Delusion, Reality, and Excentricity: Comment on Thomas Fuchs

In "Delusion, Reality, and Intersubjectivity," Thomas Fuchs offers a superb presentation of an enactive/phenomenological approach to schizophrenic delusions—an approach that is clearly superior to the poor-reality-testing formula (with its simplistic equation of delusion with "mistaken belief") that has dominated thinking about delusion in psychiatry, psychoanalysis, and cognitive-behavioral theory. As he convincingly argues, two key tendencies go a long way toward accounting for the distinctive features of delusion in schizophrenia: 1) withdrawal from practical, sensori-motoric interaction with the physical environment; and 2) failure to experience reality in intersubjective terms—as a realm of "participatory sense-making" that is open to the viewpoint, actual or potential, of other human subjects, and whose very stability is grounded in this sharing. The latter is what Merleau-Ponty (1962) was referring to when he spoke of "perceptual faith," and when he wrote these lines: "Paul and I 'together' see this landscape, we are jointly present in it, it is the same for both of us, not only as an intelligible significance, but as a certain accent of the world's style, down to its very thisness" (p. 406).

Fuchs rightly notes that schizophrenic persons fail to decenter themselves, to adopt what he calls an "excentric" position by recognizing the point of view of other persons. This lack of "excentricity" certainly helps to explain the prominence of both paranoia and grandiosity in patients in the schizophrenia spectrum—where paranoia and grandiosity can often have an all-inclusive or ontologically tinged flavor, as indicated in one patient's account: "It feels like the universe is zoned in on me" (Payne, 2012). Every human being is of course, the center of a universe, or at least, of his or her own universe; and unless one relativizes this fact, thereby demoting its general significance, one will indeed be prone to interpretations of the world that make one feel oneself to be either A) the true center who constitutes or grounds the universe (grandiosity) or B) the prime target of all surrounding glances and converging intentions (paranoia).

Fuchs is quite right to argue, then, that the schizophrenic proneness to delusion is bound up with the diminishment of normal forms of intersubjective relativizing. I would argue, however, that one should be careful not to neglect a couple of points that may cast things in a somewhat different light. One is the fact that when, in schizophrenia, the perceptual field (as Fuchs notes) becomes "subjectivized," the subjectivization at issue may involve not only a failure to take the points of view of actual other people into account, but also an abnormally acute recognition/awareness of the role of subjectivity itself (a fact that may bring some such patients closer, in a way, to Kant's Copernican revolution than to the naïve egocentricity of Piaget's young child). The latter introduces a form of perspectivism, indeed of "excentricity" (in more than one sense of that term), that is typically absent in normal individuals, who tend to live unthinkingly in the complacency of their common-sense world, and it may contribute to the experiences of derealization that are so characteristic of schizophrenia (Sass, 2017 chapters 9, 10, 11).

Also, from the point of view of some schizophrenia-spectrum individuals, the normal, commonsense viewpoint can sometime look hidebound by conventionality, closed off from the very possibility of seeing things in new or multiple perspectives, or indeed from recognizing the perspectival nature of truth. One young man with schizophrenia saw most other human beings as cognitive robots ("organic machines"), so mechanical and predictable were their conventional responses to the world (Sass, 1992, p. 334). Some patients feel they must guard their originality lest it be contaminated by too much interaction with others: "My aversion to common sense is stronger than my instinct to survive," said one patient (Stanghellini & Ballerini, 2007). Statements such as these should remind us that the absence of normal intersubjective grounding is no simple affliction or deficit, but can sometimes involve insistence on a certain kind of cognitive autonomy and relativity, the need for which or appeal of...