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| Martin Heidegger |
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| Thomas Szasz |
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| Aaron Esterson |
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| 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)
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.
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.
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 the ‘maddest’ writings of Hölderlin, Nietzsche, Trakl, Celan as ‘an “other” kind of thinking’, but he emphasised that the ‘medical interpretation’ that they were ‘ill’ was ‘correct’.
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 Boss he founded a form of psychotherapy, Daseinsanalysis, grounded in his own philosophy. In Boss’s home from 1959 to 1969 he 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 ‘schizophrenics’, ‘neurotics’, and others 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 their discipline, if it could be called a discipline. Laing and Esterson endorsed much of Boss’s work while deploring Boss’s ‘recklessness’ (Laing) and ‘lack of clarity’ (Esterson). The crucial difference was that Szasz, Laing and Esterson questioned the presumption of illness.
Szasz 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.
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 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’ makes no sense if there is no illness to approach. Holistic (or any other kind of) medicine should not degenerate into 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 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.
‘Readers’ (misreaders or non-readers) wrongly assume 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.
Among those who have misread in this way are Emmy van Deurzen and Raymond Kenward who 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 of the few existential therapists and Daseinsanalysts who even claim to have ‘read’ the book say Laing and Esterson were saying.
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 whose 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:
- Hilary Mantel. Introductions to the families in Laing and Esterson’s Sanity, Madness and the Family in Inner Circle Seminars conducted by Anthony Stadlen (2014-2019)
- ‘The simple words the people speak’: An introduction to Hilary Mantel’s introduction to her and Anthony Stadlen’s (2014) 50th-anniversary Inner Circle Seminar on ‘Maya Abbott and the Abbotts’ in Laing and Esterson’s Sanity, Madness and the Family (1964) (January 2015) ]
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 […]
[…] 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?
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.
Professor Miles Groth will join us for the afternoon. He is an existential therapist 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.
This will be an online seminar, using Zoom.
