Louis Sass on Wittgenstein and Freud

[This blog captures my initial thoughts while reading Louis Sass’s chapter in Wittgenstein, Theory and the Arts (eds. R. Allen & M. Turvey), titled: ‘Wittgenstein, Freud, and the Nature of Psychoanalytic Explanation’. The bracketed page numbers are from that book.]

Louis Sass begins by acknowledging the complex relationship Wittgenstein seemed to have with Freud and the Psychoanalytic method. Wittgenstein valued the profundity of Freud’s discoveries about the human unconscious, but disagreed with Freud’s attempt to transform this theory into a scientific, deterministic, enterprise: ‘What Wittgenstein criticises, then, is not the adopting of such frameworks but only the tendency – which he discerns in Freud and various philosophers – to mistake the frameworks themselves for something in the nature of empirical assertions or discoveries.’ (260).

While theorising explanations of human action, Wittgenstein distinguishes between causes and reasons, claiming that both partake of entirely different ‘language games’. Causes establish empirical correlations, while reasons are used to rationalize or see the point of our own or others actions, and can therefore take only an ad hoc form.  

Sass writes that Freud generally portrayed himself as a scientist pursuing causes for phenomena. ‘But Wittgenstein suggests that Freud’s actual methods are, in fact, more akin to those of an aesthetic investigator who puts things side by side or strives to give a good simile, as when a critic of literature or art seeks agreements to the aptness of certain comparisons or tries to sum up a complex artistic work or effect in a succinct expression.’ (261).

‘For Wittgenstein, a key difference between causes and reasons seems to be that, whereas causal explanation operates in the third-person realm of objective or objectifiable reality, there is something more first-person about the nature of reasons, some way in which reasons are intimately connected with the point of view of the person whose action is being accounted for.’ (262)

I wonder whether this ‘something more first-person about the nature of reasons’ can be elucidated using Polanyi’s conception of tacit knowledge (which he says underlies all forms of knowing), or whether they are incompatible positions? Polanyi writes that: ‘Our body is the ultimate instrument of all our external knowledge, whether intellectual or practical. In all our waking moments we are relying on our awareness of contacts of our body with things outside for attending to these things.’ (Loc. 322 in Kindle book ‘The Tacit Dimension’). Sounding much like a phenomenologist, he is saying that because we are bodily beings, all of our reasons (and much else) will have this ‘first-person nature’. Polanyi interestingly qualifies that this does not necessarily make them ‘subjective,’ but that is a topic for another post.

(As a side note: There seems to be ongoing debate as to whether this tacit element has much explanatory value, and might not be worth being scrapped, sticking instead with the anti-private language approach that Wittgenstein puts forward. See Tim Thornton’s chapter in The Oxford Handbook to the Philosophy of Psychiatry which compares Wittgenstein and Polanyi and concludes that Polanyi’s tacit knowledge is better conceptualised as ‘context-dependent knowing’, leaving out much of the tacit bit.)

Back to Sass – The biggest difficulty for bringing together Wittgenstein and psychoanalysis is Wittgenstein’s emphasis that self-ascriptions are sufficient and do not require any grounding, or private, introspective access to ‘inner’ mental states; whereas psychoanalysis is of course all about those private inner mental states… (Polanyi would presumably be on the side of the psychoanalysts here).

Sass emphasises that even if Wittgenstein is suggesting that no causes can be given for motives, we shouldn’t take this in a postmodernist, sceptical or relativistic fashion. To make this point he enlists the help of a philosopher personally acquainted with Wittgenstein, Freidrich Waismann, who, in his essay ‘Will and Motive’ describes a way we can understand motives as something between a ’cause’ and a ‘reason’. This treats motives as a ‘family-resemblance’ concept that has no clear boundaries (276), and is able to encompass two extremes: the cause (lawlike) and the purpose (constituted within).

Waismann acknowledges the inherent difficulty in disciplines such as psychology (and philosophy) because of the fact that ‘our ordinary concepts are too rigid’ (qtd in Sass 277), ‘we need something looser, more indefinite … In order to describe the mental we need a language that is just as flexible; which, of course, runs counter to our usual way of thinking.’

And it is here that Sass neatly brings back mention of aesthetics: ‘The project of understanding motivation – one’s own or that of another – also has much in common with that of artistic representation or appreciation, for it is something that demands active, imaginative interpretation or an attitude of subtle, connoisseur-like discernment toward the world.’ (278) Understanding motives is like understanding aesthetic patterns but this does not lead us to subjectivism in a postmodernist way, nor to pure behaviourism. (Here Sass also references Merleau-Ponty on ‘reciprocal expression’ which I have made a note to follow up in future reading).

(Earlier in the chapter Sass mentioned Wittgenstein’s notion of ‘Seeing-as’ or ‘Aspect-seeing’, which is when we can see something in a new way, while knowing that it itself has not changed (274). I always think of art’s ability to provoke this in us…)

I love the quote from Waismann that follows so I will quote it at length: ‘There really is something like digging down to deeper layers, becoming more truthful, struggling passionately, while things become clearer and clearer. There is undoubtedly such a process of plumbing the depths in which one penetrates to one’s innermost motives. So things are not entirely subjective; there is truth after all. And yet! When we want to put our finger on it, it will not stand up; when we look more closely at it, it looks different again. It is an interpretation and yet something more than an interpretation, knowledge and yet not quite knowledge: what are we dealing with? […] We require a composite concept that combines “knowing, acknowledging and interpreting. For fathoming a motive touches on all three”.’ (279, and 136 in Waismann.)

Sass concludes by summarising his two main points. What Wittgenstein and Freud have remarkably in common is their shared ideal of clarity. Wittgenstein says so much by explicitly comparing his method to psychoanalysis: ‘It is a principal function of philosophy to warn against false analogies. To warn against the false analogies which lie embedded in our forms of expression without our being fully conscious of them. I believe our method here resembles psychoanalysis which also makes conscious the unconscious and thereby renders it harmless, and I believe that this resemblance is not purely superficial. (Wittgenstein manuscript 109, 174)’ (Sass 280). (But couldn’t you say that surely most philosophers share this ideal? I imagine that even a rouge philosopher wanting to deliberately complicate our understanding of the world would be doing so in order to make that complexity clearer in some way?)

Where Wittgenstein and Freud most drastically differ, though, relates to Wittgenstein’s second ideal of ‘awe or wonder’. Freud’s method towards greater understanding of the the human psyche was driven by the desire for scientific objectivism. This was anathema to Wittgenstein, who repeatedly argued that we should remain aware of the limits of scientific knowledge, and not try to cross those lines. Wittgenstein wanted us to avoid rationalising things into generalisations or too-clear pictures. Sass quotes Wittgenstein earlier in the chapter: ‘And may we not advance any kind of theory … We must do away with all explanation, and description alone must take its place.’ (273) And of course his most famous quote encapsulates this sentiment: “Whereof one cannot speak, thereof one must be silent.” (Tractatus)

It’s somewhat ironic now that Freud is treated more seriously in humanities/arts disciplines than the sciences, and Wittgenstein’s (lay) reputation remembers predominantly his dry and methodological treatment of how we use ordinary language rather than his mysticism; but I think that is precisely the richness and value of both thinkers – both occupy an ambiguous space between two extreme camps, and can’t easily settle into either, as they themselves well knew.

Final thought – I think this is also why I am so interested in Michael Polanyi’s work at the moment, because he seems to have tried to build a comprehensive theory explaining why sciences and the humanities aren’t diametrically opposed projects at all, an idea he also lived by.

Michael Polanyi on the Arts

I have recently become interested in how the scientist-turned-philosopher Michael Polanyi’s understanding of the arts can help us theorize how creating or appreciating the arts has a role to play in clinical psychology, in particular psychoanalytic or psychodynamic approaches.

In his 1958 book Personal Knowledge, as he leads up to a discussion of ‘indwelling’, Polanyi sets forth a theory of the arts. He compares the abstract arts (music, abstract painting), to pure mathematics, describing both as ‘appreciated for the beauty of a set of complex relations embodied in them.’ Like mathematics, music ‘articulates a vast range of relationships for the mere pleasure of understanding them’ (193).

He continues: ‘Laments for the dead and songs of love are likewise formulations of earlier shapeless emotions, which are refashioned and amplified into something new by words and music.’ (194). If the arts give words to ‘shapeless emotions’ which are then ‘refashioned and amplified into something new’, is this not what psychoanalysis is trying to do within the psychoanalytic encounter?

How the arts differ from mathematics or science is that they do not try to map precisely what those underlying formulations are. The scientist is trying to construct a framework which will handle experience on our behalf, while the artist is content to allow that framework to remain such that allows us a ‘contemplative experience’ of those shapeless emotions. At the other extreme is mystic experience, which attempts to ‘dissolve the screen [which separates us from experience], stop our movement through experience […] we cease to handle things and become immersed in them.’ (197). Appreciating artistic works, we are able to contemplate those ‘shapeless emotions’ in a position that is at once immersive and detached:

‘Music, poetry, painting: the arts – whether abstract or representative – are a dwelling in and a breaking out which lie somewhere between science and worship […] Owing to its sensuous content a work of art can affect us far more comprehensively than a mathematical theorem […] Art, like mysticism, breaks through the screen of objectivity and draws on our pre-conceptual capacities of contemplative vision.’ (199).

This intermediate position of the arts reminds me of psychoanalysis as a discipline caught somewhere between a science (as holding universal ‘truths’) and an art (as always coloured by our ‘personal’ or  ‘tacit’ knowledge, that lies beyond the grasp of scientific propositions). And so, if the two share this liminal position, might they both have interesting things to teach each other?

A Common Criticism of CBT

Some critics of Cognitive Behavioural Therapy (CBT) have focussed their attack on its underlying theoretical assumption that our ‘beliefs’ cause mental distress. That’s a pretty easy target, though, once you look at the correlations between factors like poverty, abuse, systemic oppression; and mental distress – in those cases, would you really call their thinking ‘faulty’ when it reacts against these conditions? It seems more mistaken not to be distressed in those cases. So naturally, CBT theorists adjusted and now recognise that external factors play a significant role in contributing to mental distress.

In practice, that meant that CBT moved away from the ‘C’ and towards the ‘B’ (Behaviour): instead of telling the individual to change their thoughts, the idea now was to get them to change their behaviour, which would hopefully go some way towards fixing their unhelpful environment. For example, if poverty is making you depressed, why not get a job? If your husband’s drunken violence is causing you anxiety, why not go to a friend’s house next time this happens?

There are obvious problems with this – most glaringly that the focus is still on the individual (rather than the structural or societal), however, I do understand that psychologists are limited in the areas that they can help with – they aren’t politicians or social workers, after all.

Another way that the CBT theorists tried to update the underlying philosophy of CBT was to think in a less linear (‘x causes y’) fashion, replacing this with a cyclical framework of our thoughts, behaviours, emotions and physical feelings as all interrelated and mutually reinforcing.

CBT formulation - 80ss Anxiety - POINT-1

This served to disperse the blame, so now we can’t ever quite say for certain which came first: the faulty thoughts or faulty environment… Do we pick poor husbands because we think badly of ourselves, or do we think badly of ourselves because of our abusive partners?

The 5 Areas Model we are taught appears comprehensive, but I still get the feeling that the CBT-based approach is missing out on some vital aspects of human life. Predominantly, I begrudge the lack of a detailed discussion on affects and moods as non-propositional, and the importance of intersubjectivity. CBT seems to be based on some unhelpful and out-dated conceptions of how we exist in the world. The underlying theory describes the human being in a mechanistic, representational manner – someone that understands the world in propositions (or mental images) and then acts accordingly.

I am not breaking new ground by arguing that CBT feels impoverished in these respects – Anthony Ryle’s psychoanalytic alternative to CBT, CAT (replacing ‘Behavioural’ to ‘Analytic’), attempts to redress this individualistic approach by creating a space for ‘Reciprocal Roles’ formed in our early relationships with caregivers. I have not yet read as much about CAT as I would like to (I’ve only just started reading Introducing Cognitive Analytic Therapy [Ryle & Kerr 2020] – and am very much enjoying it so far), but I think there’s a chance that it also remains too firmly representational, and doesn’t fully conceptualise things like affects and moods that couldn’t easily be formulated into propositions. From what I know so far, and as suggested by its name, CAT takes a similarly computational approach to the human psyche, only it has broadened the roots of these cognitions to include our early relationships, instead of keeping the focus on the individual as a separate being. It sees cognitions as arising within intersubjective relationships and from the roles we assume within those relationships. I like this expanded concept, and perhaps I’ll find that it is a good enough update to the theory, but I will save that conclusion until I’ve finished the book. From where I stand now, however, I don’t think that we should limit ourselves to cognitions that can easily be translated into propositions or even mental images.

I’ve developed this view through my reading of phenomenological approaches to psychology, starting with Maurice Merleau-Ponty who argued that perception is direct (and hence against the subject-object distinction), similar arguments put forward by the ‘Ecological’ psychologist James Gibson, the philosopher of psychiatry Thomas Fuchs who writes of affects and moods as existing in the ‘backdrop of an experiential field’, and Enactivist philosophers of mind (Varela, Thompson, De Jaegher) who stress the ‘embodied, embedded and extensive nature of mentality’…  

Perhaps it’s a matter of temperament, but these thinkers seem to capture something that fits more with my experience as a human being. I can’t convince myself that ‘representations’ or mental images play as large a role in our thoughts, feelings and behaviour as cognitive scientists seem to believe. Maybe I have a distinctly empty inner world, but I hardly ever seem to be thinking of any clear representations of things, or even thoughts in words. From his case studies it sounded like Beck’s clients had similar difficulty in formulating what they were thinking. Of course, if I were to be asked, as they were, ‘what thought went through your mind when you last felt sad?’ I could probably think of something (as they did) but I have a feeling that I’d be creatively guessing rather than faithfully reporting what was going on my mind. Usually when I feel low it is due to a more vague sense of wrongness, more like a mood that colours my entire environment, rather than a clear ‘negative thought’; and might be due to some kind of interpersonal shift in atmosphere that I will have picked up from my partner, for example. These are distorted once they are forced into the form of a clear proposition – ‘my boyfriend doesn’t like me’ – would be the forced answer I’d give to Beck, but that wasn’t really what I thought, so if he started listing reasons as to why that might not be the case I’d find it a waste of time, or if he did a bad job and didn’t persuade me, insulting.

At the same time, I don’t believe that we need to make this an either/or dilemma – I don’t want to say that cognitive representations do not exist full stop – they may well do when we are more explicitly remembering or imagining. I just don’t think that ‘internal representations’ are all that we have – more often it feels as though we are behaving in a more automatic-pilot way – perceiving and responding to the world as it happens, and as we move through it. And I think that our moods and feelings are born and played out within interpersonal relationships and situations, rather than our inner mind observing and formulating its own little images.

The counterargument could be made, however, that maybe the CBT ‘philosophy’ doesn’t quite capture it all, but this isn’t important because the therapy works. My tutors on the Psychological Wellbeing Practitioner course are always drilling it into us not to think too much about our client’s past experiences or even their thoughts – because it’s their behaviour that we need to change, as this will have the biggest benefits. How would I go about shifting someone’s mood anyway, if it really is that nebulous thing that I have described? Beck wanted to make a practitioner’s science, not a philosophy of mind. But the low intensity CBT approach in IAPT is getting only 50% recovery rates at the moment, so I don’t think anything’s decided yet, and we should probably keep thinking and revising…

Coaches or Clinicians?

I’ve recently started training to become a Psychological Wellbeing Practitioner in an IAPT (Improving Access to Psychological Therapies) service, and what that means is that I will soon be able to deliver Low Intensity Cognitive Behavioural Therapy to ‘clients’ with mild to moderate common mental health problems such as depression and anxiety.

The training is delivered 2 days per week by lectures and seminars from University College London, and the remaining 3 days per week I spend working at my IAPT service doing assessments and low-intensity treatments.

One thing in particular that we learnt in the first week threw myself and my fellow Trainees: the fact that we should not think of ourselves as therapists or clinicians, but as coaches. We didn’t do so big-headedly, but in our previous role (when we were doing Triage Assessments and offering people Step 2 Guided Self-Help, or Low Intensity CBT), we always thought that Step 2 was a sort of CBT-lite, and so the Step 2 clinician was therefore a sort of therapist-lite.

Also, when I was learning about IAPT as an outsider, I was wrongly led to believe that the program is training ‘therapists’ not coaches. David Clark says so himself in his ‘IAPT at 10: Achievements and Challenges’ post, he writes (under the dramatic title ‘A revolution in mental health’), that to overcome the shortage of psychological therapy available to people suffering from common mental health problems, ‘the NHS has trained over 10,500 therapists and deployed them in new psychological therapy services’ (emphasis added). This is misleading, and I often find evidence of IAPT’s main advocates (usually people with a stake in the game), claiming more for the service than it deserves. I think Clark and others should be more cautious in over-selling IAPT, because it will eventually lead to disappointment when people’s expectations aren’t managed.

Thanks to that misinformation, when I used to allocate people whom I had triaged to Step 2 treatments, I always sold it as a ‘guided cognitive behavioural therapy over 6 weeks, for 30 minute sessions’. But now that we are training to be those Step 2 ‘clinicians’, we find that we are not that at all, and what we offer isn’t Cognitive Behavioural Therapy, but rather a life-coaching session.

But – I agree with this. We shouldn’t think of ourselves as clinicians or therapists because we don’t have those skills – we aren’t taught about what happens within the therapeutic relationship, and how to more supportively guide our clients through more long-lasting psychic change. I think it also serves to prevent us from feeling also like counsellors, whose role is to sit and listen to the client as they talk about whatever they feel like getting off their chest. By reminding us that we are there to encourage behaviour change (and that’s essentially it), it makes a lot of sense to call us coaches.

Having said that, however, it’s now clearer to me just how difficult I’m going to find this year in how it jars with my fundamental values and assumptions as to how psychological therapy should be. It’s odd, and I must try to check it, but I have an almost instinctual aversion to CBT and the phrase ‘evidence-based treatment’. Aaron Beck (the founder of CBT), gives me an uncomfortable feeling, I can’t help but think he’s getting something terribly wrong, or turning something complex into something robotically simple (to its detriment). I don’t have enough learning or experience to quite put into words what exactly I distrust about Beck’s cognitive approach, and I know that it has changed and improved a lot since his day so I’m probably being hugely unfair to modern practitioners of CBT, but I have read a couple of things recently that have started to confirm my uncomfortable feeling about it…

The first was a blog post by philosopher and clinical psychologist Richard Gipps, on how Beck’s turn away from psychoanalytic psychotherapy was caused by his own misunderstanding of the theory, rather than with any fundamental flaw in the approach itself.

And the second was a journal article by Michael McEachrane on the flawed assumptions that Cognitive Therapy is based on to do with what it really means to ‘think that p‘.

I’m tempted to share these two articles with the other Trainees on my course to see what they think, but I don’t want to be the bad, critical one in the bunch.

And, I do understand why IAPT uses the CBT model so religiously. The aim of IAPT is to ‘democratise psychological therapy’ – it wants to make it accessible on the NHS, and this I fervently agree with. Unfortunately, however, CBT is the only kind of therapy that can be made ‘efficient’ and ‘wide-spread’ in this way, because it’s less about the relationship that the client has with their therapist, and more about the ‘tools’ that they learn from them. So, the therapists can be quickly and inexpensively trained, because it’s not really about them and their skills.

Research has shown that this can be effective (with about a 50% recovery rate; not bad, not good?), but the jury’s out as to how long those benefits last for, and I have a feeling that the main function of having Step 2 low-intensity treatments available on the NHS isn’t so much for the good they do, but as a sifting mechanism for finding out who are the really serious cases on the waiting list who need longer-term therapy. Without Step 2, we would have one big, long waiting list for CBT Proper (Step 3), and that wouldn’t be good for anybody.

Book Review: ‘By Grand Central Station I sat Down and Wept’ by Elizabeth smart

During times of crises, one might think that we would be reminded of the triviality of our small, personal problems, but I think that one of the many things that the current Covid-19 pandemic has taught us is that our human responses aren’t always so rational.
Over the last two weeks, as the severity of the situation has made itself more and more apparent, I have observed myself alternating between fear and anxiety for the wider issues: a global recession, hundreds of thousands of deaths, what this will do to our human propensity for us- and them- distinctions; and then my own little worries: will my boyfriend still like me after potentially 3 months apart? What will I do if I get a toothache?

It seems that no matter how vast the problem, we (or at least I) still find it difficult to put our own concerns into perspective. What I try to bear in mind though, is that the big picture is made up of these tiny elements, interactions, worries. It is a pandemic precisely because we all will feel the effects of this disaster. Grand events are made up of millions of littler ones. And, of course, I remind myself that my problems are nothing compared to what hundreds of thousands, more likely millions, will have to go through as a result of this virus.

By Grand Central Station I Sat Down and Wept, an autobiographical account of the author’s affair with a married man (the poet George Barker, with whom she had four children), is a perfect study of how the events in our lives, when personally and emotionally significant, can become amplified to grandiose proportions. Comparable to, and even eclipsing, some of the twentieth century’s most horrific events.

The narrator is intelligent enough to know that the comparisons she makes are, in fact, incomparable, that millions of people being sent to gas chambers is not even on the same scale of suffering as one woman’s heartbreak; and yet, she seems to suggest a closer relation between the two. What the text seems to suggest, by weaving the personal and the historical together (reminiscent of Sylvia Plath’s equally brutal poem, ‘Daddy’), is that one makes sense because of the other. These are grand tragedies precisely because those people going into the gas chambers are people’s lovers, husbands, wives, children. If it wasn’t for the love experienced by individuals and groups, what would those traumas, in fact, be breaking?

She also suggests that it is the minute, everyday pleasures and pains that justifies everything else. Since life is undeniably hard, and filled with trials and disappointments, we must not forget how to cherish what is most precious to us. Even, or especially when, it feels like everything else is falling apart.

This wonderful book does a vital job in reminding us to keep our perspective flexible, stay able to appreciate both the small and the significant, and to never lose sight of the small things that matter to us when we have them. It is a book about loss, and sadly, the only thing we seem to be increasingly certain of right now is that this virus will mean many of us will experience loss before it’s time. I hope her beautiful language might provide some comfort to those of us feeling claustrophobic and isolated right now, whether our losses are temporary or permanent.

‘O I understand too well how we are all Lot’s wife, looking back, under our heroic loving faces. But is nothing irrefutable? Is no fact impregnable? Is there no once-in-a-billion years’ bull’s-eye worth even the slaughter of decisive action?
Our passion by the ice pond forced the sun into sight. It has rocked orphans to sleep and thickened the heart of the new-made cabinboy. Heathcliff’s look bored a hole through England which generations of heather on the wild moor never erased.
Give me my faith in the one fact, and I can cure cancer and gossip and war. Give me the fact, and then I would cut off my hands and give them to her to comfort her for an hour.
Injure me, betray me, but only make me sure of the love, for all day and all night, away from him and with him, everywhere and always, that is my gravity, and the apples (which ben ripe in my gardayne) fall only towards that.’ (100)

Book Review: ‘Radical Help’ by Hilary Cottam

I am wary of the word ‘radical’. It feels brash, idealistic, even aggressive, somehow. Maybe it’s just been overused, it seemed to crop up everywhere during my Masters degree, attempting to appeal to some sort of youthful optimism – ‘this is radical! new! you young people will love it! a complete overhaul will happen right away and it’ll be fantastic!’ – and precisely because it was everywhere, it seemed to disprove itself. The word radical became mundane, so I stopped trusting it.

It might have also become too strongly associated with the political left, as in ‘radical socialism’, and I’m still hurting from the labour party’s bitter defeat at the recent General Election. I too was blissfully caught up in the London-centric media bubble that made us optimistically believe Corbyn might actually win. The reality hit home painfully hard that we still very much live in a conservative country, and it is only to our detriment that we forget or ignore that fact.

But, I understand why Hilary Cottam named her recent book Radical Help. Her whole argument is that drastic solutions are necessary, and they are the only hope we have left if we want to save our welfare system. I broadly agree with her on this, but at the same time, I can’t help but feel that we might not succeed if we frame our argument in these terms. Quite simply, people do not like radical change, and I think (from my limited knowledge, so please correct me), history seems to suggest that slower and gradual solutions are a bit easier to take, and therefore more likely to succeed in the long run. Even shifts that seem radical in hindsight are probably more likely the result of multiple gradual causes coming together and reacting in some lucky way, rather than a genuinely novel and unprecedented ‘pivot’.

Anyway, there are many things I liked about this book. It is clearly written, inspiring, informative, and it covers a lot of ground. Hilary Cottam is a social activist and designer with an academic background in economics and history, and she has made it her mission to reduce inequality and fight social injustice. You can really feel the drive and determination that has propelled Cottam in her work, and as my mother reflected, the world would be a far better place if more politicians had these hopes and ambitions…

In the first part of the book, Cottam describes 5 experiments that she and her team designed and ran, all focusing on different populations and using different methods, but with the shared aim of increasing 4 main ‘capabilities’ of individuals that she thinks are vital to living a good life: learning/work, health/vitality, community and relationships.

Her team work by first identifying a problem, then by getting deep into the matter by immersing themselves practically with the issue at hand (speaking to people, living with them, actively listening to them), then they design a prototype and run it straight away, starting small and then hoping to grow bigger and bigger.

Here’s a quick summary of the 5 experiments:
Experiment 1: ‘Life’ worked by inviting families who are experiencing a variety of difficulties to participate, then they selected a team of service workers who were focused on helping the family to help themselves, those teams discussed amongst themselves best ways forward, and the Life family took an active role in making a practical plan of what their goals are and how they could go about achieving them.
Experiment 2: ‘Loops’ joined young people with managers and workers at companies/organisations related to their interests, hoping that they would form relationships with adults who could then work as ‘mentors’. This project failed and was stopped for potentially being dangerous to the young people. One of my first queries was, are these young people essentially working for free? And also, I thought this was a bit too idealistic because she imagined that life-changing mentor-relationships were easy to spark, which is unlikely to be the case…
Experiment 3: ‘Backr’ was an alternative to the JobCentre approach, and essentially was a MeetUp Group trying to unite unemployed people with others, plus some employed people, in the hope that someone might tell someone else of an opportunity that otherwise they wouldn’t have heard of. The rationale behind this one was that most jobs these days aren’t advertised but are found via word-of-mouth, so we just need people from different backgrounds getting together and discussing job opportunities more openly.
Experiment 4: ‘Wellogram’ focused on patients who had been informally classified as ‘heart-sink’ patients, who were suffering from a number of problems, and invited their doctors to come together to discuss each case. It was an attempt to see the patient’s whole life, rather than each little problem divorced from its wider context, in an attempt to understand the root causes better.
Experiment 5: ‘Circle’ was a technology-based attempt to bring together older individuals so that they could help each other with tasks that needed doing, because some will have capabilities that others won’t, allowing everyone to feel like a ‘helper’ rather than someone who is in need.

What I loved about her approach in each of the experiments was her fearlessness of failure. Too many development projects are run which are too scared of failing, so they rely on methods that have been used far too many times before, and no longer yield novel or unexpected insights. Straight out, Cottam acknowledges that mistakes will be made, wrong avenues taken, but she decided early on that the best way of learning is by trying, so what seems like a big mistake is actually the best way to learn.

Her main findings from all of the experiments seem to be that it’s best to start small and locally, really understanding the people and problems you are working with; people need to be ‘helped to help themselves’, not made dependent on aid; and that the most important of her 4 capabilities is relationships, what the welfare state needs to facilitate is strong bonds between people so that resources can be shared, rather than more money in the wrong places.

I agree with all of these sentiments. But, I have some criticisms (of course) that I’d like to think through…

The first, and obvious one, is that small projects are much easier than large ones. It’s easy to provide thoughtful and time-effective help when you are working with fewer people, as soon as systems get larger they automatically become more cumbersome and inefficient. Her hope is that these programs would grow organically, and that they would actually become more efficient as more people joined (because, more relationships mean more resource sharing) and she argued that ‘our capacity for relationships is infinite’. But I’m afraid I don’t agree. We obviously can’t have infinite relationships, there simply isn’t time in the day nor mental space. All of her projects, thought focusing on different populations, seemed to boil down to a kind of ‘Meet Up Group’, which was facilitated by a ‘reflector’ (or, what I thought was more like a therapist). If people with similar interests but different backgrounds are brought together, helpful connections will be made. And it works best when those people join actively as agents, rather than join feeling like they need to passively receive help from their group. This seems obvious? But it’s also obvious that bigger groups get less personal, so less meaningful, they become a crowd; and, it’s also actually quite difficult to get people involved in this way. We, especially Brits, are quite embarrassed to go to ‘Meet Ups’.

Another point of contention was that many of her projects relied on a therapist-style role, someone who knows when to step forward to offer help to the person needing it, but also when to step back and let them work it out on their own. This role was holistic, and was designed to see the individual being helped as a person with hopes, dreams and wishes of their own, rather than the specialist approach that we have at the moment (with various roles all focused on solving one specific ‘need’ or problem in an individual’s life, rather than concentrating on how to reach potentials) where none of the service providers actually get a good sense of the individual. While I totally agree with the problematic nature of Multi-disciplinary Teams that we have going on at the moment, because so much time is wasted with trying to share information across all the members involved, how are we supposed to get one person to focus and know it all? That, essentially, is a therapist dedicated to each individual needing help, and if we could do that financially, we would.

Finally, after finishing the book, and in writing the summaries of the experiments for this post, I realised that her projects weren’t really that novel or ‘radical’. What Life and Wellogram tried to do was encourage the many service providers to discuss each individual case in more depth, so that they could make a more comprehensive plan of how to help. This is what the welfare system already tries to do, but it is literally impossible to provide that kind of focussed attention on each individual. That’s why we have so many online databases and attempts to share information across services, which is exactly why the system feels cumbersome, and why so much time is wasted on admin. And in the other 3 experiments, the main idea was to form groups around similar interests but different backgrounds, hoping to forge friendships across people to get them to help each other rather than rely on services. These are both good ideas, but they are difficult to implement precisely because they are good when they are not enforced from above, which is what she acknowledges herself!

So, to conclude, I wholeheartedly admire her approach and ambitions. I think it’s vital that innovative and bold individuals try out new projects, methods, designs; because we need to learn practically, and in the real world. Having done from academia to the NHS as a support worker, I see and feel acutely the huge gap between thinking about helping people, to actually trying to do it.

I also totally agree with her conclusions – the fact that what is needed is not (just) more money, but that we also need to make the sharing of resources and connections more efficient. We live in a very well-off country with enough to go round for everyone, the problem is mainly to do with inequality of distribution. We need to forge connections, so we desperately need to value the power of supportive relationships and bring them into our welfare system. We need to stop thinking of individuals who need to be ‘helped’ or ‘cured’ alone by taking a pill or just telling them to exercise more. Cures work best when they are social, because we are social animals and are formed by the groups we are part of.

But, I’m not quite sure that she has designed viable ways of reaching these conclusions yet in any large scale. I think her projects were interesting and moderately successful predominantly because they were small, but I doubt her when she says that they could be organically grown and remain as useful. She may have slightly underestimated the difficulty of growing groups and projects… Having said that, she probably knows far more about it than I do, and probably goes into a lot more detail in her reports, as this book is supposed to be a summary rather than a detailed explanation. So I should read her project reports before I make too sudden a judgement, but that was my inkling.

Has anyone else read this book, and if so, what did you think?

Book Review: ‘Heroines’ by Kate Zambreno

‘Memoir is a woman writer’s forbidden and often avoided continent. The threat perhaps is a woman writing her own narrative, being her own author.’ (236)

This book is perhaps best defined in Kate Zambreno’s own words as an emotion-fuelled ‘memory campaign’. In it, Zambreno takes up the worthy task of rescuing the voices of forgotten literary wives of modernism, Zelda Fitzgerald and Vivienne Eliot, as well as weaving in the lives of not-so-forgotten modernist women: Virginia Woolf, Elizabeth Hardwick, Sylvia Plath. While remaining faithful to their situational and temperamental differences, the work is most alert to what they all fundamentally shared: the battle of forging a voice for themselves in world dominated by the narratives of Great Men.

Zambreno’s voice joins this ‘invisible community’ as she blends her own experience of writing the book reflexively into the text itself. Heroines is intimate, repetitive, intense; all the things that biographies usually are not, and it is driven by a powerful motive – to inspire and incite young women to do exactly what she has done (and what her rescued predecessors were prevented from doing) – to write boldly in their own voices and through their own bodies. To be their own author.

A dominating theme of the book is something that I am particularly interested in (as a graduate of both literature and psychology): the uncomfortably-close relationship between passionate women artists and diagnoses of madness:

‘The charges of borderline personality disorder are the same charges against girls writing literature, I realize – too emotional, too impulsive, no boundaries.’ (266).

Following Eliot and the New Critics, the personal, confessional, bodily, intimate, and domestic was rejected in art in favour of the impersonal, transcendent, ‘universal’ (read: masculine). They valued cool, hard prose and poetry. Life was supposed to be transformed into Art. But what Zambreno reminds us of is the terrible double-standard: these men did not extract the personal and the emotional from their work, they too expressed their extreme inner turmoil. But, when men are passionate they are Geniuses; a passionate woman is simply mad. We are prompted to ask, why was Flaubert allowed his excesses and violent moods while writing Madame Bovary, while any sign in a woman that her emotions were overwhelming was evidence of her unsuitability as an artist? The answer can only be that we simply are not ready to hear about women’s inner lives. We still live in a patriarchal world in which women are supposed to be givers rather than takers. We don’t care about how they are feeling themselves; their role is to nurture and support the feelings of others (i.e. men and children).

This is a feeling that has lasted very much into the 21st century – Karl Ove Knausguaard is hailed as a literary giant for the intensity of his six-book autobiographical series My Struggle, while Rachel Cusk’s slim memoir of her divorce was decried by Camilla Long as “acres of poetic whimsy and vague literary blah, a needy, neurotic mandolin solo of reflections on child sacrifice and asides about drains”. As philosopher Kate Manne explains in Down Girl, her brilliant analysis of the societal mechanisms that underpin the patriarchy, what we do not want to hear we readily dismiss as ‘wrong’ or ‘too much’. Instead of critiquing our reactions, we automatically dismiss the work or artist. We see everything through filters defined by the male-dominated canon that we have all grown up within, and that is not even minding the things we do not manage to see because it has been ‘mislaid’, ‘lost’ – or silenced.

Zambreno does an admirable job in recovering these voices, and when that’s not possible, uncovering the oppressive forces which succeeded in erasing them. You will finish this book enlightened on many of the significant women artists of the 20th century, and hopefully inspired to write something yourself – to write if only to counter those silencing forces that continue to press down upon women all over the world – on a blog, in a diary, online newspaper, wherever you fancy. Or, if writing isn’t your thing, you’ll have a long reading list to get through…

Another equally important take-home message of this book is the power of community, no matter how sparse or distant it may be. Zambreno wrote Heroines not just to teach us about these women, but to build for herself a community of writers like her (or not) who share her struggles. And in reading this book we are warmly invited into that community. We also learn of Zambreno’s blog (unfortunately now ‘invite only’ on Blogger), which she used during difficult times to forge connections and friendships which nourished her. She suggests that perhaps a key factor in these women’s downfall into institutionalisation was their lack of a supportive community, they were ‘isolated in their cages’. Now, with the internet, this thankfully no longer needs to be the case.

This book is a tour de force and I’ll be passing it around my friends for a long time to come.

Recovery in ‘Will and Testament’ by Vigdis Hjorth

‘I expected to become psychotic, but I didn’t, so somewhat surprised I got up, looked around, and then I left, what else could I do? It was a clear and sparkling August day, I hadn’t noticed that until now. The air was warm, I hadn’t noticed that before. I walked down Bogstadveien, what else could I do? I was surprisingly calm. It was late summer, the air was warm, the weather lovely, I hadn’t realised that until now, three weeks without analysis lay ahead of me, I turned into another street, what else could I do? I walked past a shop front and saw someone who looked like me in the window, but it couldn’t be me because she looked well. I stopped, retraced my steps and studied myself, a seemingly functioning woman. Could I see myself through her eyes? You’re clever, I said to her, and you don’t look too bad, I said to her. Shouldn’t you be out in the world doing things?’ (120)

This paragraph follows the moment when the narrator, a middle-aged theatre critic called Bergljot, realises that she has come to the end of the psychoanalysis which she is undergoing in the hope of recovering from childhood sexual abuse. The repetition of ‘what else could I do?’ marks an interesting phase of recovery – a kind of exhaustion with her pain. As humans we are designed to recover, to continue, to survive, despite hardship. Our self-preservation instincts kick in, and eventually (most of the time), we find the strength to simply continue, and find again a new kind of normality.

It seems that here, after undergoing an intensive 4x-week therapy, Bergljot was tired with reliving her pain (an aspect of psychoanalysis that has received criticism over the years), and because of this she ends up reaching the point at which she is able to move on. This is related to the idea that we must first accept our pain, confront it face-on, and only in doing so are we able to then move on from it. There are counter-arguments that suggest that in acknowledging our pain we give it too much attention, and run the risk of becoming trapped in it. But I find this situation equally plausible and worth noting, that there is only so much sadness a human can enduring, and in getting it out in the open we at least allow ourselves the opportunity of then exhausting it and ridding ourselves of at least its most debilitating aspects.

Once Bergljot accepts that she won’t be seeing her psychoanalyst that day, she finds a freedom that allows her to notice things she wasn’t able to before therapy. What strikes her is something as mundane as pleasant weather, a ‘clear and sparkling August day’. It seems that psychoanalysis worked precisely by returning to her pain so forcefully, and then once it stops, her mind was free enough to enjoy the world outside of her. It is as though the therapy absorbed all of her trauma, enveloped it so entirely, that once it ended, it took those feelings along with it. The assumption is that if, to the contrary, we avoid difficult feelings, they remain with us, subtly colouring everything we do. I thought that this was a really beautiful and poignant depiction of one aspect of recovery, the realisation that there is a whole world outside of us that does not have to do with our inner turmoil, and that our eyes have been opened to it. Trauma, in its invasive and all-enveloping character, can often overwhelm us, and make other parts of life hard to enjoy. Here, we see the narrator finally open up and start to appreciate life anew.

This book is predominantly about how to both live with and move on from traumatic and painful histories. It is most skilful in showing both how our past experiences inevitably shape us into the people that we are – and so, we are never truly ‘free’ from them – but that also, with time, eventually they become things that we can build on and recover from in creative and positive ways. Just because something forms us does not mean it has to trap us.

The book begins by describing the narrator before this healing process has taken place. At that earlier stage, her past is something that drags her down: ‘it was how I felt, how deep it went, how it pushed me into the abyss, how it weighed me down, how I started to sink’ (15). But through gradual unearthing and understanding, and when the narrator starts to insist that other people in her life join her in confronting these difficult memories, eventually, she is able to incorporate them into her life in productive ways. She describes a growing sense that the dark past must be seen and heard, it must be given space for insight and growth to occur: ‘What I was experiencing, I came to realise once I started to understand my life, was that a moment of insight was approaching like the tremors that precede an earthquake, and like an animal I could sense it before it happened’ (21). This ‘moment of insight’ will not be easy or pain-free, but it does bring with it a brightness and optimism.

Throughout the book the narrator speaks in terms of development, she fears ‘turning into a child again’ and often expresses the wish that she could feel and behave like an adult. Adulthood apparently represents clarity and understanding, while childhood is the dependent, naïve state where we are under the sway of others wishes and desires. This is a useful metaphor with which to think of this developmental growing process that occurs over time, and though it of course doesn’t map so neatly in real life, I think we can all appreciate the feeling that adulthood brings with it agency and independence, and it is this that she is seeking.

Another important contribution to the narrator’s recovery is that precisely with this ‘adult’ agency she starts to take her own wants and needs more seriously, and does not give in to the needs of others at the expense of her own. This is a valuable part of her recovery, her realisation that she must in some way stay true to herself in order to feel better:

‘Jung saw things the way his instinct encouraged him to. If he didn’t his snake would turn on him. I tried to look at things the way my instinct encouraged me to. If I didn’t, my snake would turn on me. My mum and sisters had acted in ways and said things which my snake disagreed with. I travel along the path my snake prescribes, I thought, because it’s good for me.’ (318).

Book Review: ‘On Becoming A Person’ by Carl Rogers

This book could be summarised into one paragraph, and while it has some good ideas, it is far too repetitive as a book.

Carl Roger’s came up with what he refers to as ‘client-centred therapy,’ which today sounds like something that goes without saying, but in its own time was a fairly radical and novel concept.

His argument is that each individual has innate, self-actualising tendencies towards growth and development. We all want to be the best version of ourselves that we can be, and, given the right environment and support, will strive towards becoming it. We all have a general sense of what is good for us to do, what we want to do, and how we should go about doing it, or becoming it.

This reminds me of a soft understanding of Nietzsche’s ‘will to power’ – that inner, individual will towards growth in things that feel meaningful for us. We all want to improve and ‘actualise’ ourselves as individuals with power and agency over our own lives and becomings.

Since postmodernism, however, the idea of ‘the self’ has received criticism, and it no longer feels so simple to suggest that we are all bounded individuals who know what we want. ‘The self’ is now a much murkier concept, which is made up of bits and pieces of others, our environment, the things that happen to us… So Rogers’s argument that we all just need to allow our ‘true selves’ to develop and grow seems a bit optimistic and simplistic. What exactly is that ‘true self’, and how would we go about finding it?

Anyway, Rogers says that people suffer psychological distress, and come to therapy, when they encounter problems with self-actualisation. Something has prevented them from either getting in touch with their inner self, or from realising its potential for various other reasons.

Therefore, he argues that it is the role of the therapist not to teach the individual how to live, but rather to create an environment in which the individual feels safe to know, listen to, and then act on their inner wants and needs. A fundamental catalyst for helping the individual to do this is an empathetic and non-judgemental relationship with the therapist.

The therapist must be honest and open about themselves and their own feelings (what Rogers calls ‘congruent’, or authentic), which in turn facilitates a trusting and non-judgemental relationship and allows the individual to themselves become open about their inner experiences. After openness comes acceptance, and with acceptance comes fewer defences and therefore more flexibility and responsiveness to the real world and others.

What I liked most about this idea is the emphasis it puts on the special relationship between therapist and client, as one which can be totally free from evaluation. In our other relationships with people in our lives, there is usually some kind of mutuality – we expect things from each other, there is a balance and reciprocity. Therefore, we hold each other to certain standards. Because the relationship between therapist in client is not one of friendship, there is also no real need to evaluate (according to our own standards) the other person’s motives or feelings. The therapist might completely disagree with everything the client says, but because they aren’t friends (or even potential friends), this doesn’t matter at all, and the therapist can, and should, accept entirely whatever it is that the client is saying. This is quite an unnatural relationship, and one that probably wouldn’t arise outside of the therapeutic environment, but it is one that I believe all of us would benefit from. To have someone who can listen to us, and accept us, completely without judgement.  This kind of space and freedom to air our ideas would do all of us a lot of good. It lets us see our ideas without any need to present or sell them to anyone, and thus lets us be truly honest with ourselves. Only when we can be totally honest can we then look at our thoughts objectively, and only then would we be in a strong position to critique them.

Too often when we speak of ourselves or our thoughts and feelings, we are trying to present them in a certain agreeable way, and we might end up persuading even ourselves that these are the best ways forward. When we don’t feel any pressure to ‘sell ourselves’ to even our loved ones or friends (or perhaps especially to those individuals important to us), we can see ourselves as we ‘truly’ (?) are.

Uhoh, I just fell into the ‘true selves’ trap. Which I myself find a little wobbly as a concept… So I’ll probably need to work out that thought in a blog post to come…

First Day as a Mental Health Support Worker

Yesterday I had my first shift as a Support Worker at a Recovery House; it was both exhausting and fascinating.

I arrived for 8am, which was when the night staff give us the hand-over on each individual staying at the house, how their night went, etc. so that we know how everyone is feeling in the morning. Then myself and a colleague went around each room at 9am to say hello to everyone, even if that’s just a sleepy grunt, and give some people their morning medication. The rest of the day was spent checking various inconsistencies (one lady had much less medication left than we would have expected given how much she is supposed to take), or issues (to do with housing, mis-remembered doctors appointments…). We also keep regularly checking-in on everyone, and take notes throughout of everything that happens so that we can then hand over that info to the night staff that will follow us when we leave at 9pm.

One of the most interesting parts of the day for me was shadowing a 1-on-1 chat between my colleague and a service user who had only recently come to the house, and listening to how we first get a sense of the individual joining us – what they are struggling with, what they hope to achieve, what particularly distresses them, and general background information…To be totally honest, the conversation was heartbreaking. What seemed to be the major problem for the service user, apart from her mental health difficulties (which were being relieved somewhat by medication, I think), was her lack of social networks. She said that she had no friend or family member who was there for her outside of the house. The only person ‘in her life’ was her Care Co-Ordinator. That must be so frightfully painfully lonely and horrible. I don’t think many of us can even imagine what it must be like to have literally no one that we could turn to if we were ever in a difficult situation (aunts, friends from school, neighbours…). And, in a cruel turn of fate, it is as if having that support network there is even enough to prevent us from actually needing them. I think that the very fact that we know that they are there, is enough to comfort us and stop us slipping into a spiral wherein we really need to rely on them.

In talking to this woman I suddenly realised how powerful those invisible support networks (and, of course, the less invisible ones that we get joy and love from on a regular basis) are to our mental health and stability. Her affect felt completely hopeless, and I really felt and shared her suffering as I listened to it.

Since the ‘social networks’ box that my colleague ticked seemed to be the major problem, (I must add that I really didn’t like the very obviously ‘structured’ interview style that we were doing, I understand that it is useful to quickly measure and compare over time, but it felt inhumane and insensitive when discussing such intimate difficulties.) – she tried to suggest ‘ways to improve’, such as to hang out in the lounge or kitchen more, and get to know other service users, or join one of the activities that the house runs like yoga or a film night.
These are all great ideas, but, to me it almost felt too soon to ask this lady to ‘get out a bit more’. I would have wanted to talk to her a bit more personally first, try to understand what kinds of things she as an individual could imagine enjoying doing, get a little bit more of a sense of herself first, so that she wouldn’t feel overwhelmed and incompetent while trying to socialise. I say this because she really struggled to even look either of us in the eye during the conversation. Though, actually, trying to socialise could probably only help, and maybe she would be pleasantly surprised by the ease with which everyone seems to get along in the house. So, both efforts could be used at once, I think. And of course my own presence probably didn’t help the conversation, as I was just awkwardly sitting there watching. A genuinely 1-on-1 conversation would have been easier for everyone involved.

So, those were my first day thoughts! I am very very much looking forward to getting comfortable with all the admin-stuff of the house, the millions of forms to fill, and which keys open which doors, etc., so that I can concentrate fully on providing the best possible service to the residents. Will keep you updated.