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Saturday, December 2, 2017

Badiou, the Event, and Psychiatry, Part 2: Psychiatry of the Event

Badiou, the Event, and Psychiatry, Part 2: Psychiatry of the Event

Blog of the APA
American Philosophical Association
 Published 30.11.2017

  
Associate Editor: Nathan Eckstrand, PhD


Badiou, the Event, and Psychiatry

Vincenzo Di Nicola


Part II: Psychiatry of the Event

What will philosophy say to us? It will say: “We must think the event.” We must think the exception. We must know what we have to say about that which is not ordinary. We must think change in life.
—Alain Badiou, Polemics (2006, p. 8)

Just as Badiou rejected what he calls subjective phenomenology, following his work, I criticized what I call “trauma psychiatry.” While Badiou holds that philosophy must be reckless, psychiatry as both Nietzsche and Jaspers brilliantly pointed out must be prudent and balanced, in the spirit of the Greeks’ sophrosyne. The psychiatrist needs to be methodologically up-to-date, a good communicator, attentive and empathic, and a role model, Nietzsche recommended. This is not enough, he must acquire the skills of “every other profession” (Nietzsche, cited by Jaspers, 1997). Clearly, something stands apart from the requirements (conditions) and skills and that is the core of psychiatry. For Jaspers (1997, p. 808), a psychiatrist who turned to philosophy, that was a combination of “scientific attitudes of the sceptic with a powerful personality and a profound existential faith.” Another physician-philosopher, William James (1890), referred to a similar duality of tough-minded empiricism and tender-minded rationalism.

Integrating the balance that psychiatrists need in practice with the boldness that Badiou calls for in philosophy, I called for an evental psychiatry in my doctoral dissertation (Di Nicola, 2012). The first fruits of this project are on a broader canvas, a course on psychiatry and the humanities which we pioneered at the University of Montreal (see my previous APA blog), and in more detailed form, presentations in various fora and two chapters: “Two trauma communities” which discerns a critical tension between clinical and cultural views of trauma (Di Nicola, in press, b) and “Pedagogy of the Event,” analyzing medical and psychiatric education in light of Badiou’s theory of the event (Di Nicola, in press, a). A more complete statement of my evolving project is available online: “Slow Thought: A Manifesto for a Psychiatry of the Event” (Di Nicola, 2014). 




An Evental Psychiatry of the Threshold   

Evental psychiatry describes a psychiatry that would be singular, radically contingent, inherently unstable and unpredictable. A psychiatry that is irreducible to categories and essences, open to what Badiou calls in French novation. Evental psychiatry works at the site where singularity can exist, novelty comes into being, and change may occur (developed in my doctoral dissertation with Badiou, Di Nicola, 2012).

I anticipated the event in psychiatry by describing the predicament (Di Nicola, 1997) as an alternative to categorical diagnosis. The predicament is unstable, unpredictable, pregnant, and morally charged. The predicament is not the event, but it is akin to Badiou’s notion of the evental site. The predicament occurs in a moment of rupture—it could open possibilities and thus become an event which the faithful subject maintains. While a predicament is not trauma or traumatizing per se, mishandling a predicament could trigger trauma.

An evental psychiatry would deal with threshold people in liminal situations—crossing over, arriving and departing, émigrés, immigrants, refugees of all sorts, people “betwixt and between,” in transitional states (Di Nicola, 1997), what philosopher Thomas Nail describes in his seminal work on the migrant and the border (2015, 2016). Not trauma psychiatry, that has categorized stress and trauma with the notion of Post-Traumatic Stress Disorder (PTSD), but a psychiatry concerned with “orphan cases” that addresses the liminality arising from predicaments and the threshold people it creates. People caught between subjectivation (the theme of Foucault’s work) and desubjectivation (the thread through Agamben’s work that connects him to Foucault). Albert Camus’ étranger was such a person as was Robert Musil’s “man without qualities.” Samuel Beckett’s characters are such people: “We can’t go on, we must go on.” Walter Benjamin was himself such a person and I sense a kind of wistful self-recognition in his portrait of “porosity” in Naples (Benjamin and Lacis, 2007). What is porosity in a city is reflected in the liminality of its denizens. And it is possible to imagine this more positively than Agamben’s (2005) “state of exception.” Like Simone Weil, who was rapturous about being displaced and counseled that one should uproot the tree of one’s life to make a cross of it, there is no “here” for such people, torn between affiliation and uprooting. The Canadian sensibility—dispersed among the Native Peoples, “the founding races,” and the rest of us—was framed by Northrop Frye (1995, p. 220) not as who we are but, “Where is here?”

The categorical system of psychiatry demands definitions for “caseness” with criteria for inclusion and exclusion—“brackets” in our jargon—which create boundaries, regardless of construct validity or even face validity, and the creation of “orphan cases” that do not easily fall within the boundaries. This creates the pseudo-problems of “comorbidity” and “complexity.” The complexity recognized by such a system is not the complexity of lived human experience or even the attempt to understand it but rather the complexity of shoehorning experience into categories. What falls in between or among defined categories is explained away by comorbidity (“fleas and lice,” as they say in internal medicine), leading to “complexity” and ultimately to “orphan cases.” The most common diagnosis within each diagnostic group is “NOS,” Not Otherwise Specified. That creates a lot of orphan cases for a system whose major goal is a coherent and reliable diagnostic system.

Hence the study of orphan cases is always a challenge for diagnostic systems, categorical thinking and typologies of all kinds. Orphan cases in medicine and psychiatry are what the state of exception is to political theory, and for analogous reasons, just as the exception becomes the norm, orphan cases force the creation of new categories or new ways of thinking. Orphan cases create a rupture in established systems of thought.

Categorical psychiatry becomes obsessed with measurement and with questions of reliability: inter-rater and intra-rater reliability (across raters and across time) and predictability. An evental psychiatry is more concerned with truth procedures and with questions of validity—not if it is measurable and repeatable but whether it is valid and true.

Rupture versus Continuity

Most definitions of mental health revolve around emotional stability and social functionality but these are at odds with the event. To be stable and functional by ordinary measures means to avoid ruptures, events, and the radical reorganization they engender. The entire subtext of DSM psychiatry is that health is continuity, translated as functionality and adaptation. “Life events” or stressors are ruptures that create, minimally, transitory “adjustment disorders” or more serious “mental disorders.” In evental psychiatry, rupture is the prerequisite for the possibility of event. So-called “life events”—the incidents and interruptions of normal life we call stressors—are necessary precursors to events.

One of the implications is that diagnosis as we currently understand and use this notion would not be a fundamental part of an evental psychiatry. None of the challenges to academic psychiatry concurs with its nosography. In fact, that is the first practical impact of every new theory. Pavlovian psychiatry had a radically different approach to psychiatric diagnosis, as did behaviorism based on learning theory and systemic family therapy. Except in the synthesis called psychodynamic psychiatry, psychoanalysis and academic psychiatry also have different and, since DSM-III, incompatible diagnostic schemas. A nosography based on neuroscience would also reconfigure what academic psychiatry considers the core phenomenology of psychopathology.

Discourse Therapy

Evental psychiatry’s therapy would be a kind of “Ideology Therapy” as a form of discourse analysis. Any form of “talk therapy” deals directly with ideology. This is evident not only in the sense that it deploys ideology as part of its method or technique and not only because the non-intended effects work through expectations and other unintended or unannounced influences but because it directly addresses beliefs, perceptions, motivations, ways of perceiving and understanding experience.

In classical psychoanalysis, for example, interpretations shape the patient’s understanding (insight) of their experience by analyzing defense mechanisms (already an interpretation of human experience). In cognitive therapy, cognitive schemas are posited (already a theory of mind) about how the individual perceives the world and his own experience and schemas are confronted, shaped and changes to schemas are recommended. As a clinician, I often question this in practice, which is to say, theory aside, clinicians easily misunderstand their patients. As the old joke goes, even paranoids have real enemies. It is intriguing that Lacan saw “philosophical systematization as akin to paranoia” (Badiou, 2011, p. 64). The psychoanalytic notion that everything is analyzable, that all is grist for the mill and that there are no accidents, slips or lapsi, in short, that there is no contingency in the psychoanalytic world-view is hermetic and slightly paranoid. In practice, psychoanalytic interpretations have more than a little of the paranoid as a stance. Perhaps any form of systematization runs the risk of being a hermetic system that is suspicious of alterity and change. This has been a key charge against psychoanalysis from the beginning, expressed with cynical humor by Karl Kraus, (“Psychoanalysis is that disease which considers itself its own cure”) and with sustained and pertinent critiques from philosophers of science and scientists. The most notable of the sustained critiques was by philosopher Karl Popper who established different truth procedures, falsifiability and verifiability, as standards for science and this has been echoed by philosopher-scientists like Mario Bunge and scientists like Peter Medawar. My answer to this is uncomplicated: psychoanalysis is not a scientific procedure. It is, in Badiou’s schema, a different truth procedure, that of love. Psychoanalysis is neither science nor philosophy but something new. Just as it cannot suture philosophy, psychoanalysis cannot be sutured to science or psychiatry.

Foucault (1972) described discourses as systems of thought that systematically form the subjects and the worlds of which they speak. Unlike Wittgenstein’s ladder, you cannot throw away the discourse or apparatus after you have used it. There is no illusion here that we can bracket it out or rid ourselves somehow of ideology. To do philosophy or therapy à la Foucault or Agamben would mean precisely to keep all the ladders and other apparatuses around us in plain view so we know how we got to where we are. In other words, we should eschew illusions. It is like theatre without the fourth wall. There is no recourse to hidden discourses, no “magic bullet” and no philosopher’s stone.

Evental Analysis

Such a therapy would tend towards a flattening of the hierarchy of knowledge and power, as Foucault construed it. The face-to-face encounter that Levinas described can never be altogether symmetrical but we identify the asymmetry as much as possible and negotiate the differences. Psychoanalysis is being conceived more and more as a “bipersonal field” and so much work is going on in this field that Werner Bohleber (2010) refers to an intersubjective turn.

An analysis of subjectivation, desubjectivation and resubjectivation following the models of Foucault and Agamben would be valuable. And of course, an analysis of subjectizable bodies following Badiou’s (2011) schema. The kind of philosophical archaeology that Foucault and Agamben have conducted must be conducted for each person’s predicament. Discourse therapy would examine the nested hegemonies that lie side by side, one obscuring the other, one justifying the other sometimes. Often, they are buried, like landmines, and our task is to locate them, map them, and either avoid them or disarm them.

Evental analysis or discourse therapy would apply what I dubbed Badiou’s shears to clarify the task of therapy, unsuturing psychiatry from its conditions. Then, one would do an evental analysis of the person’s world: the evental site, the type of subjectizable body, what processes are in place. An evaluation of the person’s porosity, her capacity for novation would be valuable, along with the extent to which trauma interferes with that porosity.

Let me elaborate with one detailed example. The way psychoanalysis explains its own functioning can be enhanced using evental analysis. Insight, the goal of psychoanalysis, requires fidelity. A rupture occurs in the analysand’s understanding of herself, then a reorganization follows that insight. James Joyce, who was influenced by Freud through the first Italian psychoanalyst, Edoardo Weiss, called this an epiphany. Joyce’s epiphany is Freud’s insight and may be understood as something that occurs in the evental site, which I call a predicament. The epiphany or insight is a response to the predicament. We could go so far as to say that the predicament, the evental site, is a necessary condition for insight. Only a cut, a tear in the world can create the acute sense of a rupture that requires a response. Once the analysand has her epiphany, thoughts, actions and feelings are at first interpreted, and later experienced, differently. For this translation from interpretation to insight to new experience to occur, a deep fidelity must accompany the procedure.

As with Badiou’s theory of the event, real change cannot occur without fidelity. Fidelity is what binds the insight into a world. The psychoanalytic event is insight. But any analyst can relate anecdotes of pseudo-insights, passing insights (“truths-of-the-moment”), insights that merely mimic the analyst’s worldview (transference), without being understood, integrated and lived with fidelity. Genuine healing can only come with this more complete insight—embodied, enacted insight that emerges from the analytic relationship. Healing in this sense is not operational or instrumental change, nor is it merely symptomatic relief. This reflection addresses one of the most difficult questions in any kind of therapy: how to maintain the gains, however defined. We need Badiou’s theory of the event because psychiatry needs a theory of change: how novation comes into the world and how to live with that change.

Conclusion: A New Opening

After radically redefining clinical psychiatry by introducing the phenomenological method, Karl Jaspers promptly left clinical practice, leaving others to work out the implications for psychiatry. Turning to philosophy, Jaspers brought to philosophical puzzles the insights of psychiatry. For example, Hannah Arendt’s (2006) famous formulation of Eichmann as “the banality of evil,” was taken from Jaspers’ correspondence with her.

In a similar gesture, after writing his Tractatus, perhaps the most famous and provocative work of philosophy of the last century, Wittgenstein (1922) concluded that he had resolved the problems of philosophy and abruptly abandoned academic philosophy even before it was published. Proving once again the wisdom of Jaspers’ admonition about philosophical hubris, Wittgenstein was to revisit the Tractatus in his Philosophical Investigations (1953) and other reflections on psychology, offering philosophy as therapy. 

Badiou challenged me to confront the puzzles of contemporary psychiatry by either abandoning it or boldly announcing a new vision based on the event. Accepting Badiou’s challenge, I chose to avoid Jaspers’ and Wittgenstein’s extreme gestures. As a late-career psychiatrist and an early-career philosopher, re-visioning psychiatry through the event is a philosophical prescription for both radical change in psychiatry and firm fidelity to track it through.

What could be more critically relevant to a 21st century science of the mind and of human relations than a return to metaphysics?

References

Agamben, Giorgio (2005). State of Exception, trans. by Kevin Attell. Chicago: University of Chicago Press.

Agamben, Giorgio (2009). Philosophical Archaeology, in The Signature of All Things: On Method, trans. by Luca D’Isanto with Kevin Attell. New York: Zone Books, pp. 81-111, 119-121.

Amichai, Yehuda (2000). Open Closed Open, trans. by Chana Bloch and Chana Kronfeld. New York: Harvest/Harcourt.

Arendt, Hannah (2006). Eichmann in Jerusalem: A Report on the Banality of Evil, Introduction by Amos Elon. London: Penguin Books.

Badiou, Alain (2005). Being and Event, trans. by Oliver Feltham. London: Continuum.

Badiou, Alain (2006). Polemics, trans. and with an introduction by Steve Corcoran. London: Verso.

Badiou, Alain (2008). Conditions, trans. by Steven Corcoran. London: Continuum.

Badiou, Alain (2009a). Logics of Worlds, Being and Event II, trans. by Alberto Toscano. London: Continuum.

Badiou, Alain (2009b). Pocket Pantheon: Figures of Postwar Philosophy, trans. by David Macey. London: Verso.

Badiou, Alain (2009c). Theory of the Subject, trans., and with an introduction, by Bruno Bosteels. London: Continuum.

Badiou, Alain (2011). Second Manifesto for Philosophy, trans. by Louise Burchill. Cambridge, UK: Polity Press.

Badiou, Alain and Tarby, Fabien (2013). Philosophy and the Event, trans. by Louise Burchill. Cambridge, UK: Polity Press.

Benjamin, Walter and Lacis, Asja (2007). Naples, in Reflections: Essay, Aphorisms, Autobiographical Writings, trans. by Edmund Jephcott, ed. with an introduction by Peter Demetz, Preface by Leon Wieseltier. New York: Schocken Books, pp. 163-173.

Binswanger, Ludwig (1958). The Case of Ellen West: An Anthropological-Clinical Study (trans. by Werner M. Mendel & Joseph Lyons), in Existence: A New Dimension in Psychiatry and Psychology, eds. Rollo May, Ernest Angel and Henri F. Ellenberger. New York: Basic Books, pp. 237-364, 293-294

Bohleber, Werner (2010). Destructiveness, Intersubjectivity, and Trauma: The Identity Crisis of Modern Psychoanalysis. London: Karnac Books.

Di Nicola, Vincenzo (1997). A Stranger in the Family: Culture, Families, and Therapy. New York & London: W.W. Norton & Co.

Di Nicola, Vincenzo (2011). Letters to a Young Therapist: Relational Practices for the Coming Community. New York & Dresden: Atropos Press.

Di Nicola, Vincenzo (2012). Trauma and Event: A Philosophical Archaeology. Doctoral dissertation, Saas-Fee, Switzerland: European Graduate School.

Di Nicola, Vincenzo (2014). Slow Thought: A Manifesto for a Psychiatry of the Event, Parts I & II. https://www.academia.edu/8645094/Slow_Thought_A_Manifesto_for_a_Psychiatry_of_the_Event_Parts_I_and_II_of_III_

Di Nicola, Vincenzo (in press, a). Pedagogy of the event, in Žižek and Education, ed. by Antonio Garcia, Foreword by Creston Davis, Afterword by Slavoj Žižek. Rotterdam, Netherlands: Sense Publishing, “Transgressions: Cultural Studies and Education” Series.

Di Nicola, Vincenzo (in press, b). Two trauma communities: A philosophical archaeology of cultural and clinical trauma theories, in Trauma and Transcendence: Limits in Theory and Prospects in Thinking, eds. Peter T. Capretto and Eric Boynton. New York: Fordham University Press.

Fanon, Frantz (1963). The Wretched of the Earth, trans. by Constance Farrington. New York: Grove Press.

Fanon, Frantz (1967). Black Skin, White Masks, trans. by Charles Lam Markmann. New York: Grove Press.

Feyerabend, Paul (2010). Against Method, Fourth Ed., Introduced by Ian Hacking. London: Verso.

Feyerabend, Paul (2011). The Tyranny of Science, Edited, and with an Introduction, by Eric Oberheim. Cambridge, UK: Polity Press. 

Fodor, Jerry (2000). The Mind Doesn’t Work That Way: The Scope and Limits of Computational Psychology. Cambridge, MA: MIT Press.

Foucault, Michel (1972). The Archaeology of Knowledge and the Discourse on Language. London: Tavistock Publications.

Foucault, Michel and Binswanger, Ludwig (1993). Dream and Existence, ed. by Keith Hoeller. Humanities Press.

Frye, Northrop (1995). The Bush Garden: Essays on the Canadian Imagination, Second ed., Introduction by Linda Hutcheon. Toronto: House of Anansi Press.

Gould, Stephen Jay (1981). The Mismeasure of Man. New and London: W.W. Norton and Company.

Heidegger, Martin (2008). Being and Time, trans. by John Macquarrie and Edward Robinson, Foreword by Taylor Carman. New York: HarperPerennial.

Husserl, Edmund (2012). General Introduction to Pure Phenomenology, trans. by W.R. Boyce Gibson, Introduction by Dermot Moran. London: Routledge.

Insel, Thomas R. and Landis, Story C. (2013). Twenty-five years of progress: the view from NIMH and NINDS. Neuron, 80(3): 561-7.

James, William (1890). Principles of Psychology, Vols. I and II. New York: Henry Holt and Company.

Jaspers, Karl (1997). General Psychopathology, Vols. I and II, trans. by J. Hoenig and Marian W. Hamilton, with a new forward by Paul R. McHugh, M.D. Baltimore and London: The Johns Hopkins University Press.

Kahneman, Daniel (2011). Thinking, Fast and Slow. New York: Farrar, Straus and Giroux.

Knowles, John H., ed. (1977). Doing Better and Feeling Worse: Health Care in the United States. New York and London: W.W. Norton & Co.

Laing, R.D. (1960). The Divided Self: An Existential Study in Sanity and Madness. London: Tavistock Publications.

Laing, R.D. (1961). The Self and Others. London: Tavistock Publications.

Laing, R.D. and Cooper, D.G. (1964). Reason and Violence: A Decade of Sartre’s Philosophy, 1950-1960. London: Tavistock Publications.

Lasch, Christopher (1991). The True and Only Heaven: Progress and Its Critics. New and London: W.W. Norton and Co.

Malabou, Catherine (2012). The New Wounded: From Neurosis to Brain Damage, trans. by Steven Miller. New York: Fordham University Press.

Mannheim, Karl (1936). Ideology and Utopia: An Introduction to the Sociology of Knowledge, trans. by Louis Wirth and Edward A. Shils. New York: Harvest Books/Harcourt reprint.

Nail, Thomas (2015). The Figure of the Migrant. Stanford, CA: Stanford University Press.

Nail, Thomas (2016). Theory of the Border. 2016. Oxford, UK: Oxford University Press.

Pinker, Steven (1997). How the Mind Works. New York and London: W.W. Norton and Co.

Sartre, Jean-Paul (1956). Being and Nothingness, trans. by Hazel E. Barnes. New York: Methuen.

Sartre, Jean-Paul (2002). A Sketch for a Theory of the Emotions, Preface by Mary Warnock. London: Routledge Classics.

Sparrow, Tom (2014). The End of Phenomenology: Metaphysics and the New Realism. Edinburgh: Edinburgh University Press.

Wittgenstein, Ludwig (1922). Tractatus Logico-Philosophicus, trans. by C.K. Ogden, Introduction by Bertrand Russell. London: Routledge & Kegan Paul.

Wittgenstein, Ludwig (1953). Philosophical Investigations, trans. by G.E.M. Anscombe. London: MacMillan Publishing.

Žižek, Slavoj (2014). Event: Philosophy in Transit. London: Penguin Books.

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Badiou, the Event, and Psychiatry, Part 1: Trauma and Event

Badiou, the Event, and Psychiatry, Part 1: Trauma and Event

Blog of the APA
American Philosophical Association
 Published 23.11.2017

  
Associate Editor: Nathan Eckstrand, PhD


Badiou, the Event, and Psychiatry

Vincenzo Di Nicola

Part I: Trauma and Event

Philosophy is either reckless or it is nothing.
—Alain Badiou, Second Manifesto for Philosophy (2011, p. 71)

Instead of being reckless, as Badiou demands of philosophy, by which he means a bold and fearless program of innovation and change, psychiatry has become feckless, lacking courage, retreating into scientism and methodolatry, with no clear program or way forward.

In this atmosphere, already a full professor of psychiatry with classical training in psychology, psychiatry and psychoanalysis, I decided that psychiatry could not resolve its issues through more empirical research and sterile debates, so I turned to my first love, philosophy, inspired by psychiatrist-philosopher Karl Jaspers’ admonition in his re-visioning of psychiatry based on Edmund Husserl’s phenomenology (2012). At the end of his magisterial General Psychopathology that defined modern clinical psychiatry a century ago, Jaspers (1997) warned:

If anyone thinks he can exclude philosophy and leave it aside as useless he will be eventually defeated by it in some obscure form or other (p. 770).

Let’s look at this malaise from both sides—psychiatry and philosophy. Psychiatrists are living the curse of the best of times and the worst of times! We have never had so much diversity of clinical approaches, so many promising research projects along different lines, and yet there is malaise within the profession and mixed reactions from colleagues in the humanities. This malaise is captured in the resonant title of a volume on health care in the US—“doing better and feeling worse” (Knowles, 1977). 

Why? Besides the debate about funding health care, which is at a boiling point in the USA and simmers elsewhere as well, there is within the profession of psychiatry a schism as to how to conceive of “psychopathology,” or how we conceive of mental illness. One way that Western academic psychiatrists are casting this debate is whether to persist in refining clinical criteria for defining “psychiatric disorders” with the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, now in its fifth iteration, or the Research Domain Criteria (RDoC) of the National Institute of Mental Health, until recently led by Thomas Insel, based not on clinical descriptions but on putative genetic and neuroscientific factors (Insel & Landis, 2013).

Among philosophers, there is a great divide as to questions about psychiatry, the mind, and related matters. Theorists in the “Continental” or critical theory tradition have largely addressed psychiatry through psychoanalysis, notably Lacanian psychoanalysis (e.g., Alain Badiou and Slavoj Žižek), or phenomenology, including Michel Foucault who trained first as a psychologist and translated Ludwig Binswanger’s Dream and Existence (1993) from German into French, adding a lengthy introduction. Much of Foucault’s later project, investigating aspects of the history of psychiatry and the deployment of “psychiatric power” is already on evidence there.

Theorists in the Anglo-American “analytic” or linguistic tradition, on the contrary, basically declared psychoanalysis a pseudo-science, including Karl Popper and Roger Scruton, and the attention to psychiatry, psychology and related disciplines including psychoanalysis has been via philosophy of science and is now focused on cognitive neuroscience by such stalwarts as Jerry Fodor, Daniel Dennett, and Patricia Churchland. This approach often combines with a narrow and highly selective view of the “progress of science.” This positivistic notion, reflecting Auguste Comte’s famous dictum, “Order and progress,” has been at the heart of trenchant critiques in the philosophy of science (Paul Feyerabend, 2010, 2011), the humanities (Christopher Lasch, 1991), and even within the paradigm of the life sciences (Stephen Jay Gould, 1981).  The Continental tradition sees this paradigm at best as mere empiricism (or observation) and at worst as scientific positivism.

There are, of course, many crossovers between and among these schools of thought, including one of my professors, Catherine Malabou (2012) who was a student of Derrida and now focuses her philosophical work on plasticity in experimental and clinical neuroscience.

I decided to examine nothing less than the history of modern psychiatry and its relationship to philosophy by investigating trauma. During my seminars with Alain Badiou (2005, 2009a), I was struck by the symmetry between his description of the event as an opening and my emerging understanding of trauma as a rupture. When I consulted him, Badiou immediately recognized trauma/event as a fresh and innovative pairing and contrast.

Badiou’s Four Conditions

One of Badiou’s (2008) seminal contributions is to delineate the four conditions of philosophy
art (aesthetics), love (which includes psychoanalysis, or in my view, all that is relational and contextual, what Badiou calls the multiple), science (mathematics, physics), and politics (broadly conceived as ways of communal living).

Philosophy itself doesn’t generate truth but serves as the rubric under which the conditions present the truth through their truth procedures. A key consequence is that philosophy cannot be “sutured” to its conditions. Philosophy cannot be simply reduced to one or another truth procedure. Philosophy is not merely political philosophy or aesthetics or ethics or logic, say. So, for example, Badiou would not agree with Emmanuel Levinas’ stance that “ethics precedes ontology” or ethics as a “first philosophy,” suturing philosophy to ethics.

Psychiatry has its own conditions or, to communicate with colleagues in my community of practice, I would refer to psychiatry as a discipline with sub-disciplines. Psychiatry has many sub-disciplines, whose salience and impact change over time, depending on the contemporary problems that the discipline addresses, and they range from the social determinants of health and epidemiology to genetics and neuroscience. Along the way, psychiatry has benefitted from sub-disciplines as diverse as psychoanalysis and social and transcultural psychiatry.

My argument is that like philosophy, psychiatry cannot resolve its truth claims on its own. It can only use its sub-disciplines to generate truth claims. But psychiatry’s current crisis is that it is precisely sutured to one approach to truth, represented today by genetics and neuroscience using its chosen “gold standard” of evidence-based medicine (EBM). Yet, while neuroscience is a potentially valuable sub-discipline (notwithstanding it’s inflated claims and oversold promise—as one leading psychiatrist told me, it’s “aspirational”), EBM is hollow. It’s just a rhetorical restatement of the positivistic paradigm, elevating the notion of objective data as the “gold standard” for truth.

My two fundamental critiques of EBM address the scientism and methodolatry of psychiatry and the social sciences today by posing the questions: How can we evaluate the salient evidence in psychiatry? More critically, just what evidence is salient?

Evaluating the evidence. In the first critique, EBM isn’t so much scientific as scientistic, mimicking the practices of sciences rather than its spirit of inquiry. For example, the Society for the Study of Psychiatry and Culture, which straddles psychiatry as a medical discipline and the study of culture as a social science, demands that submissions be organized by the experimental model of hypothesis, methods, results; this is clearly not an adequate model for qualitative studies in psychiatry, not to mention the narrative and participatory approach of cultural studies.

Now, even if we grant EBM its premises, my mathematical metaphor is that EBM places us at an asymptote. EBM simply puts some selected studies on the table for consideration and while this is valuable and useful in a limited way, it does not get us all the way there. In the best case, even if we accept its truth procedures to arrive at the evidence, EBM takes us closer to the crucial point, but never breaches the chasm from observation to truth.

Clarifying the available information in a critical way, the clinician can then confront the clinical dilemma: How to diagnose the problem and what interventions are indicated based on a critical review of the available evidence? Here is where we reach an asymptote—at a certain point, no matter how close EBM gets us, we still have to make a subjective judgement using all the complex processes involved in human judgments. And that is the corollary of how to evaluate the evidence: the psychology of human judgments.

The notion that these can be reduced, explained, or revealed somehow is ephemeral. While EBM offers a procedural method, genetics and neuroscience offer seductive sub-disciplines (even though they only indirectly address psychiatry’s core concerns), and cognitive psychology pretends to offer the gold standard for how humans think (Pinker, 1997) and solve problems [or are bedeviled by such problems, as both Ludwig Wittgenstein (1953) and Daniel Kahneman (2011) would have it], we cannot breach the gap. Even if we grant EBM all that it claims (and to be clear, I do not), it only highlights the crucial point that clinical judgements are inescapably human, that is to say, subjective. “Subjective” here not only means subject to error but, even more importantly, that it is a human construction. What cognitive science has done, at its best, is to outline the parameters of that construction, notably in the brilliant work of Nobelist Daniel Kahneman (2011) and his associate Amos Tversky.

What evidence? My second critique is more trenchant. Since it is purely procedural and cannot account for how proper research questions are generated or how they become dominant (the domains of Karl Mannheim’s “sociology of knowledge,” 1936), I do not grant that EBM can answer the question about what is to be construed and accepted as evidence. And, as Wittgenstein (1953) observed about psychology, the truth claims of psychology and psychiatry are not easily resolved by experimental methods:

The existence of the experimental method makes us think we have the means of resolving the problems that trouble us; though problem and method pass one another other by (p. 232).

Believing that the questions of the definition and tasks of psychiatry can be resolved by the experimental or any other method or procedure is methodolatry. Even before we consider methods, we must define in a philosophical sense what psychiatry is, what its concerns are, independent of the current tools at hand. That is what refusing to suture psychiatry to its sub-disciplines really means. And today’s temptation for suturing psychiatry to one of its sub-disciplines isn’t science, it’s scientism and methodolatry. As Jaspers (1997) concluded in his textbook of psychiatry, the effort to avoid philosophy will only result in its coming back to haunt us in some way or other.

All of this brings us to clarify psychiatry’s central task which requires three things:

1)    a general psychology as a science of human being;
2)    a coherent theory of psychiatry as a discipline; and
3)    because it proposes to help people, it needs a theory of change.
To state this more broadly, any helping profession, any approach to human problems, needs to explain three things:

·      How people function [normal psychology—cognitive scientist Steven Pinker (1997) calls it “how the mind works,” but I would not limit it to “mind,” I would minimally address mind, brain, behavior and relations—these four domains are not reducible one to the other; philosophically we can ask what is a person or what is a subject? One of Pinker’s critics, philosopher Jerry Fodor (2000), wrote a rejoinder called, The Mind Doesn’t Work That Way].

·      How problems arise (a theory of psychiatry beyond clinical descriptions or “phenomenology,” as it has come to be known in psychiatry).

·      What the conditions of change are (including what is change and how does novelty arise in human experience?).

So, Badiou offers three profound things to psychiatry:

1)    first, he offers a theory of the subject (Badiou, 2009c), essential in any human psychology;
2)    second, his theory of how philosophy works (Badiou and Tarby, 2013), with its conditions and truth procedures (Badiou, 2008), offers a way to clarify what is proper to the discipline of psychiatry and what are its sub-disciplines;
3)    third, he offers a theory of change based on the event (Badiou, 2005, 2009a), which is sorely lacking in psychiatry.

In Badiou’s work, these issues are connected. In my reading of Badiou, the three conditions for an event are: To encounter an event (which is a purely contingent encounter), to give it a name, and to be faithful to it. The subject emerges through the event. By naming it and maintaining fidelity to the event, the subject emerges as a subject to its truth. It is not mere change: what was contingent becomes a necessity (Žižek, 2104). “Being there,” as subjective phenomenology would have it, is not enough.
Phenomenology and Psychiatry

Badiou offers a new, objective phenomenology to replace the phenomenological epoché that is at the heart of Husserl’s subjective phenomenology. Now this is a rather far-reaching project. To understand how far, let’s examine how some major streams of European philosophy and psychiatry flowed into each other.

In every generation since Edmund Husserl (whose own teacher Franz Brentano was also Freud's teacher), there has been a rich dialogue between philosophers and psychiatrists: 

Philosophers                                                  Psychiatrists

Edmund Husserl (2012)                               Karl Jaspers, General Psychopathology (1997)
Epoché – Subjective Phenomenology            – Phenomenological psychiatry

Martin Heidegger, Being and Time (2008)  Ludwig Binswanger, “The Case of Ellen West”
Dasein                                                             (1958), Dream and Existence (1993)                           
                                                                        – Daseinanalyse – Existential analysis

J.-P. Sartre, Being and Nothingness (1956) R.D. Laing, The Divided Self (1960), The Self and
Existentialism         Others (1961), Reason and Violence (1964)                                                                         – Social phenomenology
Frantz Fanon, Black Skins, White Masks (1967), The Wretched of the Earth (1963)                                             – Revolutionary psychiatry
Alain Badiou, Being and Event, I &II           Di Nicola, A Stranger in the Family (1997), Letters
(2005, 2009a)                                                  to a Young Therapist (2011), Trauma & Event (2012)
Event, Objective Phenomenology                  – Relational therapy, Evental psychiatry

While he didn’t outline a psychology let alone a psychiatry, Heidegger closely followed the work of his psychiatric interlocutor, Ludwig Binswanger, with whom he maintained a lengthy and detailed correspondence.

Sartre offered an explicit psychological theory (see his Sketch for a Theory of the Emotions, 2002) and influenced R.D. Laing’s call for a “social phenomenology” in his critiques of psychiatry (while his colleague David Cooper coined the term “anti-psychiatry,” Laing specifically refuted this term). Laing and Cooper (1964) produced a précis of Sartre’s work in English with a laudatory preface by Sartre welcoming the advent of a “truly human psychiatry.”

Until I worked with him, no one in my field had really paid attention to the import of Badiou’s event for psychiatry.

This line of investigation in philosophy with its applications to psychiatry has reached an asymptote, the point of diminishing returns (see Tom Sparrow, The End of Phenomenology, 2014). We may call it, from Husserl to Sartre and their epigones in both philosophy and psychiatry, “subjective phenomenology.” With his key philosophical works, the foundational texts for a new ontology—Theory of the Subject (2009c) and Being and Event, I and II (2005, 2009a)—Badiou sets out a new “objective phenomenology.”

Deep into my philosophical investigations, Badiou offered this crucial assessment and challenge: “You are at a crossroads, either you will abandon psychiatry as such or announce a new, perhaps, evental psychiatry.” It was an accurate philosophical diagnosis! This added another year and another hundred pages to my doctoral dissertation which I called with Badiou’s approval, “Trauma and Event” (Di Nicola, 2012).  

My turn to philosophy was confirmed by Badiou’s assessment, echoed Jaspers admonition of a century earlier, and reflected the critical insight of the founder of the modern scientific approach to knowledge, Francis Bacon who in his Novum Organum (1620) distinguished “experiments of light” from “experiments of fruit” (or profit):
[W]e must first, by every kind of experiment, elicit the discovery of causes and true axioms, and seek for experiments which may afford light rather than profit. Axioms, when rightly investigated and established, prepare us not for a limited but abundant practice, and bring in their train whole troops of effects (Aphorism 70).

I tasked a triumviri of philosophers for my investigations: Foucault (1972), the philosopher of discourses and apparatuses; Agamben (2009), who adapted Foucault’s work on the apparatus and paradigm to forge a method of inquiry called “philosophical archaeology,” is our philosopher of the threshold; and Badiou (2005, 2009a), our contemporary Platonist, is the philosopher of the exception and of the event. By seizing on the profound symmetry between Badiou’s ontology based on the event and the rupture that precedes trauma, I was able to re-read the history of psychiatry, psychology and psychoanalysis through the apparatus of trauma to make it contemporary. This method is Agamben’s philosophical archaeology (2009).

Rupture is a breach that suspends the past and interrupts the world. Radically contingent, hence unpredictable and uncontrollable, it can lead to novation, an opening for new possibilities that leads to an event, or shut down into trauma, closing down possibilities. Ultimately, this allows us to discern a psychiatry of trauma (that not only concerns itself with trauma but can also be traumatizing) and a psychiatry of the event (that not only studies the event but is radically open to recognizing radical change and being faithful to it in the construction of new forms of human relations).

And, as Freud observed, everywhere we go we find that a poet has been there before us. Amichai grasped this dichotomy of being in his poem inspired by the Babylonian Talmud:

Open closed open. Before we are born everything is open
in the universe without us. For as long as we live, everything is closed
within us. And when we die, everything is open again.
Open closed open. That’s all we are.
—Yehuda Amichai, Open Closed Open (2000, p. 6)



Brief bio: Vincenzo Di Nicola, MPhil, MD, PhD, FRCPC, DFAPA, is a tenured Full Professor of Psychiatry at the University of Montreal, where he works as a Child & Adolescent Psychiatrist. Trained in psychology, psychiatry and philosophy, Professor Di Nicola completed his doctorate in philosophy at the European Graduate School, where he worked with Giorgio Agamben, Alain Badiou and Slavoj Žižek. His 2012 dissertation, “Trauma and Event: A Philosophical Archaeology,” was granted Summa cum laude and inspired his call for an Evental Psychiatry. He is now working with fellow psychiatrist and philosopher Drozdstoj Stoyanov on a volume called, Psychiatry in Crisis: At the Crossroads of Social Science, the Humanities, and Neuroscience, to be published by Springer International.

You can find more about his work on these sites: 



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References

Agamben, Giorgio (2005). State of Exception, trans. by Kevin Attell. Chicago: University of Chicago Press.

Agamben, Giorgio (2009). Philosophical Archaeology, in The Signature of All Things: On Method, trans. by Luca D’Isanto with Kevin Attell. New York: Zone Books, pp. 81-111, 119-121.

Amichai, Yehuda (2000). Open Closed Open, trans. by Chana Bloch and Chana Kronfeld. New York: Harvest/Harcourt.

Arendt, Hannah (2006). Eichmann in Jerusalem: A Report on the Banality of Evil, Introduction by Amos Elon. London: Penguin Books.

Badiou, Alain (2005). Being and Event, trans. by Oliver Feltham. London: Continuum.

Badiou, Alain (2006). Polemics, trans. and with an introduction by Steve Corcoran. London: Verso.

Badiou, Alain (2008). Conditions, trans. by Steven Corcoran. London: Continuum.

Badiou, Alain (2009a). Logics of Worlds, Being and Event II, trans. by Alberto Toscano. London: Continuum.

Badiou, Alain (2009b). Pocket Pantheon: Figures of Postwar Philosophy, trans. by David Macey. London: Verso.

Badiou, Alain (2009c). Theory of the Subject, trans., and with an introduction, by Bruno Bosteels. London: Continuum.

Badiou, Alain (2011). Second Manifesto for Philosophy, trans. by Louise Burchill. Cambridge, UK: Polity Press.

Badiou, Alain and Tarby, Fabien (2013). Philosophy and the Event, trans. by Louise Burchill. Cambridge, UK: Polity Press.

Benjamin, Walter and Lacis, Asja (2007). Naples, in Reflections: Essay, Aphorisms, Autobiographical Writings, trans. by Edmund Jephcott, ed. with an introduction by Peter Demetz, Preface by Leon Wieseltier. New York: Schocken Books, pp. 163-173.

Binswanger, Ludwig (1958). The Case of Ellen West: An Anthropological-Clinical Study (trans. by Werner M. Mendel & Joseph Lyons), in Existence: A New Dimension in Psychiatry and Psychology, eds. Rollo May, Ernest Angel and Henri F. Ellenberger. New York: Basic Books, pp. 237-364, 293-294

Bohleber, Werner (2010). Destructiveness, Intersubjectivity, and Trauma: The Identity Crisis of Modern Psychoanalysis. London: Karnac Books.

Di Nicola, Vincenzo (1997). A Stranger in the Family: Culture, Families, and Therapy. New York & London: W.W. Norton & Co.

Di Nicola, Vincenzo (2011). Letters to a Young Therapist: Relational Practices for the Coming Community. New York & Dresden: Atropos Press.

Di Nicola, Vincenzo (2012). Trauma and Event: A Philosophical Archaeology. Doctoral dissertation, Saas-Fee, Switzerland: European Graduate School.

Di Nicola, Vincenzo (2014). Slow Thought: A Manifesto for a Psychiatry of the Event, Parts I & II. https://www.academia.edu/8645094/Slow_Thought_A_Manifesto_for_a_Psychiatry_of_the_Event_Parts_I_and_II_of_III_

Di Nicola, Vincenzo (in press, a). Pedagogy of the event, in Žižek and Education, ed. by Antonio Garcia, Foreword by Creston Davis, Afterword by Slavoj Žižek. Rotterdam, Netherlands: Sense Publishing, “Transgressions: Cultural Studies and Education” Series.

Di Nicola, Vincenzo (in press, b). Two trauma communities: A philosophical archaeology of cultural and clinical trauma theories, in Trauma and Transcendence: Limits in Theory and Prospects in Thinking, eds. Peter T. Capretto and Eric Boynton. New York: Fordham University Press.

Fanon, Frantz (1963). The Wretched of the Earth, trans. by Constance Farrington. New York: Grove Press.

Fanon, Frantz (1967). Black Skin, White Masks, trans. by Charles Lam Markmann. New York: Grove Press.

Feyerabend, Paul (2010). Against Method, Fourth Ed., Introduced by Ian Hacking. London: Verso.

Feyerabend, Paul (2011). The Tyranny of Science, Edited, and with an Introduction, by Eric Oberheim. Cambridge, UK: Polity Press. 

Fodor, Jerry (2000). The Mind Doesn’t Work That Way: The Scope and Limits of Computational Psychology. Cambridge, MA: MIT Press.

Foucault, Michel (1972). The Archaeology of Knowledge and the Discourse on Language. London: Tavistock Publications.

Foucault, Michel and Binswanger, Ludwig (1993). Dream and Existence, ed. by Keith Hoeller. Humanities Press.

Frye, Northrop (1995). The Bush Garden: Essays on the Canadian Imagination, Second ed., Introduction by Linda Hutcheon. Toronto: House of Anansi Press.

Gould, Stephen Jay (1981). The Mismeasure of Man. New and London: W.W. Norton and Company.

Heidegger, Martin (2008). Being and Time, trans. by John Macquarrie and Edward Robinson, Foreword by Taylor Carman. New York: HarperPerennial.

Husserl, Edmund (2012). General Introduction to Pure Phenomenology, trans. by W.R. Boyce Gibson, Introduction by Dermot Moran. London: Routledge.

Insel, Thomas R. and Landis, Story C. (2013). Twenty-five years of progress: the view from NIMH and NINDS. Neuron, 80(3): 561-7.

James, William (1890). Principles of Psychology, Vols. I and II. New York: Henry Holt and Company.

Jaspers, Karl (1997). General Psychopathology, Vols. I and II, trans. by J. Hoenig and Marian W. Hamilton, with a new forward by Paul R. McHugh, M.D. Baltimore and London: The Johns Hopkins University Press.

Kahneman, Daniel (2011). Thinking, Fast and Slow. New York: Farrar, Straus and Giroux.

Knowles, John H., ed. (1977). Doing Better and Feeling Worse: Health Care in the United States. New York and London: W.W. Norton & Co.

Laing, R.D. (1960). The Divided Self: An Existential Study in Sanity and Madness. London: Tavistock Publications.

Laing, R.D. (1961). The Self and Others. London: Tavistock Publications.

Laing, R.D. and Cooper, D.G. (1964). Reason and Violence: A Decade of Sartre’s Philosophy, 1950-1960. London: Tavistock Publications.

Lasch, Christopher (1991). The True and Only Heaven: Progress and Its Critics. New and London: W.W. Norton and Co.

Malabou, Catherine (2012). The New Wounded: From Neurosis to Brain Damage, trans. by Steven Miller. New York: Fordham University Press.

Mannheim, Karl (1936). Ideology and Utopia: An Introduction to the Sociology of Knowledge, trans. by Louis Wirth and Edward A. Shils. New York: Harvest Books/Harcourt reprint.

Nail, Thomas (2015). The Figure of the Migrant. Stanford, CA: Stanford University Press.

Nail, Thomas (2016). Theory of the Border. 2016. Oxford, UK: Oxford University Press.

Pinker, Steven (1997). How the Mind Works. New York and London: W.W. Norton and Co.

Sartre, Jean-Paul (1956). Being and Nothingness, trans. by Hazel E. Barnes. New York: Methuen.

Sartre, Jean-Paul (2002). A Sketch for a Theory of the Emotions, Preface by Mary Warnock. London: Routledge Classics.

Sparrow, Tom (2014). The End of Phenomenology: Metaphysics and the New Realism. Edinburgh: Edinburgh University Press.

Wittgenstein, Ludwig (1922). Tractatus Logico-Philosophicus, trans. by C.K. Ogden, Introduction by Bertrand Russell. London: Routledge & Kegan Paul.

Wittgenstein, Ludwig (1953). Philosophical Investigations, trans. by G.E.M. Anscombe. London: MacMillan Publishing.

Žižek, Slavoj (2014). Event: Philosophy in Transit. London: Penguin Books.


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