Friday 1 January 2021

The Myth of ‘Mental Health’ and of ‘Psychopathology’ in Existential Analysis and Daseinsanalysis. The Dialectic: Heidegger/Szasz. Anthony Stadlen conducts Inner Circle Seminar 267 with assistance from Miles Groth (9 May 2021)



The Myth of ‘Mental Health’

and of ‘Psychopathology’
in Existential Analysis and Daseinsanalysis
 
The Dialectic: Heidegger/Szasz

Anthony Stadlen
conducts by Zoom
Inner Circle Seminar No. 267
with assistance from Miles Groth
Sunday 9 May 2021
10 a.m. to 5 p.m.

Martin Heidegger

Thomas Szasz

Aaron Esterson

Medard Boss

  

Heidegger was interested in psychiatry, especially with schizophrenics, with whom he sought contact and conversations when this was possible for him. On walks he regularly remained standing lost in thought for a while before the villa of the Freiburg psychiatrist Ruffin [...]. Once he said forthrightly that he was not convinced of the correctness of the solely medical interpretation of schizophrenia as illness. Could it not even simply be a question of an ‘other’ kind of thinking?

Wiesenhütter, E. Die Begegnung zwischen Philosophie und Tiefenpsychologie.

(1979: 158, translation by A. Stadlen)

What did Martin Heidegger mean? What Eckart Wiesenhütter says he said (above), three years after Heidegger’s death, is ambiguous. The words ‘solely’ (‘allein’) and ‘simply’ (‘einfach’) in the last two sentences suggest two possible ways of understanding ‘schizophrenia’, the second more radical than the first.

The first sentence says Heidegger doubted the ‘solely medical interpretation of schizophrenia as illness’, implying ‘schizophrenia’ might be both an ‘illness’ and ‘an “other” kind of thinking’.
But the second sentence says he wondered if it was ‘simply a question of an “other” kind of thinking’, implying not an ‘illness’ at all.

Even if Heidegger did have the temerity to suggest the second, more radical, possibility on that one occasion, he was usually careful to explain that what he endorsed was the first possibility. He did revere as ‘an “other” kind of thinking’ what were generally regarded as the ‘maddest’ writings of Hölderlin, Nietzsche, Trakl, Celan; but he tended to emphasise that the ‘medical interpretation’ that they were ‘ill’ was ‘correct’. For example, he called Paul Celan ‘sick’. He did, however, insist that the ‘madman’ in Georg Trakl’s poetry was not ‘mentally ill’. 

Of course, when Heidegger used the word ‘correct’, he usually meant wrong, in the light of his more profound understanding. But he still meant ‘correct’! How, though, did he know that the medical diagnosis was correct? He was not a doctor. But he deferred as a layman to the medical ‘expertise’ of such psychiatrists as Ludwig Binswanger and, especially, his friend Medard Boss.

With Heidegger’s help, Boss founded a form of psychotherapy, Daseinsanalysis, grounded in Heidegger’s philosophy. In Boss’s home from 1959 to 1969 Heidegger conducted the Zollikon seminars for psychiatrists and doctors. Both men opposed reductive natural-scientism. They insisted on a ‘holistic’ approach to illness. But they assumed, in relation to those who sought daseinsanalytic therapy, that it was ‘illness’ that they were ‘holistically’ approaching.

In the 1960s, the decade of the Zollikon seminars, the psychiatrists Thomas Szasz in the United States and R. D. Laing and Aaron Esterson in the United Kingdom were also seriously questioning the foundations of psychiatry. Laing and Esterson endorsed much of Boss’s work while deploring Boss’s ‘recklessness’ (Laing) and ‘lack of clarity’ (Esterson). Szasz criticised Boss’s claim to be available 24 hours a day to a patient as a ‘sham’. The crucial difference was that Szasz, Laing and Esterson questioned the presumption of illness.

Szasz, in The Myth of Mental Illness (1961), The Manufacture of Madness (1970), and many other books and papers, compared the presumption of illness to the presumption of guilt in inquisitorial legal systems. He held, on both scientific and ethical grounds, that people should be presumed healthy until proven ill, just as they are presumed innocent until proven guilty in accusatorial legal systems. He argued that both the presumption of illness and the presumption of guilt invalidate people.

However, the presumption of illness differs from the presumption of guilt in a fundamental way. The presumption of guilt at least attributes agency and responsibility; indeed, it insists on it. But the presumption of illness, and especially ‘mental illness’, attributes lack of agency and responsibility: it literally invalidates by treating the person as an invalid.

A further twist, however, to the attribution of ‘mental illness’, often made nowadays with the insistence that it should be regarded as ‘an illness like any other’, and that it should be given ‘parity of esteem’ with physical illness, is precisely that this alleged ‘illness’ is not treated as an ‘illness like any other’. ‘Mental illness’, unlike physical illness, is taken as a legal justification both for compulsory psychiatry - coercing the innocent - and for the insanity defence - excusing the guilty.

Szasz was as committed as Heidegger and Boss were to holistic medicine. He was no dualist. His first papers and first book Pain and Pleasure were on psychosomatic medicine, and he stood by them at the end of his life more than half a century later, seeing this as an important field wide open for research. But he pointed out that illness (disease) still has first to be established by a natural-scientific criterion such as Virchow’s, of cellular pathology or pathophysiology. A ‘holistic approach to illness’, he insisted, makes no sense if there is no illness to approach. Holistic (or any other kind of) medicine should not betray the ancient principle ‘First do no harm’ by making the presumption of illness.

Laing and Esterson, in Sanity, Madness and the Family (1964), and Esterson, in The Leaves of Spring (1970), demonstrated in concrete detail how, in each of eleven families in which a daughter had been medically diagnosed as ‘schizophrenic’, the presumption by the other family members that this young woman was ‘ill’ served to mystify her and invalidate her experience. Some of the diagnosed women fluctuated between accepting and challenging the family’s and the psychiatrists’ (not, of course, Laing’s or Esterson’s) definition of them as ‘ill’. Others simply accepted, in a defeated and demoralised way, that they were ‘ill’.

Laing and Esterson emphasised in the preface to the second edition of their book that readers had ignored their question, namely (1970 [1964]: viii):

Are the experience and behaviour that psychiatrists take as [boldface added] signs and symptoms of schizophrenia more socially intelligible than has come to be supposed?

They were questioning the existence of ‘schizophrenia’. But for more than half a century they have been misread as if they had left out the seven words here in boldface.

This is not an obscure detail. It is the heart of their argument. But it is so simple that almost all readers manage not to see it.

Indeed, most ‘readers’ acknowledge that they skip the Prefaces and Introduction and do not even see Laing and Esterson’s question, let alone see the point of the words here printed in boldface. Even within the chapters proper, with their readable transcriptions of family conversations and interactions, ‘readers’ ‘read’ the first section of each chapter, ‘Clinical Perspective’, as if this were the authors’ perspective. But the whole point of the book is to contrast the ‘Clinical Perspective’ section with ‘The Family Situation’ section in each of the eleven chapters. ‘The Family Situation’ exemplifies the authors’ own social-phenomenological perspective.

Laing and Esterson explain, at the end of their Introduction:
We believe that the shift of point of view that these descriptions both embody and demand has a historical significance no less radical than the shift from a demonological to a clinical viewpoint three hundred years ago.
In other words, their shift is to a point of view that is neither demonological nor clinical, but social-phenomenological. Laing and Esterson are not just questioning the existence of a particular supposed grave ‘illness’, ‘schizophrenia’: they are questioning whether these women are ‘ill’ at all.
In ten of the eleven cases (the exception is the Blairs) the question of whether the diagnosed woman is ‘ill’ at all is explicitly discussed and disputed, sometimes by the women themselves, e.g. Sarah Danzig, Ruth Gold, Mary Irwin; whereas others, notably Agnes Lawson, seem to have despairingly and without question accepted the attribution that they are ‘ill’.
So Laing and Esterson are suggesting something far more radical than most people who talk or write about them have realised. Most people assume that they are suggesting that family interactions play some part in the supposed ‘aetiology’ (the supposed cause) of the supposed dread disease ‘schizophrenia’. But Laing and Esterson say in the Preface to the second edition:
No one can deny us the right to disbelieve in the fact of schizophrenia.
That does not mean they are suggesting the women have been ‘misdiagnosed’ and are actually suffering from some other ‘illness’. To repeat: what they are disbelieving is that the women are ‘ill’ at all.
And again, to repeat: Almost all ‘readers’ assume, as certainly do non-readers, that Laing and Esterson claimed families ‘cause’ (contribute to the ‘aetiology’ of) a (hypothetical) ‘mental illness’, ‘schizophrenia’. That is to say, ‘readers’ mistakenly assume it was this presumed ‘illness’, not the presumption of such an ‘illness’, that these authors claimed was socially intelligible.

For example, Emmy van Deurzen and Raymond Kenward assert in their influential Dictionary of Existential Psychotherapy and Counselling (2005: 118): 

Laing […] believed schizophrenia was the result of the alienating power of the schizophrenogenic family.

This is what almost all the few existential therapists and Daseinsanalysts who claim to have looked at the book say Laing and Esterson were saying. They are supported in this belief by van Deurzen and Kenward’s statement (2005: 118):

[...] Laing’s overall conceptualisation of his patients was deterministic.

This has been disproved in detail by Anthony Stadlen in ‘Laing in a Lexicon’ (Existential Analysis, 18.2; 2007: 341-5). [See:

In two series of Inner Circle Seminars on the eleven families, for the 40th and 50th anniversaries of the book, we have seen how difficult it is for existential therapists, perhaps because their careers depend on it, to examine their belief in ‘mental health’, ‘mental illness’, and ‘schizophrenia’. Daseinsanalysts have expressed similar puzzlement. But for the ‘laywoman’ Dame Hilary Mantel, the great writer who introduced our second series of seminars, the phenomenological point was obvious. [See: 

Of course, as Szasz pointed out, it is possible that some persons now diagnosed as ‘schizophrenic’ are indeed ill: they may have an undiscovered brain abnormality. If such an abnormality were discovered then it would constitute a bona fide disease with mental symptoms: the province of neurologists.

But often, as Esterson says in Families, Breakdown and Psychiatry (1976: 296),

Such was the hypnotic effect of the prior assumption of illness, that one had constantly to remind oneself that there was no evidence to substantiate this assumption.

And (302):
[…] study the designated schizophrenic directly in his relevant social context in a phenomenologically and dialectically valid manner, and to a significant extent the apparent signs and symptoms of the presumed illness disappear like morning mist before the sun […]

Boss says (Grundriss der Medizin, 1971: 506, translation by A. Stadlen):
[…] with no single patient can one speak of his being schizophrenic per se. Rather, one must always ask: schizophrenic under the excessive demands of what pattern of human relationships?
This is very close to what Esterson says. But Boss’s language is still characteristically ambiguous. It still begs the question of what ‘schizophrenic’ means. Is there, or is there not, an ‘illness’, ‘schizophrenia’? Boss, one might say, from the point of view of Szasz and Esterson, is nearly there. But Boss has defined Daseinsanalysis, in the title of his book and elsewhere, as part of medicine. He and Heidegger constantly refer to ‘patients’ as ‘ill’. [See:
‘Medical Daseinsanalysis’ (January 2005)
The Madhouse of Being (January 2007)
by A. Stadlen.]
Boss thought Daseinsanalysts should be medical doctors. But Freud had argued in the 1920s that ‘doctors form a preponderating contingent of quacks in psychoanalysis’, which he insisted was not part of medicine but ‘weltliche Seelsorge’ (‘secular [worldly] soul-care’). Boss, starting with a modest claim that, as a student, he had visited Freud for some sessions in 1925, eventually claimed to have had psychoanalysis with him six times a week for six months, though Boss’s deputy and successor Gion Condrau, collaborating with Stadlen on the historiography of Daseinsanalysis, proved from the records of Boss’s Swiss military service that he cannot have been in Vienna for at least half that time. If he did visit Freud, as seems probable, though not on the scale he eventually claimed, his account is significant; he reported, memorably, his astonishment that Freud did not practise according to the alienated natural-scientistic theories of his ‘metapsychology’, but in a deeply human way. However, Boss may not quite have grasped that Freud did not regard their analytic or therapeutic meetings as medical. Heidegger appears to have accepted Boss’s apparent assumption that psychotherapy was a medical treatment without question.
Condrau, who was also a Christian-Democratic People’s Party member of the Swiss National Parliament, succeeded in getting psychotherapy by non-medical psychologists legalised. But this did not in itself constitute psychotherapy as an autonymous profession, rather than a medical or quasi-medical practice, subsidiary or ‘ancillary’ to medicine. In the United Kingdom, non-medical psychoanalysts and psychotherapists had always been legally accepted, and trained by the Freudian and Jungian societies, but until the 1970s they relied on ‘medical cover’ by doctors, who were responsible for the ‘treatment’ by the ‘lay’ analyst or therapist, who also sheltered behind the ‘covering’ doctor’s medical insurance.
Stadlen challenged this in 1973 (on behalf of the embryonic Guild of Psychotherapists, which was then followed by other psychotherapy organisations). This may be the moment psychotherapists, medical and non-medical, in the United Kingdom began to assert themselves as an autonymous profession, with, among other things, independent insurance.
However, almost all psychotherapists today, half a century on, remain devotees of ‘mental health’. They describe themselves as ‘mental health professionals’. They do not explicitly reject, or even intelligently address, involuntary psychiatry and the insanity defence: what Szasz called the ‘Siamese twins’ of the ‘mental health movement’, a movement whose structure he showed, in The Manufacture of Madness, to be formally isomorphic to that of the Inquisition.
It is true that Heidegger and Boss rejected the reification of ‘mind’ and ‘consciousness’. But they accepted involuntary psychiatry. Heidegger had recourse to it in the case of a family member. Boss practised it as a psychiatrist. For Heidegger, this was just one more way in which he affirmed that the ‘medical view was ‘correct’. For Boss, who had before the second world war been the director of a psychiatric ‘sanatorium’, Schloss Knonau, those colleagues or trainees who questioned his ‘hospitalisations’ of ‘psychotics’ were in his view ignorant and incompetent, and ought to stick to treating ‘neurotics’.
Was Heidegger in effect pleading the insanity defence by means of his ‘nervous breakdown’ when, after the second world war, he was interrogated by the denazification authorities about his political activity in the 1930s?His ‘breakdown’ appears to have been more a matter of difficulties with wife and mistress. 
The difference between the view of Szasz and Esterson and that of Heidegger and Boss may be seen by comparing Heidegger’s musings about ‘schizophrenics’, when he stopped outside Professor Hanns Ruffin’s villa on his walks around Freiburg, with the reflections, decades earlier, of the young boy Tamás Szász, on his walks with his governess around Budapest. The boy was shown large buildings: hospitals, prisons, and ... ‘mental hospitals’. He understood the first two. But the third, he protested, when he learned their nature and function, were wrongly named: they too should be called not hospitals but prisons. He saw ‘mental illness’ as the rationalisation invented to justify the incarceration of innocent people in these prisons disguised as hospitals. He never changed his position on this. As he explained, he never had to give up a belief in ‘mental illness’ because he had never had such a belief.
It is this conjunction and disjunction, this confrontation and dialectic, of Heidegger and Boss with Szasz and Esterson, that we shall explore today. 
Laing is a special case, as he equivocated about ‘mental illness’, after at first appearing in Sanity, Madness and the Family to concur with Szasz; and in at least one later interview he affirmed his belief in ‘mental illness’, in explicit disagreement with Szasz. But Esterson and Szasz remained largely in accord on this, though Esterson was critical of what he regarded as certain over-simplifications by Szasz, especially in relation to psychosis, of which Szasz had little experience, having deliberately avoided situations where ‘patients’ would see him involuntarily.
In our Covid-oriented time, when everyone is talking about so-called ‘mental health’, this seminar offers an urgently needed perspective, one which might actually help people come to terms with this unprecedented existential, emotional, psychological, interpersonal, spiritual, religious challenge better than the confused perspective of ‘mental health’. This does not mean that people offering ‘talking therapy’ within the ‘mental health’ system are doing no good; some may do much good; but this seminar asks: might they not do better, and perhaps even much better, if their thinking and practice were not muddled and muddied by the mystifying discourse of ‘mental health’? Does not this pseudo-medical approach besmirch even the most sophisticated daseinsanalytic or existential therapy? The seminar will be an opportunity to examine the evidence without which answers to these questions can only be dogmatic or speculative.
This is an apparently difficult field, though, or rather because, the basic ideas are simple; perhaps too simple for most people to understand,  It is not clear how many seminars will be required. For this reason we shall devote not just a single seminar but a whole subseries to it. There can be no definitive final seminar in the subseries. In any event, your contribution to the discussion will be warmly welcomed.

Professor Miles Groth will participate in the afternoon of this first seminar in this subseries. He is a Daseinsanalyst who has practised since 1975; Professor Emeritus in Psychology at Wagner College, Staten Island, New York City; translator of Heidegger; author of books and papers on Heidegger and Boss, including Medard Boss and the Promise of Therapy (2020); collaborator with Todd DuBose in The Soul of Existential Therapy (2020) and a Society for Existential Analysis symposium in November 2020.


Professor Keith Hoeller and Dr Albert Pacheco will join Anthony Stadlen in conducting another seminar in this subseries (date to be announced).

Professor Keith Hoeller, translator of Heidegger’s Elucidations of Hölderlin’s Poetry (2001), will again join us from Seattle, where he was Professor of Philosophy for many years. He has edited the Review of Existential Psychology and Psychotherapy from 1978, as well as books of key papers on Binswanger, Merleau-Ponty, Heidegger, Boss, Sartre, Szasz, Foucault, May. He is one of the very few authorities on both Heidegger and Szasz. He edited Thomas Szasz: Moral Philosopher of Psychiatry (1997). He contributed a chapter on Szasz to Existential Therapy (ed. Barnett, L. and Madison, G., 2012). He received the Thomas S. Szasz Award for Outstanding Services to the Cause of Civil Liberties (professional category) from the Center for Independent Thought, New York City.

Professor Hoeller co-conducted (by Zoom from Seattle, heroically through the night) Inner Circle Seminars No. 258 (The Myth of ‘Thomas Szasz’) on 14 June 2020 and No. 259 (Heidegger and Levinas on the ‘Holy’) on 2 August 2020.

Dr Albert Pacheco is Director of Behavioral Health Services for South Central Family Health Services in Los Angeles, CA. He has over 20 years of clinical experience. His doctoral dissertation, based on the work of Medard Boss, was reviewed and approved by Boss himself, and he has discussed with both Boss and Szasz their positions on ‘mental illness’. He has published articles on Boss and existential psychology and is an editorial board member of the Review of Existential Psychology and Psychiatry, which published (!) his important paper The Myth of Existential Psychiatry. He is completing a book,  An Introduction to the Existential Psychology of Medard Boss.

These will be online seminars, using Zoom.

Cost: Psychotherapy trainees £132, others £165, some bursaries; payable in advance by bank transfer or PayPal; no refunds or transfers unless seminar cancelled
Apply to: Anthony Stadlen, ‘Oakleigh’, 2A Alexandra Avenue, London N22 7XE
Tel: +44 (0) 7809 433250    E-mail: stadlenanthony@gmail.com
For further information on seminars, visit: http://anthonystadlen.blogspot.com/

The Inner Circle Seminars were founded by Anthony Stadlen in 1996 as an ethical, existential, phenomenological search for truth in psychotherapy. They have been kindly described by Thomas Szasz as ‘Institute for Advanced Studies in the Moral Foundations of Human Decency and Helpfulness’. But they are independent of all institutes, schools and universities.
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