Introduction: Understanding, Explaining, and Intersubjectivity in Schizophrenia

Karl Jaspers once asked whether it would be possible for a community of schizophrenic patients to exist, a "community united in common delusions [the content of] which they mutually elaborate as true by means of their common experience of it" (Jaspers 1963, 284). ¹ He professes himself unable to answer this question, but suggests that "[t]he putting of the question is more important than the empirical answers so far obtained" (284). What seems to have motivated Jaspers was the idea that the "personal world" in which healthy individuals live is constituted, in part, socially. It is, as he says, "characterized by objective human ties, a mutuality in which all men meet" (281) and can thus be studied as a cultural, historical phenomenon. The world of the schizophrenic patient, by contrast, seems to resist such a study. Schizophrenic patients, Jaspers suggests, live in "specific, private worlds," which are not mediated by communication with others and whose origins are to be sought in a psychopathological process that actually severs normal social ties.

Jaspers' talk of different "worlds" in which schizophrenic patients and healthy individuals live can be seen as an attempt at articulating a key concern for psychopathology, which is also central to the articles collected in this special issue. Psychological understanding may be thought to face a twofold challenge when it comes to making sense of the symptoms from which schizophrenic patients suffer: Not only do we need to make intelligible the situation in which the patients find themselves, we also need to make intelligible a sense in which this situation is radically different from our own, i.e., a sense in which that situation resists understanding "from the inside." There is a strong intuition that any attempt at understanding that construes schizophrenic symptoms as manifestations of just another subjective take on a shared reality misses the very feature that makes them so puzzling. As Naomi Eilan (2000, 97) has put it, our task is to "solve simultaneously for understanding and utter strangeness" when faced with such phenomena.

In this introduction, I cannot cover all the different ways in which the various authors approach this difficult issue and the detailed suggestions they make. Instead, I wish to concentrate on a related, but perhaps less obvious, thread running through the different contributions, which echoes the more specific link that Jaspers draws between the "specific, private worlds" of schizophrenic patients and the question as to whether there could be a community of such patients who understand "amongst themselves something which we fail to understand" (Jaspers 1963, 283f).

There are in fact several quite different ways in which this link might be understood. Jaspers, it seems, thought that schizophrenic patients do not have a problem with communication as such; it is just that they do not normally find anyone with whom they can communicate, because nobody has shared their experiences. On this view, it is just a contingent matter that there does not appear to be a schizophrenic community of the type envisaged. An alternative possibility, however, is that there is a more radical sense in which the patients are debarred from communication, and that it is actually impossible for a real community of schizophrenic patients to exist. The suggestion would be that patients have generally become unable to regard others as subjects with whom they can exchange reasons and share experiences.

Variants on something like these two suggestions can be found in a number of contributions to this special issue. Sean Spence, whose discussion focuses specifically on various forms of alien control, notes at the outset of his article that patients suffering from this symptom seem to be assailed by changes in subjectivity, which, by their very nature, implicate an altered relationship with others around them. Two case vignettes he gives provide vivid illustrations of this. In one, a male patient with tardive dyskinesia is temporarily under the impression that the reason for his impaired ability to speak is that the interviewer is trying to...