The Philosophy of Schizophrenia

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Phil-229 Trinity College In his book, The Paradoxes of Delusion, Louis Sass attempts to rebut two of most prevalent beliefs of the schizophrenic person. He argues that by viewing the schizophrenic delusions in light of solipsism, a philosophy of existence, the schizophrenic may seem far more understandable. Through his comparison of the schizophrenic and solipsist realities, Sass explains that not only is schizophrenia understandable, but that there exists within the structure of schizophrenic delusion a seemingly self-contradictory state which in actuality approximates a sort of logic more than anything else. Thus, according to Sass, schizophrenia should not be deemed a state of unreason, but rather a reason which results from a dual conceptualization of the reality. Sass first introduces the traditional understanding of madness and delusion. The most fundamental basis under which a person is diagnosed as insane is when he displays a poor of false understanding of his environment, called "poor reality testing." "...disturbance in or failure of "reality-testing" is considered to be the defining criterion for diagnosing a so called psychotic condition."(p.1) The inability to correctly perceive reality is considered to be the basis for delusion, the basic characteristic of madness. But, as Sass explains, patients with schizophrenia, "the most severe and paradigmatic kind of insanity," often do not display actual poor reality-testing. While schizophrenic patients tend to accord great importance to their delusions, they do not handle said delusions in the same way that they handle what they understand to be objective reality. "...many schizophrenics who seem to be profoundly preoccupied with their delusions...treat these same beliefs with what seems a certain distance and irony."(p.20-21) They seem to retain two understandings of reality, so called "double bookkeeping," which allows them to exist "in two parallel but separate worlds: consensual reality and the realm of their hallucinations..."(p.21) This concept helps to explain why many schizophrenic patients do not act on their delusions in a manner which is appropriate for the given delusional situation. "A patient who claims that the doctors and nurses are trying to torture and poison her may nevertheless happily consume the food they give her."(p.21) They believe that their delusions are real, but only in the context of a world known only to them. "Schreber insists...that such beliefs-he calls them "my so-called delusions"-refers to a separate realm, one that does not motivate him to act and wherein the usual criteria of worldly proof does not apply."(p.31) While common understandings of poor reality testing include a patient's belief in things which are objectively false or non-existent, Sass argues that many schizophrenics also disbelieve those things which can be deemed objectively true or real. "...often schizophrenic delusions involve not belief in the unreal but disbelief in something that most people take to be true. Schizophrenic patients may..speak disbelievingly of "my so-called children and this so-called hospital..."(p.24) Along with these "delusions of disbelief," schizophrenic patients may perceive other human beings as machines or phantoms which just seem to be real people. Sass also explains how schizophrenic patients may believe that many of their experiences are products of their own mind and consciousness, as if they have created the reality which surrounds them by their own thought. "Schizophrenics may believe that they have invented everything they encounter-that...they themselves have just invented the story they have just read"(p.22) Schreber believed that the insects he saw were created at the moment he looked at them, and disappeared as soon as he looked away. These examples, along with the schizophrenic suspicion concerning the reality of other human beings, are central to Sass' likening of schizophrenia to the philosophical notion of solipsism. A solipsist believes that his reality is the only true reality, or as Wittgenstein puts it, "The world is my idea."(p.34) Most basically, solipsism refers to the belief that everything one perceives is a product of his own mind. Like the schizophrenic, the solipsist views other people as phantoms of a sort. "For the solipsist, other people, other seeming centers of consciousness, are but dream personages, figments of the solipsist's own conscious activity and awareness."(p.34) Because the most basic tenets of solipsism are lived out in the schizophrenic delusions, Sass believes that by considering the symptoms of schizophrenia in light of the solipsist model of reality, we can gain an understanding of much of the schizophrenic condition. Sass explains that Wittgenstein saw a strong connection between solipsism and intense concentration or "staring." "The phenomenon of staring is closely bound up with the whole puzzle of solipsism."(p.35) Wittgenstein also noted the importance of inactivity to the solipsist experience. Sass explains that by interacting with and moving about the world, a person has no choice but to accept the physical and objective quality of everything around him. This recognition "precludes a sense of...subjectivization" (p.35) thus hindering the solipsist understanding that everything he sees is, in effect, a product of his own mind. By interacting with the world..one is obliged to recognize the world's otherness...in a passive state, the world may look rather different. The more one stares at things, the more they may seem to have a coefficient of subjectivity; the more they may come to seem "things seen." When staring fixedly ahead, the field of consciousness as such can come into prominence; then, it is as if the lens of awareness were clouding over and the world beyond were taking on the aphanous quality of a dream. At this point, the person can be said to experience experience rather than the world...(pp.35-36) This is to say that the longer we stare at something, the more we think of a certain object in the sense of a visual, rather than physical object. Viewed as the concept of an object rather than an object in and of itself, the thing takes on a highly subjective quality. "In this situation, any object of awareness tends to feel that it depends on me in some special way, belonging to my consciousness as a private and somehow inner possession."(p.36) Sass points out that many of Schreber's schizophrenic experiences were accompanied by just such circumstances of intense concentration and almost complete inactivity. "Apart from daily morning and afternoon walks in the garden, I mainly sat motionless the whole day on a chair at my table..."(p.37) It appears that certain types of delusions would not occur if Schreber were moving around. "The experience of "miracled-up" insects...seems not to have occurred unless Schreber was in a state of immobility...if he sat down and waited he could actually provoke this wasp miracle." (p.38) Schreber's experience of the "wasp-miracle" is perhaps the very best example of the proximity of the schizophrenic and solipsist realms. He believed that his gaze provoked the spontaneous generation of the insects, an understanding which gave Schreber the "sense of being the conscious center before whom and for whom events appear."(p.38) Sass also points out passages of Schreber's Memoirs which indicate his awareness that other minds cannot exist, a fundamental notion of solipsism. "The solipsist, who is so struck with the undeniable actuality and centrality of his own experience, obviously cannot have this same awareness of the experience of others. In fact, the more he pays attention to his own experience, the more unlikely it seems that other people can have anything like this-and the more others come to seem...not really conscious beings at all."(p.39) An understanding of solipsism helps us to see why the schizophrenic patients fail to respond to their delusions or react in what seems an inappropriate manner. As Sass explains, both schizophrenics and solipsists see reality as a mental reality of concepts or ideas. Thus is would be largely futile to attempt to act out in any physical way because tangible maneuvers could have no affect in a world where nothing is of substance. "...in a solipsistic universe, to act might feel either unnecessary or impossible: unnecessary because external conditions are at the mercy of thought...impossible because real action, action in a world able to resist my efforts, cannot occur in a purely mental universe." (p.42) In light of this "merely mental or representation" understanding of the world, it seems clear that a schizophrenic person would naturally speak in metaphor, something which Sass believes is often unknown or ignored. "A failure to realize that a patient may be describing such a mode of experience can...lead to an overly literal interpretation by the therapist, and thus the mistaken impression that the patient's reality testing has broken down."(p.44) Additionally, schizophrenic patients often perceive their own physical bodies as representational or conceptual. So when they have delusions of their bodies and other people's bodies undergoing radical physical changes, they are not bothered by it because it seems affectless and inconsequential, as if one were cutting up paper dolls. Sass explains that consideration of the solipsist reality can illustrate a potential reason for the schizophrenic anxiety, described by a doctor of Schreber's as a "tense" and "irritable" state "caused by inner uneasiness."(p.37) With the belief that the world is a product of one's own mind comes, to a schizophrenic patient, an immense feeling of responsibility. They lack the luxury of having the ability to "stop playing the game," if you will, and leave their beliefs behind. While the notion of single-handedly controlling existence is accompanied by a sense of awesome power, it also proceeds a fear of causing the demise of the universe. "One catatonic patient explained why she would hold herself immobile for hours in an uncomfortable position...it was, she said, for the purpose of 'stopping the world march to catastrophe': 'If I succeed in remaining in a perfect state of suspension, I will suspend the movement of the earth and stop the march of the world to destruction.'"(p.50) Wittgenstein believes, and rightfully so, that solipsism is wrought with contradiction. Sass also admits that schizophrenic patients are often plagued by their own contradictions, most notably simultaneous feelings of omnipotence and impotence, and the desire to make others understand their experience while believing that they are the only people capable of experience. Many of these contradictory notions do not work within the context of the solipsist world view, and thus appear at first to work against Sass' crucial comparison between schizophrenia and solipsism. However, Sass proposes that the contradictory nature of the schizophrenic experience does not undermine its close relation to solipsism, but rather demonstrates the proximity of schizophrenia to the inherently contradictory nature of solipsism itself. Schizophrenics typically oscillate persistently between a feeling of being a virtual master of the universe and a belief that their very being is in some way inconsequential. "Schreber senses at times that his boundaries extend to the ends of the universe: "It appeared that nerves-probably taken from my body-were strung over the whole heavenly vault." But he also feels that he is tiny, and almost nonexistent being lost in the vastness of space."(p.65) While the latter may seem to contradict Sass' link between the schizophrenic delusional world and the solipsist understanding of reality, Sass explains that if we simply follow Wittgenstein's argument against the solipsistic viewpoint, we see that even in self contradiction, the schizophrenic reality may maintain it's close connection with solipsism. A solipsist begins by believing in his central, controlling role of the universe. Staring and intense concentration give a person the feeling that "only me experience of the present moment is real."(p.67) But, as Wittgenstein explains, if a person follows the solipsist principles carefully, he will soon realize that he is does not see himself in his existence, even though his experience is all that really is. "If he closely scrutinizes his experiences-which...are all that exists-he must admit that he does not find himself there." He goes further to say that if a solipsist did see himself in his world, it could only be as an object of that world, which is, in affect, a product of thoughts and ideas. He cannot, from this experience, affirm his omnipotence. "...even if one did see oneself within one's experience, that self, being within the phenomenal field, could exist only as an object, not in the role of the all powerful constituting subjectivity for which the solipsist yearns..."(p.68) Furthermore, since the solipsist believe the only reality is that which is perceived, and since he cannot perceive himself as anything but an object of his own consciousness, it is necessary for the solipsist to believe there is another conscious being which perceives him as an object, thus confirming his object reality. But this concession also undermines the primary tenet of his reality being the only reality. With all of this in mind, it seems clear that the schizophrenic patients could understandably feel both all and nothing at the same time. In Schreber's case, Sass points out, his "sense of being the solipsistic center occurred at those moments when he was also experiencing the contradictory presence of another mind."(p.73) The "one" whom Schreber speaks of so frequently is generally a believer in the idea that Schreber creates the world around him. This also gives insight into the typical schizophrenic "loss of self," that is, the felling that one's thoughts are belong to some other consciousness or no one at all. This could also be related to the feeling which schizophrenics have of some foreign power controlling the direction of their gaze. By demonstrating that schizophrenia mirrors a philosophic notion like solipsism, Sass successfully illustrates that it is not entirely accurate to believe in schizophrenia as a state of unreason. While one might correctly state that solipsism is in some way illogical and unreasonable in and of itself, it would be still be reasonable to conclude that there is some inherent logic or reason in the discovery of this inherent self-con

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