What Can Philosophy Learn From Madness?

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CONVERSATIONS IN CRITICAL PSYCHIATRY

Conversations in Critical Psychiatry is an interview series that explores critical and philosophical perspectives in psychiatry and engages with prominent commentators within and outside the profession who have made meaningful criticisms of the status quo.

Wouter Kusters, PhD, is a Dutch linguist and philosopher. He is the author of Pure Waanzin (Pure Madness; Nieuwezijds; 2004) and Filosofie van de Waanzin (A Philosophy of Madness; Lemniscaat; 2014). An English translation of Filosofie van de Waanzin was published in 2020 by MIT Press with the title A Philosophy of Madness: The Experience of Psychotic Thinking (translated by Nancy Forest-Flier). Kusters works as an independent researcher, writer, teacher, and consultant in Gouda, Netherlands. For details, readers can explore his website at: https://kusterstekst.nl/.

Pure Madness was based on Kusters’ own experience of a psychotic episode in 1987. It won a pair of important prizes in the Netherlands: the Van Helsdingen Award (2004) for the best work on the intersection of philosophy and psychiatry, and the Socrates Award (2005) for the best and most inspiring Dutch philosophy book of the year. After the publication of this book, Kusters made a professional switch, turning from academic linguistics to a career as an independent writer and researcher. He started studying again as an undergraduate philosophy student, during which time he published his second book on psychosis, Alone: Messages from the Isolation Cell (Lemniscaat; 2007). Shortly afterward, in the summer of 2007, he experienced his second episode of psychosis, which led to a psychiatric hospitalization, and this provided further impetus for him to continue his work on philosophy and madness. He finished his master’s thesis in philosophy in 2010, which formed the basis of an updated version of Pure Waanzin (Pure Madness; Lemniscaat; 2013) as well as of Filosofie van de Waanzin (A Philosophy of Madness; Lemniscaat; 2014. His books were a success in the Netherlands and met with widespread acclaim. The publication of the English translation of Filosofie van de Waanzin (A Philosophy of Madness: The Experience of Psychotic Thinking; MIT Press; 2020) has brought his work to the attention of the English-speaking world, and it has prompted a renewed debate on philosophical and phenomenological perspectives on psychosis as well as the relationship between philosophy and psychosis.

Aftab: I think it would be prudent for us to begin with at least a few words regarding the nature of inquiry you are undertaking in A Philosophy of Madness, and how that relates to your own experiences of psychosis.

Kusters: My book is a philosophical treatise in the tradition of Montaigne’s Essays; in the vein of Nietzsche’s and Kierkegaard’s approaches to thought, writing, and life; and with affinities to the early works of the French existentialists, Sartre and Camus. What brings these works together is the focus on philosophical problems of good and evil, life and death, I and the other, without getting lost in academic reasoning for the sake of reasoning itself. It does not present a psychopathological theory, but it does focus on madness as a lived experience, as a concept in philosophy, and as a phenomenon called psychosis in psychiatric practice and theory. By stressing the experiential character of psychosis, which I have access to via my own memory, as well as via all kinds of reports and first-person narratives, the direction of my exploration is toward comparable experiences and their expressions. This brings us to all kinds of philosophical thoughts, bordering on reflections around religion, mysticism, and spirituality, but also to important themes of language, fiction, and nonfiction. For any psychiatrist educated a little beyond the mainstream medical illness, cure, and therapy narratives, it must be clear that my exercise brought me into the small but highly professional and well-informed tradition of phenomenological psychiatry.

Aftab: You have argued that a philosophical investigation of psychosis provides a better and less prejudicial approach than many mainstream psychological and psychiatric accounts. What sort of prejudices do you have in mind?

Kusters: The main prejudice concerns the usual way of approaching psychosis as a negative or a lack and leaving it there. That is, seeing it purely as a deficit, a disorder, a nonfunctioning of some aspect of the mind/brain/body that is supposed to be well-functioning in the individual who is not psychotic. Take for example the idea, found in various kinds of mainstream accounts, that psychosis is some kind of thought disorder. Such a judgement implies that there is good, proper thought, and that psychotic thought can be sufficiently defined as a disturbance, a disordering of this normal, natural way of thinking. It may be said that the disorder is one of jumping too fast to conclusions, or a dysregulation of perceiving salience properly, or an inability to synthesize information coherently, or it is just being plainly illogical. All such approaches share the assumption (the prejudice) that psychosis can be sufficiently defined by what it is not.

The implication of such accounts is that the psychosis is just a disruption that should be suppressed and taken away in order to let the normal flow of experience run again uninterruptedly. It is assumed that there is a healthy, sane part, and an insane, psychotic part, both manifesting themselves in various contexts and intensities. Therapy then consists in identifying and annulling the psychotic part (eg, by medication, by cognitive behavioral therapy, or by so-called psychoeducation, and stimulating the healthy part). The patient then eventually learns to associate him- or herself with the healthy part, dissociate from the disordered part, and to consider the psychosis as the illness, not belonging to who he or she really is, but as something that was intruding from the outside. They learn to say: “the psychosis disturbed the real me.” Instead of: “the psychosis showed a different aspect of me.” It thereby dissociates them from their own experiences, memories, and past.

The assumption in much theory, and the accompanying practices, is that the life-world of the individual is affected by a natural disorder, which eventually impairs the individual in their freedom, in their meaningful interaction with others, and in their sense of being a conscious individual. What most of these accounts simply miss is that the psychotic experience itself is meaningful. Psychotic individuals often experience more freedom, instead of less, and they feel their consciousness is not troubled, but they report all kinds of experiences that are phrased with positive light metaphors. By defining psychosis as a certain lack, psychiatry and psychology imply that meaning, freedom, and truth are only found in the nonpsychotic way.

What philosophy has to offer here is an examination of both sides, an inquiry into those notions that are so often assumed to be absent in psychosis. Philosophy investigates the power and implications of the negative: for instance, in what world does the psychotic live, when it is claimed that s/he does not live in a real world? How is this supposed unreality experienced? Why does it often feel more real than so-called ordinary reality? And so on. Only by letting go of our own prejudices about reality and thought, about how language and meaning operate, may we gain a deeper understanding of other (psychotic) kinds of organizations, other kinds of being-in-the-world than that of the nonpsychotic individual.

I do not have any principled criticism of the use of medication or cognitive behavioral therapy in itself. But the pretension that often accompanies the provision of effective treatment, that the clinicians understand what psychosis is better than the persons themselves—that can have a negative impact on people’s lives. If psychosis were really just like diabetes or a broken leg, a temporary natural disturbance of the mind, why would so many remain so puzzled afterwards? What is this mysterious, seductive quality of psychosis? Psychosis is not only a disorder. It is also the basis for thinking toward a different order.

Aftab: I have been wondering about the relationship between psychosis and philosophy. In my mind, one way to approach it would be to treat psychosis as a method of inquiry into the nature of reality such that, at the end of it, something is revealed about the nature of the world and our existence. Another approach might be more negative. In this approach, psychosis by itself does not tell us what reality is, but it throws our everyday epistemic complacency into disarray. We can no longer trust our sensory inputs, our perception of space and time, our social instincts, etc, and this provokes a state akin to Cartesian doubt, where we can no longer take our ordinary understanding of the world for granted. With some poetic license and oversimplification, perhaps I can refer to these positions as the epistemological and the mystical, respectively. Certainly, there can be all sorts of interesting combinations and variants of these approaches. Would you consider this to be a useful framing? If so, do you lean toward a particular position?

Kusters: That is a very illuminating framing indeed, and relates to the power of the negative. Let me comment on both positions and their relation to madness. In the original version of the Cartesian thought experiment, the one described by Descartes himself, a subject throws himself into full doubt, distrusts his senses, and searches within his own thought for a firm ground for existence, an undeniable truth, beyond all doubt. Descartes describes how in this process of radical doubt, everything is rejected because of its principled uncertainty, mutability, and transiency. The only thing that cannot be doubted, is that there is me, enveloped in a doubting process. And then from this elementary given, the famous rationalist adage follows: cogito, ergo sum (“I think, therefore I am”). In the dark nights of the mad soul, the individual with psychosis may have an analogous thought process, and they may end up in a kind of intellectual and existential despair, driven by radical self-doubt. But this despair may also take the form of an experience of perplexity about the undeniability and givenness of one’s own existence. The argumentative structure in Descartes’ texts shows similarities with the existential doubts the madman is in.

What is often forgotten in popular considerations of Cartesianism is that in building on cogito, ergo sum, Descartes goes on to prove the existence of God as well as reality, using arguments that are today seldom accepted as self-evident truths. Descartes draws the conclusion that from being able to think an utterly perfect being (God), we must conclude that this utterly perfect being exists, otherwise it would not be utterly perfect. Now, the madman may in myriad ways follow, mirror, and deviate from such ways of thinking, and may get fully lost in all kinds of imaginations that are very difficult for an outsider to understand. However, when we are aware of these philosophical problems and this basic scheme of Cartesian reasoning, we might come a little closer to some understanding.

Of course, there are also many differences between the Cartesian and the mad thought experiments. An important difference is that for Descartes this was simply a thought experiment, an epistemological exercise, but for the madman the radical doubt is a serious matter; he is drowning existentially, losing all firm ground, and desperately searching for an anchor. We might say indeed that Descartes performs an epistemological experiment, while, following the ideas of the Dutch psychiatrist and philosopher Antoine Mooij, the psychotic is involved in an ontological experiment.

Let’s look at mysticism in comparison. In the early days of Christianity, mysticism was an intellectual and theological way to argue, to contemplate, to pray, to envision, and eventually to experience awe at the greatness and the power of the Almighty God. Then there was no essential difference between mysticism, theology, and philosophy. It was only much later that mysticism became associated with visions in the West, in an epochal historical change in which visual hallucinations also became ascribed as a dominant characteristic of psychosis. Just as I stress the partially passive, experiential character of the active Cartesian doubt experiment, I view mysticism as a more active and intellectual undertaking than it is usually considered to be. The usual distinction made between active thought and passive perception (and their counterparts in psychopathology, delusions vs hallucinations) is too rigid, and it is in mad philosophy and philosophical madness that we see a continuing doubting of both, and a crossing of the separation between them, by way of the viability and flexibility of language signs and experience.

Aftab: How do you approach the experience of delusions, which on the surface represent the antithesis of philosophical thinking? Instead of an ongoing grappling with a confusing reality, in the case of delusions we see a closing down of inquiry, resulting in what has traditionally been described as a fixed, false belief, unshakeable in the face of reasoning or contrary evidence. Would you say that perhaps it is only after the delusional force of the beliefs has dissipated that we can begin to philosophically understand the meaning of that experience?

Kusters: I think that delusions in the way you describe them here are only one side of the delusional story. Unlike many superficial cognitive accounts of delusion, I think that so-called delusions are better analyzed as reactions to an underlying, and temporally preceding, delusional mood, which is in fact also the position of most phenomenologists as well as psychoanalysts. A famous adage of the latter is that delusions are not the problem, but they are instead the first attempts to express and deal with another problem, of a quite different order. Nevertheless, I fully agree that a philosophical understanding, in the common understanding of this phrase, can only happen post festum. A self-understanding and a philosophical elaboration that is intelligible to others, communicable in common language, must handle and circumnavigate the seduction to remain trapped by the awe for the ineffable, both in its ecstatic as well as despairing forms. The paradox of any such understanding, including mine, is that with this understanding, the thing itself, the psychosis, is in danger of retreating beyond the horizon. And this same striving toward understanding may attract and provoke psychosis to rise up again from the invisible. I know that some readers of my book put it down, but then had to resist being drawn back toward that enigma.

Aftab: In your interview with the webzine Mad in America, you say at one point: “Philosophy never promised you a rose garden, [and] neither do I. Furthermore, it could well be argued that there is some kind of antihuman tendency in extreme philosophical and psychotic thought. Both philosophy and madness may have intense ‘superhuman’ or ‘a-human’ powers that burn anything substantial, anything meaningful, away into a hole of nothingness. But, well, the interests of life are not necessarily those of philosophy.” Can you comment more on this misalignment between the interests of life and the interests of philosophy/psychosis?

Kusters: Most modern philosophy starts from and leads back to common-sense assumptions. Many are rooted in the Age of Enlightenment and have the overt values of modern society as their implicit background. They assume that what is argued by human thought, including the findings and results of philosophizing, are and should be beneficent for [human] life. We find that assumption under all kinds of moral and political philosophies, but also under so-called philosophy of psychiatry. However, it is not so obvious that philosophical thought should lead to beneficial effects on society or the individual.

There are a range of extreme critical philosophical views, such as views of ultraconservative, nationalist, racist, antihumanist, transhumanist, and even antinatalist nature. While some of these views are considered dangerous to society, they still remain sustained within a broadly defined space of reasons, although this may be contested by others. Some philosophical ideas go even further and have the paradoxical capacity to be self-undermining for the thinker who thinks them. They may be detrimental to what we usually consider the space of reason; they are contra [human] life. That is, they argue in quite sophisticated ways that not being is to be preferred over being. They use notions of emptiness, the void, and nothingness, not to draw positively flavored, so-called spiritual conclusions, but only to affirm annihilation, death, suicide, destruction, and [auto-]extinction. Such philosophies can be seen as a variety of nihilism—although this term refers to a much larger range of philosophies—with important names such as Friedrich Nietzsche, of course, but also Emil Cioran and especially Ray Brassier, with his devastating book Nihil Unbound. Just being against life does not mean that these ideas are untrue or can be excluded from the realm of philosophical thought. When we take philosophical thought seriously, we cannot reject conclusions just because they do not fit our restricted human-centric point of view. That is what I mean by saying the interests of life are not necessarily those of philosophy.

In the context of the relation between psychosis and philosophy, this is important to consider, and this also sweeps away all romantic humanist notions of both philosophy and psychosis. Consider the case of someone like Anders Breivik, the Norwegian terrorist and right-wing extremist. Some philosophies or world views, as well as some particular forms of madness, are thoroughly destructive and devoid of good intentions. They are closer to the darker variety of the mystical aspect of madness. American philosopher William James described it as diabolical mysticism.¹

In such cases, the philosophical aspect of the psychosis would not only consist of the strange ineffable character of an experience filled with awe and puzzlement, but also of an intra- and interpersonal struggle between life-affirming forces and life-denying, a-human or antihuman forces. The implicated question is whether we must eradicate such poisonous ideas, or must we taste and experience them ourselves, to examine the enemy, and immunize ourselves against them, with all kinds of risk of contamination? The implicated practical problem for psychiatrists is to make responsible decisions in matters that comprise philosophical and theological as well as political complexities. What is demanded of the psychiatrist here has hardly anything to do with scientific knowledge; it is also difficult to be captured in ethical guidelines, and it can only be referred to with notions like prudence.

Aftab: You have warned against romanticization of psychosis. From what I can tell, while you seem to be in favor of controlled explorations of psychosis by means of philosophy or mysticism, you do not seem to wish the clinical, raw experience of psychosis upon anyone. While you have derived insights from your experience of psychosis, I imagine that you are also glad to have come out of psychosis. How do you think we can reconcile the tension, to the extent that it exists, between the clinical and philosophical attitudes toward psychosis? Individuals with psychosis are often tremendously distressed and impaired, and they typically require some form of clinical care to help navigate this distress and impairment. How do we reconcile this with the romantic image of the madman as a misunderstood mystic or an unrecognized philosopher or with the more prosaic image of a deviant whose deviance has been pathologized?

Kusters: I think that the clinical attitude should incorporate the philosophical attitude, and clinicians should be educated in this. In fact [he laughed],I would recommend that they should all read my book, or perhaps follow the course I teach about my book! In my book, they would indeed meet these images of the misunderstood mystic, the unrecognized philosopher, and the pathologized deviant. However, my book does not want them to accept these images as the essence of psychosis, but as starting points from which a dance, dialectic, or conversation may begin between philosophy and madness, the rational and the irrational, without being condemned to one position or the other.

Aftab: Thank you!

The opinions expressed in the interviews are those of the participants and do not necessarily reflect the opinions of Psychiatric Times^TM.

Dr Aftab is a psychiatrist in Cleveland, Ohio, and a clinical assistant professor of psychiatry at Case Western Reserve University. He is a member of the executive council of the Association for the Advancement of Philosophy and Psychiatry and has been actively involved in initiatives to educate psychiatrists and trainees on the intersection of philosophy and psychiatry. He is also a member of the Psychiatric Times^TM Advisory Board. He can be reached at awaisaftab@gmail.com or on Twitter @awaisaftab.

Dr Aftab has no relevant financial disclosures or conflicts of interest. Dr Kusters receives royalties from the sales of his book and generates income from the online course he offers on his website.

Reference

1. James W. The Varieties of Religious Experience: A Study in Human Nature. Mentor Books; 1958. ❒