The Schizo-Stroller

The firmament
Of the lower abdomen
Made public.
The shame!

Who gets to judge the better man,
If the better man doesn’t judge?
It won’t be the better man,
Because the better man’s not for judging.

It’s merely an exploitative,
Disciplinary action
From a legitimation crisis
Of those who are for judging.

To investigate problems with the conception of schizophrenia in psychiatry, Blackman talks of the use of what are called Type 2 syndromes in the psychiatric literature. Type 2 in schizophrenia often refers to the negative symptoms observed in schizophrenia. As Blackman points out this distinction is often contested, however she argues it is a “good example of the ways in which psychiatry, despite its heterogeneity, is attempting to provide coherent causal explanations of psychotic experience. Thus the complex constellation of behaviours and thought processes which are problematised within the discursive practice, could be viewed as originating from two distinct disease categories.” (p.25-26). Thus symptoms such as hallucinations are considered indicators of type 1 syndrome. This phase is considered to be acute but responsive to neuroleptics. This is distinguished from a second phase, type 2, which is considered with more chronic with flattened affect and poverty of speech. This phase is thought to be more intractable, with a poor response to neuroleptics and thought to be possibly irreversible and permanent. Blackman continues “within this particular conceptual framework hallucinations appear as temporary markers of pathology which are amenable to ‘cure’, thus offering a trajectory which is used to explain why ‘hearing voices’ appears across the disease classes as a ‘symptom” (p.26). Blackman argues that this conceptual framework imposes a ‘grid’ that orders the symptom of ‘hearing voices’ encountered in practice (but not in theory). What she means by this is that the problems that stem from encountering contradictions in attempting to distinguish between ‘real’ and pseudo-hallucinations can be reorganised within a different rubric providing a theory of disease that takes into account neuro-physiology alongside the context of experience. Again, the categories that were previously used to think through this theory of disease are duration, severity and chronicity (along with insight). Blackman argues that this means psychiatry can no longer be thought of in terms of control, vividness, duration etc. (as do Rosciewicz Jr. and Rosciewicz) that more finely comprehend the complexities of hallucination, even if the medical model still requires that the patho-physiology of the individual be raised as a causal factor.
Thus in this new framework of explanation hearing voices is seen as an indicator of possible psychosis but not necessarily as definitive of schizophrenia, neither the sole diagnosis not the sole marker of a diagnosis. Blackman suggests this is a sign of a shift within psychiatry of the understanding of the phenomenon of hearing voices, but one where psychiatry is still invested in issues of genetics and heredity, but that leaves space for the creation of new perspectives, and from the point of view that I am writing from, new ways for psychiatric survivors to write their own experience into the discursive space opened up.
Blackman points out that there are particular assumptions in the perspective, gaze, which psychiatry turns on the diagnosis of hallucinatory experiences. She argues that what makes a hallucination, outside organic factors or religious experience, is the lack of any other plausible explanation. The symptoms are not to ‘speak of themselves’, instead there is a “conceptual grid used to divide the normal from the pathological within psychiatric discourse, the psychiatric gaze concerns itself with what is ‘absent’ to the immediate gaze of the psychiatrist.” (p.28). “Psychiatric discourse has… produced a taxonomy of natural diseases, of which certain symptoms, such as hearing voices are viewed as first rank signs. The ‘pure’ psychotic states are those where psychotic symptoms are viewed as signs of disease and illness, such as schizophrenia. These are often viewed as degenerative and linked either to structural changes in the brain, or biochemical or neurological deficit or imbalance (the type 2 syndromes).” (p.29). However, on noting this Blackman moves on to another aspect of the psychiatric gaze, the ‘enfeebled personality’. “This is based on a notion that there are certain persons deemed constitutionally lacking in the so-called normal propensities to equip them to deal with the stresses and strains of life.” (p.29). the method by which this enfeebled personality is ‘discovered’ is the psychiatric interview.
Blackman argues that there are two phases of the psychiatric interview; “the first is a description of the present mental state and involves a ‘provisional’ diagnosis. The second phase of history-taking is undertaken to pinpoint any ‘patho-features’ of the person’s biography, which may have made them vulnerable, or in psychiatric terms, ‘at risk’ to a disease process.” (p.30). It is worth noting here that in a sense this is little difference to ‘formulation’ as an alternative to diagnosis that is currently being promoted as a radical new approach to mental poor health and distress. “This ‘social history’ is then used as part of the grid of perception for making sense of the person’s experience. The discursive space opened up to make the distinction between what is deemed normal and what pathological is disparate and heterogeneous. It is a complex assemblage of concepts, which attempt to make it conceptually possible to ‘think’ in terms of disease and pathology. These include the status of the ‘personality’ of the individual, and the context of the experience, which is rendered in relation to the key concepts of source, vividness, control and duration. However, the most general specification, which underpins the dispersal of concepts within psychiatric discourse is the notion of the ‘enfeebled personality’; one who is viewed as unable to maintain particular kinds of relations with themselves and ‘others’. This personality is one whose ‘psychology’ is directly linked to biological inferiority or inadequacy’.” (p.31).
Blackman suggests that there is a split in psychiatric discourse between the natural and the social. “The natural (body) is made intelligible through particular ways of thinking about the body and biology, derived in part from evolutionary theory. Biology is viewed as a static, invariant set of characteristics which predispose persons to particular forms of thought, behaviour and conduct. Biology then sets limits on how a person is able to interact with the social and also the levels to which the social can impact or impinge upon the individual.” (p.31). these assumptions are then overlaid by other dualisms such as “inherited/ environmental, somatic/ psychological, psychotic/ neurotic and even the pseudo-hallucination/ hallucination.” (p.31-32). Blackman reminds us that psychiatry is not simply biologically reductive, but that it combines this ‘hard’ biology with ‘softer’ psychologically oriented science. Psychiatry makes possible its particular way of thinking about ‘hearing voices’ by targeting biology and the social in a way that conceives biology as its originary point. “Biology is opposed to the social, and the social becomes a measure of the individual’s competence in social interactions. Social and psychological life ultimately is explained with reference to biological causes.” (p.32). It is from this position in psychiatry, that I hope to move to the conception of voice hearing in ‘psychology’ before returning to phenomenology of voice haring ,and from thence a return to the dreamwork of Freud as an approach to voicework in hearing voices.

Springtime.
Taking a Dionysian stroll
During Rogation.
The air is fecund.
Twice-wyrded
As a bistort.

I am very aware my writing is ‘loaded’, in some of the prose series I try to get at language and its relation to psychosis, and in my poetry (still improving hopefully) I try to play with language and ‘hidden meaning’.

As it happens a friend asked me to parse some of my writing, so I have copied and pasted my explanation here as a sort of guide.

The orginal pice of writing that I parsed was:

“Is not the problem with ‘just words’ that they can be unjust?

Today, I was enjoying a country walk, listening to the birds and the bees, thinking of the difference between the pleasure of a ‘petit-mort’ and the microaggression of a ‘petite-turie’. “

Here is my exegesis of the meaning behind it:


The first line refers to when people use the discount (a discount is a term i take from Clarke and Dawson’s book Growing up Again: Parenting Ourselves, Parenting Our Children, they are ways to subtly demean people by diminishing thir experience), ‘they are just words’ when someone is clearly wounded by what is said. I play, as you are aware on different interpretations of the possible meanings of the semantics, the intention of the phrase is that they are no more than words but in fact having wounded someone they are clearly more than that, thus a discount. I often use the ‘come back’ “Well, if they are just words they are not worth defending”, but people can be dogamtic in their hypocrisy, so it is worth knowing that the phrase can be parsed with an understanding of the word ‘just’ in relation to ‘justice’, and thus we have the above word play… words are not ‘just’ words (neither demeaned as nothing much nor ‘just’ as in ‘ethical’) but in fact ‘unjust’. What’s more in doing so we indicate that in fact words are not ‘just’ words but aspects of the symbolic lodaded with significance that are not merely the authority of one perspective.

Then i play with words to indicate they are not just words, I talk of a country walk (many academic authors play with the idea of the ‘schizo’s stroll’ it sets a scene), but it is in the country and I am listening to the ‘birds and the bees’ this can indicate nature, it also implies voices, but it also implies ‘sex’. It is spring here and nature is currently noisy with fecund activity. However as in the human nature excuse, where human nature is used as a discount for bad behaviour (it’s just human nature) that implies some human nature overrides other human rights ignoring the need for certain norms to guide social behaviour in one sense, whilst at the same time being a norm that polices any defence against such ‘bad behaviour’ (this is before we get to a distinction of the difference between ‘human nature’ and the ‘human condition’ due to mediation and artifice in everyday lived experience. I was in the country but it was farmland, historically where i am farmland that has been farmed for 4,000 years). boys will be boys is used in the same way, as is ‘birds and the bees’. Except ‘birds and the bees’ relates to consumerism in denial of the deferrence of the death instinct – it is a ravenous undead beast), whereas death is also part of the ‘circle of life’ so to speak.

So this leads me to think how the French have less of an issue with this as their phrase for an orgasm (‘petit-mort’) implies death already. Something the phrase ‘birds and the bees’ lacks 9although of course birds and bees do die). I then move to the phrase in my mind ‘petit-tué’ which means ‘little kill’, rather than death, the state of being dead, it relates to the act of killing, and thus microaggressions that can be understood as discounts, which the phrase ‘just words’ can be. Thus we are left with the issue of just killing or unjust killing – murder – or as Schreber called it ‘soul murder’.

The meshuggah
Was labelled yetzer hara
By the gimel’s gavel.
The judge’s camel
Carried the remainder.
The meshuggah
Had nothing left to lose
But to call out
The ludicrous
Rejoinder.

Thinking ‘pon
The contradiction
Of victim blaming people
For the abuse they receive
Whilst simultaneously judging them
For answering back

Seemed to trigger phantasms,
A blinding glare,
Maggie Smith meme dick pics,
Of virtue signalling
Utilitarianly happy
Poster couples for fascism,
Their eudamonia
A just consequence
Of their normative
Lowest Common denominator
Passive observance
To the means of production.
Like symbolically castrated angels,
Lacking in genitalia.

Affective labour
For an immaculate conception
Of a literal Genesis.
A reified Jesus.

As their shadow receded
And they thought they were out of the glare
Of their own penal panopticon machine
They set about arguing like everyone else.

When the sirens
Treat language
Like Creationists
Treat Genesis

Should the ties
That strap you
To the mast
Come loose

It is useful to have an or

Demiurge
Demi urge
Partial projection
Partial reflection
Partial objection
Partial object
Negative K
Frustration
Aversion
Block
Obstacle
Adversary
Satan
Other

Demiurge
Traumatic cycle
Beyond the pleasure principle
Repetition
Can’t you hear them screaming. Underneath the pavement they are still screaming
Beneath the street the beach
The beach beneath the beach
Under the sea
Drexciya
Alien nation

The basic phenomenology of RojciewiczJr. and Rojciewicz and those similar found in psychiatry are questioned by Lisa Blackman in her book ‘Hearing Voices’. Considering it a ‘problem of hallucination’ she argues this view of hallucination, whilst an interesting phenomenology, is framed in a particular way by modern psychiatry, structured as it is through a combination of biological and psychological explanations and interventions. She begins her critique by exploring how the meaning of hallucination “has been created through the kinds of concepts and explanatory structures, which are embedded within psychiatric theorising and experimentation… [and which] claim to be based on an understanding of normal and abnormal biological and psychological functioning.” (p.15).
Blackman looks at some of this positioning within the discourse as follows: “within psychiatric discourse some of the broadest assumptions are made about what is natural) i.e. can be located within neurology for example), and what is social. Psychiatric discourse, despite its commitment to examining the social as well as the biological, is preoccupied with causality. This causality is ultimately rounded within materialist explanations, which seek to locate the exact neurophysiological mechanisms, which produce the possibility of the hallucinatory experience.” (p.18). Blackman notes that despite the focus on the biophysical aspect to psychiatry there is no unified explanation within this context, she notes a shift from a focus on dopamine to brain lipids (the book was published in 2001), circuit malfunctions, deficiencies in glutamate. She also notes that as well as the focus on neurology and genomics there also focuses on the social aspects of psychiatric experience e.g. the role of race and ethnicity with regards both outcomes and misdiagnosis. There is an epistemological shift within parts of the discourse towards the symptoms being put in the context of the lives of the patients, this is associated with a concern with treatment-resistant symptoms, where there is a sense the patients should be listened to more. This has been associated with the rise in techniques such as CBT. All these aspects Blackman locates in what she calls the ‘problem of hallucination’. This ‘problem’ is in fact two problems: the first (that we are dealing with here) is how to differentiate between ‘pseudo-hallucinations’ and hallucinations; the second the problem of non-compliance and treatment-resistant symptoms (the governance of which is dealt with in the rest of this series of blog posts).
Blackman goes on to ask, what it means to hallucinate. Blackman reads psychiatry as treating voice-hearing as usually pathological. She argues that psychiatry sees “this pathology [as] articulated as both an internal pathology (paying attention to those mechanisms and deficits producing the possibility of such an experience), and a social pathology. The voice hearer is viewed as having, or potentially losing contact with, the social world, and simultaneously losing certain capacities of social existence, such as the ability to function in work and social relationships. The voices are viewed as a sign that individuals can no longer self-regulate and control their behaviour, and are at the mercy of the voices’ demands and wishes.” (p.19).
Blackman points out that “it is not enough then, to say that somebody is hearing voices for their experience to necessarily be pronounced as a sign of illness and disease.” (p.20). In a vein similar to Rosciewicz Jr. and Rosciewicz’s typology Blackman also looks at the range of concepts and explanatory structures that psychiatry uses to distinguish ‘real’ hallucinations from ‘pseudo’ ones. These include “vividness, duration, location and control.” (p.20). Blackman takes each example one by one. The concept of source is “articulated in relation to the location of the voices and whether the person attributes them to an internal or external source. Are they perceived as coming from inside or outside his/her head?” does the person locate them within an object such as a television, or are they viewed as coming from the person’s own head? However, Blackman argues that within the literature it is not so conceptually clear cut “despite the inside/outside distinction, there are also seen to be voices which are attributed to the person’s own psychological processes, and not located in external sources. The distinction made is that these voices are ‘different’ from a person’s so-called normal thought processes. They operate in an authorial mode of address, running a continual commentary on the person’s own behaviour and conduct; insulting, judging, commanding or directly addressing. Most of the literature focuses upon the disembodying feeling generated by this constant retort, where a person is seen to lose the capacity to attend to outside experience.” (p,21). She continues “this ‘inner-directed’ focus, produced by third-person commentary, does not allow the inside/outside distinction to be the only means of differentiating the ‘real’ from the ‘pseudo’ experience. (p.21).
The criterion of vividness “focuses on the vividness of the experience, and the extent to which the intensity of the voice or image allows the person to distinguish between self-generated images or thoughts, and those objects external to him/herself.” (p.22). As an example, daydreaming, may indeed be vivid but it is still deemed to be within the ‘normal’ bounds of experience because the person can distinguish between the inside and outside. “It is not so much the vividness of the voices or imagery therefore, but to the extent to which individuals can recognise their self-generated nature. Vividness cannot therefore stand alone as an index of disease… the important discriminating principle therefore, is whether the person has an insight into their pathological nature, and can judge and control them (i.e. not act upon them).” (p.22)
“Control is a discursive concept used to make the distinction between the normal (‘pseudo’), and the pathological (‘real’) hallucination. It is an explanatory structure, which organises the dispersal of other concepts, which link together with this assemblage of elements. There may be a whole myriad of vivid imaginings or sensory misperceptions which a paerson may engage in, illusions, vivid imagery, creative thought and so forth but those signalling pathology relate to the degrees of control a person has over these imaginings. Hallucinations (proper), are not random occurrences, related to specific times or situations, such as day-dreaming or sleep, but systematised, all-powerful, all-pervading ‘events’ which engulf a person’s cognitive capacities. They are viewed as overwhelming individuals’ normal psychological propensities, leaving them unable to control themselves.” (p.22-23).
“How then,” Blackman asks “is the concept of control articulated and made intelligible? Control is to be taken as a measure of social and work functioning, where the focus is upon specifying how well a person is seen to be functioning within the external milieu.” (p.23). The DSM III R for example distinguishes between the normal and pathological based on whether there is a reduction in work or social functioning. “Control is therefore not measured in relation to vividness, but with a person’s relation to the external world. It is a measure of behaviour and conduct, and not a measure of the quality of a person’s own internal reverie. Within this division, ‘pseudo-hallucinations’ are those which do not interfere with the person’s daily functioning. In other words, the person appears to maintain an element of control over them.” (p.23). So, the time of occurrence is another factor such as falling asleep or waking up, in which case hypnagogic or hypnopompic hallucinations would be pseudo hallucinations, they are merely viewed as “the twilight state between dreaming and consciousness, when we are still living in both worlds; the mundane and the fantastical.” (p.23).
Lastly, “duration is combined and articulated with the other concepts already discussed, and reduces the complexity of explanations forming the object, hallucinations, into a differentiation, based upon the length of time the hallucination has endured within the person’s psyche. Pseudo-hallucinations are transitory, fleeting occurrences, which do not affect a person’s general level of social functioning. Hallucinations are viewed as more permanent and impermeable aspects existence forcing individuals to lose contact with their external surroundings.” (p.23). The Manchester Scale, the Positive and Negative Syndrome Scale are both psychometric scales that measure duration as an aspect of pathology. Thus, the concept of ‘duration’ ties together the various other concepts in order to distinguish between the pathological and normal.  Blackman argues that devices such as psychometric testing are examples of what Latour calls ‘inscription devices’, in attempting to make these concepts calculable, measurable and classifiable (often through a process of commensuration) they become ways in which “the prior assumptions and presuppositions of this explanatory structure are rendered into a form which produces those very properties as amenable to investigation. The object of study, in this case, duration, forms a perceptual system whereby persons are viewed as embodying the very properties that the prior assumptions embodied by the tests, presuppose. This way of approaching the ‘psychology of individuals’ is one which assumes that in order to understand human subjectivity, one needs to turn inwards, beyond the envelope of the skin. These processes ae then viewed as amenable to investigation through devices, which abstract the individual from their social environment, and attempt to measure some characteristic, which has been privileged by the investigator as a measure of psychological functioning. These ‘manipulable, coded, materialised, mathematised, two-dimensional traces’ (Rose), can then be combined with other traces, to render intelligible the gamut of human subjectivity… However, we can see within this example, that these devices are always made in conjunction with measures about social functioning which exist beyond the immediate investigative context. Even when the hallucinations are present almost continuously, the ultimate differential factor is how the person reacts to the voices i.e whether the person judges them to be ‘real’ or not. These judgments, as we have already seen, are made in relation to work and social functioning. In the end, despite the conceptual armoury, which attempts to tie the gaps and contradictions in ‘psy’ explanations together into a coherent set of explanations, the ultimate measure of hallucinatory experience is made in relation to social norms of conduct and functioning. Even though psychiatry… is a biological discipline, it is not enough to dismiss it along those lines. It is how a conception of the biological is combined with the social, and the psychological, in order to create the meaning and consequent treatment of experiences possible.” (p.24-25).
Blackman goes on to note that there have been changes in the conception of schizophrenia, and looks at the problems with this type of psychiatry. I will continue to explore this before looking at a conception of ‘voice-hearing’ experience elucidated by Marius Romme and Sandra Escher (Blackman refers to the Hearing Voices Network in her book), before returning to Rociewicz’s version of Merleau-Ponty’s ‘intentional arc’ behind their phenomenological typology of hallucination (having looked at alternative conceptions), to then ask the question of how this ‘intentional arc’ becomes slackened, which will take us to another survey of Bateson and Laing.