The Schizo-Stroller

If we are to return to Rocjiewicz and Rocjiewicz Jr’s phenomenology after exploring Lisa Blackman’s ‘problem of hallucination’ it is worth exploring Ver Eecke’s ‘dualist’ view of mental health that embraces both phenomenology and the bio-medical model (he does this in his introduction to Der Waelhen’s combination of phenomenology and Lacan so a nice segue on the return through phenomenology back to Lacan’s idea of the ideal ego and ego ideal that we took a detour from some time ago).  On the face of it Ver Eecke’s argument is just another, theory that says, sure there’s a social aspect to mental health but it’s underpinned by a biological cause. This is an issue that The British Psychological Society’s Power, Threat, Meaning Framework deals with and looks at several different approaches to criticise this stance, and we will come to this after. However, Ver Eecke’s is slightly different to some of these more psychological versions in that it deals with phenomenology and Lacanian psychoanalysis. So, for that reason I would like to examine it.
Ver Eecke starts by noting a certain dual causality model to theories of psycho-somatic illnesses within the medical profession. He quotes Van Der Kolk in saying “It is thus no longer scientifically justifiable to make clear distinctions between psychologic and biologic processes; rather we need to define our understanding of the degree which genetic, developmental, toxic and social factors converge to result in certain clinical syndromes!”. He also mentions that Finnish psychiatrist Pekka Tienari suggests that it is time “to move forward to attack the question of how genetic and environmental factors transact to influence development” (p.39-40).
Ver Eecke then spends time disagreeing with the claims that neurobiological disease is the sole cause of schizophrenia, arguing that they are not as strong as they claim, and furthermore that the evidence argues positively against it. One of the first criticisms is that twin studies of monozygotic twins show a 40-50% concordance between the twins, were the cause to be solely genetic, there would be higher concordance as they are genetically the same. Moreover, with regards such genetic causation given the lower insistence of marriage and procreation amongst people with the diagnosis, the incidence of the ‘disease’ would drop, die out. Ver Eecke quotes Portin And Alanen who, after analysing twin studies, adoption studies, environmental studies, and brain imagining findings say “in the light of the evidence provided by the epidemiological studies of the genetics of schizophrenia, it seems that the present-day conclusion is that genes are neither sufficient nor a necessary cause of schizophrenia, but a risk factor for it. Interaction between the genetic factors on the one hand physical, psychological, and psychosocial factors on the other appears to be important in the aetiology of the disease.”. Ver Eecke then goes on to quote Kendler and Diehl: “Schizophrenia is clearly a complex disorder in that gene carriers need not manifest the illness (incomplete penetration), affected individuals need not have the gene (environmental forms or phenocopies), diagnostic uncertainties cannot be avoided, and different families may carry different susceptibility genes (genetic heterogeneity)… These conclusions… are not inconsistent with the hypothesis that in some individuals, schizophrenia is largely environmental in origin, while in others the disorder is caused largely by genetic factors.” (p.40-41).
Ver Eecke then turns to studies that he argues provide direct proof that genetics are not the sole cause of schizophrenia. He refers to some a Danish study that noted differences in diagnostic rates dependent on several cultural factors: increased risk for children born to Danish mothers outside Denmark; and increased risk with unknown fathers but no maternal history of schizophrenia.
Ver Eecke then looks at the dopamine hypothesis. He argues there is as yet no satisfactory dopamine hypothesis, and that dopamine hypotheses are compatible with psychosocial factors. He points out that there are two main neurological development arguments of the dopamine hypothesis as mono-causal. Neither is satisfactory, one is a neurodegenerative one which can explain increasing negative symptoms from positive symptoms but not early onset or season of birth differences. It also fails to fully account for how this neurological degeneration occurs. The other hypothesis suggests dopamine is due to early insult or trauma (including possible in utero), and this can explain early onset but not later negative symptoms. Thus Ver Eecke moves on to examine co-causality theories of the dopamine hypothesis. He notes that the dopamine hypothesis is a theory that developed out of investigating the apparent effectiveness of medications, he then notes that clinicians have observed “that at times those medications work minimally or not at all… [and] many patients continue to have cognitive deficits and negative symptoms despite having had marked response to treatment” and that “amphetamine-induced psychoses… lack a number of features commonly associated with schizophrenia, such as the presence of negative symptoms, the specific kinds of auditory hallucinations that occur in schizophrenia, and a chronic course.” (p.42). he notes that scientists using animal research have concluded that “stress-induced dopamine release could play a role in psychotic decompensation.” (p.43). Ver Eecke  notes that in such a version of the dopamine hypothesis “stress is conceptualised as a causal factor in which dopamine is the mechanism. The theory of schizophrenia presented… implies that persons with a prepsychotic structure are vulnerable to the consequences of stress. This claim goes hand in hand with claims made by Lacanian-inspired therapists that prepsychotic persons are prone to create repeated self-inflicted stress.” (p.43).
After discussing dopamine, Ver Eecke turns to theses involving norepinephrine and serotonin. With regards norepinephrine he notes research that states that studies “do not contain sufficient evidence to suggest that a defect in the norepinephrine system is primary to the development of schizophrenia… however, the studies implicate an alteration in norepinephrine metabolism or response to stress in at least some schizophrenic patients. The noradrenergic system not only is integral to the body’s response to stress but is also involved in modulating the dopaminergic system.” With regards serotonin, he notes the same researchers state that “studies of patients with schizophrenia have failed to convincingly demonstrate that abnormalities in 5-HT [serotonin] neurotransmission mediate the expression of symptoms.” (p.43). So with regarding theses involving norepinephrine and serotonin, Ver Eecke, suggests that if one were searching for “an exclusive biological explanation for schizophrenia, it is important to remember that serotonergic neurotransmission is not believed to be a causal explanation of schizophrenia and that the possible function of the neuro noradrenergic system is explicitly linked to the body’s response to stress. One can therefore conclude that consideration of the function of these two systems in the brain includes psychological stress as a possible factor in schizophrenia.” (p.43).
Ver Eecke then turns his attention to glutamate theories. He notes that Phencyclidine (PCP, angel dust) can produce schizophrenia-like symptoms by blocking one glutamate receptor (NMDA). He notes that post-mortem studies have shown that an increased number of NMDA receptors is associated with acute psychotic states from an excess of dopamine transmission as a result of a change to the nucleus accumbens from damage to the hippocampus and amygdala (potentially prenatal). Ver Eecke notes this again results in a neurobiological appeal to psychological factors relating to stress.
Ver Eecke also looks at other chemical agents, he looks at one example each from four categories. With regards biogenic amines (eg physostigimine, DFP), an increase in cholinergic activity increases negative symptoms, whereas anticholinergic agents improve negative symptoms. With regards endogenous psychotogenes, studies show schizophrenics have a relatively low incidence of allergies as well as decreased responses to histamine. As for neuropeptides, researchers have noticed that high levels of CCK (creatinine phosphokinase) in the limbic system of schizophrenics. With regards more miscellaneous chemical agents, studies have shown that gluten-poor diets decrease psychiatric admissions, or correlate with improvements in psychiatric patients.
Ver Eecke then changes the focus from chemical agents to gender, and that the sex of the person makes a difference in the age of onset as well as possibly course and recovery outcome. He notes that Wyatt claims that “some estrogens appear to have antipsychotic effects and estrogens are known antagonists of D2 receptors. Conversely, dopamine regulates the biological effects of estrogens by decreasing the binding of that hormone to its receptors…” however “there are numerous social demands that could interact with an already altered substrate to increase the risk of developing schizophrenia.” (p.44).
In conclusion to the section I am looking at here, Ver Eecke’s notes that in the conclusion to the overview article “Schizophrenia: Neurochemical, Viral, and Immunological studies” in the Comprehensive Textbook of Psychiatry, Wyatt and his coauthors claim in defence of a medication approach that “the overwhelming beneficial effect of antipsychotic medications in schizophrenia cannot be overlooked. Regardless of the original cause of illness, the neurochemical outcome appears to be a perturbation of the dopamine neurotransmitter system” (p.44). Ver Eecke notes that in investigating these issues Wyatt et al. acknowledge stress as a variable. Thus Ver Eecke argues that “a critical evaluation of the argument for a neurobiological basis of schizophrenia needs to distinguish between, on the one hand, non-interpreted facts and, on the other hand, theoretical explanations of the facts. The survey articles that summarise the theories which attempt to understand the neurobiological basis of schizophrenia do not exclude psychosocial factors. Rather, psychosocial factors are included in the reasoning of how the major neurobiological factor (dopamine system) works.” (p.44). Ver Eecke uses the acknowledgment by researchers who observe the beneficial influences of gluten-poor diets and the low incidence of allergies that these observations do not alone indicate a cause of schizophrenia. “Rather, these non-interpreted facts indicate that there is a neurobiological factor at work in schizophrenia. But such a claim can co-exist with claims derived from other observations in both the neurobiological and psychosocial domains… thus, theoretically, the neurobiological explanation for schizophrenia does not exclude the possibility of psychosocial factors. In some neurobiological explanations, positive appeal is made to these factors.” (p.45).
I will conclude this post here and continue with Ver Eecke’s dualist model in the next post. I will say here, that the purpose of this foray into biomedical theories is to dive in deeper momentarily after looking at an embodied theory, before using the Power Threat meaning Framework to look at the issues with some of the models Ver Eecke raises here (not least the dopamine model), not least that whilst Ver Eecke makes a good case for a method of taking both biological, as he argues non-interpreted facts into account, his interpretation and distinction does not go far enough, as such I will in the future also be looking at the social construction of mental illness, around diagnosis, but also around social, economic and ideological factors, not just psychological stress models. However it is clear Ver Eecke’s conclusion paves the way for this possibility.

Blackman then turns her critical gaze to the relation of the psychological to the social. She points out that “psychology, like psychiatry, is not a unified discipline, and it’s made up of a range of disparate therapies, concepts, explanatory structures and techniques and understandings. Many different theories within psychology have been deployed in order to understand the problem of hallucination. Many of them have similarities with psychiatric understandings, attempting to locate the exact psychological, rather than strictly neurological mechanisms, which are seen to underpin the hallucinatory experience. Again, like psychiatry, only some concepts have the status of science-ready-made, and there is much dissent and controversy surrounding many of the theories offered to explain the nature of hallucination.” (p.43-44). It is worth looking at the British Psychological Society’s Power Threat Meaning Framework for an overview of both psychiatric and psychological theories of mental distress. According to Blackman, though, within the conceptual framework of psychology, hallucinations are viewed as a disorder of consciousness. These theories are called ‘seepage’ theories, that is they frame hallucinations as some kind of ‘seepage’ into consciousness of mental activity that would normally be preconscious. “Therefore, the problem of hallucination is construed within the terms of consciousness and its preconscious workings… within this framework hallucinations are experiences related to dreams, originating in the preconscious imaginary realm of the mind. When the rational mind is relaxed then these subterranean forces are brought into play… the difference between hallucinations and dreams within this framework is that the state of consciousness, which occurs during the dreamstate, is considered a normal function of sleep… however, the neuro-physiological mechanism underpinning hallucination is considered deficient, whereas during sleep the mechanism is merely relaxed.” (p.44-45).
Other theories base themselves on hyper-arousal, so whilst it is considered within the bounds of normality, a pseudo-hallucination to hear voices in hostage situations, “these theories suggest that schizophrenia is akin to a state of hyper-arousal, which deleteriously affects cognitive information-processing capacities. The state of hyper-arousal is used to explain attentional deficits, which lead the ‘schizophrenic’ to inadequately screen and process input from the external environment. It is this state which leads to the focus of the internal as opposed to the external, where a person misattributes and confuses the location of the stimuli.” (p.45-46).
Another framework is that of hallucinations as a continuum of ‘normal’ mental imagery. “’Normal’ mental imagery has been defined as a non-veridical experience involving the sensory or perceptual organs” (p.48). Blackman suggests this structure consists of two concepts, the first views hallucinations as extremely vivid mental imagery. So hallucinations are in some respects similar to normal forms of mental imagery such as ‘daydreaming, hypnosis, dreams’ etc., they are also paradoxically quantitatively different. “In other words, although hallucinations are viewed as proximate to other forms of imagery they are also, by definition, the negation of ‘normal’ mental imagery.” (p.48). However, Blackman points out that within this continuum theory, with regards the second concept “the ‘problem of hallucination’ is delimited further by incorporating and redeploying one of the main modes of psychiatric explanation, ‘a belief in the reality of the experience’.” (p.49). Thus “the empirical problem is individualised, and the two concepts conflated through attempting to classify and measure ‘reality testing’ (the ability to judge between real and imaginary events) and the ‘quality of mental imagery’.” (p.49). Blackman goes on to quote Rose saying “’they (psychologists) domesticate and discipline subjectivity, transforming the intangible, changeable, apparently free-willed conduct of people into manipulable, coded, materialised, mathematised, two-dimensional traces which may be utilised in any procedure of calculation’… The paradox is that nowhere in the literature are the norms of ‘normal’ mental functioning defined. Mental imagery is presumed to be a mental picture of the world as produced internally, thus not dependent upon actual representations of external events. However, the laws governing normal mental imagery functioning are not explained. The ‘norm’ of mental imagery is a lack of hallucination. Thus ‘abnormal’ mental imagery is a negation of ‘normal’ mental imagery, which in turn defines and classifies the limits of ‘normal’ mental imagery.” (p.50). In contrasting Hilgard’s 1965 definition of altered states of consciousness to the psychiatric definition of hallucination, both ‘focus upon the involvement of imagery or fantasy production whilst ‘awake’, or at least in a certain state of consciousness. However, hallucinations are differentiated from ‘normal’ mental imagery by invoking the notion of ‘self-conscious’ awareness. However, this criterion or mode of explanation does not suffice to delimit the definition of altered states of consciousness from the psychiatric definition of hallucination. In both definitions the subject loses volition, the willingness to act independently and attention becomes redistributed or refocused. Therefore, what is the conceptual difference between hallucinations and an altered state of consciousness such as hypnosis?” (p.50). It is here that Blackman questions the role of vividness in the distinction, not just ‘self-awareness’. As if vividness of imagery is present in both hallucination and hypnosis, then “the fundamental difference or division is that hallucinations are viewed as inherently pathological and hypnosis is not. Hypnosis is viewed as a transitory state or role, whereas hallucinations are a symptom or index of pathology, and become an integral part of the identity of the person. Thus, in order to understand why hallucinations are constituted within this framework as a continuum of ‘normal’ mental imagery, one needs to understand the antecedent for this statement to exist. Neisser has highlighted that there is no a priori reason for believing that imagery vividness is an underlying condition for a hallucinatory experience to occur – the paradox being that ‘normal’ mental imagery is defined by what is abnormal, i.e. hallucinations. Thus, although psychology aims to extend its knowledge of normal mental functioning to deal with what is constituted as individual and social pathology, the questions are posed in terms of deviation from certain norms. As Rose suggests, in relation to this argument, ‘individual psychology would seem to diagnose social pathology in terns of deviation from statistical norms. Its conception of normal and abnormal mental functioning would be constructed from the point of view of a theory of populations, averages and correlations, not from a conception of the psyche itself.’.” (p.51).  
Continuing Blackman’s argument with regards the alignment of concepts in psychology and psychiatry she states “they focus less on the brain and more on those cognitive capacities which are viewed as existing within the mind. They are attempts to locate the psychological, as opposed to the psychiatric mechanisms, which underpin the hallucinatory experience. They claim to be based upon general theories of mental functioning, which are then extended to understand these so-called deviations from normal functioning. However… it is actually the ways in which deviations, understood as pathology, are articulated, which make possible what we understand normal mental functioning to be.” (p.52). She cites Foucault, “it must not be forgotten that ‘objective’ or ‘positive’ or ‘scientific’ psychology founds its historical origin and its basis in pathological experience. It was an analysis of duplication that made possible a psychology of the personality; an analysis of compulsions and of the unconscious that provided the basis for a psychology of consciousness; an analysis of deficits that led to a psychology of intelligence”. (Blackman, p.52).
Blackman then turns to the social elements of the hallucinatory experience. But we will return to these later. Much of these debates as well as more contemporary one’s are covered by The British Psychology Society’s Power, Threat, Meaning Framework in the literature review that precedes the discussion on practice. I will be covering this Framework later, its relation to some problems of contemporary governance. But for now, I hope that my notes on Lisa Blackman cover some issues in what is considered the ‘problem of hallucination’, and in the next article I will return to some problems of phenomenology and the work of Ver Eecke, before returning to Rocjiewicz Jr and Rockjiewicz’s ‘intentional arc’.

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.

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.  

Having presented two voice-works using at least some of Freud’s techniques, I think it is important to then look at some distinctions between ‘voice-hearing’ and dreams. In a paper looking at the phenomenology of voice hearing Rojcewicz Jr. and Rojcewicz (Journal of Phenomenological Psychology, 28, No.1, 1997) they distinguish between voice hearing and dreams. Starting with Jean-Paul Sartre’s distinction between hypnagogic images and dreams, they note that hallucinations are “an isolated experience, shut off from other images, whilst the dream is ‘a world.’ Despite any seeming nonsensicality, the dream images appear in a rich spatial world. The dream action contains references to a temporal before and after. The dream so carries us into a world that every dream appears to us as a story… The hallucination is limited, fragmented, impoverished, more furtive than a dream. Only a few words occur, not a full narrative or an introduction to a world, however imaginary. The image in a dream may have multiple facets and occur In relation to many images. The auditory hallucination is isolated, has few if any spatial connections, and is experienced as detachment from other sensory modalities… auditory hallucinations lack not only the fullness of normal perception but also the richness, nuances, and multiple facets of the dream.” (p.18). They consider this distinction to be a necessary component of why auditory hallucinations appear as ‘voices’. Before we follow Rojcewicz, Jr. and Rojcewicz’s argument about voices, it might be worth familiarising ourselves with their view of other distinctive aspects of auditory hallucinations. Firstly, they note that they contrast with everyday sensory experiences, for a start the duration of hallucinations is quite limited, “what the patient usually hears is not a sustained argument or a full discussion but a only few words; the patient experiences fragments or sentences, not pages or even paragraphs… as contrasted to everyday sensory experience, hallucinations do not display multiple facets; they are disjointed, fragmented. Normally, an object is perceived from several different perspectives and in multiple facets. In auditory hallucinations, these varied perspectives of normal perception are absent. Instead of a whole object being perceived a voice is heard. This voice, disembodied, is heard in isolation from other sensory phenomena. In normal experience, a person is perceived; the person is seen, experienced, through multiple sense as well as heard. The direct, immediate words of patients are instructive here. These patients do not hear persons, they hear voices. Although the hallucinations are in harmony with the totality of the patient’s psychological life, the hallucinated voice is in isolation: in isolation from the other senses and from the full experience of the sensation of hearing. There is no interplay or variation with other sounds and phenomena.” (p. 17). They quote A. Kraus, stating, “a missing worldly background of the ‘perceived,’ and therefore a missing continuity in space and time, as well as monomodality of perception, all lead to the fact that the hallucinatory perceived world… is not perceived from varied perspectives. As Husserl… has shown, it is precisely the endless shadings of a perceived perspective, possible in normal perception, that provide the surest conviction of its reality.” (p.17-18). They follow up with a statement by Merleau-Ponty saying “If the hallucination does not occur in the stable and intersubjective world, it is because it lacks the fullness, the internal articulation that makes a true thing repose ‘in-itself,’ act and exist by itself. The hallucinatory thing is not, like a true thing, a being with depth, which contracts within itself a density of duration; and a hallucination is not, like perception, my concrete purchase on time in a living present. It glides over time, just as it glides over the world.” (p.18).
Rojcewicz Jr. and Rojcewicz also contrast auditory hallucinations to other symptoms, these include what are often classified as positive symptoms such as visual hallucinations or hallucinations of smell and touch, as well as delusions, paranoia, ideas of reference and bizarre behaviours, and negative symptoms such as emotional withdrawal and inappropriateness of affect. As observed in both the DSM and ISD classification systems auditory hallucinations without other pathological manifestations are considered more benign. They argue that “the significance of hallucinations in pathological conditions is that they are symptomatic of a pathological way of relating to the world, an abnormal way of being” (p.16). They point out that Bleuler saw hallucinations as an accessory symptom of schizophrenia and not a fundamental aspect of the condition. Freud in his study of Schreber saw hallucinations as a secondary symptom, “an attempt at some sort of restitution following the primary symptom of severe emotional withdrawal. The patient initially withdraws his emotional attachment from person and things in the world; this is the primary pathology, the most fundamental symptom. Subsequently in many cases, the patient develops hallucinations or delusions. These symptoms attempt to bring back, to reconstitute in an idiosyncratic way, the emotional attachment to persons and things in the world.” (p.16). Rojcewicz Jr., and Rojcewicz argue that these manifestations of emotional withdrawal can become self-justifying; the phrase ‘J. Edgar Hoover, proving the FBI are after the voice hearer, “derogatory hallucinations, which may occur following some blow to self-esteem, help to reinforce a distorted view of low self-worth… command hallucinations precede acts of violent acting-out.” (p.16). However, they also point out that the negative symptoms are of equal importance, “a hallucinating patient may have little social interaction, speak to few other persons, and spend his time in profound emotional withdrawal. At times the only interaction seems to be talking back to the hallucinations.” (p.17).
To understand this phenomenology of voices, Rojcewicz Jr., and Rojcewicz create a typology of the phenomena associated with voice hearing. After acknowledging benign types of auditory hallucination such as hearing a loved one who recently died, or a solo round the world sailor hearing voices after long time at sea, which we won’t explore further here, they point out that whilst other forms of voice hearing are possible such as whistles, machinery noises, animal noises, even musical sounds, the sound of a voice is the most common. People may attribute the source to all kinds such as God or angels, spirits of the dead, telepathy, AI or aliens, the voice still takes the form of human speech. However, in addition to the type of sound, hallucinations have significant characteristics that follow certain parameters: “extent (frequency, duration), location, degree of reality, sensory intensity, constancy, overt behaviour, control time, cause, experience shared, affect, and content” (p. 12). Rojcewicz Jr. and Rojcewicz investigated each in turn.
1. Type of Speech. As observed earlier it is rare to get a ‘whole sermon of speech’, rather “usually each episode of a hallucinated voice is usually relatively short-lived, but there may be many episodes in the course of one day. Nevertheless, there is often a very complex structure to some auditory hallucinations. The patient may here several distinct voices, the voices may engage in dialogue or debate with the patient or with each other, the voices may offer a running commentary on the patient’s activities, and so forth. At times the auditory hallucinations are associated with visual or other hallucinations, with paranoid ideas of reference or with delusions.” (p.13.)
2. Constancy. “In this context ‘constancy’ refers to a global measure of overall variability, not to minor changes on a given hallucination. While some patients have rapidly changing hallucinations in reference to content or to intensity, other patients may have the same hallucination at the same level of intensity over and over.” (p.13).
3. Duration. Rojcewicz Jr. and Rojcewicz quote Minkowski who points out that “hallucinations tend to be more or less ephemeral; to come into existence and then vanish suddenly; to succeed one another rapidly, without crystallizing into something stable or unchangeable. In general, each episode of a hallucination is relatively short-lived.” (p.13). As noted before Bleuler observed that “the usual occurrence is in short sentences or abrupt words, nor paragraphs or long speeches. These occur intermittently, even if in rapid sequence; it is rare that the voices are constant or continuous.” (p.13).
4. Content. According to Rojcewicz Jr. and Rojcewicz, “the usual emotional content, especially in the early stages of schizophrenia, is critical, threatening, or otherwise negative. As the illness progresses, the hallucinations can become less negative… Often the content ids of the patient’s own thoughts, acknowledged by the patient as such, but now audible.” (p.13-14). They continue “the precise, word-by-word verbal content has been studied in a few patients… over a period of time, the words were found to be non-random. Semantically related themes tend to recur, such as the same adjective or verb in different contexts every day, or the recurrence of words all related to food.” (p.14).
5. Identification. Rojcewicz Jr. and Rojcewicz state that “in a pseudo-hallucination [a voice considered to be more internal rather than external], the patient has some insight into the fact that the hallucination is not real or is created by the self (“my mind is playing tricks with me”), while in a true hallucination the experience is attributed to a real outside the self. Many individuals with schizophrenia retain a high level of conviction in the reality for this external source of their voices… At times, the hallucination is specifically identified with certainty (as the voice of God, of an FBI agent, etc.), at times it is identified in a vague way (as the voice of some unknown enemy), at a times it is not identified at all. Patients may identify the voices as coming from parts of their body, from their clothing, from material surroundings, or from persons, agents, or technical equipment that cannot be seen.” (p.14).
6. Intelligibility. Rojcewicz Jr. and Rojcewicz point out that “the voices can be mumbling, can be clear and distinct, or can be a changing combination of these features… the voices can be so loudness of the voices can vary, more or less independently of the other features listed… The voices can be so loud that other sounds are drowned out, or they can barely be perceived at all. Several voices may talk at once, so the intelligibility is diminished, or the words themselves may be fragments or neologisms without an overall sentence structure.” (p.14).
7. Spatial localisation. “The voices may occupy an indeterminate position without special localisation, or they may be more precisely situated. Patients may localise the source to a considerable distance away, to a relatively far but still within ordinary sensory range, to a distance relatively close to their body (sometimes at the same constant distance), or to a space inside the body. The voices may move between one location and another; in individual patients the change in location may have some considerable significance” (p.15) It has been noted that closer voices are sometimes more comforting and supportive. Other patients are able to describe different spatial localisations that may, say, be divided as ‘left’ good and ‘right’ bad.
8. Control. “Patients have greater or lesser degrees of control over the occurrence and effects of their hallucinations… The most extreme issue of control consists in the obeying of command hallucinations… An individual patient may be able to resist commands at one time, yet, act out on them at another time. Some patients continue to have command hallucinations without ever obeying them.” (p.15).
With regards my own voices I have had at least a few similar experiences from each parameter in the list. But with regards the examples from the last two posts then it might be a good idea to explore some. The first example was clearly in line with the argument around duration, the second was slightly different in that a narrative arc was formed. It is here that Rojcewicz Jr. and Rojcewicz’s distinction between dreams and auditory hallucinations may seem to differ. There are different arguments for this, one is that the voices occur in tandem with other symptoms. But is it right to call it purely delusional or paranoid? One way to look at this is the point made about content, in that semantically they are non-random and there is a recurrence of themes, and words, or signifiers. I use the term signifier here rather than word, as the term indicates that the ‘words’ can change their relation to signified or even referent, I would argue in much the same way that Freud interprets dreams. This though still leaves the question of the difference between manifest and latent content and whether, there are what are called ‘wish fulfilments’ (although this can, although not always necessarily, be related to past traumas, something that is acknowledged by Freud but has been further explored by people such as Romme and Escher) that cause a latent content of the duration of the ‘illness’. The relation to emotional withdrawal is related to an idea in phenomenology that Rojcewicz Jr. and Rojcewicz call the intentional arc, and I will be coming back to this, and then looking at an issue neglected by Rojcewicz Jr. and Rojcewicz which is what leads to the slackening of the intentional arc, where I will be returning to Bateson’s cybernetics. Before that in the next post I will look at a similar typology of features identified by Lisa Blackman and will be briefly acknowledging her work on what I have written about in this post, which she calls the ‘problem of hallucination’ and its place in the history of psychiatry. Before returning to the problem of the ‘slackening of the intentional arc’. And then I will return to Freud’s dream interpretations and then back to Deleuze and Gauttari on machines.

The last post looked at the experience of voices over one day, this second one looks at a more, what Lacan would call S1, S1, S1, apophenic narrative to give more of a relation of voices to dreams. The experience isn’t over a day but over a twenty-minute period where the experience was intense enough that I needed to lie down.
I had been thinking I could hear gossiping about my personal business outside, this made me very upset. But on top of this it was as if my thoughts were being interrupted, badly, the interruptions seemed to focusing on criticisms with regards what I was eating. With regards both the gossip and the food criticism (seemingly based on the right to decide what I ate as ‘they paid their taxes’) the local community seemed to be involved, I could hear some criticising, some bullying but also some supporting voices and voices defending me.
It became clear that a large part of the community was upset by the worst elements of the abusers attitude and comments. I ended up shouting out of the window in a pique of rage, in what I imagined to be in earshot of the people gossiping but also with in hearing range of where I perceived the voices that seemed to stem from supportive neighbours, I shouted what I thought were the true details of the situation being gossiped about and slandered with the gossip rather than my ‘facts-about-myself’ being discussed as if the slander were true. I then noticed someone leave the local pub (a ‘real’ visual sighting), and heard a voice saying he had left in shame at the level of slander.
At this point the voices seemed to be silenced and much of the cognitive dissent had calmed down. However, then the smaller number of bullies voices increased and became more personal, and the voice experience more internal. I then heard their names shouted out. Dave, Carol and Sara. I had previously been to the police to talk about the perceived harassment, and I shouted the names of the bullies out of the window. “We know them” came the shouts of other voices. Chaos amongst the voices seemed to start up with sounds of the community telling the bullies off.
Later in the evening, as I was lying down I hear voices say that Dave has ‘done a runner’. (The impression my mind created from trying to untangle what the voices were saying was that he was the ring leader winding Carol and Sara up). Sara carried on the harassment alone and Carol tried to make amends. Carol then came under attack from the community defending herself against charges of Nazism. However, her harassment seemed to stop from that point on.

The voice named Sara continues the harassment and then ropes in voices with names Paul, Tim, Heather and Rachel. One by one these voices get pulled out of the fight by ‘the community’ (other unnamed voices). The voice named Dave then comes back for Sara and they ‘go for one last night on the town’ (they ‘paint the town red’) and then the voices all disappear (at least from this narrative arc).
At the time I wrote down associations I had with the names of the voices, Sara was a name that, according to a book I had recently read on Twentieth Century classical music by a writer called Alex Ross, was given to Jewish girls in the holocaust by the Nazis. It was also a name of more than one previous girlfriend, both of whose relationships were short (although in different towns) where the split in one had been bad (with later gossip about me), and the other friendly, we had continued to go out ‘on the town together’ regularly. It was also the name of a cousin who had been involved in musicals when younger, and had a partner still involved I the music scene, whose great grandfather’s (my great, great, grandfather and my father’s great grandfather) Jewish East End roots I had written about a few years before and then got paranoid about (partly because my mother who told me the story may have confabulated some of it, as I found out later). My cousin’s name when using her maiden name is the same as a feminist Foucault scholar who I had read before moving to this new town, before my daughter was born, with regards running themes of voices and unresolved cognitive conflicts, it was whilst my daughter was in the High Care Dependency Unit at Great Ormond Street when she was first born, but after I had started my PhD that (was not specialising in, but) included a lot of work based on Foucault scholarship, that I found myself sitting by my daughter’s bedside with the name “FOUCAULT, FOUCAULT, FOUCAULT” screaming through my head and chasing me through the halls of the hospital. This led me to break down and have to return back home leaving my partner there, and then set up a series of events and a poor future relationship with hospitals and my daughter’s care needs after that.

Dave was the name of a ‘voice personality’ used by another mental health survivor who had bullied me on line. But was also the name of two old friends from same town as the Sara I had gone ‘on the town with’ who both ended up with schizophrenia. It is also the name of a character in a book by Will Self I had recently read, who was a taxi driver, I job I had also had previously. It was also a job I had in the town where I had the friendly relationship with the ex-girlfriend Sara, shortly before my breakdown and later hospitalisation.

The relationship with the name in the Alex Ross book seemed to be related to the fact that my partner’s dad converts Jews as his Christian mission and as part of that mission teaches about the holocaust in schools.

I would also point out that it during this voice episode my wife told me she has ‘come on’ her period. It is after this that Dave comes back to take Sara on one last night on the town (and paint the town red) before they both leave. There is clearly a relation to relationship stress here, to libidinous desires and frustration, with Sara playing different roles, but possibly related to my partner and her state of mind at the time. Given this as a period where we were both exhausted and often cranky due to the amount of time my daughter was in and out of hospital as well as the care at home.
My voices later ‘informed me’ that Carol had worked in a sandwich packing factory. I had recently come across a social media meme joke about how actual real-world help was better than thoughts and prayers which didn’t really do anything, with the punchline by the male, American, black comedian being ‘make me a fucking sandwich or something’. I had also in the past worked in a meat packing factory in Kentish Town in London (although I knew no Carols there, it was at Christmas and I spent most of the temporary job packing frozen turkeys).
I wonder if this is also associated with the eating voices, as eating is often associated with ‘control’, food disorders are sometimes considered to be related to the fact that putting food in one’s mouth is the last stop of control over one’s own body. At the time my son was struggling with his food as a picky eater due to the stress of our circumstances and of course my daughter was peg-fed as she couldn’t swallow food without aspirating. So the eating and the gossip and bullying all seem to indicate relations to control issues and stress. As well as some relation to the sandwich joke, and relation to Christmas and packing factories. My father’s mother had an anxiety swallow issue that stemmed from her father dying when she was a young adult at Christmas. At the time whilst there is an association with my partner’s father mentioned here I had no contact and no support at all from my own father. Is there a ‘substitute’ issue here too?
With regards the family relationship Heather is the name of my sister-in-law although that name only takes a small role, and oddly seems to be the only name with a direct reference, the other names being code for other people. But basically, this period seems to be about relationship struggles, interference, frustration with work, I get voices that bring taxi driving up often (along with the ‘get a job’ voice from the last post), a job I have down in three different cities and is often my fall-back job when able to work but don’t have work experience. There also seems to be an aspect that whilst before my daughter was born and I had my second breakdown I had been working on changing my ‘job skills’ but they had been frustrated. The ‘on the town’ references seem to be both a desire to enjoy myself, get out of the house, and a reference to the reasons for my partner’s ‘mood’ although it is interesting to know that upon being given the information my voices ‘leave’, the gossip Sara turning to the friendly Sara. As mentioned in last post the ‘gossip’ seems to be related to a wish for recognition, perhaps tempered with disappointment with the lack of support my partner and I were receiving, other voices at the time spent a lot of time calling me ‘ungrateful’.
I would like to point out that this is a light ‘voice work’ as I am not prepared to go to deep into my unconscious (neither was Freud), especially not the more libidinous aspects, which will be involved, on public record, that work is best done with a therapist. But hopefully I have given enough information and done enough voice work here to open up the possibility of such forms of voice interpretation.

As we go through the disparate voice statements I heard in one day, the next one, which takes the form of  ‘Get a job’, seems self-explanatory, if it were not for the fact that Freud warns us that the secondary agency makes manifestation of content often far from simple. But let’s start with the obvious I have felt persecuted for my benefit status since the Tories got in, I was even aware that the Household survey showed that whilst attitudes to disability benefits had held stable for twenty or so years, tolerance towards them took a distinct drop after 2010, which is quite likely to be a direct consequence of the increase in ‘benefit-bashing’ programs on TV and intentional policy, something activist groups like disabled People Against the Cuts as well as opposition MPs and the UN itself, have all acknowledged has created a hostile environment towards those on disability benefits. So perhaps the phrase ‘get a job’ highlights my feelings of some projected hostility towards my position out there. But perhaps there is something more to the latent content, it is clear I feel frustrated, my mental health had improved some time ago and 4 years earlier I had been working full time as a taxi driver (I had earlier than that got voices about ‘the knowledge’, although this (I don’t want to go too much into this here) seemed to be related to knowledge about ‘voice hearing’ perhaps that I had previously facilitated a ‘hearing voices’ group, that my PhD was exploring psychosis, so I had some knowledge. I also got voices about McDonalds which sometimes came across saying I should stop worrying about running a business or trying to do my PhD (I had not withdrawn at this point), or stand up for my rights as a carer, but knuckle under, give in to right wing demand and get a job at McDonald’s. But again it is more complex as my wife’s maiden name is McDonald and by this time my daughter’s care had moved to Oxford John Radcliffe, and the parent’s accommodation for the children treated there was funded by the charitable wing of McDonald’s fast food chain and was the name of that accommodation wing), and so on top of getting behind on with the academic demands of my PhD, I was considerably more ill than I had been ever before. So, I was getting annoyed, angry and ashamed with myself that I had taken several steps back from my previous position, which itself had taken a lot of work and effort to get to. But also, there was an element that I just want to get out the house and do something else (I would later get agoraphobia due to the conflicting emotional demands, almost as a form of my body and psyche telling me to just rest). I was sick of the struggling with bills and worrying whether I could pay this month’s rent, and wanted to be earning more than I was getting as an income. But it was quite clear to those around me I was too ill to do so. So again perhaps this phrase reflects confidence issues with regards self-respect for what I do actually do, the hours mentioned with regards the previous voice statement, the very real demands of my daughter’s care, the support I give my partner who also struggles with me, and the severity of how bad I my mental health was and I needed to give myself a break. But if this is part of the latent content, it must be acknowledged that the reason it manifested itself the way it did probably was how bad the hostile political environment was. So there was a wish fulfilment not to be in this frustrated position, an awareness of the political environment, combined with a lack of (and therefore desire for – a want of) recognition for my circumstances and struggle due to social isolation.

So the ‘get a job’ voice and the next voice perhaps need to be dealt with together, and this is where the comments are less overt in their manifestation – ‘Join the Army’. There is perhaps a representative linkage to the voice ‘get a job’, it seems to indicate self-discipline too. It is also what those with few job prospects are supposed to do within certain traditional cultural beliefs. When I was younger, I was in the Air Force cadets, mainly because my grandfather was in the Air Force before, during and after the war. There is also a more personal return to the voice dialogue aspect of the inner critic, an aspect of my 16-year-old self coming to terms with 4 years of school bullying, and this my traumatised self (this voice had a younger appearance) that has since led to my voice hearing. Now this 16-year-old wanted to become a jet fighter. (Join the army). But I was rejected as I was colour blind. On top of this there was the time of hearing this voice I had been amused with regards an event with my son. I often took him out to give my partner a break, so that she could sleep, and one place I often took him to was a hill fort at the top of a steep hill, where we would play being roman’s attacking the ancient Britons, or vice versa. On this occasion I was following my son up the hill but it was feeling very grumpy, my son was walking ahead happy in his toddler world unaware of my feelings behind me, although he had been obstinate earlier, so I had feelings left over from that, some general tiredness, plus the effort of climbing up the hill, yet looking at my son in front I had a sudden strong feeling of love for him, this hapless child ahead of him happy in his own world. My grandpa who had been in the RAF was also a curmudgeonly grump, although he was kind and gentle man, and he had often taken me out to museums, zoos, but especially air shows. He had died around the time I first had my breakdown in the ‘90s. but I found myself wondering whether he had ever felt this way. That moment passed, and my son and I reached the hill fort. We did the usual and ‘attacked it’ running up over the mounds yelling. Then went and looked over the view to the world below, before we made our way back. As we did so, the air show troupe the Red Arrows flew over, again reminding me and giving me strong feelings of my grandpa, almost ‘as if’ a tribute to his memory provided for me by ‘the Real’. So there were feelings for my grandpa at the time, but also my son, and my son was very interested in the army at the time, he would like to get me to read about soldiers and the military to him, and for a Christmas present I went online and bought him a second hand army surplus (ladies, small) military helmet for him to play dressing up games. So, there was an element of ‘join the army’ play. As mentioned before though I had feelings of isolation in my new role as a carer, and with my left-wing leanings there was an element of the ‘Red Army’ indicating the desire to be more politically active and get solidarity through that means. So, again, the latent content indicated isolation and lack of solidarity or recognition.

So the latent content of the wish fulfilment seems concerned with frustration, isolation lack of recognition for the stress and my circumstances, a desire not to be living like this now. It suggested ongoing exhaustion and the need for self-care and to take a break. So it is interesting to note that my notes taken describing this day indicate that the day before I had decided to take a break, to rest, and during the day, an activity I was loathe to do,  preferring to get housework done or catch up on my PhD, it seems I had sat down and watched the film Catch-22.

As we have already observed the view that hearing voices is not necessarily a pathological symptom has already been discussed, as it happens diagnostic tools such as DSM and ICD historically require at least two symptoms only one of which might be hearing voices, so hearing voices alone is theoretically insufficient reason to have a mental health diagnosis. The Hearing Voices Network on its ‘About’ page on its website writes “Hearing voices has been regarded by psychiatry as ‘auditory hallucinations’, and in many cases a symptom of schizophrenia. However not everyone who hears voices has a diagnosis of schizophrenia. There are conflicting theories from psychiatrists, psychologists and voice hearers about why people do hear voices . We believe that they are similar to dreams, symbols of our unconscious minds.” If we turn to Sigmund Freud’s Interpretation of Dreams he famously used his own dreams as source material, and for that reason I shall endeavour to do the same with my own voices (whilst as with Freud leaving some details of a personal nature out). Freud writes:

“Thought is after all nothing but a substitute for a hallucinatory wish; and as it is self-evident that dreams must be wish-fulfilments, since nothing but a wish can set our mental apparatus at work. Dreams, which fulfil their wishes along the short path of regression, have merely preserved for us in that respect a sample of the psychical apparatus’ primary method of working, a method which was abandoned as inefficient. What once dominated waking life, while the mind was still young and incompetent, seems now to have been banished into the night – just as the primitive weapons, the bows and arrows, that have been abandoned by adult men, turn up once more in the nursery. Dreaming is a piece of infantile life that has been superseded. These methods of working on the part of the psychical apparatus, which are normally suppressed in waking hours, become current once more in psychosis and then reveal their incapacity for satisfying our needs in relation to the outside world.
The unconscious wishful impulses clearly try to make themselves effective in daytime as well, and the fact of transference, as well as the psychoses, show us that they endeavour to force their way by way of the preconscious system into consciousness and to obtain control of the power of movement. Thus the censorship between the Ucs. And the Pcs., the assumption of whose existence is positively forced on us by dreams, deserves to be recognized as the watchman of our mental health. Must we not regard it, however, as an act of carelessness on the part of the watchman that it relaxes its activities during the night, allows the suppressed impulses in the Ucs. to find expression, and makes it possible for hallucinatory regression to occur once more? I think not. For even though this critical watchman goes to rest – and we have proof that its slumbers are not deep – it also shuts the door upon the power of movement. No matter what impulses from the normally inhibited Ucs. may prance upon the stage, we need feel no concern; they remain harmless, since they are unable to set in motion the motor apparatus by which alone they might modify the external world. The state of sleep guarantees the security of the citadel that must be guarded. The position is less harmless when what brings about the displacement of forces is not the nightly relaxation in the critical censorship’s output of force, but a pathological intensification of the unconscious excitations while the preconscious is still cathected and the gateway to the power of movement stands open. When this is so, the watchman is overpowered, the unconscious excitations overwhelm the Pcs. and thence obtain control over our speech and actions; or they forcibly bring about hallucinatory regression and direct the course of the apparatus (which was not designed for their use) by virtue of the attraction exercised by perceptions on the distribution of our psychical energy. To this state of things we give the name of psychosis” (p.567-568)

                If we want to give a more contemporary association with modern voice work we might think of the work of those who have found success in Voice Dialogue, as has already been mentioned,, developed for voice hearers from the work of Hal and Sidra Stone, the Talking With Voices therapy developed by psychologists such as Dirk Corsten, Eleanor Longden and Rufus May. In this form of dialogue alienated selves, often including one called the Inner Critic, are invoked, this facet of our multiple selves is supposed to come into our lives early to stop us in advance from feeling such issues as embarrassment (or fear of sanction) or danger, a role as discussed earlier that Freud’s Superego might play. The Stones’ work suggests that this tendency becomes, in many ways, stronger from observing others, however at this moment in the analysis it is sufficient to suggest it is an early ‘watchman’ and hallucinations stem from the attempt of the unconscious to be heard by the conscious, a momentary overpowering of the preconscious (or not so momentary in some cases). In this sense this relates to the relation between latent and manifest content discussed earlier. According to Freud, in dreams the voices try to fulfil a wish, but the ‘watchman’ (the secondary agency) suppresses it, and so the unconscious has to learn to express itself in code, in symbols, in metaphor. If this is the case it should be possible to unpack a psychotic experience using the methods used in Freud’s Interpretation of Dreams. Much work has been done here previously by psychoanalysts, but so much by people who have struggled with psychosis, although it should be noted that Eleanor Longden is a voice hearer herself. There are implications here, Freud stated that he did not believe that the psychotic had enough insight, although Klein and Lacan continued the work on psychosis with varied levels of success.
In Freud’s book The Interpretation of Dreams he used his own dreams on the basis that he wasn’t neurotic. I am using my own experience of voice hearing and thought insertion on the basis that I am psychotic. However, we will both use the current discourse of our time to try to examine these phenomena. In my case the philosophy, psychology and neuroscience has changed and become more complex adding to (and occasionally disproving) the discourse available to Freud at the time.
Back to Freud’s theory though, Freud wrote “In the course of my psycho-analyses of neurotics I already have analysed a thousand dream; but I do not propose to make use of this material in my present introduction to the technique and theory   of dream-interpretation. Apart from the fact that such a course would be open to the objection that these are the dreams of neuropaths, from which no valid inferences could be made as to the dreams of normal people, there is quite another reason that forces this decision upon me. The subject to which these dreams of my patients lead up is always, of course, the case history which underlies their neurosis. Each dream would therefore necessitate a lengthy introduction and an investigation of the nature and aetiological determinants of the psychoneuroses. But these questions are in themselves novelties and highly bewildering and would distract attention from the problem of dreams. On the contrary it is my intention to make use of my present elucidation of dreams as a preliminary step towards solving the more difficult problems of the psychology of the neuroses. If, however, I forgo my principal material, the dreams of my neurotic patients, I must not be too particular about what is left to me. All that remains are such dreams as have been reported to me from time to time by normal persons of my acquaintance, and others as have been quoted as instances in the literature dealing with dream-life. Unluckily, however, none of these dreams are accompanied by the analysis without which I cannot discover a dream’s meaning. My procedure is not so convenient as the popular decoding method which translates any given piece of a dream’s content by a fixed key. I, on the contrary, am prepared to find that the same piece of content may conceal a different meaning when it occurs in various people or in various contexts. Thus it comes about that I am led to my own dreams, which offers a copious and convenient material, derived from an approximately normal person and relating to multifarious occasions of daily life. No doubt I shall be met by doubts of the trustworthiness of ‘self- analyses’ of this kind; and I shall be told that they leave the door open to arbitrary conclusions. In my judgment the situation is in fact more favourable in the case of self-observation than that of other people; at all events we make the experiment and see how far self-analysis takes us with the interpretation of dreams. But I have other difficulties to overcome, which lie within myself. There is some natural hesitation about revealing so many intimate facts about one’s mental life; nor can there be any guarantee against misinterpretations by strangers. But it must be possible to overcome such hesitations. “Tout psychologiste,” writes Delboeuf [1885], “est obligé de faire l’aveu même de ses faiblesses s’il croit par là jeter du jour sur quelque problème obscur.” And it is safe to assume that my readers too will very soon find their initial interest in the indiscretions which I am bound to make replaced by an absorbing immersion in the psychological problems upon which they throw light.’ (p.104-105) As we have observed  with regards the unconscious and the relevance of Freud especially the Interpretation of Dreams, Freud argued that dreams are usually concerned with the previous day but that the censoring part of us means that the part that needs to speak, inform us of our needs, has to do so in code. For our first attempt let’s take some ‘voices’ I hear in one particular day, according to my diary they include statements such as: “Colour blind” “Join the army” “Get a job” and Criticisms of my right to be claiming benefits by a gossip. Let’s work backwards, I had been timesheeting my week to see what I activity I was doing at the time. Given the voices were partially about benefits the n with regards anxiety dreams it seems quite straightforward. In 5 days I pulled 63 hours of child care (including for one of my children who has High Care DLA), house work (affective labour!), PhD work and publishing business, so evidently my right to claim carer’s and have it topped up (as the income generating work is Therapeutic Earnings for only about 5) is legally justified. However, I would like to do more evidently, my business at the time was looking as though it was is close to taking off, but I couldn’t physically put more hours in. This then this was very frustrating. So, then my feelings about myself move from a ‘poor me’ to a ‘bad me’ (in the Richard Bentall sense), and so I seem to have invented as nemesis who is a ‘naïve realist’ but very right wing and prejudiced inner critic. At other times I hear many voices/ alienated inner thoughts and many of them argue with her defending me (as an expression of the solidarity I see out there, however when knackered, miserable and depressed my ego defences fall she ‘walks in’, to do so of course I have had to invent a character/ construct who, symbolically speaking, when confronted with an open door will blame the fact that the door is open for her act of walking through it) but this voice just doesn’t seem to ‘get’ it, even when confronted with her harassment, she defends her right to an opinion, when its pointed out that she is entitled to an opinion but not to harass someone with it, to which she either responds with disrespectful fundamental attribution errors, straw men and ad hominems or she resorts to ‘poor me’ statements, like “silly me”, “oh, it would be my fault” etc . With regards the ‘dream-day’. This period would be around 2014 during the intense period of austerity brought in by the coalition government, around 6 months to a year before the 2015 election that would be one by the Conservative government. So, my social media feed for example would be full of news about the latest example of the punitive austerity regime, as I knew members of both Disabled People Against the Cuts and Recovery in the Bin (this was around the time this second group was formed). If this is manifest content however what could the latent content be. Well, given I was hoping my business was going to take off, perhaps it was a desire not to feel criminalised by the propaganda at the time. As it happens one of the reasons I had moved to the town I was in was the cheap rent, I had done so fed up with being turned down for rentals whenever I moved, I had previously ‘recovered’ and worked full time, so although I had a relapse, I was hoping to be able to use the place as a base to get into paid work where I would be free to move wherever I wanted without having to be worried about the stigma of housing benefit. As it happens writing this later, I am still living in the same place, my mental health having turned worse after my daughter’s birth is improving but I am still unable to work full time. I now get voices that say ‘move’, there are multiple possible reasons for this, but one is the continuing frustration of not being able to ‘avoid’ the stigma if I move. I do not get this voice every day, so the question when I do get it (typing this did not trigger it) is whether there is anything I can trace the day before that would have led to it popping up the next day.
Otherwise the behaviour of the female voice though seems to be similar to games played by those from my childhood who wanted me to ‘be in the wrong’ no matter what I argued, using different strategies to get me into trouble rather than them. A sibling power game. Yet this is an aspect of my own frustration, I am not in regular contact with this family member(s). There are two factor involved here, one my frustration is to do with my limited power, for my unconscious to ‘explain’ the perfectly normal and reasonable frustration of the amount of care and affective labour that I (willingly) do but that (admittedly) frustrates my other dreams that are put on hold, so as Freud argues the secondary agency brings up previous patterns of frustration, or frustrating behaviour. With regards the dream day, we must be honest and remember I am married, my partner also puts in many hours, due to my poor mental health does more of the hospital visits and is exhausted. From observation both myself and my partner often ‘revert’ to habitual behaviour (as opposed to refreshed ‘self-aware’ behaviour) and as my partner who is the same gender as my grandma, mother and sister who all used similar games (although to no extent as severe as the voice behaviour) so she in small-scale, microaggression struggles we have in raising our children exhibits this behaviour as a self-defence mechanism when feeling sensitive and powerless. But, again, in no way as extreme as the voice construct’s behaviour. That I guess is exacerbated by my own ongoing frustration combined with my sensitivity to the hostile political environment. On top of this I also get names of certain ex-girlfriend’s (some more than others) mentioned during periods that this voice comes into play. Although this may involve listening to certain music of my youth (for example) the day before (and I have observed this time interval) rather than the behaviour itself. The last aspect is the presentation of gossip, and in a classic Freudian reversal, whilst the manifest content in part related to certain periods in my late adolescence/ early adulthood where I was the victim of malicious gossip, in fact perhaps it exhibited mine and my partner’s isolation. Not just social isolation but in part the lack of social support we were getting (for our mental health and our daughter’s care needs) due to the service cuts. And my clamouring for some practical support when we were struggling.
In the next post I will continue examining some of these voices, plus examine another voice experience with a more structured narrative than the occasional statements mentioned here.

Das Beste, was du wissen kannst,
Darfst du den Buben doch nicht sagen.
(Goethe – Faust, Part 1 Scene 4)

To take up the question of dream distortion Freud analyses one of his own dreams, the upshot of the interpretation is that it is a dream that presents some affection but seem to be some disguised insult, that is the “distortion was shown in this case to be deliberate and to be a means of dissimulation.” (p.141). Freud suggests that although some dreams are undisguised fulfilments of wishes, “in cases where the wish-fulfilment is unrecognisable, where it has been disguised, there must have existed some inclination to put up a defence against the wish; and owing to this defence the wish was unable to express itself in a distorted shape.” (p.141). Freud attempts to find a social parallel and finds an analogy in situations where there are two persons, “one of whom possess a certain degree of power which the second is obliged to take into account. In such a case the second person will distort his psychical acts, or as we might put it, will dissimulate”. (p.142). This he also relates to politeness and social convention. Freud mentions the obfuscation political writers use to avoid censorship, “the stricter the censorship, the more far-reaching will be the disguise and more ingenious too may be the means employed for putting the reader on the scent of the true meaning. The fact that the phenomena of censorship and of dreams distortion correspond down to their smallest details justifies us in presuming that they are similarly determined. We may therefore suppose that dreams are given their shape in human beings by the operation of two psychical forces (or we may describe them as currents or systems); and that one of these forces constructs the wish which is expressed by the dream, while the other exercises a censorship upon this dream-wish and, by the use of that censorship, forcibly brings about a distortion in the expression of the wish.” (142-144). Freud concludes that everything from the first agency must pass through the second agency to reach consciousness as such “we see the process of a thing becoming conscious as a specific psychical act, distinct from and independent of the process of formation of a presentation or idea; and we regard consciousness as sense organ which perceives data that arise elsewhere.” (p.144). Freud continues, “bearing in mind our assumption of the existence of two psychical agencies, we can further say that distressing dreams do in fact contain something that is distressing to the second agency, but something which at the same time fulfils a wish on the part of the first agency. They are wishful dreams in so far as every dream arises from the first agency; the relation of the second agency towards dreams is of a defensive not of a creative kind.” (p.144-145). As such we cannot understand dreams through the actions of the second agency alone. Freud reaffirms his statement “A dream is a (disguised) fulfilment of a (supressed or repressed) wish.” (p.160).
The application of procedure for Freud’s dreamwork allows him to separate latent from manifest dreams, but the three characteristics of memory in dreams Freud suggests are as follows:
“1. Dreams show a clear preference for the impressions of the previous days.
2. They make their selection upon different principles from our waking memory, since they do not recall what is essential and important but what is subsidiary and unnoticed.
3. They have at their disposal the earliest impressions of our childhood and even bring up detiuls from that period of our life which, once again, strike us as trivial and which in our waking state we believe to have long since forgotten.” (p.163-164). These details are expressed in the manifest content.
With regards characteristic 1., Freud is quite specific, “the question may be raised whether the point of contact with the dream is invariably the events of the immediately preceding day or whether it may go back to the impressions derived from a rather extensive period of the most recent past…. I am inclined to decide in favour of the exclusiveness of the claims of the day immediately preceding the dream – which I shall speak of as the ‘dream-day’. Whenever it has seemed at first that the source of a dream was an impression two or three days earlier, closer enquiry has convinced me that the impression had been recalled on the previous day and thus it was possible to show that a reproduction of the impression, occurring on the previous day, could be inserted between the day of the original event and the time of the dream; moreover it has been possible to indicate the contingency on the previous day which may have led to the recalling of the older impressions.” (p.166). Freud clarifies “the instigating agent of every dream is to be found among the experiences which one has not yet ‘slept on’. Thus, the relations of a dream’s content to impressions of the recent past (with the single exception of the day immediately preceding the night of the dream) differ in no respect from its relations to impressions dating from any remoter period. Dreams can select their material from any part of the dreamer’s life, provided only that there is a train of thought linking the experience of the dream-day (the ‘recent’ impressions) with the earlier ones.” (p.169).
The question with regards voice hearing would be how much the previous 24-hour period affects the next day’s voices manifest content, and the distortion any secondary agency may have on the elucidating the latent content of voice hearing from the manifest content. This takes awareness of the possibility that Freud may be right on this, and from thence reflection on the process. I have done this, and I will use the next article to demonstrate from my own psychotic experience with examples of my own voice hearing. If there is any relation it might then be necessary to question what this secondary agency may be in waking life. As well as updating any issues with Freud with regards advances in modern psychology and therapy. I will also be in future articles pursuing the relation of this secondary agency with regards the Word Salads as described by RD Laing, and signifyin(g) as described by Henry Louis Gates Jr. Before relating it to biopolitics, but first I want to continue looking at Freud and dreams, and its relation to Deleuze and Guattari on the machinic unconscious.

In examining this Royal Road, Freud first clarifies his idea that every dream is a wish fulfilment, he states that people would question this assertion: “’There is nothing new,’ I shall be told, ‘in the idea that some dreams are to be regarded as wish-fulfilments; the authorities noticed that fact long ago… But to assert that there are no dreams other than wish fulfilment dreams in only one more unjustifiable generalisation, though fortunately one easy to disprove…’” (p.134). And Freud suggests that a counter-argument would be distressing anxiety dreams. He responds “It does in fact look as though anxiety dreams make it impossible to assert as a general proposition… that dreams are wish-fulfilments; indeed they stamp any proposition as an absurdity… Nevertheless, there is no great difficulty in meeting these apparently conclusive objections. It is only necessary to take notice of the fact that my theory is not based on a consideration of the manifest content of dreams but refers to the thoughts which are shown by the work of interpretation to lie behind dreams. We must make a contrast between the manifest and the latent content of dreams. There is no question that there are dreams whose manifest content is the most distressing kind. But has anyone tried to interpret such dreams? To reveal the latent thoughts behind them? If not, then the two objections raised against my theory will not hold water: it still remains possible that distressing dreams and anxiety dreams, when they have been interpreted may turn out to be fulfilment of wishes.” (p.135).
Is it this that Deleuze and Guattari question when they state “These indifferent signs follow no plan, they function at all levels and enter into any and every sort of connection; each one speaks its own language, and establishes syntheses with others that are quite direct along transverse vectors, whereas the vectors between the basic elements that constitute them are quite indirect” and yet they seem to acknowledge manifest content when they say “No chain is homogeneous; all of them resemble, rather a succession of characters from different alphabets in which an ideogram, a pictogram, a tiny image of an elephant passing by, or a rising sun may suddenly make its appearance. In a chain that mixes together phonemes, morphemes, etc., without combining them, papa’s moustache, mama’s upraised arm, a ribbon, a little girl, a cop, a shoe suddenly turn up. Each chain fragments of other chains from which it ‘extracts’ a surplus value, just as the orchid code ‘attracts’ the figure of the wasp: both phenomena demonstrate the surplus value of a code. It is an entire system of shuntings along certain tracks, and of selections by lot, that bring about partially dependent, aleatory phenomena bearing a close resemblance to a Markov chain. The recordings and transmissions that have come from the internal codes, from the outside world, from one region to another of the organism, all intersect, following the endlessly ramified paths of the great disjunctive synthesis” The relation to latent content is understood thus: “If this constitutes a system of writing, it is a writing inscribed on the very surface of the Real: a strangely polyvocal kind of writing, never a biunivocalized, linearized one; a transcursive system of writing, never a discursive one; a writing that constitutes the entire domain of the ‘real inorganization’ of the passive syntheses, where we would search in vain for something that might be labelled the Signifier – writing that ceaselessly composes and decomposes the chains into signs that have nothing that impels them to become signifying.” But the clincher where they differ from Freud is this: “The vocation of the sign is to produce desire, engineering it in every direction.” The tendency for desire to engineer in every direction is the relation of Freud’s wish fulfilment to Deleuze and Guattari’s machinism. This is clearly a move towards cybernetics post-Saussure, and Lacan’s working of Freud after Saussure. And for this reason, in a while, it is worth looking at Laing’s understanding of machines as well. However, I would first like to momentarily return to Voice Dialogue and point out that the interpretation of voices by this technique still retains the knowledge that manifest content and latent content are separate. However, to look at this as a biopolitical point of view one must then look at machines in Marx’s Grundrisse, and Foucault’s understanding of the relation of machines to ordo-liberalism as an aspect of biopolitics in order to then return to the use of Voice Dialogue (and CBT for that matter) in contemporary mental health treatment, why one gets widespread policy assent (especially under austerity) and the other still lacks traction. In the meantime, let’s return to Freud’s theory of the dreamwork and its relation to the unconscious.
Upon elucidating the concept of latent and manifest content of dreams to explain wish-fulfilment in anxiety dreams, Freud suggests to effectively interpret the latent content as part of the dreamwork one must ask another question which is “Why is it that dreams with an indifferent content, which turn out to be wish-fulfilments, do not express their meanings undisguised?” that is; what is the origin of dream-distortion?