Showing posts with label Medicine. Show all posts
Showing posts with label Medicine. Show all posts

Too Much Reality, Research Time, 20/03/2018

When I was first reading Anti-Œdipus and really getting into it, I didn’t fully understand all the book’s arguments about psychiatry. I could follow the political philosophy well, but a more experienced researcher on Gilles Deleuze’s thought told me I needed some more background knowledge on the psychiatry before I could really dig into its concepts.

It’s been about 12 years since then. I think I’ve got this down reasonably.

Now, quite a lot of academic philosophy departments don’t consider Deleuze and Félix Guattari credible voices on scientific or medical issues. This is because they’re French philosophers whose major works dropped in the 1970s, so are associated with dreaded postmodernism.

Flying from reality? An excess of reality? By Mathieu Laca
Many university philosophy departments have characters more like Petersonian reaction than popular stereotypes about the discipline would have you believe.

As I’ve said before, Guattari was a groundbreaking psychiatrist, whose clinic La Borde was at the leading edge of creative new ways to treat psychotics and schizophrenics. The reason is because of his thorough materialism.

Under the influence of Freud – as well as Jung and pretty much the whole psychoanalytic model of thinking – you conceive of psychiatry as a rationalist practice. Your paradigm is what was literally called “the talking cure.”

So psychiatric practice is about the patient themselves analyzing themselves – the actual analyst acts as a guide so the patient learns the tools and understands the arguments and inferences to cure themselves. The patient understands the causes, conditions, nature, and the steps to follow in their daily lives to overcome their mental health problems.

That works for some mental health issues, but when Freud himself dealt with schizophrenics, he could do nothing. He described such patients as falling away from reality. Reality on his thinking was a material order of things and processes which you understood with rational human thought, language, and discourse.

Figure out the nature of a problem in clear thinking, after self-consciously exploring it. You can always fix your own mind if you understand its mechanics. Schizophrenics fall or fly from this because they can’t understand the world’s mechanics – empiricism is impossible.

Guattari had a totally different way to describe the schizophrenic state of mind – an excess of reality. Functioning people perceived and understood with a powerful focus. We cut away so much of a chaotic, messy environment.

Everyone is a machine. How fine is your tuning?
By Nychos
We sit on a busy bus without being overwhelmed by the activity around us – people moving back and forth, weaving through crowds in all directions, fumbling with bags and boxes, announcements of the next stop or slow stretches, cute puppies poking out of purses. We can keep our eye on a couple of things at a time.

We’re also doing this actively – making sense of all this mess on the damn bus. We remember who sat where, when our stop is, waddle to the door two or three stops in advance, stick our gloves deeper in our pockets so we don’t lose them, keeping an eye out for seated riders about to move. We can use this focussed attention as a basis to understand what’s going on and what we should do.

Schizophrenia explodes our focus. We can’t discriminate among possibilities because we spontaneously understand more causal processes than really exist. The imagination flies radically from the most trivial details. A passenger on the bus snorts out a sneeze, and it means that he’s part of the clandestine CIA plot to replace citizens with plastic machines.

We generate an excess of reality – an explosion of causes, explanations, and conditions. Unable to cut away any of our thought in perceiving or understanding, we overwhelm ourselves.

Funny part is, neurological research has a good angle on the causes of schizophrenia. It’s a destabilization of inhibitory signalling processes in the brain’s neural transmission. Destabilizing a process that should be in a proper range of inhibition.

Unable to regulate our reality – our thinking and world.

The Emptiness of Meaning in an Exploded Life, Research Time, 22/02/2018

Jean-Claude Polack once wrote a wonderful essay about Félix Guattari. Polack is a French psychiatrist who worked with Guattari at La Borde for more than a decade. His essay in The Guattari Effect volume blends philosophy, psychiatric theory, medical practice, and memoir of an old friend.

My personal favourite in the volume, even more than the essays by Guattari himself. I love Guattari, but I can never expect him to write in a straightforward way.

For that reason, Polack explains a bit better than Guattari what the core principles of their practice were, and why they constituted such a major break from Freudianism.

We are material assemblages all functioning together, and sometimes
those functions can break down or overheat.
Polack describes in very clear terms the experience of working in an indefinite-term, in-patient, live-in communal facility for the most intense psychotics in France. Their patients literally were totally unable to control their minds.

The mainstream schools of psychiatry in France in the 1960s and 70s were shot through with a rationalism that was utterly inadequate to deal with such people as psychotics.

Polack describes Freudian rationalism as the quest for the one true meaning of all the deranged and delusional behaviour a person expresses. If I can put it in the language common to semiotic and postmodern philosophy of the time – because Polack did – it’s a quest for the signifier.

This is why, from this important epistemic perspective, I find a lot of postmodernist philosophy a bit tiring compared to the concepts of Guattari and Gilles Deleuze. The emptiness of the signifier as necessary ground of meaning was a serious philosophical issue to so many – Jacques Lacan, Jean Beaudrillard, Jean-Francois Lyotard, Jacques Derrida, Gilles Deleuze.

Hang on. Yes, I did just say Gilles Deleuze. The Logic of Sense included a lot of inquiry about the signifier-signified relationship, how solid meaning in language and communication always slips away. In his creative philosophy, I consider Deleuze to have been in danger of slipping into the same lostness that so much postmodernism fell into.

We shouldn't be so afraid to conceive of ourselves as machines. No
matter how scary the prospect might be to us sometimes.
Not much danger, but a danger nonetheless. Then Guattari showed up to demonstrate that none of this signifier stuff was really all that important to the human mind and thought. It fit well with another set of concepts in Deleuze’s work – expression.

Each body has a range of potential activity that you can explore. Some of that activity is productive, helps augment and strengthen a body. But that kind of productive activity depends on restraint – channelling, controlling activity.

A seriously schizophrenic psychotic isn't able to channel her activity at all – she can only act, or follow an obsessive central idea to its endpoint. When that’s the kind of mental illness you're dealing with, a narrative explanatory technique like psychoanalysis isn’t going to work as therapy.

Guattari and Polack – and never forget the contribution of La Borde’s chief, Jean Oury – designed therapy regimens that literally retrained psychotics to control their thoughts, moods, and actions.

The stroll through the clinic gardens built relaxed spaces in experience. The grid – a communally-managed timetable of chores – reintroduced patients to performing tasks, focussing on the practical world, and responsibility to others.

It didn't work for everyone, of course. Some people’s neural systems were too damaged. Guattari often combined these re-socialization therapies with anti-psychotic drug regimens to keep people physically on an even-enough keel to function. But they worked far better on schizophrenics than the “talking cure.”

It was therapy that repaired the machine.

Knowing the Causes of Power, Research Time, 21/02/2018

There were a lot of reasons Félix Guattari broke with Jacques Lacan and the whole rest of the Freudian-influenced schools of French psychiatry. I talked about a couple last time.

How one point of unquestioned rationalism survived into the science of psychiatry – to understand the causes of the condition is itself part of the cure. How the images arising from singular cases were taken for universal symbol structures of human personalities. Both thanks to the influence of Freud.

Here’s a third issue that constituted such a radical break – the image of the therapist’s authority.

I don’t mean this in the sense of practical, institutional authority. Guattari understood that therapists, clinicians, and those who are responsible for the care and cure of the severely mentally ill required authority to do their jobs. They needed to prescribe drugs, coordinate clinical activities, design a therapy regime.

You don't really want anyone to be authorized only by themselves, do you?
All those required legal authority – the power of a signature. Your decisions had weight, and so needed to be taken with responsibility. That responsibility required thought and devotion, an ethical weight of obligation to act in the patient’s best interest – to let their good guide you.

I read an essay by Guattari a while ago that described the dominant culture of psychiatry and mental health care practice drifting from that ideal. He gives us Lacan’s words, “The analyst is authorized only by himself.”

There are two ways to read this. One is ontologically. The cause of some practicing psychoanalyst in some little town – call him Jack from Paris* – having his authority doesn’t come from Jack himself.

* Paris, Ontario.

Jack has to earn degrees and certifications in the fields you need to be expert as an analyst and therapist. He’s cultivated deep technical and philosophical medical knowledge. His legal powers are enabled by a complex web of institutions, laws, and regulations.

Another way you can read it is ethically. Jack’s authority flows from the trust people put in him – those who hired him, administer his certification renewals, maintain the laws that give him the right to prescribe drugs and therapies, and enforce those laws when they're broken.

Both are correct, of course. And not mutually exclusive. Just looking at different features of the world. The conclusion from both sides of that argument is that the statement “The analyst is authorized only by himself” isn’t adequate to empirical reality. Such an attitude isn’t going to fit properly with the real circumstances of an analyst’s working life.

What happens when a guiding philosophical element of training conflicts so brutally with the reality of practice? Breakdown. You end up with a body of professional analysts who tick the institutional boxes, but practice with none of the respect for the mentally ill that you need to practice properly.

Certainly not enough to transform respect into mutual respect. That’s the authority of expertise, an inescapably ethical relationship. Guattari understood that a philosophical principle of considering the analyst an absolute power – the revealer, prober, curer – undermines the possibility of ethical relationships among therapists and patients.

You can't really hold such a principle and practice medicine at the same time. Thought conditions reality when the reality is our actions and relationships.

Chaos Is the Natural State of Your Mind, Research Time, 20/02/2018

Researching Utopias, it's a book of ethics as well as politics and political theory. As it should be. Any political inquiry mixes questions of ethics and morality – Who are we? and What do we owe each other? respectively.

Any comprehensive book of ethics will need a conception of the subject underneath, an ontological one. If I’m going to explore questions of character, I’ll need to know what the limits and potentials of the human character are. Or at least, I’ll need a solid, dependable picture of those limits and potentials that will – at minimum – be a decent set of premises someone can consider for the sake of the wider argument.

This post comes from some notes I took on an old essay by Félix
Guattari called "Schizo Chaosmosis."
So where did I develop my general conception of the subject, of selfhood? Well, in my case, I’m picking up what Gilles Deleuze and Félix Guattari threw down.* It’s a fairly complex concept, but holding it doesn’t prevent me from engaging with anything else in philosophy or broader human science.

* Not wholesale, but with a suitable grounding in the basics of medical, neurological, and psychological science, as well as some input from Maurice Merleau-Ponty’s phenomenological thinking. But those converge more closely than you might think from stereotypes about the field.

If anything, it gives me a better grounding than researchers in the humanities whose knowledge is more discipline-bound. Guattari has a reputation among the more closed-minded majority of North American scholars as a freak opposed to real scientific inquiry.

But that’s a ridiculous stereotype – Guattari wrote like a freak, but he was a dedicated medical scientist.** He was a psychiatrist who worked with near-permanent in-patient schizophrenics. Severe schizophrenics.

** See, Merleau-Ponty researched The Phenomenology of Perception with detailed help from cutting-edge neuroscience research in the major research hospitals of Paris. He built his materialist phenomenology from some of the most influential studies of brain injury in the 20th century.

What did Guattari learn about the nature of human subjectivity from working with schizophrenics? He understood the chaos that’s always roiling inside each of our supposedly rational minds.

Learning the scientific knowledge and skill of so many thinkers
who too many mainstream North American philosophy departments
consider anti-scientific helped me realize something in my own
writing. I can be as experimental as I want in my own philosophical
work, and how I express myself. But not all the time. And carefully.
This isn't a matter of Freudian sub-conscious. The Freudian model of the mind is inherently rational – the talking cure is cure by understanding the origins. As soon as you figure out the root cause of your neuroses – the driving principle of your personal narrative – you’re cured.

Add to that, the whole point of Anti-Œdipus. Freud and the Freudians mistook the images that arose from Sigmund’s contingent practices – these patients from this city at this time in history – for universal organizing principles of human consciousness.

At La Borde, Guattari saw something much more obviously visceral, animal, dangerous, and fascinating than symbols and arguments. Schizophrenia – especially in the midst of a serious, intense breakdown – is the removal of all restraint on thought. It’s the closest humanity can get to pure chaos.

Guattari worked this out from studying his patients’ actions – how they thought and lived. Contemporary neuroscience has uncovered an appropriately literal cause of the condition – schizophrenics have a severe shortage of the neurotransmitter that inhibits our thoughts.

He saw the raw, unfettered force of the human personality. It was the liberation of a person from every constraint they had – everything they learned through enculturation and education was inconsequential. The schizophrenic was totally free.

Guattari also saw that the schizophrenic was a total basket case, unable to function in the world at all. His therapy – aside from stabilizing drugs – was accustoming them to social life through routine involvement in the operations of the clinic. Doing laundry, cleaning up, playing games, helping make meals.

Literally re-socializing them. That’s why it’s always a mistake to read Deleuze and Guattari as saying that to deterritorialize is freedom itself. Being totally deterritorialized is to become chaos – pure high-energy entropy with no limits. That’s no life. It’s an explosion.***

*** The cutting-edge neuroscience research at the heart of Merleau-Ponty’s philosophy couldn’t have happened without so many patients with so many different brain injuries. France had plenty – war veterans who had shrapnel slicing up different parts of their brains. No need for a dubious ethics board application to study serious brain injuries – the Second World War gave them all the patients needed and then some.

Guattari's was an ethical and political medical practice. He treated schizophrenia by re-socializing people – rebuilding their characters as better versions of themselves. Versions less likely to fly apart again.

Original Inequality II: A Modern Golden Mean, Research Time, 02/03/2017

Continued from last post (No, really, it just takes a while to get going). . . When I took my first undergrad-level class about Aristotle, we talked about the line that displays the Golden Mean. Virtue, the philosophy goes, is a mean at a perfect balance between two extremes. And it was diagrammed as a line.

A straight line on a chalkboard. On one end, a word for some destructive habit like recklessness. On the other end, the prof would write its opposite, but equally destructive habit, like cowardice. Then he wrote ‘bravery’ in the middle of the line and thought he explained it perfectly well.

Think about equality here in the most just sense. Imagine
the kind of society where every individual would not only
have the opportunity to be as fit and powerful as the most
athletic dancers, but where we would all become so in the
course of everyday, ordinary life.
You can draw it on an exam, but it doesn’t really explore what it means to have your behaviour balance two destructive extremes. Not what it means in your psychology and daily habits. Not in terms of how three different kinds of behaviour can actually express a single tendency.

None of those actually illuminating questions. The line is the easiest thing to draw on the exam.

I thought of this while reading Rousseau, because he seems to think about virtue in a similar way. He discusses this in a totally different context than Aristotle did. And please don’t think I’m trying to make some actual interpretive point about whether and how Aristotle’s idea really did influence Rousseau in this regard.

That’d be a totally unproductive time – a philology important only to a very well-paid scholar. And I don’t want to be a humble scholar anymore. I don’t even think I ever did want to be only a scholar.

I want to put these ideas next to each other so that someone who reads this can understand them both a little better. Understanding a concept better can let a person use an improved tool to understand the world and their life experience.

That’s basically what I think the public purpose of philosophy is. But let’s leave the really hippy-dippy stuff for another time.

So Rousseau is describing the roots of society’s decadence. In simple terms, that’s inequality. But how does this general idea of inequality spell out in everyday life? Inequality is a social corruption that’s expressed as public health problems.

Among the rich, you find diseases of gluttony and overeating – like adult-onset diabetes. Among the poor, you find diseases of poverty and hunger – like malnutrition.* The proper lifestyle is that of free people – you drink when you’re thirsty and eat when you’re hungry. You walk everywhere and exercise constantly.

A clear sign that your society is riven with destructive inequality and
profound corruption: A lot of wealthy people who let themselves
become obese out of laziness and the refusal to take any but the
physically easiest route anywhere at all.
* We’ve reversed the content in the 21st century, but it amounts to the same kind of decadence. More rich people suffer diseases of hunger like malnutrition because wealthy women often express the systemic sexism they experience as eating disorders. Poor people, meanwhile, can only afford heavily processed, starchy food and work crap jobs like call centres where they sit down for 10 hours every day.

Quite literally, an equal society is a healthy society because its people are – on the whole – healthier as individuals. Not the only kind of social and personal health Rousseau is interested in when he thinks about fundamental human equality, but it’s one very important vector.

It’s a very materialist perspective. It reminded me of what Nietzsche wrote about the importance of good health to the virtue of a society. But what matters for a thorough materialism is that social progress and virtue has this expression in the visceral matter of everyday life.

It illustrates the old Golden Mean concept better than that stupid line as well. The image of personal health helps you understand virtue as a perfectly balanced intensity. Feed yourself too much energy and you’re a slob or a decadent fatty. Maybe you undercut yourself and you’re nothing but a skeleton. Either way, you’re barely able to move. . . . To be continued