87
PHENOMENOLOGY AND MENTAL HEALTH
Tanja Lamovec*
ABSTRACT
Historical development of phenomenological thought is presented with a special regard to the area of mental health. Key terms are defined as well as the most important contributions of the respective authors. In the second part, implications for mental health theory and practice are pointed out. Some dimensions of phenomenological investigation are illustrated by descriptions of typical phenomena found in depression, mania and schizophrenia. Finally, the advantages of the phenomenological approach as a method and as a therapeutic tool are oudined.
HISTORICAL INTRODUCTION
"Phenomenology" is a word which means different things to different people. Ancient Greeks were the first to use the word phenomenon and many philosophers (Kant, Hegel) in the centuries to come used it too. Phenomenology, that the author of this article is referring to, stems from the work of Brentano and even more from Husserl. Husserl constructed phenomenology as a method, a way of attaining comprehension (not knowledge, though) of the world. Let me introduce some basic terms:
Phenomenon is that which appears to us as our experience. It is given directly, before reflection and categorization transform it. It is thus pre-reflective and pre-cate-gorical (Husserl).
Eidos (essence) of an object is that which remains constant as circumstances change. This essence comes before any theory, as an intuitive assumption (Husserl).
Intentionality is a property of mind which is always directed towards objects, is always incHned towards something, in the form of goals and purposes (Brentano). The phenomenological approach is teleological, asking what for instead of why. To be aware is to be aware of something. It allows the consciousness to transcend itself (Husserl). It implies openness to the world (Heidegger). The body is the carrier of our intentionality (Merleau - Ponty).
Intersubjectivity is probably the key concept in phenomenology. Husserl, Sartre and many others failed to give a satisfying answer to the problem of intersubjectivity-
According to Sartre, we have a need to possess the other person. Others are hell, because they can not be possessed, and, if they do allow it, they are not worth possessing. They have lost their principal attribute - their freedom, allowing themselves to be turned into objects. Possession, however, is not the same as belongingness where the other person enters the intersubjectivity of his or her own free will. Buber postulated that this can happen as a meeting, encounter, dialog, an "I-Thou" rela-
* Oddelek za psihologijo. Filozofska fakulteta, Aškerčeva 2, 61000 Ljubljana
tionship, which should be distinguished from an "I-it" relationship, characterized by objectivization and possession. The "I" of the "I-Thou" is different from the "I" of the "I-It". People who are unable to enter into an "I-Thou" relationship are doomed to possess or to be possessed. It is only to such people that Sartrean thought applies. Binswanger used the term "Mittwelt" to denote the shared world of intersubjectivity In this connection, Laing's paradigm of intersubjectivity is worth mentioning.:
So it is the interaction as well as the interexperience which create our intersubjectivity. In a dyad there are at least 4 dimensions to be taken into account. There is no "objectivity" since there are no objects. "Subjectivity can not be classified into objective categories" says Roberto Mezzina, a contemporary Italian psychiatrist. This is of course perfectly logical, yet traditional psychiatry is still trying to catch a fly with a fish-net. Let's say that person B is a psychiatric user. Traditional psychiatry would measure his or her behavior against the knowledge of categories by an expert, leaving out the experience of the former on its own right and neglecting the effect that the behavior of the latter might have upon the former. It can only be said that the paradigm of traditional psychiatry is a very primitive one, on a level with Lin-nean classificatory system in biology.
Laing also developed a method of comprehending family relationship which is based on the dialectical phenomenological method. The first dialectical movement (the thesis) is a participant observer taking part in the family's social field. She has got her assumptions in the back of her head and influences and is influenced by the interpersonal process. Then, suddenly, a contradiction appears between the implications of her assumptions and the observed and/or felt reality. It is a sign to proceed to the second movement (the negation). The observer mentally withdraws from the social field, she is now a person for herself. She comes up with an insight or, maybe, a new assumption. Then there is a third movement (the negation of negation) when she returns to the social field with a new comprehension. The totality of the social field is now seen in a new perspective.
Existentialism took over the phenomenological method. All existentialists are phenomenologists but not all phenomenologists are existentialists. See the diagram below:
The authors to the left show less and less (or no) traces of existentialism. Rogers, for example, has no existentialist implications although he is a phenomenologist.
IMPLICATIONS FOR MENTAL HEALTH
The other person is to be understood as a person and not measured as an object. His or her perceptions and feelings are to be validated as a proper part of his or her experience. The principal tool of healing is the interpersonal encounter. All sorts of disturbances are seen as stemming from the avoidance or inability to meet the other person on an "I-Thou" level. The role of a helper is to bring about the conditions which make an encounter possible. There is no way of making it happen. The encounter is a creation of both and it can not be willed. Buber says it's a mercy. The helper needs to be open to the user in a non-threatening way and be there wholly, totally.
It is worth mentioning that the encounter is a genuine human relationship and not transference. There may be elements of projection of attitudes/feelings towards parents present on the part of the user, however, these projections are not crucial in phe-
nomenology. There is no demand that the user be capable of transference. Everybody is potentially capable of an encounter, given the right conditions, internal and external.
Phenomenological approach is not therapy in psychodynamic sense, no transference is needed to explain it away. There are no interpretations. It's not therapy, it's a sort of learning, experiential learning how to establish an "I-Thou" relationship. Words are taken at face value, no hidden meanings are sought or imputed. Paraphrasing is used as a technique to clarify whether the helper has understood properly and also to reassure the user of his undivided attention. Emphatic capacities are needed, factographic knowledge is of little value. What counts most is own experience. My observation is that ex-users can be very easily taught how to be of help.
There are several dimensions of experience that demand special attention, such as: the relationship toward one's body, the relationship toward oneself, the relationship to one's social world, the temporal perspective, the spatial perspective, the attitude toward death, the peculiarities of movement, goals and purposes in life, etc.
Let's look specifically at the relationship toward the body. The major work in this area was done by the French existentialist philosopher Merleau-Ponty. In his view our bodies are not things among other things. My body is mine in a different way than my belongings. It is not an "objective" body, as studied in anatomy. My body performs the transactions between me and the world. It opens me toward the world and enables me to communicate with it as well as to manipulate it. My body is the center of my subjectivity. A breakdown in my relationship to my body precipitates a crisis, because I am no longer able to project my subjectivity into the world. To be in the world is to be human. In the event of a breakdown all intersubjectivity is gone. It is a condition different from aloneness or loneliness. To be alone presupposes an original "being together" which is still potentially there. In psychosis, there is no one there, not even the one who is supposed to inhabit that body.
The body perspective includes the awareness of oneself as a subject as well as an object. The former is "the lived body" (il corpo visuto), the latter is "the body I have" (il corpo che ho). In the usual states of consciousness we are somewhere in between, the extremes, however, are reached only under conditions that we call pathological. In the sexual act we are simultaneously a subject and an object, but not in the extreme.
Reflexive consciousness emphasizes the experience of "the body I have", while the pre-reflexive consciousness encompasses "the lived body". "The body I have" can be described as: being before me, I can see it from a distance, I can be absent from it, I can observe and explore it, I can take different perspectives (as an appearance, as a function, as a sexual body, etc.), it is contained (closed), I can conquer it..., etc. "The lived body" can be described as: myself being in my body, being my body, I can not be absent from it, I can not see it from a distance, I can not explore it, there is only one perspective possible, I can not conquer it...,etc.
Our body is always also a sexual body. There are sexual components present in all interpersonal relations. Phenomenology is concerned with the integration of sexuality into a person's being-in-the-world. Only in sexual activity there is a fusion of "the lived body" and "the body I have" into an indivisible whole. Sexuality is, however, only one among the modalities of being-in-the-world. For some people it is a central one (as psychoanalysis would have it), for others it is somewhere toward the edges, an addition. The helper should not have any preconceived notions or theories about the importance of sexuality, or of any other need, for that matter. There is no fixed hierarchy of needs (as humanistic psychology claims) that would necessarily
apply to everyone. There are persons for whom safety is unimportant, for some it is attachment, and for others sexuality. We really do not know, so we better be aware of it and ask. There is always some antagonism between "the lived body" and "the body I have". If only one modality is predominant, pathology is indicated.
For example, in depersonalization it is usually the experience of "the body I have " that has collapsed. A person does not really feel it as his own. Too much self-ob-servation, on the other hand, can also lead to depersonalization. In hypochondria there is too much emphasis on "the body I have". Much attention is drawn to this modality in search of an illness. In anorexia the aspect of the body as appearance is emphasized (which is an aspect of "the body I have"). The appearance fills the void, deriving from lack of feeling.
The experience of time and space is drastically changed in depression and mania. In depression the world is narrow, in spatial as well as in temporal sense. A person can not reach out. A depressive person is too much into her "living body", unable to create a distance, an objectivization of the body. Thus she feels heavy, constrained, unable to separate herself from her bodily presence. Instead of objectifying her body, she brings into it her whole self. In other words, the original object of the world of a depressive person-her own body-is totally immersed in depression. She identifies totally with her heaviness, slowness and tiredness. Her lack of enthusiasm, inability to project herself in space and time stem from this radical inseparability between body and mind.
In mania, the problem is basically the same. Body and mind can not separate, although they are experienced as light and swift. There is no perspective as regards the body or whatever other object. Intentionality is lost and thus projection into the world is impossible. In mania a person does not own her body anymore and can be totally dependent on the environment. While a depressive person is unable to meet others, because she is too closed, a manic person is unable to do it, because she is too open. The latter is unable to enter into a meeting, but gets drawn into it while her boundaries are lost. Without boundaries there can be no encounter, just nothingness. She reaches out too much, unable to contain herself.
In schizophrenia, the predominant mode is withdrawal from the world and rejection of it. The world seems complex, often distorted, fragmented, full of contradictions, unpredictability and ambivalence. In confusion intentionality is lost, as well as the ability to differentiate among modalities. Disnirbances of movement may also appear, indicating the inability to make a decision. Every movement reflects intentionality. Whatever hinders intentionality also destroys the possibility of an encounter as well as the possibility to manipulate the world. In extreme cases (catatonic stupor) there is total inability to form boundaries and a person may be threatened even by a glance or a voice of another. Were she to say so, she would have been considered insane and thus not taken seriously. Yet, the description of this experience is perfectly valid and understandable, taken into account the changed position of her being-in-the-world. She knows it and withdraws even more.
Confusion is an inability to put together the existing goals into a noncontradictory whole. A confused person is unable to make decisions. The world of such a person is uncertain, unclear, with little communication. There is no connection among fragmented moments in time.
Phenomenology points out that such phenomena belong to the person and not to her alleged illness. They are all the results of a missed encounter, of many missed encounters. They are not symptoms, they are signs that point to the existential position of a person as well as to her attitude toward this position.
It is useful to distinguish the idea of a process and the idea of a function, as phenomenologists do. A process is a sequence of changes in the biological conditions which can be explained causally and there is no goal neither purpose. Functions, however are the phenomena, which can not be reduced to organismic states and are connected to the elements outside the realm of physiology. They always contain a goal and a purpose. While a process is automatic, a function is intentional.
From a phenomenological point of view it looks like all pathology stems from the breakdown of intersubjectivity and intentionality. In such cases a person is faced with an impossible choice: alienation or reification. In either case a person is forced to give up himself or herself. The world can not be manipulated any more. Other people can not be met. In this perspective many acts designated as pathological, acquire significance. The act of a psychotic person, who is examining his empty palms carries a deep meaning. So does the act of a person, who is burning his hands with a cigarette, in order to feel for a moment a body, no longer his own, a body which he has deserted. Or a person, constantly asking himself and others whether he is dead or alive. In an existential sense, he is dead already, what is left is only his organism. From phenomenological perspective such acts (not behavior!) make sense (what from my point of view is your behavior, from yours is an act!).
Pathology stems from a certain lack in a person's experience. He or she lacks the feeling how it is to be known. One can only be known in an encounter. To be known is a precondition to know oneself. In the absence of being known, a state of confusion is experienced. The experience is one of object loss. The first object is oneself, one's own body. It can only be given to one by another. Otherwise, there is a world where there is no-one and no-thing. No one can live in a world such as this. Devices of escape can easily be found, only to make things worse, with some additional reification on the part of the alleged "helpers", such as our traditional psychiatry.
WHAT CAN BE EXPECTED FROM PHENOMENOLOGY
A. As a method of comprehension:
1. Comprehension of experience, pathological and normal, which is a precondition to being able to help
2. The method is suitable for the matter under investigation.
3. It gives descriptions instead of classifications, so each person can be unique.
4. It offer an alternative to the medical model in psychiatry.
5. It promotes constant awareness of assumptions, a safety valve against false "objectivity".
B. As an experiential learning tool
1. Encounter, meeting, I-thou relationship, validation of subjective experience is emphasized.
2. No need for classical diagnostic measures which stigmatize and categorize.
3. The disturbance is not seen as located inside the person, who is not considered an isolated entity. The disturbance is supposed to be in his or her mode of being-in-the-world.
4. It is suited for psychotic persons.
5. A person is not viewed through the perspective of a theory, but through his or her own eyes.
6. A helper is not a mirror, but a human being.
7. A helper is not "a subject who is supposed to know". The fact is, he or she does not know, but is getting to know.
8. A helper does not search for hidden meanings, does not offer interpretations, which reduces the chances of his or her being wrong.
REFERENCES
1. Basaglia, F. (1981). Scritti 1953-1968,1, Dalla psichiatria fenomenologica all' esperienza di Gorizia. Torino, Giulio Einandi.
2. Bello, A. A. (1982). L'oggetivita come pregiudizio. Roma, La goliardica editrice.
3. Buber, M. (1961). Between man and man. London, Fontana Library.
4. Buber, M. (1977). Ja i ti. Beograd, Vuk Karadži}.
5. Callieri, B., Castellani, A., De Vincentis, G. (1972). Lineamenti di una psicopatologia fenomenologica. Roma, Il pensiero scientifico.
6. Laing, R. D. (1965). The divided self. London, Penguin.
7. Laing, R. D. (1969). Self and others. London, Penguin.
8. Laing, R. D., Cooper, D. G. (1964). Reason and violence: A decade of Sartre's phylosophy 1950-1960. London, Tavistock.
9. Laing, R. D., Esterson, A. (1964). Sanity, madness and the family. London, Penguin.
10. Laing, R. D., Phillipson, H., Lee, A. R. (1966). Interpersonal perception. London, Tavistock.
11. Lyotard, J. F. (1969). La phénoménologie. Paris, Presses universitaires de France.
12. OpaU}, P. (1988). Egzistencijalistička psihoterapija. Beograd, Nolit. 13.Podvoll,    E.    M.    (1990).    The    seduction    of    madness.    The
revolutionary/compassionate approach to recovery at home. London, Century. 14. Van den Berg, J. H. (1961). Fenomenologia e psichiatria: Introduzione alla moderna psicopatologia fenomenologica. Milano, Casa editrice Valentino Bompiani.