This is the first of two parts of a paper forthcoming in Anthropos 57 (2). Please cite the published version.

Abstract

Psychosis is often understood in one of two ways: as a breakdown of cognitive circuitry, which has nothing to teach us as far as phenomenology is concerned and that can be treated only by focusing on the underlying causal processes that bring it about (reductionism and the ‘madness-as-nonsense’ view), or, alternatively, as a different interpretation of reality, one with nothing distinctly pathological about it (relativism). In this paper, I outline a different approach, drawing largely on Merleau-Ponty’s work, which aims to encompass both the properly unintelligible (pathological) and intelligible (expressive, phenomenologically informative) aspects of psychosis. By applying Merleau-Ponty’s analysis of expression to the problem of psychosis and psychotic language, the latter can be understood as an attempt at expression—a kind of speech without language that is most often incomplete, but that can under specific circumstances be made intelligible to others, often to significant therapeutic benefit. The present paper thus aims to complement and conceptually elucidate recent work in phenomenological psychiatry, which has demonstrated the clinical significance of enabling patients to express various aspects of their psychotic episodes.

Keywords: psychosis, phenomenology, philosophy of psychiatry, Merleau-Ponty, phenomenology of language

Psihoza kot preobrazba mesa: Merleau-pontyjevska refleksija o blaznosti

Povzetek

Psihozo se pogosto razume na dva načina: bodisi kot kognitivno »okvaro«, ki ni dovzetna za fenomenološko analizo in ki jo lahko obravnavamo samo na ravni kavzalnih procesov, ki jo povzročajo (redukcionizem, »norost kot nesmisel«), ali pa zgolj kot drugačno interpretacijo realnosti, v kateri ni ničesar patološkega (relativizem). V tem prispevku predstavim drugačen pristop k psihozi, ki se povečini opira na Merleau-Pontyjevo fenomenologijo in si prizadeva upoštevati tako dejansko neinteligibilne (patološke) kot inteligibilne (ekspresivne, fenomenološko informativne) vidike psihoze. Skozi prizmo Merleau-Pontyjeve analize izražanja predstavim problem psihotičnega izražanja kot neke vrste »govor brez jezika«, ki je najpogosteje zelo pomanjkljiv, a ga je mogoče v določenih okoliščinah narediti razumljivega za druge, kar pogosto prinaša pomembne terapevtske učinke. Namen pričujočega prispevka je tako razširiti in konceptualno podpreti novejše raziskave na področju fenomenološke psihiatrije, ki so pokazale klinični pomen omogočanja bolnikom s psihozo, da izrazijo in osmislijo različne vidike svojih izkustev.

Ključne besede: psihoza, fenomenologija, filozofija psihiatrije, Merleau-Ponty, fenomenologija jezika

Introduction

Madness is rife with paradoxicality.^[1]I am following Kusters (2020, xv-xvi) in using the terms madness and psychosis interchangeably to designate what is nowadays more commonly described by the many neatly classified terms under the … Continue reading From hallucinations of things that both are and are not there to thoughts that both are and are not one’s own, the casual disregard that madness shows for such matters as logical axioms and coherence of thought have often relegated it to the realm of the utterly unintelligible. To make matters yet more perplexing, even this status of madness itself has something paradoxical about it, for madness has throughout history been both praised and made sacred as θεία μανία and shunned to the dishonourable and untouchable outskirts of society (nowadays, of course, it is rather the isolation cell, conveniently hidden from view, where the attempt is made to fix it with pharmacological means, irrespective of any collateral damage to the mental life of the person thus afflicted—sometimes calling to mind the way one would fix a microscopic sample by replacing the water inside hitherto living cells with conveniently static resin). It is no surprise, then, that the contemporary philosophical literature abounds with many mutually incompatible and radically different accounts of madness, which cover its phenomenology (e.g. Kusters 2020; Fuchs 2024; Gipps 2022), neurobiology (e.g. Sumiyoshi et al. 2024), and the status, role, and legitimacy of psychiatry (e.g. Garson 2022).

The phenomenology of madness will be the primary focus of the present paper, though the arguments presented here will have significant implications for the philosophy of psychiatry. More specifically, I will be addressing the question of what it is that is affected in the prototypical examples of madness, namely those involving delusion, formal thought disorder and hallucinations, along with a host of other positive and negative symptoms. I will begin by presenting and then criticizing the “alternative framework” view, according to which psychosis consists in the assuming of different logical schemes to those accepted by the majority in a given society, such that the content of delusional experience and expression would still make sense for the psychotic, while its unintelligibility to us would merely be the result of the fact that we are living in different worlds, so to speak. While the sharp rejection of this view would seem to leave us with no choice but to forgo any attempt to understand or learn anything from the psychotic (thus making phenomenological psychiatry a rather hopeless enterprise), I will attempt to show in the second section that there is a promising avenue for the phenomenology of psychosis that draws mainly on Merleau-Ponty’s work, namely his understanding of the structures of meaning, thought and consciousness developed in The Phenomenology of Perception (2012) and the posthumously published Visible and the Invisible (1968). By making use of his notions of the flesh and the invisible as enactive replacements for the conventional representationalist framework, we can fruitfully describe some paradoxical aspects of madness without reducing them to something that is merely a superficial modification of non-psychotic experience (i.e. without giving up the sense in which they are beyond understanding in the way argued for by Jaspers (1963, 363)). Finally, in the third section I will sketch out a Merleau-Pontian approach to the problem of psychotic language, drawing on his differentiation between speaking speech and spoken speech developed in The Phenomenology of Perception, The Prose of the World (1973), and Signs (1964).

1 Worlds Apart: Madness as an Alternative Logical Scheme

It seems very natural to describe the prototypical aspects of psychosis—delusion, loss of reality contact, and hallucination—by saying that “a new world has come into being” for the psychotic patient (Jaspers 1963, 284). But what, precisely, does this mean? One straightforward way of understanding it would be to claim that the paradoxicality of madness results from the patient’s taking up of a different logical framework from the one employed by non-psychotic subjects. Thus, while we typically come to conclusions regarding relations of identity and causality based upon a clear demarcation between logical subjects and predicates (from ‘All men are mortal’ and ‘Socrates is a man,’ we conclude that ‘Socrates is mortal,’ not ‘All men are Socrates’), the psychotic subject alters the grounds on which such judgements can be made, such that a phonetic resemblance, for instance, is likewise a valid reason to posit an essential connection between different concepts. As Kusters (2020, 225) puts it: “The words float in the air like fluttering leaves. With no contextual footing, there’s no reason not to connect Bonaparte with blownapart. Nokia becomes associated with ‘no key.’ (…) . Language becomes a seductive game of building blocks, for who is able to hold back the torrent of expanding forms, and on what grounds? There’s no dictionary or grammar, and no other authority that can lay down the law for us. All grammars, all words, are convention, and it’s conventions that we’ve dispensed with.”

There is thus no question that language functions differently in psychosis—which is a topic that I will return to later on—but the view under consideration here, which I will call ‘relativism’ (following Gipps 2022, 191), is more specific, namely that this change consists in a different logical structure of thought that, while containing axioms that we might find unintuitive, is nevertheless as valid as any other, especially given the fact that our own rationality is likewise grounded in a bedrock of rationally unjustifiable certainties.^[2]Gipps (2022, 204) suggests that Kusters (2020) holds something approximating this view, but I find this reading implausible. I would argue instead that Kusters remains largely neutral regarding this … Continue reading This view aims to offer destigmatising recognition to the psychotic patient, but it does so at no small conceptual cost. Leaving aside the fact that it would completely undermine psychiatry and the grounds for any (self-)ascription of psychosis (hence ‘relativism’), there are two important reasons why it fails to do justice to the structures of thought and experience, whether psychotic or not.

First, as Gipps (2022, 192–4) has pointed out, it is not at all clear that it is even coherent to claim that psychiatrist and patient could have truly incommensurable logical schemes. If we say, for example, that the patient comes to conclusions regarding similarity based on phonetic resemblance rather than essential properties, we have to know that both patient and psychiatrist share the same understanding of such matters as ‘similarity,’ ‘essential properties,’ ‘identity,’ etc., which is tantamount to reducing the patient’s putatively radically different logical scheme to that of the psychiatrist (the only alternative being that no communication is in fact possible between patient and psychiatrist). Moreover, it is hard to see how we could even know anything about our own logical scheme, let alone alternative ones, since “to have such a scheme just is for one’s thought to be constrained by it” (Gipps 2022, 193), making the attempt to grasp it by somehow stepping outside of it completely impossible.

To this Wittgensteinian difficulty we can add a second, more phenomenological and Merleau-Pontian one. To talk of logical schemes in this way is to understand language as fundamentally a system of propositions aimed at representing the world (typically paired with a notion of thought as an ‘inner’ system of propositions, which must then be ‘translated’ into language), but this is a phenomenologically naïve account of the genesis and role of language. As Merleau-Ponty argued in The Phenomenology of Perception, both crucial relations in play here—namely that between thought and its expression on the one hand and that between expression and meaning on the other—are misconstrued on such a view. Rather than both being external relations, such that words would be merely arbitrary designations that thought is translated into, he argues that both are internal: speech is thus not a translation of thought but its accomplishment, and the meaning of words does not pick out logical objects in a kind of free-floating space of possible representations (which would make phonetic resemblance as a marker of essential similarity in psychosis wholly unintelligible), but rather derives from an affective gestural signification that precedes and grounds fully fledged conceptual systems (Merleau-Ponty 2012, 182–5; see also Romdenh-Romluc 2011, 186–8; Lewis 1966). The upshot of this is that language is an essentially embodied activity, grounded not in a logical scheme but in the subject’s lived body and its coupling with the environment. Phrased in a way that is very similar to the Wittgensteinian point above: “expression is not one of the curiosities that the mind may propose to examine, but the mind’s existence as act” (Merleau-Ponty 1964, 79, translation modified).

If the notion of alternative logical schemes—and with it, the view according to which paradoxical mad thought is merely a different (but equally valid) conceptual system—is thus shown to be unjustified, we seem to be left with no choice but to conclude that the paradoxical expressions in psychosis do not constitute any form of thought at all. They are instead only examples of ersatz thought, a consequence of the mind’s ‘short-circuit’ (Gipps 2022, 93), neither true nor false, but completely unintelligible. A similar point can be made regarding the status of hallucinations and delusions, namely that they are not forms of perception and belief, but merely illegitimate pretenders to those titles (see Gipps 2022, 57–9, 140–4). Being thus exiled from the realm of the rationally intelligible, such phenomena can only be understood in psychological or motivational terms, i.e. as an escape from an unbearable emotional predicament. In other words: psychosis is not a coherent alternative form of thought and experience, but merely a short-circuit into which the psychotic subject retreats when he or she is unable to cope with the realities of life.

The consequence of this, then, is that we have nothing to learn from psychosis (i.e. from first-person accounts and phenomenological investigations into the structure of psychotic experience); the only knowledge that can relate to it is wholly from the outside, namely in the form of a motivational understanding of the circumstances which bring it about. Epistemically speaking, everything functions almost as if psychosis were a nonconscious physiological state: we may inquire into its causes and learn how to treat it (not necessarily by pharmacological means), but there is nothing fruitful to be gained by listening to what the psychotic patient has to say, other than perhaps to learn something about the triggers which brought about that particular episode, but this is, once again, not learning about psychosis itself but only about matters causally related to it.^[3]I should highlight that I do not take this to be Gipps’ (2022) view, although he can at least partly be read in this vein. In fact, I’m not sure to what extent (if at all) the ideas developed in … Continue reading

While the relativist view goes too far in the direction of reducing psychotic experience to our own, this alternative ‘madness-as-nonsense’ account throws the phenomenological baby out with the delusional bathwater by negating any possibility of learning about structures of experience from psychosis. Such an approach risks making psychosis into too much of an ‘all or nothing’ affair, ignoring less pronounced phenomenological changes that have been shown to occur in the prodromal stage of schizophrenia (Parnas et al. 2005; 2016), as well as features of experience that are common to both psychotic and non-pathological states. Furthermore, there is ample precedent in the phenomenological literature of using pathological alterations of the structure of experience to elucidate distinctions and functions which would otherwise be harder to shed light on in non-pathological experience; it should suffice to point out the famous example of Schneider, of whose symptoms Merleau-Ponty made ample use in describing such matters as the ‘categorial attitude’ and the Greifen/Zeigen distinction (Merleau-Ponty 2012, 123–7 et passim). Partial (but very real) unintelligibility, which was certainly characteristic of Schneider’s case, thus does not have to be an obstacle to phenomenological understanding.^[4]It is interesting to note in passing that some of Schneider’s symptoms closely resemble those of schizophrenia (e.g. his context-insensitive understanding of stories; see Merleau-Ponty 2012, … Continue reading What would be necessary, however, is a different way of fleshing out the structures in question, one that is free from the representationalist presuppositions that characterise much of the literature and lead us inevitably into either the untenable relativist view or the equally unappealing biomedical model (see e.g. Gipps 2022, 92).

2 Merleau-Ponty’s Ontology of the Flesh

As a segway into a Merleau-Pontian approach, we should note one further difficulty with the views presented above, namely that both leave the connection between madness and philosophy—noted since antiquity and powerfully presented recently by Kusters (2020)—wholly unexplained. While the relativist model could at least be read in such a way that both madness and philosophy would represent similar shifts in one’s logical scheme, it would still leave completely open the question of why those shifts should in any way resemble one another (though even explaining that would not help much given the model’s incoherence, of course). As for the alternative, madness-as-nonsense account, any connection here would have to be completely arbitrary. Thus, while racking one’s brains over Husserl’s account of time-consciousness could have something to do with the onset of psychosis (see e.g. Kusters 2020, 243–55), that would only be due to the (pre)psychotic subject’s frustration with the matter, playing nothing more than the same motivational role that could likewise be taken up by, say, exceptionally pronounced dissatisfaction with the outcome of a particular football match.

If there is to be any kind of connection between madness as the unrestrained “passion for infinity” (Kusters 2020, xxii) and philosophy as a restrained form of that same passion—in other words, if it makes sense to understand madness as “cogitating your head off” (ibid., 37)—then this connection must be made intelligible from within psychosis, leaving us no alternative other than to boldly step into the epistemically perilous terrain of trying to understand how the structures of experience become altered in madness. Given the untenable representationalist presuppositions of any talk of logical (or conceptual) schemes, which could hardly do justice to radical changes in experience anyway, I propose that a fruitful avenue would be to make use of Merleau-Ponty’s ontology of the flesh and the invisible, developed in The Visible and the Invisible (1968). I will not be focusing here on his much better-known Phenomenology of Perception (2012) for two reasons: because its better-known status means that much of the work, in any case compatible and complementary with what will be presented here, has already been done (e.g. Kusters 2020, Fuchs 2013), and because I believe that his later and often ignored work can yet shed new light on some otherwise unintelligible aspects of psychotic experience.^[5]While Merleau-Ponty’s work is primarily situated within the phenomenological tradition, it draws on a very wide range of authors, including Gestalt theorists and structuralists. For a thorough … Continue reading

To begin, we need to get a grip on what Merleau-Ponty means by these mysterious-sounding notions. Inevitably risking oversimplification for the sake of brevity, the invisible can be understood as his account of ideality, but an ideality that is “not a set of principles or laws, but rather a system of levels posited in the sensible field by our body in its primal assuming of position before the tasks of the world” (Lingis 1968, li). This immanent perceptual logic, prefigured in the Phenomenology of Perception, is termed the invisible because it is not something that we see, but rather that by which we see and which is moreover not understood dualistically as something wholly apart from the visible; instead, the visible and the invisible are “the obverse and the reverse of one another” (Merleau-Ponty 1968, 152)—they are continuously (and can only exist as) intertwined with one another. The flesh, on the other hand, is the lived body qua visible seer, audible hearer etc.—it expresses the inextricably Janus-faced nature of mindedness, which gives us access to a world only because we ourselves are enmeshed in it (ibid.).^[6] An exceptionally good introduction to the concept of the flesh, though in a different context (namely a phenomenological critique of panpsychism), can be found in Bitbol 2016.

The relevance of these concepts for the phenomenology of psychosis lies, among other reasons, in the fact that they allow us to unify some seemingly paradoxical symptoms as alterations of the same structure. A prime example would be the oft-referenced dual movement of an “objectivization” of thoughts and “subjectivization” of perception: “Mad thoughts, unlike normal thoughts, are ‘visible.’ The perceptible outside world is ‘thought’ or ‘invented’ by the psychotic. That is to say, what normal people regard as a shared outside world is, in the experience of the psychotic, a manifestation of his ‘private thinking’” (Kusters 2020, 80). If we understand this literally, as two distinct changes, whereby thoughts are somehow experienced similarly to external objects, while the latter are assimilated to the status of thoughts, it becomes exceedingly difficult to make sense of why this would be an apt description without referencing a questionable epistemology that understands the mind as populated by sundry “inner entities” or, alternatively, taking this sort of expression so loosely that it loses all meaning (Gipps 2022, 54). Here we would do much better by focusing not on discrete perceptions and thoughts as two distinct classes of putative inner entities, but rather on the flesh as the chiasm where the subject-object structure itself emerges (Merleau-Ponty, 1968, 146). On this reading, it becomes much clearer why a loss of the “natal bond” of perceptual faith—elaborated almost universally as a movement of “withdrawal from the world” characteristic of schizophrenia (ibid., 32–36; Parnas et al. 2005)—would bring with it a change that can be described as an “objectivization” of thought. For, if all thought is essentially expression—drawing on an ideality that does not float free in a self-enclosed conceptual universe, but rather pervades the visible itself—then the loss of ‘solidity’ on part of the perceived world will necessarily have as its reverse side an ossification of expression, one that can aptly be described as objectivization. In other words: it is not that a change to the structure of perception causes a correlative shift in thought, but rather that the very differentiation of the two, as two sides of the same flesh (one accessible only to me, the other implicating other subjects) is compromised.

It is here that the relationship between madness and philosophy becomes more than an arbitrary one of motivation. If philosophical (and especially phenomenological) reflection involves a sort of “loosening” of the intentional threads that bind us to the world of perceived things (Merleau-Ponty 2012, lxxvii), then psychosis consists in their undoing—not, to be sure, a complete rupture that would leave a worldless subject cut off in a putatively private world, but rather a dedifferentiation of the structure that gives rise to both perceiver and perceived.

Similarly, the nature of delusion can be reconnected with the most fundamental structures of our embodied being-in-the-world through the notion of the invisible. What we are dealing with here is not a sphere of ideality completely cut off from embodiment—an arbitrary “logical scheme” that can be replaced by an alternative one—but rather “an ideality that is not alien to the flesh, that gives it its axes, its depth, its dimensions” (Merleau-Ponty 1968, 152). On this view, systems of logical propositions, geometrical relations and the like (which form the content of delusions), are grounded in embodied perception: “‘pure’ ideality already streams forth along the articulations of the aesthesiological body, along the contours of the sensible things” (ibid.). If this is the case, then we should expect full-blown delusions to be preceded by changes in the subject’s experience of these fundamental axes of perception, which is precisely what we find in madness: “In normal life, our minds are deeply rooted in a foundation of common past experiences and shared meanings. In psychosis, this depth is replaced by an ecstatic, blistering, endlessly deep superficiality. There is no longer any normal depth, any normal perspective, either in time or in space. Everything is equally close or far away. The feeling of familiarity in a known space disappears. Without depth, there is no anchoring. Without the difference between foreground and background, there is no foundation” (Kusters 2020, 129). The shift from ‘normal life’ to psychosis is thus couched in perceptual, rather than cognitive, terms. Indeed, even when fully fledged, delusions are described not as logical schemes, but rather as the “earthly, fragmented exterior of sublime inspiration or enchantment” (ibid., 578)—an enchantment that is at the very heart of one’s bond to the world, that is, in the flesh.