- Asking the Right Questions on Psychosis and Intelligibility
The challenge of understanding psychotic phenomena is one of the enduring problems in the philosophy of psychiatry. The first to formulate the problem in its philosophical dimension was Karl Jaspers in General Psycho-pathology (first edition, 1913). Jasper’s solution was rather pessimistic, for he argued that we cannot extend empathic understanding to certain phenomena, such as primary delusions. His work was followed by a long period of philosophical silence on the issue, and it was only three decades ago that philosophy began to engage once again with the problem of understanding. Today there is a rich literature that explores this problem: from philosophy of language to European phenomenology, and from theories of rationality to philosophy of action, researchers have left few philosophical stones unturned in their attempts to illuminate psychosis.
Sofia Jeppsson’s eloquent essay Psychosis and Intelligibility belongs to this tradition of theorizing about psychosis. She guides us gently along the challenge of understanding unusual experiences and beliefs and, along the way, provides helpful definitions of the notion of intelligibility and convincing arguments for ‘intelligibility duties’: “we ought to try to understand others and try to see them as intelligible, as far as we can.” With a philosophical style that is at once conversational and precise, Jeppsson demonstrates how she made sense of her own lived experience through some of the philosophical concepts and theories that have been developed to render psychotic phenomena intelligible. From empiricist and rationalist accounts of delusions, from the concept of the bedrock, and from the reasoning traits amplified in psychosis, Jeppsson outlines an account of psychosis. The psychotic journey often involves a quest for understanding significant, yet strange, perceptual experiences amid severely challenged certainties. This quest, Jeppsson tell us, can end in the arrival to “the feeling of finally understanding what is going on … a theory that perfectly explains everything that was going on” When this occurs, “all the pieces of the puzzle slide into place,” no matter how idiosyncratic the finished picture might appear to others.
This arrival is powerful and, indeed, personal. Jeppsson, a philosopher, found meaning in a range of philosophical concepts that afforded a meta-account of psychosis. That is how she rendered her experiences of psychosis intelligible to herself. And here we have the first question on psychosis and intelligibility and two possible ways of answering it: [End Page 255]
Q1: How can I render my own psychotic experiences intelligible to me?
a. Arrive at a ‘feeling of understanding’ (e.g., I finally understand that I am at the center of a global conspiracy—“it all makes sense now”).
b. Arrive at a meta-account of psychosis (using concepts like the bedrock, feelings of significance, etc.).
Question 1b—which is one of the questions that Jeppsson implicitly addresses in her essay—is not so much a personal account of the meaning of psychosis, as we find in Q1a, but a meta-account that moves away from individual meanings for the sake of a general interpretation. As a stance, Q1b is probably only possible with a degree of hindsight, perhaps when one is not in the immediate grips of psychosis. The second question that we could ask about psychosis and intelligibility goes like this:
Q2: How can psychotic experiences be rendered intelligible to others who have not had them?
How we go about answering this question depends on what exactly we are trying to render intelligible:
a. What needs to be rendered intelligible is the psychotic worldview itself (as articulated in Q1a)
b. What needs to be rendered intelligible is not the psychotic content, but the meta-account, or theory, of psychosis (as articulated in Q1b)
Q2b is the second question that Jeppsson addresses in her essay—she is keen to illuminate theoretical constructs such as the ‘bedrock’ and ‘feelings of significance’ through psychotic and non-psychotic experiences.
Jeppsson is therefore concerned with two things: with developing a meta-account of psychosis that accommodates her own experiences (Q1b), and with rendering this account intelligible to people who have not experienced psychosis (Q2b). But if we define intelligibility, following Jeppsson, as “grasping what it was like for the...