Monday, 14 August 2017

cognition versus recognition

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

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

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

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

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

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

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

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

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