Programme of Events 2023-24
Knowledge and Understanding Seminar
Location: By Zoom
Speaker: Richard Gipps (Oxford)
Title: 'On the Importance of Not Understanding the Patient'
Abstract: "One kind of everyday understanding that we seek has to do with making sense of what someone’s getting at or on about with her initially opaque words or actions. The retrieval of such meaning is a mainstay of everyday life and an ambition that psychology often brings with it to the clinical setting – even when the thought there under consideration is psychotic. It’s also presupposed by such efforts at understanding, causally, why the patient thinks as she does as invoke the notion of a mistake or illusion: we can’t understand why someone makes a particular mistake unless we already understand something of its content. (The understanding here is captured by suggestions like: ‘Were I in her cognitive/perceptual/somatosensory/existential/environmental predicament, I’d come to that conclusion too’).
In this paper I suggest that certain theories of thought disorder, passivity experience and delusion – theories which hope to understand the patient by retrieving his speaker’s meaning – radically fail. They do so because they trade on an alienated conception of ordinary mental life which is itself only sustained by illusions of sense; they attempt to reduce delusion to illusion; and they fail the patient by evading the fact of, rather than meeting him in the midst of, his brokenness.
Despite the impossibility of retrieving speaker’s meaning from truly psychotic discourse, this does not render unavailable other forms of understanding (symbolic/motivational, neurological, situational etc.) of the psychotic subject. Even so, if we’re to achieve, with the psychotic subject, that (moral) form of understanding which can be said to be shown someone, we must first learn to avoid the temptation of attributing speaker’s or agent’s meaning to his psychotic words and acts. To this end this paper outlines what I’ll call an ‘apophatic’ (as opposed to a ‘cataphatic’) psychopathology. This ‘apophatic’ approach aims at understanding the patient not through positively understanding her words’ meaning but instead through understanding just why some of the things we’re most tempted to say of her fail her."
In this paper I suggest that certain theories of thought disorder, passivity experience and delusion – theories which hope to understand the patient by retrieving his speaker’s meaning – radically fail. They do so because they trade on an alienated conception of ordinary mental life which is itself only sustained by illusions of sense; they attempt to reduce delusion to illusion; and they fail the patient by evading the fact of, rather than meeting him in the midst of, his brokenness.
Despite the impossibility of retrieving speaker’s meaning from truly psychotic discourse, this does not render unavailable other forms of understanding (symbolic/motivational, neurological, situational etc.) of the psychotic subject. Even so, if we’re to achieve, with the psychotic subject, that (moral) form of understanding which can be said to be shown someone, we must first learn to avoid the temptation of attributing speaker’s or agent’s meaning to his psychotic words and acts. To this end this paper outlines what I’ll call an ‘apophatic’ (as opposed to a ‘cataphatic’) psychopathology. This ‘apophatic’ approach aims at understanding the patient not through positively understanding her words’ meaning but instead through understanding just why some of the things we’re most tempted to say of her fail her."