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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.

 

 

Bibliography

 

Baumgarten Alexander G. (1963), Psychologia empirica, in Metaphysica, Olms, Hildeshein-New York. 

Brandt, Reinhard (1999), Kommentar zu Kants Anthropologie, Felix Meiner Verlag, Hamburg.

Costantini Marco, (2018), “Le patologie psichiche nel Versuch kantiano del 1764”, in Con-Textos Kantianos. International Journal of Philosophy, 7, 2018, pp. 234-251.

Fabbrizi Chiara, (2012), “L’attenzione di Kant per la corporeità: tra medicina e filosofia trascendentale”, Consecutio temporum.  Rivista critica della post-modernità, 2, pp.137-168.

Fantasia Francesca, (2021), “Kant on Punishment: between Retribution, Deterrence and Human Dignity”, The Italian Law Journal, 1, (forthcoming).

Fantasia Francesca, (2019), “Il mondo perduto. Follia e senso comune nell’Antropologia di Kant”, Consecutio rerum, 7, pp. 17-45.

Frierson Patrick, (2009), “Kant on Mental Disorder. Part 1: An Overview”, History

of Psychiatry, 3, pp. 267–289.

Kisker Karl Peter, (1957), “Kants psychiatrische Systematik”, Psychiatria et Neurologia 1/2, pp. 17-28.

Nuzzo Angela, (2008), Ideal Embodiment: Kant’s Theory of Sensibility, Bloo­mington,  Indiana University Press.

Sanchez Madrid Nuria, (2018), Controlling Mental Disorder: Kant’s Account of Mental Illness in the Anthropology Writings”, in G. Lorini and R. Louden (Eds.), Knowledge, Morals and Practice in Kant's Anthropology, Basingstoke, Hampshire-New York, Pal­gra­ve Macmillan, pp. 147-162.

Svare Helge, (2006), Body and Practice in Kant, Dordrecht, Springer.

Descripción: kant_ctk_TRANSPARENTE1.png



· Dipartimento di Filosofia, Comunicazione, Spettacolo, Univerità degli Studi Roma Tre- Italy, mariannina.failla@uniroma3.it

[1] The relationship between philosophy and medicine must be understood in a very broad sense and not strictly related to the taxonomy of diseases (Frierson, 2009: 267-289) or to Kant's psychiatric interpretations (Kriske, 1957: 17-28).

[2]  For the interweaving of philosophy, medicine and the body (Fabbrizi, 2012: 137-168); for forward-looking works on body in Kant (Svare, 2006; Nuzzo 2008).

[3] A reference to this issue can be found in (Sanchez Madrid, 2018: 147-162).

[4] The social aspects of mental illness in Kant have been usefully analysed with a linguistic-communicative perspective in (Fantasia, 2019: 17-45) and with a practical-moral view in (Frierson, 2009: 267-289).

[5] Costantini's contribution on the corporality as a source of mental illness is distanced from the aetiological interpretation , (Costantini, 2018: 234-251).

[6] The use of the method of self-observation was announced by Kant to Hufeland one year before the publication of Streit der Fakultäten in a letter dated 15 March 1797 (Kant, Br, AA 12: 148).

[7] Brandt  (1999: 306).

[8] Fantasia (2021: forthcoming).

[9] Very interesting in this regard is the essay being written by Fantasia (2021:forthcoming).

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