sass, l. - self and world in schizophrenia. three classic approaches

SASS / SELF AND WORLD IN SCHIZOPHRENIA: THREE CLASSIC APPROACHES � 251

© 2002 by The Johns Hopkins University Press

Louis A. Sass

Self and World inSchizophrenia: Three

Classic Approaches

ABSTRACT: This article presents an introductory over-view of the interpretations of schizophrenia offeredby three phenomenological psychiatrists: EugeneMinkowski (1885–1972), Wolfgang Blankenburg (b.1928), and Kimura Bin (b. 1931).

Minkowski views schizophrenia as characterizedby a diminished sense of dynamic and vital connec-tion to the world (“loss of vital contact”), often ac-companied by a hypertrophy of intellectual and statictendencies (“morbid rationalism,” “morbid geome-trism”). Blankenburg emphasizes the patient’s loss ofthe normal sense of obviousness or “natural self-evidence”—a loss of the usual common-sense back-ground that enables normal persons to cope easilywith the social and practical world. Kimura focuseson certain distortions of self-experience: a distinctivesplitting of the subjective self, alienated awareness ofone’s own ongoing consciousness, and profound un-certainty about the “I-ness” of the self.

In addition to a summary, this article offers acomparison and critique of these three approaches.The three approaches are also considered in light of amore recent, phenomenological formulation of schizo-phrenia as a disorder of self-experience (an ipseitydisturbance) involving hyperreflexivity and diminishedself-affection (i.e., heightened awareness of aspects ofexperience that would normally remain tacit or pre-supposed and decline in the feeling of existing as asubject of awareness).

Je donne une oeuvre subjective ici, oeuvre cependantqui tend de toutes ses forces vers l’objectivité.

—Eugene Minkowski

IT IS AN irony of intellectual history thatphenomenological psychiatry should beginwith a declaration, by its most brilliant expo-

nent, of the method’s total inapplicability to theillness that would, in fact, turn out to be itsprime object and source of inspiration—schizo-phrenia. In his General Psychopathology, a workfirst published in 1913 that initiated the phe-nomenological movement in psychiatry, Karl Jas-pers (1963) distinguishes between mental disor-ders that are “understandable” and those heconsiders closed to psychological comprehensionor understanding. Presumably, only the formerwould be candidates for phenomenological ex-ploration.

Whereas the phases of manic-depressive ill-ness involve understandable exaggerations ofnormal mood states and associated psychologi-cal tendencies, schizophrenia is characterized bydramatic, qualitative distortions of the most fun-damental features of human subjectivity. In Jas-per’s view, these distortions are so profound as todefy the very possibility of empathic comprehen-sion by normal persons; the only recourse is toattempt to explain them by seeking underlyingphysical causes in brain and nervous system (577–82). Jaspers particularly emphasizes mutationsof self-experience that appear to contradict Des-cartes famous argument about the cogito—theidea that the very fact of experience necessarily

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implies a self who possesses these experiences.Jaspers also mentions some other, typically schizo-phrenic experiences that appear to be psycholog-ically inaccessible, including certain “abnormalbody or organ sensations” as well as peculiarattitudes toward social reality and the common-sense world (581, 447).

This special issue of Philosophy, Psychiatry,& Psychology contains articles on schizophreniaby and about three phenomenological psychia-trists: Eugene Minkowski (1885–1972), Wolf-gang Blankenburg (b. 1928), and Kimura Bin (b.1931). They are, respectively, major figures ofthe phenomenological tradition in France, Ger-many, and Japan.1 As phenomenological psychi-atrists, all three are indebted to Jaspers’s empha-sis on “actual conscious psychic events” (2) asthe proper and primary subject matter of psy-chopathology. (The term “phenomenology” isused here in the standard philosophical and con-tinental sense—that is, to refer to the study of“lived experience,” in this context, to the subjec-tive dimension of mental disorders. This is to bedistinguished from the context of Anglophonepsychiatry in which “phenomenology” simplyrefers to readily observable signs and symptoms.)Each of the three phenomenological psychiatristsaddresses the sorts of typically schizophrenicmutations that Jaspers considered to be incom-prehensible. In contrast with Jaspers, however,neither Minkowski, nor Blankenburg, nor Kimu-ra views schizophrenia’s essential strangeness asplacing it beyond the pale of phenomenologicalunderstanding. Indeed, for each, schizophreniais not only a central topic for phenomenologicalpsychiatry, but also one whose fundamental dis-tortions are uniquely suited to illuminate keyaspects of normal human subjectivity as well(Tatossian 1997, 11; Blankenburg 1971/1991,106, 62). Each of the three has a distinctive wayof characterizing the essential disorder or disor-ders in schizophrenia. But if considered againstthe backdrop of the dominant psychiatric ap-proaches of the last century, certain strong affin-ities among their ideas quickly become apparent.

The most prominent views of schizophreniaover the past 100 years have interpreted the signsand symptoms of this illness as indicating defects

or deficits of various kinds usually involvingdecline of one or more of the higher cognitivefaculties widely considered to define the humanessence, such as rationality, volition, or the ca-pacity for abstraction or self-consciousness. Thereis no doubt that patients with schizophrenia doperform poorly on a wide variety of cognitiveand perceptual tasks. However, within the psy-chiatric mainstream (at least in North America),the emphasis on quantitative decline has oftenbeen so dominant as to exclude appreciationboth of the qualitative uniqueness of schizophren-ic orientations and of the relevance of certainexaggerated cognitive capacities.

The notion of some basic disorder of higherfunctions has often encouraged a pessimistic atti-tude about making sense of what schizophrenicshave to say; supposedly, such patients lack thekind of rationality that may be a prerequisite tomeaningful speech and dialogue. Psychoanalystshave typically been more optimistic about thepossibility of achieving some kind of psychologi-cal understanding of schizophrenics and theirperspectives on the world. Here, however, theprevailing explanatory models have traditionallyinterpreted schizophrenia as regression to infan-tile forms of experience and as dominance ofinstinct over intellect or more sophisticated emo-tional attitudes (Sass 1992a, chap. 1).

The major exceptions to the above trends arepsychiatrists and psychologists within thephenomenological tradition. The contrast to thestandard approach is especially clear in the caseof Minkowski, who views schizophrenia as char-acterized by a fundamental decline or rupture,not in higher mental capacities, but in some basicor primal sense of vitality or vital connectednesswith the world, often accompanied by a hyper-trophy of intellectual tendencies. In his article inthis issue, Professor Kimura describes a charac-teristically schizophrenic splitting of the self intoobjective and subjective (empirical and transcen-dental) aspects—a splitting that, he suggests, isactually a normal feature of all human experi-ence that happens to be more clearly revealed inthe condition of schizophrenic alienation. Thework of Blankenburg has similar implications.Far from being incompatible (as Jaspers suggest-


ed), phenomenology and schizophrenia have aspecial affinity according to Blankenburg. Blan-kenburg (1991) endorses Husserl’s description ofthe phenomenological attitude and epoché (thefamous “bracketing” of belief in objective reali-ty) as no mere intellectual exercise but as de-manding “a complete metamorphosis of the per-son” (109, 65), since it involves a stepping-outsideof the usual mode of living and a replacement ofthe naïve-natural attitude by a more reflexiveorientation. And schizophrenia, like phenome-nology, involves a pulling-back from normal im-mersion combined with concomitant forms ofreflection or self-awareness that reveal aspects ofexperience that would normally go unnoticed; inthis way, schizophrenia—a condition of alien-ation from both self and the self-evident—can besaid to offer “illuminating counterparts” to Hus-serl’s phenomenological reduction of the “natu-ral attitude” (Spiegelberg 1972, 110). Blanken-burg (this issue) considers the vulnerability tobreakdown of common sense—epitomized byschizophrenia—to be part of the basic structureof being human, for to be human is to be capableof alienation and doubt.

The purpose of this special issue of Philoso-phy, Psychiatry, & Psychology is to introducethe work of Minkowski, Blankenburg, and Kimu-ra to an Anglophone readership. Most of thisintroductory article is devoted to synopses oftheir important and original accounts of schizo-phrenia, but I also point out some similaritiesand differences among their respective views andoffer some friendly criticisms. Discussion of re-lated empirical research findings and directionscan be found in the concluding article of thisspecial issue, written by Sass and Parnas.

In the pages below I also take the liberty, atseveral points, of comparing the views ofMinkowski, Blankenburg, and Kimura with theclosely related phenomenological account offeredin my books, Madness and Modernism (1992)and The Paradoxes of Delusion (1994), and inseveral recent articles (Sass 2000; Sass, in press,a, b; Sass and Parnas, submitted; Parnas andSass, 2001). In my view, schizophrenia is bestunderstood as a particular kind of self- or ipseity-disorder (ipse is Latin for “self” or “itself”) that

is characterized by two, complementary distor-tions of the act of awareness, of what Merleau-Ponty (1962, 135, 157) called the “intentionalarc.” The first distortion is hyperreflexivity, whichrefers to certain forms of exaggerated self-con-sciousness; the second is diminished self-affec-tion or ipseity, which refers to a loss of the senseof existing as a self-possessed subject of aware-ness or activity. This notion of a two-facetedintentional-arc disturbance is not yet a highlyspecific or operationalized theoretical model; itdoes, however, offer a broad, interpretative frame-work that can help to organize our understand-ing of schizophrenia as well as to integrate theviews of Minkowski, Blankenburg, and Kimura.

Eugene Minkowski

Eugene Minkowski (1885–1972) is, along withLudwig Binswanger, one of the two founders ofthe tradition of phenomenological psychiatry.Although he discouraged discipleship—and cer-tainly never founded anything like a school—Minkowski is generally recognized as the mostbrilliant French thinker in this tradition and,along with Jacques Lacan and Henri Ey, as oneof the most significant French-language psychia-trists of the twentieth century. Minkowski wasone of the founders, in 1929, of the journalÉvolution Psychiatrique. He has had an impor-tant influence on later writers from several coun-tries, including Blankenburg and Kimura, Tellen-bach and Tatossian, Lacan, Rollo May, and R. D.Laing, as well as on many younger psychiatristsand psychologists (several of whom have con-tributed to this issue of Philosophy, Psychiatry,& Psychology).2 In 1949, the phenomenologicalphilosopher Maurice Merleau-Ponty describedMinkowski as the first “witness among us”—theone who introduced phenomenology and exis-tential analysis in France (Spiegelberg 1972, 233).

At first glance, Minkowski’s central place inphenomenology and phenomenological psychia-try may seem surprising. Unlike many psychia-trists and psychologists in this tradition (e.g.,Binswanger, whose loyalties shifted from Husserlto Heidegger and back again), Minkowski is nota disciple of any of the major phenomenological


philosophers, nor does he even refer to themwith great frequency. His literary style and gener-al intellectual orientation are also unusual. Muchphenomenological philosophy and psychiatry iswritten in a highly technical or abstract prosethat can be off-putting to the uninitiated reader.By contrast, Minkowski was a devoté of ordi-nary language (see Minkowski 1997, 193) whorelied for inspiration far more on his own every-day experience and encounters with patients thanon any psychological or philosophical theory.Minkowski (1999a) himself characterized hisapproach to psychopathology as motivated lessby a concern to extend the domain of medicinethan to restore to madness its human character(14). R. D. Laing (1963) described Minkowskias the first in the history of psychiatry to havemade a serious attempt to reconstruct the livedexperience of the other (207).

Minkowski’s almost visceral distrust of over-reliance on intellectual theorizing should not beascribed to any lack of sophistication—he corre-sponded with Bergson and Husserl, was a friendof Ludwig Binswanger, and participated in a circleof Parisian intellectuals that included AlexandreKoyré and Louis Lavelle. Minkowski was wellaware of the necessity of theorizing about mentaldisorders (1999a, 35), but wished to remind hisreaders of what they would risk losing as a result ofrigid devotion to any single theoretical perspectiveor even from conceptualization per se. The onephilosopher who did exert a great influence onMinkowski was Henri Bergson—a thinker notgenerally considered part of the phenomenologi-cal tradition and one whose key ideas are found-ed upon a critique of abstraction and analysis.

Bergson’s influence on Minkowski is well cov-ered in Annick Urfer’s contribution to this spe-cial issue. Here I will simply recall Bergson’sbasic opposition between intellect and intuition—the former associated with analysis and abstractreason and with geometrical or spatial modes ofexperience, the latter based on, and fundamen-tally attuned with, the vitality and temporal dy-namism of experience as it is actually lived—atleast by normal individuals. Bergson’s perspec-tive had an obvious impact on Minkowski’s con-ception of schizophrenia and manic-depressive

illness. But this Bergsonian perspective was im-portant as well for Minkowski’s critique of “psy-chopathology” as an intellectual discipline—forhis conception of the nature and purpose of psy-chiatric understanding itself.

Like Bergson, whom he so admired, Minkows-ki is an heir to European Romanticism who of-fers many of the same criticisms that the Roman-tic poets and philosophers directed towardEnlightenment science. Like Wordsworth (“Wemurder to dissect”), Minkowski sees analysisand atomistic modes of thought as precludingappreciation of the dynamism of organic life. InMinkowski’s view, for example, affect, will, andintellect are best understood not as separate fac-ulties in external interaction but as aspects of alarger whole, an “original unity” that is the dy-namism of human subjectivity itself (Minkowksi1999b, 57ff). Similarly, he wrote, “madness, forus, does not consist in a disturbance of judg-ment, or of perception, or of will, but in a pertur-bation of the intimate structure of the self [dumoi]” (1997, 114).

Also, like many of the Romantics, Minkowskirejects thought that would subordinate all ofreality to the principle of causality—a principlethat, by placing cause and effect on exactly thesame ontological plane, “replace[s] all the rich-ness of life with a gray and dull framework”(1999b, 48). Minkowski accepted Bergson’s em-phasis on the principle of expression, a non-causal form of relationship that recognizes thedifferent status of the inner and the outer, of thatwhich is expressed and that which does the ex-pressing (1997b, 214; 1999b, 121; also Taylor1985). Psychiatric symptoms and psychologicalstates must not be treated as isolated fragments,Minkowski insists. They are, rather, expressionsof the self—“because each psychological state,by virtue of the fact that it belongs to a person,reflects and expresses the entire personality.”What is crucial is the need “to penetrate, through[and beyond] the isolated symptoms, to the liv-ing person, to seize in a single effort of knowing,his whole way of being” (1997, 94f). At times,Minkowski describes the act of understandingalmost as a leap whereby one transcends oneselfin order to enter into the soul of the other (99).


In the introduction to his Traité de Psycho-pathologie (1999a, 33), Minkowski reminds usthat we tend to think and express ourselves insubstantives; these have the effect of reifyingwhat we describe as well as of isolating ourobject of study from its context and ground.Minkowski notes that most manuals of psychia-try begin with a description of the diverse kindsof symptoms to be found in mental disorders: forexample, distortions of memory, orientation, orperception; illusions and hallucinations groupedaccording to the different sense modalities; dis-turbances of thinking and judgment, includingflight of ideas, incoherence, obsessional ideas,fixed ideas, and delusional ideas; and so forth(42). Such listings of isolated symptoms are use-ful for the workaday practice of clinical psychia-try. They can, however, be profoundly mislead-ing if taken to imply that actual clinicalphenomena falling under a particular rubric, butcoming from a diverse set of patients, are neces-sarily very similar to each other (52).

In “Psychopathology and Philosophy,” an es-say from 1952, Minkowski describes, for exam-ple, how different the “ideas of grandeur” thatoccur in general paralysis, manic excitement, andschizophrenia tend to be. Whereas the first in-volves a wild dysregulation of thinking (“dére-glement déchainé” [unchained unruliness]), thesecond stems from a playful flight of ideas, andthe third involves disjunction and discordancecharacterized by double bookkeeping (e.g., thepatient who proclaims himself Pope yet never-theless sweeps the floor without complaint).Minkowski also mentions concerns about theend of the world, which can be highly rationalis-tic and coldly expressed in schizophrenia, where-as similar ideas are intensely and profoundlylived in the twilight states of epilepsy (1997,219f). Elsewhere, he discusses the very differentpsychological foundations that hypochondriacalpreoccupations tend to have in anxiety statesversus in schizophrenia (1997, 96) and the dis-tinct nature of both delusions and auditory-ver-bal hallucinations as found in manic-depressiveillness, schizophrenia, or mystical states (48).The purpose of the phenomenological and struc-tural approach Minkowski recommends is, then,

not merely to describe subjective symptoms, butalso to attempt to grasp the underlying unity ortrouble genérateur characteristic of particulartypes of the abnormal lived world (55). He speaksof an “organized and living unity” and of symp-toms as the “expression of a profound and char-acteristic modification of the human personalityin its entirety” (1927 [1997], 12).

In his account of schizophrenia, Minkowskidistinguishes two aspects that correspond to thetwo sides of Bergson’s dualism. Although oneaspect involves decline and the other exaggera-tion, neither can fully be captured in quantitativeterms. On one hand, such individuals tend tomanifest a loss of vital contact with reality and adulling of their subjective lives. This transforma-tion is neither a general lowering of the mentallevel nor a clouding of mental life (as in dementiaor delirium). It is, rather, a diminishment of thesense of vitality, or of existence itself, that defieseasy description. The term “anhedonia” doesnot capture the phenomenon, for not merelypleasure but all experiences are affected (1999a,304). In his Traité, Minkowski (1999a) speaks oftwo layers or strata of the self: one more periph-eral that serves the registering of external stimulias well as responses to these stimuli, the othermore deep and central—the seat and source ofthe felt and the lived (“du senti et du vécu”; 309).A characteristically schizophrenic form of split-ting or fragmentation divides these two levels tothe detriment of the lived. This affects the pa-tient’s sense of the reality and vitality of the selfand is clearly related to what has subsequentlybeen called loss or diminishment of self-affection(Parnas and Sass, 2001; Zahavi 1999), but it alsoaffects one’s experience of the world, which nowseems colorless, neutral, or dull (Minkowski1999a, 318).

Such persons may be perfectly aware of themore objective aspects of reality; yet though they“register and know,” they do not “feel” the real-ity of what they experience (1999a, 305). Suchpatients sense that they are not fully present intheir actions and experiences: Although they mayappear to behave just like other people, theyhave the sense that nothing is real, that they areonly pretending, for example, to love someone


or to feel happy or sad (303f). In extreme cases, a“nameless catastrophe” seems virtually to have“abolished” the human person; one such patientset fire to her clothing to make herself feel some-thing (308, 301).

But schizophrenia is not purely a matter ofdulling or devitalization. Along with this declinein the intuitive or vital aspects of existence, thereis often an exaggeration of the more intellectual,spatial, or schematic modes of consciousness andexpression. One manifestation of hypertrophiedintellectualism is the “interrogative attitude” de-scribed by Minkowski and Targowla (this issue).Another is a tendency toward a kind of geomet-rical or quasi-mathematical abstraction, vividlydescribed by a patient treated by Minkowski’swife, F. Minkowska:

What upsets me a lot is that I have a tendency to seeonly the skeleton in things; it can happen that I seepeople in this way. It is like geography, where riversand cities are lines and points….I schematize every-thing, I see people as points or circles. When I think ofa meeting I attended, I see the room, I represent thepeople present by points. (1999a, 326f)

Minkowski describes the expressive side ofthis as an abandonment of the mode of “repre-sentation” in favor of that of the schema. This isprecisely what one patient of mine did whenasked to draw a picture of his family. Instead ofattempting any standard form of realistic repre-sentation, he simply drew a big circle surroundedby four or five smaller ones, then explained thatthis was his family sitting around the kitchentable as seen from above. Even in relationship tohimself, a schizophrenic person may manifest akind of extreme objectivity and may describe hisown experiences as if speaking of a third person(354).

Minkowski generally presents morbid geome-trism and morbid rationalism as having a sec-ondary status in relation to the decline of the“intimate dynamism of our life” and of vitalcontact with reality, which he describes variouslyas the essential, fundamental, initial, and genera-tive disturbance (“trouble initial, trouble genéra-teur”; 1927 [1997], 5, 77f, 83). “Loss or ruptureof vital contact” is the essence of schizophrenicautism; idiosyncratic preoccupations and with-

drawal into a private or delusional world aresecondary features. The patient Paul’s interroga-tive attitude, for example, is described as a “com-pensation mechanism” by which Paul strives tofill the void left by his loss of any real, vitalinterest in the world (Minkowski and Targowla,this issue). But it is important to realize thatthese defensive or compensatory tendencies arethemselves marked by the very condition of vitaldecline to which they are a response (1999a,618–22). Schizophrenic rationalism is not mere-ly an exaggerated rationalism, but one that lacksboth the vitality and the flexibility or souplessethat is characteristic of human rationality in itsmore normal forms.

I would rank Minkowski’s La Schizophrénieamong the most important and lasting books onschizophrenia written in the twentieth century.Like many other writers on schizophrenia, I my-self have been significantly influenced by thislucid and compelling account. Minkowski’s oth-er books—Traité de Psychopathologie and LeTemps Vécu and his volumes of collected es-says—are also of considerable interest. Minkows-ki’s clinical descriptions remain unsurpassed. Hisinterpretation of autism as loss of vital contact,and his account of morbid geometrism and mor-bid rationalism, were highly original when hewrote them; they focus on key aspects of schizo-phrenia that, even today (perhaps, especially to-day) tend to be neglected or even denied. Thereare, however, several weaknesses or lacunae thatshould be mentioned. Given that Minkowski’swork was published up to seventy-five years ago,some of the following comments may seem tohave a somewhat anachronistic quality. ButMinkowski’s perspective is of more than merelyhistorical interest; if one wishes to bringMinkowski into present-day discussions—as heclearly deserves—then several points are worthbearing in mind.

My first concern pertains to the vagueness oruncertainty in Minkowski’s account of what hecalls the trouble genérateur: In what sense canthe trouble in question be said to “generate” thevarious aspects of the illness? Phenomenologicalpsychiatrists and philosophers have not alwaysbeen very clear about the precise explanatory


relevance of their phenomenological accounts.Minkowski equivocates as to whether the trou-ble genérateur precedes these other aspects as akind of prior cause or whether it is better con-ceived as a central theme or “essence” of theillness. (In La Schizophrénie, he describes loss ofvital contact as “not a consequence of otherpsychical disturbances, but an essential point [orstate] from which spring, or at least from whichit is possible to view in a uniform way all thecardinal symptoms” [1927 [1997], 87].) Onemight also wish for a more elaborate analysis ofsome of the phenomena he describes. What, forexample, does it really mean to speak of madnessas “a perturbation of the intimate structure ofthe self” (1997, 114)? Minkowski’s key notionof “vital contact,” which derives from Bergso-nian philosophy, retains a certain metaphysicalaura, and it is difficult to specify the processes ofconsciousness or cognition that are entailed.

My second point concerns Minkowski’s ten-dency to focus on a restricted set of schizophren-ic symptoms and to neglect other major symp-toms or syndromes of schizophrenia. Hisemphasis falls on what are now termed the “neg-ative symptoms,” especially apparent decline ofenergy and affective response along with devital-ization, disconnection, and diminished self-af-fection, as well as on largely compensatory formsof hyperrationalism and spatializing. Little men-tion is made of key features of what we wouldnow call the “disorganization” or the “positive”syndromes (Liddle 1987)—that is, either of themore confusing and confused types of formalthought disorder and related disturbances of lan-guage and attention, or of “bizarre” first-ranksymptoms of being inhabited or controlled by analien being or force. Minkowski’s exemplary pa-tients complain of their deadness or non-exist-ence, and they manifest rigid rationality; seldomdo they complain of the sense of bodily or mentaldiscombobulation or of the “influences” fromwithout that are prominent in many schizophrenicpatients. In one essay, Minkowksi (1997, 108f)acknowledges his difficulty in handling Bleuler’s“secondary symptoms,” which include halluci-nations and delusions. He goes on to suggest that“supplementary mechanisms,” perhaps akin to

Clérambault’s “mental automatisms” and hav-ing little to do with schizophrenia per se, may berelevant.

Minkowski’s emphasis on exaggerated ratio-nality and predilection for the static and thespatial is consistent with Bergson’s distinctionbetween the intuitive and the rational. My thirdand final observation is that Minkowski mayoveremphasize hyperrationalism, while payingtoo little attention to the disruptive, often self-undermining forms of exaggerated self-aware-ness that I have referred to as “hyper-reflexivity”(Sass 1992a). This last point will be elaboratedfurther below. Here I will simply say that hyper-reflexivity (in contrast with morbid rationalism)seems better able to account for the disruptionsof hierarchical organization characteristic ofschizophrenic thought and language as well asfor the radical forms of self-alienation exempli-fied by the first-rank symptoms.

Wolfgang Blankenburg

The richest vein of phenomenological psycho-pathology is to be found in German-languagepsychiatry—not only in the works of the famousHeidelberg School (including Jaspers, Mayer-Gross, and Kurt Schneider; Von Baeyer, Grühle,Kisker, Tellenbach, and Häfner; and currentlyrepresented by Alfred Kraus and Thomas Fuchs)but also by various other writers from Germanyand Switzerland (including Binswanger, Boss, vonGebsättel, and Erwin Straus; see Spiegelberg 1972;Tatossian 1997). Here too schizophrenia has re-ceived more attention than any other disorder.Perhaps the most prominent living representativeof this tradition is Wolfgang Blankenburg, formany years a professor and chairman of psychiatryat the University of Marburg. Now retired, Blan-kenburg has written on many aspects of psycho-pathology, psychotherapy, and psychiatric meth-odology. Here I shall focus on his best-knownwork, Der Verlust der Natürlichen Selbstver-ständlichkeit: Ein Beitrag zur Psychopathologiesymptomarmer Schizophrenien (The Loss of Nat-ural Self-Evidence: A Conribution to the Studyof Symptom-Poor Schizophrenics)—a work pub-lished in 1971 that I would rank among the most


important books on schizophrenia of the lastcentury. (Below I reference the French transla-tion of 1991 and also, in italics, the originalGerman edition of 1971; the book has not beentranslated into English.) The paper by Blanken-burg translated for this special issue appeared in1969 and can serve as an overview and introduc-tion to The Loss of Natural Self-Evidence.

In his book of 1971, Blankenburg argues thatthe central defect or abnormality in schizophre-nia is best described as a “loss of natural self-evidence.” This phrase is borrowed from “Anne,”the patient who serves as his central case exam-ple. Loss-of-natural-self-evidence is somethingbroader and more subtle than most symptomaticconcepts (97f, 55f); it refers to a loss of the usualcommon-sense orientation to reality, that is, ofthe unquestioned sense of familiarity and of theunproblematic background quality that normal-ly enables a person to take for granted so manyof the elements and dimensions of the social andpractical world. What occurs can be described asa disruption of the normal or “essential propor-tion between the sense of the obvious and itsabsence in amazement and doubt” (Spiegelberg1972, 110). Blankenburg’s approach is consis-tent with empirical studies, which show that,although schizophrenics often do surprisingly wellon many intellectual tasks requiring abstract orlogical thought, they have particular difficultieswith more practical or common-sensical prob-lems, perhaps, especially, when these relate to thesocial world (Cutting and Murphy 1988, 1990).

Blankenburg’s (1991) perspective is descrip-tive, holistic, and somewhat static. He seeks tocomprehend the overall tenor, dominant themeor style of existence, or fundamental conditionsof possibility of the schizophrenic lifeworld. Blan-kenburg is well aware of the inevitable oversim-plification and the potential arbitrariness inher-ent in any attempt to sum up the essence ofschizophrenia (27–28). Nevertheless, he suggeststhat this distinctive but subtle disturbance ofcommon sense, which he calls a form of “alien-ation,” defines a key “condition of possibility”for what he terms the “primary autism” of theschizophrenic’s form of life (1986; 1971/1991,201, 230, 232, 139; Parnas and Bovet 1991).

Blankenburg does not, however, concern himselfwith causal explanation or with tracing develop-mental trajectories. He clearly states that, whendescribing “loss of natural self-evidence” as a“basic disorder” or “Grundstörung,” he is con-cerned not with etiology but with capturing the“essence” of the transformation (p. 27, 4). (Thismay distinguish it from Minkowski’s “troublegenérateur”; see above.)

Blankenburg’s and Minkowski’s styles of do-ing phenomenological psychiatry are certainlydifferent. Whereas Minkowski seldom refers tophilosophical authors, preferring everyday lan-guage and a focus on immediate clinical realities,Blankenburg’s book is replete with philosophicalreferences and intriguing applications of ideasfrom Husserl, Merleau-Ponty, Sartre, and espe-cially Heidegger. In their views of schizophrenia,however, the two phenomenological psychiatristshave much in common. Both emphasize a distur-bance or decline in the patient’s spontaneousengagement with the world, which can be com-bined with an overreliance on (or hypertrophyof) the more intellectual forms of experience orcoping. Although “loss of natural self-evidence”has a more cognitive, and “loss of vital contact”a more dynamic or affective flavor, this differ-ence of emphasis diminishes on more carefulexamination. Both Minkowski and Blankenburgrecognize that knowing and caring are insepara-ble, that is, that our cognizing is normally im-bued with the motivations and affects that bothanchor and orient us in the world. Blankenburgwrites, in fact, that “in the ability to judge, feel-ing [is] an organ of cognition” (this issue).

According to Blankenburg, the essential orbasic mutation of schizophrenic subjectivity ap-pears in its purest and most easily discernableform in “symptom-poor” patients who lack theflorid symptoms of the illness. Along withMinkowski’s La Schizophrénie, his book offersperhaps the richest available account of the oftenneglected, subjective side of the “negative” orpredominantly “deficit” syndromes of schizo-phrenia (see also Sass 2000). But Blankenburg(1991) believes that loss of self-evidence under-lies many of what would be called the positiveand disorganization symptoms as well: He calls


it the “nonspecific specificity” (30, 97, 6, 55)that defines the essence of schizophrenic illnessand helps to account for many of its characteris-tic features.

One characteristic feature of loss-of-natural-self-evidence is how difficult it is to describe:Patients complain that they cannot capture inwords that which is afflicting them so profound-ly. Since it is not an object or an appearance butthe horizon of possibility for a certain kind ofexperience, it lies everywhere and nowhere—sofamiliar that it recedes into the background ofour awareness. (Blankenburg compares loss ofself-evidence to Heidegger’s discussion of how“being” announces itself precisely by retiring;230) As Blankenburg notes (87, 49), language isnot well suited to describing dimensions of exist-ence on which language itself is founded andwhich it tends to presuppose.

Blankenburg’s patient Anne speaks of lacking“something small…but so important that with-out it one cannot live” (103, 60). Normal peo-ple, she says, all have some sort of “way,” “man-ner of thinking,” or “frame within whicheverything plays out” (126, 140; “eine Bahn,eine Denkweise”; “der ‘Rahmen’ in dem sichalles abspiele”—79, 90); and it is by followingthis manner or way that “one thinks…that ac-tion is guided…that one behaves” (126, 79). Butwhereas others have a “natural relationship” withthis manner or way, Anne describes herself asfinding “everything, everything in general [to be]so problematic. No matter how, I don’t under-stand anything at all” (121, 75). She complainsof not being able to stay on a single continuouspathway and of continually finding herself some-how in a different world, having to start anew(138–40, 88–90). What ensues is not so muchtheoretical confusion or intellectual incompre-hension as a kind of practical incompetence andperplexity that disrupts the ease and smooth flowof normal experience and everyday practical ac-tivity and impedes independent functioning indaily life. Such persons have particular difficultyin domains that require subtle interpretation andpractical judgment; they may prefer fields thatare more logical and clear-cut, such as physics ormathematics (this issue). “The only thing that

remains for me, says Anne, “ is to rely uponrational grounds” (82; “Dann bleibt mir nichts,als mich auf Vernunftsgründe zu verlassen”, 47).

Although patients themselves will often speakof having a deficit or Defekt (Blankenburg 1991,89, 51), it is wrong to understand this loss inpurely quantitative or negative terms—as a sim-ple privation of something normally present(namely, common sense). For as Blankenburgnotes, what he calls loss of natural self-evidenceinvolves a qualitative alteration of the constitu-tive foundations of experience as well as a kindof dialectical negation (100f, 58).

The loss of natural self-evidence in negative-symptom patients is, in fact, often accompaniedby exaggerated forms of self-conscious aware-ness (hyperreflexivity) in which patients focus onaspects or processes of action and experiencethat, in normal experience, would simply go un-noticed (107–22, 63–75). Blankenburg speaks ofa characteristically “schizophrenic alienation”(34, 201, 9, 139)—a sense of being outside theusual customs and concerns of the shared socialworld, detached from the usual taken-for-grant-ed background of assumptions and practices,and somehow dislodged from the usual sense ofbeing rooted in one’s own being: “I am somehowstrange to myself; I am not myself,” said Anne(94; “Ich bin mir irgendwie fremd—bin nicht ichselbst,” 54). “It is as if I watched from some-where outside the whole bustle of the world”(113; “Es ist als ob ich das ganze Weltgetriebe sovon aussen anschaue,” 68). Anne speaks of being“hooked to” or “hung up on” (79f; hängenbleiben, 44) obvious or self-evident problemsand questions that healthy people simply takefor granted—questions that she herself oftenfound pointless ( 91,139, 52, 89). “It is impossi-ble for me to stop myself from thinking,” shesaid (82, 46). Blankenburg describes such pa-tients as experiencing an impoverishment of allvital relationships apart from the reflective rela-tionship to oneself (76; “mit ausnahme des refle-ktierenden Selbstbezugs,” 41).

According to Blankenburg (94, 54), loss ofnatural self-evidence is what underlies the character-istically schizophrenic “perplexity” (Ratlösigkeit)described in classic German psychopathology


(Störring 1939 [1987]). To understand this per-plexity, it is not sufficient to stress the patient’ssense of declining vitality and activation or thefact that, with the awareness of the normallytacit, the patient’s consciousness is now floodedwith more input, in a state of cognitive overload.More crucial, I would argue, is a radical qualita-tive shift, namely, that when tacit dimensionsbecome explicit, these dimensions can no longerperform the grounding, orienting, in effect, con-stituting function that only what remains in thebackground can play.

Normally, says Anne, a person’s “way” or“manner of thinking” develops spontaneouslyover time, and largely unnoticed, like one’s char-acter itself. Anne, however, feels herself to be atan enormous distance from any such thing: “Inmy case,” she says, “everything is just an objectof thought” (127; “Bei mir ist das alles nurangedacht,” 79). Another patient speaks of “aprocess of reversal in which what is most interiormoves toward the exterior”: “Schizophrenia,”he says, “it’s exactly as if I turned a carton insideout” (135; “Die Schizophrenie ist genau so, wiewenn ich einen Karton nach aussen stülpe,”86).A consequence of the loss of natural self-evi-dence, of the normal sense of embeddedness in aframework, is that the patient must devote ener-gy and a kind of active, conscious effort andcontrol to processes that would normally takeplace automatically. The very constitution of selfand world—normally a “transcendental opera-tion” (“transzendentale Leistung”; 1971 84;1991, 132) that arises via preconscious passivesyntheses—comes to seem fragile and now re-quires an almost physical effort that uses upavailable resources. This need for effort—whichis at the root of schizophrenic autism (1991,156, 104)—may account, at least in part, for thelack of energy and general sense of exhaustion socommon in schizophrenia (what Blankenburgcalls schizophrenic “asthenia”; 132–33, 153, 155–56, 84f, 101, 103f).

Blankenburg likens the schizophrenic’s senseof amazement before that which would seem tobe most self-evident to the wonder achieved by aphenomenological philosopher who engages inwhat Husserl called bracketing or the epoché—who suspends the normal assumptions of the

“natural attitude” in order to bring those as-sumptions to light (112, 67). This detached aware-ness and querying of normally unnoticed frame-works or social conventions account for thehyper-abstract or quasi-philosophical quality inthe thought and speech of many schizophrenicpersons. But Blankenburg also discusses someimportant differences between schizophrenia andphenomenology that are no less revealing of thenature of both schizophrenia and normalcy.

As Blankenburg notes, the phenomenologist’ssuspension of natural self-evidence is largely theresult of a theoretical position. Personal or tem-peramental factors play no more than an ancil-lary role, whereas in schizophrenia, some kind ofendogenous foundation seems key.3 Blankenburgalso emphasizes the importance in schizophreniaof abnormalities in what he calls the foundation-al, ante-predicative aspects of experience, that is,in the automatic, association or gestalt-basedprocesses that Husserl called “passive genesis”and Merleau-Ponty (1962, xviii) referred to asthe level of “operative” intentionality (in con-trast with the more active, volitional, or “reflec-tive” modes). Whereas the phenomenologicalepoché is theoretically motivated and largely vo-litional in nature, schizophrenic loss of self-evi-dence is a more insidious process grounded inendogenous abnormalities of the cognitive-affec-tive apparatus. And whereas the philosopher islikely to have to struggle against the naturalattitude, which the phenomenologist Eugen Finkcharacterized as the “natural inclination of life”(Blankenburg 1991, 116, 71), the schizophrenicis more likely to struggle to prevent it from fall-ing away. Indeed, for many schizophrenic per-sons, it is potentially misleading to speak of abracketing of self-evidence—the horizons of nor-mal self-evidence were never very secure in thefirst place (115, 70).

Blankenburg’s Loss of Natural Self-Evidenceoffers the most elaborated theoretical account ofthe subjective dimension of the so-called “nega-tive symptoms,” which many contemporary ex-perts see as the core of schizophrenia. No onewho wishes to understand the subjective dimensionof psychosis can afford to neglect this work.Here I will offer three comments on Blankenburg’simportant book. The first concerns his focus on


what might seem to be effects and his relativeneglect of generative or constitutive processes.

Blankenburg’s key concept, “loss of naturalself-evidence,” focuses on the kind of world orthe nature of the field of awareness that is expe-rienced by the schizophrenic person. In this re-spect, Blankenburg seems close to Heidegger, whoconceived of human existence as a condition ofbeing there (Dasein) and who questioned whathe saw as his mentor Husserl’s overly subjectivistand Cartesian conception of mind as constitut-ing the experiential world. Although Husserl ful-ly recognized there is no noesis (act of conscious-ness) without a correlative noema (object ofconsciousness), he nevertheless gives a specialstatus to the noetic acts, which he describes as“animating construals” or “apprehensions” thatare responsible for the transcendental constitut-ing of the objects and field of our awareness(Husserl 1983, 226, 238, 277). One may certain-ly debate the merits of a Heideggerian versus aHusserlian approach (Tatossian 1997, 12). It isworth noting, however, that the Husserlian inter-est in constituting mental processes and the gen-esis of experiential worlds is probably more con-gruent with the aspirations of contemporarypsychology and cognitive science, which seek toidentify mental processes that underlie and in thissense account for the experiential abnormalities.

My second comment on Blankenburg (1991)is that, although he states that loss of naturalself-evidence is the basic mutation underlying allforms of schizophrenia ( 21, 201, v, 138), hedoes not actually explain just how it might un-derlie the “positive” symptoms. My final criti-cism is that Blankenburg takes too restricted aview of reflexive awareness in schizophrenia andtherefore tends to downplay the central role itmay play in the illness. I would argue that anexpanded view of hyperreflexivity has the poten-tial to integrate Blankenburg’s crucial insightsinto a more comprehensive account of schizo-phrenia.

Blankenburg certainly considers reflexivity tobe an important and, in many respects, distinc-tive characteristic of schizophrenia (he explains,e.g., how the all-inclusive character of the schizo-phrenic’s self-conscious doubting and perplexitydistinguishes it from that of the obsessive neurot-

ic; 91, 52). It is important to note, however, thatwhen Blankenburg speaks of “reflexivity,” he isreferring primarily to what might be termed (fol-lowing Merleau-Ponty) a reflective type of re-flexivity (the German terms Blankenburg usesinclude Reflexivität, Reflexionskrampf, Reflex-ion, Reflektierheit, and reflektierte Alienation;53, 54, 59, 121). This is the sort that has at leasta semi-volitional quality and that typically en-gages processes of understanding or introspec-tion of an intellectual or even hyper-rational sort.(It occurs, he says, “mit Hilfe des Verstandesreflektierten…Selbstverhältnis,” 1971, 102 [“asa relationship with oneself that is reflected uponwith the aid of the understanding,”1991, 154].)Also, Blankenburg generally describes schizo-phrenic reflexivity as a “secondary” process thatdevelops in compensation for some more funda-mental or “basal” defect (involving the loss ofspontaneous attunement to common-sense reali-ty) that is rooted in abnormalities of “passivesynthesis” on the pre-reflective and pre-predica-tive plane ( 62, 93, 106, 113, 168, 30, 54, 62, 68,113f).4 For Blankenburg, then, reflexivity seemsto be primarily a response or an effect, that is,not a feature of the basic abnormality, and notsomething that might itself make a major contri-bution to the loss of natural self evidence (how-ever, see 92, 53).

But as I have argued in detail elsewhere (Sass1992a, chap. 7; 2000), it seems likely that reflex-ive ruminations compensating for a more basicloss will often have the counterproductive effectof further distancing the patient from any senseof naturalness or capacity for spontaneous ac-tion, thereby increasing the patient’s perplexityand making it more difficult to break out of whatcan easily become a kind of self-propagatingspiral. The person who attempts, for example, toreassert control and reestablish a sense of self bymeans of introspective scrutiny may end up ex-acerbating his self-alienation and fragmentation.“My downfall was insight,” explained one youngman with schizophrenia. “Too much insight canbe very dangerous, because you can tear yourmind apart.” “Well, look at the word ‘analysis,’”he said on another occasion. “That means tobreak apart. When it turns in upon itself, themind would rip itself apart.” “Once I started


destroying [my mind], I couldn’t stop” (quotedin Sass 1992a, 337f). Introspectionist studies withnormal individuals show that a kind of hyperre-flection—in this case produced in a purely voli-tional manner—can bring on some alterations ofthe sense of both self and world that are striking-ly reminiscent of what occurs in schizophrenia(Hunt 1985, 1995; Sass 1994, 90).5 AlthoughBlankenburg’s views are perfectly consistent withthis point, in his formulations he does not give itany emphasis.

I would, in fact, go further and argue thatforms of what might be termed “hyperreflexivi-ty” may also have a more fundamental role inthe disorder—that they may be an aspect of whatcould be called the Grundstörung itself.

It is true that the more intellectually intro-spective forms of hyperreflexivity on which Blan-kenburg focuses may not be basic enough to playa truly primary role in the etiology of the illness.Hyperreflexivity, however, includes not merelyactively directed or reflective forms of self-con-sciousness, but also a host of other, more passive,automatic, or “pre-reflective” ways in which anagent or subject comes to focus on itself or fea-tures of its own functioning (Sass 2000). These“operative” forms of hyperreflexivity, as we mightcall them (following Merleau-Ponty 1962, xviii),include experiences in which the normally trans-parent field of experience can become increas-ingly disrupted by a kind of automatic and pas-sively experienced popping-up of unusualsensations, feelings, or thoughts that come toacquire object-like quality. Patient reports sug-gest that in the early, premorbid stages of schizo-phrenia, this is first experienced as a largelypassive process, more like an affliction, and typ-ically involving cenesthesias, a loss of the auto-maticity of movement, and certain cognitive andperceptual disturbances—phenomena that, inGerman research on the so-called “basic symp-toms” of schizophrenia, are designated with theapt term “basal irritation” (Klosterkötter,Schultze-Lutter, Gross, Huber et al. 1997). Theseexperiences appear to involve hyperreflexiveawareness of sensations and other phenomenathat would not normally be attended to in anysustained fashion (Frith 1979; Sass 1992a). Al-

though experiences akin to the basic symptomsvery rarely occur in healthy persons or in neurot-ic or character disorders (Huber 1986, 1137),they are, in fact, remarkably similar to the expe-riences reported by normal subjects who adoptan abnormal kind of detached, introspectivestance toward their own bodily experience (seeAngyal 1936; Hunt 1985, 248; 1995, 201; Sass1994, 90–97, 159–61). They are, we might say,the perfectly normal sensations implicit in ongo-ing experience and action but now experiencedin the perfectly abnormal condition of hyperre-flexivity and altered self-affection.

The work of the philosopher Michael Polanyi(1964, 1967) illuminates the nature of the cru-cial relationship between the tacit and the focalin the automatic constitution of each act of con-sciousness. Tacitness, he argues, is the mediumor index of normal self-affection, for what wetacitly know, we inhabit or “indwell.” Any dis-turbance of this tacit-focal structure, or of theipseity and focus it implies, is likely to havesubtle but broadly reverberating effects that up-set the balance and shake the foundations ofboth self and world. I would suggest, then, thatoperative hyperreflexivity, which disrupts the tac-itness necessary for passive synthesis, may be akey element in what Blankenburg refers to as thebasic structural modification of schizophrenicDasein—an element that is implicated in a broadrange of schizophrenic symptoms (and, I mightadd, that is congruent with a variety of contem-porary neuro-cognitive hypotheses that empha-size disturbances in the deployment of attentionto novel stimuli in the light of past experience).6

It is not difficult to see how such operativehyperreflexivity, along with more compensatory,reflective forms that it may inspire, could beconducive to loss of natural self-evidence, withall the perplexity and disorganization this im-plies, and also to the disruption and slowing ofactivity and thought that can occur in schizo-phrenia. “I found recently that I was thinking ofmyself doing things before I would do them,”said one patient with schizophrenia. “If I amgoing to sit down, for example, I have got tothink of myself and almost see myself sittingdown before I do it. It’s the same with other


things like washing, eating, and even dressing—things that I have done at one time without evenbothering or thinking about at all.…All this makesme move much slower now.” (McGhie and Chap-man 1961, 107)

The lapsing into silence, inaction, or inexpres-siveness characteristic of the negative syndromecan be understood not only as a direct conse-quence of progressive distortion of normal self-experience, but also as a defensive reaction tothese disconcerting changes. When I go “com-pletely still and motionless,” one patient ex-plained, “things are easier to take in” (McGhieand Chapman 1961, 106)

But operative hyperreflexivity and its sequelaemay also help to account for the development ofthe first-rank symptoms that dominate the posi-tive syndrome.

Longitudinal studies of premorbid and pro-dromal symptoms of schizophrenia (Klosterköt-ter 1988) clearly document a progressive shiftfrom “basal irritation” to full-blown first-ranksymptoms through increasing objectification andexternalization of normally tacit inner phenome-na. They show that particular first-rank symp-toms are generally preceded by subtle subjectiveexperiences of alienation occurring in the sameexperiential domain, that is, by “basal irrita-tion” affecting the same realm (e.g., bodily sen-sation, thought, or affect) that eventually be-comes externalized and thematized in the formof first-rank symptoms affecting that realm(Klosterkötter 1992, 3, 37). To have focal aware-ness of what would usually be tacit is to objectifyor alienate that phenomenon—to cause it to beexperienced as existing at some kind of removefrom what Husserl (1989, sec. 41) called the“zero point” of orientation of ongoing experien-tial selfhood. At the extreme, the patient losesthe sense of inhabiting his own actions, thoughts,or sensations and may feel that these are underthe control of some alien being or force—as inthe first-rank symptoms.

Kimura BinThe most important representative of phe-

nomenological psychopathology in contemporaryJapan is Dr. Kimura Bin (the Japanese custom is

to place family names first, hence, Kimura Bin.),for many years a professor of psychiatry in thecity of Nagoya and later in Kyoto. During hispsychiatric training, Kimura spent two years atthe university clinic in Munich (1961–1963); lat-er he served as a visiting professor in Heidelberg(1969–1970). Kimura is well versed in Europe-an, especially German, phenomenology, and inaddition to his own contributions has translatedinto Japanese works by Heidegger, von Weiz-sacker, Binswanger, Tellenbach, Ellenberger, andBlankenburg. A number of Kimura’s articles onpsychiatric phenomenology appear in Frenchtranslation as Écrits de PsychopathologiePhénoménologique (1992). In a commentary inthis issue, John Cutting discusses the essays inthis collection covering the topics of temporalityand intersubjectivity. Here I will concentrate onwhat, to me, is Kimura’s most intriguing contri-bution: his discussion of disorders of self-experienceand excessive self-reflection in schizophrenia.

Kimura begins a brief but highly suggestiveessay, “Réflexion et soi chez le schizophrène”(1992, 117–27) with some ideas from NagaiMari, a Japanese psychiatrist whose career wascut short by an early death. Nagai distinguishedtwo kinds of excessive reflection in schizophre-nia. The first—what Nagai called “subsequentreflection”—can be found in many other condi-tions as well, including melancholia and normaladolescence. It is a purely quantitative exaggera-tion of the normal human capacity to engage incritical self-observation and involves taking one-self as an object of awareness—as when oneimagines how one must look in the eyes of an-other. Adopting Husserlian vocabulary, Kimuradescribes “subsequent reflection” as a conditionin which “a noetic reflecting self and a noematicreflected self…separate themselves clearly fromeach other” (118). (Recall that noesis is Husserl’sterm for the act of consciousness; noema refersto its intentional correlate, viz., the object andworld of which we are aware [Sokolowski 2000,59–61].)

The second type, “simultaneous reflection,” isfar more distinctive of schizophrenia, accordingto Nagai and Kimura; certainly it is very rare innormal individuals. Here the observing and the


observed are more difficult to distinguish, for inthis case the self that is observed does not havethe status of a Husserlian noema or of whatSartre would call the “en soi,” but instead re-tains the status of a subject or agent (of noesis or“pour soi”). Kimura (1992) writes, “one singlenoetic self divides itself into two simultaneous‘moments’ that alternatively occupy the place ofthe watcher and the watched, and which, as aresult, do not remain any the less subjective-noetic” (118). Simultaneous reflection seems toinvolve a certain kind of self-consciousness ofoneself as a consciousness.

Kimura stressed the difficulty, at least for nor-mal individuals, of sustaining a simultaneouspartitioning of the subjective self. The problemcan be compared to that of eyes that are unableto see themselves, at least in any direct, unmedi-ated fashion (120), or that of light that is soubiquitous as to remain itself invisible. Subjec-tivity is not, after all, an object or a thing but,rather, a dynamic vector of relationship to theworld, a constant yet elusive condition of possi-bility for the very appearance of anything—as issuggested by Heidegger’s concept of Dasein andSartre’s of the nothingness of the pour soi. Tocapture the peculiar ephemerality intrinsic to self-consciousness, Kimura quotes Kierkegaard’s def-inition of the human self as “a relationship relat-ing itself to itself” and supplements this with theJapanese philosopher Nishida Katoro’s descrip-tion of jikaku (auto-perception) as the act “ofreflecting oneself in oneself without anythingbeing the reflected” (122). Animals and infantsdo not seem capable of the more complex formsof self-consciousness and certainly not of con-sciousness of self as consciousness, which proba-bly requires the development of language; andthis, suggests Kimura, may be the reason whyschizophrenic psychoses seem to be specificallyhuman (120). There is something distinctly pecu-liar about simultaneous reflection in schizophre-nia; the possibility of this kind of self-consciousnessseems, however, to be a constituting paradox thatis bound up with the essence of human nature.

Indeed, as Blankenburg has noted and Kimura(108) acknowledges, the heightened self-con-sciousness or hyperreflexivity in schizophrenia

has something in common with the kind of re-flection that is both the goal and method ofphenomenology. Like Nagai’s “simultaneous re-flection,” the phenomenologist’s self-conscious-ness involves an explicit consciousness of self asconsciousness that is difficult for the normal butuntrained person to achieve; hence, Husserl’s in-sistence on the need for special training to over-come the “natural attitude.” But in schizophre-nia an analogous kind of self-consciousness occursquite spontaneously—sometimes almost attack-ing the person in a way that can undermine theperson’s stability and dissolve the structures ofthe outer world. A remarkable illustration of thispeculiar possibility is a passage in which thewriter Antonin Artaud (who suffered from schizo-phrenia) uses the image of “rootlets…at the cor-ners of my mind’s eye” to describe what seems tobe an encroaching awareness of his own mind inits world-constituting role and in which this dis-concerting self-awareness presages an experienceof the world trembling and threatening to disap-pear (Artaud 1976, 60; Sass 1994, 96).

In “Réflexion et soi chez le schizophrene,”Kimura (1992) notes that in the simultaneousreflection characteristic of schizophrenia, one orthe other of the two noetic selves is felt to be“other” at a given instant. When this alienationor “other-ing” affects the reflecting self, it resultsin the delusions of being observed by other peo-ple that are so common in paranoid schizophre-nia. But if it is the observed subject that is experi-enced as alien, while nevertheless retaining itsposition as a subject of will, then, says Kimura,the patient will have the experience of an aliensubjectivity who exists somehow at the intimateheart of his being (119). And this experience ofdiminished ipseity will be manifest in experienc-es or delusions of influence and alien posses-sion—as when a schizophrenic feels that his ac-tions or thoughts are under the control of someother person or force, or when he senses thatsomeone else is actually having his sensations orlooking out his own eyes.

In a closely related article, “Topologie de l’autredans le délire,” Kimura contrasts schizophreniawith non-schizophrenic forms of paranoid psy-chosis: Whereas in non-schizophrenic paranoia,


the other appears as a menacing presence situat-ed in the space of the real external world, indelusional schizophrenia what is experienced asthe other is actually a “virtual image of the self”that is felt to exist as a kind of internal enemy.“At the noetic level of the pour soi,” claimsKimura, “the self alters itself, transforming intoa not-self and is only secondarily projected intoexterior space” (1992, 192). Many such patientswith delusional schizophrenia will experience aspecific other, for example, a persecutor of somekind, but what is more significant is a kind oftranscendental otherness that underlies this seem-ingly paranoid structure (138): A pure and abso-lute otherness, or otherness in general, somehowinsinuates itself into the patient’s subjectivity,thereby depriving him of the ipseity or self-affec-tion that would normally be present.

Kimura’s discussion of self-experiences inschizophrenia is rich and suggestive with intrigu-ing implications on both a theoretical and clini-cal level. He makes an admirable attempt todistinguish schizophrenic self-disturbance fromwhat may seem to be analogous phenomena inother disorders, including borderline personality,melancholia, and ordinary depersonalization ex-periences (1992, 124ff). The abnormal experi-ences Kimura describes would certainly test any-one’s powers of description and imagination; Iadmire his effort to come to grips with the sheerstrangeness of schizophrenic experience withoutattempting to reduce this strangeness by assimi-lating it to something more familiar. Still, onewonders whether it might be possible to be morespecific or clear or to describe consciousness orcognition in ways more amenable to empiricalstudy or perhaps interdisciplinary collaborationwith the cognitive neurosciences. What, for in-stance, does it really mean to speak of experienc-ing a “virtual image of the self” within the self,or a kind of ‘transcendental alterity’ in general”?(192, 138). It would be interesting to attempt totranslate these notions into some of the conceptsof contemporary philosophy and cognitive sci-ence (see Gallagher 1997; Gallagher and Shear1999). Also, Kimura (at least in this book) sayslittle about the relationship among the severalforms of schizophrenic abnormality that he de-

scribes, and this leaves the structure of his con-ceptual model somewhat obscure.

Kimura (1992) does mention both aspects ofthe self-disorder that I would see as crucial: ex-aggerated reflexivity and a closely allied dimin-ishment of normal ipseity (e.g., 117, 191). But—at least in this collection of essays—he says littleabout how one should conceive the relationshipbetween these phenomena. Are hyperreflexivityand diminished self-affection to be understoodas intimately intertwined yet distinct processesthat can interact or give rise to each other, or,perhaps, as aspects of a single whole that isdescribed from different angles of vision? Kimu-ra does not specifically address this question. Iwould suggest that it is most consistent with theholism of a phenomenological perspective—andwith Kimura’s approach in particular—to con-ceive hyperreflexivity and diminished self-affectionas two complementary (or equiprimordial) facetsof a basic experiential transformation of the actof consciousness. Polanyi’s notion of the tacitdimension may help to illuminate this comple-mentarity: Whereas the notion of hyperreflexivi-ty emphasizes the way in which something nor-mally tacit becomes focal and explicit, the notionof diminished self-affection can be seen to em-phasize a complementary aspect of this very sameprocess—the fact that what once was tacit is nolonger being inhabited as a medium of taken-for-granted selfhood. It may be, then, that hyperre-flexivity and diminished self-affection are aspectsof the very same phenomenon, the same distor-tion of the intentional arc that we are merelylooking at from different angles and describingin different words.

It would be consistent with the Husserlianapproach mentioned in the previous section toview these aspects of the act of consciousness asthe primary or constitutive disturbance with al-terations in the field of awareness—such as lossof natural self-evidence—having a somewhat sec-ondary status. (This would seem to jibe withKimura’s statement that “a healthy individual-ization of the self is necessary to assure a healthyconstitution of natural evidence” [188].) Such aview would not imply that hyperreflexivity anddiminished self-affection (the two facets of the


disturbed act of consciousness) exist indepen-dently of, or prior to, the disturbance at the objectpole of awareness—it is, after all, essential to con-sciousness that it be consciousness of something.Hyperreflexivity and diminished self-affectionwould not be the cause so much as the conditionof possibility for the object-pole disturbance.7

I would argue, then, that these three aspectsneed to be understood as complementary aspectsof mental activity as a whole (Marbach 1993,35), with hyperreflexivity and diminished self-affection considered to be two facets of the noeticact, and loss of self-evidence as a key feature of thenoematic field of awareness. Phenomenologicalanalysis is less a matter of discovering interactingprocesses than it is of unfolding the different facetsof conscious activity in order to provide a richergrasp of its lived texture and internal structure.

Conclusion

There are obviously many differences betweenMinkowski, Blankenburg, and Kimura—differ-ences of style and intellectual approach as well asin their preferred ways of describing schizophrenia.But it would be a mistake to let these differencesobscure the affinities that link these approachestogether and allow them to compose a reason-ably coherent vision of schizophrenic disorders.

All three phenomenologists are clearly at oddswith the defect or deficit models prominent inpsychiatric theories of schizophrenia; as we haveseen, each puts considerable emphasis on exag-gerations of intellectual, rational, or other “high-er” processes. Also, each of these phenomenolo-gists adopts a holistic perspective that isinconsistent with many of the modular approach-es common in contemporary cognitive science aswell as with the emphasis on symptom over syn-drome or diagnostic entity that has become pop-ular in current psychiatry. Each of them empha-sizes paradigmatic cases (e.g., Minkowski’s andTargowla’s Paul, Blankenburg’s Anne) rather thanstatistical generalizations. It is obvious as wellthat all three psychiatrists reject Jaspers’s pessi-mism about the possibility of understanding thestrange experiences or utterances of such indi-viduals. Minkowski, Blankenburg, and Kimura

all believe that empathy and the imagination,combined with the conceptual tools provided byBergson, Husserl, Heidegger, Nishida Katoro, orother thinkers, can provide an entrée into thelived-world of schizophrenia.

One should also note that none of the threephenomenologists appears to be very sympathet-ic to the largely developmental account of schizo-phrenia that is common in the psychoanalytictradition—where schizophrenia has generallybeen seen as regression to or fixation at a devel-opmentally immature or primitive form of con-sciousness. In his Traité de Psychopathologie(1999a, 389–411), Minkowski argues that theoft-asserted parallel between schizophrenia andthe primitive mind is based on a superficial re-semblance between symptoms taken in isolation.In his view, the “magical participation” describedby the anthropologist Levy-Bruhl and others, forexample, has nothing in common with the frag-mented or vague and diffuse thinking found inschizophrenia (400). Kimura, too, conceives ofschizophrenia as antithetical to the typical con-figurations of personality or self in traditionalsocieties (1992, 135). I would agree with theircriticisms of the primitivity view. There are, infact, interesting parallels between the forms ofexperience and expression in schizophrenia andin modernist and postmodernist culture, affini-ties that reveal the central role of alienation andhyperreflexivity in the schizophrenia spectrum(Sass 1992a).8

As I mentioned before, madness has tradition-ally been defined as a loss or severe diminish-ment of “higher” mental abilities, especially rea-son but also including the capacities for volition,abstract thought, and self-conscious or self-criticalawareness. For this reason, madness has often beenviewed as the very antithesis of philosophy—thefield of intellectual endeavor whose querying andquest for meaning may seem the purest expres-sion of these capacities and the ideals they repre-sent. According to one influential tradition, philo-sophical reflection is a sort of ultimate expressionof the vitality of the human essence, but there isanother tradition that has seen philosophy assomething unnatural and “out-of-order,” con-trary to the health of the human condition (Arendt


1971, 78–79, 123). In this context, Blanken-burg’s comparison of the schizophrenic attitudewith phenomenological bracketing (the epoché)is of particular interest, for bracketing is not onlycentral to phenomenological philosophy but alsoemblematic of the withdrawal and self-examina-tion that seems essential to philosophy itself (Hus-serl 1964, 19). The views of Minkowksi andKimura have similar implications.

The “interrogative attitude” Minkowski de-scribes can seem almost a parody of certain formsof philosophical curiosity and doubt (see Wit-tgenstein’s On Certainty 1969). Kimura’s accountof the self-dividing or self-alienating introspec-tion often found in schizophrenia is highly remi-niscent of the kind of abstract speculation onthese matters to be found in such philosophers asKant and Husserl; it recalls as well the tensionsbetween internal and external or between subjec-tive and objective points of view that the philos-opher Thomas Nagel (1986) has characterized aspervading human life and as especially importantfor the generation of philosophical problems (6).As I have pointed out, the self-alienating, self-fragmenting implications of schizophrenic self-consciousness also have interesting affinities withattitudes toward the self to be found in Humeand William James (Sass 1992a, chap. 7). Thediagnosis and analysis of traditional or “meta-physical” philosophy offered by Ludwig Wit-tgenstein can, in fact, be used to illuminate thestructure of key symptoms of schizophrenia (Sass1994). Like the “metaphysical” philosopherwhom Wittgenstein criticizes, the schizophrenictends to lose contact with everyday social andpractical realities and to rely instead on alienatedbut self-validating forms of abstraction and self-reflection. Recognizing these parallels betweenphilosophy and madness forces one to go beyondthe simplistic conception of “insight” that is prev-alent in contemporary psychiatry.

In contemporary psychiatry, “lack of insight”is commonly said to be one of the most distinc-tive features of schizophrenia (Amador and Dav-id 1998). This is certainly true if “insight” isdefined in the specific, psychiatric sense of theterm, that is, as a tendency to agree with themedical or psychiatric view that one is suffering

from a mental disorder or disease and that one’sunusual experiences and actions are consequenc-es of this disorder. Persons with schizophreniamay also lack insight in the sense of lacking aquick, intuitive grasp of the conventional importof a social or practical situation. But if “insight”is understood more broadly, then the situation inschizophrenia is not nearly so clear. Certainly,schizophrenics themselves often feel that theyengage in deep and serious thought. “When I amwalking along the street,” said one such individ-ual, “it comes on me. I start to think deeply and Istart to go into a sort of trance. I think so deeplythat I almost get out of this world.” (McGhieand Chapman 1961, 109). And persons withschizophrenia often feel they have privileged ac-cess to or awareness of the true nature of thehuman psyche or the cosmos itself. Indeed, theymay “believe that they have grasped the pro-foundest of meanings; concepts such as timeless-ness, world, god, and death become enormousrevelations which when the state has subsidedcannot be reproduced or described in any way”(Jaspers 1963, 115). This feeling of insight may,of course, be nothing more than the illusion ofinsight—as Jaspers suggested was often the case inschizophrenia. There may, however, be somethingabout the schizophrenic or schizoid condition thatallows at least some such individuals not only toreveal but also to have heightened awareness ofaspects of human subjectivity and its relation-ship to the world (Sass 1992b; 2000 [2001]).

In The Phenomenology of Perception, Mer-leau-Ponty (1962) describes an experience that iscommon in schizophrenia as well as in phenome-nological reflection: the feeling that one is privyto a kind of insight or self-awareness more pro-found than is available to people more fully en-gaged with the concerns of normal life. “Reflec-tion,” he writes, “slackens the intentional threadswhich attach us to the world and thus bringsthem to our notice; it alone is consciousness ofthe world because it reveals that world as strangeand paradoxical” (xiii). Merleau-Ponty knew thatthe disengagement and introspection character-istic of phenomenological reflection did not nec-essarily offer a surefire route to reality or thetruth, that these orientations are, in fact, as capa-


ble of distorting the nature of human experienceas of revealing it (1968, xlvi, 31, 38f, 43). Hetherefore called for a kind of meta-reflection orsur-réflexion that would recognize the distor-tions that reflection itself—even in its phenome-nological form—is capable of imposing.

Many persons in the schizophrenia spectrumof disorders do seem to have a special predilec-tion both for disengagement and the forms ofconsciousness it entails—with all their potentialfor both insight and illusion. In this sense wemight echo Blankenburg in saying that schizo-phrenics, at least some schizophrenics, are natu-ral phenomenologists—though seldom of the kindthat engages in the self-critical, self-transcendingsur-réflexion for which Merleau-Ponty called.Perhaps it is not so surprising, then, that phe-nomenological psychiatry has had such an affin-ity for this paradigmatic psychiatric disorder: Itis a disorder whose very strangeness may wellstrike the phenomenologist as having an uncan-ny, and rather disconcerting, familiarity.

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Notes1. I am very grateful to Wolfgang Blankenburg and

Kimura Bin for their kind cooperation with this project,and to Eugene Minkowski’s daughter, Mme. JeanninePilliard-Minkowski, for conversations about her fa-ther. Thanks also to Pierre Bovet and James Walkupfor helpful comments on the manuscript of this intro-ductory essay, and to Annick Urfer for consultation onMinkowski’s essays.

All translations in this article are my own, andnearly all are translated from French. In the case ofworks by Blankenburg (1991) and Kimura (1992),written originally in German and Japanese, respective-ly, I worked from French translations (though I con-sulted the German in the case of Blankenburg).

2. Kimura Bin reports (e-mail communication toL.A.S., February 19, 2002) that it was his reading,while a medical student, of a Japanese translation ofMinkowski’s La Schizophrénie that made him decideto go into psychiatry.

3. Of relevance here is the prominence of schizoidfeatures in many important philosophers. See, e.g.,Sass (2001) re Ludwig Wittgenstein.

4. But see Blankenburg (1991, 29, 5f), where hequestions this distinction between fundamental or bas-al versus secondary or compensatory aspects, statingthat in schizophrenia, the two components may noteasily be separated. Blankenburg’s characterizations ofreflexivity do, however, nearly always give it a second-ary status.

In one passage, Blankenburg endorses Jaspers’s de-scription of how abnormal reflexive self-awareness caninsert itself in an almost automatic or consequential (asopposed to compensatory) fashion once it is no longeractually excluded by the natural, spontaneous flow ofimmediate life experience; Blankenburg speaks here of“insertion of reflection within immediacy “ (101; “Ein-bau der Reflexion in die Unmittelbarkeit,” 1971, 59).

5. It seems that diminished ipseity can also developin a compensatory and quasi-intentional fashion. Pa-

tients with Dissociative Identity Disorder or Post-Trau-matic Stress Disorder, e.g., seem to undergo a loss ofthe sense of their own reality or existence as experien-tial subjects that is, at least in part, defensively moti-vated. Similar developments can occur in the schizo-phrenia-spectrum: One patient, e.g., describes usingprolonged fixation of attention (staring at a spot) tobring about an at least quasi-intentional self-oblitera-tion: “I hold fast to my spot and drown myself in itdown to its very atoms” (Sèchehaye 1956, 32).

6. The notion of a (hippocampus-based) dysfunc-tion of the “comparator system,” e.g., might help toexplain the emergence of operative hyperreflexivity;for, in the absence of this normal function, what isusually presupposed (e.g., tacit sensations of bodilyawareness) are likely to emerge into focal awareness(Gray, Feldon, Rawlins, Hemsley et al. 1991). Distor-tions of working memory could also be relevant. For asummary, see Bosch (1994).

7. This constitutive type of relationship conforms toneither of the two types emphasized by analytic philos-ophers (e.g., Donald Davidson): It is neither “a psycho-physical link holding between states of affairs or events”nor “a relationship of making intelligible holding be-tween sentences.” But as Charles Taylor (1993, 318,326) points out, these two alternatives do not exhaustthe space of possibilities. The “world-shaping relation-ship” between the body and our “way of experiencing”is one example of a constitutive type of relationship.

8. This need not imply a causal link between schizo-phrenia and modernism; the parallels could be more amatter of affinities than of direct influence (Sass 1992a).It would not be surprising, however, if a propensity forbreakdown of common sense or natural self-evidencewere at least exacerbated in cultural contexts in whichskepticism and reflexivity are the rule; this might helpaccount for the greater chronicity of schizophrenia infully modernized societies (Sass, in press [b]).

sass, l. - self and world in schizophrenia. three classic approaches

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