Wittgenstein and Psychotherapy

From Paradox to Wonder

J. Heaton

• Editore: Palgrave Macmillan
• Anno: 2014
• ISBN:
  9781137367693
• Argomento: Psychology
• Categoria: Clinical Psychology

Using the work of Wittgenstein, John Heaton challenges the notion of theoretical expertise on the mind, arguing for a new understanding of therapy as an attempt by patients to express themselves in an effort to see and say what has not been said or seen, and accept that the world is not as fixed as they are constituting it.

1

Introduction

It is becoming increasingly clear that causal models of understanding mental distress, involving assumed faulty mechanisms and processes in the mind or brain, do not yield results consistent with evidence-based medicine. After decades of biological research we have learned much about the brain but little that is relevant about the whys and wherefores of mental distress. In psychotherapy no clear pattern of superiority for any one treatment has emerged. What emerges is that the placebo effect, the quality of the relationship between therapist and patient, and other non-specific factors are what are important. The theories held by the therapist may be important to her but are of little relevance to the effectiveness of the treatment. Similarly in cognitive-behaviour therapy (CBT): most of its specific features can be dispensed with, without adversely effecting outcome (Editorial, 2012; Bracken et al., 2012; Linden, 2013 pp. 166–7).

Biological psychiatry studies the brain using various functional techniques such as neuroimaging, molecular genetics and epigenetics. But we humans are not just brains, we are apes that speak. Speech for us is not just one of the things we can do, but is central to our lives. There would be no science or biological psychiatry if we could not speak. Speaking depends not only on our brains but also on the quality of our initiation into language. We have to be trained to make sense. But this initiation may be very imperfect. There is a vast amount of evidence of the importance of care-taking in infants and children. Many children learn more nonsense than sense.

In this book I return to a traditional understanding of mental distress. That is, what is central is a lack of reason in some part of our life or a loss of reason in madness. The nature of reason, of sanity, the way we operate with words to make sense or fail to, are central themes. The evidence for the effectiveness of therapy is not empirical, nor does it depend on the value we put on the pictures we are prone to believe with their limited satisfaction and manifold frustrations. The evidence lies in whether therapist and patient can make sense or not, their mutual sanity, which involves recognizing the limits of reason.

In a recent book on the philosophy of mind Hacker wrote that the central concern of the Philosophical Investigations was with the nature of linguistic representation (Hacker, 2012). Thus, Philosophical Investigations start with a long discussion on how children come to learn to speak and make sense. It delves deeply into how we learn to operate with words and the ways we are tempted to misunderstand the workings of our language and form false pictures of psychological phenomena; for example, that we humans ‘have’ a mind and a body each with a particular structure. Therefore we raise the question as to how we use words in practice instead of giving theoretical accounts of phenomena based on pictures and models. Psychotherapy cannot escape the words and concepts that make it possible. By going back to the roots of how we make sense we may come to see the place of pictures in understanding the way psychological concepts function. By this means the paradoxes and despairs that characterize much of our psychological life may be dissolved.

In empirical science we discover facts about physical objects but in psychotherapy we can only become cognizant of the mind, mental processes, the self, consciousness, feelings, when we can use psychological language. A child has to be able to express her feelings, perceptions, thoughts, before she can develop a concept of the mind, inner world, and mental processes. Psychological language does not make sense because non-sensory ‘things’ like the mind, internal objects, consciousness, existed before psychoanalysts. Rather we can only understand models of the mind because we can use psychological language. The heart of psychotherapy is not theories of the mind but concrete problems as to how we make sense or fail to. In this way it is similar to mathematics, where before we can make sense of mathematical objects and create new ones, we have to be able to use mathematical language.

I will seek to show that therapy should not be in the business of making new discoveries about the mind, behaviour, or relationships, but be concerned with paying attention to, and reminding people of, how they make, or fail to make, sense. We easily lose touch with the ground on which we stand and from which we grew and this can lead to suffering. We may descend into forms of reflective thought detached from our life. In neurosis and psychosis thoughts and words have become disengaged from the needs and desires that have given them their meaning, having lost contact with the world they sought to illuminate. We need reminders of what we have overlooked in our scramble to go beyond ourselves, out of our skin and into unhelpful ideal pictures of our minds.

Psychotherapy, understood as a talking cure, is an exploratory, non-dogmatic practice in which people are helped to free themselves from the constraining effects of idealized pictures of the relation between language, thought, and reality. In neurosis and psychosis reason appears to be constricting. Reason becomes opposed to unreason: reason appears limiting – the manacles of reason, the stones of the Law – and unreason the way to liberation and expressing oneself. Consciousness is unimportant and ordinary whereas the unconscious is what rules us and is where all the excitement lies. These tempting over-simplifications need to be overcome by reminders of the subtleties of actual language use. Attempts at further theory construction are not a creative response but compound the original confusions.

In the talking cure we show that people have developed confused pictures of reason because thinking, for them, has become exclusively contrastive, a matter of agreement and disagreement, so no wonder they struggle to become free of it. Following Wittgenstein and others, we are attentive to how we learn to recognize sense and reason. If we have had a very ‘unreasonable’ upbringing, we may create pictures of reason and believe them. A picture of reason is not the same as recognizing it. Pictures are created by us and can only show the limitations of reason, the notion of reason becomes a contrastive one.

Understanding reason involves recognizing the inner limits of reason and thought. A limit, in this sense, is set by the essential nature which it limits. This notion is not contrastive. There is nothing thought-like or rational excluded if we understand the limits of reason. Limitations, on the other hand, do involve contrast and many understand reason in that way. They imagine there is a boundary between what is reasonable and what is not. So there are hundreds of theories in psychotherapy, each claiming to be the most reasonable.

An illogical thought is an illusion, it lacks sense, it is not a thought. To say something illogical is a failure to say anything. When we act irrationally our actions do not measure up to what we say. But they may be understood as performing, seeking attention, being a nuisance, expressing our despair. Thus, someone complains that they do not feel loved and then tell me that they fall in love with someone new nearly every month. They have not got the measure of being cared for and loved. We are finite discursive beings who must use reason to come to terms with reality but cannot in that way possess it. There can be no definitive account of the limits of reason as it makes no sense to articulate it. It shows itself in sane thought, word, and action (Moore, 2013).

Wittgenstein wrote: ‘The limits of language manifests itself in the impossibility of describing the fact that corresponds to (is the translation of) a sentence without simply repeating the sentence’. (CV, p. 13)

In the talking cure we pay particular attention to modes of experience and reflections on counterfactual and paradoxical modes of meaning that are not susceptible to systematic verbal knowledge and theorizing. They are un-thematic but hold the possibility of a more complete understanding of what it is to be human. For when we are confused about reason we lose the ordinary felt unity and coherence of our life. Certain experiences, or perhaps our life, do not make sense. But it is impossible to specify into sentences just what sense we feel they ought to make. There are no rules we must follow to make sense of our life or anyone else’s, yet rule following is a basic human activity.

We are concerned with the competing claims of specific discursive practices. In the sciences strict rule following is important as is disinterestedly observing entities. In contrast, practices such as ordinary living, the arts and crafts, are not so rule bound and entities requiring disinterested observation are not relevant. Thus, observing many people making love or writing poetry does not necessarily lead to one being a good lover or poet. Practices must be timely and appropriate, like play, otherwise they become a dead letter, or merely a record of past method. There is a great danger in valuing truth independently of how it is received; as if we can possess truth by just going along with what has been asserted. Truth then can become a commodity that can be immediately grasped and stated, which we can buy and consume. Truth becomes a poison. Thus, the Sophists offered their truths for sale whereas Socrates was a lover of truth, he never claimed to possess or sell it, for what we love we cannot possess. Roughly speaking, Socrates, the Cynics, Pyrrhonian sceptics, Erasmus, Montaigne, Nietzsche, Kierkegaard, Heidegger, Wittgenstein, were particularly attentive to reminding us of the importance of timing and context in truth telling.

Montaigne’s writing is a good example. His ‘Essays’, literally ‘Trials’ or ‘Soundings’, are reflections on himself and his life. He was a gentleman, not a scholar, who knew the ways of diplomacy and the realities of the battlefield. He was concerned to understand the nature of man and thought that the way to that was to understand himself in the living of his life. He portrayed himself in all truth – his difficulties, triumphs, illnesses, travels, sexuality, and his lifelong mourning for the early death of his closest friend. For him pride was the sin of sins. He emphasised that there is a plague on Man: the opinion that he knows something.

Montaigne’s style of writing was not academic; he was not informing people about his discoveries and their importance, he left the reader to make their own judgements. He depicted the mind’s elusive wanderings, the way thoughts flow through the mind. He showed this in his digressions, in the shape of his sentences, his metaphorical habits, and how such ‘entities’ as the self emerge and disappear in the texture of writing. So he is very difficult to pin down. His reflections are thought experiments rather than propositions about some entity or statements of some particular position. For him, the way to understand man (and woman) is in movement, in play, amidst life, rather than examining them in isolation, on the couch, as if they were things in themselves and we could not be wrong about them.

I am unable to stabilise my subject: It staggers confusedly along with a natural drunkenness. I catch it as it is now, at this moment when I am lingering over it. I am not portraying being but becoming: This is a register of varied and changing occurrences, of ideas which are unresolved and, when needs be, contradictory, either because I myself have become different or because I grasp hold of different attributes or aspects of my subjects. (Montaigne, 1991, pp. 907–8)

Nor did he try to explain ‘relationships’, ‘object relations’ in psychoanalytic jargon. Speaking of his close friend:

If you press me to say why I loved him, I feel that it can only be expressed by replying: ‘Because it was him: because it was me’. Mediating this union there was, beyond all my reasoning, beyond all I can say specifically about it, some inexplicable force of destiny. (Montaigne, 1991, p. 212)

Montaigne works with the fundamental messiness of human experience. He has only a partial, incomplete apprehension of the events to which he attends; and the subject himself, Montaigne, no more reveals himself as a whole than do any objects. In no way does the subject stand above or in opposition to its objects. What is notable is that there is an overarching unity to his writing and engagement with his life.

Montaigne’s thought and practice was deeply influenced, not only by the Stoics and Epicureans, but by Greek Pyrrhonism, which developed from its founder – Pyrrho of Elis – in the fourth century BCE. He developed it from the Indian sages – possibly the Kalakarama Sutta given by the Buddha to the Greeks – when he visited India with Alexander the Great. It is notable that physicians used to be very interested in scepticism and Sextus Empiricus, one of the most important sceptics, was a practicing physician. The sceptics were concerned with the evidence for beliefs and theories, especially when they interfered with happiness and well-being. The spread of dogmatism in psychiatry, especially in the various forms of psychoanalysis, is due to the neglect of the sceptical tradition in psychiatry and psychology (Bett, 2010; Perin, 2010).

The modern philosopher who is closest to Pyrrhonian scepticism is Wittgenstein, as has been pointed out by many scholars (Fogelin, 1987; Palmer, 2004; Stern, 2004; Nordman, 2005; Kuzminski, 2008; Heaton, 2010). There is no evidence, however, that he had read Montaigne or the ancient Greek Pyrrhonists. He wrote:

I might say: if the place I want to reach could only be climbed up to by a ladder, I would give up trying to get there. For the place to which I really have to go is one that I must actually be at already. (CV, p. 10)

What philosophy requires is:

a resignation but one of feeling, not of intellect. And maybe that is what makes it so difficult for many. It can be difficult not to use an expression, just as it is difficult to hold back tears, or an outburst of rage … . What makes a subject difficult to understand … is the antithesis between understanding the subject and what most people want to see. Because of this the very things that are most obvious can be the most difficult to understand. (BT, p. 300)

The Socratic and Cynics questioning of common opinion, the Pyrrhonian suspension of judgement, Horace’s indirectness and humorous detachment in his Satires and Epistles, Montaigne’s ‘I know not’, Kierkegaard’s concept of dread as a door to authentic truth, are all examples of the restraint basic to understanding and are in contrast to the enthusiasm, hero worship, and propaganda that accompany many psychological therapies.

In a therapy attentive to the dangers of what we want to see, attention and resignation are more relevant than ambitiously making observations, speculations, and following goals of cure, especially when it is never made clear as to what cure and normality are. We do not aim to make additions to our stock of knowledge but remove misconceptions; this is the sceptical way.

One must start out with error and convert it into truth.

That is, one must reveal the source of error, otherwise hearing the truth won’t do any good. The truth cannot force its way in when something else is occupying its place.

To convince someone of the truth, it is not enough to state it, but rather one must find the path from error to truth. (PO, p. 119)

The family of concepts that are important are not discoveries, inferences, speculations, but concepts such as realizing, recognizing, appreciating, remembering. Each is something that happens in the context of what is already known; none requires knowledge acquired elsewhere; and they usually strike us or dawn on us and maybe sink in. Therapy is more like play, in that to converse and play depends on the common willingness of the participants to lend themselves to the emergence of something else: to be played or to fall into a conversation. Therapy based on a series of subjective acts like observing, discovering, inferring, speculating, theorizing, is to generalize rather than acting therapeutically. Rather the participants need to surrender to the play of therapy, knowing that she is only playing but not knowing exactly what she ‘knows’ in knowing that.

There are not merely objective problems in therapy that can be directly tackled, therapy itself needs questioning. Thus, some assume that therapy must be based on scientific principles, others that its aim should be to get people back to work as efficiently as possible, others that it should help people live authentically, others that its aim is happiness. Furthermore there may be a conflict between what the patient thinks is therapeutic and the therapist’s view. The patient may want to get back to work while the therapist is more concerned with authenticity; therapist and patient may disagree on what constitutes authenticity. Human pain and despair is held in place by a whole range of problems. If we shine light on one side, it casts long shadows on the other side. We cannot take our method of therapy at face value as there will always be un-thought elements that emerge in the process of therapy.

For we can avoid unfairness or vacuity in our assertions only by presenting the model as what it is, as an object of comparison – as a sort of yardstick; not as a preconception to which reality must correspond. (The dogmatism into which we fall so easily in doing philosophy) (PI, p. 131)

Most psychotherapies describe a particular point of view on the conflicts and despair of people, having a picture of their troubles, which depend on the desires and interests of the founder of the therapy. There is a failure to take into account that the linguistic and conceptual form of an enquiry dictates in advance the sort of answers one will receive. Psychotherapists may be confused as to the nature of reason, driven by phantasies, saying things that only appear to make sense. They may be driven by an anticipation of meaning, an expectation that guides the effort to understand, understanding depends then on wanting to understand. With their subjective consciousness and naïve understanding of language, psychotherapists all too readily assume that speech and texts simply state what is ‘there’.

Therapists usually have little interest in the problem of how both they and we come to understand. Some claim to be scientists and empiricists and have traditional empiricist views of how we acquire and justify our knowledge. They ignore the criticisms of the empirical myth that sense experience can, by itself, be an example of knowledge and conscious experience made by Kant, Frege, Russell, Wittgenstein, Sellars, and others (Sellars, 1997). Freud and Jung were part of the popular movement of modernity and enlightenment starting in the nineteenth century. They encouraged the idealization of themselves and their theories and were skilled publicists of them. They rarely questioned their own desires, their subjective acts of observing, discovering, and inferring and so, to a greater or lesser extent, their subjective-centred reason coloured their therapy. Instead of making sober, modest attempts to clarify what we know and do not know, as in genuine science; they idealized the scientific method and so led the way to the frantic exploitation of the imagined known.

Therapists both from the analytic tradition and the cognitive tradition usually assume that by basing psychotherapy on what they conceive to be the scientific method is to make a huge and permanent advance in the treatment of human mental pain. Science advances because of our ability to discover new objects and processes, coin new names for them, and so make new theories and record them. Modern science is more advanced than ancient science because it has built on the discoveries o...

Indice dei contenuti

• Cover
• Title Page
• Copyright
• Contents
• Preface
• Acknowledgements
• List of Abbreviations
• 1. Introduction
• 2. Paradoxes
• 3. Scientism
• 4. Logic and Meaning
• 5. Initiate Learning
• 6. The Self and I
• 7. Trust and Wonder
• References
• Index