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From the very beginning, scientiﬁc psychiatry has raised fundamental questions within the ﬁelds of philosophy and psychology, namely as regards the nature of the ‘psyche.’ The question of what it means to say that something is ‘psychical’ leads to speculation in psychiatry insofar as special heuristic aspects are involved.
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1. Philosophical Aspects Of Psychiatry
In accordance with Brentano’s basic idea that the psychical can be identiﬁed with the ‘intentional’ (Brentano 1874), one might argue that psychiatry is so important to philosophers because the disturbances of intentionality in various domains of the mental world of humans are what might be termed ‘negative images’ of the psychic functions which normally operate in the human mind. The special method by which Karl Jaspers (Jaspers 1913) elaborated this view of the human mind is the ‘phenomenological approach’ to various kinds of disturbances of mental functioning in psychiatric patients (deﬁciency model of psychic dimensions in Jaspers’s General Psychopathology).
However, this is not the only way in which the relationship between psychiatry and philosophy can be construed. The other aspect is the issue of the potential role of psychic ‘normalcy’ in social life. As a ﬂuctuating criterion for assigning people to a psychiatric context, normalcy cannot be regarded as a phenomenon of ‘average’ and represents merely the concept of ‘ideal typology’ (Blankenburg 1971). From a philosophical point of view, the subject of psychiatric ‘normalcy’ constitutes a major problem, since it raises the issue of the existence of an ‘individual norm’ in the sense of the ‘alterity of the other’ (Levinas 1987). Seen in this way, psychiatric disorders are not simply ‘defects’ but represent variants of normal psychic life which—when exaggerated—are interpreted as disorders and treated by psychiatrists.
This concept ﬁts in with the approach of evolutionary psychiatry which considers that psychiatric disorders have evolved because they relate to psychic functions which—in their submaximal expression— yield advantages where natural selection is concerned. Viewed in this way, psychopathology does not constitute a ‘statistical, average norm’ but an ‘individual norm,’ as has been pointed out by Blankenburg (1971). In a similar sense, Spaemann and Low (1981) have argued that health itself contains a teleological notion: ‘If 99 percent of the population suﬀered from headaches, headaches still would not be ‘‘normal’’.’ Philosophical concepts in psychiatry therefore have to address the problem of ‘normalcy’; they face the difﬁcult challenge of acknowledging deviant cognitive and mental events merely as expressions of the alterity of the other.
2. Aspects Of Greek Philosophy
The focus of Greek philosophy is on the individual, thinking and acting intentionally, and self-reﬂection is thus the cornerstone of ancient Greek thought. On the basis of the hypothesis of quasi-determinism, the Athenian philosopher Socrates (470–399 BC) asserted that the will responds to the dictates of reason. He developed the Socratic—or ‘maieutic’—method which elicits truths that lie hidden in an individual’s unconscious by means of a process of question and answer. This method—in a completely diﬀerent context—later became the basis of Sigmund Freud’s psychoanalysis and the nondirective psychotherapy of Carl R. Rogers. Socrates’ disciple Plato (427–347 BC) diﬀerentiated—for example, in his Phaedo—between the spiritual and material worlds and applied this dichotomy to man by postulating that the psyche (soul), together with its logical functions, possesses a pre-existence before the birth of the individual and survives into immortality (Plato 1966). In Timaios, Plato deﬁnes madness (manteia) as a disturbance of the vegetative components of the soul (which are located in the liver) but in the later Phaidros he tells us that it can also be sent by the gods as an elevating spiritual force. The aim of Plato’s philosophical psychology is to create harmony between the diﬀerent psychic activities. Whereas Plato’s idealism deﬁnes ideas as the only true reality, his pupil Aristotle (384–322 BC) based his psychology partly on empirical investigation, thus representing a type of realism. In his systematic discussion De anima(On the Soul ), Aristotle describes the soul as the entelechy, the self-contained purpose of the body. This purpose must be fulﬁlled in order to achieve eudaimonia (bliss). In Aristotelian thinking, philosophical self-reﬂection leads to psychological self-actualisation, and in his Ethica Nikomacheia Aristotle states that the purpose of ethics is not knowledge but action (Aristotle 1984).
Although Aristotle was the most systematic Greek philosopher and had an enormous inﬂuence on the development of modern science, the treatment of psychological matters in post-Aristotelian Hellenistic philosophy is often described as eclectic. Stoic and Epicurean philosophy, in particular, must be considered as practical psychology. Given that the increasingly urbanized Hellenistic world had a greater resemblance—in some ways—to modern society than the middle ages, this practical psychology is still of interest. Epicureans and Stoics tried to ﬁnd ways to alleviate anxiety, but their anxiety is less fear of the gods than fear and disturbance caused by a complex but fragile society. Epicurean and especially Stoic thinking played an important role in Hellenistic culture and can thus be viewed as the ﬁrst widespread popular psychological fashions.
After the fall of the Roman Empire, Christian Europe lost sight of some of Aristotle’s major works. The philosophical psychology of the dominant neo-Platonism referred back to the static aspects of Platonism, shifting away from rationalism to meta- physical speculation on the relationship between a tangible and an intangible world, between the soul and God. St. Augustine (354–430) attempted to synthesize neo-Platonism with Christianity. Following on from Seneca and Plotinus, he leaned towards introspection as his philosophical and psychological method, considering that—alongside objective observation—self- observation of inner mental processes could function as the basis of knowledge. He therefore chose self- reﬂection as the basis of his epistemology, arguing that doubt presupposes the existence of the doubter (Augustine 1984), an idea that later became extremely inﬂuential as Descartes famous Cogito ergo sum.
3. Metaphysics Of Middle Ages And The Mind–Body Problem
The philosophical psychology of the Middle Ages was metaphysical and—at the same time—deductive. The changeability of the soul and of world were interpreted philosophically as an inevitable but inferior property of the unchangeable, and consequently Christian dogmatism and neo-Platonism showed no interest in the experience of psychological interaction. With the foundation of the ﬁrst universities from the thirteenth century onwards, the process of philosophical debate increased and a more dynamic philosophical psychology developed as Aristotelian thinking was resuscitated through the medium of Arab philosophy. St. Thomas Aquinas (1225–74) attempted to integrate Christian dogma with elements of Greek and Arab philosophy. Aristotle diﬀerentiated between an active immortal intellect and a merely passive understanding one. Aquinas accepted this view, describing the intellect as a passive power, a tabula rasa which had to be ﬁlled with experience by the ﬁve exterior senses. In addition, there exists a rational power—which makes free will possible—and the soul also has vegetative components. In contrast to the neo-Platonic dichotomy of soul and body, Aquinas attempted to deﬁne man as a psycho-physical unity, as a body inspired by a soul. Taking his lead from Aristotle, Aquinas deﬁned the soul as the form of the body and as an immortal spiritual entity. According to this theory, the body of a dead person consists of the same material or substance as that of a living person. As a result of this dichotomy, it is impossible to describe the impact of mental acts on real action without becoming entangled in serious logical diﬃculties. This is the mind–body problem: the issue of whether or not the soul or mind is an incorporeal substance, a nonmaterial entity obeying laws other than those which govern the material world. Discussion of this problem has continued until the present day.
4. Modern Philosophical Psychology
Modern philosophical discussions related to psychiatric problems already at its beginning. Rene Descartes (1596–1650) reﬂected on the fundamental nature of illusions and the constitution of reality. He posed the questions of certainty of reality and compared the reality of dreams with the consciousness in wakefulness. In his Meditations on ﬁrst Philosophy Descartes arrived at the irreducibility of the cogito, putting an end to the inﬁnite regress of doubt about possible ﬁctional realities (Descartes 1996). As a consequence of this concept the modern subjectivistic understanding of consciousness has evolved, leading to the split between cogitatio and extensio, between soul and body, between the mental and the physical world, a split which represents one of the unresoluble fundamental problems in psychiatry. In this sense the dualistic understanding of the mind–body problem represents one of the central challenges, diﬃcult to overcome in philosophical psychiatry.
Refuting earlier deductive speculation, the empirical philosophy of John Locke (1632–1704) again emphasized the Aristotelian view that the human mind is like a blank sheet of paper and that all the material of reason and knowledge comes from observation, experience, and reﬂection. David Hume (1711–76) described ideas as the copies of sensory impressions. Most of our beliefs go beyond current impressions, but all that we can be certain of is perception, meaning that it is impossible, for example, to comprehend the self as a separate identity. Radicalizing this point of view, the positivism of Auguste Comte (1798–1857) postulated that the sensible comprises the whole range of knowledge and that any knowledge that cannot be comprehended by the senses must be rejected.
Immanuel Kant (1724–1804) in his precritical anthropology speculated about constitutional aspects of psychiatric disorders. In his Critique of Pure Reason he tried to deduce the a priori conditions of the possibility of experience (Kant 1974). This type of categorical analysis of mental life has been decisive for all subsequent philosophical considerations about the formation and constitution of subjectivity and consciousness.
In this sense idealism represents one of the possible forms of reactions to Kantian philosophy. For example, Georg Friedrich Hegel (1770–1831) developed an ontological approach to intellectually reconcile all elements of existence with one another within a systematic structure in which all contradictory moments of reality appear as dialectic mediations of the universal mind (Hegel 1973). The philosophical psychologist Franz Brentano (1837–1917) elaborated a comparatively modest conceptualization of the diﬀerence between the mental and the physical, thereby developing a fundamental concept of philosophy of the psyche, namely the concept of ‘intentionality.’ In his work Psychology from an Empirical Standpoint, he argued: ‘Each mental phenomenon is characterised by what the scholars of the middle ages called the intentional (also probably mental) inner existence … of an object, and which we … would call the reference to content, direction toward an object’ (Brentano 1874).
One may argue that the main characteristics of psychiatrically ill patients are disturbances of intentionality in Brentano’s understanding of this term, that is, psychic functions are ‘intentional’ insofar as they refer to an (‘internal’) object; they can ‘mean’ something, can refer to something. If this fundamental function of mental life is disturbed, i.e., the intentio recta is disturbed, a psychiatric disorder can be anticipated.
The Danish philosopher Soren Kierkegaard (1813– 55), deeply aware of Hegel’s philosophical concept of the absolute and at the same time vigorously writing against it, developed a concept of subjective reality, prestructuring the later existentialistic conceptualizations of subjectivity, deﬁning it as synthesis of soul and body, carried by spirit. His pioneer work about personal freedom formulated the questions as to The Concept of Anxiety (Kierkegaard 1980). As has been pointed out by Hersch (1989) these basic ideas are represented by ‘existence’ and ‘moment,’ in which the subject works through to the moment of the ‘reality of freedom,’ the condition of ‘anxiety.’ That means that ‘anxiety’ cannot be understood primarily as an emotional state but rather an existential condition, an intensiﬁed form of existence, leading to an autonomous subject (‘choosing the self’). Kierkegaard inﬂuenced mainly the French school of philosophical psychology (Sartre, Merleau-Ponty, Camus), whereas Brentano founded, together with his student Husserl, the German school of ‘Phenomenology,’ essential to the history of psychiatry (Husserl 1950). In this context ‘Phenomenological reduction’ has to be understood as the attention to the ‘nature of the condition of things’ and thus the ‘things as phenomena.’ A great and far-reaching concept in philosophical psychology, the philosophy of the ‘language game,’ has furthermore been elaborated within the philosophy of language by Ludwig Wittgenstein (1898–1951). Jaspers has pointed out the importance of philosophy of language, emphasizing that language is the ‘work of man.’ The universals of language also play a role in the philosophy of Arnold Gehlen (1904–76) who refered to man as a ‘non-determined animal,’ whereby Gehlen interprets the human nature as creating its own world as an ‘open world’ (Gehlen 1987). Of special importance for psychiatric philosophical psychology is the concept of Helmuth Plessner (1892–1985) who developed the idea of ‘positionality’ of human subjects. Whereas animals show a ‘centred positionality,’ human beings live, according to Plessner, in an ‘eccentric positionality’ (Plessner 1970). This concept plays a relevant part in psychiatric psychopathology, since disorders like delusions of reference and ideas of persecution may be interpreted as a disordered eccentric positionality (Emrich 1992). In Jean-Paul Sartre’s (1905–80) Being and Nothingness, the ‘decentering of the world’ plays a fundamental role in the phenomenological analysis of the ‘glance’ (Sartre 1996). Sartre’s analysis of the interpersonal relationship ends up in an intersubject ﬁght of ‘glances.’ Later Emmanuel Levinas (1905–95) acknowledged the ‘otherness of the other’ in the dimension of ‘face’: ‘The epiphany of the face is itself a word of honour in a certain way’ (Levinas 1987). This view of responsibility in the interpersonal encounter is of great importance in psychiatry; it conceptualizes an understanding of empathy in therapeutic relationships.
As a new academic discipline, psychology was obliged to assert itself against the established materialist sciences, especially medicine and biology. Positivist thinking consequently led to strongly antimentalist and anti-introspectionist tendencies in psychology. The theory that it is only via objective observation that scientiﬁc method can formulate hypothetical laws from which it can then derive deductive arguments led to the radical behaviorist position that nothing that is the product of subjective introspection can be accepted. Positivism thus reduced psychology to a science that deals with behavior and which aims to predict and control that behavior. As a result of behaviorism as represented by John Watson (1878–1958) and B. F. Skinner (1904–90), academic psychology drifted away from philosophy, becoming more practical than theoretical and more concerned with predicting and controlling behavior than with understanding it (Watson 1998, Skinner 1999). The contemporary philosophy of science, however, would claim that it is an illusion to believe that science can be reduced to a simple, objective, and entirely rule-bound methodology. Thomas Kuhn argued that such opinions are based on science textbooks that simply fail to tell the truth about the history of science (Kuhn 1996). In contrast to academic psychology, psychiatry has retained a more heterogeneous—even if contradictory—theoretical background. The main question at the start of the twenty-ﬁrst century is whether psychology and psychiatry can only be governed by certain particular scientiﬁc methodologies or if it is possible to accept the existence of diﬀerent approaches to the acquisition of knowledge. Paul Feyerabend pointed out that ‘the idea that science can, and should, be run according to ﬁxed and universal rules, is both unrealistic and pernicious’ (Feyerabend 1980). In actual fact, therapeutic practitioners—in particular— ﬁnd it unsatisfactory to consider introspective experience and objective behavior as mutually exclusive, as if they were distant continents with no contact between them. Modern therapeutic theories are thus becoming increasingly eclectic, and the gulf which used to exist between introspective psychoanalysis and behavior therapy, for example, is in the process of disappearing.
5. Self And Identity
Philosophical concepts of the ‘self’ have led to psychological consideration of the possible nature of ‘identity.’ Disturbances of the inner equilibrium of the components of the self which shape identity, brought about by processes of re-presentating by remembering, therefore make clear the potential for explanation inherent in a theory of the processes of identity formation based on a psychology of the self. As Levinas in particular has shown (Levinas 1987), however, this cannot be restricted to a theory of the structure of the ‘self’; rather it must take account of interpersonality, the existence of others (the ‘trace of the other’ referred to in the title of Levinas’ book). Any attempt to describe the danger to processes of identity formation posed by the existence of the other from the perspective of the psychology of the self must take account of the ‘ontology of the in-between’ already developed by Martin Buber (1994). For, as Theunissen (1965) demonstrates in his major work on intersubjectivity, taking the other seriously in its own being involves transcending the intentionality mode.
This philosophical/psychological concept is based on the assumption that components of a person’s self can manifest themselves in others and can exist further in them.
The basis of this primary interpersonal constitution of the psyche is the mother–child dyad of early childhood. In a way, people unconsciously always retain parts of their childhood dyad ‘within them,’ although they nevertheless consider themselves to be ego-centered ‘individuals.’ In a system of ideas in which the cogito is identiﬁed with the empirical ego, the ‘interpersonal self’ cannot be conceived. This primary (but extremely repressed or internally never realized) interpersonal constitution of the self has consequences for how people deal with what is familiar and unfamiliar, both in the other and within themselves, where aggression is concerned. Christian Scharfetter, referring to Graumann’s theory of subjective perspectivity, rightly refers to the fact that precisely the most intimate personal area of a person, his own unconscious, constitutes an alien entity, an unfamiliar area of sinister, threatening mystery. Scharfetter (1994) puts this as follows: ‘The other is not simply an alien entity, however. The other may very well be familiar; it can be close, it can be experienced as analogous (not homologous). Indeed, the alien is able to strengthen and reinforce the self. It is through the ‘You’ that the ‘I’ recognizes itself. This is an important factor where psychotherapy is concerned. However, confrontation with the alien within the self is painful; it requires not only cognitive eﬀorts (Hegel’s ‘strenuous toil of conceptual reﬂection’), but also psychological eﬀort in the form of crises in identity development.
An extremely eﬀective defense mechanism here is that of ‘projective identiﬁcation.’ This means that the unknown, the sinister, within the subject is discovered in others by projection and combated there. StreeckFischer says, for example, that ‘the confrontation with the alien has become a shock experience, one which hampers successful interaction with the alien (StreekFischer 1994). The alien is threatened as a means of stabilizing one’s own threatened self.’ As StreeckFischer shows, this mechanism becomes particularly eﬀective, is in a sense multiplied enormously, when one’s own position is not only under pressure from the danger posed by crises in the formation of identity but is also reinforced because of social pressure. Social devaluation of speciﬁc features of the self can signiﬁcantly increase projective identiﬁcation in the sense of the development of aggression. Hans-Joachim Maaz, for example, shows how in East Germany ‘social constraints under a repressive authoritarian system led to the self becoming alien and the alien becoming one’s own.’ Maaz describes the resulting aggression as follows (Maaz 1994): ‘violence and hatred of other people are always evidence of internal tensions within someone, of his no longer being able to ﬁnd and develop the self and the essential but of having to live a life too much of which is imposed by others.’
One of the great ﬁgures in the theory of mimesis is Rene Girard. In various works, notably La violence et le sacre, Girard developed a theory of mimetic occurrences (Girard 1977). If one accepts his thinking, the main point of the Oedipal drama, which in Freudian theory is said to mold early childhood, is not the Oedipal aspect as such—the desire for the mother in the Freudian sense—but the mimetic rivalry with the father. In an early work of 1961, Mensonge romantique et verite romanesque, Girard elaborated on a discovery central to the entire development of his theory. He was able to identify a phenomenon of ‘mimetic desire’ in nineteenth and twentieth century novels from Stendahl to Flaubert and Proust. The novels he examined shared a peculiar basic structure: the main characters desire someone else, but their feelings are directed toward a third person, a ‘mediateur.’ Analyzing Stendhal, Girard says: ‘in most cases of Stendhalian desire, the mediateur himself desires the object, or could desire it. This desire, whether real or assumed, is precisely what makes the object inﬁnitely desirable in the eyes of the subject.’
Desires, needs, preferences, and yearnings are thus described as being something not genuinely given, something brought forth internally by drives or makeup, but are ‘read,’ taken on from a third party because of mimetic dependency. The basic events in the process of identiﬁcation can thus be described as follows: if we can understand the other in a recreative sense only by putting ourselves into the other’s intentions, into that person’s world of desires, this means that we have to identify with that other. The amazing consequence of this is that processes of identiﬁcation are necessary for a proper interpretation of reality. In this sense, one can say that a rational explanation of the world is possible only if there is a fundamental willingness to identify with others.
As a result, one can argue that in psychiatric patients this rational world access is hampered by their impaired interpersonal relations, that is, due to disturbed mimetic processes (Emrich 1995).
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