Is Mental Illness a Form of Violence Against the Self? Notes on Ego Disintegration in Schizophrenia

It is important to note here our decision to use “mental illness” instead of “mental disease”. Even if, at a first glance, the two expressions seem to be interchangeable, matters are actually more nuanced. In the literature of medicine, there is a tendency to take “illness” as the lived experience of a subject, while “disease” is related to the objective body. Given this, our paper should surely use “mental illness” throughout, since we are not talking about, for example, some kind of brain lesion causing certain types of symptoms. S. K. Toombs, a central figure in the phenomenology of medicine, goes into the illness/disease distinction and traces its origin to Sartre, Being and Nothingness, where Sartre distinguishes four levels: pre-reflective sensory experiencing (e.g., pain); the psychic object, “suffered illness,” when one reflects upon the pain; a further reflective level where one apprehends this as “disease” by adopting the perspective of the other and seeing my body as an organism; and a fourth level of the “disease state,” which is how the physician conceptually characterizes it (Toombs 1992a: 31). On a closer examination of Sartre’s distinctions, we find out that the specific contrast in English between “illness” and “disease” comes about through the Hazel Barnes translation of Sartre's mal/maladie distinction. Sartre shows that illness (mal) is what happens when, through reflection, pain becomes a psychic object (Sartre 1956: 335ff), while disease (maladie) is what “illness” as suffered, through the body-of-others, becomes. D. Leder, another important figure in the phenomenology of medicine, considers that “The lived experience of illness came to be seen as epephenomenal; the real disease unfolded in the material world of res extensa and could best be exposed by the pathologist’s knife” (Leder 1992: 21). The same idea is highlighted by Toombs when says that the “The experience of illness means much more to the person who is ill than simply a collection of physical signs which define a particular disease” (Toombs 1992b: 127). However, P. Sundström takes a more nuanced look at the received illness/disease distinction and agrees that it makes sense but warns against absolutizing the distinction so that the patient’s focus on subjective experience refers to “illness” while physician’s focus on objective reality refers to “disease”. For more on this distinction, see Sundström (2001).

This concept stems from the psychoanalytic theory of instinct and states that the object of an instinct is the person through whom the instinctual desire is fulfilled.

In this regard, see K. Jaspers who published an article outlining the role of Husserlian phenomenology for psychiatry (Jaspers 1912). Some years later, E. Minkowski wrote about the relevance that philosophical phenomenology has for the clinical practice (Minkowski 1970). Another relevant figure in the domain of applied psychology is D. Katz who insisted that Husserlian phenomenology was essential for psychology (Katz 1950). Katz has also argued that many insights and ideas from phenomenology could be helpful for better experiments and for better theorizing and that phenomenology could as well refine his method through the experimental techniques. This mutual help between phenomenology and psychology is not simply a question of importing and applying ready ideas from one side to another, as Zahavi claims, “but a two-way exchange, where both sides could profit from the interaction” (Zahavi 2019: 12). For more on this “two-way exchange” called also “mutual illumination” see Varela et al. (1991) but also Gallagher (1997) where it is seen as a “mutual enlightenment”.

We refer here to the works of Giorgi where he defends the thesis according to which a scientific research cannot claim phenomenological status unless it is supported by some use of reduction (Giorgi 2010: 18). See Giorgi (1994, 2010).

See the work of Wilfried Bion for more on the topic of the experiential spatialization of mental contents, a feature that is specific to schizophrenia (Symington and Symington 1996).

However, we do not take this example as a hallucination, because at the current level of Renee’s disintegration, we are not dealing with a simple perception that occurs in the absence of an external stimulation, as hallucination is usually defined in the clinical and scientific literature. At this moment, Renee is struggling with a modified perception of reality that has its roots in the real. She does not see an object that is absent (and therefore not to be found in the experience of the common world), but an object that is not taken as such, neither experienced in its inter-individual relationships nor endowed with a utilitarian function. In contrast, the experience of a visual hallucination of a barracks would be phenomenologically indistinguishable from an experience of actually seeing a real barracks, because what matters here is possibility and not actuality. For a more detailed analysis of hallucinations from a phenomenological perspective, see Ratcliffe (2017).

For a broader view of this topic, see Depraz (1998: 83).

In this regard, see the works of Strawson (2000) and Gurwitsch (1941).

Sartre’s position is another example of a non-egological theory, for he claims that the ego is neither necessary, nor possible, nor actual. For more on Zahavi’s critique of Sartre’s thesis, see Zahavi (2000, 2005, 2015, 2018).

See Saussure (2011: 78): “The linguistic sign is arbitrary; language, as defined, would therefore seem to be a system which, because it depends solely on a rational principle, is free and can be organized at will. Its social nature, considered independently, does not definitely rule out this viewpoint. Doubtless it is not on a purely logical basis that group psychology operates; one must consider everything that deflects reason in actual contacts between individuals. But the thing that keeps language from being a simple convention that can be modified at the whim of interested parties is not its social nature; it is rather the action of time combined with the social force. If time is left out, the linguistic facts are incomplete and no conclusion is possible”.

To outline a complete theory of the symbol in Freud’s writings is a task that remains to be done. For more on this topic, see Petocz (1999).

Freud (1936: 15): “Tous les modes de langage propres à traduire les formes les plus subtiles de la pensée: conjonctions, prépositions, changements de déclinaison et de conjugaison, tout cela est abandonné, faute de moyens d’expression, seuls les matériaux bruts de la pensée peuvent encore s’exprimer comme dans une langue primitive, sans grammaire. L’abstrait est ramené à sa base concrète. Ce qui reste ainsi peut facilement sembler incohérent. Quand un grand nombre d’objets, de processus, sont représentés par des symboles devenus étrangers à la pensée consciente, ce fait est attribuable autant à une régression archaïque dans l’appareil psychique qu’aux exigences de la censure”.

Moreover, as Sechehaye insists in this regard, “Renee could not love herself since the primary object had refused to nourish, hence love her. When the ego is no longer charged with libidinal energy produced by the introjections of maternal love, destructive forces soon invade it”.

This is a form of violence that reminds us of what Bergeret (1995) has termed “fundamentental violence”. Bergeret defines “fundamental violence” as a vital force, claiming that violence is neither good nor bad. It follows that everything depends on the way this violence is used in the succession of crises specific to affective development.

See in this regard the work of Equipe rapide d’intervention de crise (ERIC) with adolescents. This is a mobile emergency service in Paris meant to help patients facing breakdowns, and it operates on the assumption that it is more helpful for the patient not to be hospitalized, but to be kept and treated at home. The working hypothesis of the ERIC team is thus that the patient should not be isolated from his/her family because the solution is to restore the functional hierarchies of the family, in their relation with the adolescent, through a new parental attitude. For more on this subject, see Depraz and Mauriac (2008).

It is interesting to note that this also represents a method used nowadays by many French psychiatrists in their relations with patients. The patient is no longer regarded as a vulnerable sub-ject who has to face a powerful subject (the psychiatrist), but instead as an equal member of the relationship. In this respect, Henri Grivois’s works, such as Parler avec les fous and Urgence folie (see Grivois 1998, 2007), reveal meaningful insights regarding the relation between pathology and normality, considering that the psychiatrist must enter into the world of the psychotic individual (thus becoming mad for a while) in order to understand the dynamics of the patient’s inner world better. By so doing, Grivois opens the door to a redefined conception of pathology—namely, by integrating it in the field of normality. There is no question of normality versus abnormality, but of abnormality within normality. In this respect, regarding the “paradoxical play” between multiple types of normalities, see Ciocan (2017) and Depraz and Mauriac (2009).

Through these ideas, Lisa Guenther attacks the Husserlian insistence on the absolute primacy of the singular transcendental ego by showing that to exist as a concrete person requires embodied relations with others.

See the discussion about violence and non-violence in Dodd (2017: 66–93), where he outlines the “instability” of the phenomenon of violence, which is never in a stable relationship with its means and therefore requires a closer inspection of its negative side—non-violence, always shadowed by the potential for violence.

In a similar vein, we are right to state that “the person is a non-self” (see Depraz and Mauriac 2009), and consequently that whenever a person is reduced to him/her-self, s/he is violated in his/her experiential dimension. On this subject, see also Zeltner et al. (2006).

This should not be surprising given the literature concerned with the phenomenological analysis of psychosis. In this respect, see not only the works of Minkowski (2002) and Tatossian (2011), but also recent analyses by Nixon et al. (2010) and by Brice and Piot (2011).

For a critical point of view on this topic, see Vorobej (2016).

As Galtung (1969: 171) explicitly states, “the present defnition of violence is entirely located on the consequenceside”.

For more on micro-phenomenology, see not only Eskandari et al. (2015), but also Depraz et al. (2017).