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Post-ICOSR II: Limitatations of the current phenomenology of psychosis

At ICOSR I was delighted by multiple opportunities to converse with active neuroscientists; a general lack of attention to the nuances and complications of phenomenology nevertheless troubled me.

The overall impression I walked away with was that certain nosological categories (AVHs for example) have become so thoroughly and invisibly ‘naturalized’ that the vast majority of researchers seem all but completely unable to ‘see’ past them.  Since Berrios & Markova (2012) do a wonderful job of reconstructing major historical influences on the current (‘epistemologically incoherent’) ‘received view,’ I won’t go there myself.  “Sauntering plausibility,” substantial “monetary investments in research,” structural clinical hubris, and inattention to the directional complexities of biology, culture and agentic mediation, are almost certainly all substantial contemporary contributories.   The degree of the disconnect between phenomenal experience ‘itself’ (as elucidated in my own research projects, experience and hearing voices work) and dominant academic conceptualizations nevertheless strikes me, at least on some level, as remarkable.

I regularly listen to descriptions, for example, of “voices” that are in no sense ‘literally’ auditory; that are also “felt” as presences (sometimes in a more tactile way, sometime more ‘affectively’); that are locatable and even agentically moveable or malleable (e.g. can be ‘pushed to one side’); that can occupy very specific parts of the head, brain and/or body; that can be felt passing through membranes, tissue and bones; that may be visual or visualizable; that may alternate or ‘flit’ between modalities; that may derive only from existing sounds, spoken or written words.  Their so-called “verbal” messages may likewise be directly ‘felt’—never taking the form of a spoken or written sentence or word; interpreted verbally or more straightforwardly ‘heard’ or ‘seen’ as words.  The ‘hearing’ of messages may be a dream-like experience, phantastic or phantasied, brutal, possessing, but virtually always characterized by a strength and strangeness that defies metaphor and language in the most intractable ways.   These voices (if the word ‘voice’ does not always already mislead) may be figuratively or literally loud or quiet, complex or simple, recognized or unrecognized (for so many reasons).  Are they more thought-like, more voice-like…?  Both; neither?  Experiencers are rarely sure.

“Delusions” one hears again and again, are often patients’ “explanations” for these voices (an explanatory logic that I assume derives from the often assumed, but obviously problematic, hierarchy of ‘higher order’ cognition vs ‘basic’ or lower order ‘perception’);  again, the lion’s share of “bizarre” beliefs I hear are instead often verbal descriptions (and precisely not ‘explanations’ although we might quibble over the distinction) of experiences that themselves seemingly resist any attempts at reduction to particular (more basic, primitive, ‘animal’) sensory, perceptual, vestibular, proprioceptive or affective domains. Over time, layer adds to layer; there is labeling, description, explanation, interpretation; solo ‘acts’ repeatedly intermixed and intermarried with ‘raw’ experience, with clinical and social interactions, with dialogue, with the cultural imaginary.  And finally, so often, all these experiences are doubled in the most frustratingly inarticulable ways: “real worlds” encased in solipsistic realities;  simultaneities of familiarity and radical unfamiliarity;  perfectly intact logic ‘here’ and its wild negation, suspension or potentiation ‘there’.   Fear, isolation, terror.  Possibility.  All of it.

The point of these descriptions, really not all that complicated, is to emphasize the messiness of phenomenology (or should I say, “of the phenomena themselves”).  Undeniably, distinctions, categories, taxonomies, and so forth are needed and necessary.  The first question is (yes, rhetorical): have we truly selected the most veridical, the most careful, the most phenomenologically coherent distinctions; those most likely to reveal crucial differences, correlates or indications– biologically, etiologically, epidemiologically, clinically or culturally?

If we have not (and this, clearly, is my contention), then we are faced with a series of (non-rhetorical) questions.  Which distinctions, assemblages, gestalts or taxonomic clusters are in fact most relevant, most important?  Further, which distinctions at which temporal or developmental moments? (How, e.g., can we deconstruct ‘background’ and foreground, generative and consequential, primary, secondary and tertiary.) And at which levels of explanation?  How can we move forward (particularly with measurement) given the very serious limitations of extant vocabulary and the possibility that psychotic experience may, in fact, constitutively trouble even those mental distinctions that have held up in other areas of neurology, psychiatry and cognitive neuroscience?  Is there, here, a potentially critical role for ‘experiencers’ who may not be able to provide precise positive accounts of psychosis, but nevertheless effectively play the ‘negative theologian,’ apophatically indicating what madness is not?

These are hefty questions and I do not pretend to have answers.  I would however, like to see researchers grapple with them; not over-simplifying, not ‘running’ with the easy, invisible, accepted distinctions we are all so familiar with.  There are certainly scholars doing this already (my intent is not to deny pockets of very brave work), but not nearly enough of them.

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3 thoughts on “Post-ICOSR II: Limitatations of the current phenomenology of psychosis

  1. Reblogged this on hearingthevoice and commented:
    Some interesting intersections with – and provocations for – three recent papers by Hearing the Voice Researchers: Simon McCarthy-Jones et al Stop, look, listen: the need for philosophical phenomenological perspectives on auditory verbal hallucinations(http://www.frontiersin.org/Human_Neuroscience/10.3389/fnhum.2013.00127/abstract); Simon McCarthy-Jones et al, A New Phenomenological Survey of Auditory Hallucinations: Evidence for Subtypes and Implications for Theory and Practice (http://schizophreniabulletin.oxfordjournals.org/content/early/2012/12/18/schbul.sbs156), and Angela Woods’ work on the Taxonomy of Voice-Hearing (http://www.ustream.tv/recorded/31406985) and Simon McCarthy-Jones et al’s recent paper on subtypes of AVH

  2. Pingback: This month in voices: March 2013 | This month in voices

  3. Pingback: Our Inner Voices | Neuroanthropology

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