Madness and Kant's Philosophy: The Importance of Philosophy to Medicine
Mariannina Failla·
Università degli Studi
Roma Tre, Italy
Abstract
The introduction to the Dossier on mental disorder in the work of Kant
considers the relationship between philosophy and medicine. Its brief
suggestions are linked to only one form of pathology: hypochondria, on the one
hand; to a highly particular aspect of mental disorder: its relationship with
criminal accountability or, if we wish, the legitimacy of punishment, on the
other hand.
Key words
Dietetics, Body, Hypochondria, Abstraction, Blame, Care
The Dossier on “Madness and Kant's Philosophy" features
essays from the fields of psychoanalysis, of the modern psychiatric science,
aesthetics (for example the theory of emotions, disgust, melancholy and pathologies
of the imagination) and moral philosophy (social questions of mental disorder
and moral issues related to mental pathology and its treatment). They range
across Kantian philosophy with an interdisciplinary spirit, without restriction
to those fields that directly thematise the phenomenon of mental disorder. To
offer a scenario suitable to the interweaving of disciplines present in the
Dossier I would like to present a few brief considerations on the relationship
between philosophy and medicine[1]. This relation appears in
the final part of the precritical text from 1764 (Versuch über die Krankheiten des Kopfes)
and returns in at least two later works from 1798 (Anthropologie in pragmatischer Hinsicht and Streit der Fakultäten).
Considerations
on philosophy’s contribution to medicine – bitingly ironic and lashing in the
precritical text from 1764 – later shed their sarcastic tone and raised at
least two very important questions: the first regards the body-psyche
relationship[2];
the second involves the legal aspects of mental disorder[3]. I am referring to the
collaboration among philosophy, medicine and law,
hoped for in the Anthropologie, to confront the theme of punishment
in the event of crimes committed by the mentally ill[4].
We can begin with the first question: the
body-psyche relationship. From the text Gedanken von der wahren Schätzung
der lebendigen Kräfte (Living forces, Kant’s first published
work. Written in 1744–46 and published in 1749) there is a recurring question
about the relationship between matter and immaterial substance. This theme was
strongly influenced by debate, during the 1740s, on the monad and the corelated
Leibnizian conviction of the presence of the simple immaterial substance in
material “compositum” (le composé).
It should come as no surprise that the precritical texts many times addresses
the theme of the localisation of the psyche. In Träume eines Geistersehers, released two years after the Versuch, Kant defends the idea of
the presence of the soul in the entire sentient body against the hypothesised
existence of a specific part of the body in which the immaterial element
resides. Asking ‘where’ the soul ‘lives’ is entirely specious and misleading,
as it presupposes that the body features a particular area destined to host it (Kant, TG, 02: 324). The
corporeal body is not made of disjointed parts; the error of choosing one part
as home to the soul, separate from the others, can largely be ascribed to the
physical-corpuscular vision of Descartes. Against the interpretation of the
soul incorporated in a particular part of the body, distinct and isolated from
the others, Kant hypothesised a soul whose dynamics pervade the body and extend
into all of its organs (Kant, TG, 02: 324-325). In decisively
anti-Cartesian tones, he reminds us that to consider the localisation of the
psyche we must suppose it to be everywhere the body feels; it is not a question,
therefore, of identifying a cerebral point from which the ego sets the bodily
machine in motion or by which it is modified. What occurs, then, in the case of mental disorders?
In
Versuch the
body is interpreted as the seed site of mental disorder and positioned at the
base of its genealogy: the body is the first (zuerst) to suffer a mental disturbance, often unconsciously (unvermerkt) and
therefore ignored (Kant writes in VKK, 02: 270). Precisely for this neglect,
for the obscure and confused action (imperceptible and indeterminate) of a
disturbance in the body, this latter becomes the humus in which
cognitive psychic disturbances grow and complicate. The body, while it may not
be the cause or aetiological origin[5], is anything but an inert
element in the gestation and manifestation of cognitive psychic illness (Kant, VKK, 02: 270-271). Despite its passivity, the
body is the fermenting seed that plays a role related to man’s psychic affectivity,
feelings and practical habits. The warning present in
Kant’s words appears to be: without clarifying and
distinguishing the dynamics of the body in which psychic disturbances nest, we
risk to allow the cognitive faculties and practical behaviour associated with
them to degenerate. Caring for the body is, therefore, also therapy for the
soul, while caring for the soul implies a therapeutic influence on the body.
This latter affirmation can be easily extracted from the comment on Hufeland’s medical treatise found in the late writing Streit der Fakultäten.
In this text Kant appears to complete the practical idea of the rooting of the
psyche in corporeality, convinced that the psyche itself possesses a
transformative, one could say diagnostic and therapeutic, power with respect to
the body. This is the direction of dietetics and self-observation, implemented
to offer the field of medicine a diagnostic and transformative practice for
physical and psychic practices. In Streit, the
collaboration between philosophy and medicine focuses on a particular type of
medical practice, that destined to prevent illnesses by favouring longevity. In
this context, however, I am interested in capturing the combined diagnostic and
therapeutic value of self-observation[6], directed above all toward
the mental disturbance of hypochondria. Kant himself claimed to have a natural
tendency toward hypochondria owing to a very narrow thoracic cage that favoured
neither his heartbeat nor his ability to breathe normally (Kant, SF, 07:104).
Together with this bodily diagnosis, he indicated how the mind could come to
dominate and care for this psychic-cognitive disturbance: by distracting attention
(Abkehrung der Aufmerksamkeit) from
oneself and in particular from one’s imaginary fabrications,
which Kant here refers to as Gefühle, in a very general sense (Kant, SF, 07: 104). He draws on the coupling of the opposites “attentio” and “abstractio”, already
present in the section dedicated to the intellect in Psychologia empirica by Baumgarten. This coupling is capable of explaining the opposing movement brought about
by the treatment of hypochondria, as proposed by dietetics. The process of
subjectification of the self, in which the objective world is engulfed by and
in the production of symptoms and disturbances, is opposed by self-observation
with the movement of the objectification of the self, which abstracts and
separates the self from the raving psyche (suffering from pathogenic anxieties
provoked by the body), by distracting it. Abstraction is thus propaedeutic to
distraction: “[…] Abstractio animi distracti a perceptionibus heterogeneis pluribus, qua attentio
ad certum obiectum augetur, est ANIMI COLLECTIO** […]”, Baumgarten affirms in
his Psychologia
(Baumgarten, 1963: § 638: 234). These assertions appear to dialogue with
Kant’s anthropological reflections dedicated to the ‘abstractio’, denoted as a
therapeutic technique of stoic origins that, if opportunely cultivated, permits
us to cure disturbances seeded in corporeality (Kant, HN AA 15: Refl. §
161: 58-59), as demonstrated,
in the end, by Kant’s self-observation[7].
Beside
this contribution of philosophy to medicine, which transforms the very concept
of medicine by indicating mental techniques for the prevention of
psychic-corporeal disorders, I wish to consider another problematic node that,
however, involves not only medicine and philosophy, but also law. I am alluding
to the legal implications of criminal actions committed by the mentally ill.
The
theme of punishment, of legal accountability for a crime, guides the very
brief, though interesting anthropological considerations on crimes committed by
the insane. First and foremost, there is a need to establish effective legal
accountability in the case of acts committed by someone presumed to be insane.
To evaluate whether a person has committed a crime contrary to the law in the
absence or presence of mental competency, the judge cannot turn to the faculty
of medicine, but must look to philosophy. In other words, forensic medicine (medicina forensis) is
wholly unsuited to establishing the effective mental state of the perpetrator
of a crime, as a similar evaluation is an exclusively psychological question (ist gänzlich psychologisch). The observation of physicians and
physiologists cannot delve in great depth into the ‘mechanism’ of the human
soul (das Maschinenwesen im Menschen),
(Kant, Anth AA 007: 214), that is, into the ordered
and disordered organisation of human faculties. Only philosophy can do this,
and in view of the application or non-application of punishment. This involves
the Kantian legal reflection on the legitimacy and measure of punishment. If
punishment derives its legitimacy from being the subjective reason for
respecting the law, a reason immediately provided by law itself (Kant, MS, AA
06: 218), it can be said that legitimising punishment has the value of
preventing illegal actions. I would be tempted to say that the legitimacy of
punishment was considered by Kant as a sort of legal dietetics that serves to
preventively distract attention from criminal actions, guaranteeing the safety
and therefore the longevity of the State. The measure of punishment, for its
part, is accompanied by its categoricalness and recalls, if not literally,
certainly the spirit of jus talionis based
on the perfect equivalence between crime and punishment. Any harm made to
another is also made to oneself: if we mock others, we mock ourselves, if we harm
others we harm ourselves, if we kill others we kill
ourselves; this latter passage contains the Kantian justification of the death
penalty. It is therefore the objectivity of the crime perpetrated that decides
the measure and quality of punishment without any regard for the sensibility or
social class of the person who commits the crime (Kant, MS, AA 06: 332-333), that
is, without any consideration of the subject of the crime. How then are we to
reconcile the retributive severity of punishment, briefly described here, with
the anthropological reflections employed by Kant to entrust philosophical
psychology, that in-depth look at organic and balanced relations among the
faculties, with the role of considering the subject of punishment and no longer
its object? Certainly, in Kantian legal philosophy the reference to
subjectivity is present and deals with the necessity not to offend humanity, or
better yet, not to damage the moral idea of the humanity of the accused. All
the same, this reference belongs to the field of regulating crimes against
humanity. They appear to set a limit on the rigorous and literal application of
jus talionis: those who carry out
crimes against humanity (horrendous crimes such as torture, rape, paedophilia) cannot
be subjected to the same action as this would violate the idea of humanity,
making it guilty of the same crime it intends to punish[8].
However, this type of consideration of a subject who can be held accountable
and punished is not, however, the reference for considerations of the criminal presumed
to be insane treated in Anthropologie.
In the note on the page dedicated to legal medicine and its limits, Kant speaks
of a judge who declared a woman who had killed her child after learning she had
been sentenced to the penitentiary to be insane. The judge based his ruling on
the claim that anyone who draws true conclusions from false premises is
mentally insane. What is important to recall here from the comment in the note
on the judge’s reckless and unfounded ruling is not the regret at having spared
a lucid and sane of mind guilty individual the death penalty, as this regret
perfectly belongs to the idea of the measure of punishment as objective
recompense for a crime committed; important, instead, are the words dedicated
to an assassin who was truly insane. For an insane criminal, punishment
consists, in objective terms, in social blame, which could have the aim of
guaranteeing the stability of the social fabric and preventing other deviated
behaviour; in subjective terms punishment is transformed into care for the
insane, care which cannot ignore the philosophical understanding of the depths
of the human soul. Here we are very far from the legal problems of jus talionis and the categorical nature
of punishment. The objective equality (Gleichheit) between crime and punishment is supplanted by
the preventative attention toward the wellbeing of the community and, ex
post, the possible wellbeing of the individual who has committed the crime.
With this brief example Kant appears to lead us into the heart of the pragmatic
consideration of punishment[9], adding the word ‘care’ to
those of warning and isolation, already employed in some of the Reflexionen von Moralphilosophie.
My
reflections, though brief, wish to emphasise the richness also of the minor
passages in Kant’s thinking, and the strong interdisciplinary base that
transpires from his anthropological considerations. A base that the authors of
the Dossier have managed to honour to great effect and with much
innovation.
Abbreviations for Kant’s Works
|
Anth |
Anthropologie in pragmatischer
Hinsicht, in Gesammelte Schriften, Bd. VII, G. Reimer,
Berlin 1973. |
|
Br |
Briefwechsel, in Gesammelte Schriften, Bde.
X-XIII, De Gruyter, Berlin 1969. |
|
HN |
Handschriftlicher Nachlass, in Gesammelte Schriften, Bde. XIV-XXIII,
De Gruyter, Berlin
1925-1938. |
|
MS |
Metaphysik der Sitten, in Gesammelte Schriften, Bd. VI, De Gruyter, Berlin 1914. |
|
TG |
Träume eines Geistersehers, erläutert durch Träume der Metaphysik, in Gesammelte Schriften,
Ab. I,
Bd. II, De Gruyter, Berlin 1969. |
|
VKK |
Versuch über die
Krankheiten des Kopfes, in
Gesammelte Schriften,
Ab. I,
Bd. II, De Gruyter, Berlin 1969. |
|
SF |
Der Streit der
Fakultäten, in Kant‘s Gesammelte Schriften Bd. VII G. Reimer, Berlin 1973. |
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