Thursday, April 26, 2018

The Psychiatrist and the Whims of Time

As always, the central point is a deceptively simple one: he was a psychiatrist. I don't mean this simply in a professional sense. I mean it, if I may be permitted the word, in an ontological sense. Applied to him "psychiatrist'' did not indicate a specialized field of study, a career, a life's work; applied to him "psychiatrist" summed up in four sharp syllables the totality of his being. He was not so much a man engaged in the practice of psychiatry as he was a psychiatrist to whom a body, a complex of more or less inconsequential biological accidents and habits, had been appended.
I don't say this in any pejorative sense. As psychiatrists go he was a good one, perhaps even a great one. I don't really know; as is usual in our age I have nothing to judge by but the facts. I here submit those facts to general scrutiny:
His clients included many of the most illustrious figures of our culture---eminent lawyers, bankers, actors, actresses, business leaders, rock musicians, socialites, writers, even several fellow psychiatrists, in all, dozens upon dozens whose interior geologies showed the inevitable flaws and strains, chips, cracks, fissures, and faults that the age seems expressly designed to heighten and intensify in each of us.
He adhered to no particular school. Trained in the classical Freudian tradition, he had spent several years in Europe studying under the Master's immediate heirs, but so omnivorous was his appetite for scientific knowledge of the soul, so enormous was his capacity, that he had absorbed all that had been thought, spoken, or written upon the matter, slighting no discipline or tradition, however ephemeral or negligible it might seem to his colleagues. This was the source, the wellspring, of his myth. To a Freudian he seemed a fellow Freudian, to a Jungian a Jungian, to an Adlerian an Adlerian, to an Eriksonian an Eriksonian. He understood gestalt theories and practices more thoroughly than did men who had made them their life's study, and he had mastered transactional analysis, logotherapy, milieu therapy, psychodrama, and other modern doctrines and techniques so completely that often it seemed inconceivable that he had not developed them himself. In his practice his judgment was legendary. He knew instinctively when to analyze at length, when to confront sharply, when to medicate, when to shock. He got results. Among his associates (he hardly seemed to have peers) his words approached dogma. Even when he spoke casually, off the cuff (over lunch and a drink, say), his every sentence, his every pause, seemed ex cathedra. To say simply that he was highly esteemed is to expose the poverty of language. His status was as close to that of a sage as is possible in these difficult times.
"The psyche is the fundamental ground of all existence, all experience," he liked to say. "To know it intimately is to know all that there is to know. These are fortunate times and we are fortunate men, for to understand the soul and its operations no longer requires the metaphysical cant to which our predecessors in this effort, for lack of an objective science, were forced to resort."
Naturally he was rich. He owned his office, a handsome suite in a prestigious part of the city. He had a large apartment, comfortable but not extravagant, decorated in a rich but appropriate style (he had a taste for works of African art --- carved tribal masks, primitive statuettes, that sort of thing). Near the shore he owned an older home, which he had had meticulously restored as a retreat. His single passion outside of psychiatry was sailing.
He was unmarried, perhaps because his work left him so little time for social amenities other than the professional conferences, at which he was always properly formal, strictly business. He was invariably invited to present a paper at each such congress, and just as invariably these papers were the high point of the gathering, centering as they always did around a fascinating new interpretation of psychological fact or a bold speculation so profound and far-reaching in its consequences that it promised to provide abundant raw material for the psychiatric industry for some time to come.
One might imagine that his fame was as far-reaching as were his speculations, but for many years this was not so. For a long time, his renown encompassed only that relatively small universe that is the psychiatric world, yet this limited recognition was sufficient for him. He divided his time among his practice, the psychiatric congresses, and sailing, using whatever remained to write an occasional article for the psychiatric journals.
  It was this last activity that fate chose as her wedge. In one of these articles he proposed a revolutionary new theory of the structure, function, and dynamics of the psyche. It was a complex as well as an unorthodox interpretation of known facts, a great leap of the imagination. He wrote with unusual passion, like a man who feels that he has stumbled onto a great secret. He spoke of "hitherto fore secret recesses of the psyche, individual and collective" where the "true divine fire" had been hidden from the Promethean advance of science. He alluded to a secret language of the psyche, "a grammar of incoherence, as yet unrecognized, undeciphered by conventional theorists."  He spoke of a "mechanism of the soul, a court of inevitable justice," the function of which was to punish incursion as though it were in fact blasphemy. He boldly split from much of the "objective" psychiatric thought of the past and just as boldly reshaped what remained.
From this sweeping technical speculation arose one of those savage feuds common in the intellectual community, a battle waged on paper only, but a battle no less unrestrained than the most open and furious bloodfeud of the city streets. A colleague, a West Coast theorist and practitioner, was bothered by this odd, "reactionary" interpretation and wrote a long article in rebuttal for the next edition of the journal in question. For most of this rebuttal he limited himself, as was professionally appropriate, to the specific theoretical matter at hand. He refuted our doctor (he felt) point by point. He cited the lack of data, the nearly metaphysical nature of the argument. He drew the hard conclusions of the theory, showed how, if accepted, it must retard the progress of psychological inquiry, "perhaps even of civilization itself," many decades. He was thorough and (he felt) he was fair. Still, it must be granted that among those many pages there were two sentences (perhaps three) which, if not in content then in tone, could conceivably have been interpreted as an implied personal assault. I say could have been so interpreted, for the way in which such men assault one another is perhaps as subtle and as ultimately inconclusive as the discipline to which they give their lives. Any reader who takes the trouble to visit the library will discover that it requires several intensive readings and the guidance of one well versed in the language of such matters to uncover the offending sentences, which, to our doctor, seemed as inflammatory as the shelling of Sumter or the bombing of Pearl Harbor.
Keep in mind, however, that psychiatry was the totality of this man's being, the very substance of his marrow and his cells, the single reality around which the vapors of existence had congealed into the loose fabric of matter. Thus, these two (or three) sentences, which seemed to suggest that he had transgressed the boundaries of science and had stepped over into that very mysticism that he had given his life to explaining away, these sentences slashed as deeply as any bayonet or ghetto switchblade. And they were, to him, far more deadly. Science claims as one of its prerogatives a certain precision, and these sentences, so inconsequential to the untrained spirit, were a case in point: they found their mark with surgical accuracy. Naturally his retaliation was immediate,  the instinctive response of the wounded animal. Impatient, he submitted his carefully worded reply to another of the professional journals and thereby broadened the theater of combat. In length it approached that of his  "learned colleague"  (for he still thought of the other man in this manner, not yet conscious of him as an opponent, a rival). It, too,  contained veiled allusions. It, too, provoked a quick response. So the battle was engaged. It flared for many months, ranging far and wide over the professional journals, articles and rebuttals appearing suddenly now here, now there, like tight formations of attack bombers ranging over a disputed territory. Each new article seemed ever so slightly more personal, ever so slightly more vicious; each contained more frequent and less veiled questionings of the professional competence and, at last, even of the basic stability of the two opponents. The dispute became the focal point of the psychiatric world. Troops enlisted on either side, and the journals were filled with pieces long and short supporting one position or the other. Demonstrating its debt to its culture, the dispute began to exhibit the same malicious spirit that so characterizes the public life of the age.
Such intellectual Armageddons are not rare, of course, but the public usually pursues its affairs unaware of these wars in its midst, since such conflicts, with no clear action or outcome, no maps with bright arrows showing territories lost or gained, no body counts and few atrocities, fail to excite the popular imagination. Occasionally there are exceptions to the verbose, invisible nature of such disputes.  By way of example I point out the case of Dr.  P. de Santerre, the Canadian biologist who, several years ago, resolved his quarrel over a proposed re-ordering of the phylum Coelenterata by shooting the colleague who opposed him.
Gradually, then, the conflict took on a new dimension for our doctor. He began to see himself in an unaccustomed light. It was no longer a simple theoretical dispute, no longer even a simple personal difference. His conviction of his rectitude, always strong, grew stronger yet.  The original question was now a cause. Others might enlist behind him, but the primary responsibility, the main burden,  the sacred duty, remained his and his alone.
His sailing was the first casualty. Although he continued to go up to the shore, in fact went up there more often, he rarely left the second floor study, and the bright red sailboat languished two seasons without use.   He paced the floor long after midnight for days on end in deep concentration searching the massed knowledge in his brain and on his shelves for some new fact, some new precedent or clue, that he might fling across the country in fresh salvo.
At first the question itself remained uppermost in his mind, but gradually he found that with each new word, each new sentence, each new thought,  the image of the other man's face became more vivid and dominant until it, and it alone, drove him on. The original  dogmatic  dispute took  second place,  and  it seemed to those few objective observers who remained that history was indulging her fancy for repetition, that the battle was a muted re-enactment of the furious arguments of early church fathers or of the clash of Reformation titans.
Some time later the popular press at last took notice of the affair: a crisp half-column in Time. To both men this seemed a clear signal for an escalation of sorts, and, despite the warnings of their respective supporters, they took the opportunity to move the contest outside the professional arena. The magazines of popular psychology were first.  These were followed by interviews on radio programs, by lectures at campuses across the country, and finally by several appearances on the television talk shows. The difficulty,   of course, was  that while  this  new audience was certainly intelligent,  it was not expert, not professional. The doctrinal point was  perhaps too obscure, too academic, a subtlety of high psychology presented for judgment to a lay court. Still, the  personal antagonism between the two men was sufficient to hold public interest, and they took care to season their acrimony with at least enough background material to render the vague outline of the dispute intelligible. Beyond that, the debate became primarily a public exercise in character assassination.
Reputations were now at stake, reputations were now the central issue. This much the public could appreciate. Our doctor was now the representative, the personification, the embodiment, the incarnation of the cause that had once been the idea that had at first been the crucial point of the debate. His defeat in the public arena, even if it were a defeat for the wrong reasons, was the defeat of the cause; his triumph was its triumph. The critical importance of the idea itself, that unorthodox interpretation of an arcane point at best only poorly understood by the general public to which it was now being presented, had perhaps diminished but only, our doctor would assert privately, in a tactical  sense.   Once he had been vindicated, the theory, the cause, would vindicate itself, would have the necessary room to grow, would take root and flourish in the general consciousness. It was only the stubborn resistance of this other, this enemy, that forced him to stand, as it were, in the place of his idea, to propagate and defend it in this manner.
In the end he threw himself headlong into the fray. He closed his office, abandoned his practice (temporarily, he said), and retired fulltime to the house by the shore, appearing only on those occasions when he had a chance publicly to engage his opponent. His articles, produced now in furious bouts of concentration more like temper than thought, appeared more and more frequently, gradually becoming more strident, more hysterical in tone and phrasing. To say that he began to waste away from the effort of the contest would perhaps be overly romantic, but clearly he began to show the signs of a terrible strain. His face, once calm, sustained, objective, began to undergo a transformation, to become lined, weathered as though by the sea,  deepened as though somehow it had appropriated to itself in its brief moments of anguish and (lately) doubt all the long years of anguish and doubt to which its owner, its wearer, had so patiently listened. Once strong, benign, impenetrable, it seemed now suffused with a strange light,  a strange intensity, the sort of bright frenzy one expects to find only in portraits of the artists of an age long dead, an uncanny light,  almost eerie,  almost possessed.
The public requires action if its interest is to be sustained: so runs the law of this age, perhaps of any age. It entertained this intellectual struggle for a time because the vagaries, the eccentricities, the contests of the purely academic world were not as familiar to it as, say, those of the political world, and the display of thought and spite afforded it by these two men had engaged its curiosity. But without continued action the outcome of which directly concerns its own fate (and who would presume to claim that such was the case here?), the public shifts its attention as quickly as the sea shifts sand on the beach.  Besides, the Dow was shaky and the World Series near at hand.  Our doctor's West Coast opponent realized this and was content when the expected shift of interest at last occurred. His name, up to now relatively obscure, had enjoyed a brief but intensive circulation. His practice had doubled, he had purchased a handsome office suite in a prestigious part of the city, he had moved to a larger, more comfortable apartment. When the editors first of the popular magazines and then of the scholarly journals began to return his articles, noting that the coverage had reached a saturation level, he took a two month sabbatical in Munich,  planning to launch on his return a lecture tour on an entirely unrelated subject.
For our doctor, however, these rejections were a terrible blow. That the general public might lose interest he could understand; that the scientific community should also turn its back was unthinkable. In time they would come to their senses. Meanwhile, he was determined to press on, regardless of their collective lapse. He sold the apartment in the city, he sold the bright red sailboat. He rose early, read, thought, and wrote until one or two each morning. He broke his concentration only for necessary meals, for necessary sleep, for an occasional solitary walk. He used a tape recorder now as well as a pen and paper, so that no thought, no idea,  might escape.
He lived this way for three and a half years, wholly obscure, wholly intense. One day at the end of that time a woman and her daughter, out early to collect driftwood thrown up by the tide, found him on the silent beach, pale and thin beneath an immense orange sky. The inquest ruled death by natural causes.
The party that later examined his effects found thousands of pages of manuscript and several hundred tapes, all of them dealing with his theory, many of them in the form of rambling letters, or, in the case of the tapes, imaginary conversations, addressed to the man who had been his adversary. Those who understand such things say that of this enormous testament only a minute fraction is in an intelligible form. The rest, a monument to incoherence that will provide the psychiatric industry with abundant raw material for some time to come, will require many, many years to decipher and organize. 
I am told that the work has already begun.

Monday, February 12, 2018

A Note on Skepticism


Regardless of the path he takes in life, every man of good faith sooner or later arrives at a point at which it is necessary for him to attempt to set down explicitly his fundamental beliefs. It is probable that this has always been so, probable that this has always been one of life's central tasks. Life is, to brutalize Churchill's graceful epigram, a mystery begun by an enigma and ended by a riddle; suspended between birth and death, each of us treads a course grounded firmly on assumption. Reduce man as fully as it is possible to reduce him and you arrive at his assumptions, that is, at his faith. A man is no more and no less than the total substance of his belief. Our own age, spawned, according to the historian's belief, in the intoxication and delusion of the Enlightenment, is, we are told, a skeptical one, that is, one in which "faith" as an essential element of life is devalued. The pure type of the age, then, would be some inconceivable super-skeptic, a man whose dictum would be "I believe nothing." Granted, we find many who approach the type, but on examination it will generally be found that they do so more from a sort of stunted philosophical indulgence than from any genuine and thoroughgoing skepticism. Even the true skeptic realizes the impossibility of his position, realizes that the total negation that total skepticism would imply is inherently impossible. To say that I believe nothing requires that I posit something, that is, my belief in nothing requires that I announce (the skeptic would balk at "affirm") my faith in the impossibility of faith. To be genuine such a total skepticism would require that the skeptic limit the content of his consciousness to the endless repetition of the single word "nothing... nothing... nothing" after the fashion of the mystic repeating the sacred OM. Ultimately, total skepticism is expressible only as suicide, at which point the skeptic passes from our consideration either into the nothing that he must not-believe to not-be or into the province of some other, some unknown, reality.
It is less than honest then to call ours an age of skepticism. Far better to admit that it is with ignorance and delusion that we are truly dealing, to recognize that the essential characteristic of the age is a certain self-deceit and not an actual skepticism. The problem is not that men do not believe in anything; the problem is that men do not know, are not conscious of, precisely what it is they do believe. This is not a surprising circumstance, since so many of the beliefs of the age are so hollow that their adherents would be mortally embarrassed to recognize them in themselves. A psychologist, interested in the mechanism of projection (the principle of the mote and the beam) would find fertile ground here. What we mislabel "skepticism" is the feeling that derives from the realization that we have little common faith. For this there is no remedy but for each man first to define his own individual faith and thereby lay the groundwork for the elaboration of a common faith. My own contributions, fractured, I admit, nearly to the point of incomprehension, are scattered  throughout these pages.