This blog started by posting research threads for my doctorate in philosophy at the European Graduate School, "Trauma and Event" (2012). Now, I am focusing on the crisis in psychiatry which is the subject of a forthcoming volume co-written with fellow psychiatrist and philosopher Drozdstoj Stoyanov - "Psychiatry in Crisis: At the Crossroads of Social Science, the Humanities and Neuroscience" to be published by Springer Medical in 2018.
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Saturday, December 2, 2017
Badiou, the Event, and Psychiatry, Part 1: Trauma and Event
—Alain Badiou, Second Manifesto for Philosophy
(2011, p. 71)
Instead of being reckless,
as Badiou demands of philosophy, by which he means a bold and fearless program
of innovation and change, psychiatry has become feckless, lacking courage, retreating into scientism and methodolatry,
with no clear program or way forward.
In this atmosphere, already a full professor of
psychiatry with classical training in psychology, psychiatry and
psychoanalysis, I decided that psychiatry could not resolve its issues through
more empirical research and sterile debates, so I turned to my first love,
philosophy, inspired by psychiatrist-philosopher Karl Jaspers’ admonition in
his re-visioning of psychiatry based on Edmund Husserl’s phenomenology (2012). At
the end of his magisterial General
Psychopathology that defined modern clinical psychiatry a century ago,
Jaspers (1997) warned:
If anyone thinks he can
exclude philosophy and leave it aside as useless he will be eventually defeated
by it in some obscure form or other (p. 770).
Let’s look at this malaise from both sides—psychiatry
and philosophy. Psychiatrists are living the curse of the best of times and the
worst of times! We have never had so much diversity of clinical approaches, so
many promising research projects along different lines, and yet there is
malaise within the profession and mixed reactions from colleagues in the
humanities. This malaise is captured in the resonant title of a volume on
health care in the US—“doing better and feeling worse” (Knowles, 1977).
Why? Besides the debate about funding health care, which
is at a boiling point in the USA and simmers elsewhere as well, there is within
the profession of psychiatry a schism as to how to conceive of “psychopathology,”
or how we conceive of mental illness. One way that Western academic
psychiatrists are casting this debate is whether to persist in refining clinical
criteria for defining “psychiatric disorders” with the Diagnostic and
Statistical Manual (DSM) of the American Psychiatric Association, now in its
fifth iteration, or the Research Domain Criteria (RDoC) of the National
Institute of Mental Health, until recently led by Thomas Insel, based not on
clinical descriptions but on putative genetic and neuroscientific factors (Insel
& Landis, 2013).
Among philosophers, there is a great divide as to
questions about psychiatry, the mind, and related matters. Theorists in the “Continental”
or critical theory tradition have largely addressed psychiatry through
psychoanalysis, notably Lacanian psychoanalysis (e.g., Alain Badiou and Slavoj Žižek), or phenomenology,
including Michel Foucault who trained first as a psychologist and translated Ludwig
Binswanger’s Dream and Existence (1993)
from German into French, adding a lengthy introduction. Much of Foucault’s
later project, investigating aspects of the history of psychiatry and the deployment
of “psychiatric power” is already on evidence there.
Theorists in the Anglo-American “analytic” or linguistic
tradition, on the contrary, basically declared psychoanalysis a pseudo-science,
including Karl Popper and Roger Scruton, and the attention to psychiatry, psychology
and related disciplines including psychoanalysis has been via philosophy of
science and is now focused on cognitive neuroscience by such stalwarts as Jerry
Fodor, Daniel Dennett, and Patricia Churchland. This approach often combines
with a narrow and highly selective view of the “progress of science.” This
positivistic notion, reflecting Auguste Comte’s famous dictum, “Order and
progress,” has been at the heart of trenchant critiques in the philosophy of
science (Paul Feyerabend, 2010, 2011), the humanities (Christopher Lasch,
1991), and even within the paradigm of the life sciences (Stephen Jay Gould, 1981).The Continental tradition sees this paradigm
at best as mere empiricism (or
observation) and at worst as scientific positivism.
There are, of course, many crossovers between and among
these schools of thought, including one of my professors, Catherine Malabou (2012)
who was a student of Derrida and now focuses her philosophical work on
plasticity in experimental and clinical neuroscience.
I decided to examine nothing less than the history of
modern psychiatry and its relationship to philosophy by investigating trauma.
During my seminars with Alain Badiou (2005, 2009a), I was struck by the symmetry
between his description of the event as an opening and my emerging
understanding of trauma as a rupture. When I consulted him, Badiou immediately
recognized trauma/event as a fresh
and innovative pairing and contrast.
Badiou’s Four Conditions
One of Badiou’s (2008) seminal contributions is to delineate the four conditions of philosophy—
art (aesthetics), love (which includes psychoanalysis, or in my
view, all that is relational and contextual, what Badiou calls the multiple),
science (mathematics, physics), and politics (broadly conceived as ways of
Philosophy itself doesn’t generate truth but serves as
the rubric under which the conditions present the truth through their truth
procedures. A key consequence is that philosophy cannot be “sutured” to its
conditions. Philosophy cannot be simply reduced to one or another truth
procedure. Philosophy is not merely political philosophy or aesthetics or
ethics or logic, say. So, for example, Badiou would not agree with Emmanuel Levinas’
stance that “ethics precedes ontology” or ethics as a “first philosophy,”
suturing philosophy to ethics.
Psychiatry has its own conditions or, to communicate
with colleagues in my community of practice, I would refer to psychiatry as a
discipline with sub-disciplines. Psychiatry has many sub-disciplines, whose
salience and impact change over time, depending on the contemporary problems
that the discipline addresses, and they range from the social determinants of
health and epidemiology to genetics and neuroscience. Along the way, psychiatry
has benefitted from sub-disciplines as diverse as psychoanalysis and social and
My argument is that like philosophy, psychiatry cannot
resolve its truth claims on its own. It can only use its sub-disciplines to
generate truth claims. But psychiatry’s current crisis is that it is precisely
sutured to one approach to truth, represented today by genetics and
neuroscience using its chosen “gold standard” of evidence-based medicine (EBM).
Yet, while neuroscience is a potentially valuable sub-discipline
(notwithstanding it’s inflated claims and oversold promise—as one leading
psychiatrist told me, it’s “aspirational”), EBM is hollow. It’s just a rhetorical
restatement of the positivistic paradigm, elevating the notion of objective
data as the “gold standard” for truth.
My two fundamental critiques of EBM address the scientism and methodolatry of psychiatry and the social sciences today by posing the
questions: How can we evaluate the salient evidence in psychiatry? More
critically, just what evidence is salient?
evidence. In the first critique, EBM isn’t so much
scientific as scientistic, mimicking
the practices of sciences rather than its spirit of inquiry. For example, the
Society for the Study of Psychiatry and Culture, which straddles psychiatry as
a medical discipline and the study of culture as a social science, demands that
submissions be organized by the experimental model of hypothesis, methods,
results; this is clearly not an adequate model for qualitative studies in
psychiatry, not to mention the narrative and participatory approach of cultural
Now, even if we grant EBM its premises, my mathematical
metaphor is that EBM places us at an asymptote. EBM simply puts some selected studies
on the table for consideration and while this is valuable and useful in a
limited way, it does not get us all the way there. In the best case, even if we
accept its truth procedures to arrive at the evidence, EBM takes us closer to
the crucial point, but never breaches the chasm from observation to truth.
Clarifying the available information in a critical way,
the clinician can then confront the clinical dilemma: How to diagnose the
problem and what interventions are indicated based on a critical review of the
available evidence? Here is where we reach an asymptote—at a certain point, no
matter how close EBM gets us, we still have to make a subjective judgement
using all the complex processes involved in human judgments. And that is the
corollary of how to evaluate the evidence: the psychology of human judgments.
The notion that these can be reduced, explained, or
revealed somehow is ephemeral. While EBM offers a procedural method, genetics
and neuroscience offer seductive sub-disciplines (even though they only
indirectly address psychiatry’s core concerns), and cognitive psychology
pretends to offer the gold standard for how humans think (Pinker, 1997) and
solve problems [or are bedeviled by such problems, as both Ludwig Wittgenstein (1953)
and Daniel Kahneman (2011) would have it], we cannot breach the gap. Even if we
grant EBM all that it claims (and to be clear, I do not), it only highlights
the crucial point that clinical judgements are inescapably human, that is to
say, subjective. “Subjective” here not only means subject to error but, even
more importantly, that it is a human construction. What cognitive science has
done, at its best, is to outline the parameters of that construction, notably
in the brilliant work of Nobelist Daniel Kahneman (2011) and his associate Amos
What evidence? My second critique is more trenchant. Since it is purely procedural
and cannot account for how proper research questions are generated or how they
become dominant (the domains of Karl Mannheim’s “sociology of knowledge,” 1936),
I do not grant that EBM can answer the question about what is to be construed
and accepted as evidence. And, as Wittgenstein (1953) observed about psychology,
the truth claims of psychology and psychiatry are not easily resolved by
of the experimental method makes us think we have the means of resolving the
problems that trouble us; though problem and method pass one another other by
Believing that the questions of the definition and tasks
of psychiatry can be resolved by the experimental or any other method or
procedure is methodolatry. Even
before we consider methods, we must define in a philosophical sense what
psychiatry is, what its concerns are, independent of the current tools at hand.
That is what refusing to suture psychiatry to its sub-disciplines really means.
And today’s temptation for suturing psychiatry to one of its sub-disciplines
isn’t science, it’s scientism and methodolatry. As Jaspers (1997) concluded in his
textbook of psychiatry, the effort to avoid philosophy will only result in its
coming back to haunt us in some way or other.
All of this brings us to clarify psychiatry’s central
task which requires three things:
general psychology as a science of
coherent theory of psychiatry as a
it proposes to help people, it needs a theory
To state this more broadly, any helping profession, any
approach to human problems, needs to explain three things:
·How people function [normal
psychology—cognitive scientist Steven Pinker (1997) calls it “how the mind
works,” but I would not limit it to “mind,” I would minimally address mind, brain,
behavior and relations—these four domains are not reducible one to the other;
philosophically we can ask what is a person or what is a subject? One of
Pinker’s critics, philosopher Jerry Fodor (2000), wrote a rejoinder called, The Mind Doesn’t Work That Way].
·How problems arise (a theory
of psychiatry beyond clinical descriptions or “phenomenology,” as it has come
to be known in psychiatry).
·What the conditions of change are
(including what is change and how does novelty arise in human experience?).
So, Badiou offers three profound things to psychiatry:
he offers a theory of the subject
(Badiou, 2009c), essential in any human psychology;
his theory of how philosophy works
(Badiou and Tarby, 2013), with its conditions
and truth procedures (Badiou, 2008), offers
a way to clarify what is proper to the discipline of psychiatry and what are
he offers a theory of change based on the
event (Badiou, 2005, 2009a), which is sorely lacking in psychiatry.
In Badiou’s work, these issues are connected. In my
reading of Badiou, the three conditions for an event are: To encounter an event
(which is a purely contingent encounter), to give it a name, and to be faithful
to it. The subject emerges through the event. By naming it and maintaining
fidelity to the event, the subject emerges as a subject to its truth. It is not
mere change: what was contingent becomes a necessity (Žižek, 2104). “Being there,” as subjective phenomenology would have it, is
Badiou offers a new, objective phenomenology to replace the
phenomenological epoché that is at
the heart of Husserl’s subjective phenomenology. Now this is a rather far-reaching
project. To understand how far, let’s examine how some major streams of
European philosophy and psychiatry flowed into each other.
In every generation since Edmund Husserl
(whose own teacher Franz Brentano was also Freud's teacher), there has been a
rich dialogue between philosophers and psychiatrists:
Edmund Husserl (2012)Karl Jaspers, General
While he didn’t
outline a psychology let alone a psychiatry, Heidegger closely followed the
work of his psychiatric interlocutor, Ludwig Binswanger, with whom he
maintained a lengthy and detailed correspondence.
Sartre offered an
explicit psychological theory (see his Sketch
for a Theory of the Emotions, 2002) and influenced R.D. Laing’s call for a “social
phenomenology” in his critiques of psychiatry (while his colleague David Cooper
coined the term “anti-psychiatry,” Laing specifically refuted this term). Laing
and Cooper (1964) produced a précis of Sartre’s work in English with a
laudatory preface by Sartre welcoming the advent of a “truly human psychiatry.”
Until I worked with
him, no one in my field had really paid attention to the import of Badiou’s event
This line of investigation in philosophy
with its applications to psychiatry has reached an asymptote, the point of
diminishing returns (see Tom Sparrow, The
End of Phenomenology, 2014). We may call it, from Husserl to Sartre and
their epigones in both philosophy and psychiatry, “subjective phenomenology.”
With his key philosophical works, the foundational texts for a new ontology—Theory of the Subject (2009c) and Being and Event, I and II (2005, 2009a)—Badiou
sets out a new “objective phenomenology.”
Deep into my philosophical investigations, Badiou
offered this crucial assessment and challenge: “You are at a crossroads, either
you will abandon psychiatry as such or announce a new, perhaps, evental
psychiatry.” It was an accurate philosophical diagnosis! This added another
year and another hundred pages to my doctoral dissertation which I called with
Badiou’s approval, “Trauma and Event” (Di Nicola, 2012).
My turn to philosophy was confirmed by Badiou’s assessment,
echoed Jaspers admonition of a century earlier, and reflected the critical
insight of the founder of the modern scientific approach to knowledge, Francis
Bacon who in his Novum Organum (1620)
distinguished “experiments of light” from “experiments of fruit” (or profit):
first, by every kind of experiment, elicit the discovery of causes and true
axioms, and seek for experiments which may afford light rather than profit.
Axioms, when rightly investigated and established, prepare us not for a limited
but abundant practice, and bring in their train whole troops of effects (Aphorism
I tasked a triumviri of philosophers for my investigations: Foucault (1972), the
philosopher of discourses and apparatuses; Agamben (2009), who adapted
Foucault’s work on the apparatus and paradigm to forge a method of inquiry
called “philosophical archaeology,” is our philosopher of the threshold; and
Badiou (2005, 2009a), our contemporary Platonist, is the philosopher of the
exception and of the event. By seizing on the profound symmetry between
Badiou’s ontology based on the event and the rupture that precedes trauma, I
was able to re-read the history of psychiatry, psychology and psychoanalysis
through the apparatus of trauma to make it contemporary. This method is
Agamben’s philosophical archaeology (2009).
Rupture is a breach that suspends
the past and interrupts the world. Radically contingent, hence unpredictable
and uncontrollable, it can lead to novation,
an opening for new possibilities that leads to an event, or shut down into
trauma, closing down possibilities. Ultimately, this allows us to discern a psychiatry of trauma (that not only concerns
itself with trauma but can also be traumatizing) and a psychiatry of the event (that not only studies the event but is
radically open to recognizing radical change and being faithful to it in the
construction of new forms of human relations).
And, as Freud observed, everywhere
we go we find that a poet has been there before us. Amichai grasped this
dichotomy of being in his poem inspired by the Babylonian Talmud:
closed open. Before we are born everything is open
the universe without us. For as long as we live, everything is closed
us. And when we die, everything is open again.
closed open. That’s all we are.
—Yehuda Amichai, Open Closed Open (2000, p.
Brief bio: Vincenzo Di Nicola, MPhil, MD, PhD, FRCPC, DFAPA, is a tenured Full Professor of Psychiatry at the University of Montreal, where he works as a Child & Adolescent Psychiatrist. Trained in psychology, psychiatry and philosophy, Professor Di Nicola completed his doctorate in philosophy at the European Graduate School, where he worked with Giorgio Agamben, Alain Badiou and Slavoj Žižek. His 2012 dissertation, “Trauma and Event: A Philosophical Archaeology,” was granted Summa cum laude and inspired his call for an Evental Psychiatry. He is now working with fellow psychiatrist and philosopher Drozdstoj Stoyanov on a volume called, Psychiatry in Crisis: At the Crossroads of Social Science, the Humanities, and Neuroscience, to be published by Springer International.
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