfully to convey the limits of knowledge and the limitations of language for expressing the world.’ (49) On the contrary, as the ‘New Wittgensteinians’ frequently urge, both the Tractatus and the Philosophical Investigations were designed precisely to deconstruct the very idea of limits or limitations of knowledge and language.


The final point I wish to make concerns dogmatism. Heaton tells us that ‘The most important and difficult task of elucidation is that it must avoid all dogmatism for this rarely has any therapeutic action other than that of suggestion.’ (99). Several times he describes the work of therapy as the patient working through of individual, idiosyncratic confusions and troubles. This in part is what riles him about the general theories of psychoanalysis and CBT which he sees, not as providing us with some helpful bearings and moorings whilst we tackle the distress of the individual, but as all too often functioning dogmatically to obscure the individuality of the patient. I feel sure that every honest clinician could recall of examples of this happening in both his own and his rivals’ practice.


What is troubling about Heaton’s book, however, is that his presentation of this very theme is itself dogmatically and non-reflexively pursued. Thus we are frequently simply told what is wrong with psychoanalysis or wrong with CBT in general. The failings of the uses of concepts as wielded by individual theorists on particular occasions recedes into the background. Wittgenstein urged that, in our philosophy, we pursue the process of working through our difficulties with careful attention to the details of how language is being used in particular instances. Here, however, both Wittgenstein’s ideas regarding philosophical therapy, and Heaton’s regarding psychological therapy, are presented in a purely dogmatic form. Wittgensteinian mantras are intoned in lists without explication and without a hint of dialectical handling: ‘The structure of reality cannot be understood as necessarily mirrored in language. We cannot ground propositions with sense in any intrinsic structure of an independent reality. The meaning of a word is not something in the world that is correlated with it.’ (106). Chapter 3 contains an extended discussion of the differences between writing and talking, and constitutes a eulogy to the immediacy and particularity of speech away from the abstractions of the written word. But curiously the chapter presents no self-conscious reflection on the fact that it itself is a piece of writing. Freud’s generalisations are criticised, but Heaton’s own general claims (some of which appear rather extraordinary, such as ‘every oral utterance is unique in respect to its context, pronunciation, and meaning’ (43-4)) remain unsubjected to self-reflective criticism.


Conclusion


Heaton, along with Steve de Shazer, is one of a small handful of psychotherapists who have developed their understanding of therapy through an engagement with Wittgenstein’s philosophy. His enthusiasm for and inspiration by Wittgenstein shine through throughout his text. His own pleasingly a-theoretical explication of the ‘talking cure’ provides a significant addition to the therapy literature. His use of Wittgenstein and his critique of psychoanalysis and CBT is however marred by its non-dialectical dogmatism. Rather than look and see how psychoanalysts use terms in the midst of clinical practice, metaphysical views about the nature of mind and meaning are foisted onto them on the basis of their explicit formulations. In this respect Heaton falls significantly behind Elder’s work on Freud, and the field of modern psychoanalytic psychotherapy still lacks a perspicuous grammatical synopsis.


Wittgenstein is of course not the only 20th century philosopher to have provided inspiration to psychotherapists. Perhaps the greatest influence came from Heidegger, and was felt by the ‘Daseinsanalytic’ and existential therapists who aimed to deploy Heidegger’s insights in the treatment of disturbed forms of ‘being-in-the-world’. Ludwig Binswanger, one of the earliest such proponents, has long been understood, including by his later self, as offering us a ‘creative misunderstanding’ of Heidegger’s philosophy. In short, Binswanger’s patients are presented as embodying pathologically different forms of meaningful world-construction, rather than having partly and in different ways fallen out of that being-in-the-world constitutive of meaningful life itself.


In attempting to bring Heidegger’s philosophy to bear on the psychopathology, matters ontological are tacitly and mistakenly reduced by Binswanger to ‘anthropological’ (empirical) concerns. Heaton, like Binswanger, also aims to set aside what are frequently the dehumanising scientific preoccupations in therapy, replacing them with a welcome focus on people as, or as potentially, free individuals. Like Binswanger, however, and despite his own sometime sensitivity to the key Wittgensteinian distinction between matters ‘grammatical’ and empirical, Heaton too often ends up conflating the two. Mere usages of psychoanalytic terms are described as implying adherence to metaphysical theories; grammatical rules are described as providing limits to the knowable or as mediating our experience; and dogmatism rather than dialectics too frequently ends up ruling the day. Medard Boss and later existential therapists were able to provide some kind of corrective to Binswanger’s creative misunderstandings of Heidegger. Despite Heaton’s considerable creative efforts we still await an interpreter of Wittgenstein comparable to Boss for the psychotherapy community.

Thursday, 16 June 2011

psychotherapy and the relation of theory to practice in clinical psychology

I want to have another go at articulating a fundamental difference between the use of theory in clinical psychology on the one hand, and in psychoanalysis and psychodynamic (and other) psychotherapy on the other. It is, I believe, one which easily gets lost in the way that clinical psychologists - such as myself, too much of the time - articulate the relevance of different models of disorder, or of different formulations, for the treatment.

The psychologist's articulation typically has it that the job of the reflective scientist-practitioner is to formulate an explanation of the patient's difficulties within the terms of the model, and then to guide the therapy by this explanation. You treat the disturbance-as-formulated-by-the-model, and this treatment consists accordingly in the model-guided interventions that you make. The formulation may be in whatever terms seem most appropriate (cognitive, behavioural, phenomenology, psychoanalytical, systemic, narrative, etc.), and the treatment follows from the formulation.

There is perhaps nothing wrong with this way of putting things in and of itself. I think it is a very natural way to describe the relation of CBT theory to CBT practice for example. However it can come to seem just so obvious that it can force out other ways of understanding the relation of theory to practice. The way it does so is, I believe, a clear example of the way in which what we could call the 'ideology' of CBT comes to affect the way that all the therapies are understood and practiced with clinical psychology.

Recently I've been noticing how the very idea of the scientist practitioner, implementing theory-laden understanding in the clinic, can get in the way of my own clinical practice. Let me start by explaining what I am not going on about. Here is one way of reacting against the above-described practice - the practice of the scientist practitioner: 'It is far too non-collaborative; we have an expert clinician thrusting their interventions on the patient. Whereas what would be better would be a collaborative enterprise in which clinician and patient come together to understand the patient's difficulties and figure out what to do about them'.

Now that might sound just lovely, but it really isn't what I'm on about. And the pitfalls of it as a general approach are obvious: it may i) encourage the therapist to eschew the very real expertise they do have, relative to the client, and the way they can be helpful in and through that expertise, and it may ii) encourage us to ignore the way in which the client is unable to grasp what they need (in fact that is why they have come in to start with) because their defences and transferences get in the way of their access to the understanding in question, and it may iii) lead us to ignore the way in which the therapist must beware of getting caught within the re-enacted narrowings of experience, understanding, and relating which the patient brings with him. Further, for me I think it all-too-readily leads to a kind of 'virtual therapy', in which I and the patient discuss together what they would, as it were, need from their therapy (were they to have it!), what new understandings they would need to reach; the 'they' who this is to happen to now comes to seem like someone other than the 'they' who is in the room (explanation-driven approaches to therapy such as CAT (cognitive analytic therapy) seem in particular to run the risk of this) .

But in any case, I now understand, despite the above sometime cul-de-sac in my own thinking and practice, that I'm on about something quite different from this, when I question the rightful hegemony of the reflective scientist practitioner model in the psychotherapies. And here is an alternative - and, I believe, sometimes more fruitful, although my aim here is just to clear some space for it and resist the hegemony of the scientist-practitioner approach - construal of the relation of theory to practice, a construal which draws more on a psychoanalytical, than on a clinical psychological, self-understanding:

That what is curative or restorative for people is the extraordinary ordinariness of everyday empathic conversation, acceptance, love, sharing, connection, being understood and knowing one is understood. That new development, disintegrations and reintegrations, occurs in the context of such relating. That what happens in neurosis is that development, inner movement, becomes blocked. And that the therapist must therefore work to break through defences, work to find room to stand outside of transference and make himself available nonetheless, work to negotiate projections and ally himself with the patient's better self against these forces of inner stasis. This is the 'negative' work of therapy: i.e. it is here that psychological understanding must sometimes be deployed by the therapist to inform their practice of negotiating defences. But the 'positive' work of therapy is just the therapist making themselves available as a new 'object' (a new person who can make possible a new constellation and growth of personal being) through their personal qualities as a human being. That of course is also the work that is done, when it is, by the parent or priest, friend or boss. Their human qualities may outshine some of the best therapists. But the best therapists ought at least to have a good understanding of what gets in the way of psychological transformation - gets in the way of a process which, when unblocked, will happen by itself.

Along the way, then, the therapist will use theory. But this will not typically be to guide an intervention, but to un-derail the therapeutic process. The therapist finds himself thrown out of the healthy use as an 'object' by the patient, in a cul de sac, bored, caught up in a reenactment, stuck. Theory and supervision help him at this juncture. There may or may not be an intervention; what we have instead might be, say, an interpretation. Or some other such utterance which has the function of creating space for the making of meaning once again.

---------------

In an interview in 1998, Jerome Frank put it this way: “Psychotherapy is not applied behavior science. I think that is the wrong model. Because all science is based on facts, but psychotherapy is the world of meanings, which is far from the world of facts. Psychotherapy relies on the fact that human beings react not to the facts or events themselves but to the meanings of the facts as they interpret them. Psychotherapy is the transformation of the meanings that patients attribute to events from negative to positive. I think it should be taught as an art” (Holland and Guerra 1998).

Saturday, 14 May 2011

against mineness

There are some questions in philosophy that I really just can't get on with. My hunch is that they dress themselves up as honing in on genuine theoretical projects whilst really being able to claim no more than the mere appearance of explanatory respectability.

Dan ZahaviOne which bugs me considerably is: 'What makes (me aware of) a particular experience (as) my experience?' The question gets asked, and then somewhat-phenomenalistically-inclined phenomenologists provide a theory of 'mineness', 'ipseity', 'self-intimating presencing', or what have you, by way of an answer.

But is it really a good question? Well, I do know what it is to ask 'What makes the car outside my car?' We know what kind of answer is called for - and in that knowing, know what the sense of the question is. The answer makes reference to certain paperwork, a certain financial transaction or gift, etc. But an essential part of the possibility of this kind of answer is that cars don't necessarily belong to me. I stand in a relation to the car, the relation being one of ownership, and I can say (by appeal to last night's poker game) what makes it the case that it is I rather than you who stands in this relation.

So too, I know what is being asked when you put it to me: 'What makes a chicken a bird?' To answer the question I just explain what a bird is. Here the matter of the question does not (a la 'my car' case) have to do with the possibility that a chicken might not have been a bird. Rather we just want to know what the essential features of bird-dom are that chickens enjoy. We have a grip on what such questions are asking because we know what to make of these two different deployments of 'makes'.

What I am submitting is that we don't really know what to make of 'What makes' in 'What makes a certain experience mine?' Substituting 'In virtue of what are' for 'What makes' doesn't get us any further. It just isn't obvious to me, to put a grammatical proposition in a rather too de re dress for my liking, that certain experiences are mine 'in virtue of' anything at all. Since there is nothing to be said about what makes a certain experience mine, there is accordingly also nothing to be said about what makes for my putative awareness (or what would make for my putative lack of awareness if I am suffering from a particular pathology) that a certain experience is my experience.

Similar difficulties arise for me in several other instances which the metaphysically minded are far more likely than I to find intriguing. If someone asked me 'What makes now the present moment?' I think I'd probably just have to let my jaw go slack. The only answer I can come up with is: 'Er, a grammatical rule', and  I have a sense that this will probably be experienced as more facetious than helpful.

You ask me 'What makes that woman your aunt?' I say 'Well, that's a slightly funny way of construing a question, but I can probably give you what you need if I let you know she is my father's sister.' And you say, 'No sorry, I know what an aunt is, and I appreciate how you are related, but what I want to know is what makes this woman, who is your father's sister, your aunt? Wherein the 'yourness'?' What I don't do now is develop a theory of a quality of 'myness' or 'yourness' which attaches itself to this particular relation.

Eugen Fischer
Here is what I think is going on for those who talk of the 'mineness' of my experiences. They have gotten held captive by a picture of experiences as inner objects. They may in all sorts of ways explicitly deny this but, as Eugen Fischer has described in his lovely book on Philosophical Delusion and its Therapy, this conscious denial need not prevent unconsciously entertained pictures from exerting their tacit influences on the kinds of questions we find ourselves wanting to ask.

If instead we remind ourselves that experiences are not objects but (intentional) relations to perceptibilia et al., the idea that grammatical possessives always imply ownership will rightly seem obscure. In truth we know all too well that we don't have much use for sentences which seem to invite us to suppose that we must enjoy some kind of relationship (such as ownership) with our relationships themselves.

Friday, 1 April 2011

pigs, positions, preferences: the zeugmatics of causal theories

It has - in my experience - become common for philosophers to try to persuade me of the fallacious character of what I previously took to be an a priori piece of understanding regarding my knowledge of my own mind (that reasons for action are avowable infallibly - which is to say that what we sincerely offer as reasons provides what here count as 'my reasons') by making reference to the empirical findings of Nisbett and Wilson.

A classic example is the case of why I make the choices I do. You present me with a line of differently coloured or patterned pairs of jaunty socks, and ask me to pick one. I take the pair on the right. You ask me why I took this one, and I tell you something about the charming 'little piglet' motif embroidered on them.

But then it turns out that I am no exception from a general empirical finding: that people in such situations are more likely to pick the socks (or whatever) on the right. "Aha", you say, "You thought you were picking those socks because you liked the pig motif, but really it was because of their position". The disturbing conclusion is supposed to be that we don't know our own minds - we don't know (as the gloss, which already builds in some optional philosophical 'commitments', will have it) which causal processes lie behind our very own actions.

The problem with the typical gloss is, to my mind, that it encourages a conflation which for shorthand could be described as an undiscriminating amalgamation of reasons and causes. It conflates the causal processes which lead me to perform certain actions (a bias for the right guides my choices) with the teleological ends of these actions (the reason I chose the socks because they had a pig on them) - bringing both of these under a global concept of 'reason for action' which is obfuscatory as regards the different logics of the different forms of explanantia. (The tendency I've commonly met with is to bring these two forms of explanation together by placing the teleological ends as the contents of desires and to see these desires as entering competitively into the matrix of causes which guide our actions.)

This, it seems to me, just won't do. Let us accept that desires have a dispositional form. If I like little piggy socks then, everything else being equal, I will avail myself of some. Desires, that is, are not individuated simply through our avowals ('I like piggy socks') but also through our actions (getting myself some piggy socks). Let us accept too that I am sometimes or often unaware of the efficient causes of my actions (thus I just didn't know that I am more likely to pick things on the right of a line). Finally let us accept that we may be prone to offering post-hoc rationalisations or justifications of our choices by references to appealing features of the objects chosen. It still doesn't follow, I want to claim, that it is perspicuous to present the findings of the experiments with a sentence like "You thought you chose them because of the pig symbol, but really you chose them because of their position".

One way to bring out what is wrong with this is to note that we wouldn't think it correct to describe a tendency to take objects on the right as a desire for objects on the right. Even to describe it as a preference seems more obfuscatory than clarificatory. To talk here of 'unconscious desires/preferences' seems further to conflate an epistemological with a logical concern.

How then should we describe what has happened? Well, we must acknowledge that our choice was (partly) determined by position. We must acknowledge too that, had another pair of socks with a little sheep motif been on the right, then we may have misleadingly talked of our appreciation of the sheep motif as the reason for our choice. And accept the implication from this that we tend to post-hoc rationalise our choices - to invoke desires where such an invocation is otiose.

But at no point need we fall into supposing that there is some general sense of 'explain' or 'reason' which pits positional effects against piggy appreciations. Instead there are two separate matters at play in such experimental results: (1) The limited character of our knowledge of the efficient determinants of our own actions (this is what is interesting in the findings of Nisbett and Wilson), and (2) the tendency of two key criteria (avowal and behavioural disposition), which jointly give meaning to the language game of desire, to come apart in practice (with avowal unwarrantedly outstripping behaviour through egregious self-confidence). When the social psychologist defeats the self-ascription of reason in avowal he is not to be understood as making a move within the same language-game - he is not saying x where the agent says not x. Rather he is giving us reasons to suspend our belief that here we do meet with a reason-giving language game - and reasons to consider, instead, that we meet here not with reasons but with mere rationalisations. For utterances which self-ascribe reasons only count as giving reasons if the agent is, as we must assume by default that he is, self-possessed. Yet what the social psychologist (or Freud and Bernheim, in their post-hypnotically active suggestion to the patient to open the umbrella for the doctor before he leaves the room to go out, which patient when asked 'why on earth did you do that?' provides but a daft rationalisation) engineers is a situation in which the agent lacks self-possession. A situation in which, if you like, they are instead possessed instead by the hypnotist or by the glamorous array of little piggy socks on show.

My confidence regarding my desires (2) may be overinflated. My lack of knowledge regarding the determinants of my actions (1) may be deflating. Nevertheless my overconfidence in my desires (2) is not to be understood as a pretence to the same kind of self-knowledge as would be held by someone who knows better than I the determinants of their actions (1). To say "You thought you chose them because of the pig symbol, but really you chose them because of their position" is not itself logically wrong-headed, but then neither is Dickens' zeugma: "Miss Bolo went home in a flood of tears and a sedan chair". Unlike the scientific naturalist, however, Dickens remained content to play; we are not asked by him to take seriously the idea that on another occasion, whilst we thought Miss Bolo went home in a sedan chair, actually she went home in a flood of tears.

Sunday, 13 February 2011


The Narcissism of the Private Linguist; the Private Language of the Narcissist





I've been busy writing papers recently, so have been neglecting my blog. Here however is a draft-in-progress of a talk to be given at Eugen Fischer's Philosophy as Therapy: Wittgenstein and Beyond workshop in March 2011:

1. Introduction

In this paper I present not so much a competitor, as a supplement, to the prevalent understanding of Wittgenstein’s view of metaphysical philosophy as illness and philosophy as its therapy.

On this prevalent understanding, illness in philosophy is caused by an entrapment by ‘pictures’, which pictures are due to the cognitive distortion which occurs when we unwittingly read the grammar of some concept too little along its own lines, and too much along the lines offered by the model of some other concept.

Philosophical illness then consists in the dis-ease felt when we are left having to try to reconcile our picture-driven beliefs with what we take ourselves to have reflectively grasped about our experience, understanding, and environments. Metaphysical and epistemological theories result when we try to explain (in that well worn yet curious philosophical phrase) ‘how it is (so much as) possible that’ some perfectly ordinary phenomenon – albeit one which might well start to look a good deal less than possible when seen by a vision corrupted by a philosophical picture – even obtains. (Example, when the meaning of the other's behaviour is rendered unavailable to us by a reflective conception of human mindedness which renders our internal worlds external to our comportment, we may start to feel in need of a theory as to how it is so much as possible that we can have knowledge of other minds.)

Eugen Fischer (2010) has offered us the clearest articulation of this cogent understanding of metaphysical illness. Wittgenstein’s philosophical therapy is, as Fischer sees it, a form of cognitive therapy which works by unearthing the distortions – the tacit assimilations – which drive such disease-engendering pictures. Released from the pictures which hold us captive, the dis-ease disappears and, along with it, the perceived need for explanations of (as I at least would put it,) the possibility of the actual.

By comparison with this I shall today be articulating an alternative (yet still, I believe) Wittgensteinian understanding of pathology and cure; my aim as I said is not at all to displace this cognitive conception of philosophical pictures, but to provide a supplementary perspective – in particular, a supplementary perspective which considers emotional and motivational – as well as cognitive illusory – sources of the grip which such pictures have on us. Whereas Fischer’s model of pathology and therapy is derived from cognitive therapy, mine is drawn from psychoanalysis.[1]

The psychoanalytic concept which will take centre stage here is ‘narcissism’. If I was brave enough I should attempt to trace the narcissistic strain running through the metaphysical impulse in its many manifestations. (I - perhaps foolishly – sketch some developments of this thought in the final section.) What instead will be the focus is what I am calling the ‘narcissism’ of Wittgenstein’s inner interlocutor known as the ‘private linguist’. The focus is on this because I believe that, as well as drawing on the psychoanalytic concept to make clear the character of its own arguments, philosophy is able here to return the favour by explicating a core feature of narcissism’s meaning.

This is the structure of what follows: First I document the importance to Wittgenstein of overcoming intellectual temptations to pride or vanity. Next I spell out a little of the psychoanalytical theory of narcissism. Third I provide an alternative reading of those sections of Wittgenstein’s Philosophical Investigations which are more often taken to contain something called ‘the private language argument’. This alternative reading of mine views Wittgenstein’s better self as engaged in a moral battle for honesty with that of his inner interlocutors known as the ‘private linguist’. Fourth I stress what psychoanalysis can learn from this moral battle. I conclude with some more general remarks on the narcissistic character of the metaphysical impulse in philosophy.

2. Wittgenstein and Pride

Wittgenstein’s later writings are confessional in character: ‘I want to say’, … ‘I feel like saying’… ‘Here the urge is strong’… frequently preface his remarks. Augustine’s Confessions were part of his inspiration and model (and object of critique). As Stanley Cavell writes, ‘The voice of temptation and the voice of correctness are the antagonists in Wittgenstein’s dialogues’ (Cavell, Availability, 71). This confessional character is not just a rhetorical feature of Wittgenstein’s writing. His biographer Ray Monk comments that ‘his life might be said to have been dominated by a moral struggle – the struggle to be anstandig (decent), which for him meant, above all, overcoming the temptations presented by his pride and vanity to be dishonest.’ (Monk, 278). He was preoccupied by honesty, bad and good faith, integrity, truthfulness – both in his friendships and in his work.

In his personal life Wittgenstein took great pains to make confession of his faults to his friends (Monk). In his writings we find him saying: ‘What makes a subject difficult to understand - if it is significant, important - is not that some special instruction about abstruse things is necessary to understand it. Rather it is the contrast between the understanding of the subject and what most people want to see. ... What has to be overcome is not a difficulty of the intellect, but of the will. ... Work on philosophy is ... actually more of a kind of work on oneself.’ (BT86) ‘The edifice of your pride has to be dismantled. And that means frightful work’ (CV 30); ‘One cannot speak the truth, if one has not yet conquered oneself. One cannot speak it – but not because one is still not clever enough’. (CV 35) One cannot speak it, one might rather say, because one cannot yet speak from it. Or: ‘When I say I would like to discard vanity, it is questionable whether my wanting this isn't yet again only a sort of vanity. … As long as one is on stage, one is an actor after all, regardless of what one does.’ (PPO 139)

How, we might ask, can one dismount from this theatrical stage of merely representing purported truths about one’s life – and instead be at peace, and of a piece, with life itself? How can one 'conquer oneself' and live out of the truth, rather than resigning oneself to providing descriptions, evocations, representations or approximations of it?

3. Narcissism and Psychoanalysis

Psychoanalysis aims to chart and treat the unconscious forms of evasion which prevent us from meaningfully connecting with significant others (our ‘primary objects’) in and through our feelings. As psychoanalysts see it, love is to the mind what food is to the body (Jonathan Lear). Loving attachments are the mind’s cradle (Peter Hobson): they are what make both for its growth and for its capacity to weather the storms of self-dissolution at times of stress.

The social and physical helplessness of the human child makes for the necessity of a form of (‘primary’) narcissism which will not be of interest to us today: namely that healthy yet excessive self-regard of ‘his majesty the baby’ (Freud) tolerated and encouraged by the loving parent. Too little loving attachment – too great a disturbance or absence of the child’s recognition of himself in the mirror of his objects’ gaze – and there arises the need to defend against this recognition, or against the feelings of anger which might, if expressed, damage the attachment relationship. We therefore see arising the needs to internalise prohibitions against self-expression, or to manage intolerable ambivalence through splitting the world into good and bad objects, or to destroy our capacity to know of our own emotional vulnerability.

It is at this juncture that ‘secondary narcissism’ is understood to come on the scene. To defend against the perceived unavailability of others’ loving acceptance, the narcissistic individual attempts to become her own ‘good breast’, i.e. to use the self as a surrogate for a secure base (Jeremy Holmes). Correlatively she may enviously or destructively denigrate the importance to her of others (Heinz Kohut). Self-soothing behaviours (drug use, self harm, promiscuous sex) take the place of loving relationships; others are treated un-empathically as means to ends rather than as ends in themselves. 

As we might expect, narcissism takes several different forms. The thin-skinned or hyper-vigilant narcissist is  shy and sensitive to rejection or criticism; rather than enter into real relationships they are condemned to fearfully patrolling the boundaries of their self-as-perceived-by-others. The thick-skinned or oblivious narcissist, by contrast, has little feeling for others and shows arrogant self-serving ruthlessness; they talk at, rather than to, others (Rosenfeld; Gabbard). The destructive narcissist does not so much as try to control his objects, but more dramatically takes ruthless pleasure in destroying inner signs of attachment and dependency (Rosenfeld).

The psychoanalytic theory of narcissism is complex. There are many different sub-plots; 'narcissism' may best be described as a 'family resemblance concept' (Rustin); and there exists a tendency (which may not be a bad thing) for the theory of narcissism to become more a theoretical lens through which all psychopathology (depression, personality disorders, schizophrenia) is understood than a set of testable claims of empirical psychology.

In what follows I shall take just one aspect of narcissism as central: this is the way in which the narcissist’s mind is bent out of shape through their attempting to take themselves as their own object. What I shall claim (in section 5) is that we can use Wittgenstein’s therapeutic attempts to emancipate his inner interlocutor the private linguist to give a clearer characterisation of the logic of narcissism. My hope is that in this way we will come to an understanding of how the illusions and the aspirations of the narcissist are sustained, and also come to a clearer understanding of just why the narcissistic ideal of self-sufficiency must be understood as an illusion.

4. The Private Linguist as Narcissist

Paragraphs 243ff – and especially 258 – of the Philosophical Investigations (PI) are often taken to contain an argument – the ‘private language argument’ – which is supposed to show us how we cannot develop psychological concepts (with terms (‘S’) for sensations, feelings etc.) using purely intrapsychic resources – say by ‘inwardly pointing’ to (quasi-ostensively referencing) our sensations and naming them.

As the secondary literature has it, either there is in the internal world a lack of the requisite ‘stage-setting’ for the quasi-ostensive act in which ‘S’ is to be paired with its referent (eg M McGinn), and/or it can be proved, from the absence of a consequent operational ‘criterion of correctness’ for deploying ‘S’, that the antecedent ostensive act which aimed to make for ‘S’’s normative deployment must have failed (eg Hacker, Glock). This latter interpretation, which takes the absence of a criterion of correctness as a demonstrable conclusion of a (private language) argument has, to my mind, itself conclusively been shown to fail as an argument in recent years (especially Law’s Five Private Language Arguments; also Schroeder).

The outline of this traditional (Hacker, Glock) interpretation goes something like this:

a) We can see that no operable criterion of correctness obtains for the use of 'S' despite the putative inner ostensive act.

b) Such a criterion is however required for the meaningful deployment of 'S'.

c) Therefore no actual ostensive definition can have occurred.

Depending on how it is elaborated, the difficulties said to obtain for the argument usually turn on an implausible implicit verificationism present in the demand that genuine ostensive definitions must result in operational criteria (e.g. samples, charts or measures) for the use of 'S' - or instead in (rather pointlessly) taking for granted what the private linguist is simply unlikely to accept, that criteria of correctness be of necessity publicly available (rather than available only to the private linguist). My purpose in outlining these matters here is not however to enter into a complex interpretative and logical discussion, but rather to provide a foil for the rather different interpretation of PI258ff in what follows.

Here are its broad outlines:

a) The inner world is marked as a non-normative domain, in so far as, of its very nature, there is here no scope for talk of: erroneous or correct inner judgements, a seems right / is right distinction, etc. (The 'Cartesian' idea that error in the inner world is impossible because of the clarity and distinctiveness of the deliverances of inner sense doesn't even get a look in. 'Grammar' (the logic of our concepts) has already taken care of the work of this putative inner faculty.)

b) practices such as ostensive definition, however, aim precisely to introduce or refine the meaning, and make for the normativity, of particular ostensively defined terms ('S').

c) There is therefore no possible place for ostensive definition in the inner.

In what follows the claim will be that the private linguist's resistance to such reminders is of a piece with his narcissism. The fantasy of being able to help oneself to both (i) the grammatically sanctioned certainties of subjective expression and (ii) the epistemic certainties of objective knowledge is, I shall suggest, of the very essence of narcissism itself. Wittgenstein’s struggle against his narcissistic inner voice is a perfect instance both of what is described in PI255: ‘The philosopher’s treatment of a question is like the treatment of an illness’, and of his ‘struggle to be anstandig (decent) … above all, overcoming the temptations presented by his pride and vanity to be dishonest.’ (Monk). The paragraphs following PI243 accordingly – I believe – constitute what in psychoanalysis would be called Wittgenstein’s working through of the narcissistic phantasy structure which pretends that one can reap the benefits of normativity (i.e. objective correctness, genuine empirical knowledge) without sacrificing the benefits of subjectivity (i.e. the inalienable authority of the genuine subject).

258 contains the first voicing of the key argument. The private linguist wants introspectively to define the term ‘S’ by inwardly concentrating on and pointing to a sensation arising within. Wittgenstein replies:
But “I impress it on myself” can only mean: this process brings it about that I remember the connexion right in the future. But in the present case I have no criterion of correctness. One would like to say: whatever is going to seem right to me is right. And that only means that here we can’t talk about ‘right’.
Many readings of this have, I believe, been led astray by the idea that ‘the present [our] case’ (unserm Falle) refers to a predicament peculiar to the private linguist, rather than to a feature of the quite general (subjective) context. If that (first option) were so, the most striking about the above passage would be its complete emptiness of any argument showing why and how the private linguist has failed in providing the requisite criterion. Yet substitute an acknowledgement that the inapt character of talk of correct judgement here is a function of the subjective context in general, and the argument becomes clear: Why (Wittgenstein is asking) is the private linguist aspiring to something (the founding of normativity) in a domain which, of its essential nature, repels the normative?

Let us get a fix for a moment on what it means to describe the subjective domain as (as I put it) ‘repelling the normative’. On an uncontentious understanding of Wittgenstein’s explication of selfhood, part of what is meant by talk of ‘being a subject’ and ‘subjectivity’ is that we do not normally leave it open to doubt that such a subject may think they are feeling happy, sad, pain – yet not be (hence PI258: ‘…whatever is going to seem right to me is right’… or far better: ‘here we can’t talk about ‘right’.’). (There are of course exceptional cases in which someone may be said to be self-deceiving even about occurrent feelings, cases of central importance for psychoanalysis; yet these are precisely cases in which his or her subject-hood is itself compromised. (Cf Cavell, MWM 264 (my italics): ‘to say that behaviour is expressive is … to say that in order not to express it he must suppress the behaviour, or twist it. And if he twists it far or often enough, he may lose possession of that region of the mind which that behaviour is expressing.’))

As a (grammatical) rule, to be a subject is to be treated as an authority on what one thinks or feels – an authority of a special sort, since one’s avowals of what one thinks or feels are authoritative in virtue of their being ‘transparent’ to – directly voicing, rather than correctly or incorrectly reporting on – the thoughts and feelings themselves (Finkelstein). After all, we do not typically report judgements on – express beliefs about – what we think and feel (since we normally just avow these thoughts and feelings directly). But even when we do treat ourselves in this somewhat self-alienated manner, the second-order beliefs which we thereby express are themselves presumably directly avowed, and therefore at least their articulation is not coherently describable as correct or incorrect (which is not to say that it is not coherently describable as true or false: truth and falsity one could say are functions of propositions; correctness and incorrectness functions of judgements).

There is of course nothing mysterious about this authority. It is due neither to a mysteriously incorrigible faculty of ‘inner sense’ (Kant), nor to a constructivist entitlement we are given to ex post facto ‘make up our own minds’ (Wright). It is rather a simple point of logic (‘a whole cloud of philosophy condensed into a drop of grammar’. (PI p. 222)): since an avowal of a feeling transparently voices that feeling, rather than (say) voicing a judgement about the feeling, it straightforwardly follows that talk of ‘correctness’ or ‘error’ is out of place when the avowal itself is what we are considering. What is avowed or expressed – if it is (say) a belief or judgement rather than an emotional feeling or sensation – may be correct or incorrect; the avowing itself will not be.

We achieve first-person authority to the extent that we achieve subjectivity: i.e. to the extent that we speak from (rather than about) our thoughts and feelings. What this means is that we cannot coherently be said to be ‘right’ or ‘wrong’ in our avowals, and what this in turn means is that the very idea of inscribing normative practices (i.e. practices the following of which can be described in terms of ‘right’ and ‘wrong’) through quasi-ostensive definitions in the intrapsychic context is a mere fantasy. The fantasy is however compelling precisely because, if it could be realised, it would amount to an idealised self-dependence: we could reap the harvests of inner authority whilst also not having to look outside the authoritative domain of the mind for the normative resources that are prerequisite for true knowledge. It is for this motivating reason, I believe, that Wittgenstein’s inner interlocutor does not easily relinquish his ambitions.

In 259 the interlocutor asks if there might not at least be a subjective version of normativity: perhaps ‘the rules of the private language [could take the form of] impressions of rules’. Wittgenstein’s natty reply is that ‘the balance on which impressions are weighed is not the impression of a balance.’ Working through the hold of the fantasy of (the very idea of) subjective normativity constitutes the work of several further passages. For example in 267 we have: ‘Suppose I want to justify the choice of dimensions for a bridge which I imagine to be building, by making loading tests on the material of the bridge in my imagination. This would, of course, be to imagine what is called justifying the choice of dimensions for a bridge.’ But, Wittgenstein ironically asks, ‘should we also call it justifying an imagined choice of dimensions?’ 265 contains a similar answer to the private linguist: to perform a normatively characterisable act in the imagination is to do nothing other than to imagine performing such an act. ‘Looking up a table in the imagination is no more looking up a table than the image of the result of an imagined experiment is the result of an experiment.’

What the psychoanalyst would call the ‘omnipotent’ allure of being both judge and judged, measurer and measured, nevertheless maintains a strong hold over the private linguist, a hold which reduces them to desperate measures. In 260 for example he asserts ‘Well, I believe that this is sensation S again’. Doesn’t the alleged fact of this belief at least guarantee that he must mean something by ‘S’? The answer of course is that the normative dimension of the use of ‘S’ is what gives any such assertion of belief its content – and not the other way around.

As the working through proceeds, Wittgenstein’s tone grows more confidently ironic. Hence in 268 he notes:
My right hand can write a deed of gift and my left hand a receipt. – But the further practical consequences would not be those of a gift. When the left hand has taken the money from the right, etc., we shall ask: “Well, and what of it?” And the same could be asked if a person had given himself a private definition of a word; I mean, if he has said the word to himself and at the same time has directed his attention to a sensation.
A two place relation that does work has collapsed into an otiose application. In 279 this is reduced to the even pithier: ‘Imagine someone saying “But I know how tall I am!” and laying his hand on top of his head to prove it.’ The fantasy (the 'picture') has finally lost its hold.

5. The Meaning of Narcissism

The private linguist hoped to be able to make for normativity by purely intrapsychic means. The fantasised rewards are clear: if he succeeded he would be able to help himself both to that authoritative incorrigibility which is the mark of subjectivity, yet also to the possibility of correctness, of genuine cognitive content, that is the mark of objective judgement. Such a subject would be self-satisfying in his knowledge, immune to error, closed to interrogation by others; his cognitive self-esteem would be second to none. In what follows I claim that this phantasy is the very heart of narcissism itself; the private linguist expresses narcissism as it manifests in an intellectual register, but the same wish to inscribe normativity within subjectivity is what constitutes narcissism in its emotional manifestations too.

I once witnessed an unpleasant exchange on the bus from London to Oxford. At the end of each day a preening young man manifesting a thick-skinned variety of narcissism talked on the phone, at length and at volume, to his partner. This had begun to irritate his regular fellow commuters. One of them finally confronted him, pointing out the notice on the bus window which asked passengers to keep phone calls short and quiet. The young man speedily and angrily shouted: ‘Who do you think you are to tell me what is too loud or too long?’, and carried right on with his obnoxious conversation.

This young man wanted to maintain a sense of his own entitlement, whilst at the same time refusing to submit to the authority of anyone other than himself to determine whether or not he was entitled. His angry response was so thought-stopping that no-one could reply with the obvious non-rhetorical answer ‘Well, I am a member of the general public’. In asserting here the propriety of that response I do not mean at all to sanction the viability of a reduction of normative content to the matter of how the general public tend to carry on (Kripke). The point is rather that what counts as too loud or long in a public context is precisely not something which any of us can determine within himself – as if (279) we were to place our hand on top of our head to affirm our knowledge of our own height.

A more honest response for the young man would have been to have turned his face against the idea of validation altogether: to say that he didn’t care a damn for the values in play regarding the making of phone calls. This however is where the narcissistic ‘solution’ comes in: with the idea that I can still be right in what I do whilst denying the say of anyone else regarding what is to count as right. When we are young – in the phase of ‘primary narcissism’ – this is precisely what is indulged in us. We decline (sensing its cruelty) to always hold the young child’s thoughts and actions accountable to those very same standards which at other times are nevertheless tacitly invoked to inform the meaningfulness of these thoughts and actions.

Secondary narcissism is the defensive pursuing of this strategy in later life, the strategy of having one’s own emotional cake and eating it. The narcissist cannot take the risk of authentically speaking from his own feelings, because then he would risk being found accountable in whom he himself is. Instead he tacitly authors a story for himself and others about his own life; and then lives, not out of his life, but out of his story which he endlessly rehearses. The imagined sphere of his authority is extended through the authorship of the story, but there is little real life – with its attendant doubts and wonders – here. The face that peers back from the narcissist’s mirror is cold and lifeless. The more that the narcissist attempts to ‘become his own object’ – the more that he holds himself accountable to and recognisable by what are really only ‘subjective standards’ (i.e. not actual standards) – the more lost and perverted[2] he becomes. 

The everyday concept of narcissism is of someone who is self-loving and apparently indifferent to others. The psychoanalytic concept aims to trace the various manifestations of narcissism – pathological self-preoccupation, inability to relate, treating others as means rather than as ends, self-defeating self-reliance, addictive self-soothing behaviours, etc. – to a deformation more in the form than in the contents of the narcissist’s mind. Narcissism places a kink in the subject’s capacity to give and receive acknowledgement and love. We may say with Freud that the narcissist substitutes his own ego as the object for his libidinal cathexes. What I am here suggesting this amounts to is an attitude which shows itself in a skew in the distribution of subjectivity and normativity in the narcissist’s self-understanding. The narcissist wishes to enhance his subjective authority whilst diminishing his need for objective recognition, thereby failing in the ethical challenge of acknowledging the two as correlative sides of the single coin of the personality. He eschews dependence on others, and all the creative, enriching, meaningful possibilities of this dependence. Humiliation is avoided by also avoiding that humility which is a necessary precondition for a genuine responsiveness to the other. In the place of object dependency is substituted a domain of quasi-pornographic, solipsistically deployed images which now only carry an echo of the meaning of that domain from which they have been tacitly lifted (cf Sass, Paradoxes of Delusion). The narcissist's defences are, like the insistent urgings of the private linguist, geared up to preserving the illusion of the independent determinacy of this land of shadows. 

6. Narcissism and the Metaphysical Impulse

To end let’s return again from psychoanalysis to philosophy. The example of philosophical narcissism pursued above was that of the private linguist who hoped to make room for normativity in the intrapsychic context. The narcissistic character of this is clear not only in the way he argues, but in what is argued for; it is this, I claimed, which allows us to take the distortions of the private linguist as shedding light on the meaning of narcissism itself. Accordingly we have to do with here more than cognitively-driven misunderstandings of the grammar of psychological discourse; instead we have emotionally motivated forms of self-misunderstanding which have their heart in our perennially failing attempts at tolerating having to purchase inner authority at the cost of outer responsibility.

But what of other forms of metaphysical puzzlement? Are these best understood simply and only along the cognitive-linguistic model – as e.g. grammatical propositions wearing empirical clothes? Or can we see Wittgenstein’s (or our own) other battles with the metaphysical impulse as further instances, in the intellectual register, of his (and our) ‘moral struggle … to be anstandig (decent)’ (Monk, 278)?

I see no reason to accept a universal answer to this, any more than to trace all actual psychopathology to either cognitive or motivational sources. Instead I will consider two aspects of metaphysical illnesses which seem to me to be narcissistic in character. Both concern what D Z Phillips (following Wittgenstein) called our disposition to (not merely misread, but to) 'sublime the logic of our language'. Where what 'sublimation' amounts to here is something like a tacit wrenching of a concept out of its conceptual home, followed by setting it up as an external measure of the ingredients of that home.

This becomes clearer with an example. We use the words 'real' or 'reality' to make a range of discriminations (real versus fake watches, real versus put-on emotional expressions, 'he behaved like a seargent major but in reality he was a dustman', etc.). There are what we might call the different kinds of reality or existence enjoyed by various phenomena: emotions, occupations, numbers, colours, shapes, physical objects (watches, artworks), money, etc. But if a philosopher comes along and sublimes the concept of 'reality', they may now start asking whether (even what within the local language games we take as paradigms of) smiles or primes or artworks or God or thoughts or colours or values or particules or stories or minds are 'actually real'. What it is to be 'real tout court', as it were, is not explained - and characteristically we are just supposed to intuit how to deploy the term in its decontextualised form.

Here is another example:  In the preface to his Principia, Newton reported that his physics aimed at the goal of determining the 'absolute' movements in space and time of celestial objects. By 'absolute' he means: not relative to a temporal or spatial frame of reference. For example, of a man on a ship, we may ask about the direction and velocity of his movement, but in reporting this we may fail to note that not only is he walking over the deck, but the ship itself is moving over the earth, and the earth is itself moving through space. From this we might (rightly) conclude that questions about motion are necessarily relative to frames of reference. Newton however, having 'sublimed' the concept of movement, (wrongly) takes it that there is a 'true' or 'absolute' movement to be had which is what we get when we take account not only of the man's movement over the ship, but also of the ship and the earth. Similarly when we think about measuring time: it will not do, if we are to follow Newton, to (rightly) stipulate one or another natural oscillation as a temporal frame of reference against which the phenomena of interest to us can be contrasted. Rather we should (wrongly) be able to determine the regularity or absolute duration of such measures themselves. (In order to perform both these moves Newton tacitly and incoherently attributes parts, or rates of flow, to space and time respectively themselves.)

The question remains: What is narcissistic about such acts of sublimation? As I see it there are two related aspects of such metaphysical tendencies to sublimation which betray the theorist's narcissism.

The first concerns the ambition to extract oneself from the world and to understand the phenomena we encounter from without. (The desire for context-transcending abstraction in itself is of course no bad thing - it is an essential component of thinking and theorising per se. What is incoherent however is when, with metaphysical hubris, we attempt to deploy thought outside of any context whatsoever (the 'view from nowhere' as Nagel calls it).

The second concerns the theorist's tacit arrogation to herself of the capacity to hold onto and vouchsafe the meaning and meaningfulness of her theoretical terms despite their being wrenched from those social contexts which (if she would but admit it) constitutively embed their deployment.

The psychological narcissist attempts to nourish themselves with their own love - yet love must always come from without for it to be psychologically transformative or nourishing. The private linguist indulges in the fantasy that he can make do with a subjective form of normativity to ground the meaningful deployment of the terms he introduces for his own use. More generally, the procedures of the philosophical narcissist reveal - in the very asking of his questions - his arrogation to his own mind of functions that can only be performed by socially and materially embedded discursive practices. 'I know what 'real' means all right' he says; 'What I want to know though is whether these [points to some trees which might normally function rather nicely as paradigms of 'real trees'] are real.' The narcissism consists in the tacit belief that one could, purely from within oneself, hold onto a meaning for the word 'real' despite its decontextualisation.

We could view a large part of Wittgenstein’s later philosophy as devoted to the task of persuading us that we do not after all know what we mean when we ask, say, the sceptical questions which beset us. The confident belief that we do know what we mean by our questions, but are just stuck for answers, and so must busy ourselves by ‘working on’ the theory of this or that, is a precondition of much metaphysical philosophy. It might then not be misleading to describe our coming to this ashamed yet therapeutic acknowledgement – that not only our theoretical answers, but even the questions which prompted them, fail to carry the sense we assumed they carried – as a prime intellectual example of that ‘frightful work’ of dismantling ‘the edifice of [our] pride’ (CV 30).[3]


[1] Both CBT and psychoanalysis investigate the irrationalities that lie at the heart of emotional suffering. To simplify greatly: CBT tends to trace the irrationality to inferential mistakes, whereas psychoanalysis views it as motivated by the avoidance of emotional pain. CBT, that is, looks to disturbances of mental, and psychoanalysis to disturbances of personality, functioning to explain environmentally unintelligible emotional distress. Fischer views Wittgenstein as unhelpfully constrained in his understanding of illness and therapy by the then unavailability of today’s cognitive theories of psychopathology. Like many clinicians I tend in my clinical work to use both models where appropriate; in this paper however I start to explore the rich resources of psychoanalysis for developing Wittgenstein’s understanding of philosophical illness and its therapy.
[2] Perverted: per vertere: turning away from what is genuine.
[3] This paper has been greatly improved by helpful comments in particular from Louise Braddock, and also from Sarah Richmond, Jim Hopkins and Edward Harcourt.