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Monday, January 16, 2012

Excursus: Janus-faced Terms I—The Fugue State

In my dissertation and in these blogs, I will explore some bivalent, bimodal Janus-faced terms in philosophy and psychiatry.

Janus-faced: pharmakon—the philter is both a poison and a remedy; Achilles’ spear both wounds and heals; akedah—God commands the “binding” of Isaac then saves him; skandalon—the rock over which we stumble is also a foundation stone; trauma is a wound that activates growth.

In this first excursus on Janus-faced terms, I explore the “fugue” in music (musical composition) and in psychiatry (a disturbed state of consciousness).

Excursus: Janus-faced Terms I—The Fugue State


The English term fugue originated in the 16th century and is derived from either the French word fugue or the Italian fuga. This in turn comes from Latin, also fuga, which is itself related to both fugere (‘to flee’) and fugare, (‘to chase’). The adjectival form is fugal. Variants include fughetta (literally, ‘a small fugue’) and fugato (a passage in fugal style within another work that is not a fugue).

George Eliot. The Mill on the Floss.

Book VI: The Great Temptation. Chapter 1: A Duet in Paradise

Surely the only courtship unshaken by doubts and fears must be that in which the lovers can sing together. The sense of mutual fitness that springs from the two deep notes fulfilling expectation just at the right moment between the notes of the silvery soprano, from the perfect accord of descending thirds and fifths, from the preconcerted loving chase of a fugue, is likely enough to supersede any immediate demand for less impassioned forms of agreement. The contralto will not care to catechise the bass; the tenor will foresee no embarrassing dearth of remark in evenings spent with the lovely soprano. In the provinces, too, where music was so scarce in that remote time, how could the musical people avoid falling in love with each other? Even political principle must have been in danger of relaxation under such circumstances; and the violin, faithful to rotten boroughs, must have been tempted to fraternize in a demoralizing way with a reforming violoncello. In that case, the linnet-throated soprano and the full-toned bass singing,—
(emphasis added)

We have repeated in the psychiatric notion of the fugue state, whose name is borrowed from the musical form or texture (there is a debate as to its musical quality) of the fugue, a similar paradoxical enchainement that we see in Plato’s pharmakon, Achilles’ spear, akedah—the “binding” of Isaac that I call “Isaac machine,” the Biblical skandalon or the trauma trope. Whereas in music, contrary (“contrapuntal”) elements that we may imagine “chase” each other or appear to “flee” the main musical statement are brought together to produce pleasingly complex harmonics (see George Eliot’s lovely description in The Mill on the Floss), in psychiatry, the flight is a dissociative state with interrupted memory and the simultaneous loss of and recreation of personal identity (a celebrated example occurred in the life of Agatha Christie). Again, there is a rhetorical conflation of two Latin roots—fugere, to flee and fugare, to chase.


This Janus-like face of core notions in psychiatry goes back to the roots of our philosophy and our culture.


Janus-faced: the philter is both a poison and a remedy (pharmakon), Achilles’ spear wounds and heals, God commands the binding of Isaac and saves him (akedah), the rock over which we stumble is also a foundation stone (skandalon), trauma is a wound that activates growth.


It’s as if we have built in to our culture, that is to say, our way of thinking, this aporia of bimodal or bivalent notions, a bringing together of opposites, an opposition of elements that is surely not accidental. Is it to hide, to preserve or protect, to stultify, to segregate those with knowledge and those who lack it?  There are such hints. We see them in Leo Strauss’s Persecution and the Art of Writing (personally recommended by Michel Foucault to Thomas Zummer). They are the “things hidden since the beginning of the world,” as René Girard has it with his invocation of Paul. A hidden order, as some read Foucault (inaccurately, in my view, that is to say, without nuance). 


It’s as if something in our culture wants traumas to be events (emblematization) and events to be traumas (alchemical transformations). I want to pose the question: what is the origin of that impulse or response, how does it express itself and what does it mean for us?

There is a well-known distinction about cognitive styles in medicine about classification and diagnosis: there are lumpers and splitters. That is, those who see commonalities among phenomena and want to group them together (lumpers) and those who perceive differences and nuances and want to separate them (splitters). I have argued for the presence of two therapeutic temperaments—the technocratic and the phenomenological (see my Letters to a Young Therapist: Relational Practices for the Coming Community, 2011). A fascinating line of inquiry in cultural anthropology concerns categories for thinking food. The most noted example is Lévi-Strauss’ culinary triangle: the raw, the cooked and the boiled (used to great effect in Zizek’s work, sometimes hilariously as with the examples of different types of toilets in Europe and pubic hair styles). Jean Soler’s essay on the Jewish rules for kashruth is perceptive and instructive. Yet it’s final line landed like a bomb in the world of ideas. On the evidence of Biblical dietary restrictions in Leviticus and Deuteronomy, the Hebrew mind, he concluded, was intolerant of compromise and mixtures (the edible and the non-edible)—and not only in the kitchen!1 In fact, this sort of analysis is well-established in the anthropology of Mary Douglas (see Purity and Danger: An Analysis of Conceptions of Pollution and Taboo, 1966), yet its use by Soler smacks of an unscientific, that is unscholarly, judgement.

Cognitive style and temperament aside, I am concerned in this work with conflations, reductions, evacuations.

As Foucault said, structuralism wanted to “evacuate the concept of the event” (see his interview in Paul Rabinow’s The Essential Foucault). I very much want the concept of the event to flourish to be the basis for a new vision of psychiatry.

Furthermore, I want to question Janus-faced terms that have brought us as a culture to a confused understanding of trauma as both wound and transformation. It is even evident in the comments on this blog!

I am a category splitter, will be the charge. I am technocratic in my approach, offering merely rhetorical arguments, splitting hairs, reflecting perhaps a Jewish intolerance of nuance and subtlety (lacking hybrid, synthesis and compromise in Soler’s thesis). Myself scandalized, in Girard’s terms, by the cross.

Quite to the contrary, I live on the cusp, as Spinoza did, between Judaism and Christianity (as Yirmiahu Yovel brilliantly shows in his study of Spinoza, Spinoza and Other Heretics, 1989), I have a “saturated life” in social psychologist Kenneth Gergen’s vivid phrase, of professional identities, working languages and alliances, and my thought is marked more by the “porosity” that Walter Benjamin and Asja Lacis observed in Naples than by rigid categories. When I was awarded a prize for my last book, the president of the Association des médecins psychiatres du Québec remarked wryly that the prize, named for a québecois psychiatrist, Camille Laurin, noted for establishing French as the official language of Quebec, was being given to an Italian who works in French for a book written in English!



1.     Jean Soler, who was a French diplomat stationed in Israel for eight years, concluded his article on “The Dietary Prohibitions of the Hebrews” with this incendiary statement: “whatever variations the Mosaic system may have undergone in the course of history, they do not seem to have shaken its fundamental structures. This logic, which sets up its terms in contrasting pairs and lives by the rule of refusing all that is hybrid, mixed, or arrived at by synthesis and compromise, can be seen in action to this day in Israel, and not only in its cuisine” (emphasis added), The New York Review of Books, June 14, 1979. That line still rings in my ears. It was a betrayal of the anti-categorical argument Soler so carefully built and a call to arms.

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