Replies and Responses II

Reply to Nathaniel Laor Nathaniel Laor discusses the work of the late Yehuda Fried and myself on mental illness. I cannot speak for the late Fried. Let me report, however, about the way we cooperated. He suffered from a severe writing block. We met in my place and talked. I took notes while we spoke and he repeatedly interrupted me, asking me to delete or at least alter what I was writing. In response, I asked him to explain his requests and wrote down his explanations. This led to further protests, and so on repeatedly. This is how our output took shape. Our initial contribution was our refusal to offer a definition of our subject matter (as tradition requires). Instead, we declared the physician’s task to help given patients. The fashion of the day was anti-psychiatry, the contention that mental patients use language idiosyncratically. This is not a diagnosis, at least not yet: why is this idiosyncrasy problematic? We do not consider patients strangers who speak languages different from ours; we do not consider all verbal variants sick. Fried and I attempted to comprehend the suffering of mental patients. Obviously, the suffering here involves an idiosyncratic use of a shared dictionary. We took it for granted that mental patients use of language is an attempt to express the pain of facing impossible (intellectual) tasks that they take seriously. Consequently, we took the paradoxes of paranoia seriously, wording them as best we could, and trying to offer hypotheses that might resolve them. We surmised that the taking seriously of impossible intellectual tasks makes all incipient cases of mental illness pure paranoia (paranoia vera). This is a hypothesis: the initial stage of every case of mental illness is paranoia. Now the standard diagnosis of mental illness does not accord with this hypothesis. This is so, we have surmised, because usually