Fundamentals of Taxonomy

Download PDF

Fundamentals of Taxonomy: The Rise of the DSM as a Medical Hortus Siccus and the Need for a Soul in Mental Health

Loray Daws, PhD

Abstract

This essay aims to explore the historical importance of empirical import in the domain of clinical psychiatry. It will be argued that the empirical import, although an achievement in logical construction, has not taken into full account its implications, or even its political agenda. As such, without this awareness it can be argued that psychiatry (or psychology for that matter) merely becomes a complex language and praxis ‘signal’ for the application of pre-existing institutional arrangements, facilitating an estrangement between the scientific/ symbolic/materialist realms and Being per se. What is needed is not so much knowledge of knowledge and taxonomy, but rather how it is constructed, held (in institutions, in mind), communicated, and carried ‘across’ toward Being/the Other, facilitating an indwelling and meditative thinking so as to retain mystery and openness to experience. Diagnostic thinking, taxonomy and classification as hortus siccus, focusing on Being as cut and dry so to speak, has had immense ‘narrowing’ implications on the Other. These implications will be explored through Heidegger’s philosophical thought on calculative and meditative thinking, Eric Craig’s Dasein-analytic description of Soul, and brought ‘to life’ through various case studies.

Key words: Taxonomy, classification, diagnostic and statistical manual for mental disorders, soul, deficit-correction model, Soul.

Introduction

“To care for people is more important than to care for ideas”

Harry Guntrip

The doctor is the patient’s fate

Karl Jaspers

It is difficult to ignore the reality that the use of diagnosis greatly aids the clinician in organizing an array of symptoms into coherent and communicable structures. Since the work of Hempel (Fulford, Thorton & Graham, 2006) much emphasis has been given to the inherent taxonomy of psychiatric diagnostic systems. Embedded in logical empiricism and the need for “audit trails” (p. 328) (ensuring reliability and validity), psychiatric classification has seen much change over the decades and although seemingly the domain of logical empiricism, empirical import per se may be more elusive and complex than originally thought. Various theorists such as Thomas Szasz have been vocal about the reification of taxonomy, and its contemporary hegemony could lead to various ethical difficulties evident in post-modern theories such as feminism and deconstructionism. It will be the aim in this section to discuss the philosophical-clinical importance of the latter through,

  • A brief history of the use of classification and taxonomy—its strengths and weaknesses.
  • Its ‘use’ and application and relationship to the Other, and as
  • Political tool

The debate will also conclude with case studies and the notion of ‘Soul’, as defined by the Daseinanalyst Eric Craig (2008) as it is deemed important to bridge the contemporary tendency to separate calculative thinking from meditative thinking. Through ‘Soul-care-as-dialogism’ it may be possible to develop anthropological approaches of what I refer to as triangular dialogism.

The use of diagnosis: a brief history on the use of classification and taxonomy

Based on early Greek and Latin, the word “diagnosis” has been synonymous with discernment, to distinguish (therefore ‘dia’ referring to apart or ‘a’ -part), the ability to ‘know’ or to ‘come to know’. A true testament of both Cartesian and Galilean worldviews where “I think therefore I am”, scaffolded later theorists such as Locke and others to follow in constructing a dominant approach to sense impressions. Many post-modern thinkers and schools have taken issue with this view in mental health. They include thinkers from existentialist phenomenology, constructionism and Lacanian psychoanalysis, wherein naïve materialism is said the basis of various (catastrophic) errors1 in logic when applied to man.

To return to diagnosis and its natural ‘offspring’ so to speak, i.e., taxonomy and classification, Kendell (2002) stated that any good classification system has as its aim the grouping together of similar observable phenomena—giving it a common name, a denomination (de-‘nominal’-tion), qualifying the group and making it clinical relevant (qualification). In doing so ensures a measure of prediction in terms of ‘its’ course and treatment. This seemed very evident when reading early psychiatric pioneers such as Kraepelin’s inspiring observations of manic depressive psychosis (1921, in Wolperd, 1977, pp. 33-35). A taxonomy should be (a) comprehensive, (b) easy to use, (c) clinical significant2, (d) be reliable, and (e) be valid, and in doing so remain ‘true’ or ‘evident’ over many context and culture thereby (e) serving the needs of its ‘users’3. The latter seems of importance—the needs of its users!

1 A beautiful example of such exploration can be found in Lacan’s Ècrits (2006) and Badiou’s ‘Theory of the subject’ (2009).
2 For mental health and especially clinical psychology and psychiatry this would mean it’s a ‘harmful’ ‘dysfunction’ either to the individual or to society.
3 A fascinating need as it implies a shared value system. Clearly, out of the example to follow this was not the case at all. Taxonomy and diagnoses can be used to keep ‘a part’ clients experiencing much mental anguish and society as well as the clinicians treating them.

Before a deeper exploration concerning the epistemology of mental health classification and the needs of the user, I would for a moment return to Fulford’s (in Bloch and Green, 2009, p. 70) good strawberries’ (like ‘bodily disorder’) and ‘good pictures’ (like ‘mental disorder’) description as a simplified way to organize the debate to follow. According to Fulford (in Bloch et al., 2009) there is a clear difference between what constitutes a good strawberry versus what constitutes a good picture, that is, there is a difference between said factual and evaluative meanings of that which we observe. When considering a strawberry it is not difficult to contemplate or describe in detail what constitutes a good strawberry, even a bad strawberry for that matter. Although it may have different shapes, be cultivated in different parts of the world, its color and texture (irrespective of size) usually constitutes it as a ‘good’ strawberry. There is a comfort in the clarity of its ‘goodness’ and ‘badness’. However if one considers a picture, of for example a house, what is perceived as good or bad could be more challenging to ‘frame’. That is, what constitutes a good or bad picture may have physical elements that could be measured- such as its size, the amount of paint used, its dominant or predominant style or school of technique (‘a’ Monet, renaissance art and the like) such as clarity (I am sure a vague picture may lead to uncertainty) for most it remains secondary to what the picture ‘means’ to or for the observer. A good strawberry remains (retains?) a good strawberry even if the observer decides it not so4. A picture could be perceived as art/good as it represents for this person a good example of a Monet, for another is good as its reminds them of their childhood home, for another the childhood they never had and the like. Certainly the strawberry could evoke similar associations (the strawberry as a memory of having Sunday lunches with grandma) but for the aim of the current debate suffice it to say that the strawberry lends itself to empirical import easier than a representation (the picture).

4 I have to mention in academic honesty that the more I work with the example the more I am aware that the example does have a naughty logic imbedded, i.e., although the senses I rely on to distinguish factual and evaluative meanings, ocular ad oral meanings may lead to different systems of thought, each with its factual and evaluative meanings per se. I can certainly eat my picture by gobbling it up greedily visually, creating a hunger – a visual pica. Visual pornography has such a state of mind, both factually and evaluative. Also in itself, only since I eat strawberries has it become subject to my factual and evaluative system. It existed in nature before man’s use of it, and although bad for me to eat a bad strawberry- in terms of nature decay is seen as healthy and nurturing (i.e., compost). The latter was debated thoroughly as part of the philosophy of statesman Jan Smuts (Savage, 1998).

Factual and Evaluative Meaning

Strawberries

Pictures

Agreement

No agreement

Over what makes a good strawberry

(=sweet, clean skinned, etc.)

Over what makes a good picture

Hence

Hence

The term “good strawberry” has acquired the factual meaning “sweet, clean skinned, etc”

The meaning of “good picture” has acquired no consistent factual meaning

Parallels

Parallels

Concepts of disorder in physical medicine

Concepts of disorder in psychiatry

Figure 4.‘Good strawberries’ (like ‘bodily disorder’) and ‘good pictures’ (like ‘mental disorder’) (in Fulford in Bloch and Green, 2009, p. 70 )

Given the figures as structure it could also be stated that when considering factual realities such as bipolarity, Alzheimer disease and schizophrenia, it would prove difficult in contemporary mental health contexts to ignore both its factual and evaluative meanings. Certainly as tensile structure and the inherent ‘keeping apart’ (diagnosis) one may come to predominate over the other (factual > evaluative meanings). To ‘know’ or come to know the factual of such diseases (Heidegger’s calculative thinking) in psychiatry as a profession has been instrumental in containing such devastating realities. As practitioner this has been evident in my practice. So, on the one hand one could share Kendell’s biological optimism- but if one considers personality disorders, sexual disorders and others, Szasz’s concerns seems very evidentiary. That is, mental health may be ecologized or neurologized leading to a colonization of the Real through the symbolic order (in the guise of topology, classification and thus calculative thinking) leading to the ‘Tortion’ (Badiou, 2009) of man as Being, swallowing autochthony, the subjective and meditative thinking. These concerns are also evident in modern day psychiatry. The work of Dr Allen Frances, past principle investigator of the DSM IV Task force added ‘concerning’ modern trends such as diagnostic inflation (under the auspices of prevention), homogenizing tendencies in modern culture medicalizing difference, elastic diagnostic labels swallowing up newly recruited patients, cultural perfectionism (that feeds the problematizing approach to general problems in living) that not only sells happiness5 but controls and even demands it, and last, but not least, ‘the power to label is the power to destroy’, i.e., mental illness creates willingly or not stigma;

“Being normal and fitting in with the pack are a key to survival. Evolution has wired into human nature an uncharitable wariness and lack of compassion for those who are different and don’t satisfy tribal expectations. Having a mental disorder ‘marks’ someone in ways that can cause much secondary harm. Stigma can take many forms, comes from all directions, is sometimes blatantly overt, but can also be remarkably subtle. It is the cruel comment, the unkind smirk, the exclusion from the group, the lost job opportunity, the rejected marriage proposal, the ineligibility for life insurance, the inability to adopt children or pilot a plane. …And the secondary psychological and practical harms of having a mental disorder come only partly from how others see you. A great deal of trouble comes from a change in how you see yourself-the sense of being damaged goods, feeling not normal or worthy, not a full fledged member of a group.” (in Allen,2013. P. 109).

5 Please see a very important article entitled “A proposal to classify happiness as a psychiatric disorder” by Richard P. Bentall (1992). Thank you to Mr. Andrew Nutt for providing me with the article.

A more detailed example, given by the now psychologist Eleanor Longden, may serve as educator. The following excerpt can be found in Ted Talk6 (2013) and introduces a contemporary voice of concern. This is a transcript of her talk:

The day I left home for the first time to go to university was a bright day brimming with hope and optimism. I’d done well at school. Expectations for me were high, and I gleefully entered the student life of lectures, parties and traffic cone theft.

Now appearances, of course, can be deceptive, and to an extent, this feisty, energetic persona of lecture-going and traffic cone stealing was a veneer, albeit a very well-crafted and convincing one. Underneath, I was actually deeply unhappy, insecure and fundamentally frightened — frightened of other people, of the future, of failure and of the emptiness that I felt was within me. But I was skilled at hiding it, and from the outside appeared to be someone with everything to hope for and aspire to. This fantasy of invulnerability was so complete that I even deceived myself, and as the first semester ended and the second began, there was no way that anyone could have predicted what was just about to happen.

I was leaving a seminar when it started, humming to myself, fumbling with my bag just as I’d done a hundred times before, when suddenly I heard a voice calmly observe, ”She is leaving the room.”

6 http://www.ted.com/talks/eleanor_longden_the_voices_in_my_head/ transcript?language=en Eleanor Longden The voices in my head Posted Aug 2013 Permission obtained for both presentation and publication by The Media Requests Team, 15 July 2016

I looked around, and there was no one there, but the clarity and decisiveness of the comment was unmistakable. Shaken, I left my books on the stairs and hurried home, and there it was again. ”She is opening the door.”

This was the beginning. The voice had arrived. And the voice persisted, days and then weeks of it, on and on, narrating everything I did in the third person.

“She is going to the library.”

“She is going to a lecture.” It was neutral, impassive and even, after a while, strangely companionate and reassuring, although I did notice that its calm exterior sometimes slipped and that it occasionally mirrored my own unexpressed emotion. So, for example, if I was angry and had to hide it, which I often did, being very adept at concealing how I really felt, then the voice would sound frustrated. Otherwise, it was neither sinister nor disturbing, although even at that point it was clear that it had something to communicate to me about my emotions, particularly emotions which were remote and inaccessible.

Now it was then that I made a fatal mistake, in that I told a friend about the voice, and she was horrified. A subtle conditioning process had begun, the implication that normal people don’t hear voices and the fact that I did meant that something was very seriously wrong. Such fear and mistrust was infectious. Suddenly the voice didn’t seem quite so benign anymore, and when she insisted that I seek medical attention, I duly complied, and which proved to be mistake number two.

I spent some time telling the college G.P. about what I perceived to be the real problem: anxiety, low self-worth, fears about the future, and was met with bored indifference until I mentioned the voice, upon which he dropped his pen, swung round and began to question me with a show of real interest. And to be fair, I was desperate for interest and help, and I began to tell him about my strange commentator. And I always wish, at this point, the voice had said, “She is digging her own grave.”

I was referred to a psychiatrist, who likewise took a grim view of the voice’s presence, subsequently interpreting everything I said through a lens of latent insanity. For example, I was part of a student TV station that broadcast news bulletins around the campus, and during an appointment which was running very late, I said, “I’m sorry, doctor, I’ve got to go. I’m reading the news at six.” Now it’s down on my medical records that Eleanor has delusions that she’s a television news broadcaster.

It was at this point that events began to rapidly overtake me. A hospital admission followed, the first of many, a diagnosis of schizophrenia came next, and then, worst of all, a toxic, tormenting sense of hopelessness, humiliation and despair about myself and my prospects.

But having been encouraged to see the voice not as an experience but as a symptom, my fear and resistance towards it intensified. Now essentially, this represented taking an aggressive stance towards my own mind, a kind of psychic civil war, and in turn this caused the number of voices to increase and grow progressively hostile and menacing. Helplessly and hopelessly, I began to retreat into this nightmarish inner world in which the voices were destined to become both my persecutors and my only perceived companions. They told me, for example, that if I proved myself worthy of their help, then they could change my life back to how it had been, and a series of increasingly bizarre tasks was set, a kind of labor of Hercules. It started off quite small, for example, pull out three strands of hair, but gradually it grew more extreme, culminating in commands to harm myself, and a particularly dramatic instruction:

“You see that tutor over there? You see that glass of water? Well, you have to go over and pour it over him in front of the other students.”

Which I actually did, and which needless to say did not endear me to the faculty.

In effect, a vicious cycle of fear, avoidance, mistrust and misunderstanding had been established, and this was a battle in which I felt powerless and incapable of establishing any kind of peace or reconciliation.

Two years later, and the deterioration was dramatic. By now, I had the whole frenzied repertoire: terrifying voices, grotesque visions, bizarre, intractable delusions. My mental health status had been a catalyst for discrimination, verbal abuse, and physical and sexual assault, and I’d been told by my psychiatrist, “Eleanor, you’d be better off with cancer, because cancer is easier to cure than schizophrenia.” I’d been diagnosed, drugged and discarded, and was by now so tormented by the voices that I attempted to drill a hole in my head in order to get them out.

Now looking back on the wreckage and despair of those years, it seems to me now as if someone died in that place, and yet, someone else was saved. A broken and haunted person began that journey, but the person who emerged was a survivor and would ultimately grow into the person I was destined to be.

Many people have harmed me in my life, and I remember them all, but the memories grow pale and faint in comparison with the people who’ve helped me. The fellow survivors, the fellow voice-hearers, the comrades and collaborators; the mother who never gave up on me, who knew that one day I would come back to her and was willing to wait for me for as long as it took; the doctor who only worked with me for a brief time but who reinforced his belief that recovery was not only possible but inevitable, and during a devastating period of relapse told my terrified family, “Don’t give up hope. I believe that Eleanor can get through this. Sometimes, you know, it snows as late as May, but summer always comes eventually.”

Fourteen minutes is not enough time to fully credit those good and generous people who fought with me and for me and who waited to welcome me back from that agonized, lonely place. But together, they forged a blend of courage, creativity, integrity, and an unshakeable belief that my shattered self could become healed and whole. I used to say that these people saved me, but what I now know is they did something even more important in that they empowered me to save myself, and crucially, they helped me to understand something which I’d always suspected: that my voices were a meaningful response to traumatic life events, particularly childhood events, and as such were not my enemies but a source of insight into solvable emotional problems.

Now, at first, this was very difficult to believe, not least because the voices appeared so hostile and menacing, so in this respect, a vital first step was learning to separate out a metaphorical meaning from what I’d previously interpreted to be a literal truth. So for example, voices which threatened to attack my home I learned to interpret as my own sense of fear and insecurity in the world, rather than an actual, objective danger.

Now at first, I would have believed them. I remember, for example, sitting up one night on guard outside my parents’ room to protect them from what I thought was a genuine threat from the voices. Because I’d had such a bad problem with self-injury that most of the cutlery in the house had been hidden, so I ended up arming myself with a plastic fork, kind of like picnic ware, and sort of sat outside the room clutching it and waiting to spring into action should anything happen. It was like, “Don’t mess with me. I’ve got a plastic fork, don’t you know?” Strategic.

But a later response, and much more useful, would be to try and deconstruct the message7 behind the words, so when the voices warned me not to leave the house, then I would thank them for drawing my attention to how unsafe I felt — because if I was aware of it, then I could do something positive about it –but go on to reassure both them and myself that we were safe and didn’t need to feel frightened anymore. I would set boundaries for the voices, and try to interact with them in a way that was assertive yet respectful, establishing a slow process of communication and collaboration in which we could learn to work together and support one another.

7 “There may be modes of thinking to which no known realization has so far been found to approximate. Hallucinosis, hypochondriasis and other mental ‘diseases’ may have a logic, a grammar, and a corresponding realization, none of which has so far been discovered. They may be difficult to discover because they are obscured by a ‘memory’, or a ‘desire’, or an ‘understanding’, to which they are supposed -wrongly- to approximate. Unless the obscurity can be circumvented or penetrated it will remain unobserved, as the galactic centre or the origin of the universe remains unobserved.” (W. R. Bion, A Memoir of the Future, 1990, p. ix).

Throughout all of this, what I would ultimately realize was that each voice was closely related to aspects of myself, and that each of them carried overwhelming emotions that I’d never had an opportunity to process or resolve, memories of sexual trauma and abuse, of anger, shame, guilt, low self-worth. The voices took the place of this pain and gave words to it, and possibly one of the greatest revelations was when I realized that the most hostile and aggressive voices actually represented the parts of me that had been hurt most profoundly, and as such, it was these voices that needed to be shown the greatest compassion and care.

It was armed with this knowledge that ultimately I would gather together my shattered self, each fragment represented by a different voice, gradually withdraw from all my medication, and return to psychiatry, only this time from the other side. Ten years after the voice first came, I finally graduated, this time with the highest degree in psychology the university had ever given, and one year later, the highest masters, which shall we say isn’t bad for a madwoman. In fact, one of the voices actually dictated the answers during the exam, which technically possibly counts as cheating.

And to be honest, sometimes I quite enjoyed their attention as well. As Oscar Wilde has said, the only thing worse than being talked about is not being talked about. It also makes you very good at eavesdropping, because you can listen to two conversations simultaneously. So it’s not all bad.

I worked in mental health services, I spoke at conferences, I published book chapters and academic articles, and I argued, and continue to do so, the relevance of the following concept: that an important question in psychiatry shouldn’t be what’s wrong with you but rather what’s happened to you. And all the while, I listened to my voices, with whom I’d finally learned to live with peace and respect and which in turn reflected a growing sense of compassion, acceptance and respect towards myself. And I remember the most moving and extraordinary moment when supporting another young woman who was terrorized by her voices, and becoming fully aware, for the very first time, that I no longer felt that way myself but was finally able to help someone else who was.

I’m now very proud to be a part of Intervoice, the organizational body of the International Hearing Voices Movement, an initiative inspired by the work of Professor Marius Romme and Dr. Sandra Escher, which locates voice hearing as a survival strategy, a sane reaction to insane circumstances, not as an aberrant symptom of schizophrenia to be endured, but a complex, significant and meaningful experience to be explored. Together, we envisage and enact a society that understands and respects voice hearing, supports the needs of individuals who hear voices, and which values them as full citizens. This type of society is not only possible, it’s already on its way. To paraphrase Chavez, once social change begins, it cannot be reversed. You cannot humiliate the person who feels pride. You cannot oppress the people who are not afraid anymore.

For me, the achievements of the Hearing Voices Movement are a reminder that empathy, fellowship, justice and respect are more than words; they are convictions and beliefs, and that beliefs can change the world. In the last 20 years, the Hearing Voices Movement has established hearing voices networks in 26 countries across five continents, working together to promote dignity, solidarity and empowerment for individuals in mental distress, to create a new language and practice of hope, which, at its very center, lies an unshakable belief in the power of the individual.

As Peter Levine has said, the human animal is a unique being endowed with an instinctual capacity to heal and the intellectual spirit to harness this innate capacity. In this respect, for members of society, there is no greater honor or privilege than facilitating that process of healing for someone, to bear witness, to reach out a hand, to share the burden of someone’s suffering, and to hold the hope for their recovery. And likewise, for survivors of distress and adversity, that we remember we don’t have to live our lives forever defined by the damaging things that have happened to us. We are unique. We are irreplaceable. What lies within us can never be truly colonized, contorted, or taken away. The light never goes out.

As a very wonderful doctor once said to me, “Don’t tell me what other people have told you about yourself. Tell me about you.”

In short, and similar to various existentialist scholars’ phrase ‘existence precedes essences’ the section is a beautiful reminder of the two realities the therapeutic or mental health couple constantly face. Firstly, the experiences described would easily fall into Kendell’s biological optimism and structures articulated throughout the many ages, i.e., that the symptoms described by the writer would ‘fall’ under the classification of a psychotic disorder, more specifically schizophrenia. It is of importance to note that the ‘schizophrenia- out -there’ (i.e., essentialist approach) forgets8 that the ‘out there’ is someone’s ‘in here’! The latter is currently actively explored by various feminist theories of caring (Thomas & Longden, 2013), and argues that the technological approaches to mental health fails to adequately address the meaning and contextual factors of mental illness, even psychosis. Even if the latter is paired with psychological interventions such as CBT they share in principle the basic attitude that mental health difficulty can be ascribed to disordered mechanisms in either physiology or psychology (deficit correction models of mind), that these mechanisms can be accounted for “independently of the particular contexts in which they occur” (Thomas & Longden, 2013), and that technological interventions can be designed and used independently of human relationships, values or “narratives” (p. 20). From the transcript it is of interest to note that what brought about changes per se were not so much technological interventions, but an existential basis for caring where “happening”9 could be understood. Through ‘caring’, narrative (of trauma and Being someone that experiences events), and moral imagination, science may become a guardian, if not servant, to caring and through caring. Similar to Emannuel Levinas’s notion that philosophy is not love of wisdom but wisdom of love- a thinking heart. If, as articulated by Jeff Coultier and David Ingelby “psychiatric diagnosis is merely a ‘signal’ for the application of pre-existing institutional arrangements” (Montcrieff, 2010, p. 371) estrangement will follow with a greater disparity between scientific/ symbolic / materialist realms and Being per se. That is, ‘matter’ (materiality and ‘objectivity) transformed into ‘it/what matters’ is a matter of urgency and in need of ethical resolve (if not Badiou’s revolt!).What is needed is not so much knowledge of knowledge and taxonomy, rather how it is held, communicated, constructed and carried across in relation to the Other. The latter could also be combined with indwelling and meditative thinking so as to retain mystery and openness to experience—only then is Eigenlichkeit possible (Heidegger, 1959/1966 ) to the imaginary, the symbolic, and the Real (Lacan, 2006).

8 Although not the most prudent of word choices in illustrating a complex intellectual and ethical process (diagnosis), I have yet to find descriptors able to both respect essentialist traditions and carry such practices and states of mind across into the domain of mental health without running the risk of violence to a sense of self already burdened by illness.
9 I take it this is what Badiou (2009) would refer to philosophically as “an event”.

The sceptic reader may mention that taking individual cases may be an oversimplification, and that medicine and medical diagnosis has helped many adapt to complex illnesses. Clients also actively seek diagnostic procedures for their difficulties and feel most in control of their illness if they have a diagnosis. This is certainly the case and meaningful in itself. An example may suffice: a client treated by me had the utmost respect for diagnostic nomenclature after he could successfully find a diagnosis to explain what he felt was ‘wrong’ with him. Paradoxically it took this particular client two decades to convince physicians and psychiatrist that something was amiss! At first glance I accepted the notion until spontaneously we started making sense that his search for a diagnosis had multiple meanings. Being the son of a mother that suffered period psychotic symptoms and a very strict demanding father it came as no surprise, to use the concept of the superego a bit freely, that he was exposed since an early age to immense pressures of perfectionism (‘my world is damaged—I have to be perfect, together, never needy’) and other chaotic superego demands (i.e., ‘be independent- but do as I say’). He was also frequently blamed for his own difficulty and given no sensitive regard or benign parental direction- a true Orphan of the Real (Grotstein in Allen & Collins, 1996). By ‘finding’ a diagnosis (finding ensured also agency!), that seemed to truly ‘fit’ (an explanation that could ‘tie up’, so to speak, his biological self as well as various contextual factors that included making sense of the other’s gaze as congruent and non-judgmental [treatment team], i.e. “it now makes sense why they [parents] said I was loud and aggressive-it is part of my biology, I am not a failure and just difficult!”, separating and protecting a budding psychological self), he could protect his own intuition/perception that he was ‘different’ (vs. ‘bad’) , gain an objective if not self-observing understanding in a system (in medicine and psychotherapy) that proved to supply symbolic protection10 against a brutalizing internal mother and father, and lend an supportive environment full of benign professionals (helpful humans compared to brutalizing parenting) that helped re-interpret his understanding of himself over time. Diagnosis here served as guardian, protector, elucidator, enhancer, clarifier and scaffolder of a reconstituted self (“I am rebuilding myself after I not only collapsed but was gutted by what happened in my life”).He even received grants and other support, that although at times brought its own complexity, did serve him well. The use of medication, as initiated by his own free will can still be viewed as part of eigenlichkeit—it facilitated a releasement toward the world. Philosophers such as Martin Heidegger (1959/1966) view releasement towards things, as well as an openness to the mystery of things central to finding a true relationship between nature and man,

Releasement11 towards things and openness to the mystery belong together. They grant us the possibility of dwelling in the world in a totally different way. They promise us a new ground and foundation upon which we can stand and endure in the world of technology without being imperiled by it. Releasement towards things and openness to the mystery give us a vision of a new autochthony which someday even might be fit to recapture the old and now rapidly disappearing autochthony in a changed form…(Heidegger, 1959/1966, p. 55)

10 He once mentioned that he would have liked to tell his parents that if all of us as learned people say there is something biological wrong they would know he is not to blame and thus stupid and a disappointment.

11 As opposed to, or in relationship with, comportment and classification.

For Heidegger there are two distinct ways of dwelling in the world- through calculative thinking12 and meditative thinking. Calculative thinking is central to the natural sciences, to topology and diagnosis. Heidegger does not scorn such a way of thinking but does mention that,

[This] assertion is valid in the sense that the approaching tide of technological revolution in the atomic age could so captivate, bewitch, dazzle, and beguile man that calculative thinking may someday come to be accepted and practiced as the only way of thinking (p. 56).

As mentioned earlier the very difficulties facing the mental health practitioner is not calculative thinking per se , but that it is seen and used as the only way to approach a mental health difficulty, i.e., an indifference and rejection of meditative thinking, a total ‘thought’lessness or ‘thinking- less- ness’ to other ways of being in the world, of man’s Soul,

Then man would have denied and thrown away his own special nature—that he is a meditative being. Therefore, the issue is saving of man’s essential nature. Therefore, the issue is keeping meditative thinking alive (Heidegger, 1959/1966, p. 56)

12 “There are, then, two kinds of thinking, each justified and needed in its own way: calculative thinking and meditative thinking. This meditative thinking is what we have in mind when we say that contemporary man is in flight-from-thinking. Yet you may protest: mere meditative thinking finds itself floating unaware above reality. It loses touch. It is worthless for dealing with current business. It profits nothing in carrying out practical affairs” (p.46). Calculative thinking computes, it “races from one prospect to the next. Calculative thinking is not meditative thinking, not thinking which contemplates the meaning which reigns in everything that is” (p.46)… “…meditative thinking does not just happen by itself any more than does calculative thinking. At times it requires a greater effort. It demands more practice. It is in need of even more delicate care than any other genuine craft. But it must also be able to bide its time, to await as does the farmer, whether the seed will come up and ripen” (p. 47).

Another way to illustrate this reality is through literary examples,

Calculative thinking’s impact on the native self – The Little Prince:

Meditative thinking: Albert Camus (1955/1983)—The Absurd Walls—

If I’ve told you these details about Asteroid B-612 and if I’ve given you its number, it is on account of the grown-ups. Grown-ups like numbers. When you tell them about a new friend, they never ask questions about what really matters. They never ask: “What does his voice sound like?” “What games does he like best?” “Does he collect butterflies?” They ask: “How old is he?” “How many brothers does he have?” “How much does he weigh?” “How much money does his father make?” Only then do they think they know him. If you tell grown-ups, “I saw a beautiful red brick house, with geraniums at the windows and doves on the roof they won’t be able to imagine such a house. You have to tell them, “I saw a house worth a hundred thousand francs.” Then they exclaim, “What a pretty house!”(de Saint- Exupèry, 1943/2000, p.10)

Like great works, deep feelings always mean more than they are conscious of saying. The regularity of an impulse or a repulsion in a soul is encountered again in habits of doing and thinking, is reproduced in consequences of which the soul itself knows nothing. Great feelings have with them their own universe, splendid or abject …It is probably true that a man remains forever unknown to us and that there is in him something irreducible that escapes us. But practically I know men and recognize them by their behaviour, by the totality of their deeds, by the consequences caused in life by their presence. Likewise, all those irrational feelings which offer no purchase to analysis. I can define then practically, appreciate them practically, by gathering together the sum of their consequences in the domain of intelligence, by seizing and noting all their aspects, by outlining their universe. It is certain that apparently, though I have seen the same actor a 100 times, I shall not for that reason know him any better personally. Yet if I add up the heroes he has personified and if I say that I know him a little better at the hundredth character counted off, this will be felt to contain an element of truth… But it is also evident that that method is one of analysis and not of knowledge. For methods imply metaphysics, unconsciously they disclose conclusions that they often claim not to know yet. Similarly, the last pages of a book are already contained in the first pages. Such a link is inevitable. The method defined here acknowledges the feeling that all true knowledge is impossible… (pp. 10-12) (italics added).

To return to Longden, one reads the difference of approach in the essay by Longden’s two experiences with different physicians:

Psychiatrist one [calculative thinking]:“Eleanor, you’d be better off with cancer, because cancer is easier to cure than schizophrenia.” [Language about being diseased- no eigenlichkeit and no releasement, only an I-It relationship and thus enslaved autochthony].

Psychiatrist/Doctor two [meditative thinking]: “As a very wonderful doctor once said to me, “Don’t tell me what other people have told you about yourself (alterity). Tell me about you (autochthony).” [Recognition of autochthony (eigenlichkeit) facilitating a releasement towards the world (alterity)]

Heidegger (1959/1966) augments his opinion in that “[Yet] releasement towards things and openness to the mystery never happen of themselves. They do not befall us accidentally. Both flourish only through persistent, courageous thinking… if releasement13 towards things and openness to the mystery awaken within us, then we should arrive at a path that will lead to a new ground for foundation. In that ground the creativity which produces lasting works could strike new roots” (Heidegger, 1959/1966, p. 56-57). Again Longden gives us many examples of being open to her own voices, the cumulative effort of understanding her own history and current being within her world. Diagnosis as hortus siccus can only be of use if it meets the very thing it describes-a human being. But only a human being is alive and has freedom to choose- diagnosis is the fruit of such a reality. In itself it can only accumulate further distinction, more symptoms and serve calculative thinking, at worst, oppressive superego technologies. It is even more of a concern if the use of such a reality (the mental health provider) only serves as vessel to its calculative reality.

13 This is an important word as many technologies on identity actually keeps the Other not only hidden but language and cultural practices confines the ill! Newer superego technologies may give rise to greater internal and mental forms of institutionalization under the banner of the good.

The Soul in need of articulation within Calculative logic

I also include here thinking on “Soul” as the definition provided by the existential psychoanalyst Eric Craig may not only scaffold psychiatric thinking, but may support all clinicians to follow an anthropological view to man’s psychological lived world suffering possibly integrating both modes of being- calculative as well as meditative. According Craig (2008) the word Soul is most often used to “disclose the crux of the individuals own human existence, the quintessence of one’s one and only life as lived” (Graig, 2008, p.256). More specifically , and again according to Craig “ The best I can put this tacitly held understanding, phenomenologically, is that the soul or ‘life of the soul’, is an individual’s very own situated gathering of lived experience” (p. 257). It is the unique and singular way an individual has collected, organized, processed, symbolized [put to “meaningful account” ] his or her “ongoing stream of lived experience while wending [our way] through life” (257). As seen in our contemporary analytic work this being in the lifeworld may contain known and unknown elements. Never the less, being in the world implies an ongoing relationship, an ongoing gathering together, in Winnicottian terms. It should be mentioned that an individual’s “gathering” is by no means calculable, an end product in itself; “ it is the human being as a whole, no ego, no self, no body, no world alone, but an entire existence that gathers all that it lives through and endures as a whole.” (Graig, 2008, p. 257, Italics mine).

Combined with Soul as one’s gathering of lived experience, Craig also emphasizes Soul as one’s going on being as ‘stretching along’ and borrows from Donald Winnicott’s notion that gathering implies a continuity of being. The gathering of life experience has ontic and ontological significance, and only through disclosure of such world design may the Soul be evident, if at all, as situated. “In saying that the gathering of lived-lived experience is situated, I mean only that as Da-sein, our gathering of experience is unavoidably contextualized, that is, shaped and structured by the manifold social, historical, existential, genetic, biological, and evolutionary contexts from which each of our existences arise.” (p.259). Furthermore:

“The circumstances (a) that we are the kind of being we call human being, a being that has evolved in its own kind of way and not some other way (e.g., not like the way of an insect, bird, cat, dog, dolphin, or gorilla); (b) that we are embodied as we are, not only as a particular species, but as both distinct and gendered individuals; (c) that we are cast into a very particular geological region and climate and not any other; (d) that we each appear at a particular time in history with its own cultural, socio-economic, political, and power dynamics; (e) that we also appear within a certain locally ethnic, economic and linguistic community; and (f) that we are thrown, rather haphazardly I’m afraid, into particular existential situations, that not only manifest the specific worlds of a geography, a particular community, and, especially, a particular family but also manifest all of these contexts in a peculiar, only-once-in cosmic-history manner; all these circumstances, shape our experiences and how we gather them in such pervasive and largely invisible ways we can in no way separate from them what we call ourselves, what we call our very soul” (p 259).

Despite the Soul being situated, i.e., that we are thrown into various situations, situations that may, given it being either good or bad, evoke the most fleeting of thoughts and feelings, existence in the final analysis belongs to the person who lives it, and only that person. The Soul is thus one’s very own; existence remains one’s own responsibility. Without delving into Dasein analytic technique, or any psychotherapeutic approach, Craig’s language of Soul does allow some remediation in my view supportive of more ‘whole’-some’ attitudes to mental suffering. It can be said that when faced with mental pain there may be desperate attempts to remake the world, active or inactive approaches to alter lived experience of time, space, body sense, social relationships, a reworking, a re-languaging and envisioning of one’s unique world view (world design, the physical world [Umwelt], the social and interpersonal [Mitwelt], and/or personal subjective world [Eigenwelt]). The change may be conscious or unknown, uncanny as it seems foreign or not me experiences. Given the abovementioned concerns, our access to both calculative and meditative thinking one could envision a languaging of another, a dialogue of togetherness wherein both modes of thinking can be used in such a way

that diagnostic thinking does not become a deadening objectifying discourse, enacting an experience distant contact in a period of another’s life where mutuality, solidarity and non-problematizing is central for the Soul’s gathering and stretching forward in hope [stones]. Put another way, could we find a way of dialoguing that ensures a third (triangular dialogism), a looking together at, an I –thou ‘at’, vs. the I –It inherent in empiricism. Mental health triangular dialogism can thus become, (similarly) in the work of Brazilian educator and philosopher Paulo Freire a pedagogy of communication, mutuality, solidarity, hope and a thinking heart. Again, as beautifully articulated by Langdon:

As Peter Levine has said, the human animal is a unique being endowed with an instinctual capacity to heal and the intellectual spirit to harness this innate capacity. In this respect, for members of society, there is no greater honor or privilege than facilitating that process of healing for someone, to bear witness, to reach out a hand, to share the burden of someone’s suffering, and to hold the hope for their recovery. And likewise, for survivors of distress and adversity, that we remember we don’t have to live our lives forever defined by the damaging things that have happened to us. We are unique. We are irreplaceable. What lies within us can never be truly colonized, contorted, or taken away. The light never goes out.

Conclusion

Man’s empirical and transcendental self, man’s Soul language, invites both calculative and meditative modes of being. Although both are of importance, it seems evident that contemporary culture tends to act, for complex reasons in itself, as if only calculative thinking, and thus the empirical, is of importance in the study and relating to man. It especially becomes an area of concern when the empirical gives rise to technological interventions designed and used independently of human relationships, their values and their own ‘Soul voice (s)’. Soul thinking, or triangular dialogism, may serve as guardian and ensure the development and refinement of our moral imagination, and as such, our deepest level of care towards our fellow human beings. As stated by Martin Buber:

“In certain cases, a therapist is terrified by what he is doing because he begins to suspect that, at least in such cases, but finally, perhaps, in all, something entirely other is demanded of him (or her). Something…dangerously threatening…is demanded of him: that he step forth out of the role of professional superiority, achieved and guaranteed by long training and practice, into the elementary situation between one who calls and one who is called. The abyss does not call to his confidently functioning security of action, but to the abyss, that is to the self of the doctor, that selfhood that is hidden under the structures erected through training and practice, that is itself encompassed by chaos, itself familiar with demons, but is graced with the humble power of wrestling and overcoming, and is ready to wrestle and overcome thus ever anew.” (in Agassi, 1999, pp.18-19)

Acknowledgements

Special thanks to Prof Kevin Boileau for his thorough and critical reading of the article, as well as the anonymous reader. Your perceptive reading enhanced the paper’s core concerns— I am deeply grateful.

Bibliography

Agassi, J.B. (1999). Martin Buber on psychology and psychotherapy. Essays, letters, and dialogue. USA: Syracuse University Press.

Allen, J.G. & Collins, D.T. (1996).Contemporary treatment of psychosis. Healing the relationship in the era of the brain. Northvale, New Jersey: Jason Aronson, Inc.

Angel, K. (2012). Contested psychiatric ontology and feminist critique: Female sexual dysfunction and the DSM. History of Human Sciences, 25 (4), 3-24.

Badiou, A. (2009). Theory of the Subject. London and New York: Continuum International Publishing Group.

Bion, W.R. (1990). A Memoir of the Future. Book 1-3. London: Karnac Books.

Bloch, S. & Green, S.A. (Eds.). (2009). Psychiatric ethics (4th edition). London: Oxford University Press.

Bromme, M.R. (2006). Taxonomy and ontology in Psychiatry: a survey of recent literature. Philosophy, Psychiatry and Psychology, 13 (4), 303-319.

Camus, A. (1955/1983). The myth of Sisyphus and other essays. New York: Vintage Int.

Craig, E. (2008). The human and the hidden: existential wonderings about depth, Soul and the unconscious. The Humanistic Psychologist, 36, 227-282.

de Saint- Exupèry, A. (1943/2000).The Little Prince. New York: Houghton Mifflin Harcourt.

Frances, A. (2013). Saving normal. NY, NY: HarperCollins Publishers.

Grotstein, J. S. (1997). Integrating one person and two person psychologies: Autochthony and Alterity in counterpoint. Psychoanal Q., 66, 403-430.

Fulford, K.W.M., Thorton, T. & Graham, G. (2006). Oxford textbook of philosophy and psychiatry. UK: Oxford University Press.

Heidegger, M. (1959/1966). Discourse on thinking. New York: Harper Perennial.

Henry, M. (1987/2004). Barbarism. London and New York: Continuum International Publishing group.

Lacan, J. (2006). Ecrits. New York: W.W. Norton and Company. Translation from French by Bruce Fink.

Moncrieff, J. (2010). Psychiatric diagnosis as political device. Social Theory and Health, 8(4), 370-382.

Savage, H. (1998). An Introduction to Holism. Pretoria: Wessa.

Thomas, P. & Longden, E. (2013). Madness, childhood adversity and narrative psychiatry: caring and the moral imagination. Med Humanit, 39, 119-125.

Von Broembsen, F. (1999).The sovereign self: toward a phenomenology of self-experience. Northvale, New Jersey: Jason Aronson, Inc.