Maieutics for psychiatry

By Sergi SOLÉ PLANS


 

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S. Kierkegaard by L. Hasselriis/L. Rasmussen (Koebenhavn, 2012)

 

 

 

Socrates hence adopts a questioning attitude, and this kind of questioning and answering has thus been called the Socratic method; but in this method there is more than can be given in questions and replies.

G.W.F. Hegel,
Lectures on the History of Philosophy





SOCRATES SHOWED THAT no real knowledge could be found in his contemporaries’ uncritically assumed utterances. By asking as if he knew nothing he incited others to defend their arguments until having to recognise they didn’t really know what they pretended to. He led them to a situation of aporia where they found themselves being unable to answer. But not only others, he himself said that he knew nothing, suggesting it was a wise position to be in. Ignorance. Ironically.

Here we will try to defend the utility of this negative posture in front of Hegelian stances that have been pleaded as a convenient framework for the comprehension of mental suffering. And we will do that by taking the work On the Concept of Irony with Continual Reference to Socrates as a point of departure, Kierkegaard‘s thesis dissertation published in 1841 where he examines this negative Socratic proposal and how it was misunderstood by his contemporary romantics as well as, though differently, by Hegel.

Once attained, says Kierkegaard, this negative position is however not one to stay in. Doubt is an academic exercice, not a way of life, as he shows us in the satiric comedy The Conflict between the Old and the New Soap-Cellar, where the overuse and misuse of the Cartesian principle de omnibus disputandum/dubitandum est lead to meaningless conversations in the same way Johannes Climacus ends in despair and destroyed by philosophical doubt in Johannes Climacus, or De omnibus dubitandum est. Irony, i.e. negativity, is the guide we need, a path, as it is beautifully illustrated in The Concept of Irony: “the refreshment and strengthening that come with undressing when the air gets too hot and heavy and diving into the sea of irony, not in order to stay there, of course, but in order to come out healthy, happy, and buoyant and to dress again”. Not a place to stay in, but a way to follow. Irony or, in the Greek sense, to poetically compose oneself, carries the assumption of the boundaries “within which he is poetically free” (emphasis added). Irony is then “a controlled element”, not a nihilistic broom as seems to be in the romantic ironists’ lecture of Fichte where “the ironist is the eternal I for which no actuality is adequate”. This kind of skepticism has nothing to do with the Socratic task.

For Socrates knowledge can be attained, although not in an objective exteriority as is the case in the Hegelian positive alternative to romantic relativism. This Hegelian critical posture on Socratic negativism for not providing any positive solution is refuted by Kierkegaard insofar negativity is precisely what he most praises on the Greek philosopher. In accordance to Hamann’s eulogy of Socrates’ distinction, Kierkegaard invites us in the Philosophical Fragments to stay in the difference and learn to apprehend some situations as a mere and absolute paradox. Not everything is subject to the Hegelian mediation. Once that accepted, once attained aporia in Socratic terms, once established the distinction between what we know and what we do not know, mediation excluded or tertium non datur, the way out can only be reached by a subjective appropiation of the universal idea in one’s own particular context, as shown in The Concept of Anxiety. For both Socrates and Kierkegaard truth lies in the subject, who must reconsider every inherited assertion and see whether it is true for his life. What can be positively offered is just a kind of midwifery, an exercice of Socratic maieutics to help the subject find what is true for him and from him.

This Socratic heritage on Kierkegaard’s thought can thoroughly help us to understand and deal with mental suffering or, as Kierkegaard called it, despair: “despair is the only alternative for anyone not demented enough, (…) not despairing enough, to believe that he is the chosen one”. For when that arrives we say the one is delusional or has chosen “to delude himself into thinking that what is denied to everyone else is reserved for him”, that he owns the truth. Then, as this delusional person pretends that what he is affirming is incontrovertibly true, we find ourselves in a situation similar to Socrates in front of a Greek society alienated by traditional believes and values. And both patients and Greeks probably have the same reason: not to face the anxiety inherent to existence and its lack of meaning.

To delude oneself is, for Kierkegaard, to accept that social commitments are true or, said in a different way, that there is a truth outside to be found. Opposite to that, as Joanna Moncrieff writes (here), “Hegel presents madness as a state of social withdrawal from an alienating environment”. Strangely, for Hegel we wouldn’t be mad when following the “alienating environment” but when tearing apart from it. Moreover, this retreat is understood as “a return to a pre-rational state of being”, a regression to the “life of feeling”. This is madness from a hegelian point of view, though his statements in the Enzyklopaedie der philosophischen Wissenschaften on madness as a loose but not a loss of reason, “only derangement, only a contradiction in a still subsisting reason”, have been taken by many historians as Gladys Swain as the central point of his view. We would agree with W. T. Stace when he writes that Hegel’s remarks on insanity “appear to be parenthetical, and to have no connection with the course of the dialectic” (quoted in Berthold-Bond). Or, as Berthold-Bond himself writes: “we might speak of two idealisms present in Hegel’s writing, the true idealism he associates with his philosophic system and the fantastic idealism of madness”. Though, as a philosopher of unity, as Moncrieff defines him between empiricists and Romantics, Hegel “did not come down on any side of these debates, but tried to incorporate elements from all”, it is also true that his eclectic french spokesperson Royer-Collard had to acknowledge that reason was sometimes lost, that mediation was not always possible. The absolutist need of a positive response in front of a development of human thought “riddled with contradiction and dissatisfaction”, the conviction that it “is only through overcoming these obstacles that humankind can reach its full potential, and come to exist in a state of harmony with the world”, both premises lead to the comprehension of madness as a failure, as Moncrieff illustrates with Laing‘s theory: “Madness occurs when there is a failure to integrate the social self with the private internal self, leading the ‘real’ self to split off into the world of fantasy, increasingly disconnected from the external world”. Because if this “withdrawal from the alienating world of otherness” is for Hegel “an understandable reaction”, similarly to Laing’s divided self as “a meaningful response to the ‘ontological insecurity’ or anxiety produced by interaction with other people”, he also considers it a “self-defeating response”.

To be deluded is, for Kierkegaard, to be alienated in society; to be mad is for Hegel to be alienated from society. We think that delusion can not be in the path of seeking one’s own truth but in accepting other’s uncritically. Health for Kierkegaard is to be oneself, for Hegel to try to reconcile our “infantile state of undiferentiated self-absorption” with “the social world of shared meaning and rationality”. So, what is the implication of that in our clinical practice?

We could think that mentally suffering people come to our consultation room looking for an alternative truth given that the one they are pursuing is painful and does not fulfill a fundamental loss suffered in their lives. We could legitimately ask ourselves whether they are really seeking for another truth or not, as occured to Socrates and Kierkegaard who tried to show their unwilling contemporaries that they too were lacking a subjective truth. Socrate’s trial and condemnation and Kierkegaard’s Corsair affair clearly show how uneasy their respective societies were with their preaching. Kierkegaard stands up for this posture by considering that “the relation of philosophy to history is like that of a father confessor to a penitent and therefore like him ought to [be] able to make this manifest to the penitent”, that is, to make him see that what he is assuming as truth is not valid for him. That is what both Socrates and Kierkegaard tried in their societies, and we ask ourselves if it is what we should do during our consultations, “to make this manifest to the patient”. Must we pull him out from the private internal world where, in Moncrieff’s reading terms, he is entrenched?

In that situation of aporia or “being at a loss” (description that many patients would probably share), when the patient’s delusion or the sophists’ digressions reveal themselves as sterile, Kierkegaard invites us not to follow further positive Hegelian mediations. Not to try to rescue the person from his “unreasonable” retreat to lead him back to the alienating world, a world that he was wisely trying to avoid for reasons that might remain out of our reach and understanding. That would be the positivistic response of a reductionistic psychiatry, whose dangers we could say that Kierkegaard foresaw from the very beggining in his thesis On the Concept of Irony: “scientific scholarship has come into possession of such prodigious achievements that there must be something wrong”. The response of scientific psychiatry to delusional patients is profoundly deceiving. We see everyday how strikingly useless it is to try to demonstrate to a delusional person that another truth (our truth, external, alien to him) is better compared to his. What should be done then, not persuade, as Kierkegaard states in Concluding Unscientific Postscript? Take part in what could be called an antitherapeuthic attitude or a propsychotic stance?

Here is where Socrates’ art of midwifery comes to our help by showing us the fundamental distinction between “asking in order to get an answer and asking in order to disgrace”. That is the great difference between the objectivistic and subjectivistic approaches to mental suffering in psychiatry. What Kierkegaard shows us by following Socrates is that the best option is to repel any fixed doctrine (either social or biological) so that we can understand mental health “not as a doctrine but as an existence contradiction and existence-communication”. No objective, direct or straightforward communication of a fact about the world will heal the despair we feel deep inside ourselves. Nor will we do so by overcoming dissatisfaction to “come to exist in a state of harmony with the world”. Only by accepting the Socratic lack of positivity and by maieutically inviting to a subjective apprehension of the paradoxical, contradictory and absurd situation of life will we, and our patients, be able “to find the idea for which I am willing to live and die” that Kierkegaard was so anxious to attain in the village of Gilleleje. What he despaired for was “to find a truth which is truth for me”, he said. And so do our patients.

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