Illness as Privation Rather than Liberation

I made this image when I was sick with psychosis, in 2022.

In a chapter on Heidegger from The Oxford Handbook of Phenomenological Psychiatry, we learn that Heidegger thought "that illness should be understood as a specific kind of negation, which he calls 'privation'". (32-33) "Each illness," Heidegger writes in Zollikon Seminars, "is a loss of freedom, a constriction of the possibility for living." This is an important point, because often we think psychosis involves a creative freedom, or liberation, or some such thing. I don't know enough about this, but think about Deleuze and Guattari, and their emphasis on schizophrenia as a state of being that exists outside of the state. This is an idealization, and a kind of unwillingness to see the privative aspect of the illness, for better or worse. What would it mean, then, if we were to contextualize and define psychosis as a form of privation? Are we detracting from the significance of the ailment? Are we putting it in a negative light, and therefore casting aspersions on people struggling with psychosis? What did Heidegger mean when he described psychosis as a form of privation?

I suppose we could say, to start with, that when I was psychotic, I was not entirely there. What does this mean? Psychosis took away my sense of my own history. In a very real way, it took away my self-sense. We each have a kind of self-sense, which is hard to get at or describe, but which I associate with the "background" described by Heidegger and Wittgenstein, as well as the interpersonal minimal self described by Matthew Ratcliffe. When I was psychotic, my self-sense changed - my self-image changed, though I was not aware of this happening, because I did not have insight into the alterations in my psyche that were occurring. But when I say that psychosis occluded or eclipsed or erased (for the moment) my historical self, my narrative self, my autobiographical self, in a way what I'm suggesting is that psychosis introduced into my picture of the world an impoverished sense of my own self, and therefore an impoverished sense of others and the world. This is a form of privation.

What does an impoverished sense of self look like, feel like? Perhaps we can describe it with words ordinarily associated with psychosis: a loss of contact with reality. Life is normative; everything we do takes place in a culture; language speaks us, or we speak it, but either way we are constantly acting on the basis of norms that seem to have principles or rules, although we could never make these principles or rules explicit, for if we did they would no longer function the way they do. That's kind of like reality. But the norms of madness, which are a form of impoverishment, are different, which is to say, they might involve strange obsessions with morality or religion, extreme preoccupations that stretch what we customarily think of as obsessions, religious or otherwise. This is hard to theorize. Does the background change when we are mad? I'm tempted to say it does not change. Then what happens?

Perhaps madness is an impoverished variation of and on the background. For while it takes away our history, and gives us a world that is not reality - hearing messages behind words, seeing and hearing things that are not there, convinced we are famous, or world-historical, or something like that - I think, more generally speaking, that madness disrupts our ability to experience truth, if we define truth with Heidegger as unconcealment. For if truth is something that is unconcealed, then the implication is that human being is capable of being in touch with what is torn from unconcealment, that it is part of our heritage as human beings to have an understanding of being, an understanding of the social practices in the background of our lives that we use to cope with the world. Yet it is this very understanding of being, this background understanding, that psychosis wreaks havoc with. Heidegger writes, in this vein, "there is present in all understanding an insight of Dasein into itself." This is not too far removed from Hegel stating that "Consciousness, however, is explicitly the Notion of itself." Both quotes point to the fact that any understanding of something is simultaneously an understanding of self. But what happens when we are psychotic? For we are not understanding anything. We are misunderstanding everything, at least from a third- and second-person point of view.

Also from 2022 when I was sick.

This is why and when and how privation enters into the picture. For in psychosis, the sense of self is distorted. One believes one has powers of telepathy, or other ontologically impossible things; one thinks one has control of the weather with their mind; one is in control of the fate of the world. These are examples of what Ratcliffe describes as disruptions in the modal structures of our intentionality. We believe what we are imagining; we perceive what we think. These, when insight is lacking, are not just strange experiences entertained by an otherwise okay mind; these are total experiences involving a privation in and of the self. By privation I do not mean to say, of course, that psychosis is a moral failing - quite the opposite. Psychosis happens when an impoverished vision and version of the world descends into Dasein's purview. It happens involuntarily, and is not chosen by Dasein. It happens, can happen, does happen. When it does, as naturally as breathing, Dasein is caught in a state of privation. That is what psychosis, to my mind, is.

Psychosis therefore inhibits our ability to remember who we are. It is not an enhancement - though it may feel so - but a diminishment, and it happens in a way that robs us of our agency, rather that bestowing upon us the agency we imagine we have when we are psychotic. If reason, as Hegel suggests, is "purposive activity," then when we are psychotic we experience a kind of dent in our reason, a gumming of the works, a misfiring, something in our reason that is unable to see what is actually happening. In this sense, psychosis is dogmatic and, at least in that sense, unphilosophical. "All content," Hegel writes, "is its own reflection into itself." But this does not mean solipsism, but rather insight into Dasein, into human being.

Because psychosis involves a state of privation, it also in a strange way involves a state of certainty. By certainty I do not mean an understanding of being, but rather I suppose a misunderstanding of being, for such a thing is possible in madness, even if it is premised on the possibility of an understanding. Certainty is like a form of staring rather than looking - it is incorrigible, and therefore leads to an inability to perceive or judge what is happening around one, because one is holding on so desperately or passionately or dogmatically to the world that psychosis has given, created, formed; or, better put, psychosis is holding on to one. One wonders, then, why we hold onto that world so tenaciously, with such certainty, when every single thing in the world militates against us holding that view, as every single thing in the world is not, as it were, cast in the light of psychosis. But we have to remember that psychosis is a total state, and so to tell a psychotic that what they are experiencing is not real is to tell them essentially to doubt everything their senses are telling them. And this itself sounds dogmatic and foolish to the psychotic.

I suppose another way of talking about this state of certainty in psychosis, versus a state of being fallible, corrigible, is that someone who is psychotic lives in a world that is caught somewhere between commensurability and incommensurability with the public social world. We are caught in this state because the privation we experience feels like a fullness, a fullness that suggests we are in on something, we have discovered something important that needs to be shared, or withheld, for significant reasons. This fullness is not real, but it feels real and seems real and is experienced as real. This fullness, which is actually privation, is the incommensurable aspect of psychosis. It tears us away from the public social world, to, as it were, gallop after windmills. But psychosis is commensurable because it happens in the shared social world, even as we are busy watching the shadows dance on the wall and cannot tear our staring away to look at the world bathed in plain ordinary light.

This fullness, which is privation, is in some sense the feeling that we are not alone - the ability to communicate telepathically, for example - when in reality we are extremely alone, for we are shunning the public shared world, and are seeing things that only we can see. Like the privation of this fullness, this sense of being inhabited, and therefore not alone, is a paradox of madness, since what we are experiencing is the antithesis of what is actually occurring, as the very thing that makes us feel not alone is the thing isolating us from others. There is thus a strange dialectic happening in madness between aloneness and communion, for a mad person, a person in psychosis, might feel deeply in communion with their voices while actually being utterly alone in regards to the public shared world; or conversely, feel deeply alone with others (others not being able to see or hear what they are seeing and hearing) while in fact having the possibility, though closed off at that point, for a meaningful social experience, even communion.

In this sense, there are different meanings of aloneness that surface when we are psychotic and in recovery, and these meanings intertwine in such a way as to hopefully suggest some of the contours of privation I am trying to tease out. Three of them are:

1. The aloneness that comes with being healthy, when we recognize that though the social world is primary, we are in many ways alone with our thoughts, and alone in our dying, as a possibility that stands for the individual Dasein as what Heidegger calls "our ownmost possibility." This seems to be a state of actual fullness.

2. The aloneness that comes with being psychotic, when we are so mired in psychosis that we cannot leave the solipsism engendered by our madness to reach out and communicate with another person. This is a state of privation.

3. The paradoxical aloneness that comes when we feel we are communing with our voices, but in reality are starving for social contact though, in the state we are in, such contact is not feasible or sustainable. This is a state of privation.

But how do we trade #2 or #3 for #1? How do we move from privation to actual fullness? For it seems fair to say that, when we are recovering from psychosis, we are in a way emerging from a sleep, we are shifting from one way of being to another, from one form of life to another, and this means somehow coming to accept that one is ill, or that one lives with an illness, which in turn means that one needs to face in some sense the trauma that the illness has brought on. This is extremely hard to do, and in some ways I don't even know if an understanding of the trauma with closure is possible. Trauma seems to be something we live with everyday, which surfaces now and then, and which our lives in a certain capacity seem to constantly be commenting on, even when (especially when?) we are not aware of it.

Works Cited

Hegel, G. W. F. Phenomenology of Spirit. Translated by A. V. Miller, foreword by J. N. Findlay, Oxford University Press, 1977.

Heidegger, Martin. Being and Time. Translated by John Macquarrie and Edward Robinson, Harper Perennial Modern Thought, 2008.

Ratcliffe, Matthew. Real Hallucinations: Psychiatric Illness, Intentionality, and the Interpersonal World. MIT Press, 2017.

Stanghellini, Giovanni, et al., editors. The Oxford Handbook of Phenomenological Psychopathology. Oxford University Press, 2019.

Wittgenstein, Ludwig. Ludwig Wittgenstein: Major Works. Edited by G. H. von Wright and Heikki Nyman, translated by C. K. Ogden, G. E. M. Anscombe, and others, Harper Perennial Modern Thought, 2009.

Wittgenstein, Ludwig. Philosophical Investigations. Translated by G. E. M. Anscombe, P. M. S. Hacker, and Joachim Schulte, 4th ed., Wiley-Blackwell, 2009.