Thursday, 22 August 2013

At the Limits of Meaning

Here's a neat irony: so often is it said that psychiatric problems are"meaningful" that the statement itself is starting to sound rather meaningless. Used as a rallying cry to focus attention on the content of people's experience rather than viewing its form as a kind of pathology, the "distress is meaningful" idea has become diluted and distorted through careless use. This is a shame as, like most ideas in "critical" psychology and psychiatry, it has a worthwhile core which it is worth staying in contact with.

"Man's Search For Meaning":

Pareidolia: Making Meaning Where None Exists

To say "distress has meaning" can mean the tendency we have to imbue our health problems, like anything we experience, with special significance and form associations to them. In this sense even the most random or the most biologically determined forms of health-problem have "meaning". It is very meaningful to me that I am starting to notice the slow and inevtiable movement of my hairline towards my crown, but this doesn't mean I can halt it by "making sense" of it. More seriously, it is extremely meaningful when people with Alzheimer's start to lose their memory as a result of cortical atrophy, but this is because our grasp on our minds is very significant; it does not mean they are, say, trying to repress something.

The existence of this general sort of meaning making about our lives is uncontroversial and only a rather perverse and callous person would deny it. There is, however, another sense in which distress has been taken to "mean" something, and its conflation with the weaker form above has generated some confusion.

Symptoms as Messages:

Freud was prompted to develop the technique of Psychoanalysis when it began to seem to him that the symptoms of his patients weren't just manifestations of some physical problem ("degeneracy") but were a sort of communication about the contents of their minds.

Conversion Hysteria: Meaning's Search for Expression

Freud and Breuer had noticed that when they encouraged their patients to speak freely--and without the sorts of prohibitions that teenage Viennese girls were normally subject to--their symptoms cleared up (we'll leave for now the question of whether this really took place, and for the reasons they claimed). This led them to conclude that, in some circumstances, the body itself became a channel for communicating the sorts of emotions we normally communicate in speech. Although initially of interest in the case of "conversion hysteria" (a category which has fallen into relative disuse) Freud extended the principle to obsessional behaviour (where obsessions divert the energy created by resisting expressions of desire) and hallucinations (which acted to fulfill a resisted desire).

One result of the Freudian meaning of "meaningful" was that by the middle of the 20th Century, and especially in America, psychoanalysts came to be seen as a cabal of expert decoders, essential to tell us the real underlying meaning of our actions. With the decline of the dominance of this framework there has arisen a new skepticism about what our bodies and minds can ever be said to be telling us about our lives.

Nonetheless this meaning of "meaningful" has its modern counterpart in claims that (for instance) the voices heard in psychosis are expressions of emotions which the hearer has not yet dealt with; that bouts of intense paranoia reflect a feeling of danger which has its root in early experiences. I don't want to deny or defend these claims here, they appear to have their use in some situations and not necessarily in others. Instead, I want to draw attention to the fact that they form a stronger assertion than the more banal observation that everything means something to someone, and that these two can come to be thoughtlessly merged.

Psychoanalysts: The great decoders 

Why does this matter? The weak claim (that everyone's experiences come to have meaning) and the strong claim (that the meanings are central to the phenomena, which can be healed by the right kind of understanding) have different implications for treatment, but to carelessly fudge them allows us to overlook this. If you assert the weak form then you are simply saying we should pay attention to the meaning of people's distress and try to engage with the reasons for it. If you assert the strong form then you are claiming that the right sort of interpretation can essentially dissolve certain forms of distress. This belief can be expected to lead to an anti-medication ethic as people come to see the effects of medication as a violent denial of meaning. Such a belief (which virtually amounts to a superstition) should be kept separate from the very real problem of people being unnecessarily over-medicated and it should also be kept separate from the obvious fact that talking to people about what things mean to them is a kind and helpful thing to do.

Unless we are a bit more rigourous about this separation, it is unclear whether we are saying healthcare professionals should engage with the meaning of people's suffering or whether we are saying that healthcare professionals have a special access to its interpretation. The latter is a rather arrogant claim, promoting dependency on special interpreters with defintive answers, but it can be smuggled in alongside the more benevolent position if we don't look out.

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