Synopsis and implications

This section attempts to amalgamate the intersubjective approaches of Merleau-Ponty, Binswanger, Buber, and Scheler, and based on them suggest possible implications to the comprehensibility of psychosis. These approaches suggest that we are ontically and ontologically inseparable from the world and others, understand intersubjectivity as an existential potentiality, an a priori imperative and a mode of being which conceptualises the other as a permeable embodied subject.

From a Sartrean or a Heideggerian perspective, these approaches might be criticised as suggesting an exclusively ontic or anthropological conceptualisation of intersubjectivity, which focuses mainly on interactional processes. However, based on a Merleau-Pontian, Binswangerian, Buberian and Schelerian vantage point, I advocate an exploration of intersubjective engagement that has an ontological status and endorses an approach that explains the nature of consciousness itself even in its pre-reflective sense. As has been already explored, Merleau-Ponty (1968) clearly claimed that immediate or pre-reflective embodied self-awareness is intersubjective in nature. The intersubjective approaches explored value the conscious and lived personal experience while they consider human existence as fundamentally and inextricably immersed in its world. Moreover, they move away from the Husserlian emphasis on agency and its cognitive and conscious processes and are more focused on an embodied, practical and concrete involvement with the world. I suggest that approaches that employ the paradigm of impenetrable, radical and extreme otherness to intersubjectivity (e.g. Sartre’s) are insensitive to the possibility of mutual recognition, especially in the case of psychosis. I also consider this one-sided conceptual emphasis of fundamental otherness to be problematic, especially in its application to the therapeutic situation as shall be later explained. Their lack of attention towards the process of being perceived and experienced (second-person perspective) and their overemphasis on the process of perceiving (first-person perspective) makes them inadequate to approach human distress intersubjectively, as the state occurring in the Buberian and Binswangerian betweenness of the person and the world.

Although the connection between psychosis and an intersubjective deficit is well documented, this hypothesis seems problematic to a certain extent. How can we apply this assumption in the case of a shared psychosis, such as in folie a deux and folie a plusieurs? In light of these cases when two or more people are experiencing the same psychotic experiences, someone might assume that these people are not living in isolated private worlds but instead are intersubjectively and meaningfully connected through these psychotic experiences. Moreover, in the cases of hallucinations, as is often reported in the literature (e.g. Kobayashi et al., 2004), people respond to their hallucinatory voices and hold meaningful conversations with them. Someone might rightly suggest that they are not trapped in their own private worlds but instead caught in an intersubjective world with their own hallucinatory characters and become part of an intersubjective world different from that shared by the not-psychotic community (Maung, 2012). What also seems to be ignored is that delusions are often presented as fundamentally intersubjective phenomena, both in form and content and manifest themselves in an intersubjective situation by demonstrating a persistent orientation to others by whom the person feels persecuted or manipulated.

Additionally, the person with psychosis is ‘accused’ of embodying an impenetrable otherness. Jaspers (1949/1963) for example insisted that the alteration of self-experience a person with psychosis goes through is so extreme which makes it incomprehensible, and the possibility of empathising and understanding becomes almost impossible due to the lack of meaning. Yet, intersubjectively speaking, we cannot speak of a lack of meaning as located within the self and therefore cannot meaningfully understand the self and her suffering in isolation from its context. From a Merleau-Pontian perspective meaning or its lack emerges because is found (or not) in the cultural and historical space in which the embodied subject is situated. In exploring the pre-reflective structuring of meaning in the subject’s intentionality, Merleau-Ponty asserted that it is bodily and socio-cultural in nature and implied that pre-reflective consciousness and its intentionality are intersubjectively constituted and maintained. However, existentially and intersubjectively speaking we are not only defined by our socio-cultural embeddedness. The project of becoming a self also calls for an integration of the ‘anonymous’ being or being an anonymous anybody (Keller,

2008). From a Merleau-Pontian and Schelerian viewpoints, the embodied subject is not therefore ontologically separated from others, yet is an anonymous existence, with its immediate intentionality characterised by an ambiguous structuring of meaning, which occurs in perception and expression pre-reflexively (Merleau-Pontly, 1945/1962). This ‘anonymity’, which might generate a sense of alienation in the person, is something universal and can be explored in relation to the experience of loneliness and separateness from the world and from others. Alienation is also contained in the Buberian betweenness as a collective phenomenon and the experience of separateness is transcended without negation of otherness. It accepts both otherness and mutuality as valid and recognised in the space between self and other, with the philosophically isolated ‘I’ and ‘you’ being replaced with a ‘between’. However, from a Buberian viewpoint, this process of oscillating between self and other, mutuality and separateness remains a fragile one. Along these lines, Rosfort and Stanghellini (2014, p.383) have argued that

The fragile character of human experience stems from a basic dialectical interplay of selfhood and otherness at the heart of our identity as human persons. To be a person is to live with the intimate alienation that we experience in our emotional life. Our emotions are intimate in the sense that they are our emotions, and they are alienating in the sense that at work in those self-same emotions is an otherness that constantly disturbs our sense of being an autonomous self.

These particular considerations generate several reflections within an intersubjective conceptualisation of psychosis and its psychotherapy. Someone might rightly ask: What does a person’s difficulty in relating to a person with psychosis signify about her own relation to self-alterity? How is that person’s self-experience affected in enclosing aspects of psychotic otherness? What might the difficulty in meaningfully experiencing the other with psychosis say about the possible difficulty in allowing the other with psychosis to emerge on the horizon of self-experience? What are the dynamics of a person’s oscillations between mutuality and separateness in encountering the person with psychosis? Moreover, how does the alienated experience of the person with psychosis affect the therapist’s own ambiguous

structuring of meaning pre-reflexively? I believe that these are fundamental considerations if we are to understand psychosis intersubjectively and promote recovery through the praxis of psychotherapy. However, they are hugely neglected or not adequately considered in the E-P literature on the conceptualisation and psychotherapy of psychosis let alone the broader literature. Intersubjectively speaking, the provision of any kind of psychological or psychotherapeutic input for the case of psychosis (and any other manifestation of human distress), must therefore irrefutably embrace a detailed consideration of the professional’s subjective and intersubjective experiences, which appears lacking in the literature. The literature seems to bursts with publications which document the experiences of people receiving services, and their interpretations based on the theoretical model by which the data are explored but lack a detailed analysis of the professional’s involvement and her contribution to the process of assessment, therapy, etc. To my own understanding, this is no lesser intersubjective deficit than the one the person with psychosis is ‘accused’ of.

A holistic approach to intersubjectivity must, therefore, include a second- person intersubjective methodology and epistemology where it remains necessary to explore the experiential perspectives of self and other and to consider the phenomenon of the subject reflecting upon its own subjectivity in the I-Thou encounter. The second-person approach can provide the conditions for the Buberian confirmation and suggest a dialectical process of shared meaning with its goal directed towards opening those engaged in it to new worlds of meaning through the exploration of what is shared. Since our experience in the world with others is based upon co-construction of meaning, the second-person intersubjective encounter suggests that through the Buberian notion of mutual interaction in the space between, co-construction of meaning is made possible. A second-person perspective in the case of the psychotherapy of psychosis appears, therefore, fundamental. The therapist’s understanding of the client’s experience must, therefore, remain in the second-person, which embraces the sense that the other’s experience belongs to them, whatever is experienced and is felt by them in a way that is different from the therapist’s experience of it. This process invites the process of recovering understandability, which can be a key aspect in overcoming the client’s sense of alienation. Similarly,

Gallagher (2011) coming from a dialogical perspective suggested that a second- person perspective opens up potential ways of approaching autonomy in a new light. This kind of potential provides the grounds for reflection on the therapist’s intersubjective involvements.

Concluding, the second-person approach to intersubjectivity implies that it remains necessary to explore the experiential perspectives of both parties in the relation by negotiating the shared focus of attention and trying to make sense of the intentionality in both parts. Intersubjectively conceived, there is a circular interdependence between the way the person with psychosis experiences the therapist and the way she experiences herself and the other way around. Therefore, the co- construction of intersubjectively shared narratives implies that the detailed exploration of a person’s subjective experience of self and other (the person with psychosis) allows a better understanding of the person’s relating to the world and others with tremendous implications for psychotherapy. In the following section that deals explicitly with the psychotherapy of psychosis, I focus on the form and praxis of intersubjectively informed psychotherapies for psychosis and the related psychotherapists’ experiences through an exploration of relevant literature.