Psychosis and the Common World

Psychosis is something that human beings do, something that human beings experience. It is therefore a living possibility of and for human beings. This is an important thing to remember, because we can say that it is a possibility for human beings without invoking shame or stigma. That is to say, madness as we know it is a human thing, like art, science, or religion, and any attempt at describing madness, explaining it or understanding it, has to start with human being, because that’s the only place we can start. This then suggests that a reliance on other human beings, in some capacity, is ultimately the only way we are going to heal ourselves as we recover from mental illness, since what we have lost when we were ill is the social world, the public world. There is a description by Richard Rorty that gets at this dynamic. Rorty writes,

There are two principal ways in which reflective human beings try, by placing their lives in a larger context, to give sense to their lives. The first is by telling the story of their contribution to a community. The community may be the actual historical one in which they live, or another actual one, distant in time or place, or a quite imaginary one, consisting perhaps of a dozen heroes and heroines selected from history or fiction or both. The second way is to describe themselves as standing in immediate relation to a non-human reality. This relation is immediate in the sense that it does not derive from a relation between such a reality and their tribe, or their nation, or their imagined band of comrades,. I shall say that stories of the former kind exemplify the desire for solidarity, and that stories of the latter kind exemplify the desire for objectivity. (227)

What I want to suggest is that psychosis involves a time during which a human being is forced to decide, for whatever reason, to replace solidarity with a form of objectivity, and this objectivity is what Wouter Kusters refers to in his A Philosophy of Madness as “Insight.” We can juxtapose Insight here with insight. The former refers to delusional thinking, where chance seems to be abolished, and where every single thing in the universe must cohere together in some kind of Truth, for which the embattled psychotic fights and believes. The latter is the ability to differentiate between healthy and pathological imagination, as well as the real and the unreal. Kusters’ “Insight" is a form of insanity that I was privy to. When I was ill, I was under the impression that I could speak to God, who was a kind of author with terrifying powers of telepathy. I could hear His thoughts, and He could hear mine. We talked with each other in this way - through verbal hallucinations that I interpreted as telepathy - and he showed me things, often online, where I would experience messages behind words and images, a strange combination of thought insertion, delusions of reference, and verbal hallucinations. There was a Truth, an Insight, underlying all experiences, and this was something apart from community, and sometimes opposed to community.

If objectivity involves Insight, solidarity involves insight. And insight happens, is possible, because we are part of the public world. Hubert Dreyfus speaks to this relationship between solidarity and objectivity in the context of the public world when he writes,

There is no such thing as my world, if this is taken as some private sphere of experience and meaning, which is self-sufficient and intelligible in itself, and so more fundamental than the shared public world and its local modes. Both Husserl and Sartre follow Descartes in beginning with my world and then trying to account for how an isolated subject can give meaning to other minds and to the shared intersubjective world.   Heidegger, on the contrary, thinks that it belongs to the very idea of world that it be shared, so the world is always prior to my world. (90)

Psychosis is essentially the attempt to substitute my world for the world, and therefore, as Louis Sass argues, a form of solipsism. But in substituting my world for the world, both the world and my world become eclipsed, effaced. By this I mean that psychosis is an impoverished world, a world of privation. Even when it seems to give one a richer world, because of mania, that world is still impoverished because it is cut off from the shared public world. As Matthew Ratcliffe writes, “a breakdown of the modal structure of intentionality” - intentionality referring here to processes like imagining, feeling, believing, thinking, and perceiving - “would inevitably involve changes in the structure of interpersonal experience.” That means that when one is psychotic, and therefore cut off from the public world, they are also cut off from their own interpersonal, and therefore historical self. When I was ill, aspects of my personality that were somewhat constant over the course of my life - my Jewishness, my role in my family, my friendships, my occupation - all of this dissolved, was lost. I essentially forgot who I was. And in the place of who I was stood a kind of impoverished world made out of pathological imagination.

This impoverished world of madness as the search for objectivity can be interpreted as a form of Cartesianism, the strict adherence to the notion that there is an inside versus an outside, rather than what Heidegger calls “being-in-the-world.” As Richard Polt writes about “the most basic Cartesian assumption,” “There is a special sphere in which human existence takes place, which we may call the mind, the subject, consciousness, the ego or the self. Outside this ‘subjective’ sphere, there are (or may be) ‘external objects.’ These material, physical objects are alien to us; they have no consciousness or mind, they are just brute things situated in measurable space.” (55) In this sense, Cartesianism, like madness, is a form of staring, as well as a form of solipsistic skepticism. When you are mad, the world is the self, and because the public world drops away, madness then engenders skeptical questions about the reality of the world. Yet of course the very premise from which the question springs is faulty, as the public world is not being taken into account for the sake of the questioning.

It is this basic sense of impoverishment that can be so confusing, because if being means the set of background social practices that allow us to cope with the world, then madness erodes our being, as this background does not remain intact somehow, but shatters or splinters or becomes warped. We could say that madness is a modification of being, meaning that madness can only happen because being is a phenomenon, but that does not help to explain how madness appears intuitive, appears like a deeply intimate aspect of our ontology, when it is in fact not that at all. In madness, we cannot rely on our basic sense of coping with and in the world, our basic barometer for thinking, evaluating, perceiving, judging. For in madness our very intentionality becomes confused. For example, in speaking about verbal hallucinations, Matthew Ratcliffe writes, “The content of an experience may continue to resemble that of a thought, but it somehow affects one in a way more like that of a perception.” (63) When these kind of experiences of crossed signals happens, our functioning becomes impaired, and we perceive what we are thinking, as in hallucinations, or imagine what we are believing, as in delusions.

If this disruption in intentionality is happening, it is no wonder that someone experiencing psychosis feels they have stumbled upon some great secret, that they are in touch with a non-human source, or that the public world is not real, is a manifestation of their self, as what the psychotic experiences serves to corroborate these intuitions. By disrupting the modal structure of intentionality, psychosis wreaks havoc on a person’s intuition. Psychotic thoughts come to one like regular thoughts, and feel as natural as breathing. This is why psychosis can be so insidious. It is also why psychosis is total, meaning that when one is psychotic, we are not ourselves plus psychotic thoughts, but rather we are psychosis, and this can help explain why a psychotic person, from a third-person perspective, can feel so frightening, because when we are no longer functioning in the shared public world, in a sense we are no longer reliable, since we are operating from a different set of premises, a set of premises validated by our experience, even when the public world is constantly rising up to question these premises, even when our experience is impoverished.

This is then to say that social anxiety - in a sense, the need for solidarity when it is no longer occurring - plays an enormous role in psychosis, as Ratcliffe argues in his important Real Hallucinations: Psychiatric Illness, Intentionality, and the Interpersonal World. Ratcliffe writes, “Social anxiety is predictive of schizophrenia diagnoses, and it has been proposed that the frequent presence of depression and anxiety before the onset of psychotic symptoms points to a casual role for affective disturbances. Moreover, there is evidence to suggest that anxiety, more so than depression, is specifically associated with ‘positive symptoms’ such as verbal hallucinations.” (74) When I was becoming ill, during my first episode of psychosis in my mid-to-late twenties, the first symptoms of mental illness I encountered was social anxiety. I remember traveling to England as an exchange student and for six months being mostly unable to leave my room. It was because I was terrified of other people, terrified of how I would seem unable to normally socialize like others. Sometimes, when I did leave my room to walk to the London Underground, I would feel as if my mind were changing somehow, in ways I did not understand. What developed as psychosis seemed to start as social anxiety, or at least as some kind of social disturbance. This is to say, returning to the Rorty quote, that madness leads one to believe that objectivity is more important than solidarity, because the symptoms we experience, shorn of insight, suggest that solidarity is a figment of our imagination, and that we are rather in possession of a great Insight, a form of objectivity.

If madness is a disruption in the modal structure of intentionality, and therefore a disruption in the interpersonal self, the self capable of experiencing solidarity with other people, then we also have to become wary of accounts of psychosis that tend to romanticize it, such as works by Deleuze and Guitari, R.D. Laing, or Justin Garson. For when we romanticize psychosis, we are confusing the public world, and the conformity that goes with its normativity, with a notion of conformism. We then place psychosis opposite conformism, as if to say “here is something that is not conforming, and therefore good.” But this betrays a deep misunderstanding of what psychosis and the public world are or entail. Simply because, sometimes the norms of the public world do lead to a toxic form of conformity, does not necessarily mean that the public world itself is toxic through and through, and therefore in need of madness as a kind of purifying agent. This is a romanticization of madness, and a lack of understanding regarding the public world. Dreyfus discusses this dynamic when he writes,

For both Heidegger and Wittgenstein, then, the source of the intelligibility of the world is the average public practices through which alone there can be any understanding at all. What is shared is not a conceptual scheme, i.e., not a belief system that is always implicit and arbitrary. That is just the Sartrean version of the same mistake. What we share is    simply our average comportment. Once a practice has been explained by appealing to what one does, no more basic explanation is possible. As Wittgenstein puts it in On Certainty: “Giving grounds [must] come to an end sometime. But the end is not an ungrounded presupposition: it is an ungrounded way of acting.” (155)

Someone who is psychotic, we can say, desires “the philosophical ideal of total clarity and ultimate intelligibility.” (Dreyfus, 155) This is why they are psychotic. It is Rorty’s desire for objectivity writ large, essentially the desire to find something that has an intrinsic nature. As Rorty writes, “The question of whether truth or rationality has an intrinsic nature, or whether we ought to have a positive theory about either topic, is just the question of whether our self-description ought to be constructed around a relation to human nature or around a relation to a particular collection of human beings, whether we should desire objectivity or solidarity.” Madness, though involuntary, is the idea that there is something intrinsic to human nature that the psychotic needs to find and express at all costs. Psychosis then, despite arguments to the contrary, is not like mysticism, since authentic mysticism involves a deep give and take with both a tradition and a community, and this give and take is absent in psychosis.

Works Cited

Dreyfus, Hubert L. Being-in-the-World: A Commentary on Heidegger's Being and Time, Division I. MIT Press, 1991.

Kusters, Wouter. A Philosophy of Madness: The Experience of Psychotic Thinking. Translated by Nancy Forest-Flier, MIT Press, 2020.

Polt, Richard. Heidegger: An Introduction. Cornell University Press, 1999.

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

Rorty, Richard. The Rorty Reader. Edited by Christopher J. Voparil and Richard J. Bernstein, Wiley-Blackwell, 2010.

Sass, Louis A. Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought. Harvard University Press, 1992.