2011, Number 6
Fenomenología de la intersubjetividad en la enfermedad bipolar y en la esquizofrenia
Dörr ZO
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Language: Spanish
References: 26
Page: 507-515
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ABSTRACT
I. Introduction and clinical observationsOne of the central features of the group of diseases we call schizophrenia is the alteration at the level of interpersonal relationships. Autism, considered by Bleuler (1911) as one of the primary symptoms of the disease, and contact difficulty, described by Minkowski (1927), are two examples of how far this disturbance reaches. But other symptoms of schizophrenia can also be seen from the same perspective. Thus, in the paranoid syndrome the other becomes so powerful that he can persecute, harass and invade the patient’s intimacy. Auditory hallucinations can also be conceived of as a peculiar disturbance of the relationship with an anonymous other. As we showed in a previous work, something similar occurs in instances of coenesthetic schizophrenia. Thus, one patient, suffering from this form of the disease, said in his diary, «My failure is to love very much myself. I have not found yet the way toward the you.» And later on he writes: «The world arrives directly to me, there is no distance between the world and me. And that is valid both for persons and for things… It can even happen that in the worst states I consider myself for moments like the other, whom I am looking at».
Walter von Baeyer (1955) defined the characteristics of this deformed interpersonal encounter of schizophrenics, although based on paranoid patients: lack of reciprocity, anonymization and mediatization. In the delusion of being loved, for example, the patient cannot defend himself from loving voices or from coenesthesic hallucinations related to the sexual sphere. On the other hand, that invading you, who in the beginning has a name, gradually loses his individuality and becomes collective. Finally, contact with the hallucinated other is mediated through devices such as radios or television sets.
In the case of depression, even though the complaints of the patients predominantly refer to the feeling of oneself and to bodily changes, we also observe a deep alteration of the interpersonal sphere. Two different forms of depression can be distinguished: delusional and not delusional. In the first form, the symptomatology is commanded by delusion (of guilt, ruin or disease) and in the second, by corporal symptoms, the experience of «not being able to» and the alteration of biological rhythms. And additionally, from the perspective of the encounter, both forms of depression have something in common: the progressive disinterestedness in the other and its replacement by the prevailing subject: the body in one case, delusion in the other.
In mania, what first draws attention is euphoria, hyperactivity, flight of ideas and insomnia; however, a deep alteration of interpersonality is also apparent. Thus, it is common to observe that these patients treat the other with excessive confidence and a loss of social distance up to the extreme of disrespectfulness.
II. «Apresentation», immanent temporality and intentionality in the constitution of Intersubjectivity according to Husserl
How precisely are these three elements of intersubjectivity - apresentation, temporality and intentionality- altered in manic, depressive and schizophrenic psychoses? Each section in the report that follows will begin with an introduction explaining Husserl’s understanding of these concepts. As the theory of «apresentation» is more complex and less known, a more detailed exposition of this concept will be offered.
III. Intersubjectivity and manic psychosis
Let us recall Binswanger‘s example of a manic patient who has abandoned the clinic, goes into a church where a religious service is being held, and interrupts the organist’s playing to ask him for lessons. For the layman, the attitude of the patient appears to be inappropriate and incomprehensible. A psychiatrist may speak here of facilitation and of loss of natural inhibitions. But neither of these two interpretations accounts for what is really occurring. Somatic medicine has a theory of the organism as a framework within which it can «measure» deviations with respect to the norm; psychiatry is not able to do this because its basic science is not sufficiently developed. In our opinion, that place must be occupied, following Binswanger, by phenomenology of intentional consciousness.
The organist is present for himself as the flowing of conscious contents; the sensations coming from his body; and among others the ones of his fingers playing the organ. These presentations are accompanied by the «apresentation» that he is an organist who has been hired to play in the religious service and he shares that same «apresentation» with the community assisting the church. The patient, on the contrary, does not share this «apresentation». For her the organist is certainly present, playing, but she is not capable of «apresenting» that it is a concert in the framework of a religious service. From Husserl’s theory, explained above, it is inferred that if one fails in the constitution of the alter Ego, the constitution of oneself -of one’s own Ego- also fails. Binswanger’s patient is unable to «apresentitatively» understand the sense of the organist (in his context), because she can not experience herself «apresentatively» as an Ego.
IV. Intersubjectivity and depressive psychosis
The flowing of my internal life is, certainly, inseparable from originary or primordial temporality, with respect to which objective time or the time of the clock is only a derivate. And that originary temporality is given as the permanent interspersing of three instances, called by Husserl retentio (past), protentio (future) and presentatio (present). To understand the important role played by these temporal instances both in the constitution of one’s own I (Ego) and of the other (alter Ego) we need only to think that every person who is talking at a given moment (presentation) could not say what he is saying without knowing exactly what he already said, that is, without retaining the past (retentio) and what he is going to say, in other words, without anticipating the future (protentio). And this is not only valid in the case of a speech or a lecture, but in any conversation, however simple it may be.
Now, in psychotic or delusional depression the alteration of interpersonality is not found in the failure of the «apresentation», as in mania, because we know how attached to the norms and respectful personalities prone to depression are (Tellenbach, 1961, 1983; Krauss 1977; von Zerssen, 1982), so they would never ignore the sense of the situational context in the relationship with another. Hence, what fails in the relationship of the depressive with the other? First, it is the very confinement in the body and it’s inaccessibility. But there are two other very characteristic phenomena which also could be interpreted from the perspective of intersubjectivity: self-reproaches and depressive delusional ideas. When a depressive patient reproaches himself, for example, «if I had not sold the house, then I would have not be ruined…», what he is doing is putting in the past, immovable by definition, some empty possibilities. In other words, the retentio (the past) is invaded by the protentio (the future), with which one does not arrive at any actualization in the presentatio (the present). And in depressive delusions, situations that could be possible in the future, for example, becoming guilty of something, financially ruined, or seriously ill, are lived as if they had already happened, that is, as past: protentio or anticipation is invaded by retentio (Binswanger, 1960).
V. Intersubjectivity and schizophrenia
The most fundamental concept of phenomenology is without a doubt that of intentionality. In its more generic meaning intentionality points to the fact that every psychic phenomenon is essentially characterized by being referred to something other than itself. Expressed in the words of Husserl (1962) himself, «in the simple acts of perceiving we are directed to the perceived things, in remembering to the remembered, in thinking to thoughts, in evaluating to values, in desiring to objectives and perspectives…». Through intentionality and by means of the processes of perception/aperception or of presentation/apresentation, the Self constitutes the object in its totality and with it, the common world or koinos kosmos. In schizophrenia, on the contrary, there would be a weakening of intentionality, with the following consequences:
1. Objects acquire strange aspects and multiple meanings arise from them. Example: delusional perception and delusional mood.
2. The weakening of the intentional arc leads to classic loosening of associations.
3. On occasions, what Fuchs (2005) has recently described as «reversal of intentionality» can arise. In schizophrenia the harmonic exchange of intentionalities and perspectives between the Self and the other is reversed. Thus, the other necessarily becomes the persecutor, because the intentionality of the patient is so weakened that he is not able to counteract the force of his intentionality, so the field of intersubjectivity remains under the total domination by the other.
Finally, such a weakening of intentionality enables us to explain the typical «way of life» of the schizophrenic patient which is sad, lonely and unproductive. Persons with schizophrenia are not able to go another way because the motor of life itself, which is intentionality, has failed in its constitution of the other and of the common and shared world.
It has been the work of phenomenology to discover, in the complex architecture of the human being, the place of the difficulties which lie at the core of the symptoms and syndromes we face in daily clinical practice. It will be work of neurobiology to determine the somatic mechanisms underlying these fundamental difficulties and of psychopharmacology to find medications which can help to overcome them.
REFERENCES