Abstract

This dissertation presents a reformulation of the relationship between psychoanalytic metapsychology and clinical practice. Through a development and application of Wittgenstein's philosophical method, it will be shown how metapsychological issues around human agency are themselves manifested within clinical practice--focussing particularly on their manifestation, their "instantiation," within the treatment of schizophrenic states. ;The strategy in which metapsychological dilemmas are seen to be instantiated within clinical situations will grow out of a critique of recent writings of R. Schafer and G. Klein who have attempted to resolve the "paradox" of the apparent contradiction between the picture of humans as agents which guides the clinician and the natural-science based metapsychology which is taken to underlie clinical theory. ;Wittgenstein's notion of the "grammar" of mental process language is developed and applied to issues around human agency and intention. At the center of the elaboration of Wittgenstein's approach will be the exploration of his contention that "the will is not a phenomenon." Metapsychological dilemmas around the will and human agency are be seen to constitute the "grammatical" form of some schizophrenic experience. A view of schizophrenia as a "disease of the will" is contrasted with a Wittgensteinian point of view from which we may see dilemmas of agency to be under "in-life" investigation within schizophrenic states. Particular attention is given to the instantiation of philosophical dilemmas around agency within psychotic "delusions of influence." Wittgenstein's contention that philosophy is a form of therapy provides a means to seeing the kinship between the treatment of metapsychological confusion and the therapeutic meeting of such schizophrenic delusions. Wittgenstein's treatment of philosophical solipsism is seen to provide a model for a psychotherapeutic encounter with individuals experiencing schizophrenic states. ;A discussion of the recent work of L. Sass on delusions serves as a framework for the development of the argument in this dissertation. Clinical episodes drawn from the author's work with schizophrenic individuals provide an empirical grounding. Particular attention is given to ways of understanding and meeting the religious/spiritual aspects of schizophrenic experience