Mixed Bag #5: Alastair Morgan on Continental Philosophy of Psychiatry
“Mixed Bag” is a series on Psychiatry at the Margins where I ask an expert to select 5 items to explore a particular topic: a book, a concept, a person, an article, and a surprise item (at the expert’s discretion). For each item they have to explain why they selected it and what it signifies. — Awais Aftab
Alastair Morgan, PhD is Senior Lecturer at the University of Manchester, UK. His research interests are in Critical Theory (particularly the first generation of the Frankfurt School and the philosophy of T.W. Adorno), philosophy of psychiatry and the critical medical humanities. Alastair's most recent book is Continental Philosophy of Psychiatry: The Lure of Madness, published 2022 with Palgrave MacMillan. It explores how the continental philosophical tradition in the 20th century attempted to understand madness as madness. It provides a comprehensive overview of the contributions of phenomenology, critical theory, psychoanalysis, post-structuralism and anti-psychiatry to continental philosophy and psychiatry. You can find Alastair Morgan on twitter: @morgan_alastair.
Book – Being and Time by Martin Heidegger
Morgan: I first read Being and Time after finishing my undergraduate degree in philosophy. Mine was an ignorant and solitary reading. I was not studying philosophy at the time, and I had little knowledge of Heidegger beyond references to his work in French existentialism that I had read in my late teens. I certainly had no knowledge of Heidegger’s Nazi affiliations in the early 1930s and this was the pre-internet days (for me, at least) when it was still possible to open a book unencumbered by google searches. Opening the book was like embarking on an adventure, a great journey that opened new vistas. It was mostly a philosophy of concrete existence that excited me; a book that discussed moods, anxiety, the struggle for authenticity and how it is possible to both gain and lose a world. It has remained an important text for me, one that I have read many times. My old copy has a certain aura, replete with post-it notes so brittle that they almost come apart when you open the book.
The great Marxist theorist Herbert Marcuse was around the same age as me when he first read Being and Time after its publication in 1927. Marcuse was excited by a book that promised a return to philosophizing from concrete existence and saw in Heidegger’s philosophy a means for forging links between phenomenology and Marxism, a Marxism purged of its arid scientism and returned to the concrete dilemmas of human existence. Marcuse wrote that he had no inkling of Heidegger’s politics prior to 1933 and it is still poignant reading Marcuse’s reflections from exile on how he could have been so betrayed by his old mentor.
However much we may want to turn away from it, Being and Time is right at the center of the tradition of continental philosophy of psychiatry. It was through an anthropological reading of Heidegger (Binswanger’s “productive misunderstanding”) that phenomenological psychiatry attempted to understand the world of madness; what it meant to be immersed in the world of experience and lose such a world in madness. Heidegger gives us a very profound understanding of both that immersion and its breakdown. However, the phenomenological tradition abstracted its concept of experience from the historical reality of lives lived under the conditions of capitalism. Marcuse realized this but still wanted reluctantly to do justice to his experience with Heidegger, but such justice involves both a reckoning as well as a fidelity to a text.
Such a reckoning is now partially coming to fruition through the development of a critical phenomenological psychopathology, one that questions the inherent transcendental abstractions of the tradition. For example, the philosopher and psychiatrist Rosa Ritunnano has recently written of the importance of a critical turn in phenomenological psychiatry. Such a critical turn will inevitably involve a return to Being and Time, but hopefully it will also return to those fragile texts of Heideggerean Marxism that Marcuse constructed under the spell of Heidegger’s philosophy in the dying days of the Weimar Republic, an abortive and poignant missed encounter between critical theory and phenomenology that was trampled by the forces of catastrophe.
Concept – “Negative Dialectics”
Morgan: Negative dialectics is an idea that has been centrally important for my philosophical work and that inspires my book on continental philosophy of psychiatry. Theodor W. Adorno first fully develops this idea in his book of the same name published in 1966. A positive dialectics of reason and madness begins with an encounter of strangeness, one of puzzlement and an inability to understand. However, a deeper interpretation of the difference between reason and madness reveals an identity; that within madness there lies purpose, survival and adaptation. The ostensible difference is sublated in an identity. Negative dialectics adds a further move. However much one can assert and develop an identity of reason and madness beneath their ostensible difference, there remains a final non-identity, something recalcitrant to the demands of reason. For Adorno, philosophy begins in an attention to this non-identity, this difference.
My book argues that the continental tradition of philosophy of psychiatry begins there too. It starts with Karl Jaspers’ account of the ununderstandability of madness. Jaspers and the tradition that follows him dwells within this ununderstandability to try and articulate a range of themes that constitute the continental tradition. This is not an abandonment of madness but an attention to differences, an attention both to the suffering of madness and how within some of its experiences there may lie a possibility of resistance to dominant forms of reason.
One of the important consequences of a negative dialectics is a changed concept of reconciliation. Reconciliation does not lie in an identity of differences but with a final sense of being at home with that which is alien. Negative dialectics attempts an anti-systematic philosophy, one that will always turn against itself, insist on an attention to the singular, on a priority of that which escapes a complete interpretation. In such an insistence on micrological philosophy, as Adorno terms it, there is a humility towards grand claims and a resistance of master narratives. There is also a belief that those instances that don’t conform to systematic reason offer a space for an idea of care that lies in attention to difference.
Reconciliation does not lie in an identity of differences but with a final sense of being at home with that which is alien. Negative dialectics attempts an anti-systematic philosophy, one that will always turn against itself, insist on an attention to the singular, on a priority of that which escapes a complete interpretation.
Person – Frantz Fanon
Morgan: For me, the exemplary figure in the encounter between continental philosophy and psychiatry is the Martinican philosopher Frantz Fanon. Fanon begins with an understanding that all psychiatric work is an attempt at disalienation, an effort to return the person to a place in society.
Schooled in the French approach of institutional psychotherapy at the famous institution of St. Alban, Fanon attempted to bring social approaches into the institution. This was a precursor of the later attempts to negate the institution by the Italian psychiatrist Franco Basaglia who was a great admirer of Fanon. Fanon realized that alienation does not just affect those designated as mad and isolated from society but is also something inscribed on his body when he encounters the white gaze. For Fanon, it was an attempt at disalienation that led him into psychiatry as a profession. He realized that such disalienation also required a radical questioning of wider pathologies in society and particularly a radical questioning of the colonial situation and racism.
Fanon returns to a central phenomenological question but with a critical lens. What does it mean for a person to feel at home in the world when they are subjected to a racialized gaze and colonial violence? His answer to this question develops through a body of work and practice that is remarkable in one who died so young. What is particularly fascinating about Fanon’s work is the way that his practice as a psychiatrist, a practice that was continuous throughout his life, informed the development of his philosophical concepts. Fanon the psychiatrist and the philosopher were not separate identities, but his philosophical and political work informed his psychiatric practice, just as his psychiatric encounters and experiences fed into his philosophical texts. Fanon’s theoretical work cannot be considered separately from his professional practice as a psychiatrist. In this sense, Fanon is the most complete example of the philosopher-psychiatrist in the continental tradition.
Fanon’s theoretical work cannot be considered separately from his professional practice as a psychiatrist. In this sense, Fanon is the most complete example of the philosopher-psychiatrist in the continental tradition.
Article – Minkowski’s 1922 case study
Morgan: The paper I have chosen is a seminal case study by Eugène Minkowski, one of the most important phenomenological psychiatrists. The case study as form is central to both psychoanalysis and phenomenology. It represents an attempt to come close to the particularity of experience through narrative, interpretation, explanation and often exasperation. However aesthetically convincing these case studies are, we are always left with an evanescent image of the person at the center of them, always finally escaping any conceptual grasp of their experience.
Minkowski’s case study is entitled “A psychological study and phenomenological analysis of a case of schizophrenic melancholy”. It is the case study pushed to its limits, as Minkowski spent two months with his patient as his personal physician, both night and day. The case study is a good example of the structural approach in phenomenological psychopathology, but it also demonstrates a sensitive descriptive approach. The unnamed male patient describes a complex delusional belief system that consists of a “politique des restes” (a residue politics) that has been instituted purely for him; every leftover item is being stored for a final day when he will be forced to ingest them. Minkowski describes the spatial and temporal disturbances that underlie the delusional system. There is a distortion of space where each object is viewed purely for what it leaves behind, and these residues are then enumerated to an infinitesimal degree. Every object is inspected for its waste material (the eggshell, the spent match, the cigarette butt) and then noted in an inventory of future pain when they would have to be ingested by the patient. Time was lived as a series of instants awaiting this future catastrophe. Minkowski speaks to his patient on the first night who states that his torture and execution will come that very night. When nothing happens, Minkowski expects some doubt to creep into the delusional system, but each day is lived in the shadow of the catastrophic event, and each awakening does not diminish the imminent dread. Time has lost an element of futurity.
The paper was presented at the 1922 congress of psychiatry in Zürich alongside Binswanger’s paper on phenomenology and psychiatry, and in many ways institutes the tradition of phenomenological psychopathology. In her fine recent book on the young Foucault, Elisabetta Basso recounts Minkowski’s recollections of the conference, where he viewed the bewildered faces of his colleagues who he imagines lamenting him: “. . . stumbling around in the metaphysical darkness, so far from the bright, healthy clinic”. This is perhaps an apt image for continental philosophy of psychiatry; far from the bright, healthy clinic indeed!
Surprise Item – “Airless Spaces”
Morgan: Airless Spaces is a book by the feminist philosopher Shulamith Firestone, first published in 1998. It is a short book, published in a small format, easy to slip into a pocket, almost apologetic in its size. Despite its size and length, it defies an easy reading, as some commentators have pointed out. This is partly because it is relentless in its account of a life lived in the “revolving door” of hospital stay, discharge and readmission. It documents the “slow violence” that Lauren Berlant wrote about, one where permanent institutionalization has ended but the hospital reaches into every corner of the lived life.
It is a book of testimony, but one that refuses any easy narrative, and shuns any notion of a “journey of recovery.” It consists of a series of short texts, often narrated in the third person, with occasional thinly veiled references to real people. Most of the time it is not clear whether Firestone is referring to herself or others and the texts refuse any solidarity of suffering or easy redemption.
It is a true phenomenology of concrete experiences, a life marked by the violence of psychiatric care; the forced shower; the plastic cutlery; the hospital haircut. However, it has its moments of resistance and humor throughout. Halfway through being forced into the shower, the character Corinne turns to one of the nursing staff and jabs a finger at her saying, “you are fired.” An attempted reversal of power, a recovery of dignity in the middle of its abject loss, but what follows is inevitable – “the smallest infraction brought out the whole battery”.
In 1970, Firestone had written one of the most important texts of second wave feminism, The Dialectic of Sex. Some years after this she became mentally unwell and was in an out of hospital for prolonged periods of time. Airless Spaces was the product of a moment of stabilization assisted by committed healthcare workers and supported by feminists who had been influenced by her earlier work. For a while she came up for air and produced a remarkable but relentless book, a document of experience at the edge of experience.
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