Gall Bladders and Despair
Kierkegaard is often called the father of existentialism. His was a Christian existentialist position because after describing the human condition in the bleakest of terms he advocated a “leap of faith” to cope with the condition he so vividly described. Turning against all proofs for the existence or nonexistence of God as meaningless, Kierkegaard nevertheless offers a proof of his own with a description of human psychology that, if one agrees with his diagnosis of despair, it seems reasonable to accept his solution to the despair. Is it in fact reasonable to accept it?
Several years ago I was experiencing recurring stomach problems: I often had a churning in my stomach, sometimes right after eating and sometimes long after, sometimes in a fair amount of pain with a bad taste in my mouth. Because of the discomfort I consulted a physician. He prodded my stomach, took a brief history, asked me what sort of stress I had at my work, and diagnosed an ulcer. He prescribed tranquilizers and suggested I cut down on my stressful life as a chairman of the humanities faculty at Malaspina College.
On the doctor’s authority, and because “stress” was in the press and other media at the time, I took the pills. I did not improve. I began to think the doctor was a quack. I read more about “stress” and came to realize it was a meaningless concept: some people used it to talk about non-physical events capable of affecting one’s life in strange ways; others seemed to mean the environmental effects of physical events, while others from the New Age talked of an “imbalance of life forces in the locus that is a person in the flux of life.” Stress, it seemed, was not a very specific diagnosis, and to jump ahead of my story for a moment, it would or could be used to describe the condition that finally I was found to have. My gall bladder was non-functional because it was full of stones which was certainly a stressful condition; every time it attempted to secrete bile, the stones blocked the pathway.
The second doctor I consulted started out much the same as the previous one. He took a history, tapped my stomach, and measured other vital signs. Then he said, “I think you may have a blockage problem somewhere in the gastrointestinal system. We will have to have more tests.” His “I think. . .” was an obvious signal of tentativeness of diagnosis. He had reasons to believe that his diagnosis was correct, but without further evidence he would not claim to know what the problem was.
There was a way to get further evidence. Tests included blood analysis to determine if the amount of bilirubin in my blood was within the norms for the population. X-ray pictures were taken, after ingesting barium to show up the fleshy organs, in other words, physical evidence based on technically enhancing the physician’s eyes to deduce with high probability that something was blocking part of the plumbing.
Before the tests, what reasons did the doctor have to believe his diagnosis was worth pursuing? Several. The pattern of symptoms fit the existing model of how the system works, my age, blood cholesterol levels and eating habits were part of the profile developed over the years from thousands of similar cases. He “interpreted” the facts with a certain “complex narrative” that included facts, a model, similar cases, detailed past experiences of the profession and a certain background of knowledge. He did not, however, find” stress” a useful diagnostic term, either as a description or as an etiology. Finally, after several confirming tests, surgery was recommended and performed. The gall bladder was found to be full of stones and removed. The pains stopped.
Let’s compare my experience with the diagnostic experience of the psychoanalyst in Farrell’s paper.(Note #1) After taking a history, studying the reports of the symptoms (i.e., why does this seemingly bright young man not work up to his potential?), and applying his past experiences to the case, the psychoanalyst makes a tentative diagnosis just as did my doctor: “I think it is because you always feel frightened to do directly something that father does.” This is, logically speaking, a tentative diagnosis, not a truth claim. Note, for example, if the “shrink” does not get the right answers to this and further questions, he might change his diagnosis, might find it is not father but mother who is the problem, and would find this by taking further tests. At the time he says “I think it is because” which is like a guess – an educated guess.
Educated guesses are more likely to be correct than uneducated ones, but if they are not, we don’t accuse the guesser of lying! The first doctor I visited may have been stupid, hurried or trendy, but he didn’t lie to me; he misdiagnosed me. He said: “I think you have an ulcer caused by stress.” It is true that he thought I had an ulcer, but false that I did have an ulcer. The second doctor said: “I think you have a blockage problem in the system and we’ll need further evidence to determine just what it is.” It is true he thought I had a blockage problem and true that I did, and we both knew just what would count as evidence that his diagnosis was correct: there it was, an organ the size of a marble bag stopped up with stones of various sizes! At each step in the process of testing the hypothesis, further evidence of accuracy made a more precise diagnosis possible.
We have a fairly complete and well-tested model of the digestive system from which to work. Like god, it is inside us, but unlike him/her/it, it is a visible and tangible system. A psychoanalyst of the Freudian persuasion also works from a model, but it is not a physical one. Freud, after all, got his Oedipus and Electra complexes from literature and not from dissection of brains. These models can also be evaluated in the same ways that any scientific model can be, but does it have characteristics, which are specified by explicit definition? Does it generate theoretical hypotheses? Does it provide us with verifiable predictions7 Yes, the brain is more complex than the gut in some ways, but in other ways similar enough to be studied in the laboratory. The move away from psychoanalysis in the last twenty years has been to a large extent because the neuro-biological model of the brain has proven a better “match” to the real system. Even Freud’s theory of dreams is being challenged today.
Kierkegaard in The Sickness unto Death2 uses a comparison between the physician and health and the “spiritual” physician and spiritual health. Just as no one is perfectly healthy, he argues, so too is no one perfectly free of the spiritual disease of despair. “At any rate there has lived no one and there lives no one outside of Christendom who is not in despair, and no one in Christendom, unless he be a true Christian, and if he is not quite that, he is somewhat in despair after all.”
True Christians, if there are any, are the only healthy persons; all others are in despair. What is the status of this claim? Is it the result of a long inductive process? Does one imagine Kierkegaard doing a nineteenth century Gallup poll to arrive at this generalization? (“Excuse me, are you in despair?”) I doubt it very much! And why7 Because he later tells us that “the fact that the man in despair is unaware that his condition is despair, has nothing to do with the case, he is in despair all the same.” (“Okay, then you are in despair, right? So, I mark you down as a YES. And you are not in despair? So, I mark you down as a YES.”) Obviously, an inductive survey is not going to work.
These claims then are not inductive generalizations to be- assessed as true or false. They are proclamations (or stipulatory definitions) about the model Kierkegaard is developing. ‘Is it true that everyone (or almost everyone) is in despair?’ is not a question about fact. Within the psychological and metaphysical model that Kierkegaard presents us these – are stipulated definable moves. ‘Despair’ is by definition a defining feature of the human condition. What exactly is despair in this model? It is Kierkegaard’s word for original sin, the fall, expulsion from the garden of Eden, the fall from grace, the alienation from the divine.
In conclusion: we have looked briefly at three different models and argued that the truth criteria for the claims made in the first two should be exactly the same, while in the case of Kierkegaard’s psychological/metaphysical model there are really no verifiable and testable claims or predictions being made. The differences can be seen in this way:
- 1. When the physician talks about ‘health’ it is a statistical and functional concept.
- 2. When the psychoanalyst talks about ‘mental health’ it is a functional and normative concept.
- 3. When Kierkegaard talks about ‘spiritual health’ it is a metaphysical and religious concept.
Taking the “leap of faith” as a therapy for despair turns out to be similar to taking tranquilizers as a therapy for an inoperative gall bladder.
- B. A. Farrell, “The Criteria for Psycho-Analytic Interpretation,” Essays in Philosophical Psychology, Anchor Books, 1964, pp 299-322.
2 Soren Kierkegaard, The Sickness Unto Death, Princeton University Press, Princeton, New Jersey,1974.