Heidegger, Ontology, and the Psychotic World

1.

Lately I've been reading books by and about Heidegger, and I'm wondering what are some implications of Heidegger's work for thinking helpfully about mental illness. There has been some fascinating work written about Heidegger's notion of the "ontological difference" in the context of schizophrenia, by Louis Sass, as well as important work by Clara Humpston about "ontologically impossible experiences." And we can notice straightaway that both Sass and Humpston, in their different ways, are interested in exploring the relationships between ontology and mental illness. Why is ontology useful for thinking about mental illness?

Oftentimes people define ontology as the study or science of being, yet this sounds deeply metaphysical, when in fact Heidegger intended being to be understood in a different way. Being is the background of our social practices, and has nothing to do with the eternal. Think about stepping into an elevator. You know how to stand, where to stand. You do not read a primer on elevator behavior. You just know. If we extrapolate this example to include other, broader regions of experience, anything, from looking at art to talking to a loved one to taking a test to (Heidegger's famous example) hammering a nail, we realize that there is nothing of our existence that is untouched by being, if we mean by being the background of our social practices, the kind of how by which we navigate the world. This backdrop of social practices is not the unconscious, though I guess it could include the unconscious. It is a pre-theoretical, pre-conceptual, maybe non-conceptual way that we understand the world. It allows understanding itself to happen.

But what is understanding? When someone is psychotic, are they understanding the world? Are they understanding a different world? Are they understanding the same world differently? What is the ontological difference, and what does it have to do with mental illness? What is the relationship between mental illness and Heidegger's concept of the world, or language?

Let's start with the concept of "world." I think that we can say that just as there is the theater world, the business world, the academic world - worlds with different equipment, different roles and different goals, to use terms from Hubert Dreyfus's work - there is also the psychotic world. But this psychotic world is peculiar, and it is different in a significant sense from worlds like theater, business, and academia. How? The theater, business, and academic worlds occur in the shared social world. They speak different languages in some sense, but in another sense they speak the same language, because they are absorbedly coping with and in the same shared social world. But psychosis, I want to argue, does not occur within the same shared social world; perhaps this is what makes it so unique. For the language that a psychotic speaks carries a different repertoire of references. And what the language of a psychotic refers to is not the shared social world, but a modification of it.

What is the world? The world, Heidegger argued, is the totality of references that make it up. References mean relationships, connections. This coffee cup to my right extends into infinite references, to places to objects to colors to shapes to time and so on. It is in contexts-within-contexts, my apartment within Royal Oak, within the history of coffee, within the history of cup design, within the notion of Heidegger's equipment, within the addiction to caffeine, etc. References spread quickly, like fire, to include everything and anything, and there is nothing in the world that is not a reference to something else. The world equals, then, the totality of references.

When you are psychotic, the web of references that connects you to the social world is severed. From a third-person perspective, you are part of the world, but are behaving strangely. From a first-person perspective, you are part of the world, but in another sense - the sense of Humpston's ontologically impossible expereinces - you are not part of the world, because you are telepathic, you are hearing voices, you are seeing things, and these experiences, which are impossible but experienced, lead the psychotic to think that they are somehow touching the secret of the world or standing outside it, both of which are of course impossible. When you are psychotic, you are authentically isolated, because no one else can see what you see, and what you see is meaningful to you, is in a very real sense who you are. If we are, as Heidegger would probably argue, our understanding of the world, then a psychotic is their psychosis. This is why psychosis with anosognosia - the lack of insight - is total.

What is the phenomenology, by which I basically mean the ontology, of psychosis? Three of the most important are delusions, hallucinations, and lack of insight, so I want to spend the rest of this essay going into each of these, and thinking about them through the work of Heidegger.

2. 
   

If we are going to say that a psychotic understands the world differently, then we can also say that the horizon upon which the psychotic projects their self - the horizon which enables the psychotic to engage in acts of psychotic understanding - is a different sort of horizon. What do I mean by this? A psychotic experiences time, space, self, and others differently. How?

One way to approach this topic is through the existence of the everyday. It seems like such a great context for thinking about psychosis, because psychosis burns through the everyday and makes it into something altered. The everyday is the texture of our lives, the daily rituals, going to work, seeing friends and family, doing what we do at work, leaving home, returning home, drinking coffee, eating meals, celebrating holidays, relaxing on the weekend, the everyday in all of its saving power. When we are psychotic, we discard the everyday somehow, we enter onto a plain where the everyday is not longer available or occurrent or existent. What does this mean?

I remember riding my bike for hours and hours, without any awareness of time. I no longer checked my mail, I no longer ate regular meals, I was moving from color to color somehow, idea to idea, and was without grounding of any kind. What I responded to was not the shared social world, even though and while the shared social world undergirded the world in which I moved, an autotelic world; what I responded to were the contours of my psychosis, which is to say, delusions and hallucinations, which is then to say the eradication of the everyday, and its replacement with the unreal perceived as the real.

A delusion is a false belief that someone holds against incontrovertible evidence. My delusion, strange as this sounds, was that I was a kind of shaman, placed in the world to heal minds through various forms of conflict and performance. But it is one thing to read these words, and find analogies, however tenuous, with actual people and actual practices and actual beliefs; it is another thing to step inside the web of notions that informed these delusions, and understand the delusions from the inside. So first of all, we have to take into account that my delusions were corroborated by my hallucinations. For I was hallucinating colors - seeing colors in my mind's eye, vividly - and these colors seemed to me to be religious in nature. One thing we forget about psychosis is that not only is the content of one's being strange, but the interpretation of this content is strange. To see colors is one thing, but to interpret them as religious in nature is another. When I saw colors, this strengthened my delusion that I was a shaman. When I heard voices, this strengthened my delusions that I was telepathic. You can see how this could quickly get out of control.

Sass argued that schizophrenia entails an "ontological difference." And if ontology means the background of social practices by and through which we navigate the world, then there is no doubt in my mind that when I was psychotic, I was experiencing an ontological difference. But it was a difference that was painful, it was a difference that was traumatic. For it was not like I was merely watching a television show that was the world, though this was part of my psychosis; it was that this experience of the television show jarred jaggedly with the shared social world and the everyday contexts that this world is often situated in. This traumatic and painful experience happened to a large extent because my constellation of references had changed. And when my constellation of references changed, I forgot who I was and became someone different.

The meaning of beings is being, we could say, meaning that we can only understand beings, beings only become intelligible to us, through being. The plural beings can be anything, from person to animal to plant to thing, but these only become intelligible through the backdrop of social practices, being. But what is the meaning of being? For Heidegger, the meaning of being is care, and because the meaning of being is care, the meaning of being is Temporality. What does this mean, and what does it have to do with mental illness?

When I was psychotic, the world - the shared social world - became unintellgible. What became intelligible was the psychotic world, meaning my delusions, my hallucinations, and my lack of insight (meaning my interpretation of my psychosis, which in this case contextualized it as religious). Heidegger argued that the world as we know it - the totality of references - is only intelligible because of concern or care, and that concern or care are only intelligible because of time. And this makes sense, for to care about something is to expect, to retain, and to make present, which is to say, to be formed out of time. Dasein, Heidegger's word for human being, is made out of time. But for a psychotic who exists in the psychotic world, time is neither clock time nor absorbed time. It is something different, something hard to describe, disembodied, depersonalized. Space too is not the space of everyday concern, but itself becomes charged with the contours of one's hallucinations. What lights up, then, in the psychotic world is not people, or places, or things, but people places and things transposed into a psychotic light, and therefore a psychotic understanding.

One of my favorite concepts in Heidegger, which occurs in his later work, is the "clearing." The clearing comes to replace being, in a way, as the most important concept in the work, arguably. What is the clearing? The clearing is the horizon that makes language, being, and understanding possible. It is an opening, a lightening, which makes possible the possible. We could say that a clearing happens in the shared social world when we understand something, or that our understanding something is possible because of the clearing. But in the psychotic world, the clearing is different, even if the original clearing has to happen for the psychotic clearing to occur. And I mean by this that psychosis understands the world differently, because it is an enclosed world, as opposed to an open world, and it is an enclosed world that believes it is open. This is why psychosis is dangerous, and should not be romanticized, though it is, even in works by Foucault or Deleuze and Guattari. The ontological difference is a very real thing - the psychotic world is an actual world that can be experienced - but what makes it unique is its departure from both the everyday and the shared social world.