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A Kantian solution to the problem of hypochondria 2006

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A K A N T I A N SOLUTION TO THE P R O B L E M OF HYPOCHONDRIA by K Y L A G. D E N N E D Y B.Sc, The University of British Columbia, 1995 B.A., The University of British Columbia, 2003 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF M A S T E R OF ARTS in THE F A C U L T Y OF G R A D U A T E STUDIES (Philosophy) THE UNIVERSITY OF BRITISH C O L U M B I A September 2006 © Kyla G. Dennedy, 2006 Abstract The thesis explores Kant's views on the operations of the mind from the perspective of mental infirmity, particularly hypochondria. It argues hypochondria's public prominence plays a role in the theories of the mind of several philosophers, including Kant, and in turn, Kant's theory of the operations of the mind helps further the shift to understanding hypochondria as primarily a mental disorder. Kant was a self-proclaimed hypochondriac, and yet was unusual amongst sufferers of the disorder in that he claimed to be able to control his hypochondria by way of regimen and reason. If Kant truly was able to mitigate the deleterious aspects of hypochondria merely by strictly adhering to a regimen which made reason the ruler of the mind, this may have benefit for current sufferers of hypochondria. The thesis argues that Kant hoped his account of the operations of the mind would have empirical consequences for the understanding and amelioration of mental illness in humans. In doing so, it aims to show, contra Strawson and others, that not only are transcendental idealism and the transcendental subject necessary to Kant's overall philosophy, but removing them, as Strawson does, leaves Kant's theory unable to account for the empirical consequences of the faculties of the mind - consequences which are evident when one considers Kant's own struggle with hypochondria. T A B L E O F C O N T E N T S Abstract ii Table of Contents i i i Acknowledgements iv CHAPTER I - Kant's Theory of Mental Functioning 1 Introduction 1 Kant's Theory of the Operation of the Mind 2 Sensibility 5 The Understanding 6 The Imagination 8 Judgment 11 Reason 13 The Wil l 15 Remarks 15 Empirical Consequences of Transcendental Philosophy? 16 CHAPTER II - Mental Anguish and Early Modern Theories of Mind: the Case of the Hyp 22 History of Hypochondria ' 22 Melancholia and Hypochondriasis: a History from Antiquity to Burton 23 Hypochondriasis Through the Nineteenth Century 26 Other Theories of the Operations of the Mind 32 Descartes 32 Locke 39 Hume ,.. 46 Remarks 54 CHAPTER III - Kant and Hypochondria 59 Kantian Hypochondria 60 How the Mind Works 65 How to Deal with the Hyp 71 Final Thoughts 76 Bibliography 78 - i i i - Acknowledgements For inspiration, helpful comments, criticisms, guidance, and advice I am deeply indebted to my mentor, Professor Alan Richardson. I am also grateful to the Social Sciences and Humanities Research Council of Canada for their funding of this project. \ Chapter I - Kant's Theory of Mental Functioning Introduction David Hume famously claimed that "reason is, and ought only to be the slave of the passions, and can never pretend to any other office than to serve and obey them" (' He also argued that reason could never exert direct influence over the human will. Conversely, Immanuel Kant is known as a proponent of the view that reason is the proper master of the will of a rational being. I will explore the views of Kant on the operations of the mind and the relationships between the various faculties of the mind from a rather unique perspective, that of mental illness, and in particular hypochondria in the eighteenth century. Kant was a self-proclaimed hypochondriac, and yet was unusual amongst sufferers of the disorder in that he claimed to be able to control his hypochondria by way of regimen and reason. Kant viewed hypochondriasis as a pathological process arising from the inability of reason properly to rule the mind. It is my contention that the context surrounding hypochondria and other mental disorders in the eighteenth century played no small part in Kant's theory of the operations of the mind. I would argue that Kant hoped his account of the operations of the mind would have empirical consequences for the understanding and amelioration of mental illness in humans. ' All references to Hume's Treatise are to the Norton and Norton edition in the format of (Book, Part, Section, Paragraph). Kant's Theory of the Operations of the Mind For Kant, the term 'faculty,' in the sense of a capability, capacity, or power (for which Kant's German equivalent is Vermogen) plays a key role in his philosophical project, as on his view, both knowledge and morals require faculties of the mind. Given that he thinks both moral principles and certain aspects of theoretical understanding of the world are a priori, the transcendental faculties of the mind become crucial to Kant's self-proclaimed Copernican Revolution in philosophy - a revolution in which objects are made to conform to our cognition rather than vice versa. Given their importance, Kant discusses the various faculties of the mind in all three of his Critiques, and in several other works. Throughout the Critique of Practical Reason, Kant refers to the faculties of desire, freedom, and a "pure rational faculty" - reason, which he calls the "faculty of principles" (CPrR, V : l 19-20, p.100).3 He also notes that the cognitive faculty consists of the understanding and the imagination (CPrR, V:160, p. 132). Even life itself is called a faculty by Kant! Life is the faculty of a being to act in accordance with laws of the faculty of desire. The faculty of desire is a being's faculty to be by means of its representations the cause of the reality of the objects of these representations. 2 See the Editor's Introduction to the Critique of Pure Reason p. 39 and 'Faculty' in A Kant Dictionary pp. 190- 2. 3 References to the Critique of Pure Reason are given by the page numbers in the A and B editions followed by the page number in the Guyer and Wood translation. References to the Critique of Practical Reason (CPrR), the Groundwork of the Metaphysics of Morals, Conflict of the Faculties, Versuch iiber die Krankheiten des Kopfes, and the Anthropology from a Pragmatic Point of View are given by the volume and page numbers in the Akademie edition of the works of Kant followed by the page number(s) in the translation used. References to the Critique of Judgment (CJ) are to the page numbers in the Bernard translation. - 2 - Pleasure is the representation of the agreement of an object or of an action with the subjective conditions of life, i.e., with the faculty of the causality of a representation with respect to the reality of its object (or with respect to the determination of the powers of the subject to action in order to produce the object). (CPrR, note f, Preface, V:9, p.8) The editors of the Critique of Pure Reason, Paul Guyer and Allen W. Wood, however, do not speak of Kant's philosophy as positing a cognitive faculty, but rather cognitive faculties. In a discussion of Kant's Inaugural Dissertation of 1770, they note that Kant's "characterization of sensibility as a passive power of the mind and intellect as active will remain central to many arguments in the Critique; but Kant will also subsume sensibility under the 'cognitive faculties' (Erkenntnisvermogeri) generally." (Editors' Introduction, p.39). In discussing Kant's pre-critical works, the editors note that in False Subtlety of the Four Syllogistic Figures (1762) Kant concludes that "understanding and reason, that is to say, the faculty of cognizing distinctly and the faculty of syllogistic reasoning, are not different fundamental faculties. Both consist in the capacity to judge ... (2:59)." (Editors' Introduction, p.29). In other words, understanding and reason are parts or aspects of the higher cognitive faculty; something Kant still maintains more than two decades later in the three Critiques. In addition to the understanding and reason, in the Critique of Pure Reason Kant also speaks of the faculties of imagination, sense, apperception, and the power of judgment. For example, in the Critique of Pure Reason, he writes: There are, however, three original sources (capacities or faculties of the soul), which contain the conditions of the possibility of all experience, and cannot themselves be derived from any other faculty of the mind, namely sense, imagination, and apperception. (A94, p.225) By the time of the publishing of the Critique of Practical Reason in 1788, Kant had included among the faculties of the mind the following: desire, will, freedom, reason, understanding, imagination, sensibility, judgment, and apperception. The Critique of Judgment (1790/1793), is the work in which Kant most clearly explains what he takes to be the faculties of the mind, although he leaves many of the members of the above list out of his discussion. In the Critique of Judgment, there are three superior faculties of the mind (a) knowledge (or the cognitive faculty), (b) feeling of pleasure and pain, and (c) desire, each of which is served by the three cognitive faculties (understanding, judgment, and reason) respectively. For all the faculties or capacities of the soul can be reduced to three, which cannot be any further derived from one common ground: the faculty of ' knowledge, the feeling ofpleasure and pain, and the faculty of desire. For the faculty of knowledge the understanding is alone legislative, i f . . . this faculty is referred to nature as the faculty of theoretical knowledge ... For the faculty of desire, as a supreme faculty according to the concept of freedom, the reason ... is alone a priori legislative. Now between the faculties of knowledge and desire there is the feeling of pleasure, just as the judgment mediates between the understanding and the reason. (CJ, Introduction §111, pp. 13-15) Kant sees understanding, judgment, and reason as three cognitive faculties, with judgment forming the mediating link between the other two.4 He also refers to the will, viewed as the faculty of desire, as "one of the many natural causes in the world, viz. that cause which acts in accordance with concepts." (CJ, Introduction §1, p.8) It seems somewhat puzzling that sensibility and the imagination could drop from Kant's account of the faculties of the mind in the short period of time between the first two Critiques and the third, however, perhaps Kant 4 Critique of Judgment, Preface, pp.3-4; Anthropology, §40, VII: 196-7, p.69. was concerned with the legislative relationships to the higher faculties, and as such limited his list to the faculties which met this criterion. For the purposes of my discussion of Kant's theory of the operations of the mind, I will take the following to be the relevant faculties of the mind: sensibility, understanding, imagination, reason, judgment, and the will. The first four are identified by Patricia Kitcher as the four cognitive faculties and are described as follows: "'sensibility' for the faculty concerned with perception, 'imagination' for the faculty that represents things that are no longer present, 'understanding' for the faculty of concepts, [and] 'reason' for the faculty concerned with inference" (Kitcher, Kant's Transcendental Psychology, pp.13, 22). In what follows, I will briefly explain what Kant takes the faculties of the mind to be, and discuss how the various faculties interact. Sensibility The sensibility, or lower cognitive faculty, is the "capacity (receptivity) to acquire representations through the way in which we are affected by objects" (A19/B33, p. 155). Sensibility provides us with direct access to the objects of our environment, and we then process this information using other faculties of the mind. Objects are therefore given to us by means of sensibility, and it alone affords us intuitions; but they are thought through the understanding, and from it arise concepts. But all thought, whether straightaway (directe) or through a detour (indirecte), must, <by means of certain marks,>5 ultimately be related 5 Added in the B edition. - 5 - to intuitions, thus, in our case, to sensibility, since there is no other way in which objects can be given to us." (A19/B33, p.155). As will be discussed below, sensibility and understanding must be connected by the transcendental imagination in order for experience to be possible, as sensibility alone can give us appearances, but we require the understanding (thought) in order to have objects of empirical cognition.6 As Kant famously said, "Without sensibility no object would be given to us, and without understanding none would be thought. Thoughts without content are empty, intuitions without concepts are blind." (A51/B75, pp.193-4) Sensibility, at one and the same time, both realizes the understanding and restricts it.7 The Understanding As mentioned above, in False Subtlety Kant calls the understanding "the faculty of cognizing distinctly" and notes that it consists in "the capacity to judge."8 Guyer and Wood describe the faculty of the understanding in the Critique of Pure Reason as "the source of non- empirical categories or 'pure concepts of the understanding' that must be applied to data furnished by the senses to yield empirical knowledge" (Editors' Introduction, pp.40-41). Throughout the Critique of Pure Reason, Kant himself describes the understanding in a variety of ways, including "the faculty for thinking of objects of sensible intuition," a "non- 6 A124, pp.240-1. 7 A147/B187, p.277. 8 See the Editors' Introduction to the Critique of Pure Reason, p.29. sensible faculty of cognition" which is not a faculty of intuition, the "faculty of concepts," "the faculty of cognitions," and a faculty forjudging or thinking.9 Kant is well aware of the multitude of ways he describes the understanding, and he sees them all as helping to explain one and the same faculty of the mind. We have ... explained the understanding in various ways - through a spontaneity of cognition (in contrast to the receptivity of the sensibility), through a faculty for thinking, or a faculty of concepts, or also of judgments - which explanations, i f one looks at them properly, come down to the same thing. Now we can characterize it as the faculty of rules. This designation is more fruitful, and comes closer to its essence. Sensibility gives us forms (of intuition), but the understanding gives us rules. ... The understanding is ... not merely a faculty for making rules through the comparison of the appearances; it is itself the legislation for nature, i.e., without understanding there would not be any nature at all, i.e., synthetic unity of the manifold of appearances in accordance with rules; for appearances, as such, cannot occur outside us, but exist only in our sensibility. ... The unity of apperception, however, is the transcendental ground of the necessary lawfulness of all appearances in an experience. This very same unity of apperception with regard to a manifold of representations (that namely of determining it out of a single one) is the rule, and the faculty of these.rules is the understanding. (A126-7, p.242) In the Anthropology, Kant equates the understanding with the power of knowledge. ... i f the power of knowledge in general is to be called understanding (in the most general sense of the term), understanding must include: 1) the power of apprehending given ideas to produce an intuition (attentio), 2) the power of abstracting what is common to several of these to produce a concept (abstractio), and 3) the power of reflecting to produce knowledge of the object (reflexio). (Anthropology, §6, VII:138, p.19) 9 A51/B75, p.193; A67-8/B92-3, pp.204-5; A126-7, p. 242; A160/B199, p.284; B137, p.249; A69/B94, p.205; Anthropology, §1, VII:127, p.9. The understanding imposes laws a priori upon the faculty of knowledge, allowing the understanding to provide the concepts which unify the synthesis o f the manifold o f pure intuition, which is necessary for the cognition of an object. The cognition of objects requires, in addition to the concepts of the understanding, the synthesis of the manifold of pure intuition, which is the role of the imagination. 1 0 Synthesis in general is .. . the mere effect of the imagination, of a blind though indispensable function of the soul, without which we would have no cognition at al l , but of which we are seldom even conscious. Yet to bring this synthesis to concepts is a function that pertains to the understanding, and by means of which it first provides cognition in the proper sense. (A78/B103, p.211) The Imagination The imagination is the active faculty of the synthesis of the manifold of intuition, what Kant describes as "the faculty for representing an object even without its presence in intuition; . . .a faculty for determining the sensibility a priori" (B151-2, pp.256-7). The imagination is, for Kant, the link between sensibility and understanding via the synthesis of the manifold of intuition. Kant speaks of two different facets of the imagination - the reproductive imagination and the productive imagination. The reproductive imagination rests on conditions of experience, and thus only the productive synthesis of the imagination can occur a pr ior i . 1 1 1 0 A78-9/B104, p.211. 1 1 A l 18, p.238. As a power of [producing] intuitions even when the object is not present, imagination ... is either productive or reproductive - that is, either a power of exhibiting an object originally and so prior to experience, ... or a power of exhibiting it in a derivative way, by bringing back to mind an empirical intuition we have previously had. ... Pure intuitions of space and time are original exhibitions; all others presuppose empirical intuition which, when it is connected with the concept of the object so that it becomes empirical knowledge, is called experience. {Anthropology, §28, VII: 167, p.44) The reproductive imagination is responsible for bringing an entire series of perceptions back to the mind, in order to allow for a connection to be made between impressions, thus enabling the apprehension of the manifold.12 However, a merely reproductive imagination is not sufficient for the task that Kant has assigned to the imagination, since a reproductive imagination can only do what its name suggests - copy and reproduce. The reproductive imagination may bring back to the mind a roof, a door, a window, a porch, and a chimney, but reproductive imagination can never provide me with my mother's house. The reproductive imagination brings back to mind aspects of objects which were not sensed together, and the task is to unite the aspects together in the object in which they all coexist - a task which cannot be accomplished by the reproductive imagination alone. The reproductive imagination has no way of distinguishing, for example, the window of my mother's house from that of my sister's house, so there is no guarantee that when I form a representation of a house, it will be my mother's house. What is needed is some way to ensure that the images are all of pieces of the same object. The transcendental synthesis of the productive imagination (or "imagination under the unity of apperception," which places our representations in space and time), grounds the empirical synthesis of the reproductive 1 2 A120-l,p.239. -9- imagination, and unites our disparate images into a representation of the object in which they all coexist. The associations of empirical imagination are grounded in the objective connections of transcendental imagination. As Kant indicates by his names for these faculties, we reproduce in association what we have already produced by a transcendental synthesis. (Wolff, p. 171) Or as Beatrice Longuenesse puts it: No intuition without imagination, no intuition leading to representation of (determinate) object without transcendental imagination - that is, imagination 'under the unity of apperception.' (Longuenesse, p. 109) The productive (transcendental) imagination provides the conditions for the possibility of the empirical (reproductive) imagination, via the original exhibitions of the forms of intuition - space and time. Thus the transcendental imagination must be prior to the empirical imagination.13 In the same way that, according to Kant, the judgment connects the understanding and reason, the imagination brings together sensibility and understanding. By means of the imagination, "we bring into combination the manifold of intuition on the one side and the condition of the necessary unity of apperception on the other. Both extremes, namely sensibility and understanding, must necessarily be connected by means of this transcendental function of the imagination, since otherwise the former would be sure to yield appearances but no objects of an empirical cognition, hence there would be no experience." (A 124, pp.240-1) 1 3 It can be thought of as necessarily being prior in time, although sequence in time is an empirical concept, and thus is not properly applied to the transcendental. - 10- The imagination, in its empirical aspect, will play a large role in Kant's discussion of hypochondria, and is in fact at the root of the disorder. It is when the imagination runs wild and improper associations and attributions are made to bodily sensations that hypochondria sets in. Judgment Kant refers to judgment as "the faculty of thinking the particular as contained under the universal;" a "special talent that cannot be taught but only practiced."14 Kant also states that the judgment is "the mediate cognition of an object, hence the representation of a representation of it." 1 5 ... the judgment, which in the order of our cognitive faculties forms a mediating link between understanding and reason, has also principles a priori for itself; whether these are constitutive or merely regulative (CJ, Preface, p.4) The prime function of the power of judgment is to be this link between understanding and reason - the mediating concept between the concepts of nature and the concept of freedom. It provides a purposiveness of nature which allows the mind to move from the conformity to laws of the understanding to the ultimate goal of reason - a good w i l l . 1 6 If the understanding 14 Critique of Judgment, Introduction §IV, p.15; A133/B172, p.268; Anthropology, §42, VII:199, p.71. 1 5 A68/B93, p.205. 16 Critique of Judgment, Introduction, §IX, p.33. is thought of as the faculty of rules, then the judgment is the faculty which determines whether something stands under such rules. 1 7 The decision whether or not to subsume something under a given rule is the purview of judgment alone, and i f we are going to commit an error, this is the step at which it occurs. We cannot be in error in our sensations - they are what they are, and they are not the kinds of things which can be true or false. Similarly, we cannot be in error about the concepts generated by our understanding - like sensations, concepts are neither true nor false - they simply are what they are. The understanding formulates a rule - a given set of criteria which must be satisfied for a given concept. For example, there is a certain set of criteria which must be met in order for something to be properly subsumed under the concept 'dog. ' We may also have a concept 'drog' which has the criteria of being a fur-covered, four-pawed, domesticated animal. The concept 'drog' cannot be either true or false, it is merely the given set of rules/criteria. For the most part all dogs are drogs, but not all drogs are dogs. If one were to subsume the individual Fluffy (a cat) under the concept of 'dog,' one would have made an error in judgment, but Fluffy would correctly be subsumed under the concept 'drog.' We err by placing something within the realm of that concept when it does not meet the criteria. 1 7 A 1 3 2 / B 1 7 1 , p . 2 6 8 . - 12 - Reason In the same way that sensibility and understanding are not the sources of error, neither is the faculty of reason. Reason is a faculty of inference in which the results of judgments are run through a process of logical inference to their proper conclusions - the same input should give you the same output. If the input (judgments) is in error, then the conclusions of reason will also be incorrect. We often call this faulty reasoning, but the fault lies squarely with judgment, not with reason per se. For Kant, reason is the faculty by which a human being differentiates between himself and all 18 other objects. He also calls reason the "faculty of principles" and differentiates between the interests of its speculative use (the cognition of objects) and its practical use (the determination of the will), although he maintains that pure reason, both speculative and practical, is one and the same reason, with the practical interest having priority.1 9 ... in the union of pure speculative with pure practical reason in one cognition, the latter has primacy, assuming that this union is not contingent and discretionary but based a priori on reason itself and therefore necessary. For, . without this subordination a conflict of reason with itself would arise, since i f they were merely juxtaposed (coordinate), the first would of itself close its boundaries strictly and admit nothing from the latter into its domain, while the latter would extend its boundaries over everything and, when its need required, would try to include the former within them. But one cannot require pure practical reason to be subordinate to speculative reason and so reverse the order, since all interest is ultimately practical and even that of speculative reason is only conditional and is complete in practical use alone. (CPrR, V:121,pp.l01-2) l s Groundwork, 1 V : 4 5 2 , p . 5 7 . 19 Critique of Practical Reason, V : 119-20 , p . 100. - 13 - In its speculative use, reason "goes far beyond anything that sensibility can ever afford it, and proves its highest occupation in distinguishing the world of sense and the world of understanding from each other and thereby marking out limits for the understanding itself." (Groundwork, IV:452, p.57) Speculative reason, however, can never go beyond the realm of possible experience, since its role is merely to allow us an understanding of nature as it appears to us. . . . all human cognition begins with intuitions, goes from there to concepts, and ends with ideas. Although in regard to all three elements it has sources of cognition a priori which seem at first glance to scorn the boundaries of all experience, a completed critique convinces us that reason in its speculative use can with these elements never get beyond the field of possible experience, and that the proper vocation of this supreme faculty of cognition is to employ all its methods and principles only in order to penetrate into the deepest inwardness of nature in accordance with all possible principles of unity, of which the unity of ends is the most prominent, but is never to fly across the boundaries of nature, outside which there is for us nothing but empty space. (A702-B730, p.622) In its practical use, reason's role is to determine and produce a w i l l which is good in itself, and not merely as a means to some other purpose. Just as the understanding is legislative for the faculty of knowledge, so is reason for the faculty of desire. . . . only, insofar as reason of itself (not in the service of the inclinations) determines the w i l l , is reason a true higher faculty of desire, to which the pathologically determinable is subordinate, and then only is reason really, and indeed .specifically, distinct from the latter, so that even the least admixture of the latter's impulses infringes upon its strength and superiority, just as anything at all empirical as a condition in a mathematical demonstration degrades and destroys its dignity and force. In a practical law reason determines the wi l l immediately, not by means of an intervening feeling of pleasure or displeasure, not even in this law; and that it can as pure reason be Groundwork, IV:396, pp.9-10. - 14- practical is what alone makes it possible for it to be lawgiving. (CPrR, V:24-5, p.22) The Wil l Reason's main goal is to guide our actions, i.e., to determine our will. The will decides what we are to do, and what we actually do. A will determined by reason acts based upon not inclinations, but rather the dictates of reason. In the Groundwork, Kant actually equates the will with practical reason, although in the Critique of Judgment he puts reason as the 21 legislator of the will , and not identical with it. The will of a human being is not in itself completely in conformity with reason, that is, it is not by nature necessarily obedient towards * 22 the dictates of reason, and thus is a contingently determined (or dependent) will . The human will , because it is contingently determined by reason, finds itself constantly in a battle between reason and inclinations to direct its actions. According to Kant, we must train our minds in order that reason shall be the determinant of our actions, as reason is the proper determinant of the will , and to act otherwise is to suffer weakness of the mind. This weakness of the mind is what may lead to hypochondria. Remarks The various faculties of the mind discussed above interact with one another to provide us with knowledge and guide our actions. While some faculties and tasks may seem more 21 Groundwork, 4:412, p.24; Critique of Judgment, Introduction §1, p.8. 22 Groundwork, IV:413, pp.24-5. - 1 5 - important than others, all are required in order for us to understand and negotiate our way through the world we live in. ... understanding ranks higher than sensibility (but sensibility is more necessary and indispensable). ... sensibility is like a nation without a sovereign. But a sovereign without a nation (understanding without sensibility) can do nothing at all. Understanding and sensibility, then, do not dispute over precedence, although one is called higher and the other lower. (Anthropology, §40, VII: 196, p.69) The operations of the mind may be viewed as several distinct processes which all come together to provide us with knowledge and guidance. Sensibility, understanding and the imagination work together to give us knowledge of the world in which we live. Sensibility provides us with the raw data via our senses, which is then synthesized via the imagination, and concepts are formed by the understanding. Imagination is the bridge between the intuitions of sensibility and the concepts of the understanding. Judgment then determines whether given representations should be subsumed under given concepts of the understanding, and reason makes inferences based upon these judgments. Judgment is the bridge between the concepts of the understanding and the inferences of reason. Reason then guides our actions and grounds the decisions we make. Empirical Consequences of Transcendental Philosophy? In the introduction, I claimed that Kant hoped his theory of the workings of the mind would provide both a better understanding of mental infirmity as well as a way to ameliorate the sufferings of those with mental illness. While Kant was certainly not the first to draw a link - 16- between the interactions of the faculties of the mind and mental illness, he was among the first to propose that one could find relief from the sufferings of such disorders purely through the proper discipline of the mind. In the Critique of Pure Reason, Kant, by his own admission, is engaged in transcendental philosophy. Transcendental philosophy is "a philosophy of pure, merely speculative reason" (A15/B29, p.151), concerned with how we cognize objects rather than with the objects themselves - i.e., with the conditions of the possibility of experience in general. 2 3 "The transcendental is distinguished from the empirical, . . . and involves the metacritique of knowledge and its a priori sources." (A Kant Dictionary, "Transcendental" p.400) One might ask, then, how these transcendental faculties of the mind could possibly have any empirical import? - which indeed they must i f one takes Kant 's claims seriously. Kant clearly sees his theory as making a positive contribution to the understanding of mental illnesses and infirmities, as well as providing a possible way to combat the deleterious effects of some mental disorders (particularly hypochondria), and this latter task in particular is only possible i f transcendental philosophy can have empirical consequences. Kant's discussions on the topic of hypochondria w i l l be examined in depth in the final chapter. In the Preface to the second edition of the Critique of Pure Reason, Kant states that the work is meant to be a crucial element of his self-proclaimed Copernican Revolution in philosophy. A s mentioned previously, the revolution involves making objects conform to our cognition rather than vice versa, and for Kant, the transcendental subject is crucial to the endeavour, as 2 3 A12/B25,p.l49. - 17- are the various faculties of the mind, particularly in their transcendental aspects. Kant called his critical philosophy transcendental idealism, but he clearly saw it as very distinct from the idealism of, say, Berkeley; however, in the works of some twentieth century British commentators, notably P.F. Strawson, this distinction has been lost. That traditional idealism, as a metaphysical doctrine, is plagued by a multitude of serious problems, is generally accepted among philosophers. Strawson believes that Kant's transcendental idealism is ultimately just phenomenalistic (or subjective) idealism, and if this is the case, then Kant's entire philosophy is vulnerable to the same objections raised against traditional idealism. In addition, Strawson and others "depsychologize" Kant's philosophy, dismissing or expunging any talk of cognitive faculties, processes, or powers.24 In The Bounds of Sense, Strawson calls transcendental idealism "unnecessary," "unintelligible," and "incoherent," and claims that one loses nothing by getting rid of it altogether. Strawson epitomizes this line of attack on Kant's transcendental philosophy, but he is not alone in his views. [Cjertain Anglo-Saxon thinkers, in virtue of their very critical attitude towards certain central doctrines and assumptions of Kant, have in fact purged Kant's thought of much that is merely peripheral and overlaying, and have so released Hermes in the block, the philosopher in the picture-thinker and model-maker, to a much greater extent than would otherwise have been possible. (Findlay, "Kant and Anglo-Saxon Criticism," p. 187) Strawson and some other commentators, who clam to be sympathetic to Kant's project, insist they can get Kant's philosophy to work without the transcendental subject, something Kant 2 4 Patricia Kitcher includes the following among twentieth century depsychologizers of Kant: P.F. Strawson, Jonathan Bennett, Henry Allison, and Paul Guyer (Kant's Transcendental Psychology, p.4). - 18- ( himself saw as impossible. Strawson's main goal in The Bounds of Sense is to separate the analytical argument from the transcendental doctrines of the Critique of Pure Reason, and relegate the latter to the scrap heap, calling them "superfluous to the essential structure of reasoning" (p.257). For Strawson, there are good solid arguments in the Critique which are obscured by the "doctrinal fantasies of transcendental idealism" (p.51), and he refers to transcendental psychology as nothing more than an "imaginary subject" (pp.32, 97). Though it is difficult to disentangle [transcendental idealism's] doctrines from the analytical argument of Kant's positive metaphysics of experience, yet, when the disentangling operation has been carried out, it is remarkable how little those doctrines appear to have distorted that argument. (Strawson, p.42) According to J.N. Findlay, Strawson has performed an operation on Kant; what Findlay calls the "Transcendental Excision," which "cuts out and relegates to an appendix" the Metaphysic of Transcendental Idealism. Findlay himself also performs a Transcendental Excision, but claims to save a bit more of the original Kant than does Strawson (Findlay, pp. 189-90). One might think that such an operation would leave Kant's philosophy crippled in some way, but in fact, according to Findlay, the operation is a resounding success: . After careful excision of all these transcendental organs, it might be thought that Kant's Critical Philosophy would languish and die. The reverse is the case: the patient bounds from the operating table in an access of renewed vitality. (Findlay, p. 198) Strawson would also agree that the Transcendental Excision benefits Kant's philosophy more than it hurts it. For Strawson, what is important in Kant's work does not require any appeal to transcendental philosophy, and in fact, he writes, "Kant's transcendental subjectivism ... is - 19- regularly invoked to support theses which can stand on their own feet" (Strawson, p.91). Perhaps Strawson's opinion of the value of Kant's transcendental philosophy can be summed up by the following quotation: [I]f we discard the doctrines of transcendental idealism, we not only discard the incoherences associated with the conception of the supersensible reality ... but also deprive ourselves of the problem-solving and analytical argument- aiding powers ascribed by Kant to the enclosed phenomenalistic idealism. But to lose these is to lose nothing. (Strawson, p.262) Strawson, Findlay, and others, by separating transcendental idealism from the important arguments of the Critique of Pure Reason, take themselves to have saved Kant's brilliant philosophy from the crippling objections levelled against traditional idealism. This indeed would be a great accomplishment, if (a) Kant's transcendental idealism were reducible to subjective or phenomenalistic idealism as Strawson claims, and (b) transcendental idealism is indeed separable from the rest of the Critique. However, as both Henry Allison and Patricia Kitcher have argued, Kant's transcendental idealism is not merely phenomenalistic idealism under a new name, and furthermore, as Henry Allison has clearly shown, transcendental idealism is inseparable from "virtually every facet of the Critique.''''25 I take Allison's arguments in particular to have shown just how unfounded and misguided the original motivating concerns of Strawson and others were. Allison has successfully shown that a Transcendental Excision, a la Findlay and Strawson, is neither warranted nor possible. Patricia Kitcher has argued (successfully, in my opinion) that depsychologizing Kant's philosophy and expunging any talk of faculties of the mind is 2 5 See Allison's Kant's Transcendental Idealism: An Interpretation and Defense (2004), and the earlier version of 1983, and Kitcher's Kant's Transcendental Psychology. - 2 0 - almost as egregious to Kant's philosophical project. It is my contention that Kant clearly believes that his theory of the faculties of the mind can and does have empirical consequences, and in the final chapter I hope to demonstrate this, using hypochondria as a case in point. The faculties of the mind must be understood as genuine faculties meant to inform empirical psychology. If I am successful in my arguments, this will be yet another blow to the Strawsonian view, showing once again that it must be rejected. -21 - Chapter II - Mental Anguish and Early Modern Theories of Mind: the Case of the Hyp Given my claims in the introduction that the context surrounding hypochondria in the eighteenth century played a role in motivating Kant 's theory of the mind, I need to show two things: that hypochondria was (a) a topic of concern in the medical literature, and (b) a proper topic of discussion among philosophers of the early modern to Enlightenment era. If Kant 's transcendental philosophy (in particular his theory of the operations of the mind), is meant to have empirical consequences for mental suffering, then one would expect him to say something about the topic, which he does. It w i l l be helpful to explore both the history of and writings on hypochondria which Kant may have been familiar with. This w i l l be the focus of the this chapter, after which I return to Kant in order to discuss what he had to say about hypochondria. History of Hypochondria Currently, hypochondriasis is defined as "a preoccupation with bodily functions and fears of acquiring or having a serious disease based on misinterpretation of physical symptoms," 2 6 but throughout history, the term 'hypochondriasis' has not always referred to this pathophobia. The disorder has been referred to as "melancholy," "the vapours," "the spleen," "The English Malady," and by a variety of other names. Definition taken from The Merck Manual, Seventeenth Edition, 1999, p. 1510. ' v - 22 - Melancholia and Hypochondriasis: a History from Antiquity to Burton Whereas today we view hypochondriasis as a complaint referring to an imaginary physiological disease, or a primarily mental or psychical disorder, as recently as several centuries ago it was viewed as a real and serious illness with its seat in the upper abdomen. Although the word hypochondria belongs to the most ancient of medical terms, it does not occur in classical Greek and Latin used to indicate a clinical picture; however, it was employed by Hippocrates as an anatomical concept. The first description of the disease was . . . [given] by Diocles of Carystos, who assumes the cause to be a disorder of the digestive organs (approx. 350 B.C. ) . (Ladee, Hypochondriacal Syndromes, p.7.) Hypochondriasis comes from the Greek words hypo which means under; and chondros which means cartilage, and came to refer to disorders of the organs under the cartilage of the ribs. According to Ladee, Galen was the first to speak of morbus hypochondriacus in reference to pathology of disorders of the organs of the hypochondrium in association with the humoural theory o f pathology. The organs of the hypochondrium include the stomach, liver, spleen, diaphragm, mesenterium, and the portal vein system. 2 7 Galen, and those who followed in his tradition believed that hypochondriasis, like all other diseases, was a result of an imbalance of the four humours. In the seventh century, Paulus of Aegina regarded hypochondria as a kind of melancholia. He believed that there were three forms of melancholia: (a) melancholia of the brain, (b) general melancholia, and (c) "wind 2 7 Ladee, p. 7. -23 - melancholia" (melancholia flatuosa or melancholia hypochondriaca). 2 8 In his seminal book, The Anatomy of Melancholy, first written in 1621, and revised many times, Robert Burton, a layman, retains these three genres o f melancholy, and discusses them in relation to the humoural theory of disease as well as other causes. With respect to hypochondriacal melancholia, Burton says that, "no physician can truly say which part is affected." This inability physically to locate disease remains a feature of hypochondriasis to this day. Burton's book speaks to how powerful Paulus of Aegina's classification of melancholia still was a millennium after its inception. Burton's book is still regarded as one of the most complete and comprehensive texts on melancholia as it was understood in the seventeenth century. The link of flatulence to hypochondriasis, as indicated by Paulus of Aegina's naming of the third genre of melancholia, is one which persisted well into the early modern era. It is not clear i f Paulus of Aegina was the first to formally link hypochondria to melancholia, but the connection does make sense. Melancholia comes from the Greek words melas which means black; and chole which means bile, thus melancholia is a disorder of the proportion of black bile in the organism, and is consistent with the Galenic proposition that hypochondriasis - a form of melancholia according to Paulus of Aegina - resulted from an imbalance of the humours. In melancholia, there is an excess of black bile, and since bile is associated with the organs of the hypochondrium, it makes sense to postulate a connection between Ladee, p.7. As quoted in Ladee, p.9. -24- melancholia and hypochondriasis.30 Also, black tarry stools were thought to be an indicator of too much black bile in the system, suggesting a link to flatulence. In a study of melancholy in English literature from 1580-1642, Babb claims that during this period, "[fjhe term melancholy is used ... to designate a disease (or genus of diseases) due to the presence of a melancholy humour abnormal in quantity or quality. The melancholic malady is fundamentally a physical condition. Yet its symptoms are so largely psychological that it is ordinarily regarded as a mental disease" (Babb, p.23). This physical-mental duality of the nature of hypochondriasis is evident up until the time when hypochondriasis is deemed primarily a mental disorder worthy of inclusion in sources such as the Diagnostic and Statistical Manual of Mental Disorders. While in antiquity the term 'hypochondriasis' was not, according to Ladee, generally used to refer to a clinical syndrome, the extant information does seem to indicate that there was some connection made between hypochondriasis and melancholia. As mentioned above, Paulus of Aegina's classification of hypochondriasis as a form of melancholy, was still accepted in the seventeenth century when Burton wrote The Anatomy of Melancholy. Burton lists the following symptoms for hypochondriacal or flatuous melancholy: ... besides fear and sorrow, sharp belchings, fulsome crudities, heat in the bowels, wind and rumblings in the guts, vehement gripings, pain in the belly and stomack ... cold sweat... cold joints, indigestion, they cannot endure In addition to the organs mentioned above by Ladee, Lawrence Babb adds the gall, bladder, and uterus to the list of organs of the hypochondrium. -25 - their own fulsome belchings ... midriff and bowels are pulled up, the veins about their eyes look red, and swell from vapours and wind. Hypochondriasis Through the Nineteenth Century As one moves throughout history from Burton to the nineteenth century, it is found that the term melancholy is used less to describe the syndrome in question, and other names such as 'the spleen', 'the vapours', 'hysteria', and 'the English Malady' become more prominent. Kenyon points out, ". . . the age of Wordsworth was addicted to melancholy. By this time however, the medical and pathological implications had faded. To Keats, melancholy meant simply 'sadness'" (Kenyon, p. l 18). Esther Fischer-Homberger locates the shift away from the use of the word 'melancholy' as motivated by growing doubts about the notion of black bile. 3 2 From the seventeenth to nineteenth centuries, hypochondria became a fashionable disease, and several prominent figures self-identified as hypochondriacs, including Charles Darwin, Immanuel Kant, and James Boswell. Boswell wrote seventy essays, originally published anonymously in the London Magazine between September 1777 and August 1783, under the name 'The Hypochondriack', four of which were entirely devoted to hypochondria. In these essays, Boswell provides a first-person account of dealing with this disorder; the torment which Boswell portrays can be seen in the following passages: 3 1 As quoted in F.E. Kenyon, "Hypochondriasis: A Survey of Some Historical, Clinical and Social Aspects," p. 117. 3 2 Esther Fischer-Homberger, "Hypochondriasis of the Eighteenth Century - Neurosis of the Present Century," p.394. - 2 6 - Though his reason be entire enough, and he knows that his mind is sick, his gloomy imagination is so powerful that he cannot disentangle himself from its influence, and he is in effect persuaded that its hideous representations of life are true. In all other distresses there is the relief of hope. But it is the peculiar woe of melancholy, that hope hides itself in the dark cloud. (The Hypochondriack, Essay X X X I X , December 1780, Vol.11, p.44) Finding that his reason is not able to cope with his gloomy imagination, he doubts that he may have been under a delusion when it was cheerful; so that he does not even wish to be happy as formerly, since he cannot wish for what he apprehends as fallacious. (The Hypochondriack, Essay X X X I X , December 1780, Vol.11, pp.44-5) Boswell acknowledges that some people may believe that there is a distinction between melancholy and hypochondria, but he believes them to be "different shades of the same disease" (The Hypochondriack, Essay V , February 1778, Vol.1, p. 140), and he is somewhat unusual in his time in still using the word melancholy to refer to hypochondriasis. Hysteria and hypochondriasis were also linked to one another. Prior to Thomas Sydenham (1624-89), hypochondriasis was viewed as a male complaint, while hysteria was limited to females. Sydenham viewed the two disorders as essentially one; "hypochondriasis is as like hysteria as one egg is to another."34 George Ernst Stahl (1660-1734) also regarded masculine hypochondriasis and feminine hysteria as identical diseases. Some contemporaries of Sydenham and Stahl continued to distinguish between hysteria and Fischer-Homberger, pp.391-2. As quoted in Ladee, p.9. - 2 7 - hypochondriasis, but in the post-Sydenham era both males and females could be diagnosed as * 35 hysterics or as hypochondriacs. Eighteenth century symptoms of hypochondria included: Flatulence ("vapours"), eructations, constipation (or diarrhoea), dejection, irritability of temper, unreasonable fear, misanthropy, withdrawal into solitude, restlessness, insomnia, disturbed sleep, vain lamentations, • irregularities of pulse, abnormalities of appetite (including nausea), and former manifestations of hysteria such as asthma, headaches, and motor dysfunctions (Fischer-Homberger, pp.392-3). If one compares these symptoms to those identified above by Burton as the symptoms of wind melancholia, one sees that there is a good deal of overlap in the two lists. This overlap in conjunction with the interchangeabilty of'hypochondriasis' and 'melancholia' in the literature leads one to conclude that the two disorders are indeed one. James Adair, a physician himself, noted that in the latter part of the seventeenth and early part of the eighteenth centuries, "spleen", "vapours", or "hyp" was the fashionable disease. It appeared as though everyone who was anyone seemed to be suffering from its effects, and it was no wonder; it was thought that only the intelligent and well to do were susceptible to being hypochondriacs. According to Mandeville, a physician in the early eighteenth century, the Germans called it the Disease of the Learned because "there is a greater number troubled with it than you can find in any other Class of Men" (Mandeville, Second Dialogue, pp. 148- 3 5 Bernard de Mandeville, in A Treatise of the Hypochondriack and Hysterick Passions (1711), admits that the two disorders are one and the same, but he still persists in assigning hypochondria to males, and hysteria to females. Mandeville does not say why he continues to assign the disorders along gender lines, but perhaps it was either from force of habit or because the labels were what his patients expected to hear. -28- 9). George Cheyne, another physician, wrote, "Nervous Disorders are the Diseases of the Wealthy, the Voluptuous, and the Lazy, ... and are mostly produced, and always aggravated and increased, by Luxury and Intemperance" (Cheyne, The English Malady, Part II, Ch.V, §4, p. 158). Cheyne also noted that, "it is a common Observation, (and, I think, has great Probability on its Side) that Fools, weak or stupid Persons, heavy and dull Souls, are seldom much troubled with Vapours or Lowness of Spirits" (Cheyne, Pt.I, Ch.VI, §5, p.52). Mandeville concurred with Cheyne on this point. The Thinking then of Blockheads, besides that they seldom delight in it, can do them no hurt, because it does not exhaust the Spirits, and they are almost as secure from becoming Hypochondriacal, as those, that cannot Write, from being Pillory'd for Counterfeiting other People's Hands (Mandeville, Third Dialogue, p. 165). Mandeville did not, however, think that the intelligent were doomed to suffer the ill effects of the hyp, but rather that they required diligence in following a regimen which would counteract their intellectual and sedentary lifestyle. Ingenuity only makes them proper subjects for the Disease to work upon, and the most Witty Men, i f they commit no excess in those things that exhaust the finer Spirits, but divert themselves daily with hunting the Tennis Court, or other brisk Exercises, will be as exempt from the Distemper as the greatest Logger-heads (Mandeville, Third Dialogue, p. 165). Sufferers of hypochondria were usually under the care of physicians or apothecaries who plied them with numerous treatments including emetics, cleansing agents, exercise, strict diets, evacuations, mental amusements, fresh air, mineral waters, and concoctions made from - 2 9 - a variety of herbs and chemicals. Among the most prescribed treatments were mercury and antimony. In the eighteenth century, it seems as though every ailment under the sun was viewed to be a manifestation of hypochondria under its various names. A l l Lowness of Spirits, Swelling of the Stomach, frequent Eructation, Noise in the Bowels or Ears, frequent Yawning, Inappetency, Restlesness, Inquietude, Fidgeting, Anxiety, Peevishness, Discontent, Melancholy, lethargick or watchful Disorders, in short, every Symptom, not already classed under some particular limited Distemper, is called by the general Name of Spleen and Vapours (Cheyne, Pt.II, Ch.VIII, §3, p. 194). To this list, at various points throughout his treatise, Cheyne also adds gout, kidney stones, cholick, cancer, rheumatism, jaundice, ulcers, gangrene, headaches, rottenness in the bones, ligaments, and membranes, plague, pestilence, spotted and purple fevers, small-pox, leprous diseases, and all other epidemical and infectious distempers as falling under the umbrella of the English Malady, a term he says has been used derisively by foreigners, although he does admit that these disorders make up almost a third of the complaints of the "People of Condition in England," including himself (Cheyne, Preface, p.ii). Cheyne stated his belief that "all Nervous Distempers whatsoever, from Yawning and Stretching, up to a mortal Fit of an Apoplexy, seems to me to be but one continued Disorder, or the several Steps of Degrees of it" (Cheyne, Pt.I, Ch.III, §1, p. 14). Given that it was fashionable to be a hypochondriac, the wider the diagnostic category, the more people who suffered, and the easier it was to be classified as a card-carrying hypochondriac. 3 6 Detailed recipes for various treatments may be found in the treatises of both Cheyne and Mandeville, in particular pages 184-195 of the Third Dialogue of Mandeville. - 3 0 - ' With such a broad diagnostic classification, it is not at all surprising that the standard set of symptoms described by various physicians differ considerably. For example, Mandeville states the following: [Ijndeed the immoderate Exercise of the Brain, and the Excess of Venery are so generally the occasion of the Hypochondriack Passions that in all my Experience I have hardly met with any, where I had not Reason to impute the Distemper, at least partly, to either of these, if not to both (Mandeville, Second Dialogue, p. 146). While Cheyne claims: I never saw any Person labour under severe, obstinate, and strong Nervous Complaints, but I always found at last, the Stomach, Guts, Liver, Spleen, Mesentery, or some of the great and necessary Organs or Glands of the Lower Belly were obstructed, knotted, schirrous, or spoiled (Cheyne, Pt.II, Ch.VII, §1,P-183). There is not a lot of information in the historical record as to when hypochondria became primarily associated with the fear of death and disease, but Ladee states that "[the] fear of death and the fear of things not worth fearing was mentioned as early as Aetius of Amida (a Byzantine physician of the 6 t h century)" (Ladee, p.7). Fischer-Homberger reports that until the late eighteenth and early nineteenth centuries, fear of being ill had very little to do with, and was not associated with the disorder of hypochondriasis as it was known (Fischer- Homberger, p.397). Kenyon claims "[t]he association of the term [hypochondriasis] with morbid preoccupation with physical health did not crystallize until as late as the early nineteenth century in the work of Falret (1822)" (Kenyon, p.l 17). -31 - Other Theories of the Operations of the Mind Implicit in my assertion that Kant offered his account of the operations of the mind with an eye toward understanding and explaining the anguish of sufferers of hypochondria and other mental disorders of the eighteenth century, are two other claims: the first is that hypochondria and other mental disorders were topics of concern in the eighteenth century, and the second is that Kant found something wanting in the accounts of the operations of the mind on offer in the eighteenth century. I will begin with a partial exegesis of some of the accounts of the operations of the mind on offer in the seventeenth and eighteenth centuries, particularly those of Rene Descartes, John Locke, and David Hume. My concern is less with fully fleshing out the various theories as with showing that these philosophers were concerned with the relationship between the interaction of various faculties of the mind and mental infirmity, and I will argue, with hypochondria in particular.37 I will also comment briefly on why Kant would not have found these theories of the operations of the mind fully satisfactory, both as accounts of how the mind works, and more importantly as explanations of hypochondriasis. Descartes Rene Descartes is famous for, among other things, his account of mind-body dualism. Descartes believes that humans are essentially thinking things (res cogitans) which are 3 7 The case for Hume's concern with mental infirmity and hypochondria is weaker than those for Locke and Descartes. - 3 2 - intimately associated with extended material bodies (res extensa). In Meditations on First Philosophy, as he moves from the first through to the sixth Meditation, the meditator goes from being unable to know of the existence of anything with certainty to knowledge of the existence of himself and of the external world. For Descartes, the hallmark of certain knowledge is clarity and distinctness, (i.e. one cannot help but affirm its truth), but we are prone to error because we sometimes affirm as true those things which we do not clearly and distinctly perceive. For I am indeed of such a nature that, while I perceive something very clearly and distinctly, I cannot help believing it to be true. Nevertheless, my nature is also such that I cannot focus my mental gaze always on the same thing, so as to perceive it clearly. (Med.V, VII:69, p.91) 3 8 Descartes believes that we can never be wrong about our ideas simpliciter (although our ideas can be materially untrue or fictitious), nor can we be mistaken about our affects or our volitions; the error arises in the judgments we make about our ideas, volitions, and affects. We have a tendency to affirm or deny some of these thoughts when they are not clear and distinct, but rather confused and obscure. When Descartes inquires as to the nature of his errors, he concludes that the will (which is unlimited) extends beyond the scope of the intellect (which is finite). The intellect per se cannot err, but when the will is extended to things which are not understood, we become deceived and fall into error, thus we must be vigilant in ensuring that we only affirm or deny what we perceive clearly and distinctly.39 , 8 Unless otherwise indicated, all references to the works of Descartes will reference the work, followed by the volume and page in the Adam and Tannery edition of Oeuvres de Descartes, and a page reference to the translation being used, which are as follows: Discourse on Method and Meditations on First Philosophy (Fourth edition. Donald A. Cress, Hackett Publishing Company, 1998) and Passions of the Sold (Stephen Voss, Hackett Publishing Company, 1989). 3 9 Med.IV, VII:56-58, pp.83-4. -33 - As mentioned above, Descartes divides thoughts into several categories, and it is only one class, judgments, to which we can properly ascribe the properties of truth and falsehood. Some of these thoughts are like images of things; to these alone does the word "idea" properly apply, as when I think of a man, or a chimera, or the sky, or an angel, or God. Again there are other thoughts that take different forms: for example, when I will , or fear, or affirm, or deny, there is always some thing that I grasp as the subject of my thought, yet I embrace in my thought something more than their likeness of that thing. Some of these thoughts are called volitions or affects, while others are called judgments. Now as far as ideas are concerned, i f they are considered alone and in their own right, without being referred to something else, they cannot, properly speaking, be false. ... Moreover, we need not fear that there is falsity in the will itself or in the affects, .. .thus there remain only judgments in which I must take care not to be mistaken. (Med.III, VII:37, p.71) In The Passions of the Soul, a work in which Descartes sees himself as explaining the • passions not as an orator, nor as a moral philosophers, but rather as a physicist,40 he gives a comprehensive account of the operations of the mind (or soul)4 1, in particular the passions. Descartes' theory is based largely on there being material animal spirits which when agitated, move through pores in the brain and result in the physical repositioning of a small structure in the brain called the pineal gland. The movements of the pineal gland cause us to feel various passions. It should be noted that for Descartes, the passions are mainly felt in the heart, but the effects of the passions are felt as in the soul. Both haphazard movements of spirits, and perceptions which depend on the nerves (and both cases are equally considered Preface, Reply to the Second Letter, XI:326, p. 17. 4 1 In following Descartes, I will use these terms interchangeably. - 3 4 - passions) can result in the movement of the pineal gland. The pineal gland can also be moved by the soul itself (i.e., the will). In addition to the categories of thoughts he discusses briefly in the Meditations, in the Passions, Descartes classifies thoughts as being of two main types, actions of the soul and passions of the soul. ... there remains nothing in us that we should attribute to our soul but our thoughts, which are principally of two genera - the first, namely, are the actions of the soul; the others are its passions. The ones I call its actions are all of our volitions, because we find by experience that they come directly from our soul and seem to depend only on it; as, on the other hand, all the sorts of cases of perception or knowledge to be found in us can generally be called its passions, because it is often not our soul that makes them such as they are, and because it always receives them from things that are represented by them. (Passions, Art. 17, XI:342, p.28) He defines passions of the soul as "perceptions or sensations or excitations of the soul which are referred to it in particular and which are caused, maintained, and strengthened by some movement of the spirits." (Passions, Art.27, XI:349, p.34) On this definition, something like pain would not be a passion of the soul since pain is referred to the body and not to the soul in particular. However, the passions of the soul do include emotions such as fear, apprehension, despair, and sadness, and these emotions, I would argue, have a significant role to play in hypochondriasis. Just as there are different types of thoughts, there are also several different faculties of the mind according to Descartes. The four main faculties of the mind are the intellect, the imagination, the will , and sensation, and while Descartes differentiates between the four, he - 3 5 - is clear that the faculties are not to be understood properly as "parts" of the mind, since it is one and the same mind which understands, imagines, wills , and senses.4 2 It should be noted that for Descartes the soul is a simple substance, and its indivisibility proves important for his account of the soul's immortality. The intellect is the faculty which makes judgments, the imagination creates ideas, the wi l l wil ls (i.e. affirms and denies judgments), and sensation perceives that which comes via our senses.4 3 A s he mentions in the Meditations, and reiterates in the Passions, the w i l l is free and can never be constrained. Actions of the soul (volitions) are absolutely within the power of the soul, while passions of the soul can only be indirectly altered by the soul, since they depend on the actions that produce them. The whole action of the soul consists in by merely wil l ing something, the pineal gland is made to move in a way to produce the effect corresponding to the volition 4 4 The four faculties of the mind are intimately connected in their functions. The wi l l relies on input from the other three faculties, the intellect bases its judgments on input from sensation and the imagination, and one can only imagine or conceive of something which one has had some exposure to. I have claimed that hypochondria was a topic of concern in the early modern era, and I believe that one can see elements of this concern in the works of Descartes. Hypochondria may be seen as a disorder in which errors are made in judgment in the face of certain 4 2 Med.Vl, VII:86, 101. , _ ' ' 4 3 Descartes' faculties of the mind are very similar to those of Kant, with the major difference being Kant separates the intellect into three separates faculties - the understanding, reason, and judgment. 44 Passions, Art.41, Xl:359-6, p.41. - 3 6 - sensations or passions, or perhaps as one where the imagination runs wild and the mind judges the body to be in a condition which does not conform to its actual state. I believe that regardless of which definition of hypochondriasis one subscribes to, Descartes has something to say on the matter. Hypochondria historically has been associated with the internal structures of the abdomen, and Descartes specifically mentions many of these organs when discussing an imbalance of the spirits, which we must remember, can lead to movements of the pineal gland. This inequality of the spirits may also originate from the diverse dispositions of the heart, liver, stomach, spleen, and all the other parts that contribute to their production. ... So, for example, [blood] that comes from the lower part of the liver, where the gall is, expands in the heart in a different way from that which comes from the spleen, and the later otherwise from that which comes from the veins of the arms or legs, and finally this latter entirely otherwise from alimentary juice, when having just left the stomach and bowels, it passes. rapidly through the liver to the heart. (Passions, Art. 15, XI:340-1, p.27) Perceptions of bodily sensations can arise in two ways, via sensation or via the imagination. If everything is working properly, the mind determines whether the perceptions are clear and distinct and either affirms, denies, or withholds judgment. It is when the will extends beyond the scope of the intellect, that problems occur. In the case of hypochondria, I would argue, the mind affirms a judgment to the effect that there is something awry with the body based on unclear or obscure perceptions. In most cases, there is a difference in the perceptions which arise via sensation and imagination, with the latter being less lively or vivid than the former, and thus the mind is able to distinguish them. However, it is possible to be deceived, particularly by perceptions which have reference to objects outside of us or to our bodies. - 3 7 - Among perceptions caused by the body, most depend on the nerves, but there are also some that do not depend on them, which are named imaginations, ... and they only arise because the spirits, agitated in various ways and coming upon traces of various impressions which have preceded them in the brain, haphazardly take their course through certain of its pores rather than others. ... Now even though some of these imaginations are passions of the soul, taking the word in its most fitting and particular sense, and though they can all be so named if it is taken in a more general sense, yet since they do not have so noteworthy and determinate a cause as the perceptions the soul receives by the mediation of the nerves, and since they seem to be only their shadow and picture, before we can distinguish them rightly it will be necessary to consider the difference among these other ones. (Passions, Art.21, XI:344-5, pp.29-30) It is these "other ones," i.e., those dependent upon imagination, with reference to our bodies, and not appearing as mere "shadow and picture" of perceptions arising by the mediation of the nerves, which pose a problem for the hypochondriac. There is no question we feel what we feel (we cannot be mistaken in that), however, the error occurs in our attribution of the cause of what we feel - i.e. we judge the body to be the cause when in fact it was the imagination. With respect to hypochondria, Descartes' writings may be understood as a positing a facultative account of the disorder. Hypochondria is manifested in physical symptoms, but it is actually a disorder of the mental realm. It arises when perceptions arising from the imagination are misjudged to be from sensation, and the will affirms this erroneous judgment. Descartes believes that with proper vigilance we can overcome this weakness of the mind, and ensure that only proper judgments are affirmed. " [Wjhether awake or asleep, we should never allow ourselves to be persuaded except by the evidence of our reason. And it is to be observed that I say "of our reason," and not "of our imagination" or "of our senses." (Discourse on Method, Part IV, 6:39, p.22) A favourite example is what we now refer to as - 3 8 - phantom limb pain, where people who have had a limb amputated still feel pain in the limb they no longer possess. Descartes sees this as an error in judgment since one should reasonably know that pain cannot be felt in the soul and attributed to a part of the body no longer associated with that soul . 4 5 There is no doubt they feel pain, but obviously that pain cannot be located in a limb that does not exist - phantom limb pain, like hypochondria, is all about the (mis)attribution of the sensation. It is the duty of a rational person to gain command over his mind, and prevent erroneous judgments from being affirmed and acted upon. That there is no soul so weak that it cannot, when well guided, acquire an absolute power over its passions. . . . It is also useful to know that although the movements - both of the gland and of the spirits and brain - which represent certain objects to the soul are naturally joined with those [movements] which excite certain passions in it, they can nevertheless by habituation be separated from them and joined with other quite different ones; and even that this disposition can be acquired by a single action and does not require long practice. . . . N o w these things are useful to know in order to give everyone the courage to study the regulation of his passions. For since with a little skil l one can change the movements of the brain in animals bereft of reason, it is plain that one can do it even better in men, and that even those who have the weakest souls could acquire a quite absolute dominion over all their passions i f one employed enough skill in training and guiding them. (Passions, Art.50, XI:368-70, pp.47-49) Locke In An Essay Concerning Human Understanding, John Locke describes the subject of his treatise, the understanding, as "the most elevated Faculty of the Soul" ("The Epistle to the Med.VI, VII:76-77, p.95. - 3 9 - Reader", p. 6). Other faculties of the soul, which Locke often speaks of, are the will and reason, the latter which he sees as that which separates men from beasts (IV,xvii,l). 4 6 ' 4 7 While he also refers to judgment as a faculty, calling it "The Faculty, which God has given Man to supply the want of clear and certain Knowledge in Cases where that cannot be had" (IV,xiv,3), it is not at all clear that he intends to place it on a par with the understanding and the will. The two great and principal Actions of the Mind, which are most'frequently considered, and which are so frequent, that everyone that pleases, may take notice of 'em in himself, are these two: Perception, or Thinking, and Volition, or Willing. The Power of Thinking is called the Understanding, and the Power of Volition is called the Will, and these two Powers or Abilities in the Mind are' denominated Faculties. (II,vi,2) Of the four books which comprise the Essay, it is primarily in the second ("Of Ideas") and fourth ("Of Knowledge and Opinion") where Locke articulates his theory of the workings of the mind. Locke, as an empiricist, believes that all ideas in the mind originate from experience, and denies that there are any innate ideas (the topic of the first book of the Essay). According to Locke's theory, there are two ways in which experience provides the understanding with ideas: via our senses (sensation) and through the perceptions of the operations of our own minds (reflection). Our senses transmit to the mind perceptions of various objects which affect them, and it is via these perceptions that the mind comes to have ideas of objects and their qualities, such as colour, size, texture, taste, etc. It is the 4 6 Unless otherwise indicated, all references from Locke are to his Essay Concerning Human Understanding, and will be in the form (Book, Chapter, Section). 4 7 It is unclear why Locke considers the understanding as the most elevated faculty of the soul, when it is reason which separates us from the beasts. - 40 - annexation of the perceptions to the impressions of the body which furnishes the mind with distinct ideas, and this entrance of an idea into the Understanding is what Locke calls Sensation. 48 The other source of ideas, on Locke's theory, is reflection. When the mind (or soul) comes to reflect on and consider the ideas which it contains, it is provided with another set of ideas, namely the operations of the mind, which include, among others, thinking, doubting, reasoning, willing, knowing, and believing. Thinking is what first occurs when the mind turns its view inwards upon itself, and other activities of the mind such as judging and willing may follow. The mind is able to manipulate the ideas already contained within it and from these modifications it receives other distinct ideas. • On Locke's theory, ideas are the content of the mind, while the operations of the mind are powers or abilities of the mind to perceive or consider ideas in various ways. The two main powers of the mind which Locke distinguishes are those of perceiving and preferring. The power of perceiving is the understanding, while the power of preferring is the will , which Locke describes as follows: This Power which the mind has, thus to order the consideration of any Idea, or the forbearing to consider it; or to prefer the motion of any part of the body to its rest, and vice versa in any particular instance is that which we call the Will. The actual exercise of that power, by directing any particular action, or its forbearance is that which we call Volition or Willing. (II,xxi,5) Locke, like Descartes, uses these terms interchangeably. -41 - Locke recognizes that the ordinary way of speaking of the will and the understanding is as faculties of the mind, and this often leads to confusion about the ontological status of these faculties. It may be believed that the will and the understanding are real beings or parts of the soul - separate agents which perform the actions of willing and understanding, and which rule sovereign over their respective domains. However, Locke is clear that when we speak of these faculties of the mind we are talking about powers or abilities of one and the same mind rather than parts.49 Like Descartes, Locke believes that the soul is indivisible. He also acknowledges that this confusion about what is meant by 'faculties' is very likely the main cause of the obscurity and uncertainty surrounding questions pertaining to the operations of the mind. (II,xxi.6) In addition to the confusion surrounding the ontological status of the will and the understanding caused by our way of speaking about them, there is a further misunderstanding which arises from the way we speak of these faculties, namely that one can act upon the other. Locke denies that the will can operate on the understanding, or vice versa, since it seems obvious that powers or abilities are not the sorts of things which lend themselves to be operated upon. [T]he power to do one Action, is not operated on by the power of doing another Action. For the power of Thinking operates not on the power of Chusing, nor the power of Chusing on the power of Thinking; no more than the power of Dancing operates on the power of Singing, or the power of Singing on the power of Dancing, as any one, who reflects on it, will easily perceive: And yet this is it which we say, when we thus speak, that the Will operates on the Understanding, or the Understanding on the Will. (II,xxi,18) Kant also views faculties of the mind as powers or abilities. -42- The last point I wish to mention in this synopsis of Locke's theory is his views on the passions of the soul. Passions are the opposite of actions insofar as one is passive when being acted upon, and active when one is the actor. The mind is active when thinking or willing, for example, and is passive when acted upon by feelings which are not actively produced by the mind. For Locke, the operations of the mind include both actions and passions. The term Operations here, I use in a large sence, as comprehending not barely the Actions of the Mind about its Ideas, but some sort of Passions arising sometimes from them, such as is the satisfaction or uneasiness arising from any thought. (II,i,4) Now that I've briefly outlined Locke's theory of the operations of the mind, I will turn to the question of the relationship between the faculties of the mind and mental infirmity. I have claimed that mental disease in general, and hypochondria in particular, were of great concern in the modern era, and thus one would expect to see this concern reflected in works such as Locke's Essay, and indeed I will argue that one can find evidence of this concern in the Essay. Although he does not mention hypochondria by name, I will argue that Locke is referencing this disorder in various passages of the Essay. One hallmark of mental infirmity is seen to be a lack of control over one's own mind, and Locke would agree that this is a sign of weakness of the soul. Unlike Hume who claims "reason is, and ought only to be the slave of the passions," Locke would argue that passions ought not to rule the mind. Locke acknowledges,that sometimes, strong passions do overwhelm the mind, but he argues that no one of sound mind should allow his passions to -43 - control his decision-making - the understanding must be free to examine, reason to judge, and the will to prefer. But i f any extreme disturbance (as sometimes it happens) possesses our whole Mind, as when the pain of the Rack, an impetuous uneasiness, as of Love, Anger, or any other violent Passion, running away with us, allows us not the liberty of thought, and we are not Masters enough of our own Minds to consider thoroughly, and examine fairly; ... But the forbearance of a too hasty compliance with our desires, the moderation and restraint of our Passions, so that our Understandings may be free to examine, and reason unbiased give its judgment, being that, whereon a right direction of our conduct to true Happiness depends; 'tis in this we should employ our chief care and endeavours. ... And how much this is in every ones power, every one by making resolutions to himself, such as he may keep, is easie for every one to try. Nor let any one say, he cannot govern his Passions, nor hinder them from breaking out, and carrying him into action. (II,xxi,53) Strong passions overwhelming the mind is one way in which someone may lack control over his own mind, but he may also lack control over his mind due to the actions of his own mind. For example, ideas may be improperly linked in the mind, or the mind may become obsessed with a particular idea and focus its attention on that idea to an inappropriate extent. Sometimes it is entirely appropriate for the mind to focus almost exclusively on one idea, and I do not think Locke would see this as a lack of control over the mind. For example, i f one is hog-tied and lying in the middle of a railroad track and the train is fast approaching, it would be entirely appropriate to focus one's mind on trying to untie or break one's bonds, or somehow get off the tracks. Two ideas may become linked, with or without just cause, so that the thought of the first may bring about the second. For example, i f one drank a 40oz bottle of rum, and suffered alcohol poisoning, then the mere smell of rum may cause one to feel i l l . The ideas of rum and of - 4 4 - alcohol poisoning may become inextricably linked. Another example may be if one was raped by an assailant wearing a black hooded sweatshirt and blue jeans, seeing someone wearing a black hooded sweatshirt and blue jeans may cause one to feel fear, anger, or perhaps the desire for revenge. One can see a reasonable connection between ideas in these two instances, but if perchance two unrelated ideas were to become associated, say for example you won a large sum of money in the lottery on the same night you drank the bottle of rum, your mind may make an erroneous connection between the two events. If your mind links winning money with imbibing large amount of rum, your feelings towards rum may be completely different - you may be inclined to get pie-eyed every time you're short of money! Now it is obvious that drinking lots of rum has no bearing on having the very six numbers which were picked in a random draw in the lottery, but if these ideas do become strongly associated, one's thoughts and actions may be affected. Locke sees the improper connection of ideas as a topic which is very much deserving of careful consideration. This wrong Connexion in our Minds of Ideas in themselves, loose and independent of one another, has such an influence, and is of so great force to set us awry in our Actions, as well Moral as Natural, Passions, Reasonings, and Notions themselves, that, perhaps, there is not any one thing that deserves more to be looked after. (II,xxxiii,9) This improper connection of ideas is certainly a topic which Locke sees as deserving of more attention, and I would argue that these inappropriate connections of ideas might partially explain the sufferings of hypochondriacs. Other factors relevant to this explanation are passions overwhelming the mind, and the mind's inappropriate fixation with certain impressions and ideas (in particular those involving bodily sensation), both of which Locke makes reference to in the Essay, although never directly mentioning hypochondria. I would j -45 - also suggest that the following passage, in which Locke speaks of mad men, may be seen as a direct reference to hypochondriacs. [Mad Men] do not appear to me to have lost the Faculty of Reasoning: but having joined together some Ideas very wrongly, they mistake them for Truths; and they err as Men do, that argue right from wrong Principles. For by the violence of their Imaginations, having taken their Fancies for Realities, they make right deductions from them. ... Hence it comes to pass, that a Man, who is very sober, and of a right Understanding in all other things, may in one particular be as frantick, as any in Bedlam; i f either by any sudden very strong impression, or long fixing his Fancy upon one sort of Thoughts, incoherent Ideas have been cemented together so powerfully, as to remain united. But there are degrees of Madness, as of Folly; the disorderly jumbling Ideas together, is in some more, and some less. (II,xi,13) If one accepts my claim that Locke's mad men are hypochondriacs (or at least that hypochondriacs constitute part of the class of mad men), then the following can be said about hypochondriacs: they reason properly about the ideas in their minds;5 0 they mistakenly believe fancies of their imaginations to be real; ideas have become improperly connected in their minds; and they are rational in most, i f not all, other areas of their lives. Hume With his claim about the enslavement of reason to the passions, Hume entered a long- standing debate about the relationship between the passions, reason, and the wi l l . 5 1 Much of this debate centred on the control of the will , and which faculty (reason or the passions) held They reason properly, but based upon data from erroneous judgments. 5 1 See Annotations to both ( and ( of the Treatise for a brief discussion of this debate. -46,- the power in influencing the will . I will begin by briefly looking at what Hume means by "the passions", "reason", and "the wil l" . The passions (sometimes called affections by Hume), not only constitute an integral part of human nature, but they are, on Hume's account, essential to human functioning, as they alone are capable of influencing the will. A l l the mind's perceptions can be divided into impressions and ideas. The passions are what Hume calls impressions of reflection (or secondary impressions), as opposed to impressions of sensation (or original impressions) ( Secondary impressions differ from original impressions in that they "proceed from some of these original ones, either immediately or by the interposition of its idea" ( Hume goes on to say that "the reflective impressions may be divided into two kinds, viz. the calm and the violent." ( Hume also divides the passions into direct passions - those which "arise immediately from good or evil, from pain or pleasure", and indirect passions - those which "proceed from the same principles, but by the conjunction of other qualities" ( For Hume, the faculty of reason is the understanding, and the understanding is capable of two kinds of reasoning: demonstrative and probabilistic ( Demonstrative reasoning has its proper place in the world of ideas and directs our judgments concerning causes and effects. According to Hume, demonstrative reasoning alone can never be the cause of any of our actions, as all it is capable of doing is informing us of relations between ideas and connections between matters of fact. The second type of reasoning performed by the understanding is probabilistic reasoning, which is used to judge the appropriate means to - 4 7 - pleasure and/or to pain-avoidance. Hume speaks of only two ways in which reason can influence conduct, (a) by exciting a passion by way of informing us of an object which is the proper object of that particular passion, and (b) by discovering the connection of causes and effects, so as to provide us the means of exerting a given passion ( "Reason is perfectly inert, and can never either prevent or produce any action or affection." ( Hume defines the will as "nothing but the internal impression we feel and are conscious of when we knowingly give rise to any new motion of our body, or new perception of our mind." ( It appears that the will, for Hume, must be understood not as a faculty of the mind, but rather as a feeling. However, Hume also speaks of the will as an active force, for example, "The WILL exerts itself, when either the good or the absence of the evil may be attain'd by any action of the mind or body." ( It also seems that the will is a reflective impression, although Hume clearly claims it is not a passion; "Of all the immediate effects of pain and pleasure, there is none more remarkable than the WILL; ... tho', properly speaking, it be not comprehended among the passions" ( Hume goes on to say that in order to properly understand the passions, it is necessary to understand the will. Hume begins his discussion of the will by tackling the long-standing question of whether the will is free. By way of a comparison with necessity in the physical world, he concludes that if the physical world is not free of causal influence, then in the same way, the will is not free from causal influence (2.3.1). He next addresses the question of why we believe that our wills are free, and concludes that it is because we conflate liberty of spontaneity (freedom from constraint and coercion) with liberty of indifference (freedom from causal influence), -48 - and we mistakenly believe that we have liberty of indifference when we actually only have liberty of spontaneity ( Given that the will is not free of causal influence, the question arises as to whether it is (a) the understanding, (b) the passions, or (c) both, that influence it. Hume begins Book II, Part III, Section III with the following: Nothing is more usual in philosophy, and even in common life, than to talk of the combat of passion and reason, [and] to give the preference to reason ... Every rational creature, 'tis said, is oblig'd to regulate his actions by reason; and if any other motive or principle challenge the direction of his conduct, he ought to oppose it, till it be entirely subdu'd, or at least brought to a conformity with that superior principle. ( Hume goes on to claim that this is a fallacy, and endeavours to show that, "reason alone can never be a motive to any action of the wil l ; and ... it can never oppose passion in the direction of the wi l l " ( Hume does not dispute that there is a battle for control of the wil l ; he only wants to claim that this conflict is not between the passions and the faculty of reason. Reason cannot directly motivate us to action because all it is capable of doing is informing us of relations between ideas and connections between matters of fact (demonstrative reason) and judging the appropriate means to pleasure and/or to pain-avoidance (probabilistic reason). As mentioned earlier, Hume identifies only two ways in which reason can influence conduct, (a) by exciting a passion by informing us of an object which is the proper object of that particular passion, and (b) by discovering the connection of causes and effects, so as to - 4 9 - provide us the means of exerting a given passion ( Hume argues that there is no difference in kind between that which can motivate us to action and that which can oppose such a motivation, thus if reason is incapable of the former, it must also be incapable of the latter, and therefore reason cannot oppose the passions in motivating the will . Since reason alone can never produce any action, or give rise to volition, I infer, that the same faculty is as incapable of preventing volition, or of disputing the preference with any passion or emotion. ... 'Tis impossible reason cou'd have the latter effect of preventing volition, but by giving an impulse in a contrary direction to our passion; and that impulse, had it operated alone, wou'd have been able to produce volition. Nothing can oppose or retard the impulse of passion, but a contrary impulse; and if this contrary impulse ever arises from reason, that latter faculty must have an original influence on the will, and must be able to cause, as well as hinder any act of volition. But if reason has no original influence, 'tis impossible it can withstand any principle, which has such an efficacy, or keep the mind in suspense a moment. Thus it appears, that the principle, which opposes our passion, cannot be the same with reason, and is only call'd so in an improper sense. ( If what opposes our passions is only improperly called 'reason', the question remains, what it which opposes the passions in the battle to influence the will? To this question, Hume answers, "the calm passions". Hume believes that we commonly mistake calm passions for reason, and the battle we speak of between reason and the passions is actually fought between two types of passions, the more violent ones and the calm ones. 5 2 What we commonly understand by passion.h a violent and sensible emotion of mind, when any good or evil is presented, or any object, which, by the original formation of our faculties, is fitted to excite an appetite. By reason we mean affections of the very same kind with the former; but such as operate more calmly, and cause no disorder in the temper: Which tranquility leads us into a mistake concerning them, and causes us to regard them as conclusions only of our intellectual faculties. ... Generally speaking, the violent passions See especially (, (, and ( -50- have a more powerful influence on the will ; tho' 'tis often found, that the calm ones, when corroborated by reflection, and seconded by resolution, are able to controul [sic] them in their most furious movements. (2:3.8.13) Hume notes that there are "certain calm desires and tendencies, which tho' they be real passions, produce little emotion in the mind," and "[w]hen any of these passions are calm, and cause no disorder in the soul, they are very readily taken for the determinations of reason, and are suppos'd to proceed from the same faculty, with that, which judges of truth and falsehood." ( It is this confounding of the calm passions with reason which has driven the (misguided) debate as to whether reason or the passions are in the driver's seat when it comes to determining our actions. 'Tis evident passions influence the will not in proportion to their violence, or the disorder they occasion in the temper; but on the contrary, that when a passion has once become a settled principle of action, and is the predominant inclination of the soul, it commonly produces no longer any sensible agitation. ( Here Hume is arguing that through habit we come to respond in certain ways to certain situations, and though our response on the first occasion(s) may have been driven by a more violent passion, over time, we respond the same way, despite the passion no longer being violent. The very first time a non-ring-wearer wears a ring he can constantly feel it rubbing against adjacent fingers and possibly irritating the finger on which it is worn. After several days of wearing it, he is no longer physically aware that the ring is there, as he no longer feels any discomfort or irritation. Just as the ring-wearer has become accustomed to having a ring on his finger, so we become accustomed to responding certain ways to certain situations, even without a noticeable passion to influence us. -51 - According to Hume, there is a battle for control of the will, but it occurs entirely within the realm of the passions, as only the passions are capable of influencing the will . However, reason does have a role to play in guiding our actions. While reason cannot directly influence the will , it can influence the passions, as Hume says, "the moment we perceive the falsehood of any supposition, or the insufficiency of any means our passions yield to our reason without any opposition" (, or as David Fate Norton says in the Editor's Introduction to Hume's Treatise, "reason serves, in effect, as the eyes and ears of the passions" (p. I 72). If reason acts as the "eyes and ears of the passions" and provides a system of checks and balances in order to keep the passions on the right track, is its role properly that of a slave? While reason may be subservient to the passions in some respects, I believe that Hume cannot have meant that the relationship is properly one of slave to slave-master, but rather is more analogous to a business partnership between equals, each of whom has a specific role to play. It seems that even Hume himself realized that the relationship between the understanding and the passions, for better or for worse, was reciprocal in nature. "As the emotions of the soul prevent any subtile reasoning and reflection, so these latter actions of the mind are equally prejudicial to the former." ( On Hume's account of the operations of the mind, the fundamental difference between ideas and impressions is the force and vivacity with which they are presented to the mind. Ideas are generally less forceful and vivacious than impressions, but in some circumstances may - 5 2 - come almost to rival impressions in their power. Hume admits that we can make an imaginary illness real merely through thinking about it and having the idea approach the force and vivacity of an impression. An idea of a sentiment or passion, may ... be so enliven'd as to become the very sentiment or passion. The lively idea of any object always approaches its impression; and 'tis certain we may feel sickness and pain from the mere force of imagination, and make a malady real by often thinking of it. ( — italics mine). In this passage, although he does not use the term "hypochondria," Hume seems to have provided a succinct explanation of hypochondriasis and its aetiology, in accord with his overall theory of mind. While Hume introduces the above passage in the context of a discussion of sympathy and how we might feel the pains of others as though they were our own, 5 3 there is nothing in his account of the operations of the mind to preclude such maladies from arising anew from our imagination. One of the unique features of our imagination is its ability and liberty to transpose and change its ideas ( In the same way that we can put wings or horns on horses to create Pegasus or a unicorn (neither of which exist in nature), so our imagination can combine various impressions of sensation or reflection in order to produce an idea of some complex malady. If the idea of this malady approaches the force and vivacity of an impression, it becomes difficult to differentiate between real physiological disease, and that created by the mind. Hume does not address this issue, and it is not at all clear that he saw it as problematic. 53 In fact, these pains do become our own, as the above passage ( illustrates. -53- A n interesting point to notice is that i f Hume's story is correct as an explanation of how the human mind actually works, and being able to make an imaginary disease real (i.e. hypochondria) is a proper activity of the mind, then hypochondria is a normal (or at least not an abnormal) part of human nature! Hume never discusses what constitutes human identity, and he certainly never discusses hypochondria as part of what it is to be human, but the idea that hypochondria is in some way a normal part of the human condition is an intriguing one. Remarks Kant would agree with Locke that passions overwhelming the mind, inappropriate fixation of the mind on bodily sensations and their corresponding ideas, and improper connections of ideas do play a role in the suffering of hypochondriacs, and Kant would also agree that one ought to be able to prevent one's mind from being controlled by wayward passions. However, as much as Kant believes that Locke is on the right track with respect to explaining and understanding the suffering of hypochondriacs, there are other aspects of Locke's theory which Kant cannot bring himself to endorse (many of which I did not discuss). Similarly, Kant and Descartes agree on many aspects concerning the operations of the mind, most notably that reason (or intellect) ought to have dominion over the passions and the imagination, and that hypochondria primarily results from a weakness of the mind. One aspect of Descartes theory which Kant cannot accept, however, is Cartesian mind-body dualism. -54- As much as Kant believes that Descartes and Locke are on the right track with respect to understanding hypochondria, he feels that their respective theories of the operations of the mind leave something to be desired as accounts of the actual workings of the mind, and given the elements of their theories he cannot possibly accept, he felt the need to construct a new theory of mind. Kant's theory builds upon those of Descartes and Locke, with respect to understanding hypochondria, but is quite different overall as a theory of the operations of the mind. Hume's claim that "reason is, and ought only to be the slave of the passions" can be broken down into two separate claims: reason is the slave of the passions, and reason ought to be the slave of the passions. With respect to hypochondria, I believe Kant would agree that the former is the case, and this in fact is the cause of the disorder. However, Kant would vehemently oppose Hume's suggestion that this is how things ought to be. For Kant, reason must have dominion over the mind, and it is only by restoring reason to its proper place as ruler of the mind that the devastating consequences of mental disorders such as hypochondria can be overcome. For this reason, Kant's account of the operations of the mind may be viewed as a direct response to Hume's theory. I have claimed, at least implicitly, that the philosophers I have discussed were concerned with hypochondria, which was prominent in the public consciousness during the early modern era. So far I have shown that hypochondria was a topic of concern in the public consciousness, as evidenced by the writings of Burton, Boswell, Cheyne, Mandeville and others. I have also shown that it is possible to find evidence of this concern in the works of -55 - the early modern philosophers I discuss. However, my case would be much stronger i f I could show that the philosophers were actually familiar with some of these other writings on the subject of hypochondria. I can find no evidence of Descartes or Locke having read any works on melancholia or hypochondria, although it is likely they did, however, there is some evidence that both Hume and Kant were acquainted with some of the authors on hypochondria which are discussed above. In the spring of 1734, Hume wrote a letter to a physician in which he details his struggles with "the Disease of the Learned" or "the Vapours." The intended recipient of this letter was likely either George Cheyne or John Arbuthnot. 5 4 I have discussed Cheyne above, and i f he were the intended recipient, one would have to assume that it was because Hume was familiar with him and his work with hypochondriacs. 5 5 Arbuthnot is perhaps best known as a collaborator with and great influence upon Jonathan Swift, Alexander Pope, and others. Arbuthnot, Swift, Pope, John Gay, Henry St. John, and Thomas Parnell formed the Scriblerus Club in 1713, which collectively wrote the satirical Memoirs ofMartinus Scriblerus, which was eventually published by Pope in 1741, although it is generally acknowledged that Arbuthnot was the major contributor (and the only one with any medical background). The topic of hypochondria is one of the many subjects dealt with in the work, and Cornelius Scriblerus (Martinus' father) is considered to be the basis for Laurence Sterne's Walter Originally it was believed that Cheyne was the intended recipient, but recently some scholars have argued that Hume was actually writing to John Arbuthnot, another Scottish physician who resided in London, as did Cheyne. 5 5 The letter was written the same year as Cheyne's The English Malady was published. -56- Shandy (Tristram's father). Arbuthnot also wrote an "Essay concerning the Nature of Ailments" published in 1731, and spent several years as a physician to the royal family. 5 6 Kant was acquainted with Boswell, receiving a visit from him in Konigsberg in 1784,57 and Hume was also an acquaintance of Boswell's, so it can be assumed that both Hume and Kant were well aware of Boswell's ailments, since Boswell was always eager to share his experiences with whomever would lend him their ear. Both Boswell and his companion Samuel Johnson, another self-proclaimed hypochondriac, were avid devourers of Burton's CO Anatomy of Melancholy, and had copies of the work in their personal libraries. According to Susan Meld Shell, Kant would also have been familiar with Burton, " i f not directly, then certainly through Laurence Sterne, whose 'whimsical talent' Kant praises in the Anthropology (VIL235; 104)..." (Shell, note 16, p.425). Much of Sterne's Tristram Shandy was based on information from Burton, and Swift's Gulliver's Travels also has a lot of Burtonesque material in it . 5 9 Sterne also alludes to Locke in his work, and the French Enlightenment philosophe Claude-Adrien Helvetius, is known as a developer of Locke's ideas.60 Helvetius was also influenced by Mandeville, as were Rousseau and Kant himself, with the latter having works by Helvetius in his personal library.61 5 6 See Pat Rogers' "Fat is a fictional issue: the novel and the rise of weight-watching" and Anita Guerrini's '"A club of little villains': rhetoric, professional identity and medical pamphlet wars" in Roberts and Porter's Literature and Medicine During the Eighteenth Century, and also Roy Porter's, Flesh in the Age of Reason and Madmen: A Social History of Madhouses, Mad-Doctors & Lunatics. 5 7 See Boswell's Journal entry in Mr. Boswell dines with Professor Kant. 5 8 See Porters Madmen, and Boswell's The Hypochondriack. 5 9 See Judith Hawley's "The anatomy of Tristram Shandy" and Christopher Fox's "Of logic and lycanthropy: Gulliver and the faculties of the mind," in Roberts and Porter's Literature and Medicine During the Eighteenth Century. 6 0 See Porter's Madmen, and Flesh in the Age of Reason. - 5 7 - Now that it has been established that hypochondria was in the public consciousness as well as that of philosophers of the early modern era, and that the philosophers would have been somewhat familiar with the non-philosophical writings on the topic (and vice versa), the final chapter will explore Kant's views on the topic. As mentioned in the previous chapter, Kant believed that his theory of the operations of the mind was able to both explain and provide a way to lessen the anguish of hypochondriacs. His own struggles with hypochondria served as a motivating factor for his account of the workings of the mind, and in turn his account of the mind helped to bring a greater understanding of hypochondria as a purely mental disorder. 1 See E.J. Hundert's The Enlightenment's Fable and Arthur Warda's lmmanuel Kants Bticher. -58- Chapter III - K a n t and Hypochondr ia As mentioned in the previous chapter, the eighteenth century was a time in which there was a fundamental shift in the conception of what type of disorder hypochondria was seen to be. The Galenic humoural theory, in which the disorder was viewed as a physical disease resulting from an imbalance of the four humours, was being replaced by views of hypochondriasis as predominantly a mental disorder. According to Susan Meld Shell, the new theories were divided between mechanist theories (inspired by the mechanical philosophy of Descartes) and animist theories (more loosely inspired by Paracelsus and the vitalism and plasticism of the Cambridge neo-Platonists). " Since hypochondria appears to manifest itself as a physical disorder, it behoves those who claim it to be a mental disorder to explain how a disorder of the mind could manifest itself in physical symptoms. Many of these theories explained this interaction between mind and body as being the purview of the imagination. Hypochondria was especially associated with disturbances of the imagination during a century in which imagination was coming increasingly to be regarded, by philosophers and poets alike, as the seat of interaction between mind and matter. (Shell, p.267) For Kant, the imagination is key to his discussions of hypochondria; for not only does it play a role in the interactions of the mind with reality, it is, as the mediating link between sensibility and understanding, at the root of the disorder. It is when the imagination runs 62 The Embodiment of Reason, p.267. Shell also claims that Kant, by his own account, remained agnostic on the key points dividing the two groups of theories, (see note 19, p.426). - 5 9 - wild and improper associations and attributions are made to bodily sensations that hypochondria sets in. Kantian Hypochondria Kant's discussions of hypochondria occur primarily in the following three works: Versuch tiber die Krankheiten des Kopfes (An Attempt over the Maladies of the Head) (1764), Anthropology from a Pragmatic Point of View (1798), and the third part of The Conflict of the Faculties (1798). The latter two works provide details of Kant's own struggles with hypochondriacal tendencies, while the former work is primarily a classification of mental diseases from the most mild through to the greatest madness and insanity, with a discussion of the causes of and relationships amongst the various maladies. In the Maladies of the Head, Kant differentiates between several types of mental disorders. There are those which are "despised and scoffed at" (including foolishness, arrogance, stupidity, and idiocy), and those which are pitied (imbecility and disturbed mindedness). The maladies of a disturbed mind are of as many different sorts as there are capacities of the mind, but Kant divides them into three classes - derangement [Verriickung], madness [Wahnsinn], and lunacy [Wahnwitz] (Maladies of the Head, II:264ff). Hypochondria falls into the class of maladies of derangement. The imagination constantly is forming images of things which are not present at the moment, and this is perfectly normal - it is after all, what the imagination does. When this happens in sleep, we say we are dreaming. - 6 0 - When normal persons are awake, however, outer impressions drown out these illusions, which therefore have their "full strength" only in sleep, when the entrance to the soul of the livelier, outer impressions is "closed off." "It is thus," [Kant] says, "no wonder that dreams, while they last, are taken for true experiences of real things." In the deranged, these chimerical impressions are, for whatever reason, as strong as the normal impressions of outer sense, so that even a healthy reason, i f it were subject to such chimerical impressions, would take them for real experiences. The deranged person can hence properly be said to "dream while awake." (11:264-5) (Shell, p.269) It should be noted that a deranged person still reasons correctly; the error is in taking the fantasies of the imagination to be representations of reality. What is interesting is that a deranged person is almost normal! "Between insanity and healthy {understanding} sense there is no clear division, for hypochondria fills out the middle. - Immanuel Kant (XV:218)" (Shell, p.264). It is only the fact that "waking dreams" are as vivid as the images originating from outer sensation in the deranged person that causes him to be deranged. A healthy mind takes its dreams to be true while they are being dreamt, but if upon waking a mind still takes them to be true, it is no longer a healthy mind, but rather a deranged one. The fantastic mental constitution is nowhere commoner than in hypochondria. The chimeras which this illness hatches do not properly deceive outer senses, but rather only make for the hypochondriac an illusion [Blendwerk] of the experience of his own state, either of the body or the soul, that is largely a mere crotchet [Grille].64 The hypochondriac has an il l that, wherever it may have its main seat... wanders unsteadily throughout the diverse parts of the body. But it chiefly draws a melancholy vapour around the seat of the soul, to the extent that the patient has the illusion that he feels in himself almost every illness of which he has ever heard. He therefore speaks of nothing so happily as his indisposition, gladly reads medical texts, in which he everywhere encounters his own condition. ... Because of the occurrence of such internal 6 3 Note the similarity to Locke's description of a mad man on page 46. 6 4 In the Anthropology, Kant translates 'Grille' as "cricket," which is the more common use of the word. In the context of the above quote, however, "cricket" makes no sense. -61 - fantasies the images in his brain often acquire a strength and duration that burden him ... so that his state is much like that of one deranged [eines Verriickten], only without the latter's necessity. (11:266) (Maladies of the Head, as quoted in Shell, p.268) Within the class of maladies of derangement, are several different kinds of derangement. Here Kant distinguishes between the deranged person proper, who cannot help but be deranged, and the hypochondriac, who is deranged while he suffers, but who can overcome and prevent such derangement - there is hope for the hypochondriac, and this hope relies heavily upon the actions and abilities of the will . "As a state in between healthy reason and insanity, hypochondria is comparable to that dreamlike condition we experience upon awakening; it is also a condition which ... can be cancelled by an act of wi l l " (Shell, p.271). I will discuss the role of the will later in this chapter. In the previous chapter, I discussed how hypochondria was often seen to be one and the same disorder as melancholia. For Kant, a melancholic person is not necessarily the same as a hypochondriac. Kant divides the temperaments of men into four: the sanguine, the melancholy, the choleric, and the phlegmatic. A temperament is a tendency towards a state, thus a person who is of the melancholic temperament is not necessarily the same as a person who suffers from melancholia (a state), although he does hav.e the tendency to be such a sufferer. The melancholic temperament is one in which the person "attaches great importance to everything that has to do with himself (Anthropology, §89A, VII:286-91, pp. 152-7). A melancholic temperament can predispose a person to suffer from melancholia (which is not mental derangement), but which can in turn lead to hypochondria (which is a mental derangement). 'Melancholy (melancholia) can also be a mere delusion of misery that - 6 2 - the morose self-torturer (one inclined to fret) creates for himself. Although not itself mental derangement, it can well lead to this." (Anthropology, §50, VII:213, p.83) Fretting, or anxiety is the hallmark of the hypochondriac for Kant. The main issue for a hypochondriac is that he "can feel well, ... but he can never know that he is healthy" (Conflict, VII: 100, p. 181), or, conversely, he may feel ill when there is no physiological disease. Hypochondria is marked by the anxiety that one is ill , rather than any physiological illness. ... we first divide mental illness into morbid anxiety (hypochondria) and mental derangement (mania). Hypochondria is called Grillenkrankheit from its analogy to listening, in the quiet of the night, to a cricket chirping in the house, which disturbs our mental repose and so prevents us from sleeping. The hypochondriac's illness consists in this: that certain internal physical sensations are not so much symptoms of a real disease present in the body as rather mere causes of anxiety about it; ... This is how hypochondria, as morbid anxiety, causes the patient to imagine that he is physically ill : though he knows that the illness is a product of his imagination, now and then he cannot help taking the image for something real or, vice-versa, making out of a real physical complaint (such as the discomfort that follows a meal of flatulent food) images of all sorts of serious external events and worries about his business, which vanish as soon as he has finished digesting his meal and the flatulence stops. - The hypochondriac is a crank (visionary) of the most pitiful sort: he stubbornly refuses to be talked out of his imaginings ... [a] patient - who for all his everlasting sickliness can never be sick (Anthropology, §50, VIF212-3, pp.82-3). Kant's definition of the hypochondriac as someone who is morbidly anxious about the possibility of physiological disease, is very similar, if not identical, to the everyday definition of the hypochondriac of today.65 Though Kenyon claims that the link between hypochondria Currently, hypochondriasis is defined as "a preoccupation with bodily functions and fears of acquiring or having a serious disease based on misinterpretation of physical symptoms" (The Merck Manual, Seventeenth Edition, 1999, p. 1510). -63 - and pathophobia was not firmly established until as late as the early nineteenth century, it seems as though Kant was making this association at least a quarter of a century earlier.66 The above quotation from the Anthropology also indicates another characteristic of Kant's hypochondriac, namely that he knows that his (fictitious) illness is a product of his imagination, and that he ought not to allow it to occupy his mind, and yet, he often seems helpless to overcome its influence. This same sentiment is echoed in the opening passage of the section entitled "On Hypochondria" from The Conflict of the Faculties: The exact opposite of the mind's power to master its pathological feelings is hypochondria, the weakness of abandoning oneself despondently to general morbid feelings that have no definite object (and so making no attempt to master them by reason). Since this sort of melancholia (hypochondria vaga)67 has no definite seat in the body and is a creature of the imagination, it could also be called fictitious disease, ... The opposite of the mind's self-mastery, in other words, is fainthearted brooding about the ills that could befall one, and that one would not be able to withstand if they should come. It is a kind of insanity; for though some sort of unhealthy condition (such as flatulence or constipation) may be the source of it, this state is not felt immediately, as it affects the senses, but is misrepresented as impending illness by inventive imagination. (Conflict, VII: 103, p. 187) The hypochondriac may consult various physicians, but Kant maintains that only the hypochondriac himself is truly able to halt these unbidden notions of disease. This requires that he discipline his mind in order to make reason the sovereign. "In hypochondria, the patient is well aware that something is wrong with.the course of his thoughts, insofar as his The Anthropology was based on lectures Kant gave for "a period of some thirty years" while he was "occupied with pure philosophy," so it is entirely possible that Kant was associating hypochondriasis with pathophobia even before 1798. 6 7 Kant distinguishes hypochondria vaga from what he calls localized hypochondria {hypochondria intestinalis). See footnote * Conflict of the Faculties, VII: 103, p. 187. -64- reason has not enough control over itself to direct it, to stem it or push it on" (Anthropology, §45, VII:202, pp.73-4). In order for the hypochondriac to overcome the disorder, the imagination must be set free again, and reason must determine the will . How the Mind Works It is clear from what has been said above that the imagination and reason are two important faculties of the mind with regard to hypochondria, but at this point it may be helpful to review some of the interactions of all six of the relevant faculties of the mind, namely sensibility, understanding, imagination, reason, judgment, and the will. Sensibility, understanding and the imagination work together to give us knowledge of the world in which we live. The information we get via sensibility is synthesized by the imagination, and the understanding forms concepts. Imagination is the bridge between the intuitions of sensibility and the concepts of the understanding. Whether or not given representations are subsumed under given concepts is the purview of judgment, and reason makes inferences based upon these judgments. Judgment is the bridge between the concepts of the understanding and the inferences of reason. Reason then guides our actions and grounds the decisions we make, by determining the will. With regard to hypochondria, the imagination, reason, and the will are the three most crucial faculties of the mind, although other faculties do play a part. I ' l l begin with brief a discussion of the triad of sensibility, imagination, and understanding, before moving on to a discussion of the mastery of the mind by reason. -65 - Sense is the power of intuiting when the object is present; imagination, that of intuiting even when the object is not present. - The senses, in turn, are divided into the outer senses and inner sense (sensus internus). In outer sense, the human body is affected by physical things; in inner sense, by the mind. (Anthropology, §15, VII: 153, p.32) Our senses cannot deceive us, since it cannot be false that we sense what we do. The error occurs in the attributions we make to our various sensations. The hypochondriac may be affected by either outer sense or inner sense. He may have a real pain in his intestinal tract due to the consumption of gaseous food, but if he dwells on this pain to the point of obsession, he worries that he is suffering some serious physiological illness, and his sensation of outer sense may then be transferred to inner sense, i.e., he is now primarily affected by the mind rather than a physical thing. ... i f a sensation grows so strong that we become more conscious of the organ's being affected than of the reference to an external object, external representations are changed into internal ones. ... In other words, the intensity of the sensation, ... prevents us from arriving at a concept of the object and fixes our attention merely on the subjective representation, namely the alteration of the organ. (Anthropology, §19, VII: 156, p.35) In addition to outer sensations being transformed into inner sensations, the hypochondriac can also be affected originally by inner sensations, which are erroneously thought to be outer sensations. For example, a perfectly healthy person who learns that Mary, the lady who prepares his food, has just been identified as a carrier of typhoid, may begin to feel feverish and complain of stomach pains, even though he has not contracted typhoid fever, his temperature is normal, and there are no pathological processes actually occurring in his stomach. One need not have hypochondriacal tendencies in order for this to occur, but it is more likely to occur in someone with such.tendencies. - 6 6 - ... consciousness of what we undergo insofar as we are affected by the play of our own thoughts ... rests on inner intuition. ... Its perceptions and the (true or illusory) inner experiences built up by connecting them are not merely anthropological... but psychological. ... Since we do not have different organs for sensing ourselves inwardly, we have only one inner sense, whose organ could be called the soul. It is said that inner sense is subject to illusions, which [may] consist... in mistaking its appearances for outer appearances - that is, in taking imaginings for sensations (Anthropology, §24, VII: 161, p.39). When the fantasies of the imagination are considered "real" and attributed to the body (outer sense) rather than the mind (inner sense), it seems as though we have a paradigm case of hypochondria. But remember, Kant's hypochondriac knows that his perceived illness is a figment of his imagination. Obviously on some level a judgment is made to the effect that the hypochondriac is i l l , but on another level, there is a judgment made that the hypochondriac is not i l l . In Kant's hypochondriac, reason privileges the second judgment, although the first may not be dismissed completely. In the mind of the hypochondriac, there is a battle going on between the imagination and reason. The imagination seems to indicate that the hypochondriac really is i l l (he feels that he is i l l , and he cannot be in error about what he feels, since sensation itself is merely a passive process, and error requires some active process of judgment), while reason maintains that he is merely imagining such an illness. This battle royal within the mind of the hypochondriac is likely the cause of the anxiety characteristic of the hypochondriac, and certainly is at the root of the misery which self- identified hypochondriacs, including Kant, describe: "I myself have a natural disposition to hypochondria because of my flat and narrow chest, which leaves little room for the movement of the heart and lungs; and in my earlier years this disposition made me almost - 6 7 - weary of life" (Conflict, VII : 104, p. 189) . 6 8 For Kant, the only way out of this misery is for reason to win the battle, since in the proper hierarchy of the cognitive powers, reason ought to reign sovereign. To observe in ourselves the various acts of the representative power when we call them forth merits our reflection; . . . But to try to eavesdrop on ourselves when they occur in our mind unbidden and spontaneously (as happens through the play of imagination when it invents images unintentionally) is to overturn the natural order of the cognitive powers, because then the principles of thinking do not come first (as they should), but instead follow after. If it is not already a form of mental illness (hypochondria), it leads to this and to the lunatic asylum. (Anthropology, §4, VII : 133-4, p. 15) Reason must rule the mind since the main role of practical reason is to determine the w i l l , and only a w i l l determined by reason alone can be a good wi l l . A good w i l l is one that is praiseworthy due to the fact that it puts aside inclination and answers only to the dictates of reason. However, because we are not perfect beings, like God, our w i l l is susceptible to being influenced by inclinations and passions as well as reason, so reason must battle these in order to assume its rightful position as the determiner of the wi l l . Since reason is not sufficiently competent to guide the wi l l surely with regard to its objects and the satisfaction of all our needs . . . an end to which an implanted natural instinct would have led much more certainly; and since reason is nevertheless given to us as a practical faculty, that is, as one that is to influence the will; then, where nature has everywhere else gone to work purposively in distributing its capacities, the true vocation of reason must be to produce a w i l l that is good, not perhaps as a means to other purposes, but good in itself, for which reason was absolutely necessary. (Groundwork, IV:396,p.9-10) James Boswell illustrates this misery and the grip it has over the everyday life of an hypochondriac throughout the essays published anonymously as The Hypochondriack. - 6 8 - At this point, it will be helpful to briefly discuss what Kant takes the will , passions, affects, and inclinations to be. As mentioned before, the will is the faculty of the mind responsible for our actions, and reason is the proper legislator of the will . However, the will of a human being is not in itself completely in conformity with reason, that is, it is not by nature necessarily obedient towards the dictates of reason, and thus is a contingently determined (or dependent) w i l l . 6 9 According to Kant, we must train our minds in order that reason shall be the determinant of our actions, since to act otherwise is to suffer weakness of the mind. This weakness of the mind is what may lead to hypochondria. So it is that the human being claims for himself a will which lets nothing be put to his account that belongs merely to his desires and inclinations, and on the contrary thinks as possible by means of it - indeed as necessary - actions that can be done only by disregarding all desires and sensible incitements. (Groundwork, IV:457, p.61) Inclinations, affects and passions are all deleterious to the sovereignty of reason over the mind. Kant defines an inclination as a "sensuous appetite that serves the subject as a rule (habit)" (Anthropology, §80, VII:265, p. 133), while a passion is a certain type of inclination, namely one that (a) can be subdued "only with difficulty or not at all" (Anthropology,, §73, VII:251, p. 119), and (b) that "prevents reason from comparing it with the totality of all our inclinations when we are making a choice." (Anthropology, §80, VII:265, p. 133). An affect is a "feeling of pleasure or displeasure in his present state that does not let him rise to reflection (to rational consideration of whether he should give himself up to it or refuse it)" (Anthropology, §73, VII:251, p. l 19), or put another way, an unfortunate disposition of the mind. According to Kant, "a mind that is subject to affects and passions is always ///, 6 9 Groundwork, IV:413, pp.24-5. - 6 9 - because both of them exclude the sovereignty of reason" (Anthropology, §73, VII:251, p. l 19). Of the two, Kant seems to feel that passions are the more dangerous. In an affect we are taken unawares by feeling, so that the mind's self- control.. . is suspended. ... On the other hand, passion... takes its time and reflects, no matter how intense it is, in order to reach its end. - An affect works like water breaking through a dam: a passion, like a stream that burrows ever deeper in its bed" (Anthropology, §74, VII:252, p. 120). Passions are linked to reason, in that they presuppose a maxim of acting in accordance with an end which is prescribed by inclination, and because of this, Kant likens them to incurable cancerous sores on pure practical reason.70 Reason, in its pure practical role, must overcome and disregard the influences of inclinations, affects, and passions in order to properly determine the will. If reason is successful, one may be said to be strong-willed, which in essence means that reason is determining the will , as it ought to. If reason is unsuccessful, then one suffers from weakness of the will , and the decisions one makes are not in full accordance with reason. For the hypochondriac, this means that he acts as though his fictitious disease is real, rather than seeing it for what it really is, namely a fantasy of his imagination, which leaves him in a state of ill-being. One might suspect, given what I've said above, that Kant believes that humans, being the sort of creatures they are, are not capable of completely subduing their affects and passions,71 and one would be correct is ascribing this view to Kant. Furthermore, one may also suspect that '"Anthropology, §§80-81, VII:265, p.133. 7 1 In contrast to Descartes, who believes that we can wholly subdue - 7 0 - Kant would see this empirical constraint as a hindrance to our ability to actually be moral, but this is not the case. Kant does not see this as an objection to his moral theory, but rather as an empirically well-confirmed prediction of his transcendental philosophy. It is also a political demand to address and ameliorate the social conditions (such as poverty, starvation, misery, and the like) which lead to the affects and passions controlling our lives. How to Deal with the Hyp While we cannot wholly subdue our passions and affects, Kant provides guidance for sufferers of hypochondria, which can help them to ensure reason's mastery over the imagination and passions. Kant believes that if one properly trains one's mind so that reason does reign sovereign, then one is able to overcome such weakness of the mind as is the case in hypochondria. Kant prescribes a regimen in order to ensure that reason remains strong enough to win the battles with both the inclinations, passions, and affects, and the imagination. The ineradicable passive element in sensibility is really the source of all the evil things said about it. Man's inner perfection consists in his having control over the exercise of all his powers, so that he can use them as he freely chooses. This requires that understanding rule, but without weakening sensibility... for without sensibility there would be no matter that could be worked up for the use of legislative understanding. {Anthropology, §8, VII:144,p.24) Kant's regimen, which is based upon the Stoic system of"sustine et abstine", is meant to ensure strength of the mind (in particular reason). -71 - The Stoic system made consciousness of strength of soul the pivot on which all moral dispositions were to turn; . . . they put the incentive and proper determining ground of the wi l l in an elevation of one's cast of mind above the lower incentives of the senses, which have power only through weakness of soul (note *, CPrR, V:127, p.106). If reason properly determines the w i l l , then the actions of the hypochondriac, with respect to the battle of the imagination with reason, w i l l be to banish the anxieties of pathophobia from the mind, because the anxieties are unreasonable, i.e. they are based on fantasy rather than reality. Once the reasonable person realizes his anxieties are irrational, he can put them aside and get on with the business of the day. Kant provides an autobiographical account of doing just this with respect to the oppression of his heart and lungs caused by his flat and narrow chest. [B]y reflecting that, i f the cause of this oppression of the heart was purely mechanical, nothing could be done about it, I soon came to pay no attention to it. . . . The oppression has remained with me, for its cause lies in my physical constitution. But I have mastered its influence on my thoughts and actions by diverting my attention from this feeling, as i f it had nothing to do with me. {Conflict, VII : 104, p. 189) One problem is that a hypochondriac, whilst in the depths of his illness, is not a reasonable man. The saving grace for the hypochondriac is that he is usually not in the grasp of the disorder all the time, therefore he must wisely use his "illness-free" time to cultivate his powers of reason. . . . only he himself, by disciplining the play of his thoughts, can put an end to these harassing notions that arise involuntarily - notions, indeed, of diseases that could not be prevented i f they were really forthcoming. A s long as a man is afflicted with this sickness we cannot expect him to master his morbid feelings by sheer resolution; for i f he could do this, he would not be a - 7 2 - hypochondriac. A reasonable man vetoes any such hypochondria; .:. he asks himself whether his anxiety has an object. If he finds nothing that could furnish a valid reason for his anxiety, or i f he sees that, were there really such a reason, nothing could be done to prevent its effect, he goes on, despite this claim of his inner feeling, to his agenda for the day - in other words, he leaves his oppression (which is then merely local) in its proper place (as i f it had nothing to do with him), and turns his attention to the business at hand. (Conflict, VII: 103-4, pp. 187-189) Kant's regimen does not only consist in ensuring that reason is the sovereign of the mind, but also encompasses two other elements: distraction and abstraction. By distraction I do not entirely mean not paying attention to some idea, but rather distracting oneself from constant thought of one subject by purposefully paying attention to some other idea, or just letting the imagination run free (but not, of course, run amok). Our effort to become conscious of our ideas is either paying attention to or turning away from an idea of which we are conscious (attentio or abstractio). - In abstracting we are not merely neglecting to pay attention, failing to do it (that would be distraction, distractio); we are, rather, performing a real act of the cognitive power by which one idea of which we are conscious is held apart from its connection with other ideas in one consciousness. ... In this way our idea gets the universality of a concept and so is taken into the understanding. (Anthropology, §3, VII:131, p. 13) The value of distraction is two-fold: it prevents fatigue of the mind and it lessens the chance of becoming obsessed with a given idea (and therefore helps to combat hypochondria). Kant was not the only one advocating for the importance of distraction in maintaining a healthy mind, Christoph Hufeland (most famous for coining the term 'macrobiotics' for the medical art of prolongation of life), also stressed the value of mental distraction. When one thinks too incessantly on the same subject. The same law prevails here as in regard to muscular motion. When one moves the arm continually in -73 - the same direction, one, in a quarter of an hour, w i l l become more fatigued than i f the limb had been moved two hours in various directions. Nothing exhausts so much as uniformity in the pursuit and employment of the mental powers. (Hufeland, Art of Prolonging Life, pp. 165-6) 2 But we can also distract ourselves, that is, create a diversion for involuntary reproductive imagination... This is a necessary, and in part artificial precautionary procedure for our mental health. (Kant, Anthropology, §47, VII:207, p.78) Kant believes that one should only engage in one onerous task at a time, and alternate between mental thinking and the mechanical operations of the body. He believes, that the concurrent exertion of both the mind and the body leads to trouble, for the human constitution cannot handle more than one of these tasks at a given time. But i f [a scholar] taxes his energy by occupying himself with a specific thought while he is eating or walking, he inflicts two tasks on himself at the same time - on the head and the stomach or on the head and the feet; and in the first case this brings on hypochondria, in the second, vertigo. To master these pathological states by a regimen, then, all he has to do is alternate the mechanical occupation of the stomach or the feet with the mental occupation of thinking and, while he is eating or taking a walk (restoring himself), check deliberate thought and give himself over to the free play of imagination (a quasi-mechanical activity). (Conflict, VII : 109, p.T99) In light of his concerns about the deleterious consequences of eating and thinking at the same time, Kant suggests that philosophers do not dine alone, so as to reduce the temptation to engage in deep thought while eating. Hufeland also promotes the separation of thinking-time from digestion-time, stating, "When one overstrains the mind during the time of digestion. This occasions double injury: one weakens one's self more, as more exertion is then The third part of The Conflict of the Faculties, was written as a sort of reply to Hufeland's Art of Prolonging Life. -74- necessary for thinking, and interrupts at the same time the important function of digestion." (Hufeland,p.l68) In contrast to distraction, which lessens the mind's control over itself (particularly during the free-play of imagination), abstraction is in many ways the major tool the mind uses to maintain control over its ideas. The power of abstraction is a capacity of the mind which must be cultivated and strengthened though use. 7 3 If we never engage in abstraction, we never acquire the ability to do so effectively. The ability to abstract from an idea, even when the senses urge it on us, is a far greater power than that o f paying attention to it; for it demonstrates a freedom of the power of judgment and the autonomy of the mind, by which the state of its ideas is under its control.... In this respect the power of abstraction, when it deals with sense representations, is much more difficult to exercise than the power of attention, but also more important. (Anthropology, §3, VII : 131, p. 13) In some ways, Kant prescribes periods of lesser control over the mind as a way to have more control over one's mind. According to Shell, Kant 's philosophic regimen .. . essentially consists in this: the mind's periodic release from concentrated attention on a single object, through deliberate, albeit temporary, abandonment to a distracting play of images and/or affects, and all this to energize, and thereby promote, certain vital functions of the body. In short, Kant's regimen is a deliberate and controlled surrender of mental self-direction, a way o f using play by intentionally allowing oneself to be played with. (Shell, p.282) 73 Anthropology, §3, V I I : 132, p. 13. -75 Final Thoughts In conclusion, the understanding of what hypochondria was, was undergoing a fundamental shift in the eighteenth century. It was no longer being viewed as exclusively a physical disease, but rather it was seen to be predominantly a mental disorder. In addition to this, it was the fashionable disease of the century, and there is ample evidence that not only was it in the public consciousness, but the intellectuals of the seventeenth and eighteenth century were also concerned with it. It is not clear whether the intellectuals of the period were merely tracking this already changing conception of hypochondria, or whether they were is some sense driving the change, but in the case of Kant, it could be argued that he is doing the latter, particularly with respect to seeing hypochondria as pathophobia. Kant claimed to have been able to overcome the deleterious effects of his own hypochondriacal tendencies by following a Stoical regimen which helped to strengthen his ability to make reason the sovereign of his mind. Whether of not Kant was truly successful in overcoming his hypochondria in this manner, remains an unanswered question. Both Susan Meld Shell and Peter Melville raise the question of whether Kant actually defeated his hypochondria, or merely transferred it from one obsession (his oppressed heart) to another, but such questions are beyond the scope of my project here.74 I hope to have shown that contra Strawson, the transcendental faculties not only can have empirical consequences, but they do, particularly in the case of hypochondria. The attempt by Strawson and others to de-psychologize Kant would surely result in Kant being powerless 7 4 See Shell's Embodiment of Reason, note 58, p.433 and Melville's "Illuminism and Terrorism" p.352. - 76 - to find therapeutic regimens and empirical consequences from within his theory of mind. However, given that Kant is able to do just that, it shows that the transcendental subject, which Kant insists upon and Strawson so adamantly tries to excise from Kant's critical philosophy as superfluous and unnecessary,, is a necessary and crucial element in Kant's theory of the mind. Without the transcendental faculties, Kant cannot explain how the mind is able to do what it actually does. Kant has shown, using his own battle with the hyp as a case study, that a properly trained mind can overcome and alleviate the empirical suffering of hypochondriacs. Kant has done what would be impossible for him to do after the Strawsonian Transcendental Excision, thus showing that such an operation is not only unnecessary, but deleterious to the overall functioning of the patient. -77- Bibliography Adair, James Makittrick. Essays on fashionable diseases. The dangerous effects of hot and crouded [sic] rooms. The cloathing of invalids. Lady and gentlemen doctors. And on quacks and quackery. London: sold by T.P. Bateman, 1790?. Allison, Henry E. Kant's Transcendental Idealism: An Interpretation ad Defense. Revised and Enlarged Edition. Yale University Press, 2004. Babb, Lawrence. The Elizabethan Malady: A Study of Melancholia in English Literature from 1580 to 1642. Michigan State University Press, 1951. Boswell, James. The Hypochondriack (1777'-1783). Volumes I and II. Edited by Margery Bailey. Stanford: Stanford University Press, 1928. Boswell, James. "Journal Extract." Mr. Boswell dines with Professor Kant. Thoemmes Continuum, first published © Lewis White Beck, 1979. Burton, Robert. The Anatomy of Melancholy (1651). Edited by Floyd Dell and Paul Jordan-Smith. New York: Farrar & Rinehart, 1927.. Caygill, Howard. A Kant Dictionary. The Blackwell Philosopher Dictionaries. Blackwell Publishers, 1995. Cheyne, George. The English Malady: or a Treatise of Nervous Diseases of all Kinds; as Spleen, Vapours, Lowness of Spirits, Hypochondriacal, and Hysterical Distempers, &c, second edition. London: Printed for G. Strachan and J. Leake, 1734. Descartes, Rene. Discourse on Method (1637). Discourse on Method and Meditations on First Philosophy. Fourth Edition. Translated by Donald A. Cress. Hackett Publishing Company, 1998. Descartes, Rene. Meditations on First Philosophy (1641). In Discourse on Method and Meditations on First Philosophy. Fourth Edition. Translated by Donald A . Cress. Hackett Publishing Company, 1998. Descartes, Rene. The Passions of the Soul (1649). Translated by Stephen Voss. Hackett Publishing, 1989. Findlay, J.N. "Kant and Anglo-Saxon Criticism." Kant's Theory of Knowledge - Selected Papers from the Third International Kant Congress. Edited by Lewis White Beck. Dordrecht-Holland: D. Reidel Publishing Company, 1974. Fischer-Homberger, Esther. "Hypochondriasis of the Eighteenth Century - Neurosis of the Present Century." Bulletin of the History of Medicine. Vo l .XLVI (1972):391-401. - 7 8 - Fox, Christopher. "Of logic and lycanthropy:. Gulliver and the faculties of the mind." Literature and Medicine during the Eighteenth Century. Edited by Marie Mulvey Roberts and Roy Porter. New York: Routledge, 1993. Guerrini, Anita. ' " A club of little villains': rhetoric, professional identity and medical pamphlet wars." Literature and Medicine during the Eighteenth Century. Edited by Marie Mulvey Roberts and Roy Porter. New York: Routledge, 1993. Guyer, Paul and Allen W. Wood. Critique of Pure Reason (1781/1787). Translated and edited by Paul Guyer and Allen W. Wood. New York: Cambridge University Press, 1997. Hawley, Judith. "The anatomy of Tristram Shandy." Literature and Medicine during the Eighteenth Century. Edited by Marie Mulvey Roberts and Roy Porter. New York: Routledge, 1993. Hufeland, Christopher William. Art of Prolonging Life (1794). Edited by Erasmus Wilson. Philadelphia: Lindsay & Blakiston, 1880. Hume, David. "Letter dated March 1734 to [Dr. George Cheyne]." The Letters of David Hume. Vol . I. Edited by J.Y.T. Greig. Oxford: Clarendon Press, 1932. Hume, David. A Treatise of Human Nature (1739/40). Edited by David Fate Norton and Mary J. Norton. New York: Oxford University Press, 2000. Hundert, E.J. The Enlightenment's Fable: Bernard Mandeville and the Discovery of Society. Cambridge University Press, 1994. Kant, Immanuel. Anthropology from a Pragmatic Point of View (1798/1800). Translated by Mary J. Gregor. The Hague: Martinus Nijhoff, 1974. Kant, Immanuel. The Conflict of the Faculties / Der Streit der Facultdten (1798). Translated by Mary J. Gregor. New York: Abaris Books, 1979. Kant, Immanuel. Critique of Judgment (1790/1793), Translated by J.H. Bernard. New York: Hafner Publishing Company, 1951. Kant, Immanuel. Critique of Practical Reason (1788). Edited by Mary Gregor. 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