This week, the IMH Blog is pleased to introduce blogger Dr Richard Gipps, Charted Clinical Psychologist. Richard’s blog, Philosophical Perspectives in Clinical Psychology, covers a range of topics including philosophical issues in psychology, psychotherapy and psychopathology, and engaging clients ‘with genuine and fruitful solicitude’. We encourage you to have a read and check out other posts from his site.
The post below, entitled ‘Neurotic theories of neurosis‘ was originally posted on 10 November 2012.
Here’s a hunch: That our theories of neurosis are sometimes rather radically constrained by the ways in which neurosis neurotically invites us to understand it, and by the ways in which we neurotically respond to the invitation.
Here’s a rather simple example to get us going: Geoff says he is ‘falling apart’, struggling to ‘hold himself together’, is worried he is going to ‘lose control’. Ah right, so must we think that the healthy person is one who manages to hold himself together, who is in control of his feelings? But isn’t just this precisely the hubristic idea at the heart of neurotic disorder: that we ought to be managing our feelings, actively holding ourselves together? The idea that this is what mental health amounts to is, it seems to me, clearly absurd – and yet it is all too easy to start thinking this way when we heed the invitation to understand neurosis in a neurotic manner.
What do we have to do with here? In truth it is actually the neurotic person (i.e., admittedly, pretty much all of us some of the time) who tries to keep ‘in control’, who is managing not to ‘fall apart’. For when all really is going well for us we surely aren’t best described as in the business of ‘remaining in control’ or ‘keeping it together’. That instead is what we do when we are beset by an inner conflict but manage not to show it.
When we are not neurotic we are not beset by an inner conflict; and so, because we are integrated, we have no need for control. When instead I am relaxedly myself then there is no need for me to manage anything inwardly. When all is going well we don’t have to do with, say, ego and id and superego in tension with one another (cf Jonathan Lear on Love and its Place in Nature). We aren’t trying to control unacceptable urges. The patient may come to the doctor because they want help with ‘managing their feelings’; the doctor’s job, however, is to point out the patient’s hidden premise: that feelings need to be managed – to point out that this hidden premise is precisely what is causing the argument not to go through.
Or consider anxious depression. We are often enough encouraged to try to manage our depression, to look after ourselves. In an anxious depression I lose trust that my life will work out as I hope. I become hopeless. My life, one could say, becomes a predicament. But it surely isn’t that, when things are going well for me, it is because I am managing my feelings better, that I am finding reasons to be cheerful, that I am running on hope.
When I am not anxiously depressed I am instead not focused on my own emotional processes, not anxiously thrown back on myself. Instead of thinking ‘how today shall I manage my depression’ I might instead think ‘and how today shall I live, what can I do to live today in the best (most integral, moral, helpful, meaningful) way I know how?’ ‘What responsibilities to others and to myself do I have the opportunity to discharge?’ Depression throws us out of our lives and back in on ourselves. It may seem to be merely inviting us to understand it as a condition – but what is really happening is that we are being invited to understand ourselves as beings who are conditioned. It invokes a passive, causal, language in which the subject is a being now beset by their own feelings, bodies, thoughts, circumstances. The language of agency and genuine subjectivity goes missing. Depression invites us to suppose that what we need to do is to ‘manage our minds’, a challenge which is best left unheeded by anyone who still aspires to genuine subjectivity. (Buber: ‘So long as the heaven of Thou is spread out over me, the winds of causality cower at my heels, and the whirlpool of fate stays its course.’)
Just as neurosis invites us to understand it neurotically, thereby sucking us in to the neurotic predicament, psychosis invites us to understand it psychotically. We see this in certain theories of ‘made’ thought, feeling and action. …’Ah, what these phenomena (e.g. thought insertion) reveal is that my everyday self-ascriptions of thoughts and feelings actually have a hidden dual character – such that I recognise the thoughts yet must also attribute them to my self.’… But, honestly, can you imagine a more psychotic conception of our allegedly healthy first person aptitudes? Normal thoughts and feelings suddenly become, on this theory, states that obtain in me and which I must recognise for what they are, and recognise as a product of my own psyche. Having a thought suddenly psychotically implicates me in having some kind of inner entity present to my mind. This theory of mind psychotically splits the thinker apart from the thought.
Or consider schizophrenic delusion. Here we have, I would submit, a radical failure of what the analyst’s call ‘symbolism’ – the capacity to find the mot juste to voice, give tractable form to, the feelingful inner life. Instead of the expressive and integrative life of symbol formation the patient offers us a descriptive and explanatory discourse concerning something that is happening to them: this narrative is the crystallisation of the delusion, the patch over the rent in the ego. But then, to make matters worse, the psychologist offers us a theory of delusion as a matter of a subject coming to mistaken explanations about what is going on for them – as if having an explanation here was just fine, it just being the content of the explanation in question which is the problem. (The psychologist, after all, is likely to imagine that we are positioned in the world as sense makers – beings puzzled by their surroundings engaged in their own individual projects of figuring them out. Funny how such an innocent-sounding idea can end up obliterating so much of what is important in being human – such as being someone sensitive to senses and meanings that are already there, sensitive in virtue of their being-in-the-world rather than because of any cognitive endeavours undertaken.)
Or consider PTSD. We are so often invited to think that the problem is as the patient describes: that the problem is that they are having traumatic memories which ‘intrude’ on their consciousness, memories that are not under their control. (Let me be clear: this indeed is a good description for what is experienced: the question concerns what the goodness of the description consists in.) It is as if we are being invited to choose between a conception of memory as happening to us and a conception of it as actively undertaken. But neither of these are normally the case. Rather I, the subject, am of a piece with the flow of my memory which is not (apart from rarely) engaged in in any kind of willed manner. Speaking for myself, I seem to spend a fair bit of my day quite happily in a state of associative daydream; this it seems to me is entirely normal and perfectly healthy. And during this time I quite often recall some of the deeply shocking or upsetting things that have happened to me or to those I love. I do not ‘will’ those memories, since I very rarely, basically never, will any of my memories. The traumas of my life are condensation nuclei around which associative chains cluster; sometimes I must shake myself out of these, but they pass quickly in any case, and this is just normal memory doing its normal thing. A neurotically ill mind, however, may be dissociated from its own memories, unable to bear their affective charge, and the memories will now appear as intrusions, as thrust upon them. It may be these memory intrusions for which they seek help. Now it’s bad enough if I start to construe my memories as ego-alien, to feel them as thrust on me – but now imagine that a cognitive psychologist came along to theorise the whole issue with an mechanised and entified view of memory as a matter of having inner states or processes going on inside us. Or some other mechanistic psychologist (NLP anyone?) suggests that the way forward is in substituting certain ‘cognitions’ for others. Where would be then? (Well: we’d be where we too often find ourselves.)
When we are neurotic it is hard for us to escape, since our every framing thought of the escape route is constructed out of the fabric of the neurotic trap. As if that wasn’t bad enough, it is also all too easy for the clinician to now start to theorise the project of not being neurotic in a neurotic way, to try to help the patient ‘manage their mind’. To use a rather ACT-ish metaphor: the patient asks the clinician to help him find ways to quell or avoid what he takes to be the monster threatening to break down the door of the room in which the patient is hunkered down. Now we clinicians know perfectly well that if the patient were to find the courage to open, rather than push against, this door, the alleged monster would then saunter in and out by himself and in the process shrink down to a much more tolerable size. The patient could also come to see that the monster was nothing but himself. Well, I say we know this perfectly well. But then again, when we theorise, or practice in an overly theory-driven way, it is something which it seems to me is all too easy to forget.
Dr Richard Gipps
Charted Clinical Psychologist