Excursus: The History of Psychiatry is Not the History of Madness

 

What difference does it make—for theory, for research, for policy, and for societal ethics—to change the border between a social and a health problem? The moral, the political, and the medical are culturally interrelated, but how do we best interpret that relationship and its implications?

—Arthur Kleinman (1995, p. 16)

Having trained at the world’s oldest psychiatric hospital, The Bethlem Royal Hospital in London (founded in 1247), associated with the Institute of Psychiatry and the Maudsley Hospital (founded in 1948) of the University of London, and at two prestigious North American psychiatric hospitals—the Allan Memorial Institute (founded in 1940) associated with McGill University in Montreal, and McLean Hospital in Belmont, Massachusetts (founded in 1811), associated with Harvard University, I have developed something of a perspective on psychiatric history. Several of my papers and books touch on aspects of psychiatric history (family therapy, Di Nicola, 1985a, 1985b, 1997, 2011; social psychiatry, Di Nicola, in press) or the history of psychiatric phenomena (anorexia nervosa and culture-bound syndromes, Di Nicola, 1990a, 1990b, 1992; posttraumatic stress disorder, Di Nicola, 1996).

Di Nicola, VF. Family therapy and transcultural psychiatry: an emerging synthesis. Part I: the conceptual basis. Transcultural Psychiat Res Rev. 1985a;27(2):81-113.

Di Nicola, VF. Family therapy and transcultural psychiatry: an emerging synthesis. Part II: portability and culture change. Transcultural Psychiat Res Rev. 1985b;27(3):151-180.

Di Nicola, VF. Anorexia multiforme: self-starvation in historical and cultural context. Part I: self-starvation as a historical chameleon. Transcultural Psychiat Res Rev. 1990a;27(3):165-196.

Di Nicola, VF. Anorexia multiforme: self-starvation in historical and cultural context. Part II: anorexia nervosa as a culture-reactive syndrome. Transcultural Psychiat Res Rev. 1990b;27(4):245-286.

Di Nicola, VF. De l’enfant sauvage à l’enfant fou: a prospectus for transcultural child psychiatry. In: Grizenko N, Sayegh L, Migneault P, eds. Transcultural Issues in Child Psychiatry. Montreal, QC: Éditions Douglas; 1992:7-53.

Di Nicola, VF. Ethnocultural aspects of PTSD and related disorders among children and adolescents. In: Marsella AJ, Friedman MJ, Gerrity ET, et al, eds. Ethnocultural Aspects of Posttraumatic Stress Disorder: Issues, Research, and Clinical Applications. Washington, DC: American Psychological Association; 1996:389-414.

Di Nicola, VF. A Stranger in the Family: Culture, Families, and Therapy. New York, NY and London, UK: W.W. Norton; 1997.

Di Nicola, V. Letters to a Young Therapist: Relational Practices for the Coming Community. New York, NY, and Dresden, Germany; 2011:149-162.

Di Nicola, V. Family, psychosocial, and cultural determinants of health. In: Sorel, Eliot, ed., 21^st Century Global Mental Health. Burlington, MA: Jones & Bartlett Learning; in press.

Kleinman, A. Writing at the Margin: Discourse Between Anthropology and Medicine. Berkeley, CA: University of California Press; 1995.

History of Psychiatry

Tom Burns. Psychiatry: A Very Short Introduction. Oxford: Oxford University Press, 2006.

Diego De Caro. 1997. La Psichiatria Attraverso I Secoli. Napoli: Casa Editrice Idelson.

Edward Shorter. 1997. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York, NY: John Wiley & Sons.

Jurandir Freire Costa. 2007. Historia da Psiquiatria no Brasil. Rio de Janeiro: Garamond.

Michael H. Stone. 1997. Healing the Mind: A History of Psychiatry from Antiquity to the Present. New York, NY: W.W. Norton & Co.

Edwin R. Wallace IV, John Gach, eds. History of Psychiatry and Medical Psychology. New York: Springer, 2008.

Franz G. Alexander and Sheldon T. Selesnick. 1966. The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present. Introduction by Jules H. Masserman. New York, NY: Harper & Row.

The subtitle makes my argument quite clear: the history of psychiatry is not the history of madness or even of a professionally defined psychiatric disease but rather of “psychiatric thought and practice.”

           

A scholarly journal, History of Psychiatry, is published in collaboration with the UK’s Royal College of Psychiatrists.

Then there are more specialized histories:

Henri F. Ellenberger. The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. New York: Basic Books, 1970.

Eliot S. Valenstein. 1986. Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness. New York, NY: Basic Books.

Michael Shepherd, ed. Psychiatrists on Psychiatry. Cambridge: Cambridge University Press, 1982.

Robin M. Murray and Trevor H. Tanner, eds. Lectures on the History of Psychiatry. London, UK: Gaskell/Royal College of Psychiatrists, 1990.

Three volumes are of historical interest in that they document the history of “anti-psychiatry” and a mainstream academic psychiatrist’s rebuttal:

Robert Boyers and Robert Orrill, eds. Laing and Anti-Psychiatry. Harmondsworth, Middlesex: Penguin Books, 1972.

David Ingleby, ed., Critical Psychiatry: The Politics of Mental Health. Harmondsworth, Middlesex: Penguin Books, 1981.

Antony Clare. Psychiatry in Dissent: Controversial Issues in Thought and Practice. Foreword by Michael Shepherd. London: Tavistock Publicationsm, 1976.

History of Madness

The texts dealing with the history of psychiatry are quite different than these below, which attempt to outline a history of madness, such as Roy Porter’s anthology, The Faber Book of Madness (1991).

Dale A. Peterson. 1977. The Literature of Madness: Autobiographical Writings by Mad People and Mental Patients in England and America from 1436-1975. Stanford University PhD.

Dale A. Peterson, ed. 1982. A Mad People’s History of Madness. Pittsburgh, PA: University of Pittsburgh Press.

Roy Porter. 1987. A Social History of Madness: The World Through the Eyes of the Insane. New York: Weidenfeld & Nicholson.

Roy Porter, et al., eds. The Anatomy of Madness. 3 vols.

Andrew T. Scull. 1979. Museums of Madness: The Social Organization of Insanity in Nineteenth-Century England. London, UK: Allen Lane.

Andrew Scull, ed. 1981. Madhouses, Mad-Doctors, and Madmen: The Social History of Psychiatry in the Victorian Era. Philadelphia, PA: University of Pennsylvania Press.

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None of the foregoing texts in this section on the history of madness, however, approaches the scope and reach of Foucault’s investigations into the discourse of madness.

Two of Foucault's original French texts have been elaborated in English editions:

1.     Maladie mentale et personnalité. Paris: Presses Universitaires de France, 1954.

Maladie mentale et psychologie. Revised edition. Paris: Presses Universitaires de France, 1962.

English editions:

Mental Illness and Psychology. Trans. Alan Sheridan. New York: Harper Colophon Books, 1976.

Madness: The Invention of an Idea. Alan Sheridan. New York: Harper Perennial Modern Thought, 2011. Reprinted with a new title.

2.     Folie et Déraison/Histoire de la Folie

First published in French as Folie et Déraison: Histoire de la

folie à l’âge classique. Paris: Librarie Plon, 1961.

A new French edition with a new preface by Foucault, along with appendices appeared as Histoire de la Folie à l’âge classique. Paris: Éditions Gallimard, 1972.

English editions:

Madness and Civilization: A History of Insanity in the Age of Reason. Trans. Richard Howard. New York: Random House, 1965; New York: Vintage Books, 1973. Abridged version of Histoire de la Folie.

History of Madness. Edited by Jean Khalfa, Translated by Jonathan Murphy and Jean Khalfa. London: Routledge, 2006. This edition is a translation of: Histoire de la Folie à l’âge classique (1972) with a Foreword by Ian Hacking, an Introduction by Jean Khalfa, the Prefaces to the 1961 and 1972 editions, as well as several scholarly appendices by Foucault:

“Mon corps, ce papier, ce feu” and “La folie, l’absence d’oeuvre” (Paris: Editions Gallimard, 1972); 

“Reply to Derrida” from Michel Foucault, Dits et Ecrits Vol II (Paris: Editions Gallimard, 1994)

Until recently, no one has actually tried to allow “madness” itself to speak, although Foucault approached this task by allowing texts to speak the discourse of madness. Foucault did give voice to the historical narrative of a murderer, adopting the first person in his title: “I, Pierre Rivière, having slaughtered my mother, my sister, and my brother”: A Case of Parricide in the 19^th Century (1982). In Foucault’s footsteps, Dale Peterson edited A Mad People’s History of Madness (1982) and Roy Porter wrote A Social History of Madness: The World Through the Eyes of the Insane (1987). In that work, Porter states that:

what the mad say is illuminating because it presents a world through the looking-glass, or indeed holds up the mirror to the logic (and psycho-logic) of sane society. It focuses and puts to the test the nature and limits of the rationality, humanity and “understanding” of the normal. In that sense, the late French philosopher Michel Foucault was quite right to insist that the history of unreason must be coterminous with the history of reason. They are doubles. (Porter, 1987, p. 3)

With much appreciation for the tasks that Foucault and Porter set for themselves, I do not see history this way, much less “madness and civilization,” “reason and unreason,” or psychiatry as a profession or as a subject. As a social and cultural psychiatrist, I hold with Ivan Illich’s view (clearly informed by the anthropology of Clifford Geertz):

Man, unmodified by a particular place and companionship, simply does not exist. He has never existed in this skinned condition, nor could he, by the very nature of the case, ever survive in this way. (Illich, 1975, p. 87)

All of these terms may be usefully scrutinized using Giorgio Agamben’s (2009) method of philosophical archaeology, which owes much to both Foucault and Freud. While there are many outstanding historians of psychiatry who produce fine texts, there are few historians of madness, much less interrogations of the notion of madness as such, as is revealed in the debate between Derrida and Foucault. Foucault’s critical argument is that philosophy does not and cannot take “the event of madness” seriously, which is why he treats philosophy with disregard (“my casual indifference towards philosophy,” Foucault, 2006, p. 578). I believe that psychiatrists do take “the event of madness” seriously but Foucault was no doubt sceptical about this claim and the capacity of the profession or historians of psychiatry to capture that event or discourse. Ironically, no one has influenced the contemporary imagination of madness or its history, notably among academic psychiatrists, more than he did. Oxford social psychiatrist Tom Burns’ (2006) very short introduction to psychiatry is reasoned, balanced and recognizes this. A counter  irony is that of all the texts cited here, my fellow Canadian, Ned Shorter, who is not a psychiatrist, adopts the most positivistic, evidence-based orientation to the history of psychiatry and is most critical and dismissive of both Foucault and Laing.

My main thesis here can be stated succinctly:

The history of psychiatry is not the history of madness.

I do not believe this has been said in quite this way and quite so clearly. Historians and other scholars have carped about Foucault’s failings as a historian or scholar in his twinned history of madness and reason. Historians of psychiatry seem to consciously or unknowingly conflate the history of a profession or of the historical and cultural evolution of our understanding of madness with madness itself and its permutations over time and across cultures. Even to try to tell the “coterminous,” two-faced, twinned or mirrored history of reason and madness is not the same as the histories of these two rather separate domains. The history of unreason, as Foucault and Porter would have it, and the history of understanding and treating this unreason are not two sides of a coin, mirror images, twinned, Janus-faced “doubles” or anything of the sort. At most, the history of psychiatry reflects aspects of the age of reason, as Foucault calls its, coming to terms with madness, but this is neither the history of madness nor a history of reason.

As I will argue in another work with the working title, “Psychiatry Against Itself,” my profession is in a state of constant turmoil, inventing or redescribing traditions, where Spinoza becomes “the first modern psychologist” (I’m guilty of that), grounding itself in this or that, as Kant tried to do for philosophy, and always ready to suture itself to its methodologies or theories. Very few have the courage to resist this suturing which they confuse with a grounding. When I first met R.D. Laing in 1976, he said, “I am not an anti-psychiatrist, I am an orthodox psychiatrist.” He gave the example of an archer aiming for the mark as an image of orthodox (Latin orthodoxus, from Greek, orthodoxos, from orthos, “straight, true, correct” and doxa, “opinion”) psychiatry. This left a strong impression upon me. Laing appealed to an audience of searchers, not rebels. He did not mean to end or even radically change psychiatry but to return it to its origins in order to understand the “knots” that humans are capable of getting themselves into (cf. Laing, Knots, 1970). His early work, The Divided Self (1960), was a brilliant and accessible distillation of the mainstream psychoanalytic thought at that time. There was nothing remotely heretical, radical or anti-psychiatric in this volume. He expressed ideas every bit as dense and complex as Lacan with several notable differences: Laing made selected clinical cases available as evidence of his approach, there was a coherence between the theory and the practice, and he wrote well.

Note: Anyone who retorts that opacity is a hallmark of French writing need only read Foucault and Badiou to be refuted. Unlike Lacan, any number of French thinkers write lucidly and compellingly, from Marie Cardinal to Foucault and Badiou, not forgetting Jean-Paul Sartre, Frantz Fanon, Albert Camus and Jean-Luc Nancy. On the other hand, a handful of British psychoanalysts of Laing’s era were particularly articulate and accessible—Anna Freud, Donald Winnicott and John Bowlby; all of them Laing’s teachers at the Tavistock Institute. (Note that Melanie Klein—whose basic ideas are very close to Lacan’s—is decidedly not in this list.)

Psychiatry, as a profession, bathes in the Heraclitan flux where all is change (and nothing changes). That, in my understanding, is the real history of psychiatry. It has almost nothing to do with madness and is not in itself a chapter of reason, although it does reflect a great deal about the sociology of knowledge in Karl Mannheim’s sense.

In a forthcoming chapter on family, cultural and psychosocial determinants of health for a textbook on social psychiatry for students of public health (Di Nicola, in press), I offer a historical overview of how expressions of human distress are shaped by historical and sociocultural factors:

Madness always models itself in the image of the very civilization it 

perverts.

—Cesare Lombroso (1927/1856, p. 67, my translation)  

Each era has emblematic expressions of human distress. In a prescient essay in 1856 on the reciprocal influences of madness and civilization, psychiatrist and criminologist Cesare Lombroso (1927/1856) had the germ of an idea that was taken up a century later by Michel Foucault (1973) in Madness and Civilization, elaborated in transcultural psychiatry with the notion of culture-bound syndromes (CBSs, see Di Nicola, 1990a, 1990b), and refined by Ian Hacking (1995, 1999), a philosopher of science with his notion of “looping effects.” (Adapted from the original)

Agamben, Giorgio. Philosophical archaeology. In: The Signature of All Things: On Method (trans. by Luca D’Isanto with Kevin Attell). New York: Zone Books;2009:81-111, 119-121 (Original published in Italian in 2008)

Di Nicola Vincenzo F. Anorexia multiforme: self-starvation in historical and cultural context. Part I: self-starvation as a historical chameleon. Transcultural Psychiat Res Rev. 1990;27(3):165-196.

Di Nicola, Vincenzo F. Anorexia multiforme: self-starvation in historical and cultural context. Part II: anorexia nervosa as a culture-reactive syndrome. Transcultural Psychiat Res Rev. 1990;27(4):245-286.

Di Nicola, V. Family, psychosocial, and cultural determinants of health. In: Sorel, Eliot, ed., 21^st Century Global Mental Health. Burlington, MA: Jones & Bartlett Learning; in press.

Foucault, Michel. Madness and Civilization: A History of Insanity in the Age of Reason. Howard R, trans. New York, NY: Vintage Books; 1973.

Hacking, Ian. The looping effect of human kinds. In: Sperber D, Premack D, Premack AJ, eds. Causal Cognition: An Interdisciplinary Approach. Oxford, UK: Clarendon Press; 1995:351-383.

Hacking, Ian. The Social Construction of What? Cambridge, MA: Harvard University Press; 1999.

Illich, Ivan. Medical Nemesis: The Expropriation of Health. London: Calder & Boyars; 1975.

Laing, R.D. The Divided Self. London: Tavistock Publications; 1960.

Laing, R.D. Knots. London: Tavistock Publications; 1970.

Lombroso, Cesare. Influenza della civiltà nella pazzia e della pazzia nella civiltà. In: Lombroso G., ed. Psicologia e Natura. Studi Medico-Psicologico-Naturalistici. Torino: Fratelli Bocca, Editori; 1927:52-67. (Original essay published in 1856)

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“This Desire That Isn’t Mine” - Distributed Desire and the Consciousless Subject

ZIZEK STUDIES CONFERENCE 2012

"Neo-liberal Perversions: Fantasy and Gaze in Contemporary Culture" 

The College at Brockport (SUNY)

April 28-29, 2012

Panel: “The Other That Does Not Exist”

Paper: “This Desire That Isn’t Mine”

Distributed Desire and the Consciousless Subject

Abstract

Vincenzo Di Nicola

Doctoral candidate, European Graduate School

As part of a doctoral dissertation on ‘Trauma and Event” calling for a new, objective phenomenology to declare the end of trauma psychiatry and call for an evental psychiatry, this paper invokes a series of ideas that undermine received notions of the conscious subject as a bounded individual to describe the subject that emerges from the Truth-Event:

·      Alain Badiou’s “fidelity-subjectivity” as reciprocally constitutive of event and truth;

·      Freud’s “nachträglich”/Lacan-Zizek’s “après-coup” meaning a chronologically anterior event as supplement to a posterior one;

·      Norman Cameron’s “paranoid pseudo community” as an extreme case but plausible model for relational psychology;

·      René Girard’s mimetic theory, buttressed by mirror neurons to found a theory of imitation, establishes psychology as ineluctably social;

·      Ian Hacking’s “looping effects” as reciprocal influences of professional and public discourses to explain the emergence of diagnostic categories and lived conditions with a “looping” back and forth;

·      Slavoj Zizek’s “plague of fantasies” as a deluge of imagery from the Other;

·      Badiou’s “subjectizable body” posits three types of subject, each with key processes and emblematic situations. Whereas the positivist project of modernity concerns the boundaries of the subject and paradoxically aims to tame or erase subjectivity through technology (Neil Postman):

o   The faithful subject is marked by porosity (cf. Walter Benjamin), open to radical change and witnessing (e.g., St. Paul, Primo Levi, Giorgio Agamben) of desire through processes of absorption/incorporation.

Two responses occur when porosity becomes a threat: dissipation or mimesis. These responses are described through these pairs: centrifugal vs. centripetal, dispersal vs. containment, evacuation vs. encapsulation.

o   The reactive subject, who is marked by dissipation, experiences rupture as trauma through a process of dispersal/evacuation.

o   The obscure subject is marked by mimesis, whose emblematic experience is paranoia, triggered by failed attempts at containment/encapsulation.

This paper explores one element in this sketch: Walter Benjamin’s porosity and other relational processes (Mikhail Bakhtin’s dialogism, Badiou’s multiplicity) to propose the notion of distributed desire as the emblematic feature of the faithful subject emerging from the Event. Vignettes from the film “Eternal Sunshine of the Spotless Mind” (2004) and Lacanian psychoanalyst Paul Verhaeghe’s Love in a Time of Loneliness (1999) provide illustrations. Just as après-coup (Lacan/Zizek) means that significance is in the future perfect tense—what “will have been,” distributed desire means that desire is never located, much less owned, only imitated, shared. Purely contingent, disembodied, distributed desire is appropriated by naming and incarnated through love by the faithful subject.

Excursus on Excursuses

Physicians collect “clinical pearls” to make sense of complex medical phenomena. These are usually empirical, time-tested observations about patients, such as “Feed cold, starve a fever.” In psychiatry, there is an instructive distinction between the circumstantial and tangential historian (meaning the patient as narrator of his own story). The circumstantial historian talks round and round a point but eventually makes his way to the mark, whereas the tangential historian continues veering off the point so that it is hard to grasp where he started or to see where he is going. Circumstantiality is taken to be a symptom of obsessionality, while tangentiality suggests a psychotic process. Both styles are digressive; both of them distract us from the history we wish to get from the patient. And it is also true that they tell a story in and of themselves.

The opening pages of Laurence Sterne’s Tristram Shandy are a knowing gesture by the narrator who constantly intrudes into the text with a kind of delaying tactic that builds tension almost to the breaking point. The first-person narrator of this 18^th century novel brings us to the scene of his procreation and delays the crucial moment with a series of descriptions, deviations and divagations that are not only comical but also make the point that it was these very delays that created an imbalance in the actual composition of his being. In digressing and taking excursions into other matters, the narrator artfully captures our attention and frustrates our wish to know more, making us delightfully aware of the narrator’s character and the contingency and necessity of certain facts of life. Simultaneously. We precisely come into contact with the character’s obsessionality—and our own. And we are left with the maddening experience of tangentiality—Are we going mad? Will he ever get to the point? How was such a creature ever conceived?—until we relinquish the need to control the narrative and abandon ourselves to its vagaries and pleasures. The character of Tristram Shandy is nothing if not a very digressive narrator and the text is composed entirely of picaresque excursions which in fact prove to be the substance of the story. 

The excursus is just this sort of digression in an academic text. It is somewhere between the high-brow scholium or scholion (from Greek σχόλιον “comment”, “interpretation” which couldn’t have a better academic pedigree than Spinoza’s scholia in his Ethics) and the low-brow vulgarizations or marginalia written by students. The most famous mathematical marginal note – Fermat’s last theorem –  was discovered by his son in the margins of his father’s edition of Diophantus, the Alexandrian mathematician, with the comment that the margin was too small to contain the proof.

An excursus from the main text is an aside, a diversion, a divagation, an excursion; let’s call it a deviation, a day-trip on a longer journey. (We can call it a parenthesis.)

The word comes from the Latin, excurrere, “to run out,” and has at least two somewhat opposing countercurrents in contemporary academic usage:

(a)   A “lighter” digression, almost a diversion from the main text in order not to distract from the main argument versus a separate section or appendix to comment more “seriously” on a particular point or deepen the argument of the text.

(b)  On one hand, the excursus in embedded in the main text (not written in the margin as an afterthought, relegated like a subaltern to the foot of the page or an endnote appended like a second class citizen sent to the back of the bus); on the other hand, its function is to unpack the meanings of the text.

My own first encounter with the excursus was in Brigitte Berger and Peter Berger’s The War Over the Family (1984), a work of advocacy, where it is employed to highlight the polemics over the politics and sociology of the family. Jürgen Habermas also employs excursuses (the English plural; not “excursi,” if we followed the Latin) in his masterful overview, The Philosophical Discourse of Modernity (1987).

Giorgio Agamben’s Infancy and History: On the Destruction of Experience (2007) has many “Glosses” that enliven the text, serve all the functions suggested here, and more. Agamben’s text, just as Franco-Czech writer Milan Kundera consciously composes his novels, has an almost musical, contrapuntal structure. Leland de la Durantaye’s (2009) “critical introduction” to Agamben’s work has more didactic “Scholia” sprinkled throughout the text, in an effort to deepen our understanding of Agamben’s rich, allusive writing.

In his first Gloss on one of Montaigne’s essays, Agamben lets the French master tell us the story of his fall from a horse, his loss of consciousness and the gradual recovery of his senses. I refer you to Montaigne himself for edification. Then Agamben offers his gloss:

This memory furnishes Montaigne with the pretext for a series if digressions, where the twilight state [Agamben is too wise a reader to miss the neurological overtones of this poetic but scientifically precise phrase] comes to stand for a form of experience which, albeit specific, is also in a sense experience at its extreme and most authentic, emblematically summing up the entire scope of inquiry of the Essays. (Agamben, 2007, p. 44)

An excursus, then, in a text as in life, is a pretext for allowing contingency—even horrific ideas or frightening accidents—to enter our lives, and to be open to what is extreme and authentic to become real events for us.

A Whodunit Without a Who

I am going to propose … a concept of being-there and existence without making the slightest reference to anything like consciousness, experience or human reality.

—Alain Badiou, Second Manifesto for Philosophy (2011, p. 44)

Stanislaw Lem’s The Investigation (1959)

What if the world isn’t scattered around us like a jigsaw puzzle—what if it’s like a soup with all kinds of things floating around in it, and from time to time some of them get stuck together by chance to make some kind of whole? What if everything that exists is fragmentary, incomplete, aborted, events with ends but no beginnings, events that only have middles, things that have fronts or rears but not both, with us constantly making categories, seeking out, and reconstructing, until we think we can see total love, total betrayal and defeat, although in reality we are all no more than haphazard fractions.[...:]The mathematical order of the universe is our answer to the pyramids of chaos.

The reviews of this novel by a Polish master of science fiction do not fully grasp what Lem attempts in this experimental novel, which is to attribute cause without human agency. Lem’s ontologically insecure police procedural The Investigation is a whodunit without a who. Two key examples of this in the novel are: a statistician, Dr. Harvey Sciss, offers a statistical model for the disappearance of dead bodies (statistics is not about single incidents or individual subjects but about series and groups) and the mysterious encounter of the Inspector Gregory at night in an arcade, where he confronts a stranger advancing towards him. Does it make one think of Lacan’s mirror stage? Perhaps, but the mirror stage is about the construction of identity—subjectivation, if you will, whereas this episode is the opposite, about desubjectivation—the experience of self as other, defamiliarization (cf. Viktor Shklovsky), where the incidents are stripped of human agency and identity is desubjectified.

The case proves to be impenetrable for the police inspector who is disturbed by what appears as the lack of human agency in the case of dead bodies being disturbed or disappearing:

In fact it appalls me, it’s absolutely inhuman. Human beings don’t work that way. Human beings make mistakes, it’s in the nature of things that they miscalculate from time to time, make mistakes, leave clues behind, change their plans in the middle of everything.

The inspector’s worldview and way of working is challenged. His view of existence is falling apart. Perhaps Alain Badiou, a philosopher who is also a novelist, has the key:

“Existence” is not a specific predicate of the human animal.
             (2011, p. 44)

            

Recall G.K. Chesterton’s metaphysical thriller, The Man Who Was Thursday (1908), featuring Lucian Gregory, an anarchist poet, and a Scotland Yard inspector called Gabriel Syme. In Lem’s novel, the statistician is called Sciss. This suggests: scissors, from Latin caedere, “to cut,” influenced by scindere, “to split,” and evokes abscissa, “x coordinate,” a term by which a point is mapped on a system of axes. Does Sciss’ statistical hypothesis represent an incisive cut, a disorienting split, or a new way to map reality for Gregory?

*

A Subject Without Consciousness

With nowhere to turn, isolated and lost, Inspector Gregory turns in on himself:

The day faded quickly, so quickly that the displays in the shop windows were soon being lit up for the evening. The street narrowed. Gregory found himself in a district of the city which hadn't been rebuilt since the Middle Ages. It was jammed with dark, clumsy old buildings, most of them sheltering brand-new modern shops that sparkled unnaturally like transparent glass boxes.

Gregory turned into an arcade, amazed that the thin layer of windswept snow at its entrance still hadn’t been trampled. A woman in a red hat stood nearby looking at some smiling wax manikins dressed in evening gowns. Beyond her, where some square white floodlights brightened the concrete walk, the arcade curved slightly.

Walking slowly, hardly conscious of his surroundings and whereabouts, Gregory brooded about Sciss’s laugh. What exactly had it meant, he wondered. It had to be significant. Despite appearances, Sciss didn't just do things for effect, although he was certainly arrogant enough, and consequently it followed that Sciss must have had a good reason for laughing, even if he was the only one who knew it.

Farther up the deserted arcade a man was walking toward Gregory – a tall, lean man, whose head was nodding as if he were talking to himself. Gregory was too busy with his own thoughts to pay much attention to him, but he kept him in sight out of the corner of his eye. The man drew nearer. Three shops turned off their lights for the night and the arcade suddenly became darker. The windows of a fourth shop were covered with whitewash because of a renovation in progress, and the only lights still visible were a few glittering displays in the direction from which the man was approaching.

Gregory looked up. The man’s pace slowed, but he kept coming, albeit hesitantly. Suddenly they stood facing each other, no more than a few paces apart. Still engrossed in his thoughts, Gregory stared at the tall male figure before him without really seeing his face. He took a step; the man did the same.

“What does he want?” Gregory wondered. The two men scowled at each other. In the shadows the man's broad face was hidden; he was wearing his hat pushed down on his forehead, his coat was somewhat too short, and his belt was all askew, with its end twisted loosely around the buckle. There was certainly something wrong with the buckle, Gregory thought, but he had enough problems without worrying about that too. He moved as if to walk past the stranger but found his path blocked.

“Hey,” Gregory began angrily, “what the. . .” his words faltering into silence.

The stranger. . . was himself. He was standing in front of a huge mirrored wall marking the end of the arcade. He had mistakenly walked into a glass-roofed dead end.

Unable to escape the disconcerting feeling that he was really looking at someone else, Gregory stared at his own reflection for a moment. The face that looked back at him was swarthy, not very intelligent, perhaps, but with a strong, square jaw that showed firmness, or at least so he liked to think, although more than once he had decided it was only pigheadedness.

“Had a good look?” he muttered to himself, then turned on his heels in embarrassment and headed in the direction he had come from.

Halfway up the arcade, Gregory couldn’t resist an irrational impulse to turn and look back. The “stranger” stopped also. He was far away now among some brightly lit, empty shops, heading down the arcade, busy with his own affairs in his mirror world. Gregory angrily adjusted his belt in its buckle, pushed his hat farther back on his head, and went out into the street.

In another disorienting cut, Gregory is invited to a late-night discussion at the Chief Inspector’s home, where they discuss the Lapeyrot case in Paris which is a case of folie à deux. This psychiatric syndrome, coined by the French and called shared paranoid disorder in contemporary psychiatry, occurs when one person is dominated by another to the point of losing his identity and submissively following the dominant person.

The Investigation is set in a London in which the inspector seems to feel more and more estranged. Mostly set in the dark of night and the fog of London, the novel is full of references to appearances, surfaces … glass doors, reflections, gazes, glare of lights, light falling on images, photographs, maps … partially illuminating … illusions, simulacra …

Badiou again on negation, the multiple and the conscious-less subject:

For my part … the determination of the concept of existence is conditioned by something like negation as well as self-differing. Ontologically, this is for me, the question of the void – the empty set. Phenomenologically, it is the question of negation in the various senses this can take in (classical, intuitionist and paraconsistent) logic and as applicable to the appearing of a multiple if one measures the degree of identity between this and its negation in a world. But I will plot these connections without any relation whatsoever with the conscious subject, and even less again with freedom. (2011, p. 45)

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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

Wikipedia:

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).

http://eliot.thefreelibrary.com/The-Mill-on-the-Floss/6-1#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.

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

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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.

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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). 

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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!

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Footnote

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.