- The Schizophrenic Person as a Moral Agent
We are glad to acknowledge the wide spectrum of topics posited by our commentators and at the same time the recognition of the thematic issue of our project: that the mentally ill is still a person, and that this humane dimension of his existence must be brought to the fore in psychopathological studies and kept always in the fore in the therapeutic process.
We are also glad to have encountered appreciation for the fact that long gone is the time when the clinician could have afforded to be the plenipotentiary in the therapeutic relationship, and that a more equal geometry of relations with the patient is not only useful but probably necessary for therapeutic success, intended as a "success [that] also involves complex existential issues surrounding self-ownership, personal identity and responsibility in the recovery process" (Bergqvist, 2021).
We agree that the clinician's acknowledgment of the patient's suffering and the patient's first personal sense of being understood are transformative tools in recovery (Bergqvist, 2021). The person's constitutive vulnerability needs to be recognized as a transformative resource in the healing journey through a genuine dialectic movement which is not finalized in removing this vulnerability, but rather in reassessing its meaning and potentiality in a completely different way (Brencio, 2021). Therapeutic success is always embedded into a plural dimension in which the I–Thou relationship is the pre-condition of the We-ness of existence (Binswanger, 1993). Recognition (being seen, heard, believed, and validated) is essential in a therapeutic process. But, as Flanagan (2021) writes, we would not leave this to just the therapeutic relationship, since patients are really longing for and asking for recognition more generally from others—not just from clinicians. The question is: How could philosophy and psychiatry contribute to the recognition of persons like Lorenzo in the social world? We have a dream: Can philosophy and psychiatry, and more specifically clinical phenomenology, help not just patients like Lorenzo to be recognized—but support relatives, neighbors, citizens, and all people belonging to our shared social environment recognize "mad people" like Lorenzo as members of this community and as resources for better living in our society?
Another point stressed by more than one commentary is the audacity of Lorenzo's will to be recognized as schizophrenic, embracing his "illness" to the point of making it the start of his core identity, and not refusing it, distancing himself, [End Page 35] treating it like a diagnosis on equal footing with another medical condition. Some commentators seem to be more impressed, some more doubtful; and both for good reasons! Schizophrenia is to Lorenzo an identity apparatus, rather than an illness or a diagnostic label. Banicki (2021) gets it right as he writes "It is for that reason, as it seems, that he prefers to say: "I think I am psychotic, I think I am schizophrenic! [emphasis added]," rather than satisfy himself with a conventional phrase such as 'I have the diagnosis of schizophrenia.'" There is currently a debate about how one should appropriately address persons like Lorenzo: "persons with schizophrenia," "schizophrenics," "schizophrenic persons," "persons (or patients) with a diagnosis of schizophrenia," and so on. Most contemporary experts would reject the term "schizophrenic" used as noun and prefer "person with schizophrenia." Yet, as argued by Sass (2007), the contemporary consensus downplays how schizophrenia may not merely hijack but actually transform the self; how schizophrenia may grow out of a particular personality structure, thus representing the culmination of a personal trajectory or mode of being; how schizophrenic modes of being can sometimes involve, often in paradoxical ways, certain forms of intentionality, self-awareness, commitment or even quasi-volitional choice (Stanghellini & Ballerini, 2007).
This is not merely a nominalistic problem, or an issue of political correctness; rather, it points to a crucial issue—the way "normals" actually see people like Lorenzo from a third-person perspective, the way people like Lorenzo see themselves from a first-person perspective, and finally the way they ask to be seen by the "normals." Flanagan understands how embracing his identity as a "schizophrenic" was for Lorenzo, rather than negative being...