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), [End Page 107] 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 is continuously open to be reconstituted and occurs without generating any a priori self-structuring, any so to speak formally permanent ego. But this seems to describe a structural vulnerability to alterity that is similar to the schizophrenic condition, rather than describing a healthy, well-constituted ego-boundary. Is such an enactivist account of the ego-boundary still able to sketch the clinical difference between a healthy and a pathological constitution of ego-boundary? And can a non-a priori transcendental self still be defined as transcendental?
My second objection relates to the first, insofar it emphasizes the difference between the transcendental level of the constitution of ego-boundary and the ontological level of ego experience. Gipps abandons the traditional phenomenological caution about any inference from transcendental to ontological statements and openly claims that disturbances in the constitution of the ego are ontological disturbances. It is surely a theoretical advantage: it makes the enactive approach amenable to naturalistic analysis by implying that schizophrenic disturbances are empirically verifiable at least in their sensorimotor subpersonal component. Shall they hence be considered ontologically existent as such?
My objection is ethical: from the description of a disorder as an ontological problem, it is a small step to describing a person as ontologically compromised, and another small step to consider a person as ontologically inferior. Gipps's ontological account of ego boundaries could thus lead to stigmatizing schizophrenic patients. To maintain the distinction between the transcendental and the ontological level of self-disorder is then not only clinically relevant, but also ethically necessary: a disturbance in the constitution of ego-boundary is a transcendental disorder, not an ontological one, even if it is subjectively experienced as such by patients. Even if the subpersonal level of neurological loops comprises the enaction of ego-boundary, [End Page 108] this subpersonal level cannot be confused with, nor extended to the level of personal existence, because it would undermine the person's moral and existential value. After Levinas's critique (Levinas, 1998), ontology cannot be reduced to the mere presence of naturalistically verifiable phenomena: ontology should rather be conceived as a theory about the relation between the contingent existence of human beings and the being transcending any contingency, namely, the moral value of the person. The ontological irreducibility of any person to its disorder is hence the ethical limit to any clinical theory and practice.
Daria Dibitonto teaches Moral Philosophy and Psychology at the High Academy of Religious Sciences in Novara (Italy). She pursued her PhD in Philosophy at the Avogadro University of West Piedmont, where she worked as a researcher in philosophy and psychopathology in cooperation with the Public Mental Health Centre in Chieri (Turin), spending some research months at the University Clinic of Heidelberg with Professor Thomas Fuchs. After having graduated in Psychological Sciences at the University of Turin, she is now getting her master's degree in Clinical Psychology. She has published two books and several papers. To be mentioned: No Non-sense without Imagination: Schizophrenic Delusion as Reified Imaginings Unchallengeable by Perception (2014) in M. Cappuccio, T. Froese, Enactive Cognition at the Edge of Sense-Making: Making sense of non-sense, Palgrave Macmillan and Phenomenological Psychopathology: From Spatial Disorder to the Problem of Disembodied Desire (2014), in "Rivista Internazionale di Filosofia e Psicologia."