Emancipatory Perspectives on Madness

Psychological, Social, and Spiritual Dimensions

Marie Brown, Robin S. Brown, Marie Brown, Robin S. Brown

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000299502
• Topic: Psychologie
• Subtopic: Abnormale Psychologie

This collection offers a diverse range of perspectives that seek to find meaning in madness. Mainstream biomedical approaches tend to interpret experiences commonly labelled "psychotic" as being indicative of a biological illness that can best be ameliorated with prescription drugs. In seeking to counter this perspective, psychosocial outlooks commonly focus on the role of trauma and environmental stress. Although an appreciation for the role of trauma has been critical in expanding the ways in which we view madness, an emphasis of this kind may nevertheless continue to perpetuate a subtle form of reductivism—madness continues to be understood as the product of a deficit. In seeking to move beyond causal-reductivism, this book explores a variety of perspectives on the question of finding inherent meaning in madness and extreme states.

Contributors to this book are distinguished writers and researchers from a variety of international and interdisciplinary perspectives. Topics span the fields of depth psychology and psychoanalysis, creativity, Indigenous and postcolonial approaches, neurodiversity, mad studies, and mysticism and spirituality.

This collection will be of interest to mental health professionals, students and scholars of the humanities and social sciences, and people with lived experience of madness and extreme states. Readers will come away with an appreciation of the more generative aspects of madness, and a recognition that these experiences may be important for both personal and collective healing.

Chapter 1

On the potential limits of trauma theory as an emancipatory discourse¹

Robin S. Brown

ABSTRACT: This chapter suggests that a clinical reliance on causal-reductive thinking further accentuates the sense of alienation experienced by people undergoing psychosis, and that trauma-based approaches to psychosis should therefore be adopted with care. Arguing against an emphasis on notions of developmental deficit, the author explores how psychoanalytic thinking might question some of the paradigmatic assumptions of clinical psychology.

KEYWORDS: psychoanalysis, psychosis, spirituality, teleology, trauma

Constrictive views of psychosis have the effect of further isolating the afflicted. With this in mind, in so far as clinicians cannot avoid betraying their own assumptions (whether explicitly formulated as “theoretical” or otherwise), a good theory helps the clinician to assume a more self-reflexive position and facilitates communication. Psychoanalytic thinking has sought to find ways of working with the clinician’s assumptions, either (from a classical perspective) to minimize interference with the patient’s process or (from a more relational perspective) so that the influence of the clinician’s personality might have a positive impact on the therapeutic process. The shift from one-person to two-person models of practice has often been taken to signify a less dogmatic approach to theory, wherein the clinician’s theoretical supports should not occlude the lived experience of the patient. However, in so far as approaches of this kind proceed on the basis of ideas pertaining to the causative nature of human relationships, more can yet be done in challenging paradigmatic assumptions.

Teleology in psychoanalysis

Throughout the history of psychoanalysis, the scientifically respectable ambience of a causal-reductive approach to the psyche has always been muddied with elements of teleology. A teleological approach would seek to understand a certain phenomenon not in terms of its material causes, but rather with a view to its final purpose or goal. The birth of modern science saw the exclusion of final causes as a subject fit for study, with mechanistic models of understanding being considered a marker of objectivity. Francis Bacon has sometimes been misunderstood to have sought to delegitimate teleology altogether:

Bacon holds that the existence of teleology in Nature is an obvious fact, and that the investigation of final causes is a perfectly legitimate branch of Natural Philosophy. It has, however, been misplaced; for it belongs to the division of Natural Philosophy which Bacon calls Metaphysics and not to that which he calls Physics. Bacon’s epigram that “the research into Final Causes, like a virgin dedicated to God, is barren and produces nothing” has been taken by careless or biased readers to be a condemnation of such research. It is nothing of the kind. It is simply a statement of the obvious fact that there is no art of Applied Teleology as there is an art of Applied Physics.

(Broad, 1926, para. 8)

In contrast to an approach which would seek to entirely exclude teleology from scientific practice, Immanuel Kant argued that for the sake of scientific advance teleology serves a necessary heuristic purpose. Teleology is positioned by Kant as a regulative principle. In scientific discovery, teleological thinking enables us to achieve a picture of a whole that is not yet known. He considers that cognition relies upon the metaphor of final purpose in order to achieve scientific insight, yet this teleological scaffold must ultimately be discarded if we are to achieve objective scientific knowledge. However, Kant argues that our understanding of living organisms simply cannot be resolved into mechanical terms since the thing that we seek to grasp will always elude our total comprehension. In the Critique of Judgment, he considers an organism as both cause and effect of itself.

For early psychoanalysts, particular stress was placed on understanding a person’s psychology in terms of early childhood. Freud’s notion of “psychic determinism” has often been interpreted along mechanistic lines to mean that the patient’s psychological life can be explained in purely causal terms. As Brenner (1955) puts it:

The sense of this principle is that in the mind, as in physical nature about us, nothing happens by chance, or in a random way. Each psychic event is determined by the ones that precede it. Events in our mental lives that may seem to be random and unrelated to what went on before are only apparently so. In fact, mental phenomena are no more capable of such a lack of causal connection with what preceded them than are physical ones.

(p. 2)

Despite the materialist and deterministic tone of Freud’s work, Basch (1978) argues that the strictly causal lines along which Freud’s notion of psychic determinism has often been interpreted is a misreading, and that Freud did in fact knowingly seek to allow for some question of intentionality:

Motivation, purposiveness and goal-directedness are terms that have often been, and still are in many quarters, looked at askance. They suggest that there is an ephemeral cause that beckons from afar and guides behaviour according to some design of its own. Freud was aware of this danger and tried to avoid it by refusing to entertain any notion of purpose or plan that went beyond causality rooted in the findings of physics or chemistry. Freud’s models for goal directed action were energy conversion apparatuses analogous to then recently invented machines like the electric lamp, the telegraph and the telephone…. A lamp or telephone cannot be said to have a goal; it is the user who has a purpose in mind when he turns it on. For this reason Freud’s attempt to design a mental apparatus along the lines of the physics of his day proved to be unsatisfactory. He had to introduce purpose into the simple reflex construct he designed by postulating unobservable homunculi…like the unconscious, the instincts, the ego, etc., each having its own aim and struggling for power. The very teleology that Freud sought to avoid by adhering to the thermodynamic laws of natural science was introduced into psychoanalysis by…his explanatory models.

(p. 260)

Rather than looking to ascertain how a certain thing came about, the teleological perspective is concerned with goal directedness. Any psychological approach that endorses a basic human tendency toward healing, wholeness, or health can be considered teleological in outlook. Such notions are essential if symptoms are to be respected as having a potential value. Notwithstanding American ego psychology’s penchant for pathologizing and authoritarianism, the history of psychoanalysis is in fact rife with teleological concepts. A few examples would include:

• Adler’s (1938) emphasis on the source of human motivation lying in the future rather than the past
• Rank’s (1936) focus on creativity
• Jung’s (1947) psychology of individuation as reflected in the prospective function of the psyche in its movement toward wholeness
• Bion’s (1965) notion of a truth drive
• Winnicott’s (1971) concept of a true self realized in play and expressive of an inherent tendency toward growth
• Kohut’s (1977) self-psychological outlook as reflected in the spontaneously felt need for selfobject experiences
• Loewald’s (1980) thinking on sublimation
• Bollas’s (2018) notions of personal idiom and destiny drive

Significantly, these ideas tend to moderate the relational emphasis on context and make room for some question of individual purposiveness.

Conceptualizing trauma

Any sense that mental illness might be considered purposive tends to imply what might loosely be termed a spiritual orientation toward practice. This naturally rubs up against conventional psychiatric assumption. In so far as spiritual issues are occasionally tolerated within mainstream thinking on psychosis, this is typically framed in terms of how religious or spiritual beliefs might be considered supportive of a patient’s well-being (Phillips & Stein, 2007). While there is no doubt value in this approach, a polite engagement of this kind still tends to neglect the more fundamental sense in which the clinician’s own spiritual commitments impact treatment. These commitments unavoidably emerge in theorizing about the nature and treatment of madness.

In the extent to which psychological attitudes toward psychosis have come to rely on the empirically verifiable role of trauma (Read, van Os, Morrison, & Ross, 2005), the fashion in which trauma theory is incorporated into clinical theorizing is of central importance. A teleological outlook on trauma tends to get neglected wherever our thinking leans too heavily on normative ideas about human development. Developmental approaches often emphasize a perceived deficit in the patient’s early experience leading to modes of functioning that are considered less than optimal. From this perspective, disruptions to good caregiving can be understood as the crux of intergenerational trauma. A few examples:

• Fraiberg, Adelson, and Shapiro (1975) perceive that recovery from the cycle of traumatization is dependent on the child of a traumatized parent refusing to identify with the aggressor. Where such an identification occurs, affect is thought to be split off in the child, only to return as a distortion in subsequent parenting skills.
• Drawing from Stern’s (1997) developmental theory, Adelman (1995, p. 363) conceptualizes transmission in terms of a disruption to the organization of the verbal self. For Adelman, trauma is transmitted by way of the relationship between a parent’s capacity to modulate their child’s affect and the child’s resultant capacity to verbalize.
• Bradfield (2011) is explicit when he conceptualizes the attachment relationship as the “location” of the child’s traumatic experience. The child’s need for containment is thought to elicit fear or rage in the traumatized parent, thus disturbing the attachment bond.

Whether considered in terms of split-off affect, unsymbolized experience, or attachment bonds, the belief subtending these theories is that the interpersonal transmission of trauma is fundamentally concerned with a deficit in the experience of early relationships. It is thus proposed that these deficits might subsequently be ameliorated in the work of therapy. Where there is a focus on trauma as causative of psychological deficits, however, and trauma is treated as the foundation of psychosis, there is a clear risk of conceptualizing psychotic experience merely in terms of an environmental shortfall.

Davoine and Gaudillière (2004) have developed a noteworthy clinical approach that seeks to avoid inadvertently infantilizing their patients. In History Beyond Trauma, they offer an unconventional approach to madness that they regard as nonreductive. Eschewing biological reductionism, they follow the notion that psychosis is connected to trauma. However, they expand upon this position by emphasizing the extent to which all trauma ultimately relates to the events of our collective history. Perceiving their patients as researchers, they see the clinician’s role not as that of a healer, but rather as an assistant to the work of historical research: “Sometimes a fit of madness tells us more than all the news dispatches about the left-over facts that have no right to existence” (p. xxvii). For Davoine and Gaudillière, to speak of something actively traumatic having been forgotten is misleading, in that the trauma cannot properly be said to reside in the past. The place of trauma is inferred by an absence, this being conceivable as a gap in the signifying chain of collective history. Recovery is achieved not by seeking to find containment for the unconscious (as psychoanalytic approaches that emphasize the need of a “strong ego” might assume), or by attempting to unearth something forgotten, but rather by trying to create the possibility of a repression – and hence, the hope of being able to forget. The unsymbolized trauma cannot be said to belong to the past, because it is precisely the existence of the trauma in the present that demands attention.

Accepting the patient’s experience requires that the clinician confront a conflict in themselves and move beyond causal thinking. The traumatic event is not yet an event at all, but rather the implication of something not yet nameable. Only at the intersection of shared experiences evoked by the therapeutic dyad can the patient give voice to the unspeakable. For the analyst to play a part in this means allowing the patient to lead – the clinician should view themselves as a co-participant. This entails the clinician divulging experiences of their own emerging relationship to trauma; a gesture that would more usually be considered intrusive, but out of which an alliance is formed enabling the shared process of forging history. Where conventional practice might dissuade an analyst from sharing elements of their own experience with the patient, particularly if the material is emotionally demanding, paying this kind of testimony to trauma is in this context regarded as essential.

By emphasizing the role of collective history, Davoine and Gaudillière offer an example of an approach to trauma that moves beyond interpersonal conceptions of transmission. This is not to the exclusion of the role that interpersonal factors play in giving rise to traumatic experience, but in the extent that we continue to consider these factors a cause, their effect is no longer to be perceived as the kernel of the trauma itself so much as a heightened receptivity to it – the trauma informs the sense of a calling which, in effect, enables the patient to conduct the work of historical research. Patients experiencing psychosis are often tortured by the efforts of others to “explain” psychotic experience causally.² For this reason, the only means of making a genuine connection with the patient is by way of coincidence. A clinician may discover, for instance, that the patient’s grandfather was critically ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• List of contributors
• Introduction: what are emancipatory perspectives on madness, and why do they matter?
• 1 On the potential limits of trauma theory as an emancipatory discourse
• 2 Encounters with Sioux medicine men
• 3 Transpersonal enactments and the teleology of paranoia
• 4 Re-turning the Psykhe: a creative experiment in decolonizing psychology
• 5 Divine madness: exceedance and not-knowing
• 6 Archetypal dimensions of expanded states
• 7 Reconceptualizing John Nash’s psychosis: a Lacanian perspective
• 8 The touch from without/the force from within
• 9 Creative transformations: the establishment, the mystic, and the aesthetic drive
• 10 Soul is crying
• Index