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  • Writer's pictureAndrew Field

Thoughts About Philosophy and Psychosis





I've been reading a lot of the work of Immanuel Kant and Richard Rorty, which probably sounds strange, because they are so different. Kant wanted to develop a philosophy that could serve as the foundation for all of culture. Rorty wanted to develop a philosophy that could serve as a foundationless way of viewing science and truth, in which solidarity could replace objectivity as the aim of culture. It's been interesting to read the works of these two men for many reasons, but one is that I was hospitalized three times in succession last year for my schizoaffective disorder, and it's been a pleasure to be able to read again, not through the lens of psychosis, but through the lens of my own autonomy, if I can put it that way, with focus and pleasure. Still, reading them also raised questions for me about the place of mental illness in philosophy, especially in the context of autonomy. What does it mean to lose and then regain one's autonomy? What role does insight play in this experience? What about the concept of "reality"?


I am more familiar with Rorty than Kant, but both seem very insistent on the importance of thinking about autonomy in the context of freedom: how it comes about, what it might mean, how we might think about it, how it is possible. Here is Rorty, for example, in the opening of Contingency, Irony, and Solidarity: "This historicist turn has helped free us, gradually but steadily, from theology and metaphysics - from the temptation to look for an escape from time and chance. It has helped us substitute Freedom for Truth as the goal of thinking and of social progress." (xiii) Our ability to view ourselves historically has enabled us to stop looking for ways to escape time. In so doing, we value freedom more than truth, because truth involves the desire to escape contingency and converge upon something non-human, while freedom involves the desire to proliferate and enlarge our imaginations.


Kant does not need to substitute truth for freedom, because for Kant truth is freedom. Freedom comes from the moral law, from our conscience, which is natural, and which helps us to understand the difference between right and wrong, and therefore arrive at the truth. For Rorty, no such foundation exists. We do not, according to Rorty, have some natural and transcendental faculty like the moral law that puts us closer in touch with what the universe wants. But we do, in our finitude, in free and open encounters, in the interest of solidarity, have the freedom to change our self-image and become the kind of person we wish to be.


How does mental illness figure into these theories? It seems like this humongous caveat. For a person in psychosis cannot embark on a project of self-creation, and a person in psychosis cannot make decisions for themselves in regards to right and wrong. That means that they are not free. The moral law still stands, we could say, but to the psychotic it is opaque. Or, the opportuninty for self-creation still stands, but to the psychotic it is darkened. Why is it opaque, and why is it darkened? Because of anosognosia - the condition in which the patient is unaware of their psychiatric condition. When insight dawns, as it did to me, and the patient realizes that they are sick, the possibility of recovery presents itself. If they do embark on a path of recovery then, and do recover, to whatever extent, then these projects of self-creation and decisions about right and wrong come back to othe person like something forgotten remembered. But how do we talk about this?


When insight dawns, and the patient recognizes they are sick, then a different world begins to slide into view. The world that had been, the world of psychosis, delusion, and hallucination begins to crumble, dissolve, evaporate, and what takes its place is the social public world again. Insight is therefore connected in a very deep way with the public world, with the way a person can see, at least to some extent, how they are seen by a community. This is another way of saying that insight is connected to objectivity. For delusions and hallucinations are not shared, and because they are not shared, a psychotic person cannot fully take his or her place in the community, which is a shared location, until insight dawns to some extent and recovery starts to happen.


Recovery might then be defined as the gradual reclaiming of an individual's autonomy. But that "gradual reclaiming" is such a complicated experience on the inside of the person recovering, that one begins to feel that its expression in words is difficult. For example, when I left the hospital for the third time and began to acclimate into the social world again, I remember that eye contact was very confusing for me, and that I had to relearn body language. When I was psychotic, I was so fastened onto my delusions, that the window of the social public world was closed to me.


But because insight brings back the social and public world, and therefore reinstates reality, I tend to want to equate reality with solidarity, with Rorty. Which is to say, experientially, I did not "lose sight of the moral law, only to reclaim it," as this formulation does not seem like a good way of phrasing it. A person who is in recovery, it seems to me, needs the concept of reality as the shared public world, because without that reality, there is no community to see and be seen by. Solidarity, along with medication, saved my life. If our concept of reality revolves around Truth or God, this seems more dangerous for a person recovering from psychosis, although perhaps that's a matter of subjectivity, and not connected to what Kant intended.

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