Autochthony Versus the World

Autochthony Versus the World-View of Alterity (Otherness)
-Possible Implications for contemporary Mental Health Practice and the Mental Health Client as Reluctant Philosopher-

Loray Daws, Ph.D.

Mental health as relational area contains the calling forth of a unique sort of engagement and management between the individual and his or her mental health practitioner. It is unfortunate that contemporary mental health practice sees a greater emphasis on calculative explanation ala Heidegger, objectivism, fear of the mental health patient, growing ‘state’ vigilance, ‘control’ of deviant behavior, and greater reliance on bio-medical approaches favoring non-humanist ethics. The latter has given rise to an inflation of treatment protocols, manualized treatment, complex health care ‘rules’ and ‘regulations’, actively removing human to human interaction, the very interaction needed to support the Other. In this essay special attention will be given to the concept of Autochthony versus the World-View of Alterity (Otherness), the reality of ‘psychiatric management’, the possible use and abuse of diagnosis as related to identity, and the wisdom of client’s verbalizations as signs to problems in living.
Keywords: Autochthony, alterity, psychoanalysis, dual track theory, ethics, reluctant philosopher

Contemporary mental health carries the burden of man’s psychological pain, his traumatic psychological heritage, and even his most creative expressions and failures to attend to this very suffering. Finding the various reasons for psychic pain has seen the creation of various interpretational and notational systems- from demon possession theories, witchcraft concerns, one sided biologism, and a multitude of psychological and sociological explanations- all valid expressions of our capacity to construct symbols in representing psychic difficulty. Modern mental health practice personifies the complex relationship between man’s native self as well as his relationship with the Other (alterity). This very relationship is central to healing, although extremely vulnerable to misunderstanding and misuse. The contact between the mental health practitioner and the mental health client will be approached in this essay within a critical dialogical unfolding of the ever present Autochthony ‘drive’ (†) versus the world-view of Alterity (‡) (Otherness). It is hoped that the discussion will emphasize the importance of remaining faithful to the notion that the mental health client remains particularly sensitive (and gives accurate feedback) to (‡), even more so to the frequent misunderstandings and misrecognition that occurs between (†) and (‡). (†) under the sway of cumulative life stressors as well as misrecognition engendered within the discourse of Alterity (‡) (Otherness) may give rise to an estrangement akin to Dasein-icide (du Bose, 2009) exposing the client to the most primitive of agonies. Verbatim transcripts as well as poetry and literature will be used to express the impact of one sided (‡) on (†), that is, the impact of colonization of the native self. I will open my dialogue with two clients diagnosed with bipolar disorder, and their relationship toward themselves as well as the Other (i.e., family, mental health professionals etc.).

Minding Jane
Jane consulted my practice with a diagnosis of bipolar disorder and has been making many changes, slowly and painfully adjusting to her medication and the diagnosis itself. Her psychotherapeutic and psychiatric process has had many implications for her, especially for her relationships with her family, and according to her various ‘consistently’ related narratives, backed by her husband and the psychiatrist, Jane’s family seems loath to accept both psychological or psychiatric “thinking” concerning her difficulties in mood. It would also seem that the psychiatrist, a sensitive and thoughtful Seelsorger (Care of soul), had his own difficulties ‘convincing’ the mother, in the client’s presence, about the ‘validity’ of such thinking. When the psychiatrist pointed out various double- bind communications between the mother and Jane, Jane’s mother only reported an inability to ‘understand’ the very reality of the debate, leaving both Jane and the psychiatrist uncertain as to why. It can be argued, if not interpreted, that Jane’s mother had her own inabilities that supported obstinate approaches to Jane’s predicament making it difficult to successfully ‘know’ something of the ‘reality’ of her daughter’s bipolarity, for reasons unknown to me as participant observer (till much later in the therapy ). Jane’s father also seems to interpret her difficulties in living “just” as a “bad attitude” in need of “correction”; “Whatever I feel, since I can remember, it gets interpreted like that. Makes me feel so depressed, as if I am a burden, a difficulty…” Feeling understood within her family of origin seemed a remote possibility for Jane.
Back to the present and after deciding to relocate cities, Jane requested her medical files as she had to consult a new physician. Jane received her file and noticed many references to previous ‘contacts’ she had with the medical system to access services, pre-bipolar as well as post bi-polar, with the aim of helping her with her depression. Reading her file Jane discovered that various service providers described her as being “borderline”. Now, accurate or not – their observations became part of a very complicated and emotionally painful discussion with me. During our conversation, initiated by Jane as she was confused by the description and its relationship with bipolarity, I explained to Jane the various research results and the work of Akiskal (in Maj, Akiskal, Lopez-Ibor, & Sartorius, 2002) on bipolarity, as well as Greenspan’s developmental model (1989), and indirectly my own (Daws, 2011). Discussing the content of the conversation and the approach taken is beyond the scope of the paper although it can be said I take a very optimistic developmental approach since it is scientific verifiable and non-stigmatizing (see Daws, 2011). Jane seemed to take my thoughts seriously although my explanations did not seem to sooth the “upset-ness” of the information to her sense of self, the mental pain of knowing that others now may come to know and think of her in a very specific way—a way she had never thought of, or conceptualized herself as exclusively, i.e, as “bad” and in need of further “correction” ; Here are parts of the session verbatim,
“I have difficulty thinking of myself – the fact that I went for help and its interpreted like that…It makes me doubt myself, the way I see things, that makes things worse for me… I am grappling with the borderline thing. Resent it…it’s just [quiet, struggling] (Me: Let me know what’s on your mind when you are ready Jane)…The intake nurse, it is when I went to look for therapy, before seeing the psychiatrist, and before you were recommended. She wrote the Borderline thing, although I thought I was being rational, reasonable, I could only get 5 sessions! I said that was not enough, she gave me two options, short- term counseling, or a psychiatrist. I was reasonable and rational, I was recommended mental health, and only 2 options! In 5 counseling sessions I would not be able to address it all…. Got me thinking now… questioning myself now…when I now do things I wonder if … is this now a symptom of this disorder? If I am uncertain is it identity issues? And not being put on my file… Now I am paranoid, will he [the new Doctor] treat me funny…I went in with chest- pain to the General Practitioner… I lived with it, I don’t panic , I don’t rush to the ER , the doctor did check me out and said that I scared myself, he talked down to me.. Did he read my diagnosis before he spoke to me? What bothers me is people are quick to judge, she [the nurse] sat with me for less than an hour and tosses out a diagnosis… my previous psychiatrist … she didn’t do an extensive history, told me I have recurrent depressive something, she didn’t give me a prescription, said I should take supplements and exercise; I was so depressed, she had me figured out in less than 30 minutes! Another person told me about Doctor B, he let me fill out stuff, he sat with me, interviewed me, he even had an interview with my husband and said “I think this”- “tell me, have a look and challenge my diagnosis”… I was comfortable with him and he had time for me…”
After this session Jane had a follow up session with her psychiatrist Doctor B- herein some further thoughts:
“He mentioned that he is seeing an improvement. I told him what happened. The Doctor likes to talk… [becoming tearful] I didn’t get to say how I felt, I wanted to cry, he pulled out the DSM …explained borderline and said I need 5 symptoms…. He also talked about the flaws , said there are two types, aggressive type and the softer type….I fit in there, he said that it’s a good thing, to know borderline then one can address it. He made it sound like I am in denial. I know I lose my temper, I want to control my environment, etc, but I didn’t know its borderline… [tearful and struggling]…. (Me: Take your time Jane)… [red in face-shame?] Sorry. (crying) That is where I am with that. I want to reject it, push it away, but by doing so I fulfill it! You say I may ask you, you support me but I fear, AM I THAT? I don’t mind dealing with symptoms, doing therapy, that does not bother me. But I don’t want another label. Borderline personality disorder and bipolar disorder ? Doctor B said that BPD is 5 years of therapy and you don’t do it anymore. But it is on my medical file, it can be destroyed after 7 years – that it is then not relevant anymore, but to have it on my file, I will have to deal with it, I don’t want to deal with it. Want to get rid of it… any number of things throw me off now…. Couple of years – BANG on my file, not get away from it…. The DSM is so extreme in its descriptions…. Don’t want people to equate me with that extreme… The doctor launched into the symptoms. I tried to breathe through it, didn’t get chance to say anything…. (Me: Would you like to talk to it?) Yes, it is good to be understood, he looks at it differently, he looks at it as a chance to get better, address symptoms, I really respect that, I tried to listen and take in (crying), to take in as much learning as I could and remain open minded to what he had to say.”

I gently returned to the description of BPD I felt could help her, and also mentioned if she would feel comfortable we could keep it an open conversation, i.e., that we could come back to it at any time;
“It is still like a big thing, hard to pull apart…. [laughs playfully]… I just want to be ‘healthy’, want to be better, deal with symptoms (Me: The labeling seems difficult.) Yes! You are the only person hesitant to label me as borderline or anything, how can I effectively stand against them, do I have a right, ability to have a say. Technically I am mentally ill, I need to keep trusting the professionals …. I have always been a willing patient, to listen to the experts, to do what they are asking me…. I am not comfortable in this…. If I can stand up and have a say …how to do so effectively…. Damned if I do, damned if I don’t ….(Me: To want to have a say, to say something of your own ‘treatment’…)… This is the first time I have not had a say! Previously I did…. Dr B said-look it up, argue with me….”

The narrative was followed by a beautiful, if not unconscious derivative when Jane stated that they ‘fixed’ their trailer, kept it out of the rain to ensure it had no leaks , investing in new upholstery- only to have it leaked on! That is, and mostly an interpretation held by me privately, is that Jane had a very good understanding within our work together (and with her psychiatrist) of her difficulties, that is, changing her own mental upholstery so to speak given her family of origin and her bipolar diagnosis. It may also be said that the change in diagnosis was experienced as being leaked on, especially ‘into’ and ‘onto’ an interior she felt that was ‘repaired’ already by the work done, i.e., that the repairing of the inner was spoiled from the outside by the changing interpretation of her interior (as borderline). I now turn to Matt wherein medication and psychiatry/medicine supported a “gutted interior” and greatly aided our work together.

Minding Matt
I also feel it ethical to mention an opposite experience of medication and the use of diagnosis. I have been treating a client for more than four years with what I refer to as a cycloid disorder (Daws, 2011). Matt has had many setbacks throughout his life concerning work performance and he was, according to many psychotherapeutic conversations, born into an excessively strict and competitive middle class. For many years Matt has tried in vain to “get to a diagnosis of what is wrong with me, but I always get that I am smart and only depressed as I don’t present like a typical psychiatric patient”. This was in fact true, Matt had an IQ of two standard deviations above the mean and was clearly a very intelligent individual. Unfortunately his capacity was marred by objective attention difficulties (later received a diagnosis of adult ADHD) as well as a seemingly stubborn inability to work within any context of authority. Herein some thoughts as discussed in a session two years into therapy,
“It was not until I consulted you and the psychiatrist that I knew what was wrong with me [a diagnosis of bipolarity and ADHD], to get the right medication. I still have those thoughts, the negative thoughts, but I am managing so much better. I tried to tell the doctors there was something wrong with me, that it is not just depression, but they always treated my mood with anti–depressants. That only made me feel worse. When I would get angry they would tell me to change, be happy, and that is it, no more help. I would get so angry I could smack things- I wouldn’t hurt people, but felt like it! Now it is different. I still struggle with ‘having’ a diagnosis, that there is something wrong with me and that may be the reason I can never get to a place I want to be. Maybe never. That makes me sad and angry as well. But at least I know now what is ‘wrong’ with me, the medication is making me feel better [mood stabilizer] and I can actually say that I am happy now and then. It took me 20 years to get the right help! It also makes sense why I could not focus, that I am not just a difficult and lazy person.”

Although helpful Matt remained fearful of the diagnosis as it worked against his ego-ideal of having to be extremely smart and capable. Paradoxically it also protected him against his critical internal father that called him “stupid” and “lazy bum”. Here diagnosis served as a psychic skin and supported an alternative developmental trajectory that was internalized from childhood and many adult failures in living. Psychiatry as ‘conceptualized’ beliefs and ‘conceptualized’ experience (as diagnosis) (see Fulford et al., 2006, p. 423) was thus clearly of tremendous value in the ‘case’ of Matt and more complicated in the case of Jane. Although a bit of a conceptual jump, the cases just described parallel McDowell’s (Fulford et al., 2006, p. 423) thinking on moral judgment, i.e., that although scientist may be thoroughly trained and inherently decent in their way of being (ethical in the dissemination of a diagnosis), they may still retain very limited understanding of their impact on Autochthony (†) . This is, in my view, also true for Evidence Based Practice (‡) and mental health approaches build upon logical empiricism, i.e., classification systems such as the Diagnostic and Statistical Manual of Mental Disorders with its contemporary changes that has had immense impact in the way the Other is approached and thought about. To describe this view in more detail I now turn to psychoanalytic thinking on Autochthony, Alterity, and fated situations

The Dual-Track meta-theory of James Grotstein: Autochthony, Alterity and fated situations.
The work of James Grotstein (1978, 1997), a post-modern Bionian psychoanalyst, has followed various trends in the field of psychiatry and psychoanalysis, and remains one of a few analysts who has spent a lifetime articulating the inner realities of our most injured and frightened fellow human beings (Grotstein, 1996). Conceptualizing the complex moments of meeting as to create the possibility of radical friendship needed in containing and reworking mental complexity in the mental health context, Grotstein’s articulates the following concepts important to the debate to follow; the various ‘dimensions and coordinates of inner and interpersonal space’ based on the highly complex interplay between ‘Autochthony’ and ‘Alterity’; the importance of ‘fated situations’ (destiny as related to fate), as well as developmental failures that sees the tragic lived worlds of ‘Orphans of the Real’. Creating a mental health dialogue within a transitional space, a third so to speak, allows an unfolding understanding and ‘interpretation’ of mental health ‘events’ and its complex signifiers (contextual, biological, political to name a few as seen in the works of Jacques Lacan (2006) and Michel Foucault (2006) as well as creating a sensitivity to the native self and its need to ‘come to grips’ with the various environmental demands placed on it throughout a lifespan.

In a seminal article, later taken up in works such as Orphans of the Real (in Allen et al.,1996) and Memory of Justice (van Buren & Alhanati, 2010), Grotstein focusses on the important shift from the one-person model to a two-person model in psychoanalysis, supporting an ever increasing understanding of ‘inter’-subjectivity. Achieving such a shift was made possible through the concepts of autochthony (the I born from the self-as-ground) and cosmogony which can be defined as “the technique of narratology whereby the primitive aspect of the personality employs primary process in the form of projective identification in order to claim an event as personal, thereby making it the individual’s own experience” (Grotstein, 1997, p. 404) (italics added). Rather than a passive self suffering the shadow of Pavlovian imprinting, and increasingly in theoretical tandem with modern developmental theorists, the ‘I’ is viewed an active agent from the beginning of life. That is, the infant/child is continuously, both ‘intra’- psychically and ‘inter’-subjectively organizing experience and self-other needs. In analytic language the dual processes of libidinization and aggressivization are active psychic pathways of projectively and introjectively “personalizing” interaction (self, with others and things) with emotional experience (Grotstein, 1997, p.404). Autochthony (“the fantasy that the self is defined by its self-creation and its creation of external objects”, p. 404) exists in an active and vitalizing dialectical relationship with Alterity or Otherness, i.e., “the fantasy and eventual recognition of the creation and defining of the self by external objects” (Grotstein, 1997, p. 404). Developmentally autochthony (†) can initially be viewed as ‘omnipotent self-creationism’ and as such, it may seem counter to Alterity (‡) and its vicissitudes. Alterity in essence entails (as part of Lacan’s Real) the reality, if not awareness of, dependence, lessened omnipotence, greater mutuality, and the complex interrelationship between destiny and fated situations. It must be mentioned that Alterity is described by many psychoanalysts with a both a sense of wonder and suspicion. Alterity remains the principle focus of many psychoanalytic works, especially as the interaction (†) and (‡) demands a psychological bilingualism (Charles, 2014) that takes many years to master, the failure to do so resulting in what Grotstein would call the Orphans of the Real . Even the great Eric Erikson envisioned a theory based on the notion that a person moves through various sensitive periods of negotiation where there remains a precarious ‘inter’- ‘play’ between a self- creationistic senses of self, and the allocation of a “finite range of socially meaningful models of identification” (Groake, 2013, p. 166). According to Groake; “For Erickson (1946, p.360), the development of a secure sense of self is evident in what society grants initially ‘to the infant, to keep him alive’, administers to his needs, and invests him with a ‘particular’ lifestyle.” (2013, p. 166) (italics added). This reminds very much of the pioneering work of Harry Stack Sullivan and brings into sharp focus that ego-identity remains surprisingly dependent on social ministration and management (ala Donald W. Winnicott), i.e., the average expectable environment. Ericksonian theory articulates the various negotiations, compromises, and resulting failures when this negotiation falls short, i.e., lack of trust, autonomy, initiative, identity, intimacy, and generativity, leading to feelings of utter despair. This notion has also been adopted by Daseinanalysts (Martin Heidegger, Medard Boss, Ludwig Binswanger) (Holzhey-Kunz, 2014), Frommnians, as well as Lacanians. To most of these theorists the self is born into a symbolic and imaginary order, and as such, man’s conscious and ‘un’- (non) conscious speaks more to, and of, the desire of the Other (Alterity).
This is of importance as, given Bion and Sullivan (although using different language and conceptual structures), the relevant component functions of the container (the Other) allows for the native self to projects his/her raw proto-emotions or beta- elements, “thoughts without a thinker”—into the Other (maternal container, later the world project), who, in a meditative state of reverie would absorbs, prioritizes, detoxify and transduce (Grotstein, 1997) the proto-mental elements from infinity to finiteness (good vs. bad, etc.), reflect upon these emotional communications, allow incubation while at the same time not lose touch with his/her own autochthonous sense of self.
From this incubation and resonant interchange emerges Bion’s “selected fact”, an element securing coherence to the entirety of the communication. An enlivening sharing of the self and the other, or a ‘harmonious mix up’ as described in the psychology of Michael Balint (1949). Grotstein (1997) adds the interchange, over many years allows the transformation of beta- elements into alpha-elements suitable for mentalization (thinking, thinking about thinking based on one’s own epistemology). In turn the interaction informs the infant/child/adult what he/she is both feeling and thinking, thickening the native self’s experience of its own unique ontology and epistemology (as seen in Piaget and many others). Although it reads a bit one-sidedly, it must be stated that the mother (the Other) is not, like the infant, a passive container but remains a complex psychology ensuring ‘co-creation’, for both enlarging or constricting/confining the native self . The mother/ the Other as container functions as (a) psychological translator, (b) mediator (c) filter, and (d) detoxifier. In contrast the obstructive object (or Other), which represents in essence an amalgam of the real mother/Other who cannot seem to tolerate her infant’s emotional ‘outpourings’ or ‘projections’ (may even seem to hate the infant for having emotions), would project in reverse (the so called Omega function) (Williams, 1992). Add to this scenario the infant’s frustration, confusion, anxiety and finally ‘hatred’ of such a mothering experience (his/her rejection of him/her), which the infant then projects into his image of mothering. The result – an interaction, or more specifically, an enactment of disorganization, imperviousness, disruption and fragmentation of the personality based on fear and annihilation anxieties. Without containment, negotiation and consensus we are all vulnerable to unimaginable affects and ideational content. Heidegger (see Kaufmann, 1956/1975) and many other philosophers and psychoanalysts have written about the moment(s) the world becomes uncanny or is infused with the uncanny. For many patients this is a daily reality and is repeated in various situations, relationships, and institutional life in general. There does not seem sufficient holding- no translator, mediator, filter or detoxifier supporting the native self (†) leading to enactments and problematized and problematizing interactions, whether shared publically or held privately. Paradoxically it would also seem that (‡) also ‘re’-‘acts’ with confusion, frustration, anxiety and hate of the (†)’s painful endopsychic and interpersonal struggles, or tries to colonize and thus enslave. It is also evident that, as just argued, the native self may come to ‘hate’ (‡), adding additional layers of estrangement and distancing. The final version of an encapsulated violence to the native self is seen by an excessive ‘problematizing’ Alterity evoking hate, but using its presencing (as world- mood, i.e., ‘he is always an oppositional person no matter what!’) as evidence of pathology, and as such, as central ‘reason’ for colonizing and re-educating the native self.
The psychoanalyst Marilyn Charles (2014) also describes the difficulty between (†) and (‡) as the ‘lack’ of both psychological bilingualism and the inability of truly entering the lived world of another without doing violence to the other’s ‘desire’ (in the Lacanian sense). Being psychologically bilingual a person can actively navigate the language (-ing) of self (native self- languaging) as relating to, and internalizing, the language of the Other (in Lacan’s words the Symbolic Order and the Imaginary). If the latter cannot be negotiated, so to speak, many problems in living will be found, from those suffering from being too normal (the normotic personality, Bollas, 1987) to patterns of madness wherein the autochthonous drive is forever negating or in rebellion against the Other. The result remains catastrophic for all involved. Charles (2014) beautifully articulates the importance of the relationship between desire of the (†) drive as well as the desire of (‡). As argued, obstructive processes, from childhood onward, may swallow (†), enslave, colonize, solidify, and entrap the native self. Revolt against psychological colonization and control may be at the root of many ‘mad’ patterns as found in literature and existential writings (Lang, 1967, 1969, 1971; Miller, 1981),
“Some children are able to become bilingual, to speak in the language of those around them while maintaining faith with whatever internal logic drives them. Some, however, are driven mad by the disparity between the way things seem and the mandates of the consensual world. In contrast, some young people are driven mad at the threshold of adulthood, when the “Law of the Father” threatens to deny and override the nascent, developing, autonomous self (Lacan, 1953/1977b). The need to move beyond imposed desires, to discover one’s own desire, is at the core of Lacan’s ideas about the psychoanalytic process. We develop through a series of identifications and dis-identifications with important others” (Charles, 2014, p.550)

“In my view, madness is always a function of trauma (2014, p.550)…. Selfhood then slips to the side, encapsulated in a safe place where it is less likely to be further ravaged, but also cannot easily heal or adaptively develop. As the gaps between public and private increase, so does the difficulty of navigating in public spaces . Because of the danger of being revealed but also the terrible urgency to be known, madness tends to speak in its own language : encoded and indirect, a call that both invites and repels reply.” (2014, p.551) (italics added).

To reiterate, when the native self is not allowed or supported to discover and articulate its own desire the self runs a tremendous risk of alienation, even madness, that is, a ‘selfhood’ slipping to the side. To protect the native self, especially those that have experienced much violence to their soul (Shengold, 1989), one (for example the mental health practitioner) needs to learn the unique articulation/language of the Other through entering into an authentic/authenticating conversation with the Other as seen in the works of Martin Buber (1937/1984), Emmanuel Levinas (1978) and Martin Heidegger (1966) (amongst others). This may at times imply the abandoning/suspending of the comfort of consensual realities as it is held by us as professionals (even our most sacred professional nomenclature )(Charles, 2014). More specifically, entering and speaking ‘in the patient’s tongue’ (Charles, 2014) the native self’s presencing is expected (if not hoped) to mediate the relationship between (‡) and (†), strengthening their inter-relationship through co-mingling of perspectives without hegemonic pressures; “Working with the individual with such problems—rather than problematizing the individual—is an ongoing challenge in an age in which distress and disorder are too often thought of as aberrant phenomena to be eradicated” (Charles, 2014, pp.550- 551).
An important reality accentuated by both Grotstein and Charles is not the reality of the client’s suffering per se, or even the client’s own awareness that something is amiss, but the way in which they are/were met by the Other (‡). The scientific and calculative gaze of (‡) (psychiatric nurse, establishment, psychiatrist, psychologist) may unwittingly problematize a client’s being in the world more, and as such, cultivate a general ‘feel’ of not being held by the Other, but ‘handled’. In a timeless piece of academic scholarship Erwin Goffman (1963/1986) discusses the impact of such ‘handling’ he termed ‘Stigma’. More specifically, Goffman studied in depth ‘the management of spoiled identity’ and the growing schism in such a destructive and alienating process between the private and the public. This schism serves as basis for “in-deeper-ism”, i.e., “the pressure to elaborate a lie further and further to prevent a given disclosure” (p. 83). In such a state of affairs subjectivity may go underground, find limited ‘spaces’ for expression and undergo, in Sullivanian language, malevolent transformations (Sullivan, 1953). What remains imperative is,
“Discovering the story behind the symptom can provide an essential anchor, affirming one’s very subjectivity . People are driven mad by social exclusion. The marginalized stand outside the gates and those inside are haunted by the pain and its implicit reproach. The psychotic is lost outside of history in the realm of what Lacan (1953/1977b) calls the Real, a realm outside of symbolization. For Lacan, the Real represents that which is both necessary and impossible. Unarticulated, he says, it is that which ‘doesn’t stop not being written’ and so resides outside space and time, intruding upon us in its own ways (Lacan, 1972–1973/1998, p. 59). When social forces eliminate the subject, narrating the story becomes a way of not only affirming one’s being but also one’s essential humanity.” (Charles, 2015, pp. 352-353)(italics added)
Again just think of Jane’s experience- her upholstery being leaked on. Or in Matt’s case, how supportive intervention can lead to unexpected growth. Charles, echoing many others, also holds that to access such a sensitive area of being, the mental health practitioner should always remain a skillful guest. Although diagnostic and taxonomic understanding could be of immense use , it could also be experienced as alienating, totalizing, and suffocating. That is, where diagnosis and deontological reality can eliminate the subject through intellectual de-contextualization and appropriation, what remains is an ‘ejected’ and ‘stigmatized other’ as well as an internalized order (even in those that are left behind, or ‘insides the gate’, Charles, 2014) ensuring compliance and/or rebellion as last ditched efforts at both salvaging the native self and finding some measure of connection with Alterity (Freud’s ego destroying superego). Succinctly stated, mastering life comes under the sway of the Master, threatening to engulf autochthony. The reader will note the difficulty the modern-day mental health practitioner faces- stigma as well as opening the gates between two very different worlds of experience, and reaching out to both. Stated differently, the psychoanalyst and psychiatrist Ronald Fairbairn sensitively mentioned that the psychoanalyst primarily serves as the bridge between endopsychic reality and external reality. We as practitioners need to personify the very process we envision for the other, that is, reaching into our own autochthonous strivings, our own inner authority, as well as navigating the complex relationship with Alterity. Alterity contains both freedom and violence and we should not be standing in for Alterity against the vulnerable other. This can be achieved by studying the structure of Alterity (our epistemologies, ‘cultural’ legacies) as well as truly learning the unique language of our guest. Again as stated by Charles (2014),
“If we believe that the purpose of our work is to facilitate the possibility of insight for the other, then we must try to encounter the other person as fully as we are able, to enter their world as best we might, and to try to have sufficient sense of what they are working on so that we might have any idea at all as to how we might possibly aid, rather than obstruct. Lacan’s stand insists that one cannot presume authority when questions of individual existence are at stake. This is an inherently ethical stance, a statement of a value system that demands a recognition of the inherent narcissism at the base of our presumptions regarding the ‘illness of the other’ and the proposed solutions that such a model implies” (p.555).
“ …if we are to face the challenge head on, our task is to sufficiently to be able to recognize the gaps and elusions, the condensations, the ways in which meanings are organized and formulated by that individual. If we can avoid correcting or challenging this patient’s system of meanings, then perhaps we can recognize the logic sufficiently to be able to invite a conversation that is in relation to that system. From such a position, the analytic conversation moves toward obtaining a better sense of the meanings as they exist, the ways in which they function for the person, and then perhaps—but only then—to begin to consider together ways in which that system fails the individual in relation to his or her own desires.” (Charles, 2015, pp. 555-556) (italics added).

This approach has been thoroughly articulated in the voluminous work of Michael Eigen. He continuously reminds the therapist that the patient “reads himself in the therapist’s being” (Eigen, 2001, p. 5), that although we may not be getting the ‘message’ or language of the client, we should attempt to ‘remain’ with the communication until we feel truly ‘reached’ by it. This should allow the therapist to speak “from a place he is touched, which includes his own incomplete, ongoing bonding process….” (Eigen, 2001, p.4). By remaining a welcoming Other (Eaton, 2015) we may be able to hold and grow from the client’s ‘impact’,
“[The] core ingredient […] is the impact of the patient on the therapist. Impact is primary raw datum. It is the most private intimate fact of a meeting. The therapist may hide yet secretly nurse the deep impact the patient has on him. To put the impact into words too soon may spoil its unfolding. An impact needs time to take root and grow. It occurs instantaneously, but needs the analyst’s faith, time, and loyalty in order to prosper.” (1996, p. 143; emphasis added).

This clinical attitude is clearly seen in the doctor that eventually treated Eleanor Longden when he stated (and truly wanted to know): “Don’t tell me what other people have told you about yourself- tell me about you” . The latter seems to come closer to what is meant with Heidegger’s meditative thinking- the search for a third through which two individuals, irrespective of the fact that their relationship may remain non- symmetrical, can gain from each other and can help each other transform in ethical ways. This does not exclude calculative and deficit correcting language, it does however change its power differentials, and its use potential,
“In this societal context, there is a move towards the concrete that threatens to meet the psychotic in the very place where words are no longer layered and meanings cannot be investigated… Such can be the eviscerative effect of the imposition of meaning, as can happen, for example, with diagnoses, a common theme in the research interviews. In those interviews, we could see an individual struggling to make sense of self and experience through the newly acquired language of diagnostic criteria, a language that may be clarifying and organizing, but can also be disorganizing, writing over the individual and further obscuring him or her from view.” (Charles, 2015, pp. 557-558).

One is reminded of Grotstein’s thoughts as he articulated that the individual from birth onwards orders all events encountered in his or her life, transforming them into “personal, subjective experiences by autochthonizing (“creating”) them, then by housing these autochthonized personal experiences in a fantasized cosmology (inner world of psychic reality) before finally deconstructing the “alpha-betized” elements of fantasies and dreams and reconstituting them into secondary-process, objective, symbolized thoughts.”(Grotstein, 1997, p. 414). This process is in constant need of a welcoming other as the native self thickens its self- understanding and the complex ongoing relationship with Alterity. It is true that much mental pain is encountered by reality, the Real, by the fact that no amount of omnipotence can control the other, that there exists an Impersonal Otherness. It is even more painful to know that there are many that only experience such reality as a continuation of the trauma they have had to endure since infancy. Utter despair from which we as mental health professionals also turn away due to its intensity- those that become homeless (literally), chronic institutionalized patients and patients that fall through the ‘cracks’ (again our language gives us hints at the structure). Our ‘professional language’ many at times protect us against such knowledge and relating, reflecting our limitations, our prejudice, and our fears.
To return to the complex relationship between (‡) and (†), Alterity can be considered as the awareness of the Otherness of the object. This awareness follows its own developmental trajectory as described by psychoanalysts as separation-individuation. For analysts, and so painfully described by Harry Stack Sullivan (1953), within the anxiety-arch and the tension of needs of the infant, through the ministrations of the mother, ‘learns’ to adjust to the separate world of the Other. In pathological states there seems to be a predominant need to accommodate and thus comply or rebel. The latter is usually the result of impingement, trauma, neglect, mismatch, and many other untold variations. Given the need to either comply, rebel or withdraw from Alterity both Grotstein and Charles sees ‘psychopathology’ in part as the result of a failure between the meeting between (‡) and (†) leading to a “cyclopean, single-minded perspective” (Grotstein, 1997, p. 425). Although mental health literature frequently behaves towards the client as cyclopean “If they would only see what we are trying to do” (and the like), couldn’t Alterity, as it is held by a human psyche, suffer from its own cyclopean biases? Together they may form a stereoscopic if not cubistic perspective (2 eyes needed!), even if they remain in search of a phoropter (science/theory)! Grotstein argues that it is through the dual track reality that a third can be created; “Thus, the achievement of the third dimension presupposes the developmental achievement of the dual-track, stereoscopic perspective. The third (dual-track) dimension provides a mental sanctuary due to its openness to alternative possibilities: other solutions exist” (Grotstein, 1997, p. 425). Within this mental sanctuary, balancing, or attempting to explore the dual track realities of living through psychological bilingualism may allow the restoration, reclamation, and reparation of both the native drive and give birth to a tolerable cosmogony. Grotstein adds wisdom to this sanctuary and its transformational properties when he states: “Blame and protest against the world of external objects is often objectively justifiable, but we each must ontologically ‘earn’ our passport to such objectivity—i.e., through being sufficiently in touch with a sense of self- responsibility so that we are separate from the provisional “enemies” and are thus able to hold enemies authentically responsible.” (1997, p. 426).

The same can be argued for objectivity in search of its own lost and damaged (damaging) subjectivity in the name of law, science and progress. The dual track theory may support a growing solidarity between (‡) and (†) and enhance mental health bilingualism. To explore the concept of such solidarity I now turn to the work of Prof Kevin Boileau on Vivantonomy (2015).

Vivantonomy’s Noetic, a Trans-Humanist Phenomenology of the Self: Ma Facon
Recently a client with a bipolar diagnosis I will call Tony entered my office with a sense of calm, if not joy. A rare moment, signaling years of work and tolerance, many sets- backs as well as successes. Tony proudly showed me his newest painting. Both I and Matt could enjoy his talent, as well as his ability to experience ‘joy’ due to his talent;
“I really didn’t know I had it in me…. When I initially came here….. I am excited about it, I am going to give it as a gift to a friend…. I hope he likes it…My girlfriend criticized it. She has a degree in fine arts and said that I am not following the rules….[laughing and I am relieved that he can allow and be with his experience although the important Other is experienced as critical] My own rules versus others… like we spoke previously, she wants me to go look at others’ art but I said not now, I don’t want to be influenced by their style. She want to superimpose her education and her style on mine…I was like…go away! [Laughing and said without malice or anger]….O, I also helped a lady with a poem she was writing, its initial title was Rat’s ass… It was something else, very unconventional, when she asked my advice I said to her it is like… its…her way, her voice! So we renamed it Ma Facon, i.e., my voice/way, she liked it!…You know it’s not that I don’t learn from others- I love van Gogh, his shapes and feel, I use that, it is in the background when I create…. Or how Michaelangelo used mathematics to plan size in his paintings…It when it is superimposed or I have to compare myself- that’s different!”

Tony went on to describe two beautiful thoughts based on the poem of William Ernest Henley entitled Invictus (beautifully talking to the unconquerable soul, being unafraid, being/feeling master of one’s fate, captain of one’s soul ), a poem that still brings tears to his eyes, as well as the Book of Alma- the Son of Alma (he is a Mormon)- wherein it is written that the Lamanites fought against the people of God, and even when being slaughtered on the battlefield (about 90–77 B.C.) resisted out of faith not to stain their soul by taking up arms. The fact that they allowed, chose, and even welcomed their death lead to the Lamanites to know faith and their own murderous sin. This was of importance for Tony as previously he would ‘act’ very angry. Although it begs a multitude of interpretation, given how I got to know Tony, his struggles and his soul, I thought it an important communication of his growing faith in himself, his openness to the vicissitudes, if not a critique, of Alterity. To follow a poem from Tony reflecting an oppressive Alterity (growing up in a military context) and having to fight throughout his life to be understood and accepted;

The Sky I Grew Up Under

I loved to play
Adults loved status
I loved friends
Adults loved Rank
I loved life
Adults training to Kill
I loved freedom
Adults loved to follow Orders

Adults loved Strictness of thought Parameters
I was stifled: No independent thought allowed
Corporal punishments a must for Adults
To me it only created rebellion

Adults loved to be transferred to new places
I hated to lose my friends ,soon stopped making them

Under the military sky I grew up under
There is a Culture with two major facets
The willing Slaves
The military Brat an unwilling isolated captive.

Tony, 2015

It is no surprise that Alterity was something to be resisted, to be actively fought against, i.e., a meaningful if not desperate active communication of resistance against being superimposed upon, and treated like a slave. Certainly much of the reaction can be ascribed to the way Tony was raised. It can also be argued that it made Tony a sensitive and astute observer, sensitive to the various behavioral-ideational and affective currents based on dominance. Tony’s experiences illustrates the complex relationship between both (‡) and (†), an inherent need/desire to articulate the self, to find “I didn’t know I had it in me” as well as “I don’t want to be influenced now”, although Tony clearly articulated that he also appreciates and even judiciously makes use of Alterity/ the Other (in art) as background support. It is an articulate and sound gesture to all of us involved in dialogue with Tony. Recasting the latter in existential language one could see such an attitude in the work of Emmanuel Levinas (1979) as well as Adrian van Kaam (1970) wherein there is an emphasis on true mutuality, fraternity and solidarity- an attitude (if not theory) taken up in the work on Kevin Boileau’s concept of Vivantonomy. Boileau argues that mutuality, fraternity and solidarity allow a true recognition of the Other. The various cases, Jane, Matt, and Tony illustrate this reality with much depth (this would not exclude the reality of experiencing ‘bipolarity’) and how the lack of mutuality, fraternity and solidarity throughout their lives creates a despairing estrangement. In Boileau’s own writing,
“Solidarity comes from this recognition that the Other comes from the same community. In humanism the community is the set of humans. In a trans-humanist approach the community is all sentient beings, and includes the balance of the environment. The community is all aspects, elements, forms, and beings of the ecosystem. My argument is that we need to rethink the set of beings that ought to be included a community of beings that has a comprehensive, deeper understanding of solidarity. In scientific vernacular, by definition, all beings in an ecosystem are interrelated. In a spiritual-phenomenological vernacular, each and every sentient being has the capacity to make an appeal. One can see it in their eyes. To deny that all sentient beings ought to be included in a community of solidarity is simple deception and denial. I have explained the reasons elsewhere, and previously in this essay, but in short they stem from narcissism: the not seeing what is directly in front of our eyes. If the reader is not persuaded by this obvious truth, then I advance the ecosystem argument, which science proves over and over again: each part of the environment is highly interrelated with other parts. Nothing is separate. Human beings are not separate. Unfortunately, humans have been living as if they are separate. We have pretended that we can continue to re-engineer our environment over and over, therefore, we should not be afraid to ignore the appeals of other sentient beings, and we should not be anxious about our dominating, possessory tendencies. This is simple obscurantism and ignorance.” (2015, pp. 54-55).

To ensure such a relationship Boileau argues for a Trans-Humanist Anthropology, allowing for a suspension of the predominant western scientific endeavor that isolates man from this very fact, i.e., that we are inherently communal and ‘co’-‘response’-‘able’ to each other. Western science and systems of thought such as logical empiricism instrumentalizes the Other, with severe implications on mental health practice; “This is the possessory, dominating subjectivity that instrumentalizes all others, and even in a system indoctrinated by rights and duties, fails to see the Other’s world on its own terms, as its unique manifestation” (p. 55). According to Boileau we can ensure, if not cultivate, Vivantonomy by continuously reflecting on our tendency to prioritize meaning, scaling existence and worth, by accepting a new Archimedean point wherein our contemporary and dominant discourse that we are the center of the universe can be changed holding that all living beings have equal interests and rights, acknowledging and accepting a growing depth and breadth of our responsibility to Others, and developing a new philosophical anthropology for human beings.
In reviewing Boileau’s thinking it can be argued, as seen in Charles’s work, that taking on a view of ‘one as lesser due to a mental disorder’, even though the intention remains in service of ‘help’, one runs a risk of enforcing a Masters-Slave dialectic. Although the western scientific project ensured man dominion over nature, doing so ‘over’ man’s nature carries catastrophic implications only truly seen currently in many treatment contexts. Most importantly, it carries the danger of deciding what is better for the Other, i.e., that one’s epistemology (usually embedded in scientific theories of Being, calculative in nature as read in the work of Heidegger) is of greater importance, inadvertently subsuming autochthony. Given Heidegger’s thinking the latter does infinite violence to Being, en- ‘closes’ the very fact that all humans are born to find their own ontology, becoming a philosopher of (their) Being in their own right. Mental health patients, given the processes described throughout will remain reluctant philosophers within the Master-Slave dynamic,
“ Therefore he [Martin Heidegger] can provocatively state: ‘The ontic distinction of Dasein lies in the fact that it is ontological’ (Being and Time, p.10). With this, every human being is recognized as an ontologist, that means- implicitly knowing about his own being and adopting a position towards it. The widespread notion that only the philosopher freely decides to turn his attention at leisure to the question of being is thus repudiated in favour of the thesis that every human being exists philosophically in an elemental way and that it would not even be possible explicitly to posit the philosophical basic question as to the being of beings if every single human being did not always already have an implicit, pre-ontological knowledge of being” (Holzhey-Kunz, 2014, p.44)

Although beyond the scope of the current paper to critically review and discuss the work of Lacan on the Real, it is also true that we are subject to growing impersonal cultural and scientific forces that may effectively ‘steal’ our ability to become a philosopher of Being. In the logic of Bakhtin (1993),
“Having detached the content/sense aspect of cognition from the historical act of its actualization, we can get out from within it and enter the ought only by way of a leap. To look for the actual cognitional act as a performed deed in the content/sense is the same as trying to pull oneself up by one’s own hair. The detached content of the cognitional act comes to be governed by its own immanent laws, according to which it then develops as if it had a will of its own. Inasmuch as we have entered that content, i.e., performed an act of abstraction, we are now controlled by its autonomous laws or, to be exact, we are simply no longer present in it as individually and answerably active human beings.
This is like the world of technology: it knows its own immanent law, and it submits to that law in its impetuous and unrestrained development, in spite of the fact that it has long evaded the task of understanding the cultural purpose of that development, and may serve evil rather than good. Thus instruments are perfected according to their own inner law, and as a result, they develop from what was initially a means of rational defense into a terrifying, deadly, and destructive force All that which is technological, when divorced from the once-occurrent unity of life and surrender to the will of the law immanent to its development, is frightening; it may from time to time irrupt into the once-occurrent unity as an irresponsibly destructive and terrifying force.” (p. 7)

As stated by Boileau (2015), an unreflective life project and scientific structure ensures unreflective opinions, ensuring a closing of subjectivity – an accommodation to Alterity akin to du Bose’s Dasein-icide (2009). When transcendence is denied and language is used to “taxonomically differentiate one type of being from another, which includes different levels of ontological value, rights, and protections” (2015, p. 57) one enters a new domain of bio-‘politics’, if not bio-ethical laws used to ensnare both the reluctant philosopher and the Seelsorger into fixed positions in service of a larger agenda, making ‘therapy’ increasingly difficult, if not impossible, to carry out the growth needs and realities of the native self. What would this mean in essence, that a relationship is ‘regulated’ and ‘practiced’ with such non-reflective practices and laws? I do hold that various basic assumption anxieties as articulated by Wilfred Bion (see Hopper, 2009; Scharff & Scharff, 2001; Shaw, 2014; Shur 1994) have created taxonomies as defense against many serious realities, that although we have come a way in articulating many mental health difficulties, we remain deeply affected by its presence- it ‘makes us into a THAT’. Psychiatry, the very bastion of protecting the space for ‘madness’ has been under unprecedented pressure, societal and otherwise, to not only prove its existence as a ‘science’, but to ensure a ‘safety’ (socially) that in essence begs for dialogue and reflection with all role players, not just political, but judicial and regulatory practices as well. Boileau (2015) would argue as follows, i.e., that we need to “engage in more rigorous hermeneutic inquiry of the meaning of these axioms and their competitors. In short, I propose a strong sense of the meaning of responsibility as I outlined earlier in this work. This implies a derivative duty to gain more accurate, deeper, broader, and truer perspective about the meaning of the human anthropology, and the way we fit in ecosystems in good ways. It might be argued that we already do that, but I am suggesting even greater critical awareness. I suggest this explicitly with those words, and I suggest it implicitly by arguing that through a phenomenological inquiry we can discover what is most human in humans [which implies an account of trans-humanist understanding of the whole]. I don’t think we are there yet” (p. 58)
This is imperative when considering dialoguing with those (which by definition includes ourselves), who experience an ontological unsettledness, a terror at Being and relatedness. Through Vivantonomy, a philosophy that is deeply concerned with life and living per se, we may as mental health practitioners be able to ‘hold’ and relate to both the native self as well as to Alterity with the express help and permission of the reluctant philosopher. This is not an easy task. Being treated as an ‘object’ or being ‘objectified’ unsettles heteronomous ontology, exiles experience and works against solidarity and fraternity. It is evident as practitioner that this is a tri-directional phenomena, that is, the patient, the mental health practitioner, as well as the mental health system that can be ‘objectified’. Objectifying missed how we are all co-constituted. For Boileau (2015),
“Thus, we transform human-centered anthropologies into trans-human ontologies that move us from egocentric, desirous, possessive, unmindful beings into a complex constellation of elements that constitute a new kind of humanity based on a new sort of autonomy that is grounded in Vivantonomy. These new self-constitutions include the self-as-responsible, the self-that-lives-in-solidarity, the self-who-promotes-rights-of-all-that-lives, and the self-who-lives-in-underlying-ontological-space. We could formulate these elements with more finesse, I am sure, but leaving them in their rough state articulates them with crispness and accuracy. The second moment of this transformation comes from the replacements of egocentric values and action potentials with a whole new set of values and action potentials that are virtuous within this new worldview. The values and virtues come from a new anthropology that we become more identified with through the practices that constitute them. This trans-humanist foundation re-constitutes, therefore, what we mean by autonomy and heteronomy.”(p. 63)

It is thus not the aim to upsurge that which has been painfully accumulated through centuries of thought and reflection. We owe a rich depth to many taxonomists, classificationist, revisionists, and rebels. What is equally true is that we have been witnessing a frightening demand on mental health practitioners as well as clients to suspend autochthony, to re-educate into the scientific Ideal, to exile those that give voice to such concerns through code inflation, bio-ethics, greater oversight and impingements of law, and even threatening professional’s livelihood. Protection of Autochthony should be our first ethical task.

Mental health practice allows a unique philosophical approach to the difficulties inherent in Autochthony and Alterity (Otherness). As mentioned, the contemporary mental health arena as psychological relational context calls forth a unique sort of human engagement and management mostly reflected in an over-reliance on ‘scientific explanation’, excessive objectivism of the Other, fear of the Other’s autochthony, an ever expanding vigilance and ‘control’ of so-called deviant behavior embedded within bio-ethical approaches (favoring a non-humanist ethics), all supporting many alienating/estrangement practices. By becoming sensitive to both (†)’s ontology and the world of (‡), alienating misrecognition may be suspended, inviting a philosophy of Vivantonomy and psychological bilingualism characterized by a Heideggerian meditative state/stance. It is held that such a stance may support all involved to cultivate a trans-humanist philosophy deeply reflective of its own practices, ensuring solidarity, fraternity and fidelity.

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