Johns Hopkins University Press

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 [End Page 81] 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 which seldom occurs to most normal, "well-adjusted" individuals (Sass, 2011).

We should remember, then, that the de-centration inherent in normal, intersubjective experience is, from a different point of view, actually a profound centration—a centration on what Robert Musil once called "the utopia of the status quo" (Sass, 1992, 143). This would seem, in fact, to be a point that no Husserlian phenomenologist could safely deny, given that the very basis of Husserl's method involve a putting-into-brackets of the natural attitude itself, and a withdrawal, in some sense, from a socially grounded, conventional attitude (involving the "natural attitude" and "perceptual faith") into the relative isolation of the phenomenologizing ego. It is noteworthy, in fact, that phenomenology itself may have more affinities with the schizophrenic stance than we may be comfortable in acknowledging—as Blankenburg (1991/1971, pp. 112f) pointed out.

The turning-away from social intercourse and conventional views is certainly a key feature of schizophrenia, and it surely has many correlates and causes. For one thing, it seems to reflect the contrarianism and press toward originality common in schizophrenia—what Stanghellini and Ballerini (2007) have aptly termed "antagonomia" and "idionomia." It may also have roots in lower-level cognitive-perceptual tendencies, such as a diminished tendency to interpret perceptions via expectancies. Although this prevents such persons from quickly recognizing standard situations or stimulus patterns, it also allows them to be more open to recognizing unexpected possibilities. Another relevant factor may be the propensity for the kind of floating, speculative, meandering, impractical stance mediated by the neural "default-mode network," which has a tendency to operate unsuppressed in schizophrenia, even in situations that might normally call for a more practical orientation. Both these factors may be conducive to what can be called an "anything goes" attitude (Sass & Byrom, 2015), a form of excentricity that is surely bound up with the "pathological freedom" of schizophrenic thinking (Woods, 1938, 291) and may be one possible route toward what is—or has the appearance—of delusional thinking.

Fuchs is right to emphasize the role of diminished practical engagement and intersubjectivity in the development and persistence of schizophrenic delusions. These are indeed key factors—as he shows so elegantly. What I have argued, however, is that we may need to recognize, as well, that schizophrenia can involve, not mere incapacity or disinclination for shared perspectives, but also a (not unrelated) propensity for stepping-outside the social egocentricity of "common sense." Although they may lack one kind of excentricity and flexibility, they may manifest other forms to an unusual degree. [End Page 82]

Louis A. Sass

Louis A. Sass, PhD, is Distinguished Professor in the Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University. Sass is the author of Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought and of The Paradoxes of Delusion: Wittgenstein, Schreber, and the Schizophrenic Mind. He has published articles on schizophrenia, phenomenological psychopathology, psychoanalysis, hermeneutics, and the thought of Wittgenstein, Heidegger, and Foucault—as well as on modernism/postmodernism and other cultural issues. A revised edition of Madness and Modernism, recently published by Oxford University Press, was awarded the BMA: British Medical Association First Prize as best book in the field of psychiatry for 2018.


Blankenburg, W (1991, 1971). La perte de l'évidence naturelle. Paris: Presses universitaires de France. (German original in 1971).
Fuchs, T. (2020) Delusion, reality, and intersubjectivity. Philosophy, Psychiatry & Psychology, 27 (1), 61–79
Merleau-Ponty, M. (1945/2012). Phenomenology of perception (Trans. D. A. Landes). New York: Routledge.
Payne, R. (2012). Night's end. Schizophrenia Bulletin, 38, 899–901.
Sass, L. (1992). Madness and modernism: Insanity in the light of modern art, literature, and thought. New York, Basic Books.
Sass, L. (2017). Madness and modernism: Insanity in the light of modern art, literature, and thought, revised edition. Oxford: Oxford University Press.
Sass, L. (2011). Autonomy and schizophrenia: reflections on an ideal. In: C. Piers (Ed.), Personality and psychopathology: Critical dialogues with David Shapiro. New York: Springer.
Sass, L., & Byrom, G. N. (2015). Phenomenological and neurocognitive perspectives on delusion. World Psychiatry, 14 (2), 164–173.
Stanghellini, G., & Ballerini, M. (2007). Values in persons with schizophrenia. Schizophrenia Bulletin, 2007, 33, 131–141.
Woods, W. (1938). Language study in schizophrenia. Journal of Nervous and Mental Disease, 87.

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