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[The mystical physician to the King of Thrace] said the soul was treated with certain charms, my dear Charmides, and that these charms were beautiful words.

Somatisation involves the transformation or conversion of psychological distress into more tolerable physical symptoms. This might involve a loss of motor function in a particular group of muscles, resulting, for example, in the weakness or paralysis of a limb or a side of the body. This loss of motor function might be accompanied by a corresponding sensory loss. In some cases, sensory loss might be the presenting problem, particularly if it is independent of a motor loss or if it involves one of the special senses such as sight or smell. In other cases, the psychic material is converted into an unusual pattern of motor activity such as a tic or even a seizure (sometimes called a ‘pseudoseizure’ to differentiate it from seizures that have a physical or organic basis, for example, epilepsy or a brain tumour). Pseudoseizures can be very difficult to distinguish from organic seizures. One method is to take a blood sample 10-20 minutes after the event and to measure the serum level of the hormone prolactin, which tends to be raised by an organic seizure but unaffected by a pseudoseizure. More invasive but more reliable is video telemetry, which involves continuous monitoring over a period of several days with both a video camera and an electroencephalograph to record the electrical activity along the skull.

Given that all these different types of somatised symptoms are psychological in origin, are they any less ‘real’? It is quite common for the person with somatised symptoms to deny the impact of any traumatic event and even to display a striking lack of concern for his disability (a phenomenon referred to in the psychiatric jargon as la belle indifference), thereby reinforcing any impression that the somatised symptoms are not quite kosher. Ego defences are by definition subconscious, such that the somatising person is not conscious or, at least, not entirely conscious, of the psychological origins of his physical symptoms. To him, the symptoms are entirely real, and they are also entirely real in the sense that they do in fact exist, that is, the limb cannot move, the eye cannot see, and so on. In fact, some authorities advocate replacing older terms such as ‘pseudoseizures’ or ‘hysterical seizures’ with more neutral terms such as ‘psychogenic non-epileptic seizures’ that do not imply that the somatised symptoms are in some sense false or fraudulent. The reader may recall from the discussion on depression that many people from traditional societies with what may be construed as depression present not with psychological complaints but with physical complaints such as headache or chest pain; like many ego defences, this tendency to somatise or physicalize psychic pain is deeply ingrained in our human nature, and should not be mistaken or misunderstood for a factitious disorder or malingering.

A factitious disorder is defined by physical and psychological symptoms that are manufactured or exaggerated for the purpose of benefitting from the rights associated with what the American psychologist Talcott Parsons called ‘the sick role’ (1951), in particular, to attract attention and sympathy, to be exempted from normal social roles, and, at the same time, to be absolved from any blame for the sickness. A factitious disorder with mostly physical symptoms is sometimes called Münchausen Syndrome, after the 18th century Prussian cavalry officer Baron Münchausen who was one the greatest liars in recorded history. One of his many ‘hair-raising’ claims was to have pulled himself up from a swamp by the hair on his head, or, in an alternative version, by the straps of his boots. Whereas a factitious disorder is defined by symptoms that are manufactured or exaggerated for the purpose of benefitting from the privileges of the sick role, malingering is defined by symptoms that are manufactured or exaggerated for a purpose other than benefitting from the privileges of the sick role. This purpose is usually much more concrete than the secondary gain deriving from the sick role, for instance, evading the police, claiming some form of compensation, or obtaining a bed for the night. It should be absolutely clear that such patterns of behaviour are very different from somatisation – even though, it has to be said, I have often observed cases of overlap.

In recent decades, it has become increasingly clear that psychological stressors can lead to physical symptoms not only by the psychological defence of somatisation but also by physical processes involving the nervous, endocrine, and immune systems. Since Robert Ader’s initial experiments on lab rats in the 1970s, the field of psychoneuroimmunology has taken off spectacularly. The large and ever increasing body of evidence that it has uncovered has led to the mainstream recognition not only of the adverse effects of psychological stress on health, recovery, and ageing, but also of the beneficial effects of positive emotions such as happiness, motivation, and a sense of purpose. Here again, modern science has only just caught up with the wisdom of the Ancients, who were well aware of the link between psychological wellbeing and good health.

In one of Plato’s early dialogues, the Charmides, Socrates tells the young Charmides, who has been suffering from headaches, about a charm for headaches that he had recently learned from one of the mystical physicians to the king of Thrace. According to this physician, however, it is best to cure the soul before curing the body, since health and happiness ultimately depend on the state of the soul. ‘He said the soul was treated with certain charms, my dear Charmides, and that these charms were beautiful words.’ As the virtue of temperance (sophrosyne) is the marker of the health of the soul, Socrates asks Charmides whether he thinks that he is sufficiently temperate. The Charmides takes place in 432 BC, the year of Socrate’s return to Athens from service at the battle of Potidaea, and its subject, as it turns out, is no less than the nature of sophrosyne, a philosophical term loosely translated as ‘temperance’ but with the etymological meaning ‘healthy mindedness’. As is typical with Plato, the dialogue ends in a state of aporia (a state of inconclusive non-knowledge), with Socrates accusing himself of being a worthless inquirer and a ‘babbler’. Charmides concludes that he can hardly be expected to know whether he is sufficiently temperate if not even Socrates is able to define temperance for him.

Whereas Plato associates health with the virtues and in particular with temperance (‘healthy mindedness’), Aristotle associates health with the Supreme Good for man. This Supreme Good, he says, is eudaimonia, a philosophical term that is often translated as ‘happiness’ but is perhaps best translated as ‘human flourishing’. In short, Aristotle argues that to understand the essence of a thing, it is necessary to understand its distinctive function. For example, one cannot understand what it is to be a gardener unless one can understand that the distinctive function of a gardener is ‘to tend to a garden with a certain degree of skill’. Whereas human beings need nourishment like plants and have sentience like animals, their distinctive function, says Aristotle, is their unique capacity to reason. Thus, the Supreme Good, or Happiness, for human beings is to lead a life that enables them to exercise and to develop their reason, and that is in accordance with rational principles. Part of living life according to rational principles is to seek out the right sorts of pleasure, underplaying those brutish pleasures such as food and sex that are only pleasurable incidentally in that they act as restoratives, and privileging those higher pleasures such as contemplation and friendship that are pleasurable by nature and therefore cannot admit of either pain or excess. To pursue the higher pleasures is ‘to stimulate the action of the healthy nature’ (NE, Book VII), and to be healthy is not only to be free from pain and disease, but also and most importantly to flourish according to our essential nature as human beings. So, although Plato associates health with ‘healthy mindedness’ and Aristotle with the Supreme Good, once the Supreme Good is unpacked it becomes very clear that this is merely a difference of emphasis, and that Plato and Aristotle are not in any fundamental disagreement on this issue.

Adapted from Hide and Seek: The Psychology of Self-Deception.

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John Heaton is, amongst others, a practising psychiatrist and psychotherapist, a regular lecturer on the Advanced Diploma in Existential Psychotherapy programme at Regent’s College, London, and a long- and some-time editor of the Journal for Existential Analysis.

This is Heaton’s third book with Wittgenstein in its title. In it, he applies the great philosopher’s insights to the psychotherapeutic process in all its forms. Heaton’s principle thesis is that many of our deepest and most intractable problems find their roots in linguistic confusions and limitations, and are resolved not by the search for causes inherent in the various pseudo-scientific doctrines and theories of the mind (such as those of Freud and Klein), but by careful attention to the use of language. This is particularly true in neurosis and psychosis in which language is used not so much to clarify and to communicate as to deceive and to obfuscate.

Like all the best things, the talking cure has its roots in ancient Greece with such luminaries as Socrates and Diogenes the Cynic (see my post on Diogenes here). Upon being asked to name the most beautiful of all things, Diogenes replied ‘parrhesia’ (free speech, full expression), and his intransigently courageous and sometimes delightfully shocking behaviour consistently accorded with this, his, truth. The self-understanding that underlies parrhesia is revealed not in reductionist propositions based on questionable pictures of the mind, but in the singular use of language – both by the expression and by its truthfulness. In short, it is revealed not in causes, but in reasons, with all their multiplicities and particularities.

For Wittgenstein as for Heaton, the talking cure is, like philosophy itself, a battle against the bewitchment of intelligence by means of language, for it is not knowledge but understanding that is needed to live an integrated, productive, and, dare I say it, happy, life. To date, this important, indeed, devastating, critique has had little or no impact on psychotherapeutic practices, and Heaton’s revolutionary book requires and deserves to be read not only by psychotherapists and psychiatrists but by every mental health professional. Although the book is not difficult to leaf through, she with little more than a scientific background may find it difficult to understand, accept, or come to terms with certain concepts. As Lichtenberg tells us, ‘A book is like a mirror: if an ape looks into it an apostle is hardly likely to look out … he who understands the wise is wise already.’

Neel Burton

NB: This review has also been published in the September issue of the British Journal of Psychiatry.

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Intellectual virtues are developed through teaching, and moral virtues through habit. Moral virtues are not in our nature, but nor are they contrary to our nature, which is adapted to receive them. Sight and hearing are in our nature, and so they are given to us. In contrast, the arts and the moral virtues are not given to us, but are acquired through constant exercise. Just as a man becomes a sculptor by sculpting, so he becomes just by doing just acts, temperate by doing temperate acts, brave by doing brave acts.

It is impossible to define virtue with any precision, as the goodness of a feeling or action depends on individual circumstances. However, just as strength is destroyed by a defect or excess of exercise, so the virtues are destroyed by their defect or excess. For instance, he who flies from everything becomes a coward, whereas he who meets with every danger becomes rash. In contrast, courage is preserved by the mean.

Moral excellence is closely related to pleasure and pain: it is in pursuing and avoiding pleasure and pain that bad things are done and noble things not, and so it is by pleasure and pain that bad people are bad. There are three objects of choice, the noble, the advantageous, and the pleasant, and three objects of avoidance which are their contraries, the base, the injurious, and the painful. The good tend to go right, the bad wrong, about these, and especially about pleasure which is common to the animals and which is also found in the advantageous and in the noble. A good person feels pleasure at the most beautiful or noble (kalos) actions, whereas a person who is not good often finds his perceptions of what is most pleasant to be misleading. It is harder to fight with pleasure than with anger, but both art and virtue are concerned with what is harder, and even the good is better when it is harder.

A person may do a seemingly virtuous action by chance or under compulsion. His action is truly virtuous only if (1) he knows that the action is virtuous, (2) he chooses to do the action for the sake of being virtuous, (3) his action proceeds from a firm and unchangeable character. In short, an action is truly virtuous if it is such as a virtuous person would do.

But most people do not do these, but take refuge in theory and think they are being philosophers and will become good in this way, behaving somewhat like patients who listen attentively to their doctors, but do none of the things they are ordered to do.

There are three things that are found in the soul, passions, faculties, and dispositions. As the virtues are neither passions nor faculties, they must be dispositions. In light of this, virtue can be defined as a disposition to aim at the intermediate between deficiency and excess, or, in other words, as a disposition to aim at the mean, which, unlike deficiency or excess, is a form of success and worthy of praise. While it is possible to fail in many ways, it is possible to succeed in one way alone, which is why the one is easy and the other is difficult. By the same token, men may be bad in many ways, but good in one way only.

So far so good, except that not every passion or action admits of a mean, for instance, not envy or murder. It is never a question of murdering the right person, at the right time, and in the right way, for murder is bad in itself and neither a deficiency nor an excess. The principle virtues along with their corresponding vices are listed in the table.

In some cases, one vice can be closer to the virtue than the contrary vice, for instance, rashness is closer to courage than cowardice, and prodigality is closer to liberality than meanness. This is not only because the first vice is more similar to the virtue than the contrary vice, but also because the contrary vice is the more common. Rashness is more similar to courage than cowardice, which is more common than rashness, and prodigality is more similar to liberality than meanness, which is more common than prodigality. Hence people oppose not rashness but cowardice to courage, and not prodigality but meanness to liberality.

It is no easy task to be good. For a person to increase his likelihood of hitting the mean, he should (1) avoid the vice that is furthest from the virtue, (2) consider his vices and drag himself to their contrary extremes, (3) be wary of pleasure which clouds judgement and leads astray. The person may miss the mean by a little, for instance, he may get angry too soon or not enough, and still be praised for being either manly or good-tempered. It is only if he deviates more widely from the mean that he becomes blameworthy; how widely is difficult to determine, as it depends on the individual circumstances and on how they are perceived.

For in everything it is no easy task to find the middle … anyone can get angry – that is easy – or give or spend money; but to do this to the right person, to the right extent, at the right time, with the right motive, and in the right way, that is not for everyone, nor is it easy; wherefore goodness is both rare and laudable and noble.

Adapted from Aristotle’s Universe: A Primer on Aristotle.

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One swallow does not make a summer, nor does one day; and so too one day, or a short time, does not make a man blessed and happy.

For Aristotle, a thing is best understood by looking at its end, goal, or purpose (telos). For instance, the end of a knife is to cut, and it is by grasping this that one best understands what a knife is; the end of medicine is good health, and it is by grasping this that one best understands what medicine is (or ideally should be). If one does this for some time, it soon becomes apparent that some ends are subordinate to higher ends, which are themselves subordinate to still higher ends.

If, then, there is some end of the things we do, which we desire for its own sake (everything else being desired for the sake of this) … clearly this must be the good and the chief good. Will not the knowledge of it, then, have a great influence on life? Shall we not, like archers who have a mark to aim at, be more likely to hit upon what is right?

The science that has for object the chief good, and whose end therefore includes that of all the others, is none other than the political art. To obtain the chief good for one person is fine enough, but to obtain it for the state is finer and more godlike. In inquiring into the chief good, care must be taken not to be too precise: fine and just actions admit of much variety and fluctuation of opinion, and ‘it is the mark of an educated man to look for precision in each class of things just so far as the nature of the subject admits’.

People agree that the chief good is happiness (eudaimonia), but the many and the wise disagree as to its nature. The many and vulgar identify happiness with sensual pleasure, but a life of sensual pleasure is no better than that of a beast. People of superior refinement and active disposition identify happiness with honour, but honour is merely a mark of virtue, and one that is reliant upon the recognition of others. Neither can happiness be identified with virtue itself, for then happiness would be compatible with a lifetime of sleep or inactivity or with the greatest sufferings and misfortunes.

According to Plato there is such a thing as the Form of the Good in which all good things share. However, this notion should be rejected as ‘piety requires us to honour truth above our friends’. Aristotle raises eight objections to the Theory of the Forms, but claims that this is not the place to investigate it. He revisits the subject in the Metaphysics.

Returning to the search for the chief good, a goal that is an end in itself is more worthy of pursuit than one that is merely a means to an end, and a goal that is never a means to an end but only ever an end in itself is more worthy of pursuit than one that is or can be both.

Now such a thing happiness, above all else, is held to be; for this we choose always for self and never for the sake of something else, but honour, pleasure, reason, and every virtue we choose indeed for themselves (for if nothing resulted from them we should still choose each of them), but we choose them also for the sake of happiness, judging that by means of them we shall be happy. Happiness, on the other hand, no one chooses for the sake of these, nor, in general, for anything other than itself.

All well and good, but what does happiness actually consist in? It is by understanding the distinctive function of a thing that one can understand its essence. For instance, one cannot understand what it is to be a gardener unless one can understand that the distinctive function of a gardener is ‘to tend to a garden with a certain degree of skill’. Whereas human beings need nourishment like plants and have sentience like animals, their distinctive function is their unique capacity to reason. Thus the Supreme Good, or Happiness, for human beings is to lead a life that encourages the exercise and development of reason and the practice of virtue. Happiness resides not so much in the possession as in the practice of reason and virtue, for just as it is not the strong and beautiful but those who compete well who win at the Olympic Games, so it is not the wise and virtuous but those who act well who win – and rightly win – the noble and good things in life. Their life is also more pleasant, as virtuous actions are pleasant by nature, and all the more pleasant still to the lover of virtue.

Now for most men their pleasures are in conflict with one another because these are not by nature pleasant, but the lovers of what is noble find pleasant the things that are by nature pleasant; and virtuous actions are such, so that these are pleasant for such men as well as in their own nature. Their life, therefore, has no further need of pleasure as a sort of adventitious charm, but has its pleasure in itself.

A person’s good or bad fortune can play a part in determining his happiness; for instance, happiness can be affected by such factors as material circumstances, social position, and even physical appearance. Yet, by living life to the full according to his essential nature as a rational being, a person is bound to become happy regardless of his good or bad fortune. For this reason, happiness is more a question of behaviour and of habit – of excellence and of virtue – than of luck. A person who cultivates reason and who lives according to rational principles is able to bear his misfortunes with equanimity, and thus can never be said to be truly unhappy. Even the greatest misfortunes can be borne with resignation, not through insensibility to pain but through nobility and greatness of soul.

With regard to the soul, it comprises a rational and an irrational part. The irrational part has a vegetative element that is concerned with nutrition and growth, and an appetitive element that contains a person’s impulses and that more or less obeys the rational part. If the rational part is strong, as in the virtuous person, it is able to exert a greater degree of control over the appetitive element of the irrational part. Similarly, there are two kinds of virtue, one that pertains to the intellect and that consists in philosophic and practical wisdom (dianoetic virtues), and another that pertains to the character and that consists in liberality and temperance (ethical or moral virtues). A person may be praised for either or both kinds of virtue.

Adapted from Aristotle’s Universe: A Primer on Aristotle

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The educated differ from the uneducated as much as the living from the dead. - Aristotle

The education of the citizens should match the character of the constitution, for the character of democracy creates democracy, and the character of oligarchy creates oligarchy, and the better the character, the better the government. As the entire city has but one end, education should be the same for all, and should be public rather than private. Children should be taught those useful things that are really necessary, but not all useful things, and in particular not those that are vulgar. By ‘vulgar’ is meant those that tend to deform the body or that lead to paid employment. All paid employment absorbs and degrades the mind.

The four traditional branches of education are (1) reading and writing, (2) gymnastics, (3) music, (4) drawing. The Ancients included music not for the sake of utility but for that of intellectual enjoyment in leisure. Unlike music, reading and writing and drawing do have utility, but they also have liberal applications. In particular, reading and writing can open up other forms of knowledge, and drawing can lead to an appreciation of the beauty of the human form. Leisure should not be confused with amusement and relaxation, which are the antidotes to effort and exertion. The busy man strives for an end that he has not yet attained, but happiness is the end. Thus, happiness is experienced not by busy men, but by those with leisure. That which is noble should come before that which is brutal. Courage is more a function of nobility than of ferocity, and to turn children into athletes risks injuring their forms and stunting their growth. For these reasons, children should practice nothing more strenuous than light gymnastics. Following the onset of puberty, three years should be spent in study, and only after this triennium may a youth engage in hard exercise. However, the youth should guard against labouring mind and body at the same time, for they are inimical to each other.

Returning to the subject of music, it is not easy to determine its nature, nor why anyone should have knowledge of it. Perhaps music, like sleep or drinking, offers nothing more than amusement and relaxation. Perhaps it promotes virtue. Or perhaps it contributes to the enjoyment of leisure and to mental cultivation. Some say that no freeman should play or sing unless he is intoxicated or in jest, so why learn music and not simply enjoy the pleasure and instruction that comes from hearing it from others? Our considered opinion is that children should learn music so that they might become performers and critics, but their musical education should not extend too far beyond an appreciation of rhythm and harmony, and not to instruments such as the flute or lyre which require great skill but contribute nothing to the mind.

In addition to this common pleasure, felt and shared in by all … may [music] not have also some influence over the character and the soul? It must have such an influence if characters are affected by it. And that they are so affected is proved in many ways, and not least by the power which the songs of Olympus exercise; for beyond question they inspire enthusiasm, and enthusiasm is an emotion of the ethical part of the soul. Besides, when men hear imitations, even apart from the rhythms and tunes themselves, their feelings move in sympathy. Since then music is a pleasure, and virtue consists in rejoicing and loving and hating aright, there is clearly nothing which we are so much concerned to acquire and to cultivate as the power of forming right judgments, and of taking delight in good dispositions and noble actions. Rhythm and melody supply imitations of anger and gentleness, and also of courage and temperance, and of all the qualities contrary to these, and of the other qualities of character, which hardly fall short of the actual affections…

– Politics, Book 8

Adapted from Aristotle’s Universe, NYP.