“Our depths and our home.” A few words about the other metaphor taken from Rilke: the metaphor of depth.
(Here I am conscious of cheating slightly. The word Rilke uses is Boden. Literally, this means “ground” or “bottom,” as in “the bottom of the sea.” To use the word “bottom” when talking of people has irrelevant associations. The translation could have read “our ground and our home.” I preferred to exploit the associations with the bottom of the sea, and chose “depths.” The idea of our bitter times as being part of the depths of a person seemed true to Rilke’s intentions. But now I am starting from this English word rather than from what Rilke actually said.)
While writing this book, I did not notice how often I drew on the contrast between depth and shallowness. Looking back, it needs some clarification.
The first contrast here between shallowness and depth was in the discussion of the Broadmoor interviews. The suggestion was that seeing morality in terms of opening doors for women, or thinking that swearing is as bad as bullying, is shallow because of the stress on the conventional and the trivial. The contrast was with what gives moral depth: either personal reflection on why things matter or an intuitive feel for other people and what they care about. Command moralities are shallow because unreflective obedience cannot draw on these things.
“Deep versus shallow” is a contrast not of one dimension but of several. “What is deep in a person” can refer simply to what is inaccessible to consciousness. Psychoanalysis in its early days was sometimes called “depth psychology” because of its efforts to delve below what is conscious. The same use of “deep” was found in the account David Hicks gave of the “psychiatry” in Guantanamo: “They probed and tinkered in recesses so deep, parts of ourselves we are not conscious of or in touch with in our daily lives and may not even connect with and discover in our lifetimes.”
Another version of depth is found in what was called earlier the deep sense of self: a secure and untroubled awareness of the distinct person you are. In some of the Broadmoor interviewees its absence may have created a hunger for recognition, with attempts to impress other people that they were “really someone.”
Another use of the deep/shallow contrast has to do with moral identity: the sort of person you hope to be and the values shaping that hope. Thinking about choices made by addicts raises the contrast between two ways of settling inner conflicts. Some are settled by brute strength of desire. The other approach involves asking questions about what you happen to want. These other decisions go deeper because in them people discover or express more of themselves. In turn, the kind of person someone wants to be can reflect shallowness or depth. Some of the interviewees hoped mainly to be someone with the skills of a chef or the talents of Bruce Forsyth. Others, by contrast, were aware that their previous life of earning money and getting drunk at pubs and clubs was “lived basically on one level” and saw there could be more than this. “I need the experiences outside, you know, to develop.”
People can be deepened through experiences that matter to them, as some were by the Shakespeare productions in Broadmoor. One in the audience felt a sense of peace and wholeness at the deaths at the end of King Lear. Another said Hamlet could have been his mother or brother: “So it did have a lot of meaning. I hope you understand this.” These experiences can leave a lasting imprint: one patient spoke of “something I’ll take with me for the rest of my life.” They may deepen people by enlarging their understanding: “It also brought home to me how we compound our miseries through our own destructive feelings of bitterness and vengeance … If only we could learn not to act on impulsive urges of revenge.”
Depth and authenticity are interwoven with each other in the question of whether an action—perhaps something strange done by a person with schizophrenia, or the refusal to eat by someone with anorexia—is an expression of the illness or of the person. The question reflects a contrast between an aberration and what is central or deep in a person. As Viktor Frankl pointed out, someone’s identity is partly constituted by the values that go deepest: values that “cannot be espoused and adopted by us on a conscious level—they are something that we are.” But this needs supplementing with Martha Nussbaum’s thought that it is no simple matter to find out what the deepest parts of ourselves are. Helping people find their depths may call on many Socratic conversations.
One of the great costs of ruthlessly self-interested amoralism is that it rules out the deepest relationships. Love and friendship are incompatible with pure self-interested calculation. The depth of relationships also varies with the extent to which attitude spirals evolve (attitudes toward attitudes, and so on, spiraling upward). The strength of the case against trying to medicate away the low psychological states involved in grief varies in different people. It depends on how far the grief is part of the seriousness and depth of the relationship that person had with the person whose loss they are grieving.
The Broadmoor interviews brought out some contrasts between shallow and deep respect for other people. The deep attitude of respect goes beyond the conventional politeness of opening doors for women, and beyond respecting people’s legal or moral rights. It is a way of seeing people, caught in Rainsborough’s thought that “the poorest he that is in England hath a life to lead as the greatest he.” (We would now of course explicitly include the poorest she.) The key is not just abstract assent to a platitude, but emotional awareness that other people as much as ourselves have a life to lead that is as desperately important to them as mine is to me.
This awareness goes with trying to understand another person’s interpretation of the world—and sometimes how it may have been disrupted. The depth here is going beneath the visible surface of a person. As George Herbert wrote, “A man that looks on glass, / On it may stay his eye; / Or if he pleaseth, through it passe, / And then the heav’n espie.” Though in the depths beneath the surface, it is not always heaven that comes into view. Sometimes it is the vulnerable child Ted Hughes noticed, peering through the slits in the defensive armor of adulthood. In postcombat stress it may be the dark side of what human beings can do. But understanding this darkness can give more depth than looking away from it.
People are deep or shallow in different ways. Some are reflective but have little human intuition. Others are the reverse. And so on. People come in different places on the continuum in different contexts. Depth and shallowness are relevant to psychiatric interpretation. Judging how to help a person may require trying to look into their depths.
The metaphor of visual depth perception is useful. To see the physical world in depth, we use our two eyes. The brain decodes the slightly discrepant pictures they give to get information about the relative distance of things. Knowledge of physical depth is extracted from the incompatibilities of binocular vision.
This is a metaphor for psychiatry, a field where there are truths that at first look incompatible. People are not transparent, yet often they can be interpreted. To some extent we create ourselves. Yet what we are like is quite severely constrained by factors outside our control. Psychiatric disorder can have such strange features that “domesticated” accounts often falsify it. Yet, humani nihil a me alienum puto: it is essential not to forget the extent of the shared human condition on both sides of the boundary. A major psychiatric disorder is a tragedy to be prevented if possible. Yet it may be something the person who has it would not change, “our winter foliage, our evergreen.”
On each of these issues there is a tension between what comes before the word “yet” and what comes after it. But there are no deeply incompatible truths: paradoxes exist to be resolved. Each side of the opposition may be part of the truth. Psychiatric disorder can make people in some ways radically strange without obliterating all the human psychology they share with others.
The philosophical interest is greater when the tension goes deeper. How far is self-creation compatible with the constraints of temperament and of environment? How can we take with sufficient seriousness the testimony of someone who is not sorry to have schizophrenia without falling into the shallowness of belittling how terrible it is? These are foundational questions for a philosophical account of psychiatry and of the conditions it treats. In trying to answer each question, we have to start from the two perspectives. It is only by combining whatever is ultimately defensible in each that we go deeper.
Seeing things from apparently incompatible standpoints gives a metaphor for psychiatry as a whole. We will never understand mental disorder unless we see it, as modern psychiatry does, in the clear light of scientific empiricism. But there is also the subjective perspective, which tells us so much that is not visible from the outside. To see to the depths of people with psychiatric disorder, the two perspectives have to be combined in binocular vision. We need the external scientific story. And the view from inside, interpreted with empathy but also with searching questions.