Badiou, the Event, and Psychiatry, Part 2: Psychiatry of the Event
*
Blog of the APA
American Philosophical Association
Published 30.11.2017
Associate Editor: Nathan Eckstrand, PhD
Badiou, the Event, and Psychiatry
Vincenzo Di Nicola
Part II: Psychiatry
of the Event
What
will philosophy say to us? It will say: “We must think the event.” We must
think the exception. We must know what we have to say about that which is not
ordinary. We must think change in life.
—Alain Badiou, Polemics (2006, p. 8)
Just as Badiou rejected what he calls subjective phenomenology,
following his work, I criticized what I call “trauma psychiatry.” While Badiou
holds that philosophy must be reckless, psychiatry as both Nietzsche and
Jaspers brilliantly pointed out must be prudent and balanced, in the spirit of
the Greeks’ sophrosyne. The
psychiatrist needs to be methodologically up-to-date, a good communicator,
attentive and empathic, and a role model, Nietzsche recommended. This is not
enough, he must acquire the skills of “every other profession” (Nietzsche,
cited by Jaspers, 1997). Clearly, something stands apart from the requirements
(conditions) and skills and that is the core of psychiatry. For Jaspers (1997,
p. 808), a psychiatrist who turned to philosophy, that was a combination of
“scientific attitudes of the sceptic with a powerful personality and a profound
existential faith.” Another physician-philosopher, William James (1890),
referred to a similar duality of tough-minded
empiricism and tender-minded
rationalism.
Integrating the balance that psychiatrists need in
practice with the boldness that Badiou calls for in philosophy, I called for an
evental psychiatry in my doctoral
dissertation (Di Nicola, 2012). The first fruits of this project are on a
broader canvas, a course on psychiatry and the humanities which we pioneered at
the University of Montreal (see my previous APA blog), and in more detailed
form, presentations in various fora and two chapters: “Two trauma communities”
which discerns a critical tension between clinical and cultural views of trauma
(Di Nicola, in press, b) and “Pedagogy of the Event,” analyzing medical and
psychiatric education in light of Badiou’s theory of the event (Di Nicola, in
press, a). A more complete statement of my evolving project is available
online: “Slow Thought: A Manifesto for a Psychiatry of the Event” (Di Nicola, 2014).
An Evental Psychiatry of
the Threshold
Evental psychiatry
describes a psychiatry that would be singular, radically contingent, inherently
unstable and unpredictable. A psychiatry that is irreducible to categories and
essences, open to what Badiou calls in French novation. Evental psychiatry works at the site where singularity
can exist, novelty comes into being, and change may occur (developed in my
doctoral dissertation with Badiou, Di Nicola, 2012).
I anticipated the event in psychiatry by describing the
predicament (Di Nicola, 1997) as an alternative to categorical diagnosis. The
predicament is unstable, unpredictable, pregnant, and morally charged. The
predicament is not the event, but it is akin to Badiou’s notion of the evental
site. The predicament occurs in a moment of rupture—it could open possibilities
and thus become an event which the faithful subject maintains. While a
predicament is not trauma or traumatizing per
se, mishandling a predicament could trigger trauma.
An evental psychiatry would deal with threshold people in liminal situations—crossing over,
arriving and departing, émigrés, immigrants, refugees of all sorts, people
“betwixt and between,” in
transitional states (Di Nicola, 1997),
what philosopher Thomas Nail describes in his seminal work on the migrant and
the border (2015, 2016). Not trauma psychiatry, that has categorized stress and
trauma with the notion of Post-Traumatic Stress Disorder (PTSD), but a
psychiatry concerned with “orphan cases” that addresses the liminality arising
from predicaments and the threshold people it creates. People caught between subjectivation (the theme of Foucault’s
work) and desubjectivation (the
thread through Agamben’s work that connects him to Foucault). Albert Camus’ étranger was such a person as was Robert
Musil’s “man without qualities.” Samuel Beckett’s characters are such people:
“We can’t go on, we must go on.” Walter Benjamin was himself such a person and
I sense a kind of wistful self-recognition in his portrait of “porosity” in
Naples (Benjamin and Lacis, 2007). What is porosity in a city is reflected in
the liminality of its denizens. And it is possible to imagine this more
positively than Agamben’s (2005) “state of exception.” Like Simone Weil, who
was rapturous about being displaced and counseled that one should uproot the
tree of one’s life to make a cross of it, there is no “here” for such people,
torn between affiliation and uprooting. The Canadian sensibility—dispersed
among the Native Peoples, “the founding races,” and the rest of us—was framed
by Northrop Frye (1995, p. 220) not as who we are but, “Where is here?”
The categorical system of psychiatry demands definitions for
“caseness” with criteria for inclusion and exclusion—“brackets” in our jargon—which
create boundaries, regardless of construct validity or even face validity, and
the creation of “orphan cases” that do not easily fall within the boundaries.
This creates the pseudo-problems of “comorbidity” and “complexity.” The
complexity recognized by such a system is not the complexity of lived human
experience or even the attempt to understand it but rather the complexity of
shoehorning experience into categories. What falls in between or among defined
categories is explained away by comorbidity (“fleas and lice,” as they say in internal medicine), leading to “complexity”
and ultimately to “orphan cases.” The most common diagnosis within each
diagnostic group is “NOS,” Not Otherwise Specified. That creates a lot of
orphan cases for a system whose major goal is a coherent and reliable
diagnostic system.
Hence the study of orphan cases is always a challenge for diagnostic
systems, categorical thinking and typologies of all kinds. Orphan cases in
medicine and psychiatry are what the state of exception is to political theory,
and for analogous reasons, just as the exception becomes the norm, orphan cases
force the creation of new categories or new ways of thinking. Orphan cases
create a rupture in established systems of thought.
Categorical psychiatry becomes obsessed with measurement and with
questions of reliability: inter-rater
and intra-rater reliability (across raters and across time) and predictability.
An evental psychiatry is more concerned with truth procedures and with
questions of validity—not if it is
measurable and repeatable but whether it is valid and true.
Rupture versus Continuity
Most definitions of mental health
revolve around emotional stability and social functionality but these are at
odds with the event. To be stable and functional by ordinary measures means to
avoid ruptures, events, and the radical reorganization they engender. The entire subtext of DSM psychiatry is that health is
continuity, translated as functionality and adaptation. “Life events” or
stressors are ruptures that create, minimally, transitory “adjustment
disorders” or more serious “mental disorders.” In evental psychiatry, rupture
is the prerequisite for the possibility of event. So-called “life events”—the
incidents and interruptions of normal life we call stressors—are necessary
precursors to events.
One of the implications is that
diagnosis as we currently understand and use this notion would not be a
fundamental part of an evental psychiatry. None of the challenges to academic
psychiatry concurs with its nosography. In fact, that is the first practical
impact of every new theory. Pavlovian psychiatry had a radically different
approach to psychiatric diagnosis, as did behaviorism based on learning theory
and systemic family therapy. Except in the synthesis called psychodynamic
psychiatry, psychoanalysis and academic psychiatry also have different and,
since DSM-III, incompatible diagnostic schemas. A nosography based on
neuroscience would also reconfigure what academic psychiatry considers the core
phenomenology of psychopathology.
Discourse Therapy
Evental
psychiatry’s therapy would be a kind of “Ideology
Therapy” as
a form of discourse analysis. Any form of “talk therapy” deals directly with
ideology. This
is evident not only in the sense that it deploys ideology as part of its method
or technique and not only because the non-intended effects work through
expectations and other unintended or unannounced influences but because it
directly addresses beliefs, perceptions, motivations, ways of perceiving and
understanding experience.
In classical psychoanalysis, for example, interpretations
shape the patient’s understanding (insight) of their experience by analyzing
defense mechanisms (already an interpretation of human experience). In
cognitive therapy, cognitive schemas are posited (already a theory of mind)
about how the individual perceives the world and his own experience and schemas
are confronted, shaped and changes to schemas are recommended. As a clinician,
I often question this in practice, which is to say, theory aside, clinicians
easily misunderstand their patients. As the old joke goes, even paranoids have
real enemies. It is intriguing that Lacan saw “philosophical systematization as
akin to paranoia” (Badiou, 2011, p. 64). The psychoanalytic notion that
everything is analyzable, that all is grist for the mill and that there are no
accidents, slips or lapsi, in short, that
there is no contingency in the psychoanalytic world-view is hermetic and
slightly paranoid. In practice, psychoanalytic interpretations have more than a
little of the paranoid as a stance. Perhaps any form of systematization runs
the risk of being a hermetic system that is suspicious of alterity and change.
This has been a key charge against psychoanalysis from the beginning, expressed
with cynical humor by Karl Kraus, (“Psychoanalysis is that disease which considers
itself its own cure”) and with sustained and pertinent critiques from
philosophers of science and scientists. The most notable of the sustained
critiques was by philosopher Karl Popper who established different truth
procedures, falsifiability and
verifiability, as standards for science and this has been echoed by
philosopher-scientists like Mario Bunge and scientists like Peter Medawar. My
answer to this is uncomplicated: psychoanalysis is not a scientific procedure.
It is, in Badiou’s schema, a different truth procedure, that of love.
Psychoanalysis is neither science nor philosophy but something new. Just as it
cannot suture philosophy, psychoanalysis cannot be sutured to science or
psychiatry.
Foucault (1972) described discourses as systems of thought that systematically form the subjects and the
worlds of which they speak. Unlike
Wittgenstein’s ladder, you cannot throw away the discourse or apparatus after
you have used it. There is no illusion here that we can bracket it out or rid
ourselves somehow of ideology. To do philosophy or therapy à la Foucault or Agamben would mean precisely to keep all the
ladders and other apparatuses around us in plain view so we know how we got to
where we are. In other words, we should eschew illusions. It is like theatre
without the fourth wall. There is no recourse to hidden discourses, no “magic
bullet” and no philosopher’s stone.
Evental Analysis
Such
a therapy would tend towards a flattening of the hierarchy of knowledge and
power, as Foucault construed it. The face-to-face encounter that Levinas
described can never be altogether symmetrical but we identify the asymmetry as
much as possible and negotiate the differences. Psychoanalysis is being
conceived more and more as a “bipersonal field” and so much work is going on in
this field that Werner Bohleber (2010) refers to an intersubjective turn.
An analysis of subjectivation,
desubjectivation and resubjectivation following the models of
Foucault and Agamben would be valuable. And of course, an analysis of subjectizable bodies following Badiou’s (2011)
schema. The kind of philosophical archaeology that Foucault and Agamben have
conducted must be conducted for each person’s predicament. Discourse therapy
would examine the nested hegemonies that lie side by side, one obscuring the
other, one justifying the other sometimes. Often, they are buried, like
landmines, and our task is to locate them, map them, and either avoid them or disarm
them.
Evental analysis or discourse therapy would apply what I
dubbed Badiou’s shears to clarify the
task of therapy, unsuturing
psychiatry from its conditions. Then, one would do an evental analysis of the
person’s world: the evental site, the type of subjectizable body, what
processes are in place. An evaluation of the person’s porosity, her capacity
for novation would be valuable, along
with the extent to which trauma interferes with that porosity.
Let me elaborate with one detailed
example. The way psychoanalysis explains its own functioning can be enhanced
using evental analysis. Insight, the goal of psychoanalysis, requires fidelity. A rupture occurs
in the analysand’s understanding of herself, then a reorganization follows that
insight. James Joyce, who was influenced by Freud through the first Italian
psychoanalyst, Edoardo Weiss, called this an epiphany. Joyce’s epiphany
is Freud’s insight and may be understood as something that occurs in the
evental site, which I call a predicament. The epiphany or insight is a response
to the predicament. We could go so far as to say that the predicament, the
evental site, is a necessary condition for insight. Only a cut, a tear in the
world can create the acute sense of a rupture that requires a response. Once
the analysand has her epiphany, thoughts, actions and feelings are at first
interpreted, and later experienced, differently. For this translation from
interpretation to insight to new experience to occur, a deep fidelity must
accompany the procedure.
As with Badiou’s
theory of the event, real change cannot occur without fidelity. Fidelity is
what binds the insight into a world. The psychoanalytic event is insight. But
any analyst can relate anecdotes of pseudo-insights, passing insights
(“truths-of-the-moment”), insights that merely mimic the analyst’s worldview
(transference), without being understood, integrated and lived with fidelity.
Genuine healing can only come with this more complete insight—embodied, enacted
insight that emerges from the analytic relationship. Healing in this sense is
not operational or instrumental change, nor is it merely symptomatic relief.
This reflection addresses one of the most difficult questions in any kind of
therapy: how to maintain the gains, however defined. We need Badiou’s theory of
the event because psychiatry needs a theory of change: how novation
comes into the world and how to live with that change.
Conclusion: A New Opening
After radically
redefining clinical psychiatry by introducing the phenomenological method, Karl
Jaspers promptly left clinical practice, leaving others to work out the implications
for psychiatry. Turning to philosophy, Jaspers brought to philosophical puzzles
the insights of psychiatry. For example, Hannah Arendt’s (2006) famous formulation
of Eichmann as “the banality of evil,” was taken from Jaspers’ correspondence
with her.
In a similar gesture,
after writing his Tractatus, perhaps the most famous and provocative
work of philosophy of the last century, Wittgenstein (1922) concluded that he
had resolved the problems of philosophy and abruptly abandoned academic
philosophy even before it was published. Proving once again the wisdom of
Jaspers’ admonition about philosophical hubris, Wittgenstein was to revisit the
Tractatus in his Philosophical Investigations (1953) and other
reflections on psychology, offering philosophy as therapy.
Badiou challenged me
to confront the puzzles of contemporary psychiatry by either abandoning it or
boldly announcing a new vision based on the event. Accepting Badiou’s
challenge, I chose to avoid Jaspers’ and Wittgenstein’s extreme gestures. As a
late-career psychiatrist and an early-career philosopher, re-visioning
psychiatry through the event is a philosophical prescription for both radical
change in psychiatry and firm fidelity to track it through.
What could be more
critically relevant to a 21st century science of the mind and of
human relations than a return to metaphysics?
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