- Striving to Make SenseThe Duty of Respect for Persons with Psychosis
In her wonderfully rich and insightful article, Sofia Jeppsson (2021) argues that, although a person with psychosis may seem to be strange and unintelligible to us, we nevertheless have duties of intelligibility toward them. And she draws upon her own experience to show that psychotic experiences and reasoning are more intelligible than we might have thought.
In this brief commentary, I focus on why the assumption of hypothetical intelligibility is a duty of respect owed to those experiencing psychosis. In everyday human interaction we expend significant resources on interpreting other people, largely to be able to predict and explain their behavior and to adjust our own behavior and expectations accordingly in our interactions with them. As Jeppsson illustrates, some people are more readily intelligible to us than others, but our default assumption is one of hypothetical intelligibility: if I had more information or experience this person’s actions would be intelligible to me. I proceed on the basis that they act for reasons, or out of dispositions, attachments, or emotions that are in principle accessible to me.
However, as Jonathan Glover (2014) has pointed out, people with psychiatric disorders may seem especially strange and alien to us. Their mental lives, their emotions and reasons for action seem deeply inaccessible. He quotes Jaspers “We may think we understand dispositions furthest from our own but when faced with such people we feel a gulf which defies description” (p. 126). In the face of this strangeness the assumption of hypothetical intelligibility is challenged and may be withdrawn. We retreat from what Dennett (1989) has called the intentional stance, to a more distanced mechanistic stance and may see the person as something to be explained and understood in terms of a malfunctioning brain. But in doing so we cease to see them, and respect them, as a person.
Jeppsson’s first-person account of what psychosis can be like, and of the challenges it poses to the person experiencing it, goes a long way toward demystifying the experience and making it more accessible to us. In doing so her account highlights an important ground of respect for persons that is largely undiminished in psychosis. This is the striving to make sense of oneself and one’s experience of the world that is fundamental to human agency.
According to J. David Velleman, effective human agency depends on the cognitive motives for self-knowledge and self-understanding that stand behind reflection. And he claims that these motives are constitutive of agency (Velleman, 1989; 2009). [End Page 251] Unintelligibility poses a threat to agency. Consider everyday experiences of dis-orientation. You emerge from a station entrance into the wrong street. You wake up in a strange place, not knowing where you are and perhaps, momentarily, not knowing who you are. You get off a plane and find that this is not the airport you were expecting (something that happened to me several times when I was frequently traveling between Melbourne and Sydney). In these cases, I at least, experience brief feelings of terror and paralysis. “What am I doing here? Am I in the wrong place?” As Velleman points out, I can’t do anything until I know where (and who) I am and what I am doing. It can take several moments for my bedrock of beliefs to orient me, and for memories of my more particular goals and intentions to emerge to guide my next steps.
This fundamental project all agents have of making sense of themselves and their circumstances—of being intelligible to themselves—is one that people with psychosis manifestly share. In interpreting and contextualizing their experiences, they make the best sense they can of them given their resources. As Jeppsson points out, when an illusion is persistent, and one’s bedrock of beliefs is eroded it may be hard to resist. The best explanation of your experience comes to seem that—for example—the person in the mirror is not me. The best explanation for the feelings of significance you get about the car parked across from your house is that you’re being spied upon...