Modern psychiatry has arguably been taken captive by the philosophical presuppositions of modernity to the extent that its descriptions of mental illness appear unstable and susceptible to misuse. Foucault pointed to Nicholas Cusanus as a possible alternative, and this suggestion is here taken as the point of departure for an investigation of how the understanding of the human as informed by the encounter with the eternal points us in the direction of a different understanding of reality. Kierkegaard stands in the same Neoplatonic tradition as Cusanus, but takes his approach one step further by investigating the psychopathology of disbelief through his work with anxiety and despair. The article argues that psychiatry has much to learn from a deeper engagement with this tradition.
Die moderne Psychiatrie ist von den philosophischen Voraussetzungen der Moderne insofern gefangen genommen, als ihre Beschreibungen von Geisteskrankheiten instabil und anfällig für Missbrauch erscheinen. Foucault wies auf Nicholas Cusanus als mögliche Alternative hin, und dieser Vorschlag wird hier als Ausgangspunkt für die Untersuchung genommen. Die Untersuchung versucht zu zeigen, wie das Verständnis des Menschen, wie es durch die Begegnung mit dem Ewigen vermittelt wird, uns in Richtung eines anderen Verständnisses der Realität weist. Kierkegaard steht in der gleichen neoplatonischen Tradition wie Cusanus, geht aber noch einen Schritt weiter, indem er die Psychopathologie des Unglaubens durch seine Arbeit mit Angst und Verzweiflung untersucht. Der Artikel argumentiert, dass die Psychiatrie von einer tieferen Auseinandersetzung mit dieser Tradition viel lernen kann.
From an epistemological and philosophical perspective, modern psychiatry is a heavily contested area. Psychiatry established its place within modern medical science by taking somatic medicine as its model, looking for the physiological base of mental illness. Today, many consider this approach as unduly one-sided. The American psychiatrist Thomas Szasz maintained that the very idea of “mental illness” is a contradiction. In his view, the concept of illness should be limited to the area of the undisputedly physical, and psychiatry’s attempt at finding a similar foundation for itself has resulted in nothing but pseudoscience. A similar position was represented by the Scottish psychiatrist R. D. Laing, who saw schizophrenia as a form of super-sanity in a mad world. It has therefore been argued that our understanding of health and normalcy is a social rather than a medical category, and that psychiatry paves the way for a kind of “treatment” that in reality is nothing but social control. This is the position held by Bonnie Burstow from the University of Toronto, who in 2015 published a book where she argues that the pharmaceutical industry provides us with “aggressive marketing of mind-altering drugs for illnesses that do not in fact exist” (p. 60; italics in original). Not all are as critical as Szasz, Laing and Burstow, but even among those who find the idea of mental illness indispensable, there is a growing awareness that models based on somatic medicine do not work. The steady stream of revised and enlarged editions of The Diagnostic and Statistical Manual of the American Psychiatrist Association is a point in case. What necessitates these revisions is not, as with somatic medicine, an improved understanding of aetiology and treatment, but altered preferences concerning the relevance of the conceptual tools applied for diagnosis. There is thus no doubt that mental illness is a concept that is heavily dependent on the context in which it occurs.
The context in which psychiatry developed was the Cartesian, dualist and anthropocentric concept of rationality that was anticipated by late medieval via moderna nominalism and has dominated Western civilization since the Enlightenment. An understanding of rationality that is less anthropocentric and less dependent on mind/matter-duality than is generally the case in modernity could be highly relevant for the treatment of problems usually described as mental illness. Philosophers exploring other routes than those travelled by the moderns are thus highly relevant. In his History of Madness, which was the first influential attempt at investigating the concept of madness as a means of social control, Michael Foucault suggested the Renaissance Neoplatonism of Nicholas Cusanus as an alternative to the modern attempt at defining a strict border between rationality and madness. This introduces the idea of the divine and eternal and hence unknown as the perspective from which human reason even at its best is nothing but folly. Cusanus is not alone in this emphasis; the wisdom of the fool is an important literary topic from the Renaissance to the Enlightenment. From then on, it was marginalized, but it remained at the margins as a possibly subversive power against socially sanctioned rationality. In the 19th century, Søren Kierkegaard, an important critic of modernity’s understanding of rationality and a Platonist like Cusanus, tried to regain the understanding of the folly of faith as the only adequate rationality. From this perspective, he presented profound analyses of the mental disorders of modern humans burdened by the inadequacy and one-sidedness of Enlightenment rationality. The approaches of Cusanus and Kierkegaard may thus represent viable alternatives to the modern and reasonable discourse about madness. There has been a lot of interest in Kierkegaard’s studies of the psychology of modern human beings among philosophers, theologians and literary critics. However, psychiatrists do not seem to pay attention. This article explores a path that suggests they should.
Taking my cue from Foucault’s remarks on Cusanus, I will start by looking more closely at how the ideas of rationality, madness and irrationality plays out in Cusanus’s thought. My main interest, however, is to explore how the location of faith in the area indisputably beyond the merely rational by Kierkegaard’s pseudonyms results in an understanding of psychopathology that is profoundly different from what has governed modern psychiatry.
II. Cusanus and the rejection of a privileged perspective
In all his epistemologically relevant writings, the 15th century bishop and cardinal Nicholas Cusanus is stating his difference from the late medieval nominalist via moderna. This school of thought anticipated typically modern emphases by understanding knowledge as established by observation and the processing of observation by means of univocal conceptual representation. Over against this model, Cusanus reasserted the relevance of the Platonic difference between ratio and intellectus, according to which ratio explores the difference between finite entities and intellectus explores the relation to the infinite. The ultimate goal of knowledge is thus participation in the infinite source of all reality, not the analysis of reality performed by an ahistorical and omniscient subject.
This has important implications for the understanding of the human, who is thus located at the intersection between time and space on the one hand and eternity on the other. Even more important from our perspective is, however, the implication for the understanding of knowledge. As the ultimate goal of knowledge, the capture of the presence of the infinite in the context of the finite, is never reducible to conceptual univocity, the only infallible sign that one has grasped it is the understanding that one has not. In this way, Cusanus develops Augustine’s idea of docta ignorantia or informed ignorance by means of his own exploration of the idea of coincidentia oppositorum: As the Creator is always different from everything created, one will only appreciate God’s presence in the world by acknowledging his absence.
However, the most important implication of divine difference in the context of the present investigation is that it subverts all attempts at establishing a privileged perspective. Cusanus has clearly grasped the physical implication of this principle; he understands that the omnipresence of the always different implies that the universe has no physical centre. He is thus the first within the history of European thought who in this way suggests a principle of relativity. Even more interesting is his social application of this principle; there is for Cusanus no privileged position from which to evaluate alleged knowledge. This is something Cusanus particularly emphasizes in the Idiota-writings from 1450, and the most important of these for our purpose is the first one, Idiota de sapientia.
This is a dialogue between a layman, an orator and a philosopher. The application of the dialogue form is interesting, as it suggests a Socratic approach to knowledge according to which the truth appears as the dialogue partners submit themselves to what appears as they proceed. The idiota or layman is neither mad nor stupid, but, differing from the orator and the philosopher, he has no formal training in philosophy. He does not consider that a problem, though, as wisdom is something that in his view must be obtained directly from the source, the life itself, and cannot be learned by books. The reason is that wisdom is something personal; in books, one will only find the knowledge of others and one is thus enslaved by their authority. However, the thirst for personal knowledge is inherent in every human being in the same way as the baby’s desire for milk. Just as reading about love is a poor substitute for experiencing the real thing, reading about knowledge cannot compare to experiencing it.
By way of example, the layman directs his interlocutors’ attention to what is going on where they are, which is in the marketplace. Its business consists in numbering, measuring and weighing. These are all activities that are dependent on a unit of measure that in this way is present in everything else without being fully captured or defined by anything. The unit stands above the area of experience, but is still absolutely necessary for making sense of it. By meditating on this, one may (or may not, as this is not for everybody) understand how the origin of everything is in everything without being identical with anything. In this way is introduced what Foucault describes as “the abysmal madness of the wisdom of God”: “It is higher than all knowledge and is unknowable and is inexpressible by any speech, incomprehensible by any intellect, unmeasurable by any measure, unlimitable by any limit, unboundable by any bounds, disproportional in terms of any proportion, incomparable in terms of any comparison.” This is according to the layman what can be gained from meditation on life as one experiences it.
Foucault may not be quite in resonance with Cusanus’s argument when he describes this as madness. For Cusanus, intellectus is not irrational; it is beyond rationality, which is not quite the same. However, Cusanus explicitly rejects the cornerstone of logic, the principle of non-contradiction, as far as intellectus is concerned. Contradictory statements may then be true, as the principle of coincidentia oppositorum indeed imply that they are. What is commonly conceived as madness might then not after all be too far away. What Foucault undoubtedly gets right, though, is the relativizing of rationality and its power structures that is inherent in Cusanus’s apophaticism. The essence of wisdom, which is the appreciation of the presence of the infinite One “in, with and under” something as trivial as the weighing of a pound of meat at the marketplace, is equally accessible to everybody, and everybody’s experience is equally relevant as the starting point of the ascent to the highest level. This emphasis on undifferentiated human equality may be unexpected from a cardinal who at the pinnacle of his ecclesiastical career acted as the pope’s stand-in. Still, it is there. The idiota may not be mad. However, he is certainly a representative of what we today like to call a perspective from the margins.
III. Kierkegaard and the psychopathology of disbelief
Without being aware of the work of Cusanus, Kierkegaard worked within the same tradition of Christian Neoplatonism. He makes a couple of important modifications, though. Already in his first major philosophical work, Repetition (1843), he questions the Platonic theory of knowledge as recollection; a real confrontation with infinity is dependent on the possibility of newness. This is followed by a discussion in Philosophical Fragments (1844) of the difference between Socrates, who merely establishes the occasion for understanding the truth, and “the God in time” (Christ) who in addition brings the condition for grasping truth. This thus represents a radicalization of the Platonic idea of the instant.
The implications of this radicalized Platonism are explored by Kierkegaard’s pseudonym Johannes de silentio in Fear and Trembling (1843). For this purpose, he uses the story of Abraham being asked to sacrifice his son Isaac (Gen 22) to emphasize the difference between ratio and intellectus. Abraham’s challenge is not reducible to a rationally defensible universality of morality; differing from Jephtha and Agamemnon, who are explicitly referred to in the text, Abraham is not asked to sacrifice for the greater good. Abraham is asked to believe in the reality of the promise while subverting it by sacrificing its content.
From the point of view of universal rationality, Abraham’s attitude towards his son appears as nothing but hate and murder, and the text emphasizes this aspect by referring to Jesus demanding of his followers that they hate their loved ones for his sake. The impossibility of hiding behind the universal induces anxiety (“Angst”), which is thus presented as faith’s forecourt. We are all presented with challenges that cannot be solved by referring to general rules. Beyond anxiety is the attitude of Job, which is the realization without regret that all is lost; Johannes de silentio calls this “infinite resignation”. However, faith even leaves resignation behind and believes in the reality of the absent in virtue of the absurd. Faith is the realization of coincidentia oppositorum. Outwardly, it may appear as nothing but the unfounded conviction that what is there, will always be there. However, faith has performed what is termed the double movement – resignation and faith – and thus trusts the reality of what is promised in spite of its apparent absence.
Faith and Trembling in this way advocates an approach to faith that is unrelated to all attempts at defending some kind of significance for religion and spirituality over against the critique from a more or less secularized modernity. For Johannes de silentio, the challenge of relating to the infinite is as unavoidable as its presence in literature and the experience of the human suggest, and to approach it on modern presumptions, i. e. through an attempt at verifying the correctness of one’s relating to the challenge, is nothing but a sign that one has not understood it. However, Kierkegaard has retained the understanding of Cusanus’s layman concerning the satisfaction in obtaining wisdom directly from the source. This gives him the topic for some of his later works, where he explores the absence of this satisfaction through investigations of the symptoms that follows from not facing the challenge of the infinite in an appropriate way. In The Concept of Anxiety (1844), Kierkegaard’s pseudonym Vigilius Haufniensis (“Copenhagen’s Watchman”) investigates anxiety as faith’s precondition, and in The Sickness to Death (1849) his pseudonym Anti-Climacus studies despair (“Fortvivlelse”) as the symptom of faith’s absence.
The Concept of Anxiety is an investigation of the psychology of the relation to the infinite as it comes through as either faith or sin. Vigilius is critical of the idea of hereditary sin, which puts Adam in a special position. We are all sinners in the same way, Vigilius maintains. Before becoming a sinner, Adam/the human is ignorant of the difference between good and evil. This ignorance places the human before the abyss of infinite possibility from which all humans pull back. This retraction, which establishes the human in his or her individuality, is sin. Anxiety is neither good nor bad; it is a sign of the uncontrollable presence of the infinite. It thus instantiates a challenge that no human is up to because humans are after all finite. One withdraws from the challenge, and in so doing, one sets oneself as a human subject by becoming a sinner. Sin thus occurs through a qualitative leap that in itself is inaccessible for psychology and indeed for any kind of rational analysis; it has, like infinity, to be grasped as the condition of existence. From this reality, there is no escape; Vigilius has therefore no respect for the Pelagian understanding of salvation through mere self-determination.
Faith grasps the instantiation of the infinite and thus leaves anxiety behind. Apart from that it is always present; the attempt at liberating oneself from the anxiety of existence that results in the human becoming a sinner does not help. There are two kinds of anxiety, though. It may be directed toward the evil outcome of sin, and thus recognize the goodness of the good. However, it may also appear as anxiety towards the good. This is according to Vigilius what characterizes the demonic. This results in a self-encapsulation (“det Indesluttede”) that isolates the individual from the redeeming possibility of communication. On the individual level, this leads to what we today would call psychosomatic disorders. On the social level, it appears as a tendency to superficiality, as no one has the courage to appropriate truth in freedom. Within the context of the religious, this appears as orthodoxy without the power of appropriation (“Inderlighed”). This is dogmatic correctness without a real relation to the manifestation of the infinite. It is an attitude that according to Vigilius deserves the mockery it so often attracts. The withdrawal from appropriation can also appear as disbelief or superstition, which according to Vigilius are flip sides of the same coin.
For Vigilius, the experience of anxiety is the insuppressible sign that we are located at the crossroads between the infinite and the finite. It presents us with the challenge of infinite possibility in a way that never goes away, and the attempt at overlooking it merely lets is resurface in another shape. However, The Concept of Anxiety only lets us look at the psychological precondition of faith and sin. What we still lack is the analysis of disbelief as seen from the perspective of faith. Disbelief then appears as despair, the investigation of which is the subject of The Sickness unto Death. Its pseudonymous author, Anti-Climacus, is the antipode of Johannes Climacus, the writer of Philosophical Fragments and Concluding Unscientific Postscript, who as an unbeliever investigates the phenomenology of faith. Anti-Climacus writes from the perspective of faith, but still for the benefit of the unbeliever.
The starting point of the analysis of this book is the understanding of the human as “a synthesis of the infinite and the finite, or temporal and eternal, or freedom and necessity”. To be oneself is thus to find one’s self to be “transparently grounded in the power that established it”. In this case, there is no despair. In all other cases, despair is present as an illness in one’s self in one (or a combination) of three different shapes: Not being aware that one has a self, despairingly not wanting to be oneself, or despairingly wanting to be oneself. There are two ways of analysing it, either according to the elements of the synthesis or according to the degree of one’s awareness of it. Analysed according to the elements of the synthesis, the despairing human either appears as an enthusiast lacking finitude or a philistine who attaches ultimate significance to the trivial. Or one may be locked into the perspective of the rationally necessary without understanding the significance of infinite possibility. Analysed according the level of awareness, one is either ignorant of having a self, desperately not wanting to be oneself (by transforming the infinite to something one thinks one can handle), or desperately wanting to be oneself (by realizing infinity through one’s own power). The one closest to faith is the latter one, but he or she differs through the inability to lose oneself. The person who despairs in this way, has grasped the infinite significance of one’s self, but it will never be realized because of the self’s defiance toward “the power that established it”.
After having analysed the despairing human as an unbeliever in the first half of The Sickness unto Death, Anti-Climacus in the second half analyses him or her as a sinner who will not accept the word of forgiveness. One may despair concerning the promise of forgiveness either because one does not believe it (despair in weakness), or because one does not accept that one is a sinner (despair in defiance). The latter group is made up of those who have made themselves into gods by reserving the right to decide what to believe and to reject. In both cases, the proclamation of the gospel has resulted in offense. This is a sad reality, but still important as it confirms the fact that the God relationship can never be reduced to the level of a universal rationality. If everybody believed in the reality of divine presence, it would presumably be untrue. This is another case of coincidentia oppositorum: Statements concerning the infinite can only be true if disputed.
In the same way as Cusanus, Kierkegaard’s various pseudonyms concur in locating faith firmly in the area beyond the rationally defensible. However, Kierkegaard is considerably more ambitious in describing the psychological implications of faith’s absence. Anxiety, i. e. the basic feeling that something is wrong without one being able to define its cause or cure, is by Vigilius Haufniensis interpreted as a sign of one being confronted by what is, and always will remain, beyond rational control. Anxiety is therefore not something to be suppressed; it is something to be explored, lest it reappear as psychosomatic stress or cultural superficiality. Lack of appreciation of one’s relation with the infinite results in despair. For some, this despair is so deep that they are not even aware of it; for those who know where to look, it is still observable as a consistent preference for the trivial and insignificant. Others are aware of their despair. It may then appear in what Anti-Climacus calls its weak form, characterized by the reduction of the infinite to the level of the universal and realizable; in this case, intellectus disappears and ratio reigns alone. Or it may appear as defiance, through which the despairing individual insists on realizing the ultimate and the infinite on its own. One may then retain the understanding that the ultimate is after all not realizable through universal reason. However, one will forever fall despairingly short of reaching the goal.
IV. An integrated perspective on madness
Plato, Cusanus and Kierkegaard thus share an emphasis that the essentials of reality are not and will never be graspable by human reason; setting this as the norm should thus be considered as the undisputed sign of folly. An implication of this with particular relevance for the epistemology of psychiatry is that the precise understanding of mind/matter-duality will forever escape us. Psychiatry must thus either live with this as a fact or forever remain a pseudoscience haunted by a superstitious belief in the stability of its ontology. Another implication is that it emphasizes the epistemological relevance of the perspective of the allegedly mad; the explicit rejection of the principle of non-contradiction as far as intellectus is concerned suggests that the rationality of the mad may be closer to reality than the strict logic of those in control of the socially sanctioned definitions. Madness is thus not a problem to be solved, but an opportunity to be explored as a unique possibility of wisdom and insight, which is something authors and artists always have been aware of. Psychiatric “treatment” should thus be replaced by competence in listening to the presumably insane and learning from them. As a bonus, it would then presumably experience the healing potential of including the allegedly mad within a communicative fellowship characterized by mutual recognition.
Plato, Cusanus and Kierkegaard further agree that the ambiguity of reality is best captured by understanding the possible presence of the infinite as the ultimate challenge of the human condition. This results in an understanding of faith as the realization of the truly human, and, particularly in Kierkegaard, in penetrating analyses of the psychopathology if its absence explored by means of the experiences of anxiety and despair as unavoidable aspects of human existence. The distinction between the spiritual and the secular then disappears as far as mental sanity and insanity is concerned. The relation to the infinite is a challenge that is common for all of humanity. Suppressing it may then result in symptoms that are worse than what an allegedly religiously neutral, i. e. one-sidedly rational, care for the mentally ill is supposed to heal. This includes an understanding of the demonic as characterized by a fear of the good that leads to the breakdown of human communication. Exorcism and inclusion in a communicative fellowship thus appear as essentially the same thing. This is also repeatedly emphasized in the gospel stories of the exorcisms of Jesus.
Studied religious neutrality and fear of touching the spiritual, which largely is what characterizes modern psychiatry, thus appear as nothing but psychological repression mechanisms. This is presumably the outcome of psychiatry not wanting to enter the business of promoting one or other of the traditional religions understood as competing bodies of doctrinal knowledge. This fear is understandable, but there are other ways of handling it. Taking one’s point of departure in the apophaticism of Plato, Cusanus and Kierkegaard, one will have to maintain that the significance of the faith perspective can only be confirmed by its lack of a definite confirmation. It remains an open question and can never move into the area of established rationality without being transformed into something different. Psychiatry is thus for the sake of its own adequacy dependent on being founded on an appreciation of the significance of the infinite and indefinable while leaving its possible manifestations to the area beyond the rational, i. e. the liturgical celebration of the narratives determining the identity of the worshipping community. This is not religious neutrality; on the contrary, it is founded on a deep appreciation of the significance of spirituality for the realization of the truly human. It remains neutral, though, in not being committed to a specific religious tradition.
Any idea of illness, mental or bodily, consciously or unconsciously presumes an idea of what the normal or ideal human life is. Modernity has favoured a formal idea of rationality that essentially leaves it clueless when it comes to understanding the good life. Psychiatry, as a child of modernity with scientific ambitions, is badly in need of an improved philosophical foundation. Serious engagement with the works of Plato, Cusanus and Kierkegaard could be a good place to start.
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