Why Schizophrenia Is so Relevant to Enaction and to Clinical Ethics: Naturalizing the Transcendental and the Risk of Stigmatizing

The mutual interest between embodied cognitive sciences, in particular enactivism, and phenomenological psychopathology has significantly increased in the last 15 years (Colombetti, 2013; Dibitonto, 2014; Fuchs, 2009; Fuchs, Sattel, & Henningsen, 2010; Parnas et al., 2011; Sass & Parnas, 2003, 2007; Sass, Parnas, Zahavi, 2011; Stanghellini, 2004). Gipps's article contributes to this field of research by defining ego boundaries in an enactivist framework to explain how the distinction self-other emerges and is maintained in ordinary healthy conditions, and how it is weakened and impaired in cases of schizophrenia. Gipps's first tenet is: The ego-boundary is enacted equiprimordially with experience, that is, it coarises with the self's perception of its world. Nevertheless, it cannot be considered a mere part of experience, as it is rather its condition of possibility: the ego-boundary is a formal and transcendental (i.e. structural and constitutive) aspect of experi ence. The corresponding schizophrenia-tenet is: schizophrenic disturbances of the ego-boundary are disturbances of alterity: primary disturbances of the very constitution of the self as it arises in defining itself in contradistinction to a perceived other or to a perceived environment. The enactivist account is then presented as an ontological account, describing biologically existing phenomena that are, as such, naturalistically investigable - in contrast to the mainstream epistemological account that considers schizophrenia as a theoretical construct. For example, instead of regarding voice-hearing or thought insertion as failures in self-awareness (in the form of a mistaken inference: "I am not aware of being the author of this piece of inner mulling, therefore it must be ego alien"), the enactivist account regards such phenomena as truly and originally ego-alien, as constituted ab initio as non-ego. According to Gipps, subjective feelings of 'ontological insecurity' (Laing, 1959), such as "I cannot know whether I exist" (Hesnard, 1909), thus correspond to a de facto disordered constitution of the ego-boundary.

Gipps's account shows the theoretical usefulness of the distinction between the empirical (lived) ego and transcendental (structural and constitutive) ego. As Gipps explicitly mentions this key philosophical point, it is odd that there are no references to Blankenburg's The Loss of Natural Self-Evidence (1971). Regarding the constitution of the self, Blankenburg differentiates the natural, empirical, experiencing self, from the transcendental self that structures one's experiences. The clinical relevance of this theoretical distinction is that it allows us to distinguish between neurotic and schizophrenic insecurity: neurotic insecurity pertains to the empirical self, whereas schizophrenic insecurity concerns the transcendental self. A disorder in the empirical self does not imply a disorder in the transcendental self—and vice versa. The schizophrenic patient can indeed show a certain self-assurance (or reassurance), especially regarding delusions or hallucinations, whereas the neurotic patient can be highly insecure without any weakening of her ego-boundary (Blankenburg, 1971, 100–101).

But Blankenburg, even though he considers the relation between the empirical and transcendental self as a continuous, dynamical process, repeatedly underlines the a priori character of the transcendental self: it is something occurring "before" the empirical self. His patient Anne for instance precisely complains of the lack of something preceding experience which she calls something "before that," before that ordinary practical understanding also known as "common sense." Blankenburg thus shows the relevance of the a priori for the life-world by engaging with psychopathology: according to him the structuring self can be experienced in its a priori function only when it is weakened or disordered; otherwise it is transparent to experience (Blankenburg, 1971, pp. 83–92).

Following Blankenburg's view, it is then doubtful that the transcendental enaction of the ego-boundary is equiprimordial with experience, as Gipps maintains. This is a key theoretical point: if the transcendental self is no longer considered as an a priori given boundedness of the self, but rather as a self-boundary that is equiprimordially constituted with active and receptive experience, the transcendental level of experience as such can be reconceived as to become naturalistically investigable. Such enaction of the ego-boundary as equiprimordial with experience...