For anyone wanting to understand how psychoanalytic psychotherapy works from within the consulting room, this book is brilliant. Whilst telling the intimate and detailed stories of work with her patients (who have all consented to her doing so, of course), Dr Luepnitz also draws on and elucidates complex psychoanalytic concepts from Winnicott, Freud, and Lacan, without it feeling tacked on or dryly pedagogical.
It is quite clear that these concepts are no longer cloistered within psychoanalytic circles. I am sure that most experienced practitioners, of all psychotherapeutic types, are fully aware of and sensitive to the ‘transference’, ‘splitting’, and ‘projective identification’ dynamics (to name a few…) that arise in their therapeutic work.
But what I think makes this book so special is how it demonstrates how psychoanalytic work not only brought to light and labelled these processes, but how the bulk of its therapeutic power lies in directly working with and through those processes as they arise within the therapeutic encounter. Dr Luepnitz guides us through not only what happened in her work with her patients, but also gives us the most admirable and diligent example of self-reflexivity by the therapist. Nothing she felt, said, or did, with her clients was left un-considered. And we see in each example, especially, how precisely that care and thought that she gave these experiences was what lead to the therapeutic ‘breakthrough’ and resulted in significant benefit to the patient.
For an example, with a Black female patient called Pearl, Dr Luepnitz finds herself wanting to break her policy of requiring patients to pay for missed sessions, with the thought: ‘How can I charge this poor black woman?’, but with reflection she then realises that this was more of a counter-transference problem on her behalf, a ‘simple rescue fantasy,’ and not one that she should act on, for the mutual benefit of both parties. I will quote at length now, as I don’t think these dilemmas could be worded more clearly:
‘As we have seen in other cases, a “resistance” to making the unconscious conscious belongs to the therapist as well as to the patient. For both, there is a yes and a no, always. I saw my not charging Pearl as a bit of resistance to doing the work. That is, sensing that Pearl was expressing anger or resentment through her no-shows, I nonetheless chose to let them pass, rather than invite her criticism. It was an act of self-protection. […] All therapists at some moment with every patient construct a kind of protective lining to shield themselves from what is going on in the patient’s head. One wants to know and yet also does not want to know… Unique to psychoanalytic training is the emphasis on disciplining oneself to face rather than disavow one’s resistances.’ (193-194)
Undoubtedly, and as she herself admits at the beginning, the limitation to this case-study approach is that she’s only describing the ‘positive cases’. It is unlikely that someone who got no benefit from her treatment and had a terrible experience would then agree to her publishing the details of their analysis. So, this book doesn’t go any way in proving or even supporting the idea that psychoanalytic psychotherapy is better or worse than any other kind. But I think we all have much to learn by seeing such honest and detailed therapeutic work between such a remarkable analyst and her equally remarkable patients.
Though working in IAPT, a CBT-dominant mental health service, if you have read any of my posts before you’ll know that my temperament aligns far more naturally with the dynamic, interpersonal and exploratory therapeutic modalities. This means I often find myself in unpleasant moral dilemmas where I worry that I am short-changing my clients by sticking faithfully to the ‘Behavioural Activation Protocol’, but have zero other training that could better guide me with my clients.
So, I’ve started to read the textbooks of other psychotherapies, for some pointers of what kind of approach I have a better fit with, and to inspire ideas as to where my career path goes next…
The first book I’ve finished is Alessandra Lemma, Mary Target & Peter Fonagy’s Brief Dynamic Interpersonal Therapy: A Clinician’s Guide (2011), and it felt like balm to my CBT-crushed soul. The book is a treatment manual for practicing clinicians to deliver short-term, focussed, psychodynamic therapy for complex cases of depression and anxiety. (And they define short-term as 16 sessions! What would they call my 6 thirty-minute IAPT sessions I wonder?).
This is an interesting concept, because psychodynamic clinicians are usually allergic to manuals and time-constraints, seeing the complexity and variety of human nature as bound to doom any standardised approach to failure.
There are three key points about this kind of therapy that make it far more appealing to me than CBT.
Firstly, the importance given to interpersonal processes, both past and present. DIT structures itself around an Interpersonal-Affective Focus (IPAF), which it does by identifying one dominant and recurring unconscious interpersonal pattern. For example, an individual might find that, for whatever reason, they tend to see themselves as ‘a flawed woman’ and significant others as ‘critical and superior’, which, played out enough times in various relationships, would quite naturally lead to depressive symptoms. The logic behind this is the idea that because we are social animals that depend so strongly on others, most forms of psychological distress will likely be caused by, and then maintained, in some disrupted interpersonal functioning. Maybe we experience some form of interpersonal trauma, which then makes us fearful of getting emotionally close to someone, so we withdraw, but then feel lonely and depressed. From my limited clinical experience thus far, it does seem like the vast majority of psychological distress is usually due to, or resulting in, problems in relationships. Because of this focus, a key DIT technique involves working within the transference relationship, as this is a ‘live’ relationship in which those patterns are likely to surface, and hence can be a useful place to begin exploring those patterns in a safe and non-judgemental space.
Second, the attention to affect. To most fruitfully use the transference and countertransference processes that occur within the therapeutic relationship, DIT takes a far more detailed and exploratory approach to the individual’s affect on a moment-by-moment basis during the sessions, as these affects are likely to give important clues about their interpersonal patterns. The thought here is that the better able we are at identifying our affects, the more control we will have over them in future, as we might be able to shift the perspective and not get so wrapped up in the more automatic/unconscious affective patterns that might otherwise control us.
And third, the move away from symptoms and towards a more holistic view of what makes a life worth living. (The absence of symptoms does not a meaningful life make!) DIT understands symptoms as existing further along the line from where the problem started. Symptoms, such as anxiety or panic, might be manifestations of faulty interpersonal/affective patterns as they are enacted in situations that are not well suited to them, so are more like the tip of the iceberg. CBT approaches tend to treat panic symptoms as if that were the only thing going on in that person’s internal world (they might well be), whereas psychodynamic approaches are more interested in why and how that symptom started. They attend more to an individual’s underlying personality structure, which typically might not even bring a person into therapy in the first place (most of us take our personality as a given). The idea here is that by working at the deeper levels of human psychology, the therapeutic benefits will hopefully be more long-lasting, as the anxiety or panic won’t just pop up later on in another form. I think this narrow attention of CBT on presenting symptoms only, especially the low-intensity CBT in IAPT, might explain the 50% relapse rates (within a year) of the clients who ‘recover’. And we must not forget that those clients who ‘recover’ are only ~50% of those ‘completing’ treatment.
I’ll finish this post with a quote from the book summarising the main aims of DIT, being to:
‘Identify what he/she feels, encouraging the patient to stay with a current feeling as it emerges in the session.
Communicate what he/she feels more effectively.
Build greater facility in connecting his/her feelings, thoughts, and actions, and how these relate to others’ internal states and behaviour.
The therapist thus strives to help the patient to identify the way in which his/her feelings are guided by the particular self and other representation that is activated in a given relationship. The patient’s conscious affect, though important given that this is what the patient feel’s troubled by … may yet conceal latent affect that may be even more disturbing to the patient.’ (pg. 158).
This book is divided into two parts. The first part is an autobiographical account of Viktor Frankl’s time in concentration camps during the second World War, and the second part is a more academic exposition of the type of psychotherapy that he created, Logotherapy.
He begins the book with an admission that ‘This book does not claim to be an account of the facts’, which is an interesting start, given that I think most people opening a book about the Holocaust are going into it prepared to be smacked in the face with some cold hard truths, and (hopefully) a willingness to take the survivors’ at their word. My comment isn’t to suggest that Frankl is painting a fictional picture, but he is reminding us that even factual accounts of events, especially those involving immense suffering, will always be shot through with the strong emotions colouring a first-person account. Which makes it then all the more surprising, and initially disorienting, to find in the pages that follow an absence of emotion, to the point where it can feel quite like watching a scientist observing the facts. This is soon explained however, when Frankl writes that: ‘Cold curiosity predominated in even in Auschwitz, somehow detaching the mind from its surroundings, which came to be regarded with a kind of objectivity’ (29). He describes this as a self-preservation mechanism, and we come closer to understanding just what happens at the limit of human cruelty and suffering experienced in concentration camps all over the world.
What the book goes on to teach us, is that positive transformation can be achieved even through the most horrendous experiences of suffering. This is a hard idea to take. Our immediate reaction might be to reject that kind of inhumane suffering forthright as an absolute evil (which it is), but what Frankl pushes us to confront is the possibility that so long as someone is still alive, there is still hope. Something can be made of the situation, even if it is only a kind of ‘spiritual’ and inner transformation. And what he wants us to take from that fact, those of us so far from having any comparable kind of experience of hardship, is that our experiences of difficulty can also be transformed into something meaningful and positive. This is another surprising move of the book – as we might feel uncomfortable trying to place the two different kinds of suffering side by side in this way – especially when ours might feel trivial in comparison.
But that is exactly what he asks us to do, to use his experience as something we can learn from to live our lives in more meaningful ways. And this is how we arrive at Part 2, on Logotherapy, which is a therapy designed to help the individual discover, and live by, the unique meaning that they can create for their lives. Frankl explains that there are three different ways we can discover meaning: ‘(1) by creating a work or doing a deed; (2) by experiencing something or encountering someone; and (3) by the attitude we take toward unavoidable suffering’ (155). (Note the importance of the word ‘unavoidable’ to qualify suffering here, Frankl is adamant that self-inflicted suffering is masochism, without the potential for self-actualization). Where logotherapy differs from Freudian psychoanalysis is that according to Logotherapy, ‘man’s search for meaning is the primary motivation in his life and not a “secondary rationalisation” of instinctual drives’ (105), and this has close links with Nietzsche’s idea of the will to power – but Frankl edits the phrase to will to meaning.
The first way we discover meaning, ‘creating a work or doing a deed’, is fairly self-explanatory and well-established, so Frankl doesn’t dwell on it. The second, ‘experiencing something or encountering someone’, Frankl explains by delving into the meaning of love: ‘Love is the only way to grasp another human being in the innermost core of his personality … by his love, the loving person enables the beloved person to actualise these potentialities’ (116). I think it is still an open question as to whether this kind of ‘therapeutic’ love can exist within a psychotherapeutic relationship (my inclination is towards the negative), but that’s something I’ll write about in a future post. It sounds like Frankl is talking predominantly about real-world love experiences here, so maybe he’d agree with me. The third way to find meaning, ‘through suffering,’ is what Part 1 had described for us, as he was somehow able to transform his experience of suffering into something with meaning. However, I would like to tentatively suggest that perhaps point 1 (‘creating a work or doing a deed’) also has a role to play in what enabled Frankl to find meaning through suffering (point 3). From what we learn in the autobiographical part of his book, it seems as though Frankl’s role as a doctor towards the end of his time in the camps was at least partially what helped him survive, both physically and psychologically. At one point, given the chance to escape, Frankl decides to stay in the camp hospital and tend to his dying patients.
I like the idea of life as guided by those three ways of creating meaning: Works and deeds, experiences and relationships, and the strength to try to step back from our suffering to see what good can come of it, even if that might only be an increased ability to empathise.
I’ll finish by sharing some of my favourite quotes from the book:
‘Yes, a man can get used to anything, but do not ask us how.’ (30)
‘An abnormal reaction to an abnormal situation is normal behaviour.’ (32)
‘A thought transfixed me: for the first time in my life I saw the truth as it is set into song by so many poets, proclaimed as the final wisdom by so many thinkers. The truth – that love is the ultimate and highest goal to which man can aspire.’ (49)
‘This intensification of inner life helped the prisoner find a refuge from the emptiness, desolation and spiritual poverty of his experience, by letting him escape into the past.’ (50)
‘Humour was another of the soul’s weapons in the fight for self-preservation. It is well known that humour, more than anything else in the human make-up, can afford an aloofness and an ability to rise above any situation, even if only for a few seconds.’ (54)
‘Suffering completely fills the human soul and conscious mind, no matter whether the suffering is great or little. Therefore the “size” of human suffering is absolutely relative. It also follows that a very trifling thing can cause the greatest of joys.’ (55)
‘No man should judge unless he asks himself in absolute honesty whether in a similar situation he might not have done the same.’ (58)
‘The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity – even under the most difficult circumstances – to add deeper meaning to his life.’ (76)
‘It is a peculiarity of man that he can only live by looking to the future – sub specie aeternitatis.’ (81)
‘Thus it can seem that mental health is based on a certain degree of tension, the tension between what one has already achieved and what one still ought to accomplish […] What man actually needs is not a tensionless state but rather the striving and struggling for a worthwhile goal, a freely chosen task. What he needs is not the discharge or tension at any cost but the call of a potential meaning waiting to be fulfilled by him.’ (110)
This book is filled with wisdom, and I think it would be helpful for any mental health professional working with adolescents (regardless of their preferred brand of therapeutic approach) so I’ll attempt to summarise its main points:
The Freudian psychoanalysts were wrong to treat adolescence as primarily a return to infantile id drives/impulses (only with different conflicts against a more strongly developed superego), and instead it should be seen on its own terms, as a distinct developmental period. We should take the transformations of puberty and the tumultuousness of the experience as meaningful in itself, and with its own progressive functions (telos), rather than as some kind of a backward step. And to do this we should use a phenomenological approach, staying close to the actual experiences of adolescents, rather than theoretically hypothesising what we think is happening…
The best starting point for understanding adolescence is seeing it as time of paradox and conflict – the adolescent is pulled in both ways at once: back towards its childhood, but also towards adulthood and the wider social world (beyond the family unit). This paradoxical position, or point of tension, defines what it is like to be an adolescent. Adolescents are both a child and an adult at once, and they are constantly negotiating between the archetypes representing these: the puer (youth) and the senex (older adult). What I think Frankel takes from Donald Winnicott is also the idea that the boldness and bravery of adolescence is something society needs as a creative and refreshing force; we should appreciate their ‘fierce and stubborn morality’ and their way of refusing ‘false solutions’. Winnicott wrote somewhere that ‘Infinite potential is youth’s precious and fleeting possession’. What typically society tends to dislike about adolescence is something that we should rather appreciate and value in itself – ‘Could we imagine that the instinctual turmoil of adolescence creates a special sensitivity and receptivity to the world and that this can manifest in the pleasure with which ideas are entertained, engaged and undertaken?’ (98)
Adolescents in our era have a particularly difficult time also because there are no, or few, community-organised initiatory rites designed to mark the transition period. Primitive societies usually did have some kind of ritual/initiation designed to mark the young person’s entry into the adult world, which meant that it could be a fairly quick and organised process. Frankel quotes Michael Ventura here: ‘Tribal adults didn’t run from this moment in their children as we do; they celebrated it. They would assault their adolescents with, quite literally, holy terror: rituals that had been kept secret from the young till that moment – rituals that focused upon the young all the light and darkness of their tribe’s collective psyche, all its sense of mystery, all its questions, and all the stories told both to contain and answer those questions’ (69). Because these initiatory rites are an ‘archetypal human need’, our adolescents can’t just skip them, but rather must invent a kind of replacement for these community-organised ones on their own, and evidence of their attempts can be seen in youth gang culture, self-mutilation, substance-abuse, and impulsive/risky sexual behaviour.
Frankel offers Jung’s insights as more helpful and relevant to working with adolescents than Freud’s, primarily because Jung sees the self as a ‘self-regulating system’ (5), in contrast to Freud’s Id which is always in need of externally-imposed prohibitory forces. If parents and clinicians of adolescents remember that the best way to stop someone – particularly an adolescent – doing something unhelpful is to speak to with their own ‘inhibitory’ sense, and get them to arrive at the desire not to do it themselves (rather than simply acting as that external prohibitory force), then they’ll be better able to help them.
Final point that I want to share is Frankel’s suggestion that art and cultural artefacts should have a much larger role to play in clinical work with adolescents. In connection to the idea that inhibitory forces must be engaged with adolescents having a particularly difficult time, Frankel writes that: ‘The inhibition of action produces imagination. Experiencing an inhibition is feeling into the imaginative pattern that contains the impulse towards action. Engaging an instinctual impulse imaginally, feeling where it is rooted in the body, may reduce the need literally to take action. Thus imagination is one of the most effective tools we have in working with adolescents who are prone to impulsive behaviour.’ (169) In order to connect meaningfully with adolescents, we must be prepared to meet them on their own level, which might not necessarily be the ‘literal’ adult world. We must instead stay empathetically attuned to the deeper meanings in their narratives – and art might provide that fruitful meeting-ground.
If a book had the power to redeem 2020 for me, this one would be it. It’s so refreshing to read a book that manages to change your mindset or show you old things in a new and surprising way, and this one succeeds at both. At the same time, the book gave form and substance to ideas that had been floating around my mind since my disillusionment with psychology (as it is typically taught) during my undergraduate degree and beyond. It reminded me of one of my favourite quotes of Montaigne: ‘We are all patchwork, and so shapeless and diverse in composition that each bit, each moment, plays its own game.’
James Hillman was a psychologist and Jungian psychotherapist who founded the movement of ‘archetypal psychology’. The approach is an invigorating blend of philosophy, religion, myth, art, history, classicism, literature, depth psychology, rhetoric, and more…
The general idea of the book – if it could be summarised easily, which it cannot – is that we humans are both myth-makers and made-by-myths. There is not one ‘I’ within us that directs and controls us, nor something so coherent as an ‘ego’ à la Freud. Hillman complains that ‘diversification of personality, and its differentiation and vivification have been suppressed. “Integration of personality” has become the moral task of psychotherapeutics.’ (2) Instead, we are better thought of as a composite of various mythical archetypes or Gods that have been carried through culture down the ages, and at times we are led by some more than others. Some situations call for certain Gods rather than others, as all are characters each with their own strengths and weaknesses, and a distinct way-of-being. Before I go further, it is worth noting that none of this should be taken literally – literalism is one of the most insidious culprits that Hillman identifies as holding too much power in our era, and that is why he relies on the Ancient Greek mythical personas as the ‘archetypes’ that govern our soul. Hillman defines archetypes in a helpful way for those of us unfamiliar with Jung’s work, as ‘the deepest patterns of psychic functioning, the roots of the soul governing the perspectives we have of ourselves and the world.’ (xix).
For psychology to return to ‘the soul’, we must remain cognizant of the power each of these various Gods holds within ourselves and allow each space to exist freely, and in relation with the others. That is the benefit of both dreams and pathologies, both give voice to the characters that typically we may suppress when we aim for an integrated (but false) ‘wholeness’ under the ego or subjective ‘I’. I found this idea hugely liberating, and therapeutic in itself somehow. Thinking of our psychopathologies as means through which our internal ‘Gods’ are communicating with us to alert us to some kind of mis-alignment either within ourselves, or between ourselves and our environment, felt novel and comforting. The idea lets us both try to cure or resolve the conflict while allowing us to accept it on its own terms. His own words capturing the role our psychopathologies play are more bombastic, which makes for far more exciting reading: ‘do not forgive me the means by which the divine powers connect and become real: my complexes, which are my sacrifices to these powers … Forgiveness of the confusions in which I am submerged, the wounds that give me eyes to see with, the errant and renegade in my behaviour, blots out the Gods’ main route of access.’ (186)
Hillman’s approach in general also aligned with my feeling that psychology as a discipline had lost some of the creativity that is necessary to capture the immense complexity and richness that each of us hold within us. That was precisely why I turned to studying literature at postgraduate level after my undergraduate degree in psychology – and I was unsurprised to find that Hillman too had an academic background in literature. But literature and the arts are by no means the only disciplines that can enrich psychology, psychology can only gain by incorporating concepts and approaches from other disciplines, if only because humans (with other interests) are its subject.
There is far more in the book than I can adequately capture in one post, so I do really urge you to find a copy of this book and read it for yourselves.
This ground-breaking work revises traditional understandings of schizophrenia as ‘a form of encroaching dementia, regression, or dominance by instinct and the irrational’ and instead views it as ‘involving unusual forms of self-consciousness together with associated alienation and withdrawal – not only from the surrounding world and other human beings, but also from one’s own thoughts, feelings, and bodily presence.’ (Preface).
It is a work of ‘comparative phenomenology,’ which uses modernist art and literature as a tool to help us better understand schizophrenia. By placing both next to each other, Sass draws out some striking similarities to illuminate a potential logic that might underpin them both.
Sass argues that both modernist art and schizophrenia can be understood as evidencing ‘hyperreflexivity’ and a concomitant ‘alienation’. The range of material that he covers, and the detailed analyses of case studies of individuals with schizophrenia, make this book a brilliant attempt at better understanding a mental disorder that has, since its conception, baffled psychiatrists and researchers.
My own academic background is in both psychology and literature, so I was extremely excited to see the disciplines used productively together to help us understand, phenomenologically, madness – and, by bringing its opposite into relief, sanity as well. Sass doesn’t try to explain the aetiology of schizophrenia, other than gesturing towards the likely conclusion that it will involve several primary and secondary factors, in unpredictable combinations, and this is a good thing. His aim is to understand, rather than explain, and this book does a fantastic job in making sense of symptoms and behaviours that have typically been distinctive by their complete incomprehensibility. I thoroughly recommend this book to anyone interested in phenomenological psychopathology and/or modernist art.
I’d be very interested to know whether any other scholar has attempted a study of contemporary, 21st century art and thought, in its relation to another form of madness? It seems that Sass is right in identifying the parallels between 20th century modernist art and schizophrenia, but times have changed, and I wonder what the contemporary parallel could be? The present day has moved interestingly away from the ‘modernist/postmodernist’ zeitgeist that Sass studied, into new territory, and I think one deserving the same kind of scrutiny that Sass gave the 20th century!
‘There are two widespread human characteristics which are responsible for the fact that the regulations of civilization can only be maintained by a certain degree of coercion – namely, that men are not spontaneously fond of work and that arguments are of no avail against their passions.’ (8)
I don’t agree with the above quote, I would counter that human beings are spontaneously fond of meaningful work, and that there are countless examples of men forgoing passion for legitimate reasons.
‘So long as a person’s early years are influenced not only be a sexual inhibition of thought but also by a religious inhibition and by a loyal inhibition derived from this, we cannot really tell what in fact he is like.’ (48)
Civilization and its Discontents (1930)
‘If we want to represent historical sequence in spatial terms we can only do it by juxtaposition in space: the same space cannot have two different contents. Our attempt seems to be an idle game. It has only one justification. It shows us how far we are from mastering the characteristics of mental life by representing them in pictorial terms.’ (71)
^ This quote felt relevant as an argument against the reductionist drive to explain everything in terms of neuroscience! But I’m probably stretching it a little...
‘Happiness, in the reduced sense in which we recognise it at possible, is a problem of the economics of the libido. There is no golden rule which applies to everyone: every man must find out for himself in what particular fashion he can be saved.’ (83)
‘In this respect civilization behaves towards sexuality as a people or a stratum of its population does which has subjected another one to its exploitation.’ (104)
The following two pessimistic quotes I am sorry to say that I think he’s right:
‘In abolishing private property we deprive the human love of aggression of one of its instruments, certainly a strong one, though certainly not the strongest; but we have in no way altered the differences in power and influence which are misused by aggressiveness, nor have we altered anything in its nature. Aggressiveness was not created by property.’ (113).
‘It is always possible to bind together a considerable number of people in love, so long as there are other people left over to receive the manifestations of their aggressiveness.’ (114)
‘And now, I think, the meaning of the evolution of civilization is no longer obscure to us. It must present the struggle between Eros and Death, between the instinct of life and the instinct of destruction, as it works itself out in the human species. This struggle is what all life essentially consists of, and the evolution of civilization may therefore be simply described as the struggle for life of the human species. And it is this battle of the giants that our nurse-maids try to appease with their lullaby about Heaven.’ (122)
‘Just as a planet revolves around a central body as well as rotating on its own axis, so the human individual takes part in the course of development of mankind at the same time as he pursues his own path in life.’ (141)
[This blog captures my initial thoughts while reading Louis Sass’s chapter in Wittgenstein, Theory and the Arts (eds. R. Allen & M. Turvey), titled: ‘Wittgenstein, Freud, and the Nature of Psychoanalytic Explanation’. The bracketed page numbers are from that book.]
Louis Sass begins by acknowledging the complex relationship Wittgenstein seemed to have with Freud and the Psychoanalytic method. Wittgenstein valued the profundity of Freud’s discoveries about the human unconscious, but disagreed with Freud’s attempt to transform this theory into a scientific, deterministic, enterprise: ‘What Wittgenstein criticises, then, is not the adopting of such frameworks but only the tendency – which he discerns in Freud and various philosophers – to mistake the frameworks themselves for something in the nature of empirical assertions or discoveries.’ (260).
While theorising explanations of human action, Wittgenstein distinguishes between causes and reasons, claiming that both partake of entirely different ‘language games’. Causes establish empirical correlations, while reasons are used to rationalize or see the point of our own or others actions, and can therefore take only an ad hoc form.
Sass writes that Freud generally portrayed himself as a scientist pursuing causes for phenomena. ‘But Wittgenstein suggests that Freud’s actual methods are, in fact, more akin to those of an aesthetic investigator who puts things side by side or strives to give a good simile, as when a critic of literature or art seeks agreements to the aptness of certain comparisons or tries to sum up a complex artistic work or effect in a succinct expression.’ (261).
‘For Wittgenstein, a key difference between causes and reasons seems to be that, whereas causal explanation operates in the third-person realm of objective or objectifiable reality, there is something more first-person about the nature of reasons, some way in which reasons are intimately connected with the point of view of the person whose action is being accounted for.’ (262)
I wonder whether this ‘something more first-person about the nature of reasons’ can be elucidated using Polanyi’s conception of tacit knowledge (which he says underlies all forms of knowing), or whether they are incompatible positions? Polanyi writes that: ‘Our body is the ultimate instrument of all our external knowledge, whether intellectual or practical. In all our waking moments we are relying on our awareness of contacts of our body with things outside for attending to these things.’ (Loc. 322 in Kindle book ‘The Tacit Dimension’). Sounding much like a phenomenologist, he is saying that because we are bodily beings, all of our reasons (and much else) will have this ‘first-person nature’. Polanyi interestingly qualifies that this does not necessarily make them ‘subjective,’ but that is a topic for another post.
(As a side note: There seems to be ongoing debate as to whether this tacit element has much explanatory value, and might not be worth being scrapped, sticking instead with the anti-private language approach that Wittgenstein puts forward. See Tim Thornton’s chapter in The Oxford Handbook to the Philosophy of Psychiatry which compares Wittgenstein and Polanyi and concludes that Polanyi’s tacit knowledge is better conceptualised as ‘context-dependent knowing’, leaving out much of the tacit bit.)
Back to Sass – The biggest difficulty for bringing together Wittgenstein and psychoanalysis is Wittgenstein’s emphasis that self-ascriptions are sufficient and do not require any grounding, or private, introspective access to ‘inner’ mental states; whereas psychoanalysis is of course all about those private inner mental states… (Polanyi would presumably be on the side of the psychoanalysts here).
Sass emphasises that even if Wittgenstein is suggesting that no causes can be given for motives, we shouldn’t take this in a postmodernist, sceptical or relativistic fashion. To make this point he enlists the help of a philosopher personally acquainted with Wittgenstein, Freidrich Waismann, who, in his essay ‘Will and Motive’ describes a way we can understand motives as something between a ’cause’ and a ‘reason’. This treats motives as a ‘family-resemblance’ concept that has no clear boundaries (276), and is able to encompass two extremes: the cause (lawlike) and the purpose (constituted within).
Waismann acknowledges the inherent difficulty in disciplines such as psychology (and philosophy) because of the fact that ‘our ordinary concepts are too rigid’ (qtd in Sass 277), ‘we need something looser, more indefinite … In order to describe the mental we need a language that is just as flexible; which, of course, runs counter to our usual way of thinking.’
And it is here that Sass neatly brings back mention of aesthetics: ‘The project of understanding motivation – one’s own or that of another – also has much in common with that of artistic representation or appreciation, for it is something that demands active, imaginative interpretation or an attitude of subtle, connoisseur-like discernment toward the world.’ (278) Understanding motives is like understanding aesthetic patterns but this does not lead us to subjectivism in a postmodernist way, nor to pure behaviourism. (Here Sass also references Merleau-Ponty on ‘reciprocal expression’ which I have made a note to follow up in future reading).
(Earlier in the chapter Sass mentioned Wittgenstein’s notion of ‘Seeing-as’ or ‘Aspect-seeing’, which is when we can see something in a new way, while knowing that it itself has not changed (274). I always think of art’s ability to provoke this in us…)
I love the quote from Waismann that follows so I will quote it at length: ‘There really is something like digging down to deeper layers, becoming more truthful, struggling passionately, while things become clearer and clearer. There is undoubtedly such a process of plumbing the depths in which one penetrates to one’s innermost motives. So things are not entirely subjective; there is truth after all. And yet! When we want to put our finger on it, it will not stand up; when we look more closely at it, it looks different again. It is an interpretation and yet something more than an interpretation, knowledge and yet not quite knowledge: what are we dealing with? […] We require a composite concept that combines “knowing, acknowledging and interpreting. For fathoming a motive touches on all three”.’ (279, and 136 in Waismann.)
Sass concludes by summarising his two main points. What Wittgenstein and Freud have remarkably in common is their shared ideal of clarity. Wittgenstein says so much by explicitly comparing his method to psychoanalysis: ‘It is a principal function of philosophy to warn against false analogies. To warn against the false analogies which lie embedded in our forms of expression without our being fully conscious of them. I believe our method here resembles psychoanalysis which also makes conscious the unconscious and thereby renders it harmless, and I believe that this resemblance is not purely superficial. (Wittgenstein manuscript 109, 174)’ (Sass 280). (But couldn’t you say that surely most philosophers share this ideal? I imagine that even a rouge philosopher wanting to deliberately complicate our understanding of the world would be doing so in order to make that complexity clearer in some way?)
Where Wittgenstein and Freud most drastically differ, though, relates to Wittgenstein’s second ideal of ‘awe or wonder’. Freud’s method towards greater understanding of the the human psyche was driven by the desire for scientific objectivism. This was anathema to Wittgenstein, who repeatedly argued that we should remain aware of the limits of scientific knowledge, and not try to cross those lines. Wittgenstein wanted us to avoid rationalising things into generalisations or too-clear pictures. Sass quotes Wittgenstein earlier in the chapter: ‘And may we not advance any kind of theory … We must do away with all explanation, and description alone must take its place.’ (273) And of course his most famous quote encapsulates this sentiment: “Whereof one cannot speak, thereof one must be silent.” (Tractatus)
It’s somewhat ironic now that Freud is treated more seriously in humanities/arts disciplines than the sciences, and Wittgenstein’s (lay) reputation remembers predominantly his dry and methodological treatment of how we use ordinary language rather than his mysticism; but I think that is precisely the richness and value of both thinkers – both occupy an ambiguous space between two extreme camps, and can’t easily settle into either, as they themselves well knew.
Final thought – I think this is also why I am so interested in Michael Polanyi’s work at the moment, because he seems to have tried to build a comprehensive theory explaining why sciences and the humanities aren’t diametrically opposed projects at all, an idea he also lived by.
During times of crises, one might think that we would be reminded of the triviality of our small, personal problems, but I think that one of the many things that the current Covid-19 pandemic has taught us is that our human responses aren’t always so rational. Over the last two weeks, as the severity of the situation has made itself more and more apparent, I have observed myself alternating between fear and anxiety for the wider issues: a global recession, hundreds of thousands of deaths, what this will do to our human propensity for us- and them- distinctions; and then my own little worries: will my boyfriend still like me after potentially 3 months apart? What will I do if I get a toothache?
It seems that no matter how vast the problem, we (or at least I) still find it difficult to put our own concerns into perspective. What I try to bear in mind though, is that the big picture is made up of these tiny elements, interactions, worries. It is a pandemic precisely because we all will feel the effects of this disaster. Grand events are made up of millions of littler ones. And, of course, I remind myself that my problems are nothing compared to what hundreds of thousands, more likely millions, will have to go through as a result of this virus.
By Grand Central Station I Sat Down and Wept, an autobiographical account of the author’s affair with a married man (the poet George Barker, with whom she had four children), is a perfect study of how the events in our lives, when personally and emotionally significant, can become amplified to grandiose proportions. Comparable to, and even eclipsing, some of the twentieth century’s most horrific events.
The narrator is intelligent enough to know that the comparisons she makes are, in fact, incomparable, that millions of people being sent to gas chambers is not even on the same scale of suffering as one woman’s heartbreak; and yet, she seems to suggest a closer relation between the two. What the text seems to suggest, by weaving the personal and the historical together (reminiscent of Sylvia Plath’s equally brutal poem, ‘Daddy’), is that one makes sense because of the other. These are grand tragedies precisely because those people going into the gas chambers are people’s lovers, husbands, wives, children. If it wasn’t for the love experienced by individuals and groups, what would those traumas, in fact, be breaking?
She also suggests that it is the minute, everyday pleasures and pains that justifies everything else. Since life is undeniably hard, and filled with trials and disappointments, we must not forget how to cherish what is most precious to us. Even, or especially when, it feels like everything else is falling apart.
This wonderful book does a vital job in reminding us to keep our perspective flexible, stay able to appreciate both the small and the significant, and to never lose sight of the small things that matter to us when we have them. It is a book about loss, and sadly, the only thing we seem to be increasingly certain of right now is that this virus will mean many of us will experience loss before it’s time. I hope her beautiful language might provide some comfort to those of us feeling claustrophobic and isolated right now, whether our losses are temporary or permanent.
‘O I understand too well how we are all Lot’s wife, looking back, under our heroic loving faces. But is nothing irrefutable? Is no fact impregnable? Is there no once-in-a-billion years’ bull’s-eye worth even the slaughter of decisive action? Our passion by the ice pond forced the sun into sight. It has rocked orphans to sleep and thickened the heart of the new-made cabinboy. Heathcliff’s look bored a hole through England which generations of heather on the wild moor never erased. Give me my faith in the one fact, and I can cure cancer and gossip and war. Give me the fact, and then I would cut off my hands and give them to her to comfort her for an hour. Injure me, betray me, but only make me sure of the love, for all day and all night, away from him and with him, everywhere and always, that is my gravity, and the apples (which ben ripe in my gardayne) fall only towards that.’ (100)
I am wary of the word ‘radical’. It feels brash, idealistic, even aggressive, somehow. Maybe it’s just been overused, it seemed to crop up everywhere during my Masters degree, attempting to appeal to some sort of youthful optimism – ‘this is radical! new! you young people will love it! a complete overhaul will happen right away and it’ll be fantastic!’ – and precisely because it was everywhere, it seemed to disprove itself. The word radical became mundane, so I stopped trusting it.
It might have also become too strongly associated with the political left, as in ‘radical socialism’, and I’m still hurting from the labour party’s bitter defeat at the recent General Election. I too was blissfully caught up in the London-centric media bubble that made us optimistically believe Corbyn might actually win. The reality hit home painfully hard that we still very much live in a conservative country, and it is only to our detriment that we forget or ignore that fact.
But, I understand why Hilary Cottam named her recent book Radical Help. Her whole argument is that drastic solutions are necessary, and they are the only hope we have left if we want to save our welfare system. I broadly agree with her on this, but at the same time, I can’t help but feel that we might not succeed if we frame our argument in these terms. Quite simply, people do not like radical change, and I think (from my limited knowledge, so please correct me), history seems to suggest that slower and gradual solutions are a bit easier to take, and therefore more likely to succeed in the long run. Even shifts that seem radical in hindsight are probably more likely the result of multiple gradual causes coming together and reacting in some lucky way, rather than a genuinely novel and unprecedented ‘pivot’.
Anyway, there are many things I liked about this book. It is clearly written, inspiring, informative, and it covers a lot of ground. Hilary Cottam is a social activist and designer with an academic background in economics and history, and she has made it her mission to reduce inequality and fight social injustice. You can really feel the drive and determination that has propelled Cottam in her work, and as my mother reflected, the world would be a far better place if more politicians had these hopes and ambitions…
In the first part of the book, Cottam describes 5 experiments that she and her team designed and ran, all focusing on different populations and using different methods, but with the shared aim of increasing 4 main ‘capabilities’ of individuals that she thinks are vital to living a good life: learning/work, health/vitality, community and relationships.
Her team work by first identifying a problem, then by getting deep into the matter by immersing themselves practically with the issue at hand (speaking to people, living with them, actively listening to them), then they design a prototype and run it straight away, starting small and then hoping to grow bigger and bigger.
Here’s a quick summary of the 5 experiments: Experiment 1: ‘Life’ worked by inviting families who are experiencing a variety of difficulties to participate, then they selected a team of service workers who were focused on helping the family to help themselves, those teams discussed amongst themselves best ways forward, and the Life family took an active role in making a practical plan of what their goals are and how they could go about achieving them. Experiment 2: ‘Loops’ joined young people with managers and workers at companies/organisations related to their interests, hoping that they would form relationships with adults who could then work as ‘mentors’. This project failed and was stopped for potentially being dangerous to the young people. One of my first queries was, are these young people essentially working for free? And also, I thought this was a bit too idealistic because she imagined that life-changing mentor-relationships were easy to spark, which is unlikely to be the case… Experiment 3: ‘Backr’ was an alternative to the JobCentre approach, and essentially was a MeetUp Group trying to unite unemployed people with others, plus some employed people, in the hope that someone might tell someone else of an opportunity that otherwise they wouldn’t have heard of. The rationale behind this one was that most jobs these days aren’t advertised but are found via word-of-mouth, so we just need people from different backgrounds getting together and discussing job opportunities more openly. Experiment 4: ‘Wellogram’ focused on patients who had been informally classified as ‘heart-sink’ patients, who were suffering from a number of problems, and invited their doctors to come together to discuss each case. It was an attempt to see the patient’s whole life, rather than each little problem divorced from its wider context, in an attempt to understand the root causes better. Experiment 5: ‘Circle’ was a technology-based attempt to bring together older individuals so that they could help each other with tasks that needed doing, because some will have capabilities that others won’t, allowing everyone to feel like a ‘helper’ rather than someone who is in need.
What I loved about her approach in each of the experiments was her fearlessness of failure. Too many development projects are run which are too scared of failing, so they rely on methods that have been used far too many times before, and no longer yield novel or unexpected insights. Straight out, Cottam acknowledges that mistakes will be made, wrong avenues taken, but she decided early on that the best way of learning is by trying, so what seems like a big mistake is actually the best way to learn.
Her main findings from all of the experiments seem to be that it’s best to start small and locally, really understanding the people and problems you are working with; people need to be ‘helped to help themselves’, not made dependent on aid; and that the most important of her 4 capabilities is relationships, what the welfare state needs to facilitate is strong bonds between people so that resources can be shared, rather than more money in the wrong places.
I agree with all of these sentiments. But, I have some criticisms (of course) that I’d like to think through…
The first, and obvious one, is that small projects are much easier than large ones. It’s easy to provide thoughtful and time-effective help when you are working with fewer people, as soon as systems get larger they automatically become more cumbersome and inefficient. Her hope is that these programs would grow organically, and that they would actually become more efficient as more people joined (because, more relationships mean more resource sharing) and she argued that ‘our capacity for relationships is infinite’. But I’m afraid I don’t agree. We obviously can’t have infinite relationships, there simply isn’t time in the day nor mental space. All of her projects, thought focusing on different populations, seemed to boil down to a kind of ‘Meet Up Group’, which was facilitated by a ‘reflector’ (or, what I thought was more like a therapist). If people with similar interests but different backgrounds are brought together, helpful connections will be made. And it works best when those people join actively as agents, rather than join feeling like they need to passively receive help from their group. This seems obvious? But it’s also obvious that bigger groups get less personal, so less meaningful, they become a crowd; and, it’s also actually quite difficult to get people involved in this way. We, especially Brits, are quite embarrassed to go to ‘Meet Ups’.
Another point of contention was that many of her projects relied on a therapist-style role, someone who knows when to step forward to offer help to the person needing it, but also when to step back and let them work it out on their own. This role was holistic, and was designed to see the individual being helped as a person with hopes, dreams and wishes of their own, rather than the specialist approach that we have at the moment (with various roles all focused on solving one specific ‘need’ or problem in an individual’s life, rather than concentrating on how to reach potentials) where none of the service providers actually get a good sense of the individual. While I totally agree with the problematic nature of Multi-disciplinary Teams that we have going on at the moment, because so much time is wasted with trying to share information across all the members involved, how are we supposed to get one person to focus and know it all? That, essentially, is a therapist dedicated to each individual needing help, and if we could do that financially, we would.
Finally, after finishing the book, and in writing the summaries of the experiments for this post, I realised that her projects weren’t really that novel or ‘radical’. What Life and Wellogram tried to do was encourage the many service providers to discuss each individual case in more depth, so that they could make a more comprehensive plan of how to help. This is what the welfare system already tries to do, but it is literally impossible to provide that kind of focussed attention on each individual. That’s why we have so many online databases and attempts to share information across services, which is exactly why the system feels cumbersome, and why so much time is wasted on admin. And in the other 3 experiments, the main idea was to form groups around similar interests but different backgrounds, hoping to forge friendships across people to get them to help each other rather than rely on services. These are both good ideas, but they are difficult to implement precisely because they are good when they are not enforced from above, which is what she acknowledges herself!
So, to conclude, I wholeheartedly admire her approach and ambitions. I think it’s vital that innovative and bold individuals try out new projects, methods, designs; because we need to learn practically, and in the real world. Having done from academia to the NHS as a support worker, I see and feel acutely the huge gap between thinking about helping people, to actually trying to do it.
I also totally agree with her conclusions – the fact that what is needed is not (just) more money, but that we also need to make the sharing of resources and connections more efficient. We live in a very well-off country with enough to go round for everyone, the problem is mainly to do with inequality of distribution. We need to forge connections, so we desperately need to value the power of supportive relationships and bring them into our welfare system. We need to stop thinking of individuals who need to be ‘helped’ or ‘cured’ alone by taking a pill or just telling them to exercise more. Cures work best when they are social, because we are social animals and are formed by the groups we are part of.
But, I’m not quite sure that she has designed viable ways of reaching these conclusions yet in any large scale. I think her projects were interesting and moderately successful predominantly because they were small, but I doubt her when she says that they could be organically grown and remain as useful. She may have slightly underestimated the difficulty of growing groups and projects… Having said that, she probably knows far more about it than I do, and probably goes into a lot more detail in her reports, as this book is supposed to be a summary rather than a detailed explanation. So I should read her project reports before I make too sudden a judgement, but that was my inkling.
Has anyone else read this book, and if so, what did you think?