Phenomenology and the Social Context of Psychiatry: Social Relations, Psychopathology, and Husserl’s Philosophy 9781350044302, 9781350044333, 9781350044319

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Phenomenology and the Social Context of Psychiatry

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Bloomsbury Studies in Continental Philosophy Presents cutting edge scholarship in the field of modern European thought. The wholly original arguments, perspectives and research findings in titles in this series make it an important and stimulating resource for students and academics from across the discipline. Breathing with Luce Irigaray, edited by Lenart Skof and Emily A. Holmes Deleuze and Art, Anne Sauvagnargues Deleuze and the Diagram: Aesthetic Threads in Visual Organization, Jakub Zdebik Derrida, Badiou and the Formal Imperative, Christopher Norris Desire in Ashes: Deconstruction, Psychoanalysis, Philosophy, edited by Simon Morgan Wortham and Chiara Alfano Early Phenomenology, edited by Brian Harding and Michael R. Kelly Egalitarian Moments, Devin Zane Shaw Ernst Bloch and His Contemporaries, Ivan Boldyrev Why there is no Post-Structuralism in France, Johannes Angermuller Gadamer’s Poetics: A Critique of Modern Aesthetics, John Arthos Heidegger, History and the Holocaust, Mahon O’Brien Heidegger and the Emergence of the Question of Being, Jesús Adrián Escudero Husserl’s Ethics and Practical Intentionality, Susi Ferrarello Immanent Transcendence: Reconfiguring Materialism in Continental Philosophy, Patrice Haynes Merleau-Ponty’s Existential Phenomenology and the Realization of Philosophy, Bryan A. Smyth Mortal Thought: Hölderlin and Philosophy, James Luchte Nietzsche and Political Thought, edited by Keith Ansell-Pearson Nietzsche as a Scholar of Antiquity, Helmut Heit Philosophy, Sophistry, Antiphilosophy: Badiou’s Dispute with Lyotard, Matthew R. McLennan The Poetic Imagination in Heidegger and Schelling, Christopher Yates Post-Rationalism: Psychoanalysis, Epistemology, and Marxism in Post-War France, Tom Eyers Revisiting Normativity with Deleuze, edited by Rosi Braidotti and Patricia Pisters Towards the Critique of Violence: Walter Benjamin and Giorgio Agamben, Brendan Moran and Carlo Salzani

Phenomenology and the Social Context of Psychiatry Social Relations, Psychopathology, and Husserl’s Philosophy Edited by Magnus Englander

BLOOMSBURY ACADEMIC Bloomsbury Publishing Plc 50 Bedford Square, London, WC1B 3DP, UK 1385 Broadway, New York, NY 10018, USA BLOOMSBURY, BLOOMSBURY ACADEMIC and the Diana logo are trademarks of Bloomsbury Publishing Plc First published 2018 Paperback edition published 2020 © Magnus Englander and contributors, 2018 Magnus Englander have asserted their right under the Copyright, Designs and Patents Act, 1988, to be identified as Editors of this work. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system, without prior permission in writing from the publishers. Bloomsbury Publishing Plc does not have any control over, or responsibility for, any third-party websites referred to or in this book. All internet addresses given in this book were correct at the time of going to press. The author and publisher regret any inconvenience caused if addresses have changed or sites have ceased to exist, but can accept no responsibility for any such changes. A catalogue record for this book is available from the British Library. A catalog record for this book is available from the Library of Congress. ISBN: HB: 978-1-3500-4430-2 PB: 978-1-3501-6644-8 ePDF: 978-1-3500-4431-9 eBook: 978-1-3500-4432-6 Series: Bloomsbury Studies in Continental Philosophy Typeset by Newgen Knowledge Works Pvt. Ltd., Chennai, India. To find out more about our authors and books visit www.bloomsbury.com and sign up for our newsletters.

Contents List of Contributors

Introduction: Towards a Phenomenological Social Psychiatry Magnus Englander 1

Transcendental Intersubjectivity as the Foundation for a Phenomenological Social Psychiatry Larry Davidson

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Schizophrenia, Psychosis, and Empathy Mads Gram Henriksen

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Empathy in a Social Psychiatry Magnus Englander

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On the Empathic Mode of Intuition: A Phenomenological Foundation for Social Psychiatry Scott D. Churchill

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Research Methods for Person-Centred Health Science: Fordham Studies of Suffering and Transcendence Frederick J. Wertz, Miraj U. Desai, Emily Maynard, Justin R. Misurell, Mary Beth Morrissey, Batya Rotter, and Nicoletta C. Skoufalos

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A Phenomenological Understanding of Postpartum Depression and Its Treatment Idun Røseth and Rob Bongaardt

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A Phenomenology of Sensus Communis: Outline of a Phenomenological Approach to Social Psychiatry Samuel Thoma and Thomas Fuchs

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Husserl’s Ethics and Psychiatry Susi Ferrarello

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The I and the We: Psychological Reflections on Husserl’s Egology Marc Applebaum

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Names Index Subject Index

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Contributors Marc Applebaum, PhD, faculty member in the College of Social Sciences, Department of Humanistic and Clinical Psychology, Saybrook University, Oakland, CA, USA. Rob Bongaardt, PhD, professor at the Faculty of Health and Social Sciences, University College of Southeast Norway, Porsgrunn, Norway. Scott D.  Churchill, PhD, professor of psychology at the Department of Psychology at the University of Dallas, Irving, TX, USA. Larry Davidson, PhD, professor of psychiatry and director of the Program for Recovery and Community Health, Yale School of Medicine, New Haven, CT, USA. Miraj U. Desai, PhD, associate research scientist and faculty member, Program for Recovery and Community Health, Yale School of Medicine, New Haven, CT, USA. Magnus Englander, PhD, associate professor at the Faculty of Health and Society, Department of Social Work, Malmö University, Malmö, Sweden. Susi Ferrarello, PhD, faculty member at the Department of Philosophy, University of San Francisco, San Francisco, CA, USA. Thomas Fuchs, MD, PhD, Karl Jaspers Professor for Philosophical Foundations of Psychiatry and Psychotherapy at the University of Heidelberg and the Clinic for General Psychiatry, Center for Psychosocial Medicine, University Clinic Heidelberg, Heidelberg, Germany. Mads Gram Henriksen, PhD, senior lecturer & researcher at Mental Health Center Glostrup, University Hospital of Copenhagen, and Center for Subjectivity Research, University of Copenhagen, Denmark. Emily Maynard, PhD, postdoctoral fellow in clinical psychology, Gevirtz Graduate School of Education, University of California, Santa Barbara, USA.

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Justin R. Misurell, Ph.D. Clinical Assistant Professor of Child and Adolescent Psychiatry at the Child Study Center at NYU Langone Medical Center, NY, USA. Mary Beth Morrissey, PhD, Research Fellow, Global Healthcare Innovation Management Center, Fordham University, NY, USA. Batya Rotter, PhD, independent practice of psychology, Jerusalem, Israel. Idun Røseth, PhD, psychologist at the Department of Child and Adolescent Psychiatry, Telemark Hospital, Skien, Norway. Nicoletta C. Skoufalos, PhD, GreenTPsychology LLC, New York City, USA. Samuel Thoma, MD, researcher at the University of Heidelberg and the Clinic for General Psychiatry, Center for Psychosocial Medicine, University Clinic Heidelberg (with a PhD project entitled Phänomenologisch-anthropologische Grundlagen der Sozialpsychatrie), Heidelberg, Germany. Frederick J. Wertz, PhD, professor of psychology, Department of Psychology, Fordham University, New York City, NY, USA.

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Introduction: Towards a Phenomenological Social Psychiatry Magnus Englander

This book is about the foundations of a social psychiatry. The overall purpose is to go beyond social psychiatry as it currently relates to the social sciences (as in, e.g., Morgan & Bhugra, 2010)  and disclose its phenomenological ground. However, it is not in our interest to stand opposed to social psychiatry as a social science, nor to refute psychiatry as a medical science, but to seek the essence of psychiatry within the social world. Karl Jaspers (1913/1997, p. 710) once wrote, The transmission of culture like the entire life of man is accomplished within a community. The individual reaches his fulfillment and finds his place, meaning and field of activity in the community in which he lives. The tensions between himself and the community are one of the understandable sources of his psychiatric disturbances. Every moment of the day the community is effectively present for every individual.

In other words, to ignore the social world in its relation to mental illness is to disregard the human condition as constituted by our being-with-others. The prefix social has also become ambiguous in its relation to psychiatry, as it has become to other related disciplines carrying it, such as, for example, social psychology and social work. In other words, what does such a prefix really mean? Does it refer to social as in cultural generative meanings, to society at large, to community, to family and friends; does it point to the minimal social context of a face-to-face situation; does it represent the social as in social science; does it signify equality in a political sense, or does it perhaps indicate a critical stance and opposition towards a biomedical psychiatry? Priebe and Finzen (2002) have reported that at a 1970 historical debate about social psychiatry in Germany, the word social was considered unnecessary, because psychiatry was by its very nature already social. But could we ever reclaim the term psychiatry as automatically including the social or has such a possibility been lost forever because of

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psychiatry’s permanent home within the medical sciences and its scientific context within the biomedical model? Perhaps it was a mistake to connect psychiatry to medicine in the first place, even though one could argue from a historical point of view that this was necessary in order to free persons suffering from mental illness and from moral judgement and inhumane treatment. But what if it is the social world that is the ultimate concern for psychiatry? Erwin Straus (1969, p. 2) once wrote, ‘While the activities of the physician are directed generally to man as a living creature, to the organism and its function, the psychiatrist is concerned with man as a citizen of the historical and social world or worlds.’ From such a point of departure, and as explored in this particular volume, the prefix social can also constitute a foundation for psychiatry and can guide us to answers within the deeper levels of transcendental intersubjectivity, to the problems of interpersonal understanding, and to our being-with-one-another – insofar as such notions relate fundamentally to the psyche, to nosology, to the human condition, and to social justice. Hence, the prefix social becomes not just essential in order to understand the context in which psychiatry thrives, but also as a reminder of its praefigere – or better, its ground. There is a long tradition of phenomenology within psychiatry dating back to the work of Karl Jaspers, Ludwig Binswanger, Eugene Minkowski, Erwin Straus, and many others (Spiegelberg, 1972). This tradition is very much alive in contemporary European psychiatry. Two of the contributing chapters of this volume stem directly from this tradition; that is, from the Center for Subjectivity Research at the University of Copenhagen and also from the University of Heidelberg. The emergence of the American tradition in phenomenological psychiatry has mostly been associated with the 1958 publication of May, Angel, and Ellenberger’s edited volume Existence. However, in the early 1960s, there was also an original development of a phenomenological psychology inaugurated by Amedeo Giorgi (1970) at Duquesne University that included a fruitful exchange and collaboration with European phenomenological psychiatrists such as Erwin Straus, J. H. van den Berg, Viktor Frankl, and several others (for an overview, see Smith [2010]), many of whom also served as consulting editors for the Journal of Phenomenological Psychology (Giorgi, 1971). This particular tradition has had ripple effects, gaining a foothold in several research programs and universities throughout America and Europe. In our current volume, we have representatives from American phenomenological psychology and its relation to phenomenological psychiatry, mental health care, and clinical psychology. These authors represent, for example, the recovery-oriented psychiatric research program at Yale University, studies in clinical psychology at Fordham

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University, psychological research at the University of Dallas, phenomenological psychological research at Saybrook University, as well as interdisciplinary and psychological research in the Scandinavian Countries (e.g., at Malmö University in Sweden). As the editor of this volume, it is my belief that a phenomenological approach to a social psychiatry requires a reawakening of the collaboration between European phenomenological psychiatry and American phenomenological psychology. As Spiegelberg (1972, p.  xxxiv) once stated in his historical introduction to Phenomenology in Psychology and Psychiatry, ‘[A] luxuriant field like ours had better not be cluttered by too many varieties and subdivisions which may even interfere with growth.’ The first chapter is by Larry Davidson, who explores how social psychiatry can find its foundation in Husserlian transcendental intersubjectivity. Davidson’s contribution builds upon his extensive studies of Husserl’s last years and the unfinished work The Crisis of the European Sciences and Transcendental Phenomenology. He frames his chapter based upon the Husserlian argument that we are only separate from each other after the fact that we are alike, and not the other (Cartesian) way around. He then brings this argument into the context of a recovery-oriented psychiatry, phenomenological psychological research on schizophrenia, and further into topics such as social justice. Chapter  2 is written by Mads Gram Henriksen, who takes us through the topic of psychosis and its problematic connections to contemporary nosology. Henriksen challenges mainstream views of delusions and hallucinations being portrayed as poor reality testing and he offers us instead a first-person perspective, where he draws from Blueler’s notion of double bookkeeping. He then provides us with a phenomenological analysis of the self in relation to schizophrenia, which takes us beyond the surface of symptomology to a disclosure of the lived experience. In his conclusion, Henriksen makes a plea for the social dimension of psychiatric practice and our ability to empathize as a means towards clinical, interpersonal understanding. In Chapter 3, Magnus Englander connects his roots in American phenomenological psychology with European contemporary phenomenological philosophical and psychiatric research on social cognition. He adopts a second-person perspective towards empathy and explores interpersonal understanding from the perception of the other within the face-to-face context. Englander works from his pedagogical and qualitative research on the phenomenological psychological approach to empathy training and makes a case for an empathic (psychological) reduction leading to a phenomenological attitude that can be adopted by the psychiatric professional within the context of the face-to-face situation.

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In Chapter 4, Scott Churchill covers extensive ground as he takes us through the historical roots of empathy including its early use in psychology and phenomenology; from Lipps’s original view, to Husserl, Schutz, Dilthey, Scheler, Merleau-Ponty, Jaspers, and Heidegger. Drawing on Heidegger’s Zollikon seminars, held to an audience of Swiss physicians and psychiatrists, Churchill points us in the direction of the relationality of the lived body and to Mitbefindlichkeit and its contrast to two isolated egos trying to understand each other. Overall, Churchill argues for an embodied second-person perspective of empathy as resonating with the other. In Chapter 5, Frederick J. Wertz, Miraj Desai, Emily Maynard, Justin Misurell, Mary Beth Morrissey, Batya Rotter, and Nicoletta C. Skoufalos turn our focus to Giorgi’s phenomenological psychological method, as it has been applied to research in clinical psychology at Fordham University. Wertz and others show us the applicability of Giorgi’s method in analysing a wide range of phenomena such as studies on bulimia nervosa, bipolar disorder, autism, trauma and resilience, recovery from schizophrenia, and suffering and decision-making. Overall, these authors illuminate the human depth that qualitative, psychological research strategies can provide in the context of researching clinical psychological phenomena. Chapter  6 is by Idun Røseth and Rob Bongaardt, who present an example of phenomenological psychological research findings into the phenomenon of postpartum depression and how phenomenological insights can further enrich a social psychiatry. Drawing from the tradition of American phenomenological psychology and European phenomenological psychiatry and philosophy, Røseth and Bongaardt explicate the relation between phenomenological research results on postpartum depression and clinical practice. The findings of the lived experience of postpartum depression suggest this condition to be an existential crisis embedded within the interaction. Chapter  7 is a contribution by Samuel Thoma and Thomas Fuchs. These authors provide us with an analysis of the ‘Phenomenology of sensus communis’ as a possible foundation for a social psychiatry. Drawing from a wide range of phenomenological psychiatry and philosophy, Thoma and Fuchs take us through sensus communis constituted by rhythmical bodily sensing, social sense, and common sense and how these three aspects interrelate in their intricate relation to psychopathology. The chapter also points to consequences for treatment congruent with the authors’ conclusions. In Chapter  8, Susi Ferrarello explores how Husserl’s ethics can serve as the foundation for psychotherapy, psychiatry, and the relation between the

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community and the person suffering from mental illness. Ferrarello uses Husserl’s notion of the volitional body, practical intentionality, and the three layers of time to illuminate some of the struggles of the lived experience of mental illness. From such a stance, she provides us with the preconceptual and affective dimensions of interpersonal relations and shows us how Husserl’s ethics can provide the foundation for a social approach to psychiatry. Pointing to the work of Gendlin and Rogers as examples of acknowledging the worldview of their clients, she thus suggests an ethical-empathic stance towards professional practice. Chapter 9 is written by Marc Applebaum, whose purpose is to illuminate the we through a study of the layers of the I as they are rooted and disclosed within a relational matrix and the inescapable co-presence of the Other. He situates a social psychiatry within the exploration that takes us beyond the empirical ego to its pre-egoic foundation. Applebaum then takes us through Husserl’s layers of the ego, and shows us the ego’s interrelatedness to active and passive intentionality, providing an example from everyday life. The connection to a social psychiatry is at times implicit, but receives clarification in the phenomenological claim that the ego is constituted within a primordial context of communalization. As a final note, even though post–Second World War social psychiatry has already established itself as a social science throughout the world and has been closely tied to work carried out by professionals in the social service sector, it is the intention of the authors of this volume to explore matters in terms of their phenomenological ground. This work is by no means an attempt towards a social reductionism of mental illness. Instead it is a phenomenological explication of mental illness as embedded in the social world. Nor is it an attempt to impose a perspective as if it were an ingredient to be added to clinical research or practice or to the social service sector. Rather, it is an attempt to reveal a foundation for a social psychiatry to be possible in the first place.

References Giorgi, A. (1970). Psychology as a human science: A phenomenologically based approach. New York: Harper & Row. Giorgi, A. (1971). General information (including list of editors and consulting editors). Journal of Phenomenological Psychology, 1:2. Jaspers, K. (1913/1997). General psychopathology, vol II (trans. J. Hoenig & M. W. Hamilton). Baltimore, MD: Johns Hopkins University Press.

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May, R., Angel, E., & Ellenberger, H. F. (1958). Existence: A new dimension in psychiatry and psychology. New York: Basic Books. Morgan, C., & Bhugra, D. (red.) (2010). Principles of social psychiatry (2nd ed.). Chichester, UK: Wiley-Blackwell. Priebe, S., & Finzen, A. (2002). On the different connotations of social psychiatry. Social Psychiatry and Psychiatric Epidemiology, 37: 47–9. Smith, D. L. (2010). A history of Amedeo P. Giorgi’s contribution to the psychology department and phenomenology center of Duquesne University in his twenty-five years there. In T. F. Cloonan & C. Thiboutot (eds), The redirection of psychology: Essays in honor of Amedeo P. Giorgi, pp. 329–51. Montreal, Quebec: CIRP. Spiegelberg, H. (1972). Phenomenology in psychology and psychiatry: A historical introduction. Evanston, IL: Northwestern University Press. Straus, E. W. (1969). Psychiatry and philosophy. In E. W. Straus, M. Natanson, & H. Ey, Psychiatry and philosophy (ed. M. Natanson). Berlin – Heidelberg: Springer-Verlag.

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Transcendental Intersubjectivity as the Foundation for a Phenomenological Social Psychiatry Larry Davidson

Introduction Even after the transcendental reduction, subjectivity does not cease objectifying itself as man among fellow men and things; it is just that this continuing self-constitution is now a transcendentally elucidated process. The horizon of constituted self-objectification (even when transcendentally ‘transparent’) determines the legitimate problem sphere of psychology. Eugen Fink’s outline for the continuation of The Crisis (1970, p. 399)

As a Jewish intellectual living in Germany in the 1930s, it is extremely unlikely that Edmund Husserl held to the self-contained, or monad-ological, view of human subjectivity that seems to permeate much of phenomenology as it has since applied in the study of psychology and psychiatry. In fact, in his last, and tragically incomplete, text, The Crisis of European Sciences and Transcendental Phenomenology (The Crisis), Husserl makes an impassioned plea for addressing a crisis that he views as decidedly social and cultural in nature. Yet even within philosophical phenomenology, more attention appears to have been paid to the ‘problem’ of establishing the possibility of there being an intersubjective connection, an empathic relationship, between two self-contained egos than to what Husserl may have meant when he – at least in his later works (e.g., 1970) – defined transcendental consciousness as intersubjective in nature. This chapter is based on the premise that the problem of intersubjectivity at the psychological level (i.e., how I access the subjectivity of other consciousnesses)

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was resolved by Husserl (1970, p. 108) at the transcendental level by conceptualizing consciousness to be fundamentally a ‘living together’ with, as opposed to a living separately or independently from, others. Human subjects come to constitute themselves as separate, independent egos as a result of, rather than prior to, their awareness of others like themselves. There is therefore no ‘problem’ of intersubjectivity, as it is a primary given in our experience, a foundation for, and context within which, we come to know ourselves as subjects. It is then based on this intersubjective understanding of the transcendental that we can develop a phenomenological approach suited to the tasks of a social psychiatry. Readers who are confused by this very first step in our argument, who have come to believe, for instance, that ‘the transcendental’ is relevant only to the work of philosophers, are referred to previous publications in which my colleagues and I  have argued that the transcendental perspective provides an invaluable framework for phenomenological investigations at any level of focus. Otherwise, the core problem of psychologism  – which preoccupied Husserl throughout his career – continues to haunt not only philosophy, but also psychology and any other associated human or social science as well (Davidson, 1988, 1994, 2003; Davidson & Cosgrove, 1991, 2002; Davidson & Solomon, 2010; Davidson et al., 2004). Rather than reiterate that argument here, I will elucidate how the transcendental is understood both in the text of The Crisis and in Fink’s authorized outline for the remainder of the book (1970). Note, for example, how the opening passage above, drawn from the outline Fink had drafted for Husserl’s (1970, p. 399) approval, states that it is ‘the horizon of constituted selfobjectification (even when transcendentally “transparent”)’ that ‘determines the legitimate problem sphere of psychology’. Psychology, and by extension psychiatry, are to be concerned with the human subject understood as a constituted self-objectification of the transcendental as made transparent through the transcendental phenomenological reduction that occupies center stage in The Crisis. The first section of this chapter will deal with laying out descriptively what it means to view human subjects as ‘constituted self-objectifications’ of the transcendental and how this philosophical understanding overcomes the problem of solipsism and establishes a foundation for the possibility of empathy. The second section then describes how, on this basis, the struggles and recoveries of persons diagnosed with ‘schizophrenia’ can be accessed, understood, and supported by a social psychiatry that takes into serious account – has as its phenomenological ‘horizon’ – the historical, social, political, economic, and cultural context in which these persons live. Illustrative examples for this section will be

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drawn from the body of empirical phenomenological research that we have conducted with such persons over the past twenty-five years. Finally, we will suggest implications of the findings of this research for transforming clinical practice in psychiatry and psychology.

Transcendental Intersubjectivity We, each ‘I-the-man’ and all of us together, belong to the world as living with one another in the world; and the world is our world, valid for our consciousness as existing precisely through this ‘living together.’ (Husserl, 1970, p. 108)

It has only been since the time of Descartes that philosophers have begun with the solitary ego, with the givenness of individual consciousness, as their point of departure. For most of us who do not spend untold hours alone either staring into lit hearths or strolling down country lanes, this might seem like an odd place to begin. We do not emerge from the womb with a fully developed and intact sense of ourselves as a solitary, constituting ego. Rather, as we have learned from Daniel Stern (1985) and others, humans develop a sense of self in relation to others. I first come to know myself as a person separate from others through my relationships with them, and come to form a sense of identity that is heavily influenced by how those others view and treat me. There can be no ‘I’ without at least one ‘you’ that together constitute a ‘we’. This interdependence of the social and personal – what has come to be considered a fundamental fact of infant development discovered through close observation, and taken as the basis for hypotheses about the neural origins of identity – was argued on a philosophical basis by Husserl nearly a century ago. Beginning as he did in his own reflections with the legacy left by Descartes and Kant (not surprisingly the two thinkers who also figure most prominently in The Crisis), Husserl did struggle early in his career with finding a way to escape a solipsistic view of consciousness. His Cartesian Meditations (1977) is devoted in large part to this problem, but falls short of coming to any satisfactory solution. Our seemingly immediate access to others as human subjects does not appear to rely on imaginative leaps or speculative conjectures about how these other embodied creatures may or must function similarly to me. So when he takes up once again the matter of the psychological ego as conceptualized by Descartes and Kant in The Crisis, Husserl (1970) is driven to a radically different

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conclusion. He suggests that the world I experience is not given to me primarily as ‘my’ world, but rather as ‘our’ world. ‘The world exists not only for isolated men but for the community of men,’ he writes, ‘and this is due to the fact that even what is straightforwardly perceptual is communalized’ (p. 163). What is ‘straightforwardly perceptual’ is perceived not only as something for me, but as something for others as well. To be a thing, a tree, which is separate from its infinite appearances or adumbrations, is not only to be a tree for me but is to be perceived precisely as also being an object that will be perceived in the same way by others standing next to me. In the case of objects that have sociocultural meanings, such as a lamppost, there is the additional aspect, the ‘coconsciousness’, that it is perceived as an object that was made by other subjects. Writes Husserl (1970, p. 370): ‘Every straightforward understanding of [cultural facts] as an experiential fact involves the “co-consciousness” that it is something constructed through human activity.’ The world is always already a shared world. Even were you and I to disagree about the nature of a given object – I see a tree where you see a lamppost – we still share the same basic world in which both such a perceived object and such a disagreement can take place. Descartes’ reliance on the exercise of reason through systematic doubt in the present fails to account for how things came to be perceived in the way they were in the first place. In Husserlian terms, the Cartesian/Kantian approach remained locked within solipsism because it lacked a ‘genetic’ account of how consciousness comes to understand itself over time. But humans, as Husserl had emphasized prior to Heidegger, are temporal creatures; we cannot be fully accessed or understood through a static or cross-sectional approach. In other words, life is simply not lived solipsistically, but within the context of a human community in which my own personal perspective on the world is engaged in what Husserl (1970, p. 172) calls a process of ‘reciprocal correction’ with the perspectives of others with whom I come into contact. I am not left to make sense of the world by myself. Even if it may appear to be so at a given time, as in sitting alone in front of a lit hearth, this appearance is only made possible on the basis of innumerable other experiences through which I have come to know myself, and my hearth, to be what they are. The sense that I make now is both based on previous strata of sense made and made through an active engagement with others who are likewise engaged in sense making; the consensual ‘reality’ that results is just that, that is, consensual and contextual, social and historical. We come to recognize the role that consciousness plays in constituting such a reality through performance of the transcendental phenomenological reduction.

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Should we stop short of coming to this transcendental understanding of consciousness as intersubjective and self-objectifying, we would unwittingly elevate one perspective on the world above others, resulting in the view that some experiences are more correct or true or directly in touch with ‘the real’ than others, which would then be considered deficient or deviant in comparison (Davidson et al., 2004). But all experiences are precisely what they are, that is, experiences, and as such can be neither deficient nor deviant in and of themselves. These kinds of distinctions belong to the realm of judgement, reasoning, and sociocultural norms, not to the nature of experiences per se. This is the radical position that Husserl takes with regard to the transcendental, and one of the reasons why he insists that it is a necessary foundation even for the conduct of psychology and other human sciences that deal with how consciousness is self-objectified in the lifeworld. To fail to appreciate that all experiences are valid as experiences, and that the sense a person derives from his or her experiences is engaged in a process of reciprocal correction with the sense others in the person’s life (including those from the past) derive from their own experiences is to fail to grasp the constituted nature of the world we all share. It is to view the world as an already completed, independently existing ‘thing’ of a definite nature that remains the same over time (Davidson, Flanagan, Roe, & Styron, 2006). While such a view might have been acceptable to a seventeenthcentury religious perspective on the world as having been created out of nothing by an independent, all powerful God, it does not begin to do justice to the sociocultural lifeworld of self-objectifying transcendental egos whose world is constantly being made anew. For the Husserl of The Crisis, it was an urgent and all-important matter that the world that had been created in Europe in the first part of the twentieth century was on a path to self-destruction and that drastic measures were needed to avoid this fate. What I will argue in the remainder of this chapter is that it is still an urgent and important matter that the world that is currently being created in the first part of the twenty-first century is continuing to pose significant risks to the health and well-being of human beings (as well as to the planet as a whole). For psychiatry, and the broader mental health field, to become a part of the solution to this crisis, consciousness must first be understood in both its transcendental and its intersubjective nature. Only then will the experiences of all people be given equal weight in the constitution of our shared reality, and only then will all people, eventually, be valued and accepted as members of a shared civil society as a result.

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Towards a Phenomenological Social Psychiatry of Schizophrenia What remains, now, is not a multiplicity of separate souls, each reduced to its pure interiority, but rather: just as there is a sole universal nature as a self-enclosed framework of unity, so there is a sole psychic framework, a total framework of all souls, which are united not externally but internally . . . through the intentional interpenetration which is the communalization of their lives . . . It belongs to each soul that it have its particular world-consciousness in a way which is originally its own, namely, through the fact that it has empathy experiences, experiencing consciousness of others as [also] having a world, the same world, that is, each apperceiving it in his own apperceptions. (Husserl, 1970, p. 255)

Grounding psychiatry in a transcendental phenomenological perspective establishes a number of important principles for both our research and our practice. These include:  (i)  all human beings are to be viewed as constituting subjects, active agents, in their own lives; (ii) all of the experiences human beings have are valid as experiences and contribute (in one way or another) to the constitution of our shared world; (iii) even in the case of psychosis, empathy between human beings is and remains possible, and is accessible as an essential tool for research and practice through the intentional interpenetration of souls that form a unitary psychic framework; and (iv) each individual must be approached, understood, and ‘treated’ (a problematic term, as we shall see) within the context of this unitary psychic framework, that is, as an active, constituting subject whose identity is formed in and through internal relations with other active, constituting subjects. It is important to emphasize, as Husserl does in the passage above, that these relationships are internal because we tend to perceive others as external to ourselves due to the fact that consciousness is embodied in human beings, each of whom thus appears to have an existence independent of the other. To remain faithful to Husserl’s transcendental insight into the intersubjective nature of consciousness, we must recognize that a more primordial relationship exists between subjects through intentionality and empathy prior to, and as the foundation for making sense of, consciousness as belonging uniquely to each embodied individual within a shared community. It is through this internal connection, through being part of a ‘unitary psychic framework’, that I come to understand who and what I am in relation to concrete others, and through which any external relationships I  may develop then become possible. We are always already

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belonging together, sharing a basic sense of human community, regardless of how we then – based on multiple factors, some of which we explore below – end up relating, or not relating, to others. External relationships between embodied subjects would not be possible, were they not developed on the ground of this always already internally shared sense of humanity. While we need not think of the nature of this internal connection as mysterious, mystical, or paranormal, Husserl’s use of the term ‘soul’ does suggest that it might be spiritual in nature. Regardless of whether one interprets it to be spiritual or not, what is important for our science of psychiatry is that we understand it to be deeply implicated in how we develop a sense of personal identity as an individual human being to begin with, especially because this will also relate to how we assist others in recovering a sense of self in the aftermath of a serious mental illness. As Levinas (1969) was to argue a generation after Husserl’s death, we come to recognize humanity in and through the face of others, coming to learn about ourselves as subjects through their eyes. It will be extremely difficult to maintain a sense of human identity, or to regain a lost sense of identity, should others in my life not recognize in my face, not perceive in my eyes, the fundamental fact of my belonging to the human race – despite any of the less important ways in which I differ from them (e.g., race, ethnicity, diagnosis). Yet this is precisely what has happened, and in many places continues to happen, in the lives of persons diagnosed with schizophrenia. The central importance of this issue has been suggested by several sources, from the time of Kraepelin to the present. The descriptive psychopathology and clinical literatures have long noted the loss of a coherent sense of self as a core characteristic of schizophrenia (Kraepelin, 1904; Bleuler, 1950; FrommReichmann, 1950; Jaspers, 1963; Meyer, 1950; Schilder, 1976; Sullivan, 1940). This observation has been confirmed and expanded on eloquently in firstperson accounts of schizophrenia; most recently in the autobiography of Elyn Saks (2007, pp. 46–7), who writes that the most disabling aspect of this condition is that ‘consciousness gradually loses it coherence. One’s center gives way . . . There is no longer a sturdy vantage point from which to look out, take things in, assess what’s happening. No core holds things together’. At the same time, there is an increasing body of empirical research pointing to the role of a loss of a functional sense of self underlying some of the symptoms of psychosis (e.g., Bayne & Pacherie, 2007; Frith & Allen, 1983; Frith & Done, 1986, 1989; Synofzik et  al., 2010; Voss et  al., 2010). For example, Frith (1987) attributed delusions and hallucinations to ‘a failure to recognize the self in action’, while Jeannerod (2009) concluded from a review of neuroscientific

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research that the sense of agency is ‘deeply impaired’ in persons with schizophrenia, with ‘first rank symptoms testify[ing] to the loss of the ability . . . to attribute their own thoughts, internal speech, covert or overt actions to themselves’. And our own extensive qualitative research on this issue led John Strauss and me to suggest, almost twenty-five years ago, that ‘the process of rediscovering and reconstructing an enduring sense of the self as an active and responsible agent provides an important, and perhaps crucial, source of improvement’ (Davidson & Strauss, 1992, p. 131). What was perhaps missing, or at least underappreciated, in many of these earlier theoretical accounts is the extra-individual – the social, cultural, political, and economic – nature of both of the processes of loss and reclamation of such a sense of self. In other words, most of these earlier accounts – including many first-person accounts – tend to describe and understand the loss and reconstruction of an active and effective sense of self as if these processes occurred in a vacuum, as if they were entirely up to the individual himself or herself, a kind of ‘bootstrapping’ of personal identity. Unfortunately, this same tendency has been reflected in the growing ‘recovery’ literature, beginning with Patricia Deegan’s (1988) original description of the concept of ‘recovery’ as referring to ‘the lived or real life experience of people as they accept and overcome the challenge of the disability . . . [as] they experience themselves as recovering a new sense of self and of purpose within and beyond the limits of the disability’. This description was then further developed a few years later in a highly influential article by Bill Anthony (1993), in which he defined ‘recovery’ as: A deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.

Based on these kinds of highly person-centric depictions, recovery has come, at least in the English-speaking world (Davidson & Tse, 2014), to be understood primarily as a ‘deeply personal, unique’ individual journey, in which other people play at best a supporting role. And as a result, the concept has become vulnerable to misuse and abuse in political and policy circles, with persons who are having difficulty entering into, pursuing, or sustaining recovery being blamed for their own suffering and/or being denied services or supports because they

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do not appear to be using them efficiently (Rowe & Davidson, in press; Slade et al., 2014). But it is possible to preserve an important, even central, role for the person to play in his or her own recovery without having to ignore or deny the important roles of social, cultural, political, and economic factors as well. With few exceptions (e.g., Warner, 1985), however, these factors have seldom been pursued outside of the field of what has been described as ‘anti-psychiatry’, in which the reality of schizophrenia as an illness, or even as a personal struggle, has been rejected altogether in favour of a view of mental illnesses as ‘social constructions’ used to silence and deny dissenting voices. It has apparently been extremely difficult to acknowledge the presence of a debilitating condition while at the same time considering how that condition may be influenced in its nature, its effects, its course, and its outcomes by the social contexts in which it occurs (Strauss, 2014). Returning to our grounding in Husserl and Levinas, though, we recall that at least in relation to being able to redevelop, and preserve, a sense of self as a human being  – a core challenge in recovering from schizophrenia  – the role of others may be crucial as well. This is especially the case when those others deny, rather than validate or confirm, the basic humanity of the person who is struggling to recover, as happened broadly within the context of the custodial institutions of the first half of the twentieth century and as continues to occur, perhaps in a less obvious way, within the context of community-based care today. So potent were the effects of these institutions that the first phenomenologically oriented social psychiatrist, Franco Basaglia (1987), declared at the beginning of the de-institutionalization movement that it was not possible to tease out any effects of the illness itself as they were so overlain with what he described as the ‘secondary illness’ of the hospital context. Unfortunately, so prevalent do discrimination and dehumanization continue to be within the context of community-based care that Basaglia’s caution remains warranted. In terms of previous research and practice, it is true that glimmers of recognition of the interpersonal dimension of the processes of regaining a self may be found in the work of Fromm-Reichmann (1950) and Sullivan (1940), but their work was limited to the role of the psychotherapist in what remained primarily institution-based treatment. More contemporary efforts have begun to focus on how social stigma, and its internalization in ‘self-stigma’, may impede recovery (Brohan et al., 2010; Chiu et al., 2013; Corrigan, Watson, & Barr, 2006; Watson et al., 2007; Rüsch et al., 2010), but initial efforts to address this have

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remained largely restricted to the level of the individual (Yanos, Roe, & Lysaker, 2011; Yanos et al., 2012). Cross-cultural studies have provided some clues as to the possible role of cultural and economic factors in influencing outcome, with persons living in capitalist, industrial societies faring less well than those in the developing world (e.g., Davidson, 1988; Lin & Kleinman, 1988; Warner, 1985; Waxler, 1979). These approaches, though, are limited in their understanding of the connections between these various factors and, importantly, in their implications for how best to promote recovery. So what does Husserl’s transcendental phenomenology have to offer in relation to understanding the intersubjective nature of recovery? Phenomenology begins with experience, which might appear on the surface to be individual in nature as well. But to view experience as entirely individual in nature is to repeat the Cartesian/Kantian error of failing to look at the genesis, the constitution, of the meanings being accessed through, and derived from, experience. This is perhaps easiest to understand in the case of what Husserl described as the ‘co-consciousness’ of social and cultural objects, such as stadiums, libraries, or even universities, such as Yale. Where does Yale ‘exist’ as a university? It is not reducible to the bricks used to construct some of its buildings, the office of the university president, or the geographic perimeters of its campus (which, in the case of Yale, snakes through much of the town of New Haven). While it is experienced to some degree differently by each person who comes into contact with ‘it’ (even if virtually through the press or the internet), it also is experienced as the same to a sufficient degree to maintain its identity over more than 300 years. What, then, of this experience is individual in nature and what is not? The experience of beginning at, or even visiting, Yale is likely to be different for a third generation ‘legacy’ freshman (a person whose parent and grandparent also attended Yale) and a first-time foreign student just arrived from India or China. Many – but not all – of these differences can be traced to their differing life experiences up to that point, which provide the broader context for their experiences of Yale per se. What if the same were true of the concept of ‘self ’? That is, what if a person’s sense of self was likewise largely a result of his or her life experiences to date? Those life experiences – like all experiences – would build on previously constituted strata of sense passed down through the generations as mediated by what Husserl (1977, p. 64) describes as the person’s own ‘predelineative horizon’ of sedimented meanings that are now ‘pre-given’ to his or her consciousness. I have no more of a direct route to getting to know myself than through my own experience, and my own experience, within a transcendental

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phenomenological framework, necessarily ‘reaches out beyond the isolated subjective processes’ of my own ego (p. 48) to its implicit, pre-delineated context of what has been pregiven to me historically, socially, and culturally. It is in order to capture and understand the role of these pre-given strata of sense that have formed through the sedimentation of meanings from prior experiences – both my own and those of others in the past and present – that our phenomenological approach needs to incorporate the transcendental reduction. While we must understand the horizon of my experience to be itself a constituted achievement, it is crucial that we understand that it has been constituted not by my own (psychological) ego, not by me as an individual, but by others as well, both by those who preceded me and those who are concurrent to me (and even perhaps by my imagined future heirs). In no sense do I ‘choose’ to whom I am born, in what home I grow up, who my ancestors were, or what historical, social, and cultural context in which I am to experience my formative years as a human being. Yet all of these factors bear directly on what kinds of experiences I will have and how I will come to know who and what I am as a person. It is perhaps because of the role of this historical, social, and cultural horizon in providing the context for individual experience that seeking recourse to the transcendental has been criticized as absorbing the psychological into the social (e.g., Giorgi & Giorgi, 2008). It is not so much a matter of losing the psychological, though, as it is appreciating that what comes to be viewed as the psychological is always already a socially, culturally, and historically constituted phenomenon. The psychological, in other words, does not exist on its own in some essentialist, Platonic, form irrespective of the social and cultural context in which it is being explored or conceptualized. Psychological concepts are not timeless or universal, but are relative to the context in which they are being developed. Psychology represents, in Husserlian terms, one ‘regional ontology’ among others. Due to the fact that consciousness, as embodied, appears to be individual in nature, though, Husserl affords psychology the status of being the ‘first’ science to be established following the ‘return’ from the transcendental (Davidson & Solomon, 2010). The primacy of psychology may also be due to that fact that it pertains to the interaction between the individual and his or her intentional horizon, to how persons ‘take up’ the context of meaning into which they have been born. I suggested earlier that ‘many – but not all’ of the differences between individuals’ experiences can be traced to their previous experiences. Ascribing all such differences to life history would run the risk of falling into historicism, just as ascribing all differences to individual choice would run into

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psychologism. The challenge is to allow for a non-psychological, non-historical, non-social, and so on ego to be informed or influenced or shaped by all of these various factors without allowing for the ego to be totally absorbed into any one of them. That is the role of the transcendental that Husserl conceives of as non-worldly. And so in this way is transcendental phenomenology able to provide the foundation for a social psychiatry by preserving both the importance of history, culture, and society along with the crucial role of the individual in taking up these sedimented strata of sense in the teleological pursuit of a meaningful life.

Not an Individual Journey Common courtesy works because it’s common; it’s something every human being gets just because they’re human. Things like saying ‘excuse me’ when you reach over someone to reach for a piece of paper, like saying ‘God bless you’ when someone sneezes, things like asking you if you’d like some water when you get up to get some for yourself. It’s basic, but it means so much to someone who’s been treated like an unhuman for decades. It’s basic, and it may seem trivial to you, but to people like me, it’s water to a dying parched husk of a person. Interactions like the[se] . . . have more positive impact on the consumer than any elaborate treatment plan ever could. (Quoted in Davidson & Johnson, 2013, p. 258)

What this means concretely is that people neither develop nor recover from what we currently consider to be schizophrenia on their own. On the surface, or through the lens of a simplistic approach to neuroscience, it may appear to be the result of a brain disease that is only very partially ‘treated’ by a combination of medications and psychosocial interventions. Like Descartes’ doubt, however, this is at best a static or cross-sectional account of a present moment in the life of a person who has both a past and a future. In addition to lacking a scientific basis, the brain disease model fails to explain or account for the large number of people who experience significant improvements over time, many of which occur in the absence of ‘treatment’. Less simplistic, one-dimensional approaches to neuroscience may be very helpful in understanding the neuronal underpinnings of a sense of agency – as in the studies conducted by Firth and reviewed by Jeannerod above – as one component of a biopsychosocial set of processes, but these will necessarily be genetic in nature and will be based on a view of the brain as inextricably intertwined with its social environment, that is, which includes other embodied brains as well.

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What would such studies need to explore in terms of the life context of the person who is developing, or recovering from, schizophrenia? The same territory as would be explored by a phenomenologically oriented psychologist, that is, the life experiences that the person is having and the historical-social-cultural horizon in which they take place. In developing schizophrenia, people appear to have experiences in which their coherent sense of agency is called into question. Perhaps the sense of agency they developed early in life remained more vulnerable to such attacks, which other people might better withstand. Or perhaps they are exposed to experiences other people typically do not have which then undermine an otherwise solid sense of agency. Earlier theories attributed these kinds of attacks to ‘schizophrenogenic’ mothers or families (e.g., psychoanalysis) or to society as a whole (e.g., Laing, 1969), while more contemporary studies are finding a high prevalence of adverse childhood events (e.g., Read et al., 2005; Rosenberg et al., 2007; Varese et al., 2012). It is also possible, though, that a compromised sense of self may occur in response to, rather than as the cause of, such experiences as hallucinations and other neurocognitive impairments (e.g., Frith, 1987); experiences which make it difficult to maintain a coherent sense of agency. Regardless of causes – which remain to be determined – we have learned that the recovery process depends, at least in part, on the opportunities and resources available to people as they are challenged to reconstruct their sense of self. This occurs on the macro level in terms of the social determinants of health (e.g., poverty, prolonged unemployment, discrimination) as they relate to the onset of psychosis (e.g., Morgan & Hutchinson, 2009) and the duration of untreated psychosis (e.g., Morgan et al., 2006). And, as alluded to above (Warner, 1985), cross-cultural studies have suggested that persons with schizophrenia fare better in non-industrial, non-capitalist economies in which they can maintain valued social roles and preserve social support without having to secure and maintain competitive employment in a profit-oriented society. Related issues have been explored at more length, and in more philosophical depth, by Deleuze and Guattari in their two volume series on Capitalism and Schizophrenia (1977, 1988). For Deleuze and Guattari, the concept of having a univocal sense of self is itself problematic and a result of capitalism. One does not have to share their aspirations for an ego-less liberation of desiring flows to appreciate how the expectations for productivity and demands for success of industrial capitalist economies may make recovery from schizophrenia more difficult. It is perhaps at the micro level, however, that phenomenology is best positioned to shed light on the contextual factors at play in what is actually an

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extra-individual ‘journey’ of recovery. The woman quoted above writes eloquently of being ‘treated like an unhuman for decades’. We have suggested in earlier publications that a cornerstone of recovery is having a sense of belonging with a community of one’s peers (Davidson, 2011; Davidson & Johnson, 2013, 2014). In both cases, this foundation for recovery is not something a person can provide for himself or herself. I cannot simply will myself to have a sense of belonging, I cannot make other people accept me within their ranks, I cannot establish a foundation for belonging for myself by myself. Having a sense of belonging necessarily requires the caring, compassionate actions of others, it requires others to treat me like ‘a human’ (as opposed to ‘an unhuman’), it requires being included in the life of one’s community as a valued and contributing member rather than being shunned, ignored, or relegated to the margins of society. As the woman quoted above went on to say: I can come to recognize that ‘I am a human being’ because I found someone who can identify me as one . . . I didn’t enter recovery until someone else thought I was worth recovery, until someone else loved me. I didn’t think I was worth recovery until someone else did. (Quoted in Davidson & Johnson, 2013, p. 260)

I first learned this lesson many years ago from a woman who was homeless in San Francisco. As I began to walk past her on the street she asked me for money, to which I replied: ‘I’m sorry, I don’t have any to spare.’ Expecting her to be disappointed, if not disgruntled, I was surprised when she smiled and responded: ‘Thanks for acknowledging me. Most people treat me as if I’m invisible. At least you see me.’ If we think of recovery only as a deeply personal journey of reclaiming a new sense of self, then we risk losing sight of all the other things that need to be in place for people to get their lives back. Things like being seen, being treated as a human being, like having a safe, stable, and affordable home in a supportive environment, having a job or being in school, having a loving family and friends, and having a sense of belonging to a community. None of us achieve or acquire all of these different essentials in life solely or entirely by ourselves as individuals. We are born into a community, raised in a community, play valued roles in a community like parent, tenant, employee, sibling, and voter. These essentials cannot be placed on hold and reserved for people until some imagined time in the future when they are considered ‘well’, in part because they are essential to people becoming well in the first place – and in part because they are rights to be acknowledged rather than privileges to be earned. In the future, we can hope that persons developing a serious mental illness will not have to lose all of these valued roles  – these ways of engaging and

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participating actively and meaningfully in all aspects of community life – as a result of becoming ill. We can hope that young people early in the course of a mental illness will be able to stay in school, will be able to keep their friends, and will be able to go on to learn how to drive, how to date, and, eventually, how to be a contributing citizen . . . just like most everyone else. But we know the history of psychiatry, and we know that this has tragically not been the case for many people. Through a combination of the stigma that accrues to these conditions, the discrimination those who experience these conditions face as a result, the lack of material resources that also results from the lack of social and political will to reverse this long-standing discrimination, and the traditional, narrow view of contemporary psychiatry on the management of symptoms, many people have lost these various indicators, benefits, and, as it turns out, basic requirements for exercising their citizenship. They have stopped being a student or employee, they have lost their friends, forgotten how to drive, and may find it hard to believe that anyone would want to date them. This has been a tragic loss, not only for the person and his or her loved ones, but for society as a whole. And it makes the process of recovery all the more difficult. It is for this reason that the recovery movement is now evolving to place more of an emphasis on social inclusion and the restoration of citizenship, on what society needs to do to make recovery possible and to support people in their efforts to reclaim their lives (e.g., Rowe & Davidson, in press). Doing so doesn’t make working with individuals any less crucial, but it provides a needed context in which this work can be effective. While much work remains to be done in this regard, we can at least derive some comfort, and inspiration, from the practice Basaglia – who I suggested was the first phenomenological social psychiatrist – developed in Italy in the 1960s and 1970s. As Basaglia argued, shifting the frame from an individual’s psychopathology to a community’s opportunities and resources doesn’t ignore or detract from the proper work of psychiatry. Rather, it secures the foundation necessary for this work to be able to succeed. Writes Basaglia (1987): The approach that underlies this work is in no way an attempt to evade the central point of illness. In this new context, however, the conflicts which had previously been regarded as internal to the patient . . . are thrown back on the wider society from whence they came . . . For the mental health worker, this means an entirely new role: instead of acting as a go-between in the relationship between patient and hospital, he has to enter into conflicts in the real world – the family,

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Larry Davidson the workplace, or the welfare agencies . . . Moreover, mental health workers are no longer impartial: they have to face the inequalities of power which engendered these crises, and put themselves wholeheartedly on the side of the weak. Acting outside the asylum situation, they of course lack any established expertise or authority: thus they have to function without any predetermined responses, on the basis of nothing more nor less than their total commitment to the patient.

Conclusion On the occasion of the tenth anniversary of the drafting of the first international declaration of human rights at the United Nations, Eleanore Roosevelt (1958) said the following: Where, after all, do universal human rights begin? In small places, close to home – so close and so small that they cannot be seen on any maps of the world. Yet they are the world of the individual person; the neighborhood he lives in; the school or college he attends; the factory, farm, or office where he works. Such are the places where every man, woman, and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.

Focusing on experiences of everyday life, phenomenology is particularly wellsuited as a methodology for studying such ‘small places, close to home’. When returning to those places from the transcendental perspective achieved through the transcendental reduction, we are able to consider them as constituted contexts in all of their historical, social, cultural, political, and economic richness. Only then are we adequately equipped to explore and understand persons as self-objectifications of transcendental intersubjectivity in a way that preserves their full humanity. This is especially relevant, and especially needed, in the case of persons whose humanity has been distorted or denied. As Basaglia made clear, in such a case, our science, as well as our practice, can no longer be viewed as ‘impartial’. They become instead forces in the fight for social justice. This, too, was foreseen by Husserl (1970) in the 1930s when he felt compelled to confront a crisis in European sciences; disciplines which he perceived as having become ‘sciences of death’. The answer then, as it is now, is to ground psychiatry in transcendental phenomenology so that it may become, instead, a ‘science of life’ (ibid.; Davidson & Solomon, 2010).

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References Anthony, W. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychiatric Rehabilitation Journal, 16(4):11–23. Basaglia, F. (1987). Psychiatry inside out: Selected writings of Franco Basaglia. New York: Columbia University Press. Bayne, T., & Pacherie, E. (2007). Narrators and comparators: The architecture of agentive self-awareness. Synthese, 159: 475–91. Bleuler, E. (1950). Dementia praecox or the group of schizophrenias. New York: International Universities Press. Brohan, E., Elgie, R., Sartorius, N., Thornicroft, G., & GAMIAN-Europe Study Group. (2010). Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: The GAMIAN-Europe study. Schizophrenia Research, 122(1):232–8. Chiu, M. Y. L., Davidson, L., Lo, W. T. L., Yiu, M. G. C., & Ho, W. W. N. (2013). Modeling self-agency among people with schizophrenia: Empirical evidence for consumer-based recovery. Psychopathology, 46(6):413–20. Corrigan, P. W., Watson, A. C., & Barr, L. (2006). The self-stigma of mental illness: Implications for self-esteem and self-efficacy. Journal of Social and Clinical Psychology, 25(8):875–84. Davidson, L. (1988). Husserl’s refutation of psychologism and the possibility of a phenomenological psychology. Journal of Phenomenological Psychology, 19: 1–17. Davidson, L. (1994). Phenomenological research in schizophrenia: From philosophical anthropology to empirical science. Journal of Phenomenological Psychology, 25: 104–30. Davidson, L. (2003). Living outside mental illness: Qualitative studies of recovery in schizophrenia. New York: New York University Press. Davidson, L. (2011). Recovery from psychosis: What’s love got to do with it? Psychosis, 3(2):105–14. Davidson, L., & Cosgrove, L. (1991). Psychologism and phenomenological psychology revisited, Part I: The liberation from naturalism. Journal of Phenomenological Psychology, 22: 87–108. Davidson, L., & Cosgrove, L. A. (2002). Psychologism and phenomenological psychology revisited, Part II: The return to positivity. Journal of Phenomenological Psychology, 33(2):141–77. Davidson, L., Flanagan, E., Roe, D., & Styron, T. (2006). Leading a horse to water: An action perspective on mental health policy. Journal of Clinical Psychology, 62(9):1141–55. Davidson, L., & Johnson, A. (2013). It’s the little things that count: Rebuilding a sense of self in schizophrenia. Tidsskrift for Psykisk Helsearbeid, 10(3):258–63. Davidson, L., & Johnson, A. (2014). Promoting safety in the midst of psychosis: An interpersonal dimension of recovery. Psychosis, 6(1):77–9.

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Davidson, L., & Solomon, L. A. (2010). The value of transcendental phenomenology for psychology: The case of psychosis. In T. F. Cloonan & C. Thibotout (eds), The redirection of psychology: Essays in honor of Amedeo P. Giorgi, pp. 73–93. Montreal, Quebec: CIRP. Davidson, L., Staeheli, M. R., Stayner, D. A., & Sells, D. (2004). Language, suffering, and the question of immanence: Toward a respectful phenomenological psychopathology. Journal of Phenomenological Psychology, 35(2):197–232. Davidson, L., & Strauss, J. S. (1992). Sense of self in recovery from severe mental illness. British Journal of Medical Psychology, 65:131–45. Davidson, L., & Tse, S. (2014). What will it take for recovery to flourish in Hong Kong? East Asian Archives of Psychiatry, 24:110–16. Deegan, P. E. (1988). Recovery: The lived experience of rehabilitation. Psychiatric Rehabilitation Journal, 11(4):11–19. Deleuze, G., & Guattari, F. (1977). Anti-Oedipus: Capitalism and schizophrenia. Minneapolis: University of Minnesota Press. Deleuze, G., & Guattari, F. (1988). A thousand plateaus: Capitalism and schizophrenia. London: Bloomsbury Publishing. Frith C. D. (1987). The positive and negative symptoms of schizophrenia reflect impairments in the perception and initiation of action. Psychological Medicine, 17: 631–48. Frith, C. D., & Allen, H. A. (1983). The skin-conductance orienting response as an index of attention. Biological Psychiatry, 17:27–39. Frith, C. D., & Done, D. J. (1986). Routes to action in reaction-time tasks. Psychological Research, 48: 169–77. Frith, C. D., & Done, D. J. (1989). Experiences of alien control in schizophrenia reflect a disorder in the central monitoring of action. Psychological Medicine, 19: 359–63. Fromm-Reichmann, F. (1950). Principles of intensive psychotherapy. Chicago: University of Chicago Press. Giorgi, A., & Giorgi, B. (2008). Phenomenological psychology. In C. Willig & W. Stainton- Rogers (eds), The Sage handbook of qualitative research in psychology, Ebook: pp. 3–29, print pp. 165–79. London: Sage. Husserl, E. (1970). The crisis of European sciences and transcendental phenomenology. Evanston, IL: Northwestern University Press. Husserl, E. (1977). Cartesian meditations. The Hague: Martinus Nijhoff. Jaspers, K. (1963). General psychopathology. Chicago: University of Chicago Press. Jeannerod, M. (2009). The sense of agency and its disturbances in schizophrenia: A reappraisal. Experimental Brain Research, 192:527–32. Kraepelin, E. (1904). Clinical psychiatry (6th ed.). New York: Macmillan. Laing, R. D. (1969). The divided self. New York: Pantheon. Levinas, E. (1969). Totality and infinity. Pittsburgh: Duquesne University Press. Lin, K. M., & Kleinman, A. M. (1988). Psychopathology and clinical course of schizophrenia: A cross-cultural perspective. Schizophrenia Bulletin, 14: 555–67.

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Meyer, A. (1950). The collected papers of Adolf Meyer. Baltimore, MD: Johns Hopkins University Press. Morgan, C., Abdul-Al, R., Lappin, J. M., Jones, P., Fearon, P., Leese, M., Croudace, T., Morgan, K., Dazzan, P., Craig, T., & Leff, J. (2006). Clinical and social determinants of duration of untreated psychosis in the AESOP first-episode psychosis study. The British Journal of Psychiatry, 189(5):446–52. Morgan, C., & Hutchinson, G. (2009). The social determinants of psychosis in migrant and ethnic minority populations: A public health tragedy. Psychological Medicine, 1:1–5. Read, J., Os, J. V., Morrison, A. P., & Ross, C. A. (2005). Childhood trauma, psychosis and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112(5):330–50. Roosevelt, E. (1958). ‘The Great Question’, remarks delivered at the United Nations in New York on 27 March 1958. Rosenberg, S. D., Lu, W., Mueser, K. T., Jankowski, M. K., & Cournos, F. (2007). Correlates of adverse childhood events among adults with schizophrenia spectrum disorders. Psychiatric Services, 58: 245–53. Rowe, M., & Davidson, L. (In press). Recovering citizenship. Israel Journal of Psychiatry and Related Sciences. Rüsch, N., Corrigan, P. W., Todd, A. R., & Bodenhausen, G. V. (2010). Implicit selfstigma in people with mental illness. The Journal of Nervous and Mental Disease, 198(2):150–3. Saks, E. (2007). The center cannot hold: My journey through madness. New York: Hyperion. Schilder, P. (1976). On psychoses. New York: International Universities Press. Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., Perkins, R., Shepard, G., Tse, S., & Whitley, R. (2014). Uses and abuses of recovery: Implementing recovery-oriented practices in mental health systems. World Psychiatry, 13(1):12–20. Stern, D. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. Harper; Clean & Tight Contents edition. Strauss, J. S. (2014). Reconceptualizing schizophrenia. Schizophrenia Bulletin, 40 (Suppl 2):S97–S100. Sullivan, H. S. (1940). Conceptions of modern psychiatry. New York: Norton. Synofzik, M., Their, P., Leube, D., Schlotterbeck, P., & Lindner, A. (2010). Misattributions of agency in schizophrenia are based on imprecise predictions about the sensory consequences of one’s actions. Brain, 133:262–71. Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., Read, J., Os, J. V., & Bentall, R. P. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective-and cross-sectional cohort studies. Schizophrenia Bulletin, 38(4):661–71. Voss, M., Moore, J., Hauser, M., Gallinat, J., Heinz, A., & Haggard, P. (2010). Altered awareness of action in schizophrenia: A specific deficit in predicting action consequences. Brain, 133:3104–112.

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Warner, R. (1985). Recovery from schizophrenia: Psychiatry and political economy. New York: Routledge & Kegan Paul. Watson, A. C., Corrigan, P., Larson, J. E., & Sells, M. (2007). Self-stigma in people with mental illness. Schizophrenia Bulletin, 33(6):1312–18. Waxler, N. E. (1979). Is outcome for schizophrenia better in nonindustrial societies? The.case of Sri Lanka. Journal of Nervous and Mental Disease, 167:144–58. Yanos, P. T., Roe, D., & Lysaker, P. H. (2011). Narrative enhancement and cognitive therapy: A new group-based treatment for internalized stigma among persons with severe mental illness. International Journal of Group Psychotherapy, 61(4):576–95. Yanos, P. T., Roe, D., West, M. L., Smith, S. M., & Lysaker, P. H. (2012). Groupbased treatment for internalized stigma among persons with severe mental illness: Findings from a randomized controlled trial. Psychological Services, 9(3):248.

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Schizophrenia, Psychosis, and Empathy Mads Gram Henriksen

Introduction This chapter sheds light on the nature of psychosis in schizophrenia. First, the contemporary concept of psychosis is explored. Although ‘psychosis’ remains undefined in the contemporary diagnostic manuals, the definition of ‘hallucination’ and ‘delusion’ suggests that psychosis still is conceived as poor reality testing. Second, this conception of psychosis is critically examined through a clinical-phenomenological exploration of primary delusion and hallucination in schizophrenia. Furthermore, it is argued that the majority of psychotic patients with schizophrenia does not simply mistake the imaginary for the real (as implied in the notion of poor reality testing) but seems rather to exist in a kind of double ontological orientation (i.e. double bookkeeping), which usually allows them to distinguish the psychotic world from the shared-social world. Third, the origin of double bookkeeping is sought in certain anomalous self-experiences (i.e. selfdisorders). Finally, in the concluding remarks, an attempt is made to elicit the form of empathy that is enabled by the clinical-phenomenological approach to the psychopathology of schizophrenia.

The Concept of Psychosis ‘Psychosis’ is a medical term referring to an abnormal condition of the human mind. The concept first appeared in a medical context in the nineteenth century, where Canstatt (1841) introduced it to describe psychic manifestations of ‘neurosis’, which, in the eighteenth century, had been introduced to denote diseases of the nervous system that were not accompanied by fever (Jones, 2015,

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p. 3). Since then, the meaning of ‘psychosis’ and ‘neurosis’ has changed dramatically: ‘neurosis’, to the extent that this concept is still used, signifies a range of mental conditions in which the grasp of reality remains generally unaffected (e.g. anxiety disorders, obsessive-compulsive disorders, and personality disorders), whereas ‘psychosis’ signifies mental disorders with an impaired grasp of reality, frequently reflected in the presence of delusion or hallucination.1 Psychosis may occur in organic disorders (e.g., delirium), substance-related disorders (e.g., toxin exposure), affective disorders (e.g., bipolar disorder), and non-affective disorders (e.g., schizophrenia). In this context, it deserves to be mentioned that some studies suggest that psychosis frequently also occurs in patients diagnosed with non-psychotic mental disorders like anxiety (e.g., Wigman et al., 2012) as well as in healthy individuals (e.g., Posey & Losch, 1983; Barrett & Etheridge, 1992), thereby clearing the way for conceiving psychosis as a continuous or dimensional phenotype (e.g., van Os & Reininghaus, 2016). While this is not the place to engage in any sort of real debate about this conception of psychosis (e.g., Parnas & Henriksen, 2016a), it is noteworthy that the clinical and methodological quality of this literature often is debatable.2 Despite rapid advances in cognitive neuroscience and molecular biology, no robust biomarker for psychosis has been identified and there seems to be no immediate prospect for obtaining it. In other words, diagnosing psychosis continues to rely on clinical assessment and thus on the psychopathological knowledge and expertise of the clinician. The concept of psychosis is pivotal to psychiatry; it plays a crucial role in the classification of psychiatric disorders and guides the treatment of these disorders. Furthermore, the concept of psychosis has considerable ethical and legal implications. In some countries, a person may be committed to a mental institution and undergo involuntary treatment if she is found to be psychotic, and, in the court of justice in some countries, a person who is believed to be psychotic at the time of his crime should not be punished but sentenced to psychiatric treatment. The relatively recent debate about the sanity or lack thereof of the Norwegian mass murderer Anders Behring Breivik, vividly illustrated by the two conflicting psychiatric reports in his trial,3 stressed the need for a clear answer to the notoriously difficult question: what is psychosis? Given the concept’s significance for psychiatric nosology and treatment as well as its ethical and legal implications, it is unsatisfying that the concept of psychosis remains undefined in the current diagnostic manuals of ICD-10 and DSM-5. These manuals do not even use the noun ‘psychosis’ but only the adjective ‘psychotic’, which merely indicates the presence of delusions,

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hallucinations, formal thought disorders or specific abnormalities of behaviour. However, the definitions of ‘delusion’ and ‘hallucination’ (vide infra) strongly imply that psychosis is still conceived as impaired reality testing, thus following the DSM-III definition of ‘psychotic’ as ‘a term indicating gross impairment in reality testing’ (APA, 1980, p.  367). In brief, ‘reality testing’, a concept originally coined by Freud and later adopted by the cognitive sciences, refers to a hypothetical function that apparently enables us to discriminate between stimuli from external reality and from one’s own mind, for example, is the book in front of me really ‘out there in the world’ or is it rather a remembered or imagined book? In the case of hallucination, the claim is basically that the patient takes her imagination (e.g., a thought or mental image of spiders crawling under her skin) for a veridical perceptual sense-experience, thereby ascribing intersubjective reality or validity to the imagined object (i.e., she feels spiders crawling under her skin). While psychosis indisputably involves an impaired grasp of reality, it is, as we shall see, not at all clear that psychosis necessarily amounts to a failure of reality testing. Although psychosis occurs in many different disorders and has a variety of different manifestations, I will in this chapter focus exclusively on schizophrenia. Schizophrenia has often been considered ‘madness par excellence’, with a certain strangeness or incomprehensibility as its hallmark. In the following, I explore if a clinical-phenomenological approach may allow the world of psychosis in schizophrenia, which traditionally has been deemed bizarre or not understandable, to appear less enigmatic and allow for some form of empathic understanding of these distinctly human experiences.

The World of Psychosis in Schizophrenia In the following, I will focus on primary delusions and hallucinations in schizophrenia, leaving aside formal thought disorders and abnormalities of behaviour. As we shall see, a characteristic feature of primary delusions and hallucinations is their markedly ‘subjective’ or, more precisely, ‘solipsistic’ quality (Sass, 1994). They always appear ‘insufficiently objective’, they are never fully inscribed into the texture of the world but continue to carry a residual layer of subjectivity, and they seem to implicate another realm or world that looms up before the patient alone (Parnas & Henriksen, 2016b). The latter will be explored under the heading of ‘double bookkeeping’.

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Delusion Traditionally, ‘delusion’ is defined as a belief that has the following properties: (i) its content is false (or highly unlikely), (ii) it is held with certainty, and (iii) it is incorrigible. With varying additional properties, this definition has persisted in the diagnostic manuals.4 Bizarre delusion, a subcategory of delusion, is defined as such ‘if they are clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences’ (APA, 2013, p. 87; cf. ICD-10 [WHO, 1992, p. 87]). Nearly all properties of the definitions of delusion and bizarre delusion have been extensively criticized (e.g., Spitzer, 1990; Parnas & Sass, 2001; Heinimaa, 2002; Cermolacce, Sass, & Parnas, 2010; Henriksen, 2013). Instead of echoing this criticism here, let us note that these definitions focus almost exclusively on the content of delusion. This preoccupation with the content of delusion invariably renders some delusions incomprehensible or bizarre, that is, their content simply leaves us baffled – for example, as Parnas and Henriksen (2013, p. 323) put it, ‘How can we possibly understand a person who is fully convinced that her neighbour for no apparent reason is inserting malicious thoughts into her head, [or] a person who believes that his bodily movements are controlled by external forces.’ If we are to understand such delusions, they suggest, ‘we must realize that the content and structure of these experiences are dialectically intertwined, and therefore we must take into account the altered framework of experiencing in schizophrenia’ (p. 324). In the following, an attempt is made to shed some light on the ‘structure’ of delusional and hallucinatory experience and on the ‘altered framework of experiencing’. The three defining properties of delusion (i–iii) are often ascribed to Jaspers (1997). However, Jaspers does precisely not take these properties to define what a delusion is but merely as external characteristics (‘äußere Merkmale’), suggesting the presence of delusion: ‘To say simply that a delusion is a mistaken idea which is firmly held by the patient and which cannot be corrected gives only a superficial and incorrect answer to the problem’ (p. 93). Instead of equating delusion with a specific type of belief or judgement that possesses certain properties, Jaspers argues that delusion ‘manifests itself in judgments’ (p. 95; italics in original). In brief, delusion proper5 is not a belief; rather, the delusional belief is a secondary product of the primary delusional experience. According to Jaspers, delusion proper, which he regarded as highly characteristic of schizophrenia, is not an independent phenomenon, occurring in an otherwise unaffected consciousness, but presupposes and ‘implies a transformation in our total awareness of reality’ (ibid.; italics in original).

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A significant late-prodromal, near-psychotic aspect of this transformation in the ‘total awareness of reality’ is visible in the so-called delusional mood, which is presumed to precede the onset of primary delusion in schizophrenia. Jaspers does not offer a full account of delusional mood (see Conrad, 2002; Henriksen & Parnas, in press) but describes how this predelusional state is permeated by a global, diffuse, ominous feeling of something (not yet defined) impending – as one patient puts it, ‘Something is going on; do tell me what on earth is going on’ (Jaspers, 1997, p. 98). Patients are somehow certain that ‘something’ is going on or that ‘something’ is about to happen but the nature of this ‘something’ eludes their grasp; it has not yet materialized into something concrete, into a proper ‘object’, as it were. In fact, the very crystallization of this perplexed state of atmospheric insecurity into a more definable object or quasi-object marks the onset of psychosis (e.g., ‘I’m under surveillance’ or ‘they are influencing my thoughts’). In delusional mood, Jaspers says, patients feel uncanny (‘unheimlich’). In this unbearable state, patients desperately search for solutions and answers, instinctively seeking ‘some fixed point to which they can cling’ (ibid.). Finally reaching the fixed point, Jaspers says, ‘is like being relieved from some enormous burden’ (ibid.). The fixed point, lending perspective, certainty, and meaning, is the delusion. Most importantly, a primary delusion does not crystalize through a process of inferential reasoning or a gradual piecing together of parts that progressively solidifies into a delusional belief (as in the case of ‘secondary’ delusions or ‘delusion-like ideas’, as Jaspers calls them6). Rather, primary delusions have the experiential structure of an epiphany (Ey, 1973; Conrad, 2002), that is, they are experientially given as a sudden, striking, and profound realization, manifesting what it discloses as undoubtedly true – the experience is given in such way that it reveals it to be so (Parnas & Henriksen, 2016b). As Gennart (2011, p.  324) aptly points out, the meaning of (revelatory) primary delusional experience is not grasped through the patient’s efforts of interpretation but is immediately articulated through its very manifestation, imposing itself on the patient and bypassing his potentiality for distance, doubt, and critical reflection. Similarly, Jaspers (1997, p. 99) speaks of ‘an immediate, intrusive knowledge of the meaning and it is this which is itself the delusional experience’. In other words, the revelatory givenness of primary delusions is the source of their incorrigibility and absolute sense of certainty (Müller-Suur, 1950). From a phenomenological perspective, primary delusions are not essentially false or dysfunctional beliefs, determined by certain cognitive biases that distort information processing (e.g., ‘jumping to conclusions data gathering bias’, ‘externalizing attributional style’, or ‘theory of mind deficits’) as they typically are conceptualized in the influential

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literature of cognitive-behavioral therapy for schizophrenia (Škodlar et al., 2013, p. 257). ‘For any true grasp of delusion’, Jaspers (1997, p. 97) stresses, ‘it is most important to free ourselves from this prejudice that there has to be some poverty of intelligence at the root of it.’7

Hallucination In 1817, Esquirol defined ‘hallucinations’ as perceptions that occur without external objects or stimuli (cf. Berrios, 1996, p. 37f.). With little variation, this definition has endured, for example, DSM-5 defines ‘hallucinations’ as ‘perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control’ (APA, 2013, p. 87). Although Esquirol’s definition has remained largely unchanged in the history of psychiatry, it is noteworthy that the meaning of the concept ‘hallucination’ has changed dramatically. Today, hallucination is conceptualized as a disorder of perception, whereas hallucination, for Esquirol, essentially is ‘a cerebral or psychological phenomenon that takes place independently from the senses’ (cited in Berrios, 1996, p. 37; italics added). Furthermore, Esquirol stressed the crucial role of the hallucinating patient’s ‘intimate conviction’ of perceiving something in the absence of a relevant object (ibid.), which suggests a much closer relationship between hallucination and delusion than we tend to think of today, where these concepts designate disorders of perception and judgement, respectively. Despite its long endurance, the definition of hallucination has been widely criticized (see, e.g., Leudar et al., 1997; Liester, 1998; Lothane, 1982; Stanghellini & Cutting, 2003). Rather than reiterating this criticism here, let us have a closer look at the basic element of the contemporary definition, namely, that hallucinations are abnormal perceptions or perception-like experiences. The basic question is if this is true? Or differently put, had Esquirol got it all wrong, when he believed that hallucinations were unrelated to disorders of perception? At a first glance, a hallucination may seem to be an abnormal perceptual experience – the person, who hallucinates, appears to perceive something that is unperceivable for others, for example, hearing a ‘voice’ that no one else can hear or seeing something that others cannot see. From a clinical-phenomenological perspective, the perceptual quality of hallucinations is ambiguous and it seems to vary depending on the specific mental disorder. For example, transient hallucination is a frequent symptom and a diagnostic criterion for alcohol withdrawal – these patients will often visually ‘see’ something, say, insects crawling on their skin

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(which may lead to formication) or rats running on the floor. These hallucinations seem similar to veridical perceptions in the sense that their hallucinatory object usually is experienced as very real, as right there in the world, and they tend to provoke adequate behavioural responses (e.g., scratching the skin or fleeing from the rats). In schizophrenia, by contrast, hallucinations are rarely experienced in this way. Although hallucinations may occur in all sense modalities in schizophrenia (auditory, visual, tactile, olfactory, gustatory), auditory verbal hallucinations (AVHs) are by far the most frequently encountered type of hallucination in schizophrenia. In the following, I address only AVHs in schizophrenia, exploring their content and structure. With regard to the content of AVHs, most patients suffer from ‘voices’ that are demeaning, humiliating, or threatening, but some patients also hear ‘voices’ that guide them in life. The ‘voices’ may vary on a number of dimensions, for example, with regard to their clarity (from murmur to distinct voices), volume (from whispering to shouting), linguistics (words, sentences, or, though more rarely, dialogues), and form of address (where discussing voices or running commentary have been considered especially important in schizophrenia). Even the taken-for-granted acoustic quality of ‘voices’ may vary (sometimes ‘voices’ even lack an acoustic or auditory quality) and patients rarely report that they hear the ‘voices’ through their ears – for example, as one of Bleuler’s (1950, p. 114) patients puts it, ‘The voices are unlike spoken voices but are as if thought.’ In brief, what is referred to as AVHs or ‘voices’ are not a univocal, well-defined symptom but probably a wide group of mental phenomena that most likely are etiologically and pathogenetically heterogeneous (Ey, 1973; Henriksen, Raballo, & Parnas, 2015; Henriksen & Parnas, 2015). Turning now to the structure or experiential givenness of AVHs in schizophrenia, some interesting features emerge that appear to distinguish AVHs from veridical auditory perceptions. Unlike the latter, (i)  AVHs do often not involve integration of multiple sense modalities but occur in a single modality; (ii) AVHs are usually not experienced actively in the sense of being controlled by a willed attention; (iii) AVHs violate the physical constraints of the sensorial space and are often experienced as ubiquitous (e.g., if the ‘voice’ is experienced as coming from the ‘outside’, then its intensity usually remains unaffected by moving towards or away from its source or by interposition of barriers); (iv) AVHs do not always have a temporal structure but may be revealed to the patient as sudden, immediate flashes of meaning (similar to the revelatory givenness of primary delusion); (v) AVHs are typically experienced as private phenomena, that is, patients do usually not expect others to be able to hear the ‘voices’ they

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hear (Aggernæs, 1972); and, finally, (vi) patients rarely mistake their hallucinatory ‘voices’ for real voices in the external world. These phenomenological features of AVHs in schizophrenia indicate that ‘voices’ are not inscribed in the world, that is, they do not take place in or occupy a spatio-temporal position in the shared-social world, and they do not seem to be given to the patient through the medium of perception. This is also an insight of Merleau-Ponty (2002, p. 395), ‘Hallucinations are played out on a stage different from that of the perceived world.’ In other words, ‘voices’ are not in the world but rather in front of it or, as Merleau-Ponty puts it, superimposed on it (ibid.). Typically, ‘voices’ are felt to be ‘hyper-proximate’ to the patient’s innermost recesses (Charbonneau, 2004), which precludes taking a protective distance, shelter, or flight. In this respect, ‘voices’ resemble the character of haunting – as one of our patients puts it, ‘I cannot shut her [the voice] out. She is always there.’ ‘Voices’ articulate a radical experience of ‘another presence’ in the midst of one’s own subjectivity or inner world (Henriksen & Parnas, 2014, p. 545; vide infra). Crucially, AVHs, like primary delusion, seem to presuppose and occur in another, inner or private world that somehow exists alongside the shared-social world (Henriksen & Parnas, 2014; Parnas & Henriksen, 2016b).

Double bookkeeping Already Bleuler (1950, p.  56), who coined the concept of schizophrenia, described double bookkeeping as a cardinal feature of schizophrenia: ‘It is especially important to know that these patients carry on a kind of ‘double entrybookkeeping’ in many of their relationships. They know the real state of affairs as well as the falsified one and will answer according to the circumstances with one kind or the other type of orientation – or both together.’ He further states, ‘As a matter of fact the contradictions with reality are, for the most part, hardly noted at all . . . Not only do delusion and reality exist consecutively in various states of lucidity, but they can also exist simultaneously in conditions of full consciousness where one would expect that they would be mutually exclusive’ (p. 126). Jaspers also touched upon this issue, considering it a central source of incomprehensibility and incorrigibility in schizophrenia, but his intuition was not grasped or expressed as clearly as Bleuler’s. Jaspers (1997, 105f.) writes, We cannot say that the patient’s whole world has changed, because to a very large extent he can conduct himself like a healthy person in thinking and behaving. But his world has changed . . . Reality for him does not always carry the

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same meaning as that of normal reality . . . Hence the attitude of the patient to the content of his delusion is peculiarly inconsequent at times . . . Belief in reality can range through all degrees, from a mere play with possibilities via a double reality – the empirical and the delusional – to unequivocal attitudes in which the delusional content reigns as the sole absolute reality.

Unfortunately, Bleuler’s original insight about the quintessential role of double bookkeeping in schizophrenia sunk into oblivion. Bleuler himself offers many vivid, clinical examples of double bookkeeping; a few of them will be explored below. Although they more or less all exemplify a peculiar tension or mismatch between, on the one side, entertaining a specific delusion or hallucination and, on the other side, a striking failure to act upon this very experience, double bookkeeping is not reducible to this mismatch. Rather, the mismatch is a strong indicator that the patient harbours double bookkeeping. Following Bleuler’s insight, as elicited in the quotations above, double bookkeeping has recently been defined as a predicament and ability to simultaneously live in two different worlds, namely, the shared-social world and a private, solipsistic, and, at times, psychotic world (Henriksen & Parnas, 2014, p. 544). On this account, the reason why the two worlds are not ‘mutually exclusive’ is rooted in their different ontological status, which enables patients to experience them as two different, incommensurable, and thus not conflicting worlds, thereby allowing them to coexist and only occasionally to collide (ibid.). Before further keying in on the nature of double bookkeeping, let us have a look at some prototypical examples. The following, quite famous passage is perhaps one of the most illuminating examples of double bookkeeping: ‘Kings and Emperors, Popes, and Redeemers engage, for the most part, in quite banal work, provided they still have any energy at all for activity. This is true not only of patients in institutions, but also of those who are completely free. None of our generals has ever attempted to act in accordance with his imaginary rank and station’ (Bleuler, 1950, p. 129). Most clinicians are familiar with some manifestations of this paradoxical phenomenon, though they are not always as spectacular as in Bleuler’s vignettes. For example, it could be patients who claim that others are automatons or phantoms but who nevertheless interact with them as if they were real (cf. Sass, 1994, p. 21) or patients who claim to be God, yet willingly clean their room and sweep the floor. Double bookkeeping may also be visible in the patients’ attitudes towards the staff – as Bleuler (1950, p. 130) puts is, ‘they curse us in the strongest terms as their poisoners, only to ask us in the very next moment to examine them for

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some minor ailment, or to ask for a cigarette’. Finally, hallucinations may also be embedded in a form of double bookkeeping. Here is another illustrative example from Bleuler: ‘A catatonic patient was in great fear of a hallucinated Judas Iscariot who was threatening her with a sword. She cried out that the Judas be driven away, but in between she begged for a piece of chocolate’ (p. 43). What is enigmatic in these examples is of course the striking incongruity between the ‘intimate conviction’ of the truth or validity of the delusional or hallucinatory experience and the conspicuous lack of adequate actions. Normally, we tend to perceive actions as confirmations of beliefs but in these cases we are left wondering whether or not the patients actually believe what they claim to believe. Another crucial aspect of double bookkeeping is illustrated in the case of Renée: ‘Little by little I brought myself to confine to my friends that the world was about to be destroyed, that planes were coming to bomb and annihilate us. Although I often offered these confidences jestingly I firmly believed them . . . Nonetheless, I did not believe the world would be destroyed as I believed in real facts’ (Sechehaye, 1951, p. 14f.; italics added). Renée fully believes in her eschatological delusion (the world is about to be destroyed) but she does not believe in it in the same way as she believes in real facts (like ‘there is a bottle of water on my desk’ or ‘this desk is made of wood’). Apparently, she is to some extent able to differentiate her beliefs pertaining to the shared-social world (e.g., real facts) from her delusional belief that somehow pertains to her alone. Sass (2014) describes another patient, who was ‘absolutely convinced’ that aliens were gunning in the street, while, at the same time being perfectly aware ‘that others would not be affected by the alien bullets and [the patient] was thus utterly unsurprised to see them walking around unfazed’. Primary delusions seem to occur in a solipsistic, psychotic world that looms up before the patients alone; a purely subjective world distinct from the shared-social world with its metaphysical constraints and consequentiality. As Sass (1994, p. 46) aptly puts it, the ‘delusional world of many schizophrenic-type patients is not, then, a flesh-andblood world of shared action and risk but a mind’s-eye world’.8 According to Sass, there is an inherent solipsistic quality, a ‘coefficient of subjectivity’ (p. 27), to primary delusions, indicating that these delusions, though asserted confidently and held with certainty, may pertain to a solipsistic world rather than to matter of affairs in the public, consensual world. This lack of any straightforward referentiality to the shared-social world may explain why the patients’ behaviour often is strikingly at odds with what we would expect from someone who firmly holds such beliefs – to act in a solipsistic world may, Sass says, ‘feel either unnecessary or impossible’ (p. 42) – as well as why these delusions tend to be immune

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to counterarguments (we should not expect a primary delusion formed within a solipsistic world to be proven wrong in the public domain). From the perspective of double bookkeeping, many symptoms of schizophrenia are perhaps not as incomprehensible as they often are cut out to be. By now, it should be evident that psychosis in the form of double bookkeeping is the contradistinction to psychosis defined as poor reality testing. Poor reality testing implies that patients take the imaginary for real, thus conflating the world of psychosis with the shared-social world. By contrast, double bookkeeping implies that patients are aware of both the psychotic and the intersubjective world and often, though not necessarily always, are able to tell them apart. In this context, it merits attention that Sass and Pienkos (2013) and Sass (2014) offer an interesting alternative, which they, using a term from the world of photography, call ‘double exposure’, which refers neither to a coalition nor to a differentiation of realities but rather to a merging or crossing of different perspectives on reality. Obviously, this is a valuable observation, emphasizing in particular the feeling of unreality that may pervade the psychotic as well as the shared-social world to the extent that the very distinction between what is real and what is unreal seems to evaporate. Yet, it is not entirely clear why double exposure is something apart from double bookkeeping rather than one of its manifestations.

Self-Disorders and the Origin of Double Bookkeeping How does double bookkeeping come about? In the following, I suggest that double bookkeeping may be rooted in a constellation of certain typical, non-psychotic, and mainly trait-like anomalous self-experiences, namely, self-disorders. During the past two decades, empirical studies have documented that self-disorders aggregate in schizophrenia spectrum disorders but not in other mental disorders (Parnas et al., 2003; Parnas et al., 2005a; Haug et al., 2012; Raballo & Parnas, 2012; Nordgaard & Parnas, 2014) and self-disorders have been found to predict subsequent schizophrenia spectrum diagnosis as well as psychosis onset (Parnas et al., 2011; Nelson, Thompson, & Yung, 2012; Parnas, Carter, & Nordgaard, 2016) (for a review, see Parnas & Henriksen [2014]). The aggregation of self-disorders in schizophrenia destabilizes the framework of experiencing and threatens the tacit, foundational self-world structure (the ‘intentional arc’). It has been proposed that the self-disorders weaken the ordinary immersion in the shared-social world and throw the patient into a new, solipsistic world.9 Unconstrained by the natural

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certitudes concerning causality, space, time, and non-contradiction that govern the shared-social world and make it predictable, ontologically secure, and homely, the solipsistic world may appear as only apparent, staged, unreal, minddependent, or prone to non-causal relations, for example, reflected in experiences of primary self-reference or magical thinking (Parnas & Henriksen, 2013; Henriksen & Parnas, 2014). The coexistence of the shared-social and the solipsistic world implies here a kind of ‘pre-psychotic double bookkeeping’ (Parnas & Henriksen, 2013, p. 326). Let us now have a look at some of the most frequently reported self-disorders in the schizophrenia spectrum. Typically, patients complain of feeling as if they do not truly exist, of lacking an inner core, and of being radically, though often ineffably, different from others (Anderssein). The distinctness of ‘Anderssein’ appears to be a pervasive sense of feeling ontologically different, that is, it is a feeling of being different in which one’s very sense of being human is alarmingly at stake and it is often a source of profound solitude and suffering. Patients also frequently describe a deficient sense of ‘mineness’ of the experiential field, for example, certain thoughts or bodily movements may feel as if the patients do not generate them (e.g., ‘my thoughts feel strange as if they aren’t really coming from me’). Complaints of thematically unrelated thoughts that break into and interfere with the main train of thoughts or of rapid, parallel trains of thoughts that occur with a clear loss of meaning (e.g., ‘my thoughts are like rockets, shooting in all directions at once. It’s one big chaos’) or of thoughts that suddenly disappear completely are often encountered. Thoughts may also acquire spatial or quasi-spatial qualities and many patients report that they listen to their own thoughts spoken aloud internally with their own voice (Gedankenlautwerden). Often, patients also complain of not feeling truly present in the world (e.g., ‘I live in a sort of bubble, where the world does not matter. I lack synchrony with the people around me’). Problems with common sense, which have been thoroughly described by Blankenburg (1971), are also typically reported; these problems reflect an inability to take for granted what others consider obvious or matter of fact (e.g., reflected in questions such as ‘why do people say “hello” to each other?’, ‘why is the sky blue?’, or ‘why is the colour code in traffic signals red-yellow-green?’) and often patients hyper-reflect on the relevant issues in an attempt to decode their meaning. We may also observe a variety of bodily disturbances (e.g., ‘the body feels awkward as if it does not really fit. It feels like the body is not really me, as if it is rather a machine controlled by my brain, as if the body is a mere appendage’), mirror phenomena (e.g., ‘it is as if the reflected image is not supposed to be me . . . When I pass by a mirror, I must stop and make sure that there have not been too many

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changes’), transitivistic phenomena (e.g., feeling radically exposed, too open or without any barriers), and quasi-solipsistic experiences (e.g., transient feelings of centrality or of extraordinary insight into hidden dimensions of reality).10 The self-disorders described above are perhaps best conceived as manifestations of a basic disturbance of ‘ipseity’ or ‘minimal self ’ (Sass & Parnas, 2003; Cermolacce, Naudin, & Parnas, 2007; Nelson, Parnas, & Sass, 2014; Parnas & Henriksen, 2014)  – a disturbance that destabilizes the pre-reflective sense of self-presence that tacitly pervades all our experiential life. The normally tacit sense of ‘I-me-myself ’ no longer saturates the experiential life in an unproblematic manner, thereby enabling usually silent or otherwise anonymous regions to emerge with alien prominence within the very intimacy of one’s experiential field (Parnas & Henriksen, 2016b). This wavering sense of self-presence destructures the experiential field (e.g., the me/not-me [self-other] boundary) and enables ‘another presence’ (vide supra) to articulate itself in the midst of one’s own subjectivity (ibid.). This experience of ‘another presence’ is considered a crucial source of double bookkeeping and it has been designated ‘the phenomenological core of primary psychotic experience in schizophrenia’ (ibid., p. 85; authors’ italics). Eventually, this alien presence may materialize into a persecuting, influencing, or hallucinatory Other – for example, reflected in radical experiences of someone or something, in the innermost recesses of the self, listening to you (delusion of being bugged), looking at you (delusion of being filmed), touching you (delusion of control), or speaking to or about you (AVHs) (ibid.).

Conclusion and a Plea for Empathy This chapter has strived to illuminate the potential and relevance of phenomenology for grasping essential features of the psychopathology of schizophrenia. I have argued that the current definition of psychosis, delusion, and hallucination is at odds with the phenomenology of these experiences in schizophrenia. Future efforts to redefine the basic concepts of psychopathology in a phenomenologically faithful way are of paramount importance not only for obtaining a more valid description and classification of mental symptoms but also for our ability to grasp the patients’ experiences and lifeworld, which is crucial for offering adequate therapeutic support. A therapeutic target, emerging on the basis of what has been discussed here, could consist both in addressing the vulnerability involved in the self-disorders and in helping the patients to balance or negotiate an existence that is exposed to two different worlds (rather than treating

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with the purpose of eliminating the solipsistic and, at times, psychotic world). Although such a phenomenologically informed psychotherapy for schizophrenia remains to be developed, important resources may be drawn from Corin’s (1990) work on ‘positive withdrawal’ and Davidson’s (2003) work on recovery in schizophrenia. Finally, a note on empathy. It has repeatedly been stated that certain pathological experiences in schizophrenia, in particular bizarre delusions, are far beyond empathic understanding. In this chapter (and elsewhere), I have argued against this claim (e.g., Henriksen, 2013; Parnas & Henriksen, 2013). The creation of the category of bizarre delusion in DSM-III (APA, 1980) was initially justified by a cursory reference to Kraepelin’s observation that schizophrenic delusions often are ‘non-sensical’ and to Jaspers’s claim that primary delusions cannot be understood (Parnas & Henriksen, 2013, p.  323). However, it seems that the operative notion of comprehensibility is far too restrictive. For an experience to be understandable, on Jaspers’s (1997, p. 301) account, it must basically be accessible through empathy in the sense of projecting oneself into the other’s psychic situation and being able to genetically understand how the other’s mental states emerge from each other. In other words, Jaspers’s criterion for the comprehensibility of pathological phenomena is that they largely fall within the range of normal experiences (Henriksen, 2013, p. 110f). I agree with Jaspers that primary pathological phenomena in schizophrenia – so often fraught with coexisting attitudes and inner contradictions – are psychologically irreducible, that is, we cannot understand the emergence of a primary delusion in the same way that we can understand the development of a depressive episode following the loss of a beloved one. However, the mere fact that primary pathological phenomena are psychologically irreducible does exclude their comprehensibility. We have other forms of understanding and empathy at our disposal. Despite the apparent strangeness and paradoxical qualities inherent in schizophrenia, we can by means of phenomenological analysis begin to unravel and understand these experiences and the lifeworlds in which they are embedded. It is crucial to realize that the schizophrenic lifeworld in various ways is different from that experienced in normal conditions, as pointed out by Jaspers and Bleuler. Crucially, double bookkeeping implies an altered ontological position or, as Ratcliffe (2008, p. 194) puts is, ‘With an altered sense of reality, patients cannot take things to be the case in the usual way, as the sense of ‘is’ and ‘is not’ has changed’ (italics in original). Ignoring this fact is to not do justice to the complexity of the patients’ experiences and challenges. If we are to empathically understand the core pathological experiences, then the task is to reconstruct the

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altered framework of experiencing and lifeworld in schizophrenia. Although we may not be able to imagine precisely what it feels like to, say, have the privacy of one’s subjectivity compromised (transitivism), we can easily imagine a variety of consequences of this disturbing feeling of being ‘too open’ such as fear of others having access to one’s innermost thoughts and inclinations to socially withdraw. Such an understanding has similarities with what Ratcliffe (2012) terms ‘radical empathy’ and which I elsewhere have described as a ‘philosophical understanding’ (Henriksen, 2013, p. 125). Phenomenology enables a form of empathy in the sense that it allows us to understand something of what it might be like to experience the world as patients with schizophrenia sometimes do. Although the more precise nature of this form of empathy remains to be accounted for, it is evident that it requires effectuation of the phenomenological epochē (i.e., we must suspend our normally taken-for-granted beliefs about the world) and faithfully try to reconstruct the altered framework of experiencing and lifeworld in schizophrenia – a life world usually deprived of the ontological securities and natural certitudes that ground a normal existence. Effectuating the epochē and adopting a phenomenological stance is not something that we by default know how to do, but it is something that we can learn to do (Englander, 2014).

Notes 1. For a brief history of the concept of psychosis, see Bürgy (2008) or Jones (2015). However, these contributions do not address the more fundamental question about the nature of psychosis. For phenomenological and philosophical considerations on this issue, see Parnas (2015a). 2. Two observations may illustrate this point. First, patients who are psychotic and anxious (as many patients with a psychotic disorder may be) should of course not have been diagnosed with anxiety disorder in the very first place. In other words, psychosis is not allowed within the nosological boundaries of anxiety disorder in ICD-10 (WHO, 1992, pp. 134–42). Instead of jumping to the conclusion that psychosis is prevalent in patients with anxiety disorder, we ought to be sceptical about the clinical validity of the diagnoses in these cases. However, the problem runs deeper than that of misdiagnosis and, more generally, of differential diagnostic disarray (Parnas, 2015b). A substantial part of the problem is in fact nosological, that is, the diagnostic threshold for schizophrenia in ICD-10 and DSM-5 (APA, 2013) is formulated at such high chronicity levels that only quite stable and fully crystalized delusions or hallucinations fulfil the diagnostic

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criteria. The implication is that patients, who suffer from more insidious or less flamboyant forms of psychosis (e.g., hebephrenia), who do not show clear-cut psychotic symptoms with a duration of at least one month or who experience predominately ‘subthreshold’ or ‘attenuated’ positive symptoms, do not fulfil the diagnostic criteria for schizophrenia and thus receive another diagnosis. These circumstances seem to blur the clinical picture and eventually invite the illusion that psychosis is widely present in non-psychotic mental disorders (Parnas & Henriksen, 2016a). Second, the self-rating scales, typically used to demonstrate the presence of ‘psychotic-like experiences’ in the general population, have been found to be entirely uncorrelated with clinician-rated scales of ‘attenuated psychotic symptoms’ (Schultze-Lutter et al., 2014). In another important study, Stanghellini et al. (2012) demonstrated that hallucinatory experiences in a nonclinical population are remarkably different from hallucinations in schizophrenia. More specifically, the nonclinical population reported hypnagogic, hypnopompic, and pseudo-hallucinations as single, isolated phenomena or related to circumstantial stressors, whereas the patients with schizophrenia reported genuine hallucinations that were intimately intertwined with their selfdisorders, personal identity, and metamorphosis of self-world relationship. 3. In 2011, Breivik butchered seventy-seven civilians in his attacks in Olso and on the island Utøya. During his trial, two diagnostic reports arrived at remarkably different conclusions, namely, paranoid schizophrenia and narcissistic personality disorder with antisocial traits, respectively. On the basis of the latter diagnosis, Breivik was sentenced to twenty-one years in preventive custody with a minimum time of ten years. His case is reminiscent of the case of the French peasant Pierre Marie Rivière, who, in an act of cruelty, slaughtered his mother, sister, and brother in 1835. Also in this case, diagnostic reports arrived at conflicting conclusions, namely, again, sane and insane (psychosis), respectively. Rivière was eventually sentenced to life imprisonment (for a thorough discussion of the two cases, see Nilsson, Parnas, & Parnas [2015]). 4. For example, in DSM-III-R (APA, 1987), ICD-10, DSM-IV-TR (APA, 2000), and DSM-5. 5. Jaspers famously distinguishes between delusions proper (also called true or primary delusions) and delusion-like ideas. The latter emerge in a psychological comprehensible way from preceding experiences and affects, whereas the former emerge from primary pathological experiences, which are psychologically irreducible and thus incomprehensible. Jaspers’s distinction between delusions proper and delusion-like ideas is echoed in the distinction between bizarre and non-bizarre delusion in DSM-5 and ICD-10. 6. Delusions of jealousy and (non-bizarre) persecutory delusions are typical examples of secondary delusions, which may be seen in all forms of psychoses.

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7. The following brief exchange between George W. Mackey, a professor of mathematics at Harvard University, and John Forbes Nash Jr., Nobel Prize winner in economics and a schizophrenia sufferer, may serve to illustrate this point. Mackey asks, ‘How could you, a mathematician, a man devoted to reason and logical proof . . . how could you believe that extra-terrestrials are sending you messages? How could you believe that you are being recruited by aliens from outer space to save the world?’ Nash replies, ‘Because . . . the ideas I had about supernatural beings came to me the same way that my mathematical ideas did. So I took them seriously’ (Nasar, 1998, p. 11; italics added). 8. Sass employs here Schreber’s notion of seeing with the ‘mind’s eye’ (geistigen Auge), which Schreber (2000, p. 120) distinguishes from seeing with the ‘bodily eye’ (körperlichen Auge). Schreber coined the term of the ‘mind’s eye’ to articulate his experience of continual communication, through ‘nerve-contact’ and ‘rays’, with God. 9. In Jaspers (1997, p. 117), we find a related observation: ‘The awakening of new worlds in the schizophrenic transformation of the individual goes along with the alienation of natural world.’ 10. The patient quotations in this section appear in Henriksen & Nordgaard (2014). For details and rich clinical descriptions of self-disorders, see Parnas & Handest (2003), Parnas et al. (2005b), Henriksen & Parnas (2012), and Henriksen & Nordgaard (2016).

References Aggernæs, A. (1972). The experienced reality of hallucinations and other psychological phenomena: An empirical analysis. Acta Psychiatrica Scandinavica, 48:220–38. APA: American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders: DSM-III. Washington, DC: APA. APA: American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders: DSM-III, revised. Washington, DC: APA. APA: American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV, text revision. Washington, DC: APA. APA: American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington: APA. Barrett, T. R., & Etheridge, E. (1992). Verbal hallucinations in normals, I: People who hear ‘voices’. Applied Cognitive Psychology, 6:379–87. Berrios, G. E. (1996). The history of mental symptoms: Descriptive psychopathology since the nineteenth century. New York: Cambridge University Press. Blankenburg, W. (1971). Der Verlust der natürlichen Selbstverständlichkeit. Ein Beitrag zur Psychopathologie symptomarmer Schizophrenien. Stuttgart: Enke.

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Bleuler, E. (1950). Dementia praecox or the group of schizophrenias, trans. J. Zinkin New York: International University Press. Bürgy, M. (2008). The concept of psychosis: Historical and phenomenological aspects. Schizophrenia Bulletin, 34:1200–10. Canstatt, C. (1841). Handbuch der Medizinischen Klinik. Stuttgart: Enke. Cermolacce, M., Naudin, J., & Parnas, J. (2007). The ‘minimal self ’ in psychopathology: Re-examining the self-disorders in the schizophrenia spectrum. Consciousness and Cognition, 16: 703–14. Cermolacce, M., Sass, L. A., & Parnas, J. (2010). What is bizarre in bizarre delusions? A critical review. Schizophrenia Bulletin, 36:667–79. Charbonneau, G. (2004). Introduction à la phénoménologie des hallucinations. In G. Charbonneau (ed.), Introduction à la phénoménologie des hallucinations, pp. 17–42. Paris: Circle hermeneutique. Conrad, K. (2002). Die beginnende Schizophrenie. Versuch einer Gestaltanalyse des Wahns. Bonn: Edition Das Narrenschiff im Psychiatrie-Verlag. Corin, E. (1990). Facts and meaning in psychiatry: An anthropological approach to the lifeworlds of schizophrenics. Culture, Medicine, and Psychiatry, 14:153–88. Davidson, L. (2003). Living outside mental illness: Qualitative studies of recovery in schizophrenia. New York: New York University Press. Englander, M. (2014). Empathy training from a phenomenological perspective. Journal of Phenomenological Psychology, 45: 5–26. Ey, H. (1973). Traite des hallucinations, Tome I et II. Paris: Masson. Gennart, M. (2011). Corporéité et présence. Jalons pour une approche du corps dans la psychose. Argenteuil: Le Cercle Hermeneutique. Haug, E., Lien, L., Raballo, A. Bratlien, U., Øie, M., Andreassen, O. A., Melle, I., & Møller, P. (2012). Selective aggregation of self-disorders in first-treatment DSM-IV schizophrenia spectrum disorders. Journal of Nervous and Mental Disease, 200:632–6. Heinimaa, M. (2002). Incomprehensibility: The role of the concept in DSM-IV definition of schizophrenic delusions. Medicine, Health Care and Philosophy, 5:291–5. Henriksen, M. G. (2013). On incomprehensibility in schizophrenia. Phenomenology and the Cognitive Sciences, 12:105–29. Henriksen, M. G., & Nordgaard, J. (2014). Schizophrenia as a disorder of the self. Journal of Psychopathology, 20: 435–41. Henriksen, M. G., & Nordgaard, J. (2016). Self-disorders in schizophrenia. In G. Stanghellini & M. Aragona (eds), An experiential approach to psychopathology: What is it like to suffer from mental disorders, pp. 265–80. New York: Springer. Henriksen, M. G., & Parnas, J. (2012). Clinical manifestations of self-disorders and the Gestalt of schizophrenia. Schizophrenia Bulletin, 38:657–60. Henriksen, M. G., & Parnas, J. (2014). Self-disorders and schizophrenia: A phenomenological reappraisal of poor insight and noncompliance. Schizophrenia Bulletin, 40:542–7.

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Henriksen, M. G., & Parnas, J. (2015). Phenomenology, meaning, and metaphor. Philosophy, Psychiatry, & Psychology, 22:193–6. Henriksen, M. G., & Parnas, J. (in press). Delusional mood. In G. Stanghellini et al. (eds), The Oxford handbook of phenomenological psychopathology. Oxford: Oxford University Press. Henriksen, M. G., Raballo, A., & Parnas, J. (2015). The pathogenesis of auditory verbal hallucinations in schizophrenia: A clinical-phenomenological account. Philosophy, Psychiatry, & Psychology, 22:165–81. Jaspers, K. (1997). General psychopathology, trans. J. Hoenig & M. W. Hamilton. London: Johns Hopkins University Press. Jones, S. M. (2015). History of concept of psychosis: What was it, what is it? In F. Waters & M. Stephane (eds), The assessment of psychosis: A reference book and rating scales for research and practice, pp. 3–16. New York: Routledge. Leudar, I., Thomas, P., McNally, D., & Glinski, A. (1997). What voices do with words: Pragmatics of verbal hallucinations. Psychological Medicine, 27: 885–98. Liester, M. B. (1998). Toward a new definition of hallucination. American Journal of Orthopsychiatry, 68:305–12. Lothane, Z. (1982). The psychopathology of hallucinations – a methodological analysis. British Journal of Medical Psychology, 55:335–48. Merleau-Ponty, M. (2002). Phenomenology of perception. London: Routledge. Müller-Suur, H. (1950). Das Gewissheitsbewusstsein beim schizophrenen und beim paranoischen Wahnerleben. Fortschritte der Neurologie, Psychiatrie, und ihrer Grenzgebiete, 18:44–51. Nasar, S. (1998). A beautiful mind. New York: Simon & Schuster. Nelson, B., Parnas, J., & Sass, L. A. (2014). Disturbance of minimal self (ipseity) in schizophrenia: clarification and current status. Schizophrenia Bulletin, 40:479–82. Nelson, B., Thompson, A., & Yung, A. R. (2012). Basic self-disturbance predicts psychosis onset in the ultra high risk for psychosis ‘prodromal’ population. Schizophrenia Bulletin, 38:1277–87. Nilsson, L. S., Parnas, A. U., & Parnas, J. (2015). Diagnosing insanity 170 years apart: Pierre Rivière and Anders Breivik. Journal of Psychopathology, 21:109–18. Nordgaard, J., & Parnas, J. (2014). Self-disorders and schizophrenia spectrum: A study of 100 first hospital admissions. Schizophrenia Bulletin, 40:1300–307. Parnas, J. (2015a). Philosophical and phenomenological perspectives on psychosis. In F. Waters & M. Stephane (eds), The assessment of psychosis: A reference book and rating scales for research and practice, pp. 17–43. New York: Routledge. Parnas, J. (2015b). Differential diagnosis and current polythetic classification. World Psychiatry, 14:284–7. Parnas, J., Carter, J., & Nordgaard, J. (2016): Premorbid self-disorders and lifetime diagnosis in the schizophrenia spectrum: A prospective high-risk study. Early Intervention in Psychiatry, 10:45–53.

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Parnas, J., & Handest, P. (2003): Phenomenology of anomalous experiences in early schizophrenia. Comprehensive Psychiatry, 44:121–34. Parnas, J,. Handest, P., Jansson, L., & Saebye, D. (2005a). Anomalous subjective experience among first-admitted schizophrenia spectrum patients: Empirical investigation. Psychopathology, 38:259–67. Parnas, J., Handest, P., Saebye, D., & Jansson, L. (2003). Anomalies of subjective experience in schizophrenia and psychotic bipolar illness. Acta Psychiatrica Scandinavica, 108: 126–33. Parnas, J., & Henriksen, M. G. (2013). Subjectivity and schizophrenia: Another look at incomprehensibility and treatment non-adherence. Psychopathology, 46:320–9. Parnas, J., & Henriksen, M. G. (2014). Disordered self in the schizophrenia spectrum: A clinical and research perspective. Harvard Review of Psychiatry, 22:251–65. Parnas, J., & Henriksen, M. G. (2016a). Epistemological error and the illusion of phenomenological continuity. World Psychiatry, 15:126–7. Parnas, J., & Henriksen, M. G. (2016b). Mysticism and schizophrenia: A phenomenological exploration of the structure of consciousness in the schizophrenia spectrum disorders. Consciousness and Cognition, 43: 75–88. Parnas, J., Møller, P., Kircher, T., Thalbitzer, J., Jansson, L., Handest, P., & Zahavi, D. (2005b). EASE: Examination of anomalous self-experience. Psychopathology, 38:236–58. Parnas, J., Raballo, A., Handest, P., Jansson, L., Vollmer-Larsen, A., & Saebye, D. (2011). Self-experience in the early phases of schizophrenia: 5-year follow-up of the Copenhagen Prodromal Study. World Psychiatry, 10:200–204. Parnas, J., & Sass, L. A. (2001). Self, solipsism, and schizophrenic delusions. Philosophy, Psychiatry, and Psychology, 8:101–20. Posey, T. B., & Losch, M. E. (1983). Auditory hallucinations of hearing voices in 375 normal subjects. Imagination, Cognition, and Personality, 3:99–113. Raballo, A., & Parnas, J. (2012). Examination of anomalous self-experience: Initial study of the structure of self-disorders in schizophrenia spectrum. Journal of Nervous and Mental Disease, 200:577–83. Ratcliffe, M. (2008). Feelings of being: Phenomenology, psychiatry and the sense of reality. New York: Oxford University Press. Ratcliffe, M. (2012). Phenomenology as a form of empathy. Inquiry, 55:473–95. Sass, L. A. (1994). Paradoxes of delusion: Wittgenstein, Schreber, and the schizophrenic mind. Ithaca, NY: Cornell. Sass, L. A. (2014). Delusion and double book-keeping. In T. Fuchs, T. Breyer, & C. Mundt (eds), Karl Jaspers’ philosophy and psychopathology, pp. 125–47. New York: Springer. Sass, L. A., & Parnas, J. (2003). Schizophrenia, consciousness, and the self. Schizophrenia Bulletin, 29, 427–44.

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Sass, L. A., & Pienkos, E. (2013). Delusions: The phenomenological approach. In K. W. M. Fulford, M. Davies, G. Graham, J. Sadler, & G. Stanghellini (eds), Oxford handbook of philosophy of psychiatry, pp. 632–57. Oxford: Oxford University Press. Schreber, D. P. (2000). Memoirs of my nervous illness, trans. I. Macalpine & R. A. Hunter. New York: New York Review of Books. Schultze-Lutter, F., Renner, F., Paruch, J., Julkowski, D., Klosterkötter, J., & Ruhmann, S. (2014). Self-reported psychotic-like experiences are a poor estimate of clinicianrated attenuated and frank delusions and hallucinations. Psychopathology, 47:194–201. Sechehaye, M. (1951). Autobiography of a schizophrenic girl, trans. G. Rubin-Rabson. New York: Grune & Stratton. Škodlar, B., Henriksen, M. G., Sass, L. A., Nelson, B., & Parnas, J. (2013). Cognitivebehavioral therapy for schizophrenia: A critical evaluation of its theoretical framework from a clinical-phenomenological perspective. Psychopathology, 46:249–65. Spitzer, M. (1990). On defining delusions. Comprehensive Psychiatry, 31:377–97. Stanghellini, G., & Cutting, J. (2003). Auditory verbal hallucinations – breaking the silence of inner dialogue. Psychopathology, 36:120–8. Stanghellini, G., Langer, Á. I., Ambrosini, A., & Cangas, A. J. (2012). Quality of hallucinatory experiences: Differences between a clinical and a non-clinical sample. World Psychiatry, 11: 110–13. Van Os, J., & Reininghaus, U. (2016). Psychosis as a transdiagnostic and extended phenotype in the general population. World Psychiatry, 15: 118–24. WHO: World Health Organization (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: WHO. Wigman, J. T., van Nierop, M., Vollebergh, W. A., Lieb, R., Beesdo-Baum, K., Wittchen, H. U., & van Os, J. (2012). Evidence that psychotic symptoms are prevalent in disorders of anxiety and depression, impacting on illness onset, risk, and severity – implications for diagnosis and ultra-high risk research. Schizophrenia Bulletin, 38:247–57.

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Empathy in a Social Psychiatry Magnus Englander

The psychologist has the problematics of intentionality through his own original sphere, but this is never isolable for him. Through the empathy of his original sphere of consciousness, through what arises out of it, as a component which is never lacking, he also already has a universal intersubjective horizon, even though he may not notice it at first. (Husserl, 1970, p. 243)

Introduction When we think of social psychiatry, we often think of research and work towards social justice for persons suffering from mental illness (e.g., Bhugra & Till, 2013; Davidson, Rakfeldt, & Strauss, 2010). However, we also need to situate social psychiatry within the minimal social context of the face-to-face situation; what Alfred Schutz (1945, 1967) once emphasized as the basic structure of interpersonal understanding. The face-to-face context brings out questions of how we know and understand others in terms of empathy. We often turn to modern psychology, psychotherapy, and even to cognitive neuroscience to find answers to such questions. I will argue that the foundation of empathy as explicated within the mainstream perspective in such disciplines is questionable. The purpose of this chapter is to outline a plausible answer to the following question: Could a phenomenological psychological approach to empathy have anything specific to contribute to the minimal social situation of the face-to-face (professional) encounter in a social psychiatry? First, I will make an inquiry into the potential value of a phenomenological understanding of empathy. Second, I will clarify how empathy is essential as a means to interpersonal understanding when working with persons suffering from mental illness. Third, I will make a brief sketch of the empathic (psychological) reduction that can aid the mental health care

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professional and students in training in approaching their work with clients in terms of interpersonal understanding.

Empathy as Perception of the Other The field of social psychiatry, just like other related fields, for example, social work, seems to draw its foundational knowledge about empathy from twentiethcentury clinical and counseling psychology. The most influential perspective seems to be the psychoanalytic perspective in psychology, especially Sigmund Freud’s view on empathy, an interpretation that originated in Theodor Lipps’s theory of empathy as imitation and projection (Coplan & Goldie, 2011). The psychoanalyst Heinz Kohut (1981/2010, pp. 125–6), representing Self Psychology, approached empathy together with introspection as ‘informers of appropriate action’, and suggested that we should do the following: ‘ “put yourself into the shoes of ”, think yourself appropriately into the inner life of another person, then you can use this knowledge for your purposes’. The psychoanalytic view has also had implications for clinical social work, especially in terms of gaining insight into relational, psychotherapeutic processes. For example, Rohr (2012, p. 452) acknowledges that empathy is a central concept in psychoanalytic thought and an important part of ‘counter transference reactions’. Even humanistic psychology could not escape the historical trace back to Lipps’s influential account of empathy as imitation. For instance, Carl Rogers (1989, p. 226) defines ‘empathy’ as ‘To sense the client’s private world as if it were your own, but without ever losing the “as if ” quality – this is empathy, and this seems essential to therapy.’ From the perspective of twentieth-century psychology, the view of empathy within the face-to-face context seems to have been mainly influenced by a type of monadology, in which a type of matching or identification of mental states became the method towards interpersonal understanding. However, viewing a human being as a self-contained monad relating to other monads externally is a distorted view of human interaction. According to Merleau-Ponty (1964, p. 114), Given the presuppositions with which that psychology works, given the prejudices it adopted from the start without any kind of criticism, the relation with others becomes incomprehensible for it. What, in fact, is the psyche [psychisme] – mine or the other’s – for classical psychology? All psychologists of the classical period are in tacit agreement on this point: the psyche, or the psychic, is

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what is given to only one person. It seems, in effect, that one might admit without further examination or discussion that what constitutes the psyche in me or in others is something incommunicable. I alone am able to grasp my psyche – for example, my sensations of green or of red. You will never know them as I know them; you will never experience them in my place. A consequence of this idea is that the psyche of another appears to me as radically inaccessible, at least in its own existence. I cannot reach other lives, other thought processes, since by hypothesis they are open only to inspection by a single individual: the one who owns them. (Emphasis in original)

Research in contemporary, (mainstream) cognitive neuroscience seems to suffer the same shortcomings. This limitation is prevalent in explicit and/or implicit simulation theory in the cognitive neurosciences. Gallagher (2005, p. 222) critiques this shortcoming in cognitive neuroscience, The subject seemingly reads off the meaning of the other, not directly from the other’s actions, but from the internal simulation of the subject’s own ‘as if ’ actions. This view suggests that the subject who understands the other person is not interacting with the other person so much as interacting with an internally simulated model of himself, pretending to be the other person. (Emphasis in original)

Hence, views that support simulation, or other accounts that take their departure in focusing upon the reaction, eschew an essential step in terms of interpersonal understanding and empathy, namely, that of human interaction. Following the work of Edith Stein (1964), Max Scheler (2008), and Edmund Husserl (2006), contemporary phenomenological philosophers have recently argued for a conception of empathy as direct social perception of the other (Gallagher, 2008a, b; Gallagher & Zahavi, 2012; Krueger & Overgaard, 2012; Zahavi, 2011). Instead of portraying the phenomenon of empathy as a form of simulation or matching of emotional states (e.g., Goldman, 2006; Gallese, 2003), the phenomenological account argues that understanding originates in our perception of others rather than in our reactions to others (e.g., Gallagher, 2008a, pp. 131–2). Of course, one could imagine what it is like for the other and this could be considered an indirect or sophisticated form of empathy, however, the importance of the phenomenological argument is to point out that interpersonal understanding in the here and now within the face-to-face context begins with perception of the other and is not primarily derived through internal simulations or theoretical inferences (e.g., Gallagher, 2008a; Stein, 1964; Zahavi, 2011). Contextualized within a horizontal intentionality, we are already within

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the perception of others (Gallagher & Zahavi, 2012, p. 119), and to then portray empathy as simulation seems unnecessary and beside the point. Gallagher (2008a, pp. 131–2), critiquing the phenomenon of empathy as beginning with simulation, makes a case for the phenomenological argument using the following example, I see a woman in front of me enthusiastically and gleefully reaching to pick up a snake; at the same time I am experiencing revulsion and disgust about that very possibility. Her action, which I fully sense and understand from her enthusiastic and gleeful expression to be something that she likes to do, triggers in me precisely the opposite feelings. In this case, neither my neural states, nor my motor actions (I may be retreating with gestures of disgust just as she is advancing toward the snake with gestures of enthusiasm), nor my feelings/cognitions match hers. Yet I understand her actions and emotions (which are completely different from mine), indeed that is what is motivating my own actions and emotions, and, moreover, I do this without even meeting the minimal necessary condition for simulation, that is, matching my state to hers. I suggest that no simulation in any form is involved in this kind of case, and I suggest that this kind of case is not rare. So that’s the trouble for the universal claim made for simulation.

In other words, it becomes essential to view our reaction as subsequent to our direct social perception of the other. To take an imaginative walk in the other’s shoes in the face-to-face context means that one must first have been present to somebody’s expression  – or more precisely to somebody’s expressive unity (Zahavi, 2011, p. 10). Hence, empathy as perception of the other indicates a primary focus on someone other than oneself. The simulation model would mean that I would have to find a match between my own state and that of the other. But what if, as we saw in Gallagher’s (2008a) example above (of the woman picking up the snake), the reaction could not find a match, even though the perceiver understood the expression? In other words, our understanding of the other as other could never originate by means of simulation. According to Gallagher (2012, p. 363), ‘The question is, when we project ourselves imaginatively into the perspective of the other, when we put ourselves in his or her shoes, do we really attain an understanding of the other or are we merely reiterating ourselves?’ This is not to say that empathy as perception of the other is the only means towards interpersonal understanding; instead it highlights the a priori of the perceptual act, that is, ‘other perception’, directed towards the lived body of the other, in order for interaction to be possible in the

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first place (as opposed to a ‘robotic monad’ simulating something within its own closed system). In other words, to portray empathy as simulation would be to direct our understanding of the other away from the other. To view empathy as perception of the other means that our understanding of the other starts with the other, commonly referred to in contemporary phenomenological research as second-person access (Zahavi, 2010). Zahavi (2007, p. 197) writes, The second- (and third-) person access to psychological states differ from the first-person access, but this difference is not an imperfection or a shortcoming; rather, it is constitutional. It makes the experience in question an experience of another, rather than self-experience . . . To demand more, to claim that I would have a real experience of the other only if I experienced her feelings or thoughts in the same way as she herself does, is nonsensical. It would imply that I would only experience another if I experienced her in the same way that I experience myself, i.e., it would lead to an abolition of the difference between self and other. Thus, the giveness of the other is of a rather peculiar kind. We experience the meaningful behavior of others as expressive mental states that transcend the behavior that expresses them.

Hence, empathy as perception of the other is not understood as something decontextualized, disembodied, and limited to the isolated expression of the other (Gallagher, 2008b), but the second-person perspective points directly to the social; namely, our ability to differentiate between a thing and a lived body. As Fuchs (2012, p.  24) has pointed out, ‘Expressive bodies, meaningful gestures, intentions-in-action and contextual background information enable us to directly perceive the other as a psychophysical unity, without necessary recourse to first person simulation or third person inference.’ Such an account acknowledges both the importance of the context and the second-person access as the point of departure for interpersonal understanding. Another aspect of the phenomenology of empathy is the importance of the here-and-now, as highlighted in the classic work of Edith Stein (1964), especially in regard to Stein’s first level of empathy as perception of the other. In a practical sense, the here-and-now becomes important in terms of second-person access in following the expression of the other as perception of the other, or ‘empathizing perception’ as Husserl (2006) would have called it. When someone is expressing experiential content, professionally we tend to be primarily concerned with the content itself, as a problem to be solved, and we therefore typically fail to recognize the importance of our direct social perception of the other that takes place

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in the present moment, that is, in the here-and-now, as it unfolds in the faceto-face context (Englander, 2014). Zooming in on the content in itself, perhaps in an attempt to solve the other’s problem, we fail to include the experiential other. As I have suggested elsewhere, such ‘naive habits’ can be disclosed in a phenomenological psychological approach to empathy training in which working professionals and university students can learn how to remain longer within ‘other perception’ (ibid.). Let us end this section by taking a look at a recent phenomenological description of empathy. Gallagher and Zahavi (2012 p. 203) write, Empathy is defined as a form of intentionality in which one is directed towards the other’s lived experience . . . Any intentional act that discloses or presents the other’s subjectivity from the second-person perspective counts as empathy . . . The phenomenological conception of empathy thus stands opposed to any theory that claims our primary mode of understanding others is by perceiving their bodily behavior and then inferring or hypothesizing that their behavior is caused by experiences or inner mental states similar to those that apparently cause similar behavior in us. Rather, in empathy, we experience the other directly as a person, as an intentional being whose bodily gestures and actions are expressive of his or her experiences or states of mind. (Italics in original)

Thus, empathy as perception of the other means following the meaningexpression of the other in the present moment. Empathy is also a necessary a priori layer within the interaction of a we-intentionality (Zahavi, 2015); that is, it is the other’s meanings that we are together directed towards when interpersonal understanding occurs.

Psychiatry, Mental Illness, and Empathy In the face-to-face situation within the context of psychiatric practice, staying in the here-and-now and following the other’s meaning-expression can be seen as what constitutes the possibility of interpersonal understanding within this professional encounter. In an interview provided by Davidson (2014, p. 248), a person suffering from schizophrenia states the following, I’m not a crazy person, but it’s the point that we go through things that people can’t even fully imagine. We can tell you certain things, but it’s almost like saying you’ve never been to prison. I can tell you about prison. I can tell you everything.

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But until you experience being in prison, it’s a whole different story. And that’s how it is with this sickness thing that we’re diagnosed with.

The first reaction that most of us experience is a sort of agreement with the person. But this agreement is based upon our own common sense reaction and our positing the content as factual content. If we instead return to our perception of the other and our presence to the expression of the other in the here-andnow, right before our attention was directed to our own reaction to the content, we recognize that the person suffering from schizophrenia was telling us that we will not be able to understand her. If instead, we stay in the here-and-now within the realm of our perception of the other person’s expression, we could move towards a we-intentionality (i.e., being present to something together) and provide the other with a description based upon our presence of the other’s meaning-expression, that is, empathy, such as: ‘You feel as if I will never be able to understand your situation.’1 What did we just do? We understood her. If nothing else, such an example shows us how essential the here-and-now is for empathy in a face-to-face context. Following the meaning-expression of the other in the here-and-now (as exemplified above) also means that one is primarily following the experiential other, which is to say, from a second-person perspective, that one is focusing on the experiential self (e.g., Zahavi, 2014) of the other. Now, such a statement might at first appear impossible, because it is the experiential self that ultimately separates me from the other (Zahavi, 2014). However, the experiential self, or minimal self, is of primary interest in terms of empathy, because it is the prereflective, first-person of the other that expresses meaning to us. In his research on the phenomenology of the self, Zahavi (2007), has made a rough distinction between the narrative self and the experiential or minimal self that can be of value for our discussion here.2 The first-person perspective and the experiential self have often been portrayed as synonymous with intentionality, internal-time consciousness, and the lived body and hence a prerequisite for a narrative self (Gallagher & Zahavi, 2012). As Zahavi (2007, p. 200) has pointed out, ‘In order to tell stories about one’s own experiences and actions, one must already be in possession of a first-person perspective.’ Starting with second-person access, following the meaning-expression of the other also means that one is primarily following the experiential other and the narrative as it unfolds from the other, rather than following the content of the narrative as the primary object, as an object in itself, that is, existing independently of the person’s experience of it, analyzing it, and later returning to the person and serving her with an explanation of her

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condition. As we can see in our example above, turning to our own reaction to the narrative content itself would be to turn away from the experiential other. This experiential (minimal) self is often referred to as ipseity, or a sense of ‘mineness’, indicating the closeness of ownership of one’s experience (Gallagher & Zahavi, 2012; Parnas et al., 2005). Ownership differs from agency in that one can maintain ownership of an experience even if one’s sense of agency is lost (Gallagher, 2005; Gallagher & Zahavi, 2012). For example, if someone were to push me, I would lose my experience of agency, but I would not lose my ownership of whose experience it is. In terms of psychopathology, such a distinction becomes more complex. Take, for example, hallucinations, such as hearing voices in schizophrenia. There is clearly a loss of not just agency, but also of ownership, because the voices are experienced as belonging to someone else than oneself (Davidson, 2003; Gallagher & Zahavi, 2012; Gallagher, 2005). Let us turn to empathy as perception of the other and see how we could approach this. If the client expresses that the voices are experienced as belonging to someone else, the professional could be present to the expression of the experiential other as a person who has agency and the ownership of a lived experience of something, even though the meaning, from the client’s first-person perspective, is a loss of both agency and ownership. Within the context of a professional encounter, such a presence could reflect to the other that there has not been a complete loss of the experiential (minimal) self, as in you experience something – at least not from the context of the interaction. Hence empathy and a description of one’s presence to the other’s meaning-expression can also be of value as a means to the client’s own personal reflection. As Stein (1964, p. 82) writes, Empathy proves to have yet another side as an aid to grasping ourselves. As Scheler has shown us, inner perception contains within it the possibility of deception. Empathy now offers itself to us as a corrective for such deceptions along with further corroboratory or contradictory perceptual acts. It is possible for another to ‘judge me more accurately’ than I judge myself and give me clarity about myself. For example, he notices that I look around me for approval as I show kindness, while I myself think I am acting out of pure generosity. This is how empathy and inner perception work hand in hand to give me myself to myself.

In other words, empathy as second-person access could be of importance for the face-to-face context in that it can provide for the possibility to aid the person suffering from mental illness in their own struggle to reflect on their own experiences.

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To clarify my last point, Stein’s (1964) reference to Scheler’s deception does not imply that the client’s lived experience of the loss of ipseity is the same as lying to ourselves, or that these types of experiences represent some kind of Freudian denial. As Davidson (2003) has pointed out, we tend to demand an unrealistic sense of awareness towards a person suffering from mental illness that we would never demand for other serious illnesses, and if clients do not have this awareness, they are seen as being in denial or in some sort of stage of self-deception. Such reasoning belongs to the stigma surrounding mental illness. Of course, there are clients who understand that their experience is a hallucination and also clients who experience a great sense of control and agency over their hallucinations. This means that professionals working in a social psychiatry have to be able at times to transcend such simplified psychological explanations such as deception and/or denial. Schizophrenia provides a good example here because as Parnas et al. (2005) and Parnas and Henriksen (2014) have emphasized, it is a self-disorder in which the experience of loss of ipseity is at the experiential core of the illness. Empathy in a phenomenological sense follows the expression from this experiential (minimal) other. In contrast to emotional contagion, empathy as perception of the other is preserving the distance between self and other. As Zahavi (2010, p.  291) has emphasized, ‘The focus is on the other, and not on yourself, not on how it would be like for you to be in the shoes of the other. That is, the distance between self and other is preserved and upheld.’ Consequently, staying within the realm of perception of the other presents us with another possibility, which is to realize how empathy can be utilized within other layers of the interaction such as in a genuine we-intentionality within the face-to-face, professional context. According to Zahavi (2015, p. 97), ‘The self-other differentiation, the distinction between self and other, consequently precedes the emergence of, and is retained in, the we.’ This is not to say that ‘preserving the distance’ to the other is to regress to the medical tradition and the physician’s so-called detached concern, but instead we focus our awareness on whose experience we are attempting to understand. Understanding the other is not about seeking a collapse of perspectives (as in emotional contagion), but to realize that I can never have the other’s experience. To recognize that I am not able to have the other’s experience is not to say that I am not able to understand meanings as expressed by the other. Working within the realm of social interaction in the field of psychiatry means working from the outmost limits of our horizon. Within professional fields such as clinical psychology and psychiatry, clinical social work, psychiatric nursing,

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and recovery-oriented guidance, one cannot rely only on an everyday ‘mundane empathy’ (to use Ratcliffe’s [2012, p. 477] expression). At times one must deliberately adopt a phenomenological attitude in order to understand difficult cases of psychopathology (e.g., Ratcliffe, 2012; Englander, 2014, 2015). Historically, when we have failed to understand persons suffering from psychopathology, our conclusion has been that persons with, for example, autism or schizophrenia, do not resonate (cf. Parnas, Bovet, & Zahavi, 2002). It is worth noting that both Husserl and Jaspers had their shortcomings in terms of viewing empathy as a possibility in regard to mental illness (Luft & Schlimme, 2013; Davidson, 2014). Although there are some indications of the possibility of empathy in both Jaspers’s ‘existential communication’ and Husserl’s ‘minimal empathizing’ (Luft & Schlimme, 2013, p. 346), some clues are clearly still missing. Although Luft and Schlimme (2013) and also Davidson (2003) have shown that we are capable of overcoming such shortcomings in Husserl and Jaspers, we are still in need of a methodological account of how to make interpersonal understanding possible in the face-to-face context.

The Empathic Reduction In the section that follows, I will make an attempt at a brief sketch of a modification of the phenomenological psychological reduction, as it could be utilized by mental health professionals, in their attempt to empathize with clients in the face-to-face context. I  have previously described a type of professional enactment of empathy that is possible by first utilizing the phenomenological psychological reduction, which has led to a phenomenological psychological approach to empathy training for university students and working professionals (Englander, 2014). Also, I  have previously suggested this as a modification of the psychological reduction for the face-to-face context and referred to it as the empathic reduction (Englander, 2015). This will only be outlined here in order to show its relevance to a phenomenological psychological approach to the face-toface context in a professional social psychiatry.3 Before I  proceed, it is essential to mention that Ratcliffe (2012) has a similar proposal in which he claims that the phenomenological attitude can be adopted as a ‘phenomenological stance’ in order to understand experiences of mental illnesses, something that he has referred to as ‘radical empathy’. Ratcliffe’s (2012) argument against simulation theory is similar to that

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of Zahavi’s (e.g., 2010), and he follows Stein’s (1964) take on empathy. In Ratcliffe’s seminal paper Phenomenology as a Form of Empathy (2012), there are parallels to my own work on a phenomenological psychological approach to empathy training (Englander, 2014, 2015; Englander & Folkesson, 2014; Englander & Robinson, 2009). Nevertheless, I will start this section by turning my attention to my own research tradition in American phenomenological psychology (e.g., Giorgi, 1970, 1985, 2009) and psychiatry (Davidson, 2003), and then work with this tradition in a dialogue with Ratcliffe’s (2012) ‘radical empathy’. So let us begin by looking at the psychological reduction and its relation to empathy. The psychological reduction is described by Giorgi (2009, p.  98) as follows, ‘Within this reduction, the objects of experience are reduced (that is, reduced to phenomena as presented), but the acts of consciousness correlated with such objects belong to a human mode of consciousness.’ In the context of a social psychiatry and the face-to-face situation, professionals can thus bracket the existential index of the objects as well as their own presuppositions about phenomena as expressed by the other, in the here-and-now. Such a method could disclose the meanings that I am present to, based upon what is being expressed by the other; however, the reduction remains partial and within the realms of a human mode of consciousness. In other words, one follows the meaning-expression (i.e., phenomena as expressed by the other) and can treat it from the psychological reduction as one’s presence to psychological meanings. As Davidson (2003, p. 100) puts it, We place in brackets all realities ordinarily presumed to exist outside of this person’s experience, including the causal context of nature, and focus exclusively on her experiences themselves as the realities in which we are interested. Rather than explaining her experience on the basis of the underlying causes, we attempt to understand its meaning and structure from the perspective of the subject as it was lived (i.e., experienced) by her. (Emphasis in original)

One is thus considering the objects of the other’s expression as phenomena. If a client is hearing voices, the lived experience is there for the client, whether the voices are real or not. Hence, meanings rest on the intentional relation and one could argue that it is essential to use the psychological reduction in the face-to-face psychiatric context in order to be present to phenomena such as, for example, hallucinations in schizophrenia. So in using the gist of the psychological reduction, that is, bracketing the existential index of the

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object, we are now able to be present to the other as she is expressing psychological meanings in the world. Instead of engaging our beliefs and judgement about the objects being expressed by the other, we are now treating the objects as phenomena and thus we are entering the realm of interpersonal understanding. The reduction utilized in the face-to-face context is the partial psychological reduction in order to remain within a human mode of consciousness. This is not to say that transcendental approaches cannot be used in other contexts (e.g., in a research context) or to rule out the transcendental reduction altogether for the face-to-face context. Rather, it is to situate empathy within the face-to-face context and in relation to a human mode of consciousness. This is similar to what Giorgi (2009, p. 92) in his phenomenological psychology would call a ‘circumscribable task’. According to Giorgi ‘What is required is a shift in attitude so that one can be fully attentively present to an ongoing experience rather than habitually present to it’ (ibid.). The point of agreement seems to be to consider the acts within the realm of a human mode of consciousness and to treat the objects of experience as phenomena. However, it is important to note that we are situated within the here-and-now of the face-to-face situation, that is, we are not within the research context. Let us then continue our modification of the psychological reduction and situate it within the face-to-face context, with empathy as perception of the other, and with a second-person perspective. In order to situate a minimal account of empathy within the psychological reduction and to make an intentional empathy possible, we will have to turn to Ratcliffe’s (2012) ‘Radical Empathy’. According to Ratcliffe, ‘Radical empathy, I propose, is a way of engaging with others’ experiences that involves suspending the usual assumption that both parties share the same modal space’ (p. 483). As we saw in our account above of the phenomenology of empathy, it is essential not to confuse our own state with that of the other if understanding of the other is what we are aiming for, hence ruling out attempts to match the other’s mental state. This leaves us with a second-person focus following the other’s meaning-expression in the here-and-now within the face-to-face context. We now face the possibility of engaging in an interaction, in which we can take empathy into the interactional layer of the we and respond to the other by describing our presence to the psychological meanings in the expression unfolding right in front of us. The empathic reduction helps us to be present to the other as other and to tend more carefully to the other’s expression of psychological meanings, thus enabling us to differentiate between our own perception and the positing of the

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other. This differentiation between perception and positing becomes essential for understanding others. Giorgi (2009, p. 90) clarifies this point, When I walk into the restaurant and see tables, chairs, waitresses, and other customers, I simply take them to be real things and people who are sharing that particular space and time with me. Analysis shows, however, that there is a difference between the perceptions of the objects or persons and the positing of them as real things or real others. Ambiguous situations expose this quick double-step process because the positing is slowed down. This happens when one is trying to determine if a figure in a store window is a person or a mannequin, or when one sees a person who might be an old friend or perhaps is simply resembling the friend. We then recognize that there is a difference between merely ‘being present’ to an object and positing it as really being thus and so. The speed and habituality of such acts often make us ignore presentational aspects of the given that are important or make us posit as existing certain characteristics that do not warrant such positings.

Consequently, the empathic reduction can allow us to slow down the process of positing that habitually follows our perception of the other, and thus not confuse our own states with that of the other, even as we enter into a professional, we-relationship. My proposal is meant as complementary to the overall work of a phenomenological psychology and psychiatry, especially in the relation to a recoveryoriented psychiatry (Davidson, 2003), but also in relation to psychiatric interviews (Parnas et al., 2005). The empathic reduction is meant as a professional point of departure, or better, as perception, a ‘mode of access’ (MerleauPonty’s, 1964, p.  34) when one seeks an understanding of one’s client in the face-to-face context. The empathic reduction as a professional attitude can also open up for the possibility to realize empathy within interactional layers of a weintentionality as the foundation for a professional alliance. As a final note, I have purposely refrained from explicating the role of free imaginative variations as well as explored concepts such as pairing and apperception in relation to the empathic reduction, topics that I have previously touched upon elsewhere (Englander, 2014) and which will be explored in more detail in future projects. In addition, it is essential to note that perception of the other is not the same as having the other’s experience or adopting the other’s view from the point of view of her experiential self, because that would be absurd (see, e.g., Gallagher & Zahavi, 2012, p. 204; Zahavi, 2014, p. 22) and would mean the demise of the other.

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Conclusion To combine the psychological reduction with empathy as a second-person perspective within a face-to-face context means that we can professionally engage in an intentional empathy. Having the empathic (psychological) reduction at hand also means that it becomes possible to find ways to improve supervision of both students and working professionals in a professional social psychiatry. One could suggest that the empathic reduction could also be the point of departure for interpersonal understanding in clinical social work, psychiatric nursing, clinical and counseling psychology, and so on. Such a professional attitude will help us to know whose experience we are attending to and to understand whose life we are initially trying to understand. If Scheler (2008) was right in that empathy must precede sympathy, as professionals in psychiatric practice we must first know whom we are seeking to follow. Hence, even though there is much more to psychiatric work with clients than empathy, there is simply no beginning without it.

Notes 1. Note that such a statement was not motivated by aiming to paraphrase the other person’s expression, but to provide a response that captured the empathizer’s presence of the intentionality within the other’s expression. Written examples are often misinterpreted in such a way. 2. It is essential not to confuse these different aspects of the self with empirical entities; rather, they are ways to describe essential structures of consciousness. 3. Scott Churchill (2012a, b) also provides a phenomenological psychological account of empathy from a second-person perspective, integrating insights from both Husserl and Heidegger. Churchill presents us with the possibility of resonating with the other within the second-person perspective. Churchill (2012a, p. 4) states, ‘The unsatisfactory alternatives of dispassionate third person and imaginative first person perspectives can be transcended when I allow myself to resonate with the other: such as when I am the second person whom the other addresses’ (emphasis in original).

References Bhugra, D., & Till, A. (2013). Public mental health is about social psychiatry. International Journal of Social Psychiatry, 59(2):105–106. Churchill, S. D. (2012a). Resoundings of the flesh: Caring for others by way of ‘second person’ perspectivity. International Journal of Qualitative Studies in Health and Wellbeing, 7:8187; http://dx.doi.org/10.3402/qhw.v7i0.8187.

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Churchill, S. D. (2012b). Teaching phenomenology by way of ‘second-person perspectivity’: From my thirty years at the University of Dallas. In Teaching of phenomenology [Special issue]. Indo-Pacific Journal of Phenomenology, 12: 1–14. Coplan, A., & Goldie, P. (2011). Empathy: Philosophical and psychological perspectives. Oxford: Oxford University Press. Davidson, L. (2003). Living outside mental illness. New York: New York University Press. Davidson, L. (2014). Book Review of Matthew R. Broome, Robert Harland, Gareth S. Owen, Argyris Stringaris (eds) (2013). The Maudsley reader in phenomenological psychiatry. Journal of Phenomenological Psychology, 45(2):245–50. Davidson, L., Rakfeldt, J., & Strauss, J. (2010). The roots of the recovery movement in psychiatry: Lessons learned. West Sussex: Wiley-Blackwell. Englander, M. (2014). Empathy training from a phenomenological perspective. Journal of Phenomenological Psychology, 45(1): 5–26. Englander, M. (2015). Selfhood, empathy, and dignity. In S. Ferrarello & S. Giacchetti (eds), Identity and values, pp. 75–88. Cambridge: Cambridge Scholars Publishing. Englander, M., & Folkesson, A. (2014). Evaluating the phenomenological approach to empathy training. Journal of Humanistic Psychology, 54(3): 294–313. Englander, M., & Robinson, P. (2009). En fenomenologiskt grundad vårdpedagogisk metod för utbildning i empatiskt bemötande. Nordic Journal of Nursing Research & Clinical Studies/Vård i Norden, 4/2009, 29(94): 38–40. Fuchs, T. (2012). The phenomenology and development of social perspectives. Phenomenology and the cognitive sciences, DOI 10.1007/s11097-012-9267-x. Gallagher, S. (2005). How the body shapes the mind. Oxford: Oxford University Press. Gallagher, S. (2008a). Brainstorming: Views and interviews on the mind. Exeter: Imprint Academic. Gallagher, S. (2008b). Direct perception in the intersubjective context. Consciousness and Cognition, 17(2):535–43. Gallagher, S. (2012). Empathy, simulation, and narrative. Science in Context, 25(3):355–81. Gallagher, S., & Zahavi, D. (2012). The phenomenological mind. London: Routledge. Gallese, V. (2003). The roots of empathy: The shared manifold hypothesis and the neural basis of intersubjectivity. Psychopathology, 36: 171–80. Giorgi, A. (1970). Psychology as a human science: A phenomenologically based approach. New York: Harper & Row. Giorgi, A. (ed.) (1985). Phenomenology and psychological research. Pittsburgh, PA: Duquesne University Press. Giorgi, A. (2009). The descriptive phenomenological method in psychology: A modified Husserlian approach. Pittsburgh, PA: Duquesne University Press. Goldman, A. I. (2006). Simulating minds: The philosophy, psychology, and neuroscience of mindreading. New York: Oxford University Press. Husserl, E. (1970). The crisis of European sciences and transcendental phenomenology (trans. D. Carr). Evanston, IL: Northwestern University Press. Husserl, E. (2006). The basic problems of phenomenology: From the lectures, winter semester, 1910–1911 (trans. I. Farin & J. G. Hart). Dordrecht: Springer.

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Kohut, H. (1981/2010) On empathy. International Journal of Psychoanalytic Self Psychology, 5(2):122–31. Krueger, J., and Overgaard, S. (2012). Seeing subjectivity: Defending a perceptual account of other minds. ProtoSociology: Consciousness and Subjectivity, 47:239–62. Luft, S. & Schlimme, J. E. (2013). The phenomenology of intersubjectivity in Jaspers and Husserl: On the capacities and limits of empathy and communication in psychiatric praxis. Psychopathology, 46(5):345–54. Merleau-Ponty, M. (1964). The primacy of perception: And other essays on phenomenological psychology, the philosophy of art, history and politics (ed. J. M. Edie). Evanston, IL: Northwestern University Press. Parnas, J., Bovet, P., & Zahavi, D. (2002). Schizophrenic autism: Clinical phenomenology and pathogenetic implications. World Psychiatry, 3(1):131–6. Parnas, J., & Henriksen, M. G. (2014). Disordered self in the schizophrenia spectrum: A clinical and research perspective. Harvard Review of Psychiatry, 22(5):251–65. 10.1097/HRP.0000000000000040. Parnas, J., Møller, P. Kircher, T., Thalbitzer, J., Jansson, L., Handest, P., & Zahavi, D. (2005). EASE: Examination of Anomalous Self-Experience. Psychopathology, 38: 236–58. DOI: 10.1159/000088441. Ratcliffe, M. (2012). Phenomenology as a form of empathy. Inquiry, 55(5):473–95. Rogers, C. R. (1989). The Carl Rogers reader (ed. H. Kirschenbaum & V. L. Henderson). Boston, MA: Houghton Mifflin Company. Rohr, E. (2012). Challenging empathy: Experiences as a group analytic supervisor in a post-conflict society. Clinical Social Work Journal, 40: 450–6. Scheler, M. (2008). The nature of sympathy. New Brunswick, NJ: Transaction Publishers. Schutz, A. (1945). On multiple realities. Philosophy and Phenomenological Research, 5(4):533–76. Schutz, A. (1967). The phenomenology of the social world. Evanston, IL: Northwestern University Press. Stein, E. (1964). On the problem of empathy. Dordrecht: Springer. Zahavi, D. (2007). Self and other: The limits of narrative understanding. In D. D. Hutto (ed.) Narrative and understanding persons, pp. 179–201. Royal Institute of Philosophy Supplement: 60. Cambridge University Press. Zahavi, D. (2010). Empathy, embodiment and interpersonal understanding: From Lipps to Schutz. Inquiry, 53/3:285–306. Zahavi, D. (2011). Empathy and direct social perception: A phenomenological proposal. Review of Philosophy and Psychology, 2(3):541–58. Zahavi, D. (2014). Self and other. Oxford: Oxford University Press. Zahavi, D. (2015). You, me and we: The sharing of emotional experiences. Journal of Consciousness Studies, 22(1–2):84–101.

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On the Empathic Mode of Intuition A Phenomenological Foundation for Social Psychiatry Scott D. Churchill

Introduction If phenomenology is really going to return ‘to the matters themselves’ of everyday life, and if a phenomenological method for the fields of psychology and psychiatry is to attain more than a disinterested Cartesian stance towards its subject matter, then we cannot content ourselves with being a mind that inspects its data, an ethereal cogito cut off from the Eros of the body. The mistake of the rationalists was to think that a ‘pure reason’ would be capable of speaking truth about the lifeworld. Empiricists, however, stress the passivity of perception, and in the development of scientific method prefer to bracket ‘subjective’ impressions. Phenomenology, in suggesting that the body is one’s point of view on the world and thereby ‘the psychic object par excellence’ (Sartre, 1943/1956, p. 347), invites us to become more attuned to the logos of the body. This means becoming more sensitive to the lived body as both subject matter and method of psychology. Colleagues such as Kenneth Shapiro (1985) in his book Bodily Reflective Modes: A Phenomenological Method for Psychology, David Abram (1996) in The Spell of the Sensuous, and Alphonso Lingis (1994) in The Community of Those Who Have Nothing in Common have advanced our methodological understanding of the body as a mode of access to the meaning of experience, whether our own or somebody else’s. All three have drawn from the work of Merleau-Ponty and other phenomenologists to develop richly embodied approaches to their

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perception of self and others. My own intrigue with phenomena of bodily expressivity as well as with bodily sensitivity to others was reawakened by the call for contributions to this text on ‘Social Psychiatry,’ and has inspired me to renew my own reflections upon the phenomena of intuition, empathy, and what I have elsewhere referred to as ‘second person perspectivity’ (Churchill, 2001, 2006, 2007, 2010, 2012a, b). Within the we-relationship (the ‘first-person plural’), one can adopt a ‘second-person’ perspective with regard to the other, when we are addressing or being-addressed by the other. Whether in word or in gesture, this exchange taking place between two people constitutes a special relationship – one that allows for everything from empathy to microaggression to occur. For example, when I ‘feel my way into’ the eyes of the other who is looking at me, I may feel the other’s warmth (and thus perceive them to be ‘empathic’), or I may feel the other’s cool disdain (and thus believe they have ‘microaggressed’ upon me). My own ‘feeling into’ the other’s expression – regardless of whether I perceive warmth or aggression in the other – represents my own act of empathy, insofar as empathic perception enables me to co-experience both the good and the bad that resides within the other’s soul.1 Empathy is possible, however, within both second- and third-person perspectives. ‘Third-person’ empathy occurs when the other is not addressing me directly, but, for example, when I am reading her journals (or when she reads mine) and one of us feels the other’s joys and sorrows. We all are familiar with the experience of ‘reading’ a person’s expression in a photograph in which the other is engaged in a situation. The person who is looking at the photograph is not personally involved in the situation, and yet can ‘empathize’ with the meaning perceived in the face of the other. We are indeed capable of empathy towards others, even at a distance. Susan Sontag (2003) wrote about this in her captivating book Regarding the Pain of Others where she discusses the impact and function of war photographs in communicating suffering.

Empathy as an Investigatory Posture: Imitations of Intentionality Empathy has been described as ‘the process by which one person is able to imaginatively place himself in another’s role and situation in order to understand the other’s feelings, point of view, attitudes, and tendencies to act in a given situation’ (Gorden, 1969, pp. 18–19). Edmund Husserl (1952) sometimes referred

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to it as ‘trading places’, while Alfred Schutz (1973) referred to an ‘interchangeability of standpoints’. In contemporary parlance, the term ‘empathy’ is more often associated with therapeutic than theoretical or methodological literature in psychology. The notion of empathy has, in fact, been used by many psychologists in describing the clinician’s presence to a client (Allport, 1937; Rogers, 1951; Sarbin, Taft, & Bailey, 1960; Wiens, 1976; Schafer, 1983). In the early days of its use, the term ‘empathy’ was used to suggest ‘the imitative assumption of the postures and facial expressions of other people’ (Allport, 1937, p. 530). In the clinical context, it has been said that the psychologist ‘puts himself in his client’s place’ (Combs & Snygg, 1959, p. 254), ‘uses his imagination’ (Hamlyn, 1974), or ‘listens with the third ear’ (Reik, 1948) to understand the client’s experience. It also has been suggested that the psychologist might ‘try to imitate the changing positions of a client to try intuitively to infer his unverbalized feelings’ (Wiens, 1976, p. 35). One psychologist went so far as to say, ‘When we cannot imitate an individual’s behavior we are at a loss to understand it’ (Kempf, quoted in Allport, 1937, p. 530). When I perceive conduct I am perceiving not only an action that takes place in the midst of the world, but an intentionality. Intentions do not lie buried deep within the recesses of one’s cogito; rather they are phenomena of the lived body. Sartre (1943/1956, p. 320) writes: ‘I see his gesture and at the same time I determine his goal.’ It is in this sense that Merleau-Ponty (1969/1973, p. 33) can say ‘To imitate is not to act like others but to obtain the same result as others.’ Even a young child understands that behavior is originally a lived orientation to the world, an arrangement of means in view of an end. Merleau-Ponty cites the child of thirty-two months, observed by Guillaume, ‘who has been asked to imitate the movement of turning his eyes from one side to the other. The child begins by turning his head. This fact effectively proves that the child is imitating the result and not the means by which the model obtains these results’ (p. 35). Imitation is itself grounded in empathy as a mode of presence to others – which, in turn, is a fully bodily phenomenon, and not some ‘attitude’ that one adopts or even feigns in the presence of others (see Churchill [in press] for an elaboration of this phenomenon of imitative empathy). What, then, is this empathy by which I invest myself in other peoples’ gestures, and they inhabit mine? If my body is indeed my point of view on the world, then it will be in my body that the other’s body becomes known to me. And since my own body is first lived and only subsequently known (through reflection), it requires a phenomenological ‘reduction’ (or style of focusing) to turn our gaze towards the ‘lived body’ itself as the means which delivers the world over to us.2

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Just as emotion is lived as a consciousness of the world of emotion, and not as a reflective apprehension of the emotion itself, bodily experience in general is an experience of the world given to me through my body, rather than some kind of a self-consciousness of the body. This is why empathy (die Einfühlung) was originally understood as a projective phenomenon, where slight motor movements induced in one’s own body by another’s presence evoke experiential qualities that are perceived ‘over there’ in the other person (Lipps, 1903).3 In this view, the kinesthetic sensations and accompanying feelings resulting from one’s assuming the postures and facial expressions of others become the very source of our knowledge of other people. As Wilhelm Reich (1933/1972, p.  362) observed, the other’s ‘expressive movements involuntarily bring about an imitation in our own organism’ (emphasis in the original). We thereby sense in and through our own bodies the intentions and affects that animate the other, and simultaneously understand our tacit experience as significative of the other’s lived meanings. Husserl (1910–11/2006) was familiar with Lipps, but preferred the expression ‘empathizing perception’ (einfühlende Wahrnehmung) over the term ‘empathy’, perhaps because he did not want to use a substantive noun to express what is essentially a process, preferring instead to use an adjective (einfühlende) derived from a verb (einfühlen) to describe what ultimately amounts to a species of perception. A decade later, he would affirm the idea of the body’s intrinsic wisdom being the very source of empathy; he would also designate this ‘mediated’ perception made possible through empathy as ‘the first transcendence’ from self to other (Husserl, 1921/1973a). In his final years, he would explore how transcendental subjectivity opens up most fundamentally in and through the body (Leib) into transcendental intersubjectivity (Husserl, 1939/1970, Part Three).

Apperception and Empathy: Husserl’s Phenomenology of Intersubjectivity Husserl made a distinction between Urpräsenz and Appräsenz (1952, pp. 162– 72). Accordingly, only my own experiences are given to me in ‘originary presence’; the experiences of another person are not directly presented to me, but are ‘appresented’. This means that the other’s ‘inner life’ (Innerlichkeit) is given to me only partially and in conjunction with aspects that are fully present, namely, bodily presentations. Even prior to the analogical apperception of the other’s intentional life, there is at first the experiencing of the other’s body (Körper) as

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an animated body (Leibkörper)4: ‘The apperception of bodies other than one’s own as somatic, i.e., as organisms of other persons or animals, requires an appresentative transfer by analogy from our own somatic experience to what is at first given only as a corporeal thing’ (Gurwitsch, 1974, p. 95; also see Husserl, 1950/ 1960, pp. 110–11). Thus the other is given to me directly in perception only as a physical object. I must ‘transfer’ to this other corporeal being the nature which I originally understood only my own corporeality to embody, namely, the nature of an ‘organism’ (i.e., a center of intentions). Husserl elaborated the concept of apperception with the concept of empathy (das Einfühlen), which we might characterize here as a feeling-oneself-into the intentionality of another. For Husserl (1928/1997, p. 222), it is important to note that this is undertaken while adopting the stance of ‘non-participating onlookers’; that is, we remain as ‘third-person’ witnesses for Husserl, even, it would seem, within his phenomenological reduction. It was through this empathy, which for Husserl amounted to an imaginative transfer or projection or investment of oneself into the other’s world, that one could co-perform the other’s meaning-bestowing acts and thereby grasp the meaning of those acts. Schutz (1966) took this idea of accessing the other’s meaning-contexts a step further in the direction of ‘motivational contexts’. To fully appreciate the meaning of human acts, one must grasp the actor’s motives and their context: I may also in my imagination place myself in possible contexts of motives, in possible situations, and decide how I would behave under the then prevailing circumstances. The personal life shows a certain typicality . . . In terms of these typicalities I comprehend the behavior of my fellow-man and its motives. When I co-perform his acts in phantasy his motives become my quasi motives, and thus comprehensible. (p. 33)

Schutz (1970, p.  173) characterized the understanding that emerges from Husserl’s empathizing perception as only a ‘reflective analysis carried out after the fact’. The moment one begins to imagine (einbilden) the other’s experience (quite literally, picturing to oneself what it might be like in the other’s position), one is no longer involved in direct perception of the other; rather, one is engaged in a reflective attitude. For example, ‘we project the other’s goal as if it were our own and fancy ourselves carrying it out’, or ‘we may recall in concrete detail how we once carried out a similar action ourselves’ (p.  176). Schutz reminds us that no matter how we use our imagination to understand another person, it is still from our point of view, and thus we are using our meaning-context, which is biographically different from the other person’s. To the extent that the

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other then becomes an ‘object’ grasped within our own meaning-context (with our presumption of what Schutz had referred to as a ‘congruence of relevance systems’5), the understanding gained through Husserl’s empathizing perception would remain limited by the scope of one’s own imagination. For Schutz (1970, p.  196), the movement towards a more genuine understanding of another person occurs when ‘I exchange my role as observer for that of a participant’. It is only when I participate as a ‘consociate’ in a face-to-face encounter that I can ask questions of the other (as opposed to posing questions to myself about the other), that I can check my perceptions against the other’s self-interpretation. ‘It is only in the life of consociates that the individual identity, the uniqueness of the person, may be grasped’ (Schutz, 1962, p. xxxiii). Then the observer’s living intentionality carries him along without having to make constant playbacks of his own past or imaginary experience . . . the observer keeps pace, as it were, with each step of the observed person’s action, identifying himself with the latter’s experiences within a common ‘we-relationship.’ (Schutz, 1970, p. 177)

Empathy as the Spirit’s Way of Knowing Geisteswissenschaft was the term Dilthey coined to translate into German John Stuart Mill’s (1872/1988) ‘moral science’ – in contradistinction to ‘natural science’ (Naturwissenschaft). Dilthey (1894/1977a, p 27) famously observed, ‘Die Natur erklären wir; das Seelenleben verstehen wir’  – nature we can explain; but the life of the soul is something we must grasp through understanding. Geisteswissenschaft has been rendered back into English over the course of the past century more typically as ‘human studies’. Oddly, when ‘Wissenschaft’ is used in connection with nature, it becomes ‘natural science’; but when used in connection with Geist (the Spirit), it becomes demoted to ‘human studies.’ It was Amedeo Giorgi (1970) who reclaimed the term ‘science’ for the ‘human sciences’ in his landmark work Psychology as a Human Science:  A  PhenomenologicallyBased Approach. The idea of a hermeneutical interpretation of others’ expressions was articulated by Dilthey (1927/1977b) in his discussion of ‘the higher forms of understanding.’ Dilthey himself reserved the term ‘hermeneutics’ for the analysis of written expressions (p. 135), and uses the more descriptive term ‘co-experiencing’ (Nacherleben, a way of ‘moving towards’ the other in one’s own experiencing) to

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refer to the general method of understanding other persons’ expressions. For Dilthey, the lived reality of the individual was the ultimate referent of a descriptive psychology6; therefore, more general (nomothetic) investigations of human psychological life would be undertaken ultimately in service of the researcher’s idiographic interest in the human person. In this way, idiographic investigation holds in its ‘foresight’ the investigator’s guiding fore-conceptions about human life: ‘Its presupposition is knowledge of psychic life and of its relations to milieu and circumstances’ (p.  129). The goal of this ‘higher understanding’ was to articulate ‘the relation between another person’s manifold of expressions of life and the inner context in which they are grounded’ (ibid.). This relation, which is accessed through interpretation (die Deutung7), Dilthey called ‘the secret of the person’ (p. 131). Dilthey’s (1927/1977b) method was founded upon a ‘transposition’ (sich versetzen) or projection of oneself into the life-context of the person one is attempting to understand. This method calls upon the utilization of all one’s powers of comprehension, including what the researcher knows on the basis of his or her own familiarity with the vicissitudes of psychological life. ‘If the point of view from which the task of understanding is undertaken implies the presence of one’s own experienced psychic nexus, then this is also denoted as the transferring of one’s own self into a given set of expressions of life’ (p. 132). By this he means an imaginative recreation of the other’s experience by means of the researcher’s own ‘projected’ or ‘transferred’ experience, fueled presumably by sympathy and empathy (p. 133). Although circumstances may limit one’s own possibilities for experience, one is also able, due to the co-determination of one’s possibilities ‘from within’, to experience many others’ existences in one’s imagination (p. 135). With Dilthey (1924/1977) we find a foundation for the understanding of others that is elaborated in the works of many subsequent phenomenologists. This foundation rests on the perceiver’s human giftedness for ‘co-experiencing’ the experience of others so that one can begin to grasp how a particular expression or manifold of expressions signifies the world of the individual. This apprehension originates from lived experience and remains connected with it. The processes of the whole psyche operate together in this experience . . . In the lived experience particular occurrence is supported by the totality of psychic life and the nexus in which it itself stands, and the whole of psychic life belongs to immediate experience. The latter already determines the nature of our understanding [Verstehen] of ourselves and of others. We explain by purely intellectual

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Scott D. Churchill processes, but we understand through the concurrence of all the powers of the psyche in the apprehension. In understanding we proceed from the coherent whole which is livingly given to us in order to make the particular intelligible to us. (p. 55; emphasis added)

The question, then, is precisely how ‘all the powers of the psyche’ come to play in the Geisteswissenschaften. Indeed, the term Geisteswissenschaft can be better translated in other ways than as ‘human science’ or ‘human studies.’ First (and more obviously, following the use of the objective genitive), it can be grasped as the science that takes the spiritual order as its object of study – the science ‘of ’ the world of Geist (the realm of humanity, culture, and spiritual phenomena in the broadest sense, which could include the lives of other sentient beings). However, it might be more fruitful if we were to consider the subjective (or possessive) genitive, by way of which this term could be regarded as ‘the spirit’s way of knowing’.8 Furthermore, the German word for science – Wissenschaft – Heidegger tells us is a compound of two verbs: wissen and schaffen – knowing and creating – thus, creating knowledge. The Greek ‘gnosis’ also means ‘knowing’ – but gnosis is the past participle of the verb ‘to see’, so it means ‘to have seen’; and thus Brentano’s (1874/1973) ‘psychognosis’ meant ‘to have seen the psyche,’ and the psychiatric term psychodia-gnosis means to have seen ‘through’ to the psyche (presumably, seeing through the surface of behavior to its depth dimension, ‘character’). This notion of ‘seeing’ as an encountering of others in the world is of vital importance to the task of psychiatry (see Churchill [1998]). Seeing through the surface appearance to the depths of a person requires something other than the usual empirical method. It requires empathy, by means of which we are able to resonate with meaning in the lives of others. Indeed, compassionate understanding became the basis for the great German philosopher and psychiatrist Karl Jaspers’s (1913/1963) idea for a Verstehende Psychologie  – a field of psychiatric investigation, grounded in empathy as an investigatory posture, by means of which we come to resonate with the other’s experience and come to know (or ‘to have seen through to’) something about the other’s so-called inner life. One of the greatest early figures9 in the history of the application of phenomenology to psychology, Jaspers developed an entire (and quite massive) portion of his General Psychopathology, the section entitled Verstehende Psychologie – in contrast to an equally significant portion entitled Erklärende Psychologie – as it was his opinion that we needed an explanatory science to pick up where descriptive science left off.10 There really is

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no good translation for what Jaspers (1913/1963, p. 6) rendered as Verstehende Psychologie  – he simply referred to it as the ‘empathic’ mode of access to the object, namely, the expressions of psychological life, in contrast to the ‘empirical’ method, which gave us access to the world of objects (see also pp. 301–13). In his magnum opus, Jaspers followed Dilthey (1894/1927) in constructing a field for psychiatric investigation that is grounded in two methods: the empirical method, which gives us the patient as an object in the world among other objects; and the empathic method, which delivers us over to the patient as a subject for whom the world exists. R. D. Laing (1959, p. 25) echoed Jaspers when he contrasted the psychiatric modes of relating to the patient ‘as person or as thing’. Much of Heidegger’s (1987/2001b) seminars held in Zollikon, Switzerland, were devoted to an attempt to teach physicians, psychiatrists, and other health care workers something about this ‘spirit’s way of knowing’ – this fundamentally different mode of understanding. He wanted to teach them what it would mean to truly approach their patients as persons. As a philosopher influenced by Husserl, Heidegger wanted to articulate what would be the proper domain of philosophy. In his early lecture courses, Heidegger (1923/1999, 1985/2001a) would repeatedly point us in the direction of the affairs of everyday life, or what he called ‘factical life’ (1922/1989, pp. 246–7).11 Indeed, the ‘human’ in ‘human science’ might refer more to the method of access for this science – being a uniquely human mode of understanding and encounter with others – rather than to the content of this science (i.e., the human realm as such).12 The question for Heidegger was always the question of access: how could we bring ourselves to the encounter with human factical life? In one of his previous lecture courses (1921–22), Heidegger (1921–22/2001, p. 139) observed: ‘At issue is not the acquisition of new concepts . . . within the old way of understanding; on the contrary, [what is at issue is] to be attentive . . . to an originally different mode of understanding’ (emphasis added). What, indeed, could be this ‘originally different’ mode of understanding to which we should be attentive?

Heideggerian Modes of Attending to the Givenness of Others For Heidegger, one can never escape as researchers (or even as practitioners) from the ‘hermeneutic circle.’ The questions one asks determine the answers one receives, just as the subject matter (if we know how to listen) teaches us how to

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ask the right questions. In his Swiss seminars with physicians, Heidegger (1987/ 2001, p. 79) observed: ‘The thematic domains of psyche and soma are determined by the manner each can be accessed, and in turn, the way of access is determined by the subject matter, hence, by soma and psyche. We move in a circle. . . . What is called a “circle” here belongs to the essential structure of human knowledge.’ It is interesting that four decades after writing Sein und Zeit Heidegger was contemplating the place of the body in philosophical as well as psychiatric work. More specifically, he was interested in how the lived body (Leib) provides access to the field of interest for physicians, psychiatrists, and philosophers alike. In his 11 May 1965 seminar in Zollikon, Heidegger stated13: Now we will leap to the problem of the body. To begin, let us consider two statements made by Nietzsche: . . . ‘The idea of the body is more astonishing than the idea of the ancient “soul”. . . .’ The phenomenon of the body is the richer, the more distinct, the more comprehensible phenomenon [than the soul]. It should have methodological priority, without our deciding anything about its ultimate significance. (p. 80)

Whatever Nietzsche might have had in mind regarding ‘the methodological priority’ of the body, Heidegger certainly had his own ideas; and he made direct reference to specific expressive phenomena of the body in the context of his elaboration of this philosophical principle to his audience of physicians: (May 14, 1965) In our previous session we tried to familiarize ourselves a little more with the problem of the body. We did not make much progress. Our first task was, and still is, to enable us to see certain phenomena, such as blushing, grasping, pain, and sadness. It is crucial to leave these phenomena the way we see them without trying to reduce them to something else. . . . Instead, we must pay attention to the question of to what extent these phenomena are already sufficiently determined on their own terms and to what extent they refer to other phenomena to which they essentially belong. (p. 85)

Here he is admonishing us not to reduce blushing to ‘something else’, for example, the increased flow of blood in the face. Rather, we are asked to stay with such phenomena ‘on their own terms’: what does a blush mean? And to what extent does the blush ‘refer to other phenomena to which they essentially belong’? Heidegger observes: In each case the body always participates in the being-here [Da-sein], but how?  .  .  . Perhaps one comes closer to the phenomenon of the body by

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distinguishing between the different limits of a corporeal thing [Körper] and those of the body [Leib]. . . . the difference between the limits of the corporeal thing and the body. . . consists in the fact that the bodily limit is extended beyond the corporeal limits. . . . [when I look at you, my body does not end with my eyeballs.] ‘the body is in each case my body. . . . The bodying forth of the body is determined by the way of my being. (p. 86)

Heidegger’s (2002/2009, p.  17) comments here echo his own Marburg lecture course of 1924, where he reflected on the deeper meaning of Aristotle’s word ‘ousia’ that is typically translated as ‘substance’ – for Heidegger, this word would more properly be rendered as ‘the being in the how of its being’. From the very start of Heidegger’s thinking, he was inspired by Aristotle to focus not on things or entities or beings per se; but rather on the how of the ‘be-ing’ of any entity. Here, over forty years later in his seminars with Swiss physicians and psychiatrists, Heidegger was still developing the same theme, except in sometimes more esoteric language. In 1965 he was asking his audience of physicians, ‘what kind of being belongs to my body?’ He responded: [I]f the body as body is always my body, then this is my own way of being. Thus, bodying forth is co-determined by my being human in the sense of the ecstatic sojourn amidst the beings in the clearing. The limit of bodying forth is the Horizon of being within which I sojourn. Therefore, the limits of my bodying forth changes constantly through the change in the reach of my sojourn. (p. 87)

My bodily experience thus bears direct reference to the ‘sojourn’ of my being with others. Here is where we get closer to the matter of dialogue. In the transcripts of his Zollikon Seminars with physicians, Heidegger (2001b) stated: Human speaking is saying. . . . According to its ancient etymological meaning, to ‘say’ is to ‘show’, to let be seen. Within philosophy we must not limit the word ‘gesture’ merely to ‘expression’. Instead, we must characterize all comportment of the human being as being in the world, determined by the bodying forth of the body. Each movement of my body as a ‘gesture’ . . . is always already in a certain region which is open through the thing to which I am in a relationship, for instance, when I take something into my hand. (pp. 90–1) What does the word ‘gesture’ [Gebärde] mean? Last time we spoke about blushing. We usually take blushing as an expression, that is, we immediately take it as a sign of an internal state of mind. But what lies in the phenomena of blushing

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Scott D. Churchill itself? It too is a gesture in so far as the one who blushes is related to his fellow human beings. With this you see how bodiliness has a peculiar ‘estatic’ meaning. I emphasize this to such a degree in order to get you away from the misinterpretation of ‘expression’! French psychologists also misinterpret everything as an expression of something interior instead of seeing the phenomena of the body in the context of which men are in relationship to each other. (p. 91)

Thus for Heidegger, the expressive phenomena of our bodies refers first and foremost to our relationality – and not to either ‘inner states’ (res cogitans) or physiological phenomena (res extensa). Furthermore, this relationality is visible from the outside, when we witness the behavior of the other within its field. As Merleau-Ponty (1945/1964e, pp. 52–3) observed in his essay ‘The Film and the New Psychology’: young children understand gestures and facial expressions long before they can reproduce them on their own; the meaning must, so to speak, adhere to the behavior. We must reject that prejudice which makes ‘inner realities’ out of love, hate, or anger, leaving them accessible to one single witness:  the person who feels them. Anger, shame, hate, and love are not psychic facts hidden at the bottom of another’s consciousness: they . . . exist on this face or in those gestures, not hidden behind them.

To the extent that our expressions, our words, our gestures all bear the mark of our bodies, it will also be through the lived body that we have access to the other’s expressions and expressive life. The Geist is thus accessed, expressed, and interpreted by means of Leib. The body is the key to our method in philosophy as well as in social psychiatry. We come at last to Heidegger’s (1987/2001b) perhaps most important observation for the current discussion of empathy’s role as an investigatory posture: The problem of method in science is equivalent to the problem of the body. The problem of the body is primarily a problem of method. (p. 93; emphasis added) In physics, the theory of relativity introduced the position of the observer as a theme of science. . . . That means that the bodiliness of the human being comes into play within the ‘objectivity’ of natural science. . . . does this only hold true for scientific research, or is it true here precisely because in general the bodying forth of the human being’s body co-determines the human being’s being-in-theworld? (p. 93; emphasis added)

This interest that Heidegger shows in our bodily relationship with the world is nowhere more apparent than in his conception of Befindlichkeit, first presented in Being and Time but reiterated in his later Zollikon Seminars.

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Befindlichkeit and Bodying-Forth On 1 March 1966, Heidegger held a class where he and his seminar participants discussed the phenomenon of ‘stress’ and Heidegger immediately turned the discussion to his concept of Befindlichkeit. It is the attunement determining Da-sein in its particular relationship to the world, to the [being of the other with Dasein], and to itself. Ontological disposition [Befindlichkeit] founds the particular feelings of well-being and discontent yet is itself founded again in the human being’s being exposed toward beings as a whole. (p. 139) In so far as the human being is being with, as he remains essentially related to another human, language as such is conversation [Gespräch] . . . This must be said more clearly: insofar as we are conversation, being with belongs to being human. (p. 140)

In all his discussions of what it means to be human in his seventeen years of conducting seminars with the physicians at Zollikon, Heidegger had only this to say about empathy: The often quoted psychological theory of empathy rests on this obviously incorrect concept: This theory starts by imagining an ego in a purely Cartesian sense – an Ego given by itself in the first instance who then feels his way into the other – thus discovering that the other is a human being as well in the sense of an alter Ego. Nevertheless, this is a pure fabrication. If one speaks about the often quoted I-Thou and We relationships, then one says something very incomplete. These phrases still have their origin in a primarily isolated Ego.14 We must ask: With whom, and where am I, when I am with you? It is a being-with that means a way of existing with you in the manner of being-in-the-world, especially a being-with one another in our relatedness to the things encountering us. This means . . . I sojourn with you in the same being-here. Being-with one another is [phenomenologically] not a relationship of a subject to another subject. For the next seminar, I must think of a method leading you along the path where you can specifically engage yourselves in this ‘being-with’ by being along with what is encountering you. pp. 11–12

Unfortunately, Heidegger did not follow up on this plan in his subsequent sessions. It will remain, therefore, for us to pick up the path of his thinking in our own retrievals of his thought.

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Heidegger’s Notion of Mitbefindlichkeit Around the time that Husserl (1973b) was further developing his intersubjectivity papers (the mid-1920s), Heidegger was busy at work on Sein und Zeit (1926– 27).15 There he tells us that in the hearkening that comes from dwelling-with the Other, we are able to experience something of who the other person is, through our mode of attunement to him. In both psychotherapy and psychological research, as well as in everyday life, this hearkening itself requires a sensitivity to one’s own attunement (in this case, an attunement to the Other) as well as a sensitivity to the attunement of Others. When listening to a patient, or reading qualitative data, this sensitivity requires a bracketing of our own ‘first-person’ feelings in similar situations so that we can leave our capacity for ‘feeling’ available to ourselves as our mode of attunement to the mode of Being-in revealed in the data. Our own subjective processes thus become ‘instruments’ of our perception of others. Hence, we can only truly understand the Other when we have been able to feel or suffer with the Other. We are not reminded of our own suffering; this can come later. But for now, we ‘suffer-with’ as we bear witness to the Other. We might even become attuned to a suffering that lies just below the surface of the Other’s expression, somewhere just out of his reach. But we feel it, we sense its presence, we know that it is there. It is not revealed in ‘what is said in the talk’ (das Geredete) but rather in what we understand that the talk is ‘about’ (das Beredete). Such understanding requires what I want to develop here as moments of ‘shared attunement’ that occur quite spontaneously, and which can only be ‘cultivated’ – but never ‘made to happen’ in the researcher’s experience: Being-with-one-another understandingly. This is what we mean by ‘secondperson’ consciousness: we do not revert to our own world (Eigenwelt); we remain curious and attentive to the Others’ ‘own’-world, which is now a ‘shared’ world. It is worth considering Heidegger’s (1972, p. 162) rarely mentioned concept of Mitbefindlichkeit as a mode of access to the Other’s experience. In order for others’ narratives to resonate within my own experience, I  must first experience myself in an attuned relationship to the Other’s experience. This is far from being a merely ‘intellectual’ relationship to the data. Data analysis – which we sometimes call ‘phenomenological description,’ other times call ‘hermeneutic reading’  – is not a detached reflection on themes. Nor is it ever a conveying of experiences ‘from the interior of one subject into the interior of another’ (Heidegger, 1927/1962, p. 205). It is entering into the other’s being-in-the-world through a ‘transposing’ of oneself ‘into’ the experience of the other, in such a

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way that there results a ‘sharing with’ (mitteilen) the Other.16 When the other’s expressions speak genuinely to us, we resonate with the Other’s attunement, in such a way that it is no longer ‘alien’ (Fremd also means ‘strange’ or ‘other’) to us. This of course has implications for both sides of the psychological encounter. On the side of the person who is being revealed, it means that it is their very relationship to the world that is being revealed – not ‘inner meanings’ pertaining to an ‘inner self ’, but rather meanings that are now visible in his face, in the way that he reveals himself to me through his composure, through his manner, through the expression on his face, through the smile that breaks through the despair that we witnessed but a moment ago. (And whether that smile is a despairing smile or a hopeful one has everything to do with the circumstances in which we find the Other. It is in his ‘outside’, in his relationship to what lies around him in the Worldhood of his world, that the full meaning of his expression rings true.17) If Heidegger has laid the ontological foundation for situating our lived experience of resonating with others in a way that brings us into connection with the other’s ‘state-of-mind’ or affective disposition, we shall turn now to Max Scheler, who in his own way has moved beyond Husserl’s (1973b) approach to intersubjectivity.

Towards a Phenomenology of ‘Second-Person’ Perspectivity Scheler’s (1923/1954, p.  244) text The Nature of Sympathy calls into question what is, in fact, the twofold starting point of Husserl’s approach to the perception of others, namely, ‘(1) that it is always our own self, merely, that is primarily given to us; (2) that what is primarily given in the case of others is merely the appearance of the body’. In his critique of ‘reasoning by analogy’ and ‘projective empathy’, Scheler declares that these assumptions ‘involve a complete departure from the phenomenological standpoint, replacing it . . . by a realistic one’ (ibid.). He posits instead the primacy of a pre-personal flow of experience wherein what is immediately given in our intersubjective awareness is a stream of conscious experiences at first undifferentiated between ‘I’ and ‘Thou’ (p. 246). To this phenomenon he gives the name ‘Seinsteilnahme’, or ‘sharing in the being of another.’ Likewise, in Merleau-Ponty’s ontology of ‘the flesh’, the other and myself comprise one system with two terms, wherein we ‘function as one unique body’ (1964/1968, p.  215); ‘he and I  are like organs of one single intercorporeality’

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(1960/1964d, p. 168). Merleau-Ponty (1964/1968, pp. 138, 180) further describes this as the ‘reciprocal insertion and intertwining of others in us and of us in them’. The other is given to me through ‘a sort of reflection’ (Merleau-Ponty, 1945/1962, p. 353; 1964/1968, p. 256) which opens myself to the other and allows me to ‘invest’ myself in his expression: the reciprocity between self and other is constituted by the nature of human flesh as touching/touched, visible/invisible. The other’s body provides me with a mirror through which to see the surface of my own interiority. In one of his more elusive passages, Merleau-Ponty (1961/ 1964a, p. 168) wrote: ‘The mirror’s ghost lies outside my body, and by the same token my own body’s “invisibility” can invest the other bodies I see. Hence my body can assume segments derived from the body of another, just as my substance passes into them; man is the mirror for man.’ There was no intent by either Scheler or Merleau-Ponty to articulate this ‘sharing’ or ‘mirroring’ as a mode of ‘thinking about’ others; rather they were speaking of a nascent perception of others at the level of affective experience. If there were any thinking going on at all, it would be a ‘thinking from’ the other, rather than a ‘thinking at’ them. The medium for Scheler’s Seinsteilnahme was the lived-body. In his own characterization of this phenomenon, Merleau-Ponty (1945/1962, p. 354) wrote: ‘my body and the other person’s are one whole, two sides of one and the same phenomenon, and the anonymous existence of which my body is the ever-renewed trance henceforth inhabits both bodies simultaneously.’ Where Scheler and Merleau-Ponty depart from Husserl is in their characterization of this pre-personal perception not as a form of imagination or apperception, but as a sense of ‘fellow-feeling’ (Scheler, 1923/1954, p. 8) or ‘intertwining’ (Merleau-Ponty, 1964/1968, p. 143). Each grants us that we have only our own view of the other’s corporeal experience, for it would be impossible to represent to ourselves the way the other feels his or her own body. In spite of this, the meaning of the other’s experience is ‘given for us in expressive phenomena  – again, not by inference, but directly, as a sort of primary “‘perception’” (Scheler, 1923/1954, p. 10). The other’s body appears ‘as the bearer of a dialectic’ (Merleau-Ponty, 1942/1963, p. 204) which is given to us perceptually, because our spontaneous way of seeing is already the perception of form, or meaning (1948/1964b, p. 49). The structure of behavior as it presents itself to perceptual consciousness already reveals the signification of behavior. Emotions, for instance, are ‘styles of conduct which are visible from the outside’ (Merleau-Ponty, 1948/1964b p. 53): ‘It is in the blush that we perceive shame, in the laughter joy. To say that “our only initial datum is the body” is completely erroneous’ (Scheler, 1923/1954, p. 10).

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Fellow-feeling thus gives us an immediate mode of access to the other’s experience through a coupling of our embodied selves into one intercorporeal schema. Even prior to any explicit communicative interactions between myself and the other, ‘there is initially a state of pre-communication (Max Scheler) wherein the other’s intentions somehow play across my body while my intentions play across his’ (Merleau-Ponty, 1960/1964d, p.  119). Scheler described this pre-personal access to the other as an ‘inner perception’ through which ‘everyone can apprehend the experience of his fellow-men just as directly (or indirectly) as he can his own’ (1923/1954, p. 256). As flesh we are by nature ‘connatural’ (MerleauPonty, 1945/1962, p. 217) with each other and thus always already in touch with each other: As an embodied subject I am exposed to the other person, just as he is to me, and I identify myself with the person speaking before me. (Merleau-Ponty, 1969/ 1973, p. 18) There is a universality of feeling – and it is upon this that our identification rests, the generalization of my body, the perception of the other. (p. 137)

When Merleau-Ponty spoke of ‘a universality of feeling’, he may have been articulating an ontological ‘condition of possibility’ for what Scheler simply called ‘sympathy’. Reflecting on his experience of other people, Scheler (1923/ 1954, p.  245) remarked, ‘nothing is more certain than that we can think the thoughts of others as well as our own, and can feel their feelings (in sympathy) as we do our own’. This does not imply that we employ extra-sensory perception in our encounters with others, even if Merleau-Ponty (1964/1968, p. 244) did make reference to a kind of ‘telepathy’. Rather, I seize upon the other person’s acts by ‘re-enacting’ them. In his Phenomenology of Perception, Merleau-Ponty (1945/ 1962, p. 353) stated: ‘I re-enact the alien existence in a sort of reflection’ (p. 353). By ‘reflection’ here, Merleau-Ponty (1964/1968) did not mean anything like an act of intellectual contemplation; rather, the kind of reflection he was referring to here would be developed by him later as ‘the reversibilities of the flesh’, as revealed in the mirroring of gestures and intentions. To summarize, then, the primary datum in our experience of the other is not the mere appearance of the other’s body, but a stream of experience at first undifferentiated into separate identities. Thus we have immediate perceptual access to the ‘inner subjective state’ (Innerlichkeit) of the other. To the extent that this ‘fellow-feeling’, or ‘intertwining’, of myself and the other is not originally based upon past experiences or typified knowledge of persons, our intersubjective understanding is not limited to apperception. With Scheler and Merleau-Ponty,

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we find a liberation of the other’s experience such that it can be given to us in direct, spontaneous, pre-personal perception  – not ‘behind’ but rather ‘in’ the other’s conduct in a situation. This would become relevant in attempting to understand how one person’s perceptual experience provides access to another person’s world. That is, to quote Merleau-Ponty (1961/1964c, p. 65), ‘Nothing prevents me from explaining the meaning of the lived experience of another person, insofar as I have access to it, by perception.’ The important thing here is that what we are talking about here is a perceptual moment, within my encounter with the other, in which I feel present to the other’s being. We do not always feel present to other’s being when we are passing people on the street; it is, rather, in the up-close moment of contact where the other looks me in the eyes, and where we move beyond the momentary glance, holding the gaze, and studying each other’s face for signs of expression. In such moments, when the other looks back at me, I can feel a deeper sense of their attunement – something that Heidegger called ‘Mitbefindlichkeit’ and that Scheler (1954, 1973) referred to as ‘sympathy’. This is a ‘shared attunement’, in which I come to know something about the other, even if I cannot yet put it into words. And yet, according to Heidegger, we can experience this shared attunement when the other attempts to communicate his or her experience to us, even without the use of words. An attunement-with, along with an understanding of our Being-with, is ‘shared’ when our Being-with-one-another is constituted understandingly through encounter (Heidegger, 1927/1972, p. 162). What is key to this passage is that he tells us not only an understanding of our being together gets communicated but also, equiprimordially, we ‘find ourselves’ (sich befinden) ‘tuning in’ to a shared mood or disposition. The first-person plural simply establishes a plurality of subjects; it is the second-person experience that puts one in communicative exchange with another ‘me’ – with a ‘someone who will listen to me’. It is within this context of our relational lives that we not only address the other, reaching out to anotherperson, but also feel ourselves addressed by the other even if only by an appeal of the eyes. In this address, we experience a tacit call to respond, to assist, to share the moment, to offer help. And, it is when we find ourselves on the receiving side of this communication, when we are addressed or when our own gesture is responded to, that I speak of the second-person perspective. If I cannot know your experience the way that you do, I nonetheless am able, insofar as I am there with you, to experience from this empathic ‘second-person’ perspective a glimpse into your own existence.

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Notes Based on a presentation ‘Resonating with Meaning in the Lives of Others: Invitation to Empathy’ to the ‘Phenomenology, Empathy, and Psychiatry’ Conference, University of Malmö, 21 May 2015. 1. Indeed, the premise of the ‘Hannibal Lecter’ novels and films is that one can empathize with evil itself: in Michael Mann’s (1986) Manhunter, a forensic detective with a talent for ‘feeling his way into’ the evil intentions of unknown serial killers needs a rest from the stress of resonating with such horrific intentionalities. In this case, the individual’s ability to empathize can become a burden. It is also worth noting the character of Hannibal Lecter himself is that of a mad psychiatrist: a onetime healer, gifted with profoundly empathic sensitivities, which he no longer uses in the service of healing others; but instead to amuse himself with the frailties of others. 2. Englander (2014, 2015) has developed Husserl’s (1962/1977, 1928/1997) notion of a psychological phenomenological reduction in conjunction with his reading of Stein (1917/1989) and Zahavi (2007, 2010, 2011a & b, 2014), who have performed their own detailed analyses of empathy. Englander’s concept of an empathic reduction corresponds in part to Husserl’s (1910–11/2006) own intersubjective reduction (also referred to as a ‘double reduction’). Where Husserl only points in the direction of the process by which we ‘trade places’ and co-perform the positings of the other’s ego, Englander (2014, 2015) actually goes on to develop the notion of an ‘empathic reduction’ in an original and compelling manner. Within my own aforementioned framework of ‘second-person perspectivity’ (Churchill 2001, 2006, 2007, 2010, 2012a, b), the empathic reduction would emerge as one among a number of possible standpoints. The second person perspective is more like a ‘condition of possibility’ for the particular attitudes one can adopt in our spontaneous as well as more formal efforts to understand the other. Because my own employment of the second-person perspective has been primarily empathic (rather than, e.g., defensive or aggressive), I have been prone in my own writings to refer to the second-person perspective almost exclusively in its empathic modality, almost to the point of equivocating them. But it would be more accurate to refer to the empathic attitude (or reduction) as a possible modality within the second-person – as well as third-person – perspective. 3. Lipps’s (1902, 1903/1935) discussion of die Einfühlung was an elaboration of the concept as used by Rudolf Hermann Lotze and Wilhelm Wundt in the development of a doctrine of aesthetics. The English translation ‘empathy’ was coined by Wundt’s student E. G. Titchener. The original connection of the term with aesthetics owes to J. G. von Heider’s use of the gerund das Einfühlen to express the artist’s imaginative insight into individual styles of experience. The concept was also implicit in Coleridge’s idea of ‘an imaginative union of the percipi and the percipere, the ‘perceived’ and the “perceiver” ’ (Engell, 1981, p. 157).

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4. In the second volume of the Ideas, as well as in the Crisis, Husserl distinguished the body as Körper from the body as Leib, corresponding to which there are two attitudes, which are the noetic correlatives that serve as the conditions of possibility for these two notions of the body: the naturalistic attitude, and the personalistic attitude in which ‘our own activity and interest is not in explaining . . . the behavior of others, but in responding to their movements and gestures’ (Heinamaa, 2003, p 26). Husserl’s thesis is that ‘originally’ we experience both our bodies and the bodies of others – including both animals and humans – as expressive. He writes: ‘Each movement of the Body is full of soul, the coming and going, the standing and sitting, the walking and dancing, etc.’ (p. 252). 5. For Schutz, ‘the general thesis of the alter ego’ (1970, p. 166) – also referred to as ‘the reciprocity of perspectives’ (Schutz, 1973, p. 11) – has two correlates: the interchangeability of standpoints, and the congruence of relevance systems. This constitutes part of what Husserl called ‘the natural attitude’ – the belief that the world actually is the way it appears to me. When in everyday life – or even in professional work, including ‘phenomenological research’ – one begins to interpret the meaningful expressions of another, one presumes both an interchangeability of standpoints and a congruence of relevance systems. That is, our own exercise of imagination (einbilden) in filling-in the other’s expressive gestures with meaning is itself based upon this ‘natural presumption’ that we can experience the world in similar ways. 6. The influence of this aspect of Dilthey’s thought on Heidegger has not been explored, though it seems remarkable that similar to Dilthey’s interest in the person was Heidegger’s (1923/1999) interest – during approximately the same time period of the early 1920s – in developing his philosophy in the direction of a ‘phenomenological hermeneutics of facticity’ that would take the ‘jeweilige Wie’ of individual experience as its ultimate focus. This direction he attributed at the time to Aristotle; though, it was clear that Heidegger was reading Dilthey as well, as evidenced by the latter’s inclusion in the introduction to Heidegger’s 1925 Lecture Course on The History of the Concept of Time (1979/1985). 7. Bettelheim (1983) explains that the term Deutung means ‘the attempt to grasp at the meaning’ of something – and not some heavy-handed act of theoretical interpretation, where one would impose meaning or order from the outside to someone else’s inner experience. This is why Freud’s choice of title for his ‘dream book’ was not Die Bedeutung der Träume, but rather Die Traumdeutung (which I suggest might be playfully read as both ‘the attempt to grasp at the meaning of dreams’ and ‘the dream’s attempt to grasp at meaning’). 8. The great Estonian biologist Jakob von Uexküll (1909, 1934) taught us something about the ‘spirit’s way of knowing nature’ in his classic 1934 work A Stroll through the Worlds of Animals and Men: A Picture Book of Invisible Worlds. He writes: ‘These different worlds, which are as manifold as the animals themselves, present to all nature lovers new lands of such wealth and beauty that a walk through them is well worth while, even though they unfold not to the physical but only to the spiritual

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eye. So, reader, join us as we ramble through these worlds of wonder.’ (1934, p. 6, emphasis added). ‘To do so, we must first blow, in fancy, a soap bubble around each creature to represent its own world, filled with the perceptions which it alone knows. When we ourselves then step into one of these bubbles, the familiar meadow is transformed . . . . A new world comes into being – the Umwelt . . . This we may call the phenomenal world or the self-world of the animal.’ (p. 5). Such an approach to the world of animals would eventually inspire a new generation of phenomenological psychiatrists to build their own approaches to understanding the ‘worlds’ of their patients upon von Uexküll’s Umwelt-research (see May, Angel, & Ellenberger, 1958). Heidegger (1983/1995), Binswanger (in May et.al., 1958), and Merleau-Ponty (1995/2003) would eventually credit von Uexküll with having inspired their own reflections upon worlds and worldhood. Brentano (1874/1973) was actually first to distinguish the realms of the various sciences on the basis of access rather than content: that is, he subordinated the definition of the content or subject matter of one’s science according to the mode of access that one would utilize to make this content evident. For Brentano, ‘external perception’ gave us the realm of nature, accessible to us by means of the senses; whereas ‘inner perception’ (not to be confused with ‘introspection’) gave us the realm of the psychological, made available to us by means of a species of intuition (an-schauen) that is not reducible to the senses. It was Dilthey (1894/1977a, 1927/ 1977b) who would clarify this ‘inner perception’ as ‘Verstehen’. With this term, Dilthey (1894/1977a, p. 55) invoked all of the human powers of understanding: not just rational thinking, but also feeling, intuiting, imagining, sensing, remembering. Levinas, following Husserl (1913/1982, 1952/1989), would later describe how this encounter or ‘intuition’ (die Anschauung) constituted a primordial means for discovering others from within our own personal framework of experience: ‘A phenomenological intuition of the life of others, a reflection by Einfühlung opens the field of transcendental intersubjectivity’ (Levinas, 1973, p. 150). Jan van den Berg (1972, p. 124) would later comment wryly that ‘hypotheses emerge where the description of reality has been discontinued too soon’. Later, in Being and Time, Heidegger’s preferred terms became ‘existence’ and ‘Beingin-the-world’. With regard to the ‘matters’ (Sachen) on which we should focus, Heidegger (1927/1962, p. 33) wrote: ‘The question of existence [Existenz] is one of Dasein’s ontical “affairs” [Sachen]’ – and in so referring to these ‘affairs’ it can be argued that he was making implicit reference to Husserl’s (1901/1968, p. 6) famous invocation: ‘wir wollen auf die “Sachen selbst” zurückgehen’. The methodological question, however, would be that of finding the most appropriate mode of access to these affairs of everyday life – and on the question of access, Heidegger would differ significantly from the approach taken by his mentor Husserl. One might argue, for example, that Jane Goodall’s (1990, p. 8) published observations of chimpanzees in their natural habitat represent a truly human

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science approach to animal psychology insofar as she champions empathy and intuition as her methods of access to her subject matter. 13. Here and throughout this section I will quote at length from Heidegger to give the reader unfamiliar with his Zollikon Seminars a taste of how he addressed himself to the phenomenology of the body in relation to Miteinandersein. 14. It should be noted that Heidegger’s criticism here is directed more towards Husserl’s notions of ‘subjectivity’ and ‘inter-subjectivity’ and less in regards to the concept of empathy taken at face value. Heidegger (1927/1972, p. 162) only objects to Husserl’s employment of empathy to bridge an alleged gap between otherwise fundamentally isolated Egos. 15. There, in a dense section in which he formally presents Dasein’s modes of disclosedness, Heidegger developed a threefold structure in which Befindlichkeit, Verstehen, and Rede (logos) are identified as the ontological sources of the understanding of self and others. Understanding is revealed to us first through what he calls our modes of attunement (Gestimmungen), which are made possible by the fact that we are fundamentally in the world in such a way that we always first and foremost ‘find ourselves’ situated (Befindlichkeit) and that it is in and through this ‘finding oneself ’ affectively attuned, that we are able to begin to understand ourselves and eventually to give expression (Rede) to this self-understanding. In his allimportant section on ‘Dasein and Discourse: Language’ [sec. 34], Heidegger (1927/ 1962) made some remarkable pronouncements regarding the very nature of listening, of hearing, of ‘being-open’ to oneself and to others, and eventually, of ‘hearkening’: Listening to . . . is Dasein’s existential way of Being-open as Being-with for Others. Indeed, hearing constitutes the primary and authentic way in which Dasein is open for its ownmost potentiality-for-Being – as in hearing the voice of the friend whom every Dasein carries with it. Dasein hears, because it understands. . . . Being-with develops in listening to one another [Aufeinanderhören], which can be done in several possible ways: following, going along with, and the privative modes of not-hearing, resisting, defying, and turning away. It is on the basis of this potentiality for hearing, which is existentially primary, that anything like hearkening [Horchen] becomes possible. (pp. 206–207) . . . when we are explicitly hearing the discourse of another, we proximally understand what is said, or – to put it more exactly – we are already with him, in advance, alongside the entity which the discourse is about. . . . The person who ‘cannot hear’ and ‘must feel’ may perhaps be the one who is able to hearken very well, and precisely because of this. (p. 207) So in other words, hearkening can be a deeper kind of listening, in which we listen in silence. This requires being in the presence of another, whether in actual fact, or in some virtual reality, such as in watching a film. In the extreme close-up, Truffaut showed us that we achieve the most intimate portrait of the Other, precisely

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because it is in the face that we find revealed the true ‘subjectivity’ of the Other. (See footnote 18 below.) 16. The actual passage from Being and Time reads as follows: In this more general kind of communication [Mitteilung], the Articulation of Being with one another understandingly is constituted. Through it a co-state-ofmind [Mitbefindlichkeit] gets ‘shared’, and so does the understanding of Beingwith. Communication is never anything like a conveying of experiences . . . from the interior of one subject into the interior of another. . . . In talking, Dasein expresses itself not because it has, in the first instance, been encapsulated as something ‘internal’ over against something outside, but because as Being-in-theworld it is already ‘outside’ when it understands. (Heidegger, 1927/1962, p. 205) 17. As we watch a film, we begin to feel the characters’ intentionality. For example, when we observe Scarlett Johansson’s subtle facial expressions in Sofia Coppola’s (2003) film Lost in Translation, we are able to feel her loneliness, her feelings of abandonment in the world, her longing for a connection, her delight in the face of Bill Murray’s playfulness. In her notes to the press, the director suggested that the film is about ‘one moment’: we can interpret this to mean this moment in their lives when they were alone together in Tokyo – or we can interpret it to mean the final moment that the entire film leads up to. This film is truly an example of expressionist cinema, to the extent that its theme is not an ‘idea’, nor the plot, nor the character – it is about a feeling, a mood. And this mood is revealed to us in a profound moment of Mitbefindlichkeit which either works or does not work for the particular viewer. It is not a failing of the film if everyone is not moved by it. But if the film works at all on the viewer, it works in this expressionist mode of evoking a mood, and evoking it so strongly, that one longs in the final moments of the film for a catharsis, and regardless of whether one is man or woman, one finds it in the look on Scarlett’s face when Bill Murray finally hugs her. We never know what he says to her; but then, we don’t have to know, because her face says it all. This is what I mean when I invoke Heidegger’s notion of Mitbefindlichkeit. It is a shared moment in which we live the moment with the other person. And in this moment we are touched and transformed.

References Abram, D. (1996). The spell of the sensuous: Perception and language in a more-thanhuman world. New York: Random House. Allport, G. W. (1937). Personality: A psychological interpretation. New York: Henry Holt & Co. Bettelheim, B. (1983). Freud and man’s soul. New York: Vintage Books.

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Brentano, F. (1973). Psychology from an empirical standpoint (trans. A. C. Rancurello, D. B. Terrell, & L. L. McAlister). New York: Humanities Press. (Original work published 1874.) Churchill, S. D. (1998). The intentionality of psychodiagnostic seeing: A phenomenological investigation of clinical impression formation. In R. Valle (ed.), Phenomenological inquiry: Existential and transpersonal dimensions, pp. 175–207. New York: Plenum Press. Churchill, S. D. (2001). Intercorporeality, gestural communication, and the voices of silence: Towards a phenomenological ethology – Part Two. Somatics XIII(2):40–5. Churchill, S. D. (2006). Encountering the animal other: Reflections on moments of empathic seeing. The Indo-Pacific Journal of Phenomenology: Special Issue on Methodology, 6:1–13. Churchill, S. D. (2007). Experiencing the other within the we: Phenomenology with a bonobo. In L. Embree and T. Nenon (eds), Phenomenology 2005, vol. IV: Selected essays from North America, pp. 147–70. Bucharest: Zeta E-Books. Churchill, S. D. (2010). Second person perspectivity in observing and understanding emotional expression. In L. Embree, M. Barber, & T. J. Nenon (eds), Phenomenology 2010, vol. 5: Selected essays from North America. Part 2: Phenomenology beyond philosophy, pp. 81–106. Bucharest: Zeta Books/Paris: Arghos-Diffusion. Churchill, S. D. (2012a). Resoundings of the flesh: Caring for others by way of ‘second person’ perspectivity. International Journal of Qualitative Studies in Health and Wellbeing, 7:8187; http://dx.doi.org/10.3402/qhw.v7i0.8187. Churchill, S. D. (2012b). Teaching phenomenology by way of ‘second-person perspectivity’: From my thirty years at the University of Dallas. In Teaching of phenomenology [Special issue]. Indo-Pacific Journal of Phenomenology, 12: 1–14. Churchill, S. D. (in press). Imitative empathy: An intuitive method for psychology. Ramify. Combs, A. W., & Snygg, D. (1959). Individual behavior: A perceptual approach to behavior. New York: Harper & Brothers. Coppola, S. (director). (2003). Lost in translation [Motion picture]. USA: Focus Films. Dilthey, W. (1977a). Ideas concerning a descriptive and analytical psychology (1894) (trans. R. M. Zaner). In W. Dilthey, Descriptive psychology and historical understanding, pp. 21–120. The Hague: Martinus Nijhoff. (Original work published 1924.) Dilthey, W. (1977b). The understanding of other persons and their expressions of life (trans. K. L. Heiges). In W. Dilthey, Descriptive psychology and historical understanding, pp. 123–44. The Hague: Martinus Nijhoff. (Original work published 1927.) Engell, J. (1981). The creative imagination: Enlightenment to romanticism. Cambridge, MA: Harvard University Press. Englander, M. (2014). Empathy training from a phenomenological perspective. Journal of Phenomenological Psychology, 45(1): 5–26.

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Englander, M. (2015). Selfhood, empathy, and dignity. In S. Ferrarello & S. Giacchetti (eds), Identity and Values, pp. 75–88. Cambridge: Cambridge Scholars Publishing. Giorgi, A. (1970). Psychology as a human science: A phenomenologically based approach. New York: Harper & Row. Goodall, J. (1990). Through a window: My thirty years with the chimpanzees of Gombe. Boston, MA: Houghton Mifflin Company. Gorden, R. L. (1969). Interviewing: Strategy, techniques, and tactics. Homewood, IL: Dorsey. Gurwitsch, A. (1974). Phenomenology and the theory of science (ed. L. Embree). Evanston, IL: Northwestern University Press. Hamlyn, D. W. (1974). Person-perception and our understanding of others. In T. Mischel (ed.), Understanding other persons. Totowa, NJ: Rowan and Littlefield. Heidegger, M. (1962). Being and time (trans. J. MacQuarrie & E. Robinson). New York: Harper & Row. (Original work published 1927.) Heidegger, M. (1972). Sein und Zeit [Being and time] (12th ed.). Tuebingen, Germany : Max Niemeyer Verlag. (Original work published 1927.) Heidegger, M. (1985). Prolegomena to the history of the concept of time (trans. T. Kisiel). Bloomington: Indiana University Press. (Original work prepared in 1925 and published in 1979.) Heidegger. M. (1989). Phaenomenologische Interpretationen zu Aristoteles (Anziege der hermeneutischen Situation) [Phenomenological interpretations of Aristotle (A display of the hermeneutical situation)]. Dilthey Jahrbuch 6. (Original essay written 1922.) Heidegger, M. (1995). The fundamental concepts of metaphysics: World, finitude, solitude (trans. W. McNeill & N. Walker). Bloomington: Indiana University Press. (Original lecture course given 1929–30 and published 1983.) Heidegger, M. (1999). Ontology: The hermeneutics of facticity (trans. J. van Buren). Bloomington: Indiana University Press. (Original lecture course presented 1923 and published 1988.) Heidegger, M. (2001a). Phenomenological interpretations of Aristotle: Initiation into phenomenological research (trans. R. Rojcewicz). Bloomington: Indiana University Press. (Original lecture course presented 1921–22 and published 1985.) Heidegger, M. (2001b). Zollikon seminars: Protocols – conversations – letters (ed. M. Boss, trans. F. Mayr & R. Askay). Evanston, IL: Northwestern University Press. (Original work published 1987.) Heidegger, M. (2009). Basic concepts of Aristotelian philosophy (trans. R. D. Metcalf & M. B. Tanzer). Bloomington: Indiana University Press. (Original lecture course presented 1924 and published 2002.) Heinamaa, S. (2003). Toward a phenomenology of sexual difference: Husserl, MerleauPonty, Beauvoir. Lanham, MD: Rowman & Littlefield. Husserl, E. (1952). Ideen zu einer reinen Phänomenologie und Phänomenologische Philosophie II: Phänomenologische Untersuchungen zur Konstitution (Ideas

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pertaining to a pure phenomenology and to a phenomenological philosophy. Second Book: Phenomenological investigations of constitution). In Husserliana (vol. 4). The Hague: Martinus Nijhoff. Husserl, E. (1960). Cartesian meditations: An introduction to phenomenology (trans. D. Cairns). The Hague: Martinus Nijhoff. (Original work published 1950.) Husserl, E. (1968). Logische Untersuchungen: Zweiter Band: Untersuchungen zur Phänomenologie und Theorie der Erkenntnis – I. Teil (5 Auflage) (Logical investigations: Vol. 2. Investigations in phenomenology and the theory of knowledge – part 1 [5th ed.]). Tuebingen, Germany : Max Niemeyer Verlag. (Original work published 1901.) Husserl, E. (1970). The crisis of European sciences and transcendental phenomenology (trans. D. Carr). Evanston, IL: Northwestern University Press. (Original work published 1939.) Husserl, E. (1973a). Die Apperzeption des eigenen Liebes als die originale Leibapperzeption und die Mittelbarkeit der Apperzeption des fremden Liebes. Die Konstitution der ersten wahren Transzendenz durch die Einfühlung (Sommersemester 1921) (The apperception of one’s own body as the original body-awareness and the mediacy of the apperception of the other’s body. The constitution of the first true transcendence through empathy [Summer Semester 1921]). In E. Husserl, Husserliana (vol. 14, pp. 3–10). The Hague: Martinus Nijhoff. Husserl, E. (1973b). Husserliana 13, 14, 15: Zur Phänomenologie der Intersubjektivität (Towards a phenomenology of intersubjectivity). The Hague: Martinus Nijhoff. (Original works written 1905–35.) Husserl, E. (1977). Phenomenological psychology: Lectures, summer semester, 1925 (trans. J. Scanlon). Boston: Martinus Nijhoff. (Original work published 1962.) Husserl, E. (1982). Ideas pertaining to a pure phenomenology and a phenomenological philosophy, First Book: General introduction to a pure phenomenology (trans. F. Kersten). Boston: Martinus Nijhoff. (Original work published 1913.) Husserl, E. (1989). Ideas pertaining to a pure phenomenology and to a phenomenological philosophy, Second Book: Studies in the phenomenology of constitution (trans. R. Rojcewicz & A. Schuwer). Boston: Kluwer. (Original work written 1928 and published posthumously in 1952.) Husserl, E. (1997). The Amsterdam lectures on phenomenological psychology (trans. R. E. Palmer). In Psychological and transcendental phenomenology and the confrontation with Heidegger (1927–1931) (trans. T. Sheehan & R. E. Palmer). Netherlands: Kluwer Academic Publishers. (Original work delivered in 1928.) Husserl, E. (2006). The basic problems of phenomenology: From the lectures, Winter Semester, 1910–1911 (trans. I. Farin & J. G. Hart). Dordrecht: Springer. (Original lecture course presented 1910–11.) Jaspers, K. (1963). General psychopathology (trans. J. Hoenig & M. W. Hamilton). Chicago: University of Chicago Press. (Original work published 1913.)

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Laing, R. D. (1959). The divided self: An existential study in sanity and madness. New York: Penguin. Levinas, E. (1973). The theory of intuition in Husserl’s phenomenology (trans. A. Orianne). Evanston, IL: Northwestern University Press. (Original work published 1963.) Lingis, A. (1994). The community of those who have nothing in common. Bloomington: Indiana University Press. Lipps, T. (1903). Leitfaden der Psychologie (Textbook of psychology). Leipzig: Engelmann. Lipps, T. (1935). Empathy, inner imitation, and sense-feelings. In Rader (ed.), A modern book of aesthetics, pp. 374–82. New York: Holt and Company. (Original work published 1903.) Mann, M. (director). (1986). Manhunter. USA: DeLaurentiis Entertainment Group & Red Dragon Productions. May, R., Angel, E., & Ellenberger, H. F. (eds). (1958). Existence: A new dimension for psychiatry and psychology. New York: Simon & Schuster. Merleau-Ponty, M. (1962). Phenomenology of perception (trans. C. Smith). London: Routledge & Kegan Paul. (Original work published 1945.) Merleau-Ponty, M. (1963). The structure of behavior (trans. A. L. Fisher). Boston: Beacon Press, 1963. (Original work published 1942.) Merleau-Ponty, M. (1964a). Eye and mind (trans. C. Dallery). In Merleau-Ponty, The primacy of perception, pp. 159–90. Evanston, IL: Northwestern University Press. (Original work published 1961.) Merleau-Ponty, M. (1964b). The metaphysical in man (trans. H. L. Dreyfus & P. A. Dreyfus). In M. Merleau-Ponty, Sense and non-sense, pp. 83–98. Evanston, IL: Northwestern University Press. (Original work published 1948.) Merleau-Ponty, M. (1964c). Phenomenology and the sciences of Man (trans. J. Wild). In M. Merleau-Ponty, The primacy of perception, pp. 43–95. Evanston, IL: Northwestern University Press. (Original work published 1961.) Merleau-Ponty, M. (1964d). The philosopher and his shadow (trans. R. C. McCleary). In M. Merleau-Ponty, Signs, pp. 159–81. Evanston, IL: Northwestern University Press. (Original work published 1960.) Merleau-Ponty, M. (1964e). The film and the new psychology (trans. H. L. Dreyfus & P. A. Dreyfus). In M. Merleau-Ponty, Sense and non-sense, pp. 48–59. Evanston, IL: Northwestern University Press. (Original lecture given 1945.) Merleau-Ponty, M. (1968). The visible and the invisible (trans. A. Lingis). Evanston, IL: Northwestern University Press. (Original work published.) Merleau-Ponty, M. (1973). The prose of the world (trans. J. O’Neill). Evanston, IL: Northwestern University Press. (Original work published 1969.) Merleau-Ponty, M. (2003). Nature: Course notes from the College de France (trans. R. Vallier). Evanston, IL: Northwestern University Press. (Original work published 1995.)

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Mill, J. S. (1988). The logic of the moral sciences. Peru, IL: Open Court Publishing. (Original work published 1872.) Reich, W. (1972). Character analysis (trans. V. R. Carfagno). New York: Simon and Schuster. (Original work published 1933.) Reik, T. (1948). Listening with the third ear. New York: Farrar, Strauss. Rogers, C. (1951). Client-centered therapy. Boston, MA: Houghton Mifflin Company. Sarbin, T. R., Taft, R., & Bailey, D. E. (1960). Clinical inference and cognitive theory. New York: Holt, Rinehart and Winston. Sartre, J.-P. (1956). Being and nothingness: An essay on phenomenological ontology (trans. H. Barnes). New York: Washington Square Press. (Original work published 1943.) Schafer, R. (1983). The analytic attitude. New York: Basic Books. Scheler, M. (1954). The nature of sympathy (trans. P. Heath). New Haven: Yale. (Original work published 1923.) Scheler, M. (1973). Wesen und Formen der Sympathie (Essence and forms of sympathy). Bern: Francke Verlag. Schutz, A. (1962). On multiple realities. In A. Schutz, Collected papers I: The problem of social reality, pp. 207–59. The Hague: Martinus Nijhoff. Schutz, A. (1966). Edmund Husserl’s Ideas, Vol. II. In A. Schutz, Collected Papers III: Studies in phenomenological philosophy. The Hague: Martinus Nihjoff. Schutz, A. (1970). On phenomenology and social relations (ed. H. R. Wagner). Chicago: University of Chicago Press. Schutz, A. (1973). Collected papers I: The problem of social reality (ed. M. Natanson). The Hague: Martinus Nijhoff. Shapiro, K.J. (1985). Bodily reflective modes: A phenomenological method for psychology. Durham: Duke University Press. Sontag, S. (2003). Regarding the pain of others. New York: Farrar, Straus and Giroux. Stein, E. (1989). On the problem of empathy (trans. W. Stein). Washington, DC: ICS Publications. (Original work published 1917.) van den Berg, J. H. (1972). A different existence. Pittsburgh, PA: Duquesne University Press. von Uexküll, J. (1909). Umwelt und Innerwelt der Tiere (The environment and the innerworld of animals). Berlin: Springer. von Uexküll, J. (1934). Streifzuege durch die Umwelten von Tieren und Menschen – Ein Bilderbuch unsichtbarer Welten (Intimate wanderings through the worlds of animals and men: A picture book of invisible worlds). Berlin: Springer. Wiens, A. (1976). Psychological assessment. In I. Weiner (ed.), Clinical methods in psychology. New York: Wiley. Zahavi, D. (2007). Self and other: The limits of narrative understanding. In D. D. Hutto (ed.) Narrative and understanding persons, pp. 179–201. Royal Institute of Philosophy Supplement: 60. Cambridge University Press. Zahavi, D. (2010). Empathy, embodiment and interpersonal understanding: From Lipps to Schutz. Inquiry, 53(3):285–306.

On the Empathic Mode of Intuition Zahavi, D. (2011a). Empathy and direct social perception: A phenomenological proposal. Review of Philosophy and Psychology, 2(3):541–58. Zahavi, D. (2011b). Empathy and mirroring: Husserl and Gallese. In R. Breuer and U. Melle (eds), Life, subjectivity and art: Essays in honor of Rudolf Bernet. Dordrecht: Springer. Zahavi, D. (2014). Self and other. Oxford: Oxford University Press.

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Research Methods for Person-Centred Health Science Fordham Studies of Suffering and Transcendence Frederick J. Wertz, Miraj U. Desai, Emily Maynard, Justin R. Misurell, Mary Beth Morrissey, Batya Rotter, and Nicoletta C. Skoufalos

Introduction Phenomenology has had a limited presence in doctorate-granting departments of psychology despite compelling works on its potential contributions. The lack of inclusion is disturbing given over a century of psychological and psychiatric research by phenomenological philosophers, psychiatrists, and psychologists (Wertz, 2006). There has been an increasing emphasis on biological and ‘evidence-based practice’ research, which privileges randomized, control trials (RCTs) for specialized treatments of mental disorders. Such research aims to compete with the successes of medicine based on a turn-of-the-twentiethcentury model of science, with some of its advocates likening much contemporary clinical practice to blood-letting patients with leeches before science regulated medicine. Contemporary medicine, however, is increasingly turning from this simple disease model to a ‘person-centred’ model, not only in psychiatry but in general medicine and health care (Mezzich et al., 2010; 2015). This largely practice-based movement, which has been endorsed internationally by dozens of health groups including the World Health Organization, centres holistically on the ‘person who has the disease’. This general approach is applicable beyond medicine to virtually all human affairs and includes a strong emphasis on human subjectivity, on the meanings and values in the person’s bodily, psychological, social, and spiritual life. Although this holistic and person-centred

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approach offers much of practical value, it remains in need of a fitting philosophy of science and research methodology. Phenomenology offers an interdisciplinary approach specifically suited for the study of conscious persons-in-context, and thereby offers clinical psychology and the health sciences a means through which to study the subject matter with scientific rigor. Over the past decade, in an APA-approved, PhD program in clinical psychology at Fordham University, we have developed a phenomenological clinical psychology that employs research methods following Edmund Husserl, as formulated by Amedeo Giorgi and informed by Heidegger, Sartre, de Beauvoir, Merleau-Ponty, Fanon, and Levinas. We have addressed basic problems and controversies in the field that require knowledge of personal subjectivity. In research on such topics as eating disorders, depression, bipolar disorder, autism, trauma and resilience, psychosis, and dementia, some doctoral students have gone extra miles to learn phenomenology in addition to the APA-approved curriculum and have conducted research in collaboration with other faculty from across the spectrum of psychology. Phenomenological methods have served as a vehicle that complements, expands, and revisions traditional clinical psychology.

Research Methods for Phenomenological Psychology Phenomenology in clinical psychology ‘Back to the things themselves!’ Husserl developed the scientific method called phenomenology in order to investigate what has variously been called consciousness, lived experience, and existence. With profound admiration for the great successes of the physical sciences and technologies, Husserl argued that these methods, which lacked self-understanding and philosophical grounding, could not provide a universal scientific foundation for understanding human life in its fullness. Indeed, reductive, physicalistic science had been unable to address the deepest problems of human life and death in order to responsibly shape our collective destiny, which requires additional methods and conceptualizations capable of offering knowledge of subjectivity. Husserl (1913, 1925, 1954) developed methods to study consciousness for use in philosophy and the human sciences. Without a proper scientific approach to the study of subjectivity, research and theorizing in psychology and related health disciplines remain riddled with fundamental problems such as a lack of ecological validity, fragmentation, and a remote, insufficiently grounded approach to important subject

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matter  – experience, meaning, values, and action (Giorgi, 1970a). Although psychiatry concerns and employs many terms that suggest a focus on mental life –depression, hallucination, and traumatic stress – the extant terms, methods, and theories used for the subject matter of psychiatry have functioned without rigorous knowledge of what these subjective phenomena are. ‘[W]e can absolutely not rest content with “mere words”, i.e. with a merely symbolic understanding of words . . . Meanings inspired only by remote, confused, inauthentic intuitions – if by any intuitions at all – are not enough:  We must go back to the “things themselves”’ (Husserl, 1901/1970, p. 252; italics added).

Lacking knowledge of ‘what mental disorders are’ In psychiatry, the dominant approach is the biomedical model, which includes knowledge of diagnosis, etiology, treatment, and prevention of mental disorders. Although its limits have been recognized and a broader model including psychological, social, and spiritual life suggested (Engel, 1981), it remains prevalent. Controversies surrounding this model continue at every level, for instance in the recent crisis of the revision of the taxonomic system for DSM-5, in lamentation about the inconclusiveness and fragmentation of research and theory, in concern with the multiplicity and uncertain efficacy of treatments, and in acknowledgement of limited success of prevention. These problems rest to a significant extent on a more fundamental one – the lack of clarification of the subject matter to which this model is applied:  ‘mental disorders’. Diagnostic criteria are not equivalent to the mental life of which they are criteria. Even a perfectly valid diagnostic criterion that could serve categorization flawlessly, such as a biomarker present in every individual who meets all other ‘diagnostic criteria’ and absent in every healthy individual, does not provide knowledge of the psychological processes to which the label ‘mental disorder’ is applied, however useful and even sufficient such partial information is in differential categorization. In principle within the medical model, psychiatry attempts to diagnose, causally explain, treat, and prevent what are called ‘mental disorders’ without explicit, valid, and properly clarified scientific knowledge of the full breadth and scope, the very identity of what is being so named and categorized – what the subject matter of psychiatry are. What is diagnosed, what is causally explained, what is treated, and what is prevented requires specifically qualitative determination as a mental phenomenon. Clinical observation and common sense rightly inform us that the category ‘mental disorder’ generally refers to mental ‘distress’ and ‘dysfunction,’ and professionals offer important clinical observations of the variety

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of forms taken, including ‘symptoms’. However, such informally documented information used in determining diagnostic criteria, etiological hypotheses, and treatment outcome targets remains without any rigorous scientific method of describing what each ‘mental disorder’ is – what people are distressed about and what kind of functioning is impeded. Phenomenology, in its return ‘to the things themselves’, provides such a method, a method that is specifically designed to study what the various forms of mental life are, in their ecological contexts. This method does not oppose but complements other methods, providing crucial foundational knowledge of what psychiatry attempts to diagnose, explain, treat, and prevent.

Husserl’s phenomenological method and notion of ‘intentionality’ Husserl’s method for studying mental life involves two intertwined kinds of analysis, intentional and eidetic. Intentional analysis brings the researcher into contact with the mental life, particularly its meaning function, and eidetic analysis enables the researcher to grasp what it is – its essential structure. The researcher prepares to conduct intentional analysis by adopting a certain necessary attitude that, for purposes of simplicity, we characterize as two ‘epochēs’ that lead to the ‘phenomenological reduction’. Epochē means abstention, or bracketing, and the first such operation is to put aside existing theories and knowledge of the mental life under investigation. This allows the researcher to turn to experience as it is concretely lived and presents itself in the lifeworld, as opposed to representations in relatively abstract words, categories, hypotheses, and research. The second epochē abstains from the naïve positing of existence that takes place in experience and instead attends to the way situations present themselves to experience, their correlative subjective relativity  – the meanings, values, and utility of situations as given immediately in experience. Each of these epochēs involves a vocational attention to certain data and inattention to others. The first epochē shifts the investigator’s attention from extant scientific knowledge to the lifeworld  – the lived world. The second epochē, by abstaining from concerns about the independent existence of objects (as well as irrelevant assumptions on the part of the researcher), reduces the field to the way the world is experienced. This phenomenological reduction allows the researcher to conduct what is called ‘intentional analysis’, an investigation of the experience-world correlation, in order to bring to light the subjective processes and meanings of situations as they present themselves to consciousness.

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The second major methodical procedure, which is employed in tandem with intentional analysis and gives phenomenology its scientificity (Sowa, 2007), involves the eidetic attitude and reduction, which focuses on what the subject matter is (Husserl, 1913, 1954; Wertz, 2010). Eidetic analysis is the procedure of qualitative analysis par excellence. It begins with an individual example of the subject matter as it is given in ‘intuition’  – that is, as it presents itself in concrete immediacy. Then, using free imaginative variation of its features and comparisons with other empirical instances of the subject matter, the researcher identifies the essential (eidetic) structure of the subject matter and describes its constituents and their holistic interrelations that are invariant across all factual and imagined examples. In his description of the essence of consciousness, Husserl brought to light the essential ‘intentionality’ of every act of consciousness, its being ‘conscious of an object.’ Consciousness is a very important function in the lives of human beings, for through consciousness we are related to the world, each other, and ourselves. By virtue of being conscious, persons transcend themselves in relations with what lies beyond their conscious acts – objects, situations, other people, the past, the future, and indeed the entire world as a changing historical context. Subjectivity (primordially intersubjective), which includes embodied, efficacious action, is transcendence  – a temporal flowing in and through the world with others. The world as experienced includes not only materiality but a more complex constitution whose meanings involve its temporality, utility, values, sociality, and goals.

Giorgi’s contribution: A research method for phenomenological psychology Giorgi (1970b, 1975, 1985, 2009)  has developed procedures for psychological research based on Husserl’s phenomenology (Wertz, 1983, 2005, 2015; Wertz et al., 2011). This method begins with the identification of empirical examples of psychological subject matter and the collection of descriptions of psychological life in ordinary language, from the perspective of either persons themselves or other witnesses of them. For instance, research participants might be asked to provide a written description, or to describe verbally in an interview, a situation in which they lived through such research topics as learning, perception, problem-solving, anxiety, depression, hallucination, or a traumatic injury. These descriptions are not derived from nor biased by theory because participants

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typically have little to no scientific knowledge of the subject matter, and when they do, data about the origin and development of their knowledge is gathered. Descriptions are not structured according to hypotheses, previous research, or any scientific knowledge (but structured by research participants), thereby operationalizing the epochē of scientific knowledge and enabling the investigator to focus on the way the concrete lifeworld is presented through their experiences. These descriptions provide data expressing empirical examples of the subject matter, including the contextually situated meanings, goals, values, social relations, and practices that the participants lived through over time. Giorgi (2009) has suggested four steps in analysing this data. 







First, the researcher reads each description openly, gathering a sense of the whole without posing specific research questions or focusing on the study’s subject matter. Second, within the phenomenological attitude, the researcher differentiates meaning units, demarcating shifts in the meaning of the situation as expressed in the description, in order to identify parsimonious segments for subsequent analysis. Third, the researcher reflects psychologically on each meaning unit in an effort to explicate mental life revealed in the description with reference to the specific research topic, questions, and goals. Fourth, the researcher synthesizes reflections in a description of the general psychological general structure(s) of the subject matter, thoroughly utilizing all insights and available data in a coherent description of the research topic with respect to all research questions.

Between the third and fourth steps, some researchers synthesize reflections on individual instances of the phenomenon in order to describe idiographic psychological structures that provide knowledge of particular instances of the subject matter and to inform the final formulation of more general structures (Wertz, 1983, 2005; Wertz et al., 2011). It is important to note that Giorgi’s procedures can be employed beyond psychology, for research in such disciplines as sociology and political science as well as in such interdisciplinary professions as nursing and social work, with appropriate modifications of attitude, focus, and research questions (Giorgi, 2009). Here, these procedures of open reading, differentiating shifts in meaning, explicating the experience-meaningful world relations, and describing structures at varying levels of generality (including idiographic, typical, and highly general) were all performed in the psychological phenomenological attitude, wherein the researcher suspended interest in

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the independent existence of the situation described and attended strictly to the way that situations were presented to individual participants – their meanings as given through the psychological processes. Imaginative free variation was used throughout the process, especially in the third and fourth stage reflections, in order to determine, based on empirical examples, what the mental subject matter entails – those invariances that make factual characteristics examples of what they are, the subject matter being researched, for instance, learning, perception, depression, delusion, traumatic stress, or recovery.

Studies of Suffering and Transcendence Using Phenomenological Psychological Methods The following six research projects employed phenomenological methods to better understand subject matters of psychiatry. Our aim was to explicate the experiences under investigation in their full temporal structure, which invariably involved profound suffering that, when faithfully understood, revealed transcendent goals of the participants. Of note is that these studies did not assume the discipline’s terms, research, or theories. For instance, such terms as ‘mental disorder’ and ‘psychopathology’ were avoided in the course of the research and formulations of findings unless given in participants’ experience. These studies found highly organized structures of mental life, often rendering the very term ‘mental disorder’ problematic and misleading, particularly if limited to deficit and illness. Some experiences categorized by psychiatry as ‘pathological’ were lived by research participants normally and some were, according to their personal significance, the best and most successful moments in participants’ lives. In addition, all experiences included profound and rich meanings beyond the usual connotations of technical terms (which are placed in single quotation marks). The descriptions of the following studies are relatively brief, barely sketching some outlines of the research goals and questions, procedures of method, findings, and implications, which typically required at least 250 and sometimes 400 pages.

Bulimia: Fragmented knowledge and the problem of subclinical symptoms In a study on the development of bulimia nervosa (BN), Skoufalos (2010) presented a holistic description of BN by using a comparative phenomenological psychological analysis of interviews and focus group discussions with

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individuals with clinically diagnosable BN, subclinical BN (SCBN), and without BN (NBN). Previous research on BN had brought to light numerous risk factors and had supported many informative etiological theories. However, knowledge of such associated factors as sociotropy, dissociation, and anger as well as such determinants as family, psychodynamic, behavioral, and cognitive processes were unintegrated. Some researchers (e.g., Gleaves et  al., 2000) also debated whether or not SCBN, which involves clinically significant binging and purging at frequencies too low to meet diagnostic criteria, is similar to BN and may lead to BN even though it is not currently a diagnostic category. By tracing the life historical development of BN and comparing it with those of SCBN and NBN, Skoufalos provided integrative knowledge of associated and etiological factors and of the similarities and differences between people classified as having clinical and subclinical BN. Using validated questionnaires, 322 undergraduates were screened for symptoms of BN and SCBN. Participants filled out an extensive battery of questionnaires used to measure the various factors found by previous research, such as anger, sociotropy, and dissociation. Classification of participants into three groups (BN, SCBN, and NBN) was confirmed using the diagnostic gold standard SCID-I/NP (First et al., 2002). In individual interviews and focus groups, four participants classified as having BN and ten participants classified as having SCBN were asked to describe the origin (i.e., first episode) and development of their binging and purging in the overall context of their life history. Six participants in the NBN group were asked to describe their eating practices, also placing these in their overall life-history. Participants elaborated on some of questionnaire item responses in order to better tie standard research measurements to their life historical contexts. For example, a participant may have been asked, ‘You indicated on one of the questionnaires that you ‘always feel rejected in social situations’. Can you describe a specific situation when you felt that way?’ The researcher gathered examples from childhood, adolescence, and college years. Participants in all three groups engaged in a focus group where they shared life experiences relevant to the research. The interactive spontaneity of the focus group discussions evoked new data for analysis. The phenomenological psychological analysis, using Giorgi’s (1985) steps supplemented by a saturation assessment procedure, yielded two dramatically different structures for the BN and SCBN groups that applied to all individuals validly diagnosed without exception. The life-historical development of BN was found to be deeply rooted in an experience of loneliness and isolation, in a desperate and failing search for refuge in love and bodily comfort. In sharp contrast

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to the attempt to ameliorate such deep disconnection from others and personal emptiness, the origins of SCBN involved close, affectionate relations with others in which participants suffered risks of rejection when they did not perfectly fulfill uncritically adopted expectations of significant others. Although the general structures of both BN and SCBN include as essential problematic family relationships, devalued body image, sociotropy, dissociation, and feelings of anger, very different qualitative meanings of these constituents were found in the lifehistorical developmental structures of persons with BN and SBN. Despite the similarities among behaviors within BN and SCBN, the holistic, phenomenological meaning structures supported their differential diagnostic classification and even the frequency of binging and purging as a criterion for a clinically significant distinction. However, the findings also importantly highlight serious suffering in the lives of persons who do not meet current BN diagnostic criteria and who may benefit from caring professionals’ help. The very distinct experiences in what has been labelled ‘BN’ and ‘SCBN’ involve different meanings of binging and purging as well as different body images, family dynamics, concerns about social acceptance, and difficulties expressing emotions such as anger. Overall, the two holistic descriptions of BN and SCBN provide more stable, coherent, and comprehensive psychological knowledge that overcomes previous fragmentation and incompleteness by including personal goals and meanings within social, cultural, and developmental contexts.

Being diagnosed with bipolar disorder: Acceptance and rejection of diagnosis ‘Bipolar disorders’ (BD) are considered serious mental illnesses that involve severe suffering and disruption in developmental trajectories. Early diagnosis and treatment have been recognized as a very significant problem affecting many emerging adults (ages eighteen to twenty-five), where a significant number do not seek help, understand treatments as relevant, or even accept the diagnosis when it is communicated to them by a mental health professional. Maynard’s (2016) research aimed to understand the experience, acceptance, and rejection of this diagnosis by analyzing narratives of emerging adults. This study engaged nine emerging adults from a university student pool and CraigsList in New York City. After volunteers reported having been diagnosed with BP, Maynard confirmed the validity of their diagnoses with the gold standard assessment instrument, the SCID, administered after each in-depth interview so that the validation did not bias descriptive data. Maynard’s interviews

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focused on participants’ life historical experiences, beginning before the diagnosis and ending with the present acceptance or rejection of the diagnosis. Great care and effort was devoted to gathering descriptions of experiences before the diagnosis that were unfettered by concepts and words that had been subsequently incorporated, such as ‘a manic episode’, ‘symptoms of depression’, ‘my illness’, and so on. Participants were able to construct narratives that described the original experiences, providing a basis for Maynard to analyse meticulously the process of meaning making that occurred prior to and in the course of being diagnosed, with all its complex life consequences. The process begins with experiences Maynard called ‘rising’ and ‘falling’, in which persons are fulfilling successfully and failing miserably to achieve personal goals relevant to their becoming adults. The phrase ‘bipolar disorder’ originally signified something alien that belonged to others who were ‘crazy’, unlike themselves. Participants received their diagnoses in the course of trying to overcome significant developmental challenges, which is how they had previously understood the experiences that they were now told were ‘bipolar symptoms’. Although extreme experiences of ‘falling’ and serious interpersonal ruptures with important others in the course of ‘rising’ were sometimes, with guidance by a sympathetic other, reconstrued as a ‘mental disorder’, many ‘rising’ experiences had the meaning of important personal triumphs, leaving participants profoundly threatened by their reinterpretations as a ‘mental illness’, with its meaning of being alien to themselves and targeted for elimination by treatment. Engaging in a complex process of reflection, participants either opposed or admitted their diagnosis as a possibility, in each case motivated by a desire to obtain greater agency over the particular situational challenges that afforded successful forward movement into adulthood. Maynard explicated a single temporal structure of the transitions from opposition to admittance and from admittance to acceptance of the diagnosis as contextually situated within participants’ life historical development. This temporal psychological structure includes a description of the sense of self and the person’s social/relational positioning. Both the rejection and appropriation of the diagnosis had the meaning of recovering one’s agency in the face of the objectifying and alienating diagnostic process, which included a power inequality with the diagnostician that was antithetical to the empowerment participants were seeking as emerging adults. Those who eventually accepted this objectification, not of their ‘selves’ but of specific moments of suffering through ups/downs, came to construe past experiences as ‘not me’ or as ‘something I  need to overcome’ in order to achieve their life goals. This structure highlights paradoxical aspects of the experience of

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diagnosis and calls attention to the difficulties for the person in distinguishing between the self and ‘the disorder’. Maynard’s study contributed to informing professionals of the need for a collaborative model of care based on a therapeutic alliance that facilitates a fulfillment of the patient’s life historical goals rather than merely the identification and elimination of what diagnosticians view as symptoms of psychopathology, thereby aligning care with the strivings and concrete meanings of the diagnosis for the emerging adult. Other practical recommendations arising from the structural analysis included the utilization, in health care, of peer-led egalitarian communities in making meaning of one’s past and forging one’s future by accepting or rejecting the diagnosis and appropriating ‘treatment’ and other practical options along their paths into adulthood.

Autism in India: The introduction of ‘Western’ approaches in a ‘non-Western’ culture Desai (2012) was interested in cultural issues vis-à-vis clinical psychology, specifically how people in various cultures experience, understand, and handle what would be diagnosed as a behavioral or mental health problem in North America and Europe (and increasingly elsewhere). This topic is of increasing interest due to ongoing globalization and intercultural exchange, which calls for clinical psychology and related behavioral health fields to more fully develop knowledge of diverse cultures and local communities to inform practice and policy. Desai worked with collaborators at the Sangath Centre in India as part of a larger project, funded by Autism Speaks (Grant No. 5621)  that sought to better understand the local experiences of parents whose children had been given a diagnosis of an autism spectrum disorder (ASD). He investigated how these parents understood and cared for their children over time, from anticipations before their child’s birth to the present, including their interactions with practitioners from the diverse traditions of care. In order to understand parents’ lives as embedded in their cultural contexts, researchers put aside theoretical and cultural preconceptions, soliciting and analysing descriptions based directly on parents’ ‘indigenous’ experiences. Participants for the study were the mothers and fathers as well as one uncle and aunt of caregivers in twelve families of children diagnosed with an ASD by local professionals using DSM-based criteria (i.e., thirteen total parent sets). After being identified in urban, semi-urban, and rural schools, centres, and community groups, participants were interviewed for one to two hours, and

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follow-up interviews provided more in-depth exploration of parents’ experiences and more comprehensive narratives. The analysis, following Giorgi’s (1985, 2009) method, discerned the general temporal structure of parenting a child with ASD from before birth expectations through the present time (Desai et al., 2012). One of the most important findings concerned the context of parents’ local community in the meaning of their child’s life at various developmental junctures. Parents came to struggle with the open question of whether their child would be accepted, welcomed, and have a valued place in progressively expanding social settings, usually beginning with school and culminating in the adult world of work and community. These concerns developed over four temporal phases (substructures): Phase 1: Perceiving their child as having an open future, and welcoming their child with a nurturing relationship; Phase 2:  Perceiving their child’s unexpected social disruptions as temporary within familiar settings, and seeking advice when the situation is unmanageable; Phase 3: Unfavorably comparing their child’s performances to those of other children in pivotal community settings and seeking help for their child to meet pedagogical goals; Phase 4: Accepting their child’s pervasively limited world-relations in the present and future while pursuing alternate adult activities and making the world more welcoming for children like their own. When parents saw that their child’s standing and future success were threatened in social settings, their attitude featured paradoxes of acceptance and change, with regard to first their child and then the social world. That is, typically in Phase 3, parents accepted their child’s limitations and then attempted to change them to fit the evident social norms, whereas in Phase 4, they accepted and attempted to change restrictive social norms in order to fit with their child’s uniqueness and specialness. These parental concerns about the interdependence of their child’s thriving and potential changes in the social world influenced how parents experienced, appropriated, and/or rejected the concept of ‘autism’, as well as any other diagnoses or interventions regardless of cultural origin. The notion of ‘autism’ had a range of meanings: As a guide to possible ways their child would progress towards social aims, as an organizing concept for collective social action, and as a means of reduction of parental self-blame for their child’s situation. Some parents barely considered ‘autism’ but focused on vocational goals for their child. In each variation, the world and the child’s future remained the primary background of meaning. Overall, the findings suggest the necessity of scholars, practitioners, and policymakers to consider the central meaning of the community for parents, throughout their child’s development and in the future, in affording acceptance,

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welcome, and support through relative security and practical living. These foundational concerns structured the parenting experience, informed their practical actions, and were more central than cultural dichotomies like ‘East or West.’ Indeed, many Indian parents creatively synthesized approaches derived from various cultures in their efforts to secure a place of belonging for their children. The findings suggest a possibility of collaborative partnerships between external ‘carers’ (professional, community, religious, etc.) and parents, not only in individual help and attention, but in changing the social world to be more accommodating and welcoming for differently abled children and adults.

Resilience among combat soldiers: Problems generalizing about trauma and resilience In a study exploring soldiers and veterans’ experiences of resilience during situations of combat stress and post-combat transitions to civilian life, Rotter (2015) sought to understand the servicemen’s lifeworld and the meaning of resilience within it. Her work speaks to the recent trend in the military to adopt Positive Psychology terms to address growing mental health concerns, where the emphasis on ‘trauma’ and its treatment has been replaced with an emphasis on ‘resilience’ and preventive programs that aim to increase well-being and health among servicemen. However, despite growing interest in the phenomenon of military resilience, no universally accepted definition of ‘resilience’ exists in the scientific literature, and an understanding of military resilience has often been generalized from other trauma populations, such as children who face chronic adversity (Wald et  al., 2006; Ungar, 2008; Bonanno, 2012). In addition, while the construct of resilience developed as a departure from a pathology-oriented model of trauma, within the scientific literature, the resilience of servicemen is almost always measured by what it is not: the absence of clinical symptomatology. As a result of these conceptual and methodological problems, a foundational understanding of what it means to be resilient in the context of the military is missing. In order to develop a psychological structure of military resilience from the perspective of servicemen, Rotter interviewed fourteen (male) Israeli combat veterans and gathered examples of their experiences before, during, and after combat, specifically situations in which the veteran felt he did well, transcended situations of danger, persevered, and achieved his combat and civilian goals, respectively. The temporal, spatial, social, and embodied dimensions of psychological life that permeated these veterans’ narratives were then analysed. For example, a focus on the temporal dimension highlighted how demands placed

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on the pre-conscript before combat were developmentally different from those placed on the veteran after combat; a focus on the spatial dimensions illuminated how soldiers and veterans moved between different spatial spheres (e.g., home life vs. military base vs. combat zone) and developed different modesof-being to adapt and survive within their spatial context; and a focus on the social dimensions highlighted how different relational factors facilitated the soldier’s successful adaptation to a military and civilian contexts, respectively. These various constituents of the soldier cum veteran’s experiences were then described and organized in a psychological structure of military resilience, one where characteristics, processes, and outcomes of resilience were presented as being meaningful lived. Rotter defined ‘resilience’ as a process of shifting, learning, and changing in order to align one’s position (or ‘modes-of-being’) with life-context, and an outcome where one could experience congruence and at-homeness in each lifecontext. Here, the overarching ability to transition between modes-of-being, as well as to recognize when such shifts were valuable, was an essential characteristic of success in both military and civilian life. For example, a soldier found a home and considered himself a ‘good soldier’ in combat when he was able to shift into, and embody Soldier Mode – where he aligned with the goals and protocols of military life, a complete subordination to commanding others, a sense of belonging and solidarity with comrades, and a physical and mental readiness to seamlessly engage in his combat activities. The veteran found a home in civilian life when he was able to diminish the wounds of his combat past and align himself with the goals of civilian life, such as starting a family, finding a career path, and ‘moving forward’, which he did initially through a process of ‘unscripting’ from the military structures of his past to build a new civilian identity. In addition, Rotter identified different pathways of resilience in civilian life, where veterans either walled off their past, or integrated past suffering into a new understanding of selfhood and life mission. She noted that resilient veterans could still feel emotional pain from their military past, as well as question morally ambiguous situations they were placed in throughout service, as long as they were additionally able to find meaning and support in civilian life that allowed them to achieve a sense of wholeness, pride, and achievement in their call to service. By mapping the temporal substructures through which Israeli soldiers and veterans move through conscription, combat service, and homecoming, Rotter’s study highlights that military resilience is not just the absence of pathology but a complex constellation of characteristics, processes, and outcomes that the

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soldier and veteran engage in throughout their military service. Moreover, by highlighting how these servicemen experience resilience within a cultural and national context where combat service is viewed as an altruistic act on behalf of the nation and her survival, Rotter’s study illustrates the importance of defining phenomenon from the contextual perspective of those who live it. Psychologists and researchers may not share the same meanings of war and service as military personnel, and outsider definitions of these complex phenomena can ultimately negatively impact mental health efforts with this population. An understanding of the characteristics that are required for combat and post-combat resilience, as well as an appreciation of the different pathways veterans engage in when reentering civilian life, provides guidance to those who wish to promote the wellbeing of servicemen by actually highlighting what ‘resilience’ means to those who live it.

‘Psychosis’: Recovery among African Americans in urban community context Misurell’s (2007) predoctoral research, with findings developed for presentation by Olbert et al. (2013), focused on recovery from serious mental illness among African Americans living in urban communities. The literature on ‘schizophrenia’ suggests that symptom remission is only a partial treatment goal. Although ethnic and cultural factors have been recognized as important in treatment, little research focused on ethnic minorities and on African Americans, who are disproportionately diagnosed with schizophrenia in comparison to Caucasians. This underserved minority population also faces the dual pressure of racial and mental health stigma in their recovery. Misurell’s study investigated the intersectionality of ethnicity, poverty, and severe mental illness in the recovery process. Misurell’s research was embedded in a larger clinical trial, the Culturally Responsive Person-Centered Care for Psychosis project (Tondora et al., 2010). This randomized outcome study, which assessed the additive impact of peerassisted person-centred care planning, allowed Misurell’s phenomenological investigation of experiences of ten participants (five male, five female) with DSM-IV-TR diagnoses of schizophrenia (paranoid type; n = 5), schizoaffective disorder (n = 3), or major depressive disorder with psychotic features (n = 2). These participants, ages ranging from 23 to 57 (M  =  42.4, SD  =  10.7), were receiving peer support services and had been living outside the hospital for at least six months. In in-depth interviews, Misurell asked participants to ‘walk

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him through’ the series of events that led to their first hospitalization and diagnosis and then to describe their experiences in recovery, including those concerning their mental health services. Misurell’s analysis of the recovery process included individual psychological structures for each of the ten participants as well as one general structure that reflected a series of five temporal stages that all participants lived through. Although utterly unique in its details, the individual structure found in the life of Marvin, a forty-eight-year-old African American male diagnosed with ‘schizophrenia, paranoid type,’ revealed more general meanings and provided an introduction to the explicitly general knowledge that followed (Olbert et al., 2013). The description begins with (i) Marvin’s secure, protected world in which he was raised by his loving but dominating grandmother, followed by ten years of highly structured life in the military and police academy. In a series of life events including the death of his grandmother, the loss of his job, and a life-threatening cardiac condition followed by a series of surgeries, Marvin’s life unraveled. His hospital experiences included preferential treatment of white patients and bloody, mutilating surgeries by uncaring doctors. Out of the hospital, feeling badly injured and unable to work, Marvin began to have terrifying visions of blood flowing down walls and evil people sitting on his shoulder, commanding him to kill other people. Within this first stage of the individual structure, ‘broken and bloody’, Marvin wandered homelessly and consistently feeling threatened with annihilation. In rage and despair, Marvin attempted to kill himself to finally achieve peace. Common meanings of detrimentality pervaded racial discrimination, coronary and psychiatric health services, anomalous visions and his suicide attempt. Recovery (ii) began in a dramatically different encounter with a ‘white lady’ (hospital receptionist) who ushered Marvin into a new world that revived the safety and security of his childhood but allowed him to develop autonomous, collaborative agency. When I first got here, I met this sweet, nice, lady downstairs. She told me – I’ll never forget it, she said, ‘We gotta work together on this. You work with me and I’m gonna work with you.’ She said it like a momma. I said ‘Yes maam.’ She said, ‘First off, we’re gonna get you some medicine, medicine’s that’s gonna work for you, not against you.’ I came back here the next day and I told that lady the medicine sure helped. I ain’t dream about nothing last night. I ain’t seen nothing on the wall. I  ain’t thinking about killing myself or nothing. I don’t look back. I don’t think about when I was seeing the blood on the walls or people on my shoulder talking to me about killing people. I can go home

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and take my medicine in the morning or at night before I go to bed and it don’t bother me. But I can get up in the morning just as happy as the next person.

This second substructure of ‘homecoming’ included nurturing, accepting others who valued Marvin, treated him as a person of value without racial discrimination, and collaborated with him reciprocally. Within this kind of relationship, Marvin received help, began to ‘breathe easier’, heal, and develop his efficacious agency, achieving a new, comfortable body-world integration in which he began to emerge as an independent adult who was in charge of his health and life. I listen to the doctor, and I’m taking my medication because it is helping me, but when it comes down to it, I’m gonna be the one who tells them what to do when it comes to my health. I ain’t trying to be mean and ugly about it, but when it comes down to me, I’m gonna have it the way I want to because, I look at it this way–they ain’t gonna die for me. I can make a whole lot of decisions about my life. Living my life the way I wanna live it, at least, the little part that I got to live of it.

With new comfort, social solidarity, and self-determination, Marvin reentered the community, still in a protective home-like program but now (iii) attempting to master dynamic challenges such as continuing health problems, lonely isolation, financial impoverishment, and unemployment as he extended his agency towards health, solidarity, work, and enjoyment of life. It’s the people here that make the difference. Race and color doesn’t make a difference to them. The people treat you the way that you wanna be treated. They don’t have no grudge against you if you’re black, white, Puerto Rican, whatever color you is. That’s a lie if they say these people care about that. The way I feel about them, they brighten up my day everyday. They’ve been real nice to me. They’re some nice people.

This third phase was called ‘centrifugal movement from the safe, nurturing home toward increasing independence’. As Marvin actively engaged in recovery in his community program, he found ‘new models for love and care’ (iv), including leaders who had emerged from suffering like his own as well as brothers and sisters who were similarly struggling. Of crucial importance was his peer support worker, Jim, who was himself in the process of recovery and was the first faithful father-like carer in Marvin’s life. I talk to Jim and he helps my days a lot. He’s like a mentor. I had a job (interview) a month ago and I went to Jim and I said, ‘Yo, Mr. Jim, I need to talk to you.’ He

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didn’t say, ‘I ain’t got time.’ And me and him sat down and talked. He said, ‘You can’t get mad about it. If people ain’t gonna hire you, they just ain’t gonna hire you.’ I feel confidence now in talking to him, bringing my problem to him and he shed light on that problem that I got. He’s a pretty good guy. I belong in this program and that’s what I’m doing. I fit in good with them. I feel safe with these people.

Marvin’s religious experience was essential: ‘My religion plays a large part in it because I have faith in God. If you ain’t got faith in God, you ain’t got nothing. I believe God is healing me right now.’ In his final phase of recovery (v), Marvin moved from being cared-for to caring-for others: He extended his love in paternal fidelity to his own family and then to his community. He became a mentor to his nephew and anticipated helping others through the recovery program. His aim in life was equality, dignity, and a bright future in the face of the world’s turmoil for coming generations of his fellow African Americans. Regarding the research, Marvin said, ‘I enjoyed this interview. You’re about the third person I been open with about my life.’ The general psychological structure of recovery from serious mental illness showed five stages. Stage I: Precarious community: Social detrimentality, indifference, and mistrust. Stage II:  Homecoming:  Re-experiencing familial care as a ground of personal agency. Stage III: Enlarging community: Forging social connections in the face of challenges beyond the secure home. Stage IV: Appropriating generative models of love and care. Stage V: Extending one’s emerging love and leadership to others: Contributing to world peace. The psychological structure of recovery is fundamentally a teleological process that requires collaborative others through a series of temporal stages that depends on economic and social support, including the acquisition and maintenance of material resources; negotiating health and treatment choices; building or rebuilding fulfilling family life and social communities; and working with others to achieve satisfying and esteemed social positions. Environmental and societal situations take on meanings of constricting or supporting the person’s emergence from suffering though efficacious agency that eventually makes the world a better place  – giving back. Barriers to successful action such as racism, medical paternalism, and lack of work opportunities in the urban environment may preclude or complicate recovery despite strong and resolute striving towards these goals. Shattered urban communities – crucibles of the pain, rage, and terror of racism and severe mental illness in a unitary structure call for social justice as integral to the person’s recovering, maintaining health, and contributing to the betterment of the world.

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Suffering and decision-making in serious illness and at the end of life: Resilience and recovery of agency through care transitions The experience of suffering among older adults is a neglected area of scientific inquiry. In Morrissey’s (2011) study, frail, nursing home residents described their situations, including the traumatic losses of home and familiar surroundings upon their transitions to facility care. The central research interest was the study of suffering in serious illness and related decision-making. Data collection for the study was conducted in an urban nursing home setting over a period of six months. Purposive sampling was used to select eight study participants who met the following eligibility criteria: Women; seventy-five years of age or older; with at least one family caregiver; eligible for Medicare and Medicaid; residing in the nursing home; and clinical assessment of frailty. Exclusion criteria were: Cognitive incapacity or a legal determination of incompetence by a court. Of the eight participants, two males served as comparison cases. The study featured in-depth descriptions of the lifeworlds of elderly women that revealed the unexamined complex social structure of suffering and decision-making in its temporal and developmental moments. Phenomenological analysis conducted at both the individual and general levels yielded individual structures and one general structure of suffering and decision-making. The study findings identified the maternal, described as the ‘Maternal Ground’ (Morrissey, 2011, 2015), in a first temporal moment of meaning prior to suffering experiences. This Maternal Ground served as the foundation for the development of embodied agency, sociality, and spirituality in the person’s life. As that which was lost in suffering, this most significant meaning horizon was retained from the lived past. It was profoundly implicit in the second moment of present suffering – the specific losses of their previous home, family, friends, and bodily health/comfort, as well as in the third moment of the structure – the decisionmaking efforts aimed at a better future in the nursing home. A  genetic analysis identified and located the Maternal Ground as the first, founding temporal moment and horizon of suffering and decision-making that began at the origin of the participants’ life history. Sedimented meanings constellating maternal origins from which participants lived had rich social dimensions reaching from the earliest moments of care that were developed over the life course. A merged and entangled support system in the home, family, community, work, and caring for specific others – a retained past built on and extending maternal foundations – was implicated in the present nursing home life, which included the promise and yet uncertainty of the future. The essential constituents of the first temporal

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moment for participants were unconditional loving care, empathy, a welcoming and generative home, mutual desire, and diffuse well-being. The original home was experienced by participants as a protective place of dwelling and welcoming hospitality that was pain-free and palliating – providing nourishment, comfort, security, and soothing. The maternal was also the foundation of powerful spiritual intentionalities and movements for participants rooted in faith and fidelity, a life-affirming context affording strength for participants in their suffering. The study revealed the loss of maternal foundations and loss of agency in a central temporal moment of care transitions to the nursing home as invariant in the structure of suffering and the context of decision-making. In contrast with the genetic Maternal Ground, the central moment of suffering involved participants’ pain, illness, social discord, and isolation – the loss of the maternal foundation of agency, social mutuality, and bodily well-being. Participants suffered cascading specific losses that threatened not only their personhood but their relationship with the world and their futural horizon – the very promise of the future flourishing to the moment of death. This moment of lost maternal foundations involved no relief, no rescue from the accumulation of burden and the multiple afflictions that assailed the chronically ill persons and undermined the very foundation of their self and relations with others at the end of life. In a third temporal moment, an agentic, life-affirming, and empathic careseeking struggle towards well-being was revealed as a type of suffering and decision-making supported by palliative and maternal care practices, nurturance, and security. In this temporal moment of ‘Struggling toward Well-Being’, participants were living through suffering, living with serious illness, and coping with approaching the end of life. They engaged in decision-making processes that were relational and social, involving not only family, but other residents and their caregivers. Decisions were valued and action was undertaken based on whether they helped to re-establish maternal foundations; to restore trust and empathic care; to foster agentic growth, resilience, and well-being; and to fashion a welcoming home even if in an imagined future. In this last temporal moment, suffering and well-being co-existed in light of the transcendent lifegoals of seriously ill elderly persons. These study findings have implications for practice, policy, research, and the growing impetus for a paradigm shift in nursing homes away from the dominant medical model of disease diagnosis and symptom management to a more relational, palliative care ethics (Morrissey, 2011, 2015) among professional caregivers, especially hands-on staff, that provides seriously ill elderly with opportunities for development and growth even at the end of their lives. Psychologists

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and other helping professionals are called upon to advocate for more residentcentred institutional environments and maternal practice interventions for vulnerable elderly persons at the end of life that are critical to a culture change movement in nursing homes and across all care settings.

Findings and methods in phenomenological clinical psychology At its most general level, what is called ‘mental disorder’ is neither a thing nor isolated mental condition, but a fundamentally teleological, temporal, and social structure of meaning that emerges in the dynamic course of human transcendence. The acting person is central, in and of the meaningful world, striving for transcendent goals. In psychological suffering, the fulfillment of personally important aims becomes challenged in a complex process in which supportive social structures are lost, other people are experienced as unavailable and detrimental, embodied agency is impeded and compromised, and the future darkens. Psychological knowledge of these structures complements diagnostic criteria and quantitative research methods that include hypothesis testing, variable measurement, and the establishment of quantitative relationships with statistical significance and probabilities, by providing an understanding of what hypotheses, criteria, and measurements are about, with qualitative knowledge of ‘the things themselves’ as they originally present themselves in the lifeworld. Our studies in clinical psychology offered holistic knowledge that is both clinically and personally significant, at various levels of generality: Idiographic knowledge of individual persons’ lives, mid-level knowledge of typical psychological processes shared by many individuals, and highly general knowledge of human suffering and transcendence. Such psychological knowledge is at all levels contextual and holistic, as it structurally interrelates variable factual constituents in their meaningful organizations and transformations through time. Ascending levels of generality form a continuum, rising from utterly unique individual narratives to the most highly general structures of intentionality. Notably, the idiographic knowledge offered by phenomenological psychological research is not limited to revealing particular persons’ lives, for individual structures explicate more general meanings in each individual’s concrete existence. Typical structures, though not reflective of what all persons live through, are important both theoretically, socially, and practically because the broad applicability of their mid-level commonality informs theory, sensitizes empathic social understanding, and guides practical care, for instance, for the ‘types’ (typical structures) of bulimia, types of responses to diagnosis, and types of resilience among soldiers.

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Finding psychological life to be essentially changing and temporal, phenomenological knowledge also highlights dynamic processes. Our studies detailed the temporal stages (substructures) of suffering and transcendence in the development of ‘bulimia’, rejecting/accepting the diagnosis of bipolar disorder, parenting a child diagnosed with ASD from birth to adulthood, military resilience from pre-conscription to veteran life, the recovery from serious mental illness, and decision-making in the course of serious illnesses late in life. One deep and highlevel generality brought to light by these studies is the essential sociality of psychological life, for instance, what Morrissey (2011) named the Maternal Ground, which provides ever-important security, nurturance, and a foundation for developing individual agency, which is essential in mental health and recovery. The psychological processes revealed in phenomenological research are by no means a matter of an isolated mind, brain, and behavior but rather, as intentional analysis shows, meaningful relations and engagements in the world that extends beyond individual persons and includes embodied, social, and material interdependencies. Resolving the problems of clinical psychology required analysing the constitutive structures of the complex lifeworld, including historically sedimented medical practices of diagnosis and medication; social stigma; cultural norms of bodily thinness; educational and vocational expectations and opportunities; military regulations and operations; skilled health care institutions; online peer networking and advocacy; and religious organizations. Suffering involved challenges to personal agency and the flourishing of individual persons in these diverse lifeworld situations, and the achievement of personal goals often required a transformation of extant bodily, social, historical, and spiritual realities in collaboration with others. By virtue of its capability to provide knowledge of what is essential to the structures of lived experience, with an emphasis on the meanings of situations in the world, phenomenological psychology provides crucial research methods for person-centred health science with an explicitly holistic understanding.

Phenomenological Science for Health and Humanity Our phenomenological psychological studies show that the meaning and value of health care is to be understood in the context of the sufferer’s transcendent goals and commitments. The relationship with carers, from receptionists to nurses, physicians, psychologists, counselors, family, as well as diagnoses,

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treatments, institutions, policies, and research have meaning only in their relation to persons’ agentic striving for a good life, as defined by such worldly ends as a better life for grandchildren, a dignified job that does good, a world without racism, moral and spiritual resolution in a flawed life filled with love and care. Phenomenology provides health science with methods to research the phenomena and problems of the health care field – ‘diseases’, ‘interventions’, and ‘prevention strategies’ – with regard to their meanings as related to personal ends that intrinsically implicate community and culture. Informed by this knowledge, health care can take advantage of psychological services as well as community advocacy, resources, and activism in solidarity with those combating stigma, eliminating gender-based violence and sexist ideals, providing maternal institutions for the elderly and the severely incapacitated, creating spaces of belonging for differently abled children, and generating peer-led egalitarian learning for persons in recovery, part and parcel of which is the recovering person’s giving back to and even transforming the world. The problems of clinical psychology, including psychiatric concepts, diagnostic criteria, interventions, and policies lead directly to a much larger reality of which scientific knowledge is readily achievable through phenomenology, as a multidisciplinary science of the lifeworld. Its study of subjectivity, which features the analysis of meaning, offers knowledge that is both complementary and critical of research that abstracts from the complex constitution of the subjectively given lifeworld as do the physical and biological sciences. The focus on suffering and transcendence in person-centred clinical psychological research offers knowledge that implicates meanings in the larger worldly context, affirming the need for comprehensive interdisciplinary science of the lifeworld, including health, education, politics, and other related areas of human endeavour. Personcentred science requires knowledge of the interdependencies of psychological and the biological, social, and spiritual in order to inform practices and policies that support and impede the holistic flourishing of persons. Health science requires not only natural science but a broader foundation for knowledge of human strengths and transcendence as well as human suffering, with a comprehensive understanding of the world in all its meanings for the humans engaged in it. Phenomenology, employed in psychology along with biology, sociology, economics, political science, environmental science, anthropology, history, theology, and philosophy, offers a broad scientific foundation necessary for transand interdisciplinary, person-centred science within a universal science of the lifeworld.

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References Bonanno, G. A. (2012). Uses and abuses of the resilience construct: Loss, trauma, and health-related adversities. Social Science & Medicine, 74(5):753–6. Desai, M. U. (2012). Caring in context: Parenting a child with an autism spectrum disorder in India (doctoral dissertation). Fordham University, New York. ProQuest (3563395) Desai, M. U., Divan, G., Wertz, F. J., & Patel, V. (2012). The discovery of autism: Indian parents’ experiences of caring for their child with an autism spectrum disorder. Transcultural Psychiatry, 49:613–37. Engel, G. L. (1981). The clinical application of the biopsychosocial model. Journal of Medicine and Philosophy, 6(2):101–24. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV TR Axis I disorders, research version, non-patient edition. (SCID-I/NP). New York: Biometrics Research, New York State Psychiatric Institute. Giorgi, A. (1970a). Psychology as a human science: A phenomenologically based approach. New York: Harper. Giorgi, A. (1970b). Toward phenomenologically based research in psychology. Journal of Phenomenological Psychology, 1: 75–98. Giorgi, A. (1975). An application of the phenomenological method in psychology. In A. Giorgi, C. Fischer, & E. Murray (eds), Duquesne Studies in Phenomenological Psychology II, pp. 82–103. Pittsburgh PA: Duquesne University Press. Giorgi, A. (1985). Phenomenology and psychological research. Pittsburgh, PA: Duquesne University Press. Giorgi, A. (2009). The descriptive phenomenological method in psychology: A modified Husserlian approach. Pittsburgh, PA: Duquesne University Press. Gleaves, D. H., Lowe, M. R., Snow, A. C., Green, B. A., & Murphey-Eberenz, K. P. (2000). Continuity and discontinuity models of bulimia nervosa: A taxometric investigation. Journal of Abnormal Psychology, 109(1):56–68. Husserl, E. (1901). Logical investigations, 2 volumes (trans. J. N. Findlay). New York: Humanities Press, 1970. Husserl, E. (1913). Ideas pertaining to a pure phenomenology and to a phenomenological philosophy, first book (trans. F. Kersten). The Hague: Martinus Nijhoff, 1983. Husserl, E. (1925). Phenomenological psychology: Lectures, summer semester, 1925 (trans. J. Scanlon). Boston, MA: Martinus Nijhoff, 1977. Husserl, E. (1954). The crisis of European sciences and transcendental phenomenology (trans. D. Carr). Evanston, IL: Northwestern University Press. (Original work published 1936.) Maynard, E. (2016). The experience of being diagnosed with bipolar disorder in emerging adulthood: A phenomenological analysis (doctoral dissertation). Fordham University, New York. ProQuest (#10788).

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Mezzich, J., Snaedal, J., van Weel, C., & Heath, I. (2010). Toward person-centered medicine: From disease to patient to person. Mount Sinai Journal of Medicine, 77:304–306. Mezzich, J. S., Appleyard, J., Botbol, M., Ghebrehiwet, T., Groves, J., Salloun, I. M., and van Dulmen, S. (2015). Primary health care and person-centered medicine. The International Journal of Person Centered Medicine, 5(2):45–60. Misurell, J. R. (2007). Processes of recovery among African Americans living with serious mental illness in the urban community: A qualitative investigation (unpublished predoctoral project). Fordham University, New York. Morrissey, M. B. (2011). Suffering and decision making among seriously ill elderly women (doctoral dissertation). Fordham University, New York. ProQuest (#3458134). Morrissey, M. B. (2015). Suffering narratives of older adults: A phenomenological approach to serious illness, chronic pain, recovery and maternal care. New York: Routledge. Olbert, C., Misurell, J. R., Wertz, F. J., & Davidson, L. (2013). Processes of recovery among African Americans living with serious mental illness in the urban community. Unpublished paper presented at Annual Conference of Interdisciplinary Coalition of North American Phenomenologists, Ramapo, New Jersey. Rotter, B. (2015). Resilience of Israeli soldiers in transition from military to civilian life: A phenomenological study (doctoral dissertation). Fordham University, New York. ProQuest (#). Skoufalos, N. C. (2010). The development of bulimia nervosa: A phenomenological psychological analysis (doctoral dissertation). Fordham University, New York. ProQuest (#3438468). Sowa, R. (2007). Essences and eidetic laws in Edmund Husserl’s descriptive eidetics. The Yearbook for Phenomenology and Phenomenological Philosophy, 7:77–108. Tondora, J., O’Connell, M., Miller, R., Dinzeo, T., Bellamy, C., Andres-Hyman, R., & Davidson, L. (2010). A clinical trial of peer-based culturally responsive personcentered care for psychosis for African Americans and Latinos. Clinical Trials, 7:368–79. Ungar, M. (2008). Resilience across cultures. British Journal of Social Work, 38:218–35. Wald, J., Taylor, S., Asmunson, G. J. G., Jang, K. L., & Stapleton, J. (2006). Literature review of concepts: Psychological resiliency (CR 2006-073). Toronto, Ontario: Defense Research and Development Canada. Wertz, F. J. (1983). From everyday to psychological description: Analyzing the moments of a qualitative data analysis. Journal of Phenomenological Psychology, 14(2):197–241. Wertz, F. J. (2005). Phenomenological research methods for counseling psychology. Journal of Counseling Psychology, 52:167–77. Wertz, F. J. (2006). Phenomenological currents in 20th century psychology. In H. Dreyfus & M. A. Wrathall (eds), Companion to existential-phenomenological philosophy, pp. 392–408. Oxford, UK: Blackwell Publishing Inc.

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Wertz, F. J. (2010). The method of eidetic analysis for psychology. In T. F. Cloonan & C. Thiboutot (eds), The redirection of psychology: Essays in honor of Amedeo P. Giorgi, pp. 261–78. Montréal, Québec: Le Cercle Interdisciplinaire de Recherches Phénoménologiques (CIRP), l’Université du Québec à Montréal et Rimouski. Wertz, F. J. (2015). Phenomenology: Methods, historical development, and applications in psychology. In J. Martin, J. Sugarman, and K. Slaney (eds), The Wiley handbook of theoretical and philosophical psychology: Methods, approaches, and new directions in the social sciences. Hoboken, NJ: Wiley. Wertz, F. J., Charmaz, K., McMullen, L., Josselson, R., Anderson, R., & McSpadden, E. (2011). Five ways of doing qualitative analysis: Phenomenological psychology, grounded theory, discourse analysis, narrative research, and intuitive inquiry. New York: Guilford Press.

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A Phenomenological Understanding of Postpartum Depression and Its Treatment Idun Røseth and Rob Bongaardt

Introduction In 1985, Amedeo Giorgi wrote that it is ‘no secret that the field of psychology is not at one with itself ’ (p. 20), a quotation that still rings true today. The rapidly growing neuro-biological paradigm and the psychiatric diagnostic system that govern much of clinical practice in psychiatric hospitals reveal a large gap between diagnostic descriptions and neuro-biological causal theories on the one hand, and the actual experience of an illness on the other. Phenomenologists are critical of the strong tendency to reduce our minds to our brains and to isolate illness from its embeddedness in a social world. After all, brains do not perceive, think, or feel, but persons do, and they are continuously engaged in interpersonal situations. Advancing beyond a sheer critical stance, phenomenology offers psychiatry a humanistic perspective by which to conduct research on phenomena as they are experienced subjectively, and to perform clinical work that gives primacy to a patient’s subjective experience. This is what we want to show through our research on postpartum depression and clinical experience of treatment of mothers. Transitioning into motherhood can be said to represent an existential crisis, where the body, interpersonal relationships, and daily life are most intimately intertwined. Most mothers live through this transformational experience without encountering serious challenges to their mental health, but for some mothers this is a time of despair or depression. In the dominant psychiatric tradition, postpartum depression is primarily treated as something inherent in the individual, but at the same time something separate from the person.

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For example, when a depressed mother describes a deeply troubling lack of love for her infant, this can be labelled as a symptom of depression, hypothesizing that it is caused by hormonal dysregulation after birth, which in turn is related to genetic susceptibility (Halbreich, 2005). In the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013), ‘depression’ is described as a cluster of symptoms, yet often reified and treated as a physical disease that may attack any woman after birth. Popular magazines have typically adopted this medical perspective on psychiatric diseases by writing headlines like:  Beware of the symptoms, you may have postpartum depression (Stoppard & Gammell, 2003)! Frequently we have patients that ask if they are depressed, and an affirmative answer often changes the way they perceive themselves. They start explaining their feelings by invoking the diagnosis: ‘Aha, I don’t feel motherly love because I’m depressed!’. While a medical understanding of depression may relieve some of the guilt that plagues depressed mothers, it also may prevent her from acquiring a sense of response-ability and taking the initiative to embark on a journey of recovery. In this chapter, we first provide a description of core phenomenological principles, namely, the epochē and the eidetic reduction, and the foundational insights of phenomenology into intersubjectivity and empathy. Second, we describe our research on postpartum depression, which is based on these principles. Third, we explain how these principles also inform our clinical practice. Finally, we sketch how we approach developmental problems stemming from postpartum depression from within a phenomenological perspective. A  phenomenologically grounded social psychiatry can use phenomenological descriptions derived from research to tune in to the lifeworld of patients. ‘[U]nity [in the field of psychology] is possible because the analyses of experience in therapeutic and research situations are similar even if the aims are different’ (Giorgi, 1985b, p. 21).

Foundational Phenomenological Principles and Insights Since a thorough description of the phenomenological method and its foundational insights is beyond the scope of this chapter, we will present a sketch of some of its essential features.

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Epochē and the eidetic reduction One main objective of phenomenologists in both research and therapy is to uncover the world as it is lived by a person. Our lived experience is presented to us as meaningful, that is, we experience relations or objects in the world that somehow make sense to us. The experienced world is ordered in meaningful patterns or Gestalts (Merleau-Ponty, 2012). In everyday life, we treat these patterns as existing in the world independently from us, but phenomenology teaches us that we can only know the world as it appears to us. All phenomena are thereby a product of both the intentional act of consciousness (noesis) and the intended object (noema) (Husserl, 1913/1962). Consciousness can be directed towards immanent objects (e.g., memories, fantasies, or hallucinations) or transcendent objects (in the physical world). The intentional act is perhaps best understood as constitutive: ‘consciousness makes objects come present, it actualizes presences’ (Giorgi, 2009, p. 105). It follows that in mental illness, for instance, symptoms do not reflect defects that reside within the mind or brain. Rather, they point to a disturbance in how a person constitutes the world, including other persons, his or her body, time, and sense of self. Phenomena are thus in essence constituted, relational, and embedded in a sociocultural world. Of central importance for the phenomenological method are the so-called epochē and the ensuing reduction (Giorgi, 2009). The epochē is the suspension, or bracketing, of all knowledge that comes from the natural attitude: all facts, theories, common sense, and personal experience concerning a phenomenon. Only what presents itself to one’s consciousness, and the manner in which it presents itself, is regarded as permissible knowledge. The (phenomenological) reduction is the suspension of our affirmation of the existence ‘out there in the world’ of what presents itself to consciousness; we reduce our experiences of the world to phenomena. Underlying the epochē and the reduction is thus a deep realization that we constitute the world that is presented to us by us; our (ap) perceptions are gestalt composites of our conscious acts and the world (Husserl, 1964). The phenomenological method is not merely a matter of making conscious and reflecting on one’s own subjectivity but rather a matter of entering another attitude entirely. ‘The epoché is an action that involves one’s total existential position toward the world and it is profoundly personal’ (Morley, 2010, p. 225; italics in original). The epochē and the reduction form the starting point for any phenomenological study in which one seeks to find the essence of a phenomenon, its

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invariance, its eidos, or implicit form (Giorgi, 1985a, 2009). This process of identifying essences is called the eidetic reduction and it is achieved through the method of imaginative variation. Through imaginative variation, described experiences of a phenomenon are varied in one’s mind in order to identify the more general qualities of the phenomenon. In psychology, one typically seeks descriptions of psychological essences in a middle range where one is sensitive to the cultural and historical context rather than universal descriptions at a philosophical level.

Intersubjectivity and empathy Husserl proposed that we are constitutive subjects in a world that is in essence intersubjective (Zahavi, 2003). Between persons there is an embodied attunement with unreflective adjustment and synchronization of posture and movement, and the pitch and tone of voices. We develop implicit and habitual ways of being with and reacting to other persons, which create a feeling of familiarity (Shusterman, 2012; Stern, 1985). When perceiving an other person, my body and the other’s are coupled, there is ‘the transfer of my intentions to the other’s body and of his intentions to my own’ (Merleau-Ponty, 1947/1964a, p. 118). We interlink our constitutive functions, as Gurwitch (1966) puts it. We are not solipsistic egos closed in on ourselves, doomed to never really know the feelings and thoughts of others; we have the ability to experience directly the feelings and intentions of the other. Admittedly, this is not as the other experiences herself, but nevertheless we have direct access to important aspects of his emotions and intentions through his bodily behavior (Zahavi, 2010). This is further explained by Scheler (1970), who described empathy as a specific mode of consciousness that is different from perceiving an inanimate object. Our experiences with others are subject-subject relations; we immediately recognize the other as having a separate consciousness that is partly accessible and partly inaccessible to us. It is this asymmetry which Husserl described as essential in intersubjectivity; without it we would have an undifferentiated collectivity (Husserl in Zahavi, 2003, p. 114). ‘[T]he other’s intentions somehow play across my body, while my intentions play across his’; this is experienced as a range of possibilities for social interaction (Merleau-Ponty, 1947/1964a, p.  119; italics in original; Froese & Gallagher, 2012). We perceive not only another person’s gestures as ‘observable behavior’, but also their ‘inward formulation’, that is, we see things in terms of how they feel (Whitney, 2012). Our interactions with others are sedimented in

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the environment; together we leave an imprint on nature. ‘Just as nature penetrates into the center of my personal life and intertwines with it, behaviors also descend into nature and are deposited there in the form of the cultural world’ (Merleau-Ponty, 1945/2012, p.  363). Cultural objects represent more general meanings that are shared between persons within cultures. Our environment is filled with objects that have a pull on us and afford certain actions. It is within the shared cultural world (field) of meanings that we understand others’ emotions, acts, and intentions. Language is a cultural medium through which we act in the world; it ‘bears the sense of thought as a footprint signifies the movement and effort of a body’ (Merleau-Ponty, 1960/1964b, p. 44). When talking with another person we form a common ground where we are collaborators in a synchronized co-constitution of ‘a single fabric’, that is, our dialogue (Merleau-Ponty, 1945/ 2012, p.  370). This synchronicity in our dialogue, however, does not mean that the other’s thoughts and words are constructed by this dialogue. True, my responses might afford, or draw from him thoughts, emotions, or actions he could not have anticipated or that are new to him. Nevertheless, his thoughts and emotions are his; they are constituted by him and limited by his possibilities of ways of being in the world with others. It is through dialogue that we can reach intersubjective agreement on affairs of the world and reach more ‘objective’ knowledge. This shared phenomenological world is the ground on which all research and psychotherapy take place. It is on the base of the phenomenological understanding of intersubjectivity and empathy that we can study and try to describe psychopathology and how a therapist can help those who suffer.

The Meaning Structure of Postpartum Depression Following hints from Husserl, Giorgi (2009) appropriated the philosophical phenomenological method in order to make it more suitable as a scientific and psychological method. He transformed the method in order to study other people’s experiences and to get descriptions in the middle range, sensitive to social and cultural contexts. Limiting the phenomenological reduction to the objects of consciousness, his method involves a partial and psychological reduction and not a transcendental one. Giorgi’s method also involves the epochē and the eidetic reduction, and is systematized through a four-step analysis (ibid.). Our phenomenological study of postpartum depression was based on Giorgi’s

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method. It describes how mothers, after birth, experienced an alienation and estrangement from the baby and other persons (Røseth, Binder, & Malt, 2011, pp. 179–80): Crumbling under a world perceived as dangerous, the mother fears for her baby’s safety. She is tormented by a painful feeling of insecurity and anxiety that infiltrates normal everyday activities. Her anxiety is nourished by her own emotional past and present; however, she is mostly unaware of this process. The lived body manifests itself as an obstacle by its heaviness and lack of energy. She feels out of touch with the world, the baby, and other people. Painfully aware of this alienation, she tries to convince herself rationally of her love for the baby. Being unable to live up to her own expectations regarding love and care for her baby makes her vulnerable to the gaze of others. She feels guilt because she perceives her mothering skills as inadequate, and she feels shame because she perceives herself as inferior or bad. She transforms her experience of time into guilt for missed opportunities for loving and caring for her baby. She also grieves her baby’s loss of a loving caring mother. Anxiety or strong feelings of guilt and shame make the woman conceal her true thoughts and feelings and withdraw from social others. Although desperately in need of help to care for the baby, she often interprets support as a confirmation of her failure as a mother. In constraining herself by isolation she feels ambivalent. She fears social situations, but at the same time she feels terribly lonely, and thus longs for good social relations which she hopes can relieve her pain.

This meaning structure reveals the invariance within the various experiences of postpartum depression that women may have. A main facet of the structure is the disintegration of the habitual world and an existential crisis. While we used the epochē and imaginative variation to derive the meaning structure of postpartum depression from what mothers told us about their experiences, we now ‘remove the brackets’ and facilitate a dialogue between our findings and other phenomenological insights. We do so to deepen and broaden our understanding of the phenomenon under study. Transitioning into motherhood involves adjusting to a new and often radically different world (Røseth, 2013) – a new world that integrates earlier life with that of being a mother of a totally dependent and vulnerable infant. With the birth of the baby, the world has acquired a different sense. Often, the baby integrates well into the mother’s world; the daily care of her child quickly becomes an interpersonal and bodily habit, which creates a sense of familiarity when being with the baby. Their bodies become coupled, adjusting habitually and pre-linguistically

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to each other. Realizing a new integration, the mother has now extended her world. ‘Habit expresses the power we have of dilating our being in the world, or of altering our existence’ (Merleau-Ponty, 1945/2012, p. 180). Merleau-Ponty described how communication between two persons can be a perfect symphony, a synchronized coupling, or interlinking of their constitutive functions. But what happens when a person becomes unable to connect in a habitual and synchronized manner with others? The structure of depression postpartum presented above reveals a fundamental change in how the mother exists in the world with others. The process of integrating and habituating being with the baby is not successfully resolved. What Stern (1995) described as a rhythmic and melodic interaction, the mutual resonance that often characterizes the communication between mother and baby, is disturbed. The mother feels unable to fully integrate the vulnerable baby in herself; on the contrary, it presents as an obstacle to gain access to the world. She resolves this unfulfilled integration by caring for the baby in a ‘mechanical’ way. She follows routines and does what must be done, solving problems analytically. But she experiences this as difficult and stressful; the world has lost its inviting pull and it does not afford engagement in social-cultural settings. The mother’s old world, before the birth of the baby, has lost its original meaning and she is incapable of inhabiting a new world. The world that was lived as a part of self is now perceived as filled with obstacles and the mother feels rejected and threatened by it. This breakdown of the unreflective interpersonal and habitual world is deeply anxiety provoking, shattering the feeling of ‘being at home’, leaving the mother alienated (Sartre, 1943/1956). ‘The depressed mothers are stuck in limbo, temporarily unable to go back to the world as it was, or to enter the new hidden world that looms ahead’ (Røseth, 2013, p. 48). How can phenomenologically informed psychotherapy help these depressed mothers heal? What makes the particular therapeutic kind of relationship a meeting where change becomes possible?

Phenomenological Therapy In clinical practice, the therapeutic focus is on the mother-child or the mothertherapist relationship, or both. For some mothers, the act of re-establishing familiar patterns of interaction within their world, such as exercise, being with friends, or getting back to work, is essential in their recovery. The process of

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synchronization in any of these lifeworld dimensions can involve other dimensions. A  small change in one dimension of the world that involves a feeling of security or being ‘at home’ may spur a more synchronized relationship to the world and others. It is our clinical experience that depressed mothers who struggle with alienation in the relationship with their child, with other people, and with the world at large can thus benefit from therapy directed at any of these dimensions. In what follows, we will take a closer look at therapy directed towards the mother and the mother-child dyad.

The mother in focus An important aspect of postpartum depression is the disintegration of the habitual world, so an essential part of therapy should involve facilitating and establishing a new order and sense of stability, security, and ‘at home-ness’ in the world. As a therapist, being informed by a phenomenological understanding of intersubjectivity, empathy, and the epochē, one may help the mother in the process of synchronization or coupling with the baby. When in therapy, the establishment of an open, accepting, and secure atmosphere that enables an affective coupling and synchronized encounter with a therapist is the first step that may spur a positive change in the mother’s relationship with the world and other people, as it aids the transition from crisis to stability and a habitual feeling of ‘at home-ness’. To be met with acceptance, warmth, and empathy involves the therapist being emotionally flexible and tuned in to the specific patient’s emotions and her mode of being. The experience of an emotionally attuned and synchronized encounter may also reduce self-sustaining and negative self-appraisals and encourage the mother’s own capacity to grow and heal (Hart, 2011; Stern, 1995; Winnicott, 1965). Through this open presence, the therapist helps the mother to endure and regulate negative feelings, and makes it possible to explore and integrate traumatic memories in the patient-therapist encounter. Merleau-Ponty (1945/1962, pp.  182–3) explained that expression does not translate meaning, but rather brings meaning into being. To express experiences opens up new dimensions of the lifeworld, which in itself implies a change for the mother. Once experiences are expressed, their meaning can be explored and reflected upon, which helps her to achieve a greater understanding of her history and of her self (Brudal, 2014; Fonagy et al., 2005). The methodological step of the epochē and the reduction, when appropriated in a therapeutic context, can be understood as a form of disciplined empathy

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where the therapist engages in a specific mode of consciousness, transporting himself or herself within the other’s experience (Morley, 2010), engaging in the rhythm, dynamics, and affects that the other enacts (Merleau-Ponty, 2012; Stern, 1985, 1995; Trevarthen, 1979b). The empathic encounter is disciplined in the sense that the therapist brackets his or her theoretical and personal theories and assumptions, and refrains from the existential claim (Langdridge, 2013). The therapist’s focus is on how the other experiences and lives in her world, being attentive to the often subconscious, implicit essential psychological meanings of her experience. The epochē and the reduction in a therapeutic setting ensure a being with the other in her experience (Spinelli, 2005). Initially all experience that the patient reveals is equally important, a principle that has been named horizontalization (Langdridge, 2013, p. 24). One refrains from making hierarchies of meaning according to one or another theory or designated symptoms of disorders, and instead strives to let the whole experience of the mother, precisely how it presents itself, to come to the fore. The next step in therapy is to make sense of the patterns of organization of the mother’s illness (Fuchs, 2010). As the therapy proceeds, the therapist looks for recurrent patterns as the patient often repeats crucial meanings. Through this process, the therapist conducts the eidetic reduction in which the invariant properties of the mother’s experience can be revealed by imaginatively altering aspects of the phenomenon in his or her mind in order to discern invariant psychological meanings from the more concrete and particular (Røseth, Bongaardt, & Binder, 2011). This can be characterized as a way of being for the other (Spinelli, 2005). After the therapist has reached an idea of the essence of the mother’s illness, he or she can ‘remove the brackets’ of the epochē, and initiate a dialogue with already existing knowledge of the phenomenon. Phenomenological research on the phenomenon at hand, in this case postpartum depression, can further inform the therapist about invariant psychological meanings, and how these come to the fore in the mother’s lifeworld. Therapy differs from phenomenological research with respect to its goal. The goal of phenomenological research is to describe the phenomenon, whereas the goal in therapy is often to enable patients to make a change in their lives (Giorgi, 2009). In order to enable the patient to change, it is pertinent to make her gradually aware of how she is an active agent in her constitution of her world and to initiate reflections on this process. For example, through therapy, one mother gradually became aware of how her childhood abuse still had a presence forming her experience of her child as well as men. This enabled her to confront the trauma, giving it a place in her past life while opening up for new possibilities in

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her present and future life (Røseth, Bongaardt, & Binder, 2011). It is important to remember that therapy is not a linear process, and that the therapist should be constantly open to new information that may modify insights into the psychological meanings of the mother’s illness. A phenomenologist acknowledges that he or she cannot exhaust and describe the phenomenon in its totality, but only grasp certain facets of it from a limited number of perspectives (Giorgi, 2009). Although the therapist can never know the phenomenon in its totality, nor experience it from the first-person perspective, there are often essential aspects that are accessible to the therapist while these are, initially, pre-reflective and hidden for the patient. To tactfully reveal and further explore the often hidden organizing patterns of her illness allows the mother to reflect on how she constitutes the world, which may empower her to make a change in this.

The mother-child dyad in focus When working with postpartum depressed mothers and the mother-child dyad, we often address the mother’s depression first. As therapy proceeds, the focus enlarges to also include the mother’s interaction with the infant. The ‘still face’ experiment of Ed Tronick et al. (1978) reveals the importance of an emotionally available caregiver for the well-being and development of the infant; already from birth, the baby is dependent on a sensitive, fine-tuned, and synchronized interaction with a primary caregiver to help regulate its internal states (cf. also Trevarthen, 1979a, b; Stern, 1985, 1995). In Winnicott’s (1965) terms one can say that the child needs ‘good enough mothering’ and a ‘holding environment’ for a healthy development. If the infant is left in a disorganized and stressful internal state over longer periods of time, this may lead to a chronic heightened stress response than can have a detrimental effect on the child’s development (Hart, 2011; Schore, 2003; Stien & Kendall, 2004). Recent developmental research on child neglect and abuse shows that the quality of caregiving the infant received in the first years of life impacts not only its psychological but also its physical health, because a heightened stress response makes it more vulnerable to cardiovascular diseases, cancer, diabetes, and so on (Hart, 2011). This naturally makes it pertinent to work directly with the mother-child interaction, and imperative to find good methods in order to both study and treat relational disorders. Depressed mothers have described feelings of alienation from the baby and other people. A pertinent question is how this sense of alienation affects their interaction with the child and its well-being. Another question is how we should understand and possibly treat interactional disorders between mother and child.

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The phenomenological insights into intersubjectivity and empathy imply that a loving relationship between mother and child does not spring from entities intrinsic to mind or body (such as ‘instincts’ or genes), but emerge from engagement between persons sharing bodily, social, and cultural dimensions of their respective lifeworlds (Merleau-Ponty, 1945/1962; Toombs, 2001). Somehow, when the mother feels alienated from the baby, this means that the world in which she interacts with the baby is not directly experienced as affording her the initiation of an intimate ‘loving’ interaction. As the intuitive, implicit coupling with the baby has not developed, the mother, often driven by guilt, tries to compensate through explicitly and reflectively controlling her actions, mimicking what is lacking. She behaves ‘as if ’ she loves the infant with varying degrees of success. These patterns of interaction between mother and infant become sedimented in the infant’s implicit relational knowing, which is a temporally organized pattern that is acted out in the future interaction with others (Fuchs & De Jaegher, 2009; Stern, 1995). The infant may actively yet unwittingly contribute to maintaining disorders in the dyad by enacting this relational mode of being. For example, an infant of an alienated and depressed mother may after repeated failed attempts to elicit a positive response, learn to relate to the mother in a more distant and indirect way. In turn, the mother may feel rejected by the infant’s response, which increases her feelings of alienation, guilt, and shame. Developmental researchers like Trevarthen, Stern, and Winnicott have contributed important knowledge about infant development and mother-infant interaction that is relevant for phenomenology. However, a developmental approach is yet to be fully developed from within phenomenology. Here we can merely sketch how we approach developmental problems stemming from postpartum depression from within a phenomenological perspective. From this perspective the affective coupling of intentional behavior between mother and child can be described. Merleau-Ponty (1945/2012) rejected the primacy of speech over physical gestures. According to him, there is no fundamental difference between modes of expression, as all such bodily activities express meanings that are available to other people’s experience, words, and bodily gestures alike. Accordingly, the therapist can perceive and describe the degree of synchronicity, emotional tone, and attunement between mother and child. Also the presence of shared joy, sadness, rejection, and so forth is available to the therapist; there is no need for interpretation or theory to understand their meaningful and non-linguistic interaction. ‘[E]xpression confers on what it expresses an existence in itself, installs it in

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nature as a thing perceived and accessible to all’ (Merleau-Ponty, 1945/1962, p. 183). In other words, the therapist can describe how the mother and the child pre-reflectively handle separations and reunions, and with how much confidence and ease, or the lack thereof, the mother interacts with the child. The epochē ensures that the therapist stays with what is given as expressed through the behavior of mother and infant. Furthermore, working with the eidetic reduction, the therapist can tease out the psychological meanings revealed through repetitions in the interaction. Next, these phenomenological descriptions of micro-processes in the mother-infant dyad can be tactfully presented to the mother in order to reveal the interactional patterns that sustain the unfulfilled potential of the relationship. Just as interviews are recorded, mother-child interactions can be videotaped in order to capture small, but significant and meaningful segments. In the clinic, structured and non-structured observations of mother-child interaction are often indispensable in the treatment of disorders in this interaction. Fine-grained analysis of micro-processes in mother-child interactions reveals important relational patterns that otherwise would remain hidden and implicit. For example, a mother who feels rejected by her infant may through a phenomenological video analysis see the small signs that reveal how much the infant needs her. Watching the interaction on tape makes the pre-reflective and bodily enactment of relational knowledge explicit for the mother – it is a powerful intervention that enables the mother to make a conscious effort to change and develop new ways of being with her infant.

Conclusion In this chapter we showed how research and therapy grounded in descriptive phenomenological principles could come together and create unity in the clinical psychological practice with postpartum depressed mothers and their infants. Adopting the mindset of the epochē enables the therapist to be with the mother in her lifeworld. The eidetic reduction and research based on these same phenomenological principles enables the therapist to be there for the mother and her relationship with her child. The resulting clinical conversations are anchored in the fundamental intersubjectivity of human beings, which supports emotional resonance and verbalized confirmation of mutual understanding and new insights.

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Note We thank Amedeo Giorgi for insightful and helpful comments on an earlier draft of this chapter

References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Brudal, L. (2014). Empatisk Kommunikasjon – et verktøy for menneskemøter (Empathic communication – a tool for human encounters). Oslo: Gyldendal Akademisk. Fonagy, P., Gergely, G., Jurist, E., & Target, M. (eds). (2005). Affect regulation, mentalization and the development of the self. New York: Other Press. Froese, T., & Gallagher S. (2012). Getting interaction theory (IT) together: Integrating developmental, phenomenological, and dynamical approaches to social interaction. Interaction Studies, 13(3):436–68. DOI 10.1075/is.13.3.06fro. Fuchs, T. (2010). Subjectivity and intersubjectivity in psychiatric diagnosis. Psychopathology, 43: 268–74. DOI 10.1159/000315126. Fuchs, T., & De Jaegher, H. (2009). Enactive intersubjectivity: Participatory sensemaking and mutual incorporation. Phenomenological Cognitive Science, 8: 465–68. DOI 10.1007/s11097-009-9136-4. Giorgi, A. (1985a). Phenomenology and psychological research. Pittsburgh, PA: Duquesne University Press. Giorgi, A. (1985b). Toward a phenomenologically based unified paradigm for psychology. In D. Kruger (ed.), The changing reality of modern man, pp. 20–34. Pittsburgh, PA: Duquesne University Press. Giorgi, A. (2009). The descriptive phenomenological method in psychology: A modified Husserlian approach. Pittsburgh, PA: Duquesne University Press. Gurwitch, A. (1966). Studies in phenomenology and psychology. Evanston, IL: Northwestern University Press. Halbreich, U. (2005). Postpartum disorders: Multiple interacting underlying mechanisms and risk factors. Journal of Affective Disorders, 88(1):1–7. Hart, S. (2011). Den følsomme hjernen. Hjernens utvikling gjennom tilknytning og samhørighetsbånd (The sensitive brain. The brain’s development through connections and ties of solidarity). Oslo: Gyldendal Norsk Forlag. Husserl, E. (1962). Ideas: General introduction to pure phenomenology (Book 1, trans. W. R. B. Gibson). New York: Collier Books. (Originally published in German 1913.) Husserl, E. (1964). The phenomenology of internal time consciousness (trans. J. S. Churchill). The Hague: Martinus Nijhoff.

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Langdridge, D. (2013). Existential counseling and psychotherapy. Los Angeles, CA: SAGE. Merleau-Ponty, M. (1962). Phenomenology of perception (trans. C. Smith). London: Routledge & Kegan Paul. (Originally published in French 1945.) Merleau-Ponty, M. (1964a). The child’s relation with others. In J. M. Edie. The primacy of perception, pp. 96–155. Evanston, IL: Northwestern University Press. (Originally published in French 1947.) Merleau-Ponty, M. (1964b). Signs. Evanston, IL: Northwestern University Press. (Originally published in French 1960.) Merleau-Ponty, M. (2012). Phenomenology of perception (trans. D. A. Landes). London: Routledge & Francis Group. (Originally published in French 1945.) Morley, J. (2010). It’s always about the epoché. Les Collectifs du Cirp, 1: 223–32. Røseth, I. (2013). The essential meaning structure of postpartum depression: A qualitative study (doctoral dissertation). Oslo: AIT OSLO AS. Røseth, I., Binder, P,-E., & Malt, U. F. (2011). Two ways of living through postpartum depression. Journal of Phenomenological Psychology, 42(2):174–94. Røseth, I., Bongaardt, R., & Binder, P.-E. (2011). Postpartum depression and incest intertwined: A case study. International Journal of Qualitative Studies on Health and Well-Being, 6: 7244. Sartre, J. P. (1956). Being and nothingness (trans. H. E. Barne). New York: The Washington Square Press. (Originally published in French 1943.) Scheler, M. (1970). The nature of sympathy (trans. P. Heath). New York: Archon Books. (Originally published in German 1912.) Schore, A. (2003). Affect dysregulation and disorders of the self. New York: W. W. Norton. Shusterman, R. (2012). Thinking through the body: Essays in somaestetics. New York: Cambridge University Press. Spinelli, E. (2005). Interpreted world: An introduction to phenomenological psychology. London: SAGE Publications Inc. Stern, D. N. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. New York: Basic Books. Stern, D. N. (1995). The motherhood constellation: A unified view of parent-infant psychotherapy. New York: Basic Books. Stien, P. T., & Kendall, J. (2004). Psychological trauma and the developing brain. New York: Routledge. Stoppard, J. M., & Gammell, D. J. (2003). Depressed women’s treatment experiences: Exploring themes of medicalization and empowerment. In J. M. Stoppard & L. M. McMullen (eds), Situating sadness: Women and depression in a social context, pp. 39–61. New York: New York University Press. Toombs, K. S. (2001). Phenomenology and medicine. In K. S. Toombs (eds), Handbook of phenomenology and medicine, pp. 1–289. Dordrecht: Kluwer Academic Publisher.

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Trevarthen, C. (1979a). Communication and cooperation in early infancy: A description of primary intersubjectivity. In A. Lock (ed.), Before speech, pp. 321– 47. Cambridge UK: Cambridge University Press. Trevarthen, C. (1979b). Musicality and the intrinsic motive pulse: Evidence from human psychobiology and infant communication. Musicae Scientiae, 155–215. Tronick, E. Z., Als, H., Adamson, L., Wose, S., & Brazelton, T. B. (1978). The infant’s response to entrapment between contradictory messaged in face-to-face interaction. Journal of the American Academy of Child & Adolescent Psychiatry, 17:1–13. Whitney, S. (2012). Affects, images and childlike perception: Self-other difference in Merleau-Ponty’s Sorbonne Lectures. PhaenEx, 7(2):185–221. Winnicott, D. W. (1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. New York: International Universities Press, Inc. Zahavi, D. (2003). Husserl’s phenomenology. Stanford: Stanford University Press. Zahavi, D. (2010). Empathy, embodiment and interpersonal understanding: From Lipps to Schutz. Inquiry, 53(3):285–306. DOI 10.1080/00201741003784663.

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A Phenomenology of Sensus Communis Outline of a Phenomenological Approach to Social Psychiatry Samuel Thoma and Thomas Fuchs

Introduction Within the recent evolution of the so-called new philosophy of psychiatry and its impact on psychiatric theory and practice, phenomenological psychiatry is a central reference.1 However, until now consequences for social psychiatry were rarely taken into account in these debates. This seems surprising because in today’s perspective phenomenological and social psychiatry share a lot of theoretical as well as practical hypotheses. Moreover, they share a common history:  Michel Foucault was not only an important critic of psychiatry but also, in his first publications, appeared as phenomenological-psychiatric author, whose grappling with the theories of Ludwig Binswanger and Roland Kuhn had an important impact on his later works.2 In England it was the so-called anti-psychiatrist Ronald D. Laing whose oeuvre was strongly marked by the phenomenological approach and whose study The Divided Self (2010) is still an important reference for phenomenological descriptions of schizophrenic experience (Sass, 1992). In Italy phenomenological psychiatry played an important role for Franco Basaglia, main figure of the Italian reform of psychiatry (Basaglia, 1981). Ultimately it was probably in Germany that phenomenological psychiatry was most closely linked to social psychiatry. Here many important social psychiatrists and promoters of the West-German but also East-German psychiatry reform were scholars of the phenomenological-psychiatric school.3 This historical overview indicates an influential connection between phenomenological psychiatry and social psychiatry. But it is also the current conceptual

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concerns of both schools that make a close collaboration between them seem almost natural. We would like to propose, therefore, a phenomenological theory of sensus communis as a way to prove this in detail.

General Remarks on Sensus Communis The psychopathology of common sense initiated by Wolfgang Blankenburg (2012) is one of the main research-domains of contemporary phenomenological psychiatry4 and is in our view the most useful one to be linked to social-psychiatric questions. Hence, we follow Stanghellini’s idea that the concept of common sense can be easily linked with questions about the minimal self and pre-reflective selfaffection in mental illness (Sass & Parnas, 2003; Parnas et al., 2005; Stanghellini, 2004). However, we prefer the term ‘sensus communis’ for such an integrative use of the concept, which we will explain below. A brief historical outline will allow us to distinguish three dimensions of the sensus communis concept: (i) koinē aísthēsis as a fundamental intermodal capacity to sense the world and oneself through the medium of the lived body; (ii) social sense, derived from primary social interactions with others, enabling a habitual, pre-reflective and confident relation with the social world; (iii) common sense, as the capacity to think in accordance with intersubjectively shared, self-evident rules, and to apply them to specific situations. Clifford Geertz (1983, p. 76) once remarked that common sense is ‘perhaps the central category in a wide range of modern philosophical systems’ (emphasis in the original). One might even say that in contemporary philosophy common sense has itself become a commonsensical motive of different philosophical schools and of the humanities in general.5 Etymologically the term goes back to the ancient Greek koinē aísthēsis, which was later translated into Latin as sensus communis from which the modern term common sense is derived. This etymological evolution was accompanied by important semantic changes. Aristotle described koinē aísthēsis as the capacity of living beings to integrate different sensory modalities along with the ability to sense oneself in perceiving the surrounding world (Aristotle, 2008; Heller-Roazen, 2009; Gregoric, 2012). The Romans often conceptualized sensus communis as the ability to act humanely and with kindness towards the community,6 a meaning that in the end of the seventeenth century was taken up by Gianbattista Vico and Anthony Shaftesbury (2000, p.  50), who described sensus communis as a ‘social feeling or sense of

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partnership with humankind’. Finally, in the modern age common sense meant a fundamental and pragmatic capacity to think in commonly shared principles, or as an erudite Englishman in 1721 put it: ‘By a man of common sense, we mean one who knows, as we say, white from black, and chalk from cheese; that two and two make four; and that a mountain is bigger than a mole hill’ (quoted after Rosenfeld [2011, p. 22]). Consequently, common sense was mainly used in three different ways: as a perceptive, a social, and a cognitive capacity. It goes without saying, however, that this is only a simplified scheme of the complex and dynamic history of common sense.7 On the whole our point is that, from a historical perspective, common sense is a much richer notion than we usually think it is – or our common sense thinks it is. Moreover we believe that the plurality of perceptual, social, and cognitive meanings of common sense is not historically contingent but also based on a conceptually necessary connection that we would like to draw upon in this chapter. Since it was sensus communis that, from a historical point of view, was used in the most encompassing sense of the three aforementioned aspects, we prefer the term as a general designation of our analysis. Hence, we will limit the use of the term common sense to its cognitive dimension.

The Phenomenology of Sensus Communis We will now give an account of sensus communis in its three different aspects based on several concepts of phenomenological theory. Since our aim is to contribute to a theoretical connection with social psychiatry, we will hint at the common ground of these aspects within sociological theory. We then look at psychopathology in connection with socio-epidemiological findings and we finally ask for socio-therapeutic implications.

Koinē aísthēsis – sensing oneself and the world The Greek term aísthēsis should not be confused with our common understanding of perception. Influenced by the dominance of vision in modern thought, we generally take perception as something we actively exert on objects from a fixed and safe distance. In terms of aísthēsis, however, we should rather understand perception in ways of sensing and touching the world, whereby the subject gets in close contact with what is sensed, moves towards it, and is moved by it. Erwin

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Straus (1956) speaks of sensing (Empfinden) as a fundamental communication of a bodily subject with the world, a communication that we share with animals. With Straus we may conceive of aísthēsis as an interaction in its most basic, bodily form. Moreover this sensing of the world should always be taken as a holistic structure: it is not the sum one ends up with by adding the different senses or sensory modalities, but an indivisible layer of sense-experience, a sensorium commune,8 through which we communicate with the world. Hence, the different sensory modalities are only accentuations of that communication and not its atomistic elements. In the modalities of touch and taste the world is sensed as especially near to our body: we feel touched when touching something else and vice versa. The sense of smell is closely linked to atmospheric impressions such as familiarity or uncanniness, freshness or decay (Tellenbach, 1968). Hearing and seeing enable us to sense things very distant from us. Whereas hearing depends on sounds appearing over time (melodies or utterances), seeing enables us to discern something from a certain perspective and by moving around it. As Straus puts it, none of these senses ‘plays in only one tonality’.9 If, for instance, we visually see a withered bouquet of flowers from a certain distance and smell its insipid odor as intrusively close, we at the same time also see this odor on the withered blossoms, and we smell its withered look in its insipid odor. Another example would be a concert where we not only hear the music but also see it in the movements of the orchestra’s conductor and musicians (cf. von Weizsäcker, 1950, p. 79). Hence, we might also call this sensorium commune an intermodal sense. Intermodality or coenesthesia consequently is not a rare or even pathological case of our sensory perception but constitutes its very essence. But koinē aísthēsis not only includes the intermodal perception of the surrounding world, but also the capacity of vital self-sensing (Aristotle, 2008; Heller-Roazen, 2009). According to Straus (1956, p.  373), self-sensing and sensing of the world must always be seen as a unity for which he uses the term ‘sympathetic sensing’: ‘The “with” [“sym” of sympathetic] means that by sensing I don’t experience myself and additionally the world, but that the experience of sensing unfolds in two directions, towards the world and towards the I. Sensing is sympathetic experience, i.e. by sensing I  experience transformations of my relation to the world – a relation that outlasts and unifies all particular moments because it is one.’ In terms of sympathetic sensing, self-sensing is never static but in a constant state of becoming in relation with the world. This reciprocal articulation of self-sensing and sensing of the world may be best understood as rhythm. Rhythm is, as the French phenomenologist Henri Maldiney (2012,

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p.  207) comments on Straus, ‘the truth of this first communication with the world, which is aísthēsis’. Moreover, the surrounding world and its rhythms resonate in our own rhythmical experience. Here we may think of rhythms of touching and being touched, of tastes, smells, sounds, and visual structures that come and go but also more fundamental rhythms of sleeping and waking, activity and rest, need and satisfaction. On this most fundamental level of sensing, we are constantly transformed by our surrounding world, without discerning its objective givenness independent from us, but instead in the way of an ambient, anonymous, and rhythmical becoming (cf. Minkowski, 1995, pp.  59, 63; Van Duppen, forthcoming).10 However, this resonance is not all-encompassing; rather, our lived body is in constant alternation between states of synchronization and desynchronization with its surroundings (Fuchs, 2013a). An example where this fundamental communication with the world is disturbed would be melancholic depression: Here, patients feel as though they are lagging behind their surrounding world and lose their sense of sympathetic synchronicity with it.11 This leads to the so-called feeling of not-feeling the world and oneself anymore (also known as derealization and depersonalization), an experience that may culminate in delusions of not being alive anymore (Cotard’s syndrome).

Social sense – sense for shared habitualities The communication with the world is not just a fixed condition; on the contrary, it is only through repetition and habituation that we become acquainted with both the world and ourselves. This familiarization is enabled through the most basic form of intersubjectivity, namely, intercorporeality. In intercorporeal encounters we not only resonate with the world but our own resonance is taken up and modified by the resonance of others. Intercorporeality can be described as a circle of expressions of person A leading to impressions in person B, which being expressed in turn lead to impressions in person A, and so on (Fuchs, 2013d, p. 624 ff.). This circular process not only amplifies but also profoundly modifies our rhythmical experience. In early childhood, it entails the sedimentation of shared habits and interactive styles into the infant’s implicit or body memory (Fuchs, 2012). Moreover, intercorporeality is the primary sphere through which infants become acquainted with the world and acquire a fundamental ‘croyance originaire’ (Maldiney, 2012, p. 207) or ‘perceptual faith’ (Merleau-Ponty, 2005, p. 305) in the shared world. This fundamental confidence and familiarity with

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the world is essentially gained through others by gaining confidence in them, at first in the course of successful dyadic interactions. From here, this confidence extends to joint attention on objects, co-operative practices of interacting with the environment, and finally to the seemingly solitary interaction with the material world during which others are only potentially co-present. As we can see, the familiarity of others and the familiarity of the world are closely interrelated; both are ultimately based on intercorporeal interactions and shared practices experienced early in life. Therefore we may speak of a unitary social sense, which covers our ‘knowledge by acquaintance’ (James, 1890, p. 221) both with others and with the shared world. Social sense, like koîné aísthēsis, is a resonant faculty. Through it, we respond to situations in accordance with implicit, socially shared habits. But social sense is not a fait accompli, a mere repetition of habits, but something that has to be re-founded in every new situation. We have to accommodate to unfamiliar situations, persons, or objects, and transform our habits in the face of new environmental affordances. Hence, we must not only retrieve what is and has been a common habit before, but must also continuously strive to recreate it. This becomes especially evident in the phenomenon of tact (cf. Gadamer, 1990, p. 20 ff.). Tact cannot be reduced to the capacity of applying rules of etiquette to a social situation. Rather, it is needed in situations where the application of rules is limited. It is a sense for what is socially demanded in concrete situations within the implicit horizon of interactive habits. An example would be meeting an acquaintance who just suffered the death of a family member. Our knowledge of social etiquette would help us to have a small talk with her but it is limited as it doesn’t tell us if, when, and how she would want us to address the loss of her family member. We may only sense it in that very situation and attune our familiar ways of interaction to it. Hence tact is not a cognitive or rule-based faculty; rather, it can be defined as the intuitive capacity to maintain interactive familiarity in unfamiliar social situations. The relevance of the social sense for the constitution of intersubjectivity also comes to the fore in cases where it is disturbed. People with autism and also schizophrenic autism often suffer from not being able to rely on shared habits and empathy in social encounters, making it hard for both sides to establish a feeling of familiarity. Thus, instead of intuitively attuning with the other, high-functioning autistic individuals have to use strategies of explicit mentalizing and inferring from social cues in order to compensate for the lacking capacities of intercorporeal understanding (Zahavi & Parnas, 2003). This is described in Oliver Sacks’s (1995, p. 270) report on Temple Grandin, a woman with Asperger’s syndrome:

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It has to do, she has inferred, with an implicit knowledge of social conventions and codes, of cultural presuppositions of every sort. This implicit knowledge, which every normal person accumulates and generates throughout life on the basis of experience and encounters with others, Temple seems to be largely devoid of. Lacking it, she has instead to ‘compute’ others’ intentions and states of mind, to try to make algorithmic, explicit, what for the rest of us is second nature. (Cf. Fuchs, 2013b)12

Finally, our concept of social sense may be linked to Pierre Bourdieu’s theory of habitus13 which is highly coherent with phenomenological research on the social constitution of experience, habituation, and embodiment.14 Later on we will indicate some of its potential benefits for a phenomenological approach to social psychiatry.

Common sense – rule-guided and pragmatic thinking The last aspect of sensus communis is common sense which we take as a basic human capacity of thought and reflection. However, when speaking of common sense we generally prefer the term ‘thinking’ to ‘reflecting’ since the latter implies a rather distanced and disengaged relation towards one’s experiences. While such a reflective stance may be part of common sense, especially in critical situations, common sense is in most cases characterized by aware and engaged thinking in concrete situations. Hence, following Sutton et al. (2011, p. 95) we take thought not as ‘an inner realm behind practical skill, but [as] an intrinsic and worldly aspect of our real-time engagement in complex physical and cultural activities’. Commonsensical thinking is guided by fundamental and commonly shared rules and axioms, as outlined by James Beattie (1915, p.  217):  ‘I exist, things equal to one and the same thing are equal to one another, the sun rose today, . . . the three angles of a triangle are equal to two right angles, etc. – I am conscious that my mind admits and acquiesces in them.’ These axioms of common sense constitute, in Wittgenstein’s terms, our bedrock of unquestioned certainties (cf. Wittgenstein, 1972, pp.  94–9, 245–54). Yet despite the fact that these axioms seem so evident to us, it would be wrong to conceive of them as culturally irrelative.15 One should rather stress the social validity of common sense rules than ask for their general truth. In other words, common sense knowledge primarily is not true, but shared knowledge that connects us with a certain sociocultural group and the viewpoint of its ‘generalized other’ (Mead, 1972, p. 172 ff.). This becomes even more evident with other aspects of common sense knowledge such as the cultural corpus of proverbs and idiomatic expressions,16

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the knowledge of conventions and finally social role-knowledge. Here common sense not only functions as a general ‘bedrock of unquestioned certainties’ but has a more specific and normative function. Through common sense, we know how one has to behave, that is, we know and expect a certain role, a role-other, and a role-set17 with rules that everyone follows in concrete social situations. This also implies a fundamentally pragmatic significance of common sense knowledge. Applying general rules of interaction helps us to maintain coherent social interactions in cases of insufficient habitualities. Relying on our knowledge of roles and rituals, we do not have to reflect on how to interact when our embodied habits do not match or could not yet accommodate to one another. When interacting with strangers in public places or at official meetings there is always a rule, both general and anonymous, of how one should greet or thank each other, and how one should talk or apologize to each other, and so on. This rule-guided regulation of social interaction mostly occurs on an implicit level but may also be made explicit, especially in cases of misdemeanor where we remind ourselves or others that certain things are ‘just not done’, like, for instance, not excusing oneself when stepping on a stranger’s toe. Spontaneously referring to common sense rules corresponds to referring one’s situation to the ‘generalized other’ and to localize oneself in it. But despite the certainty and smoothness with which we do so, this general reference is something we must acquire throughout our lives and which repeatedly conflicts with our habitual experience.18 The anthropological condition for such an acquirement of general rules and their almost natural application in everyday life is what Helmuth Plessner (1975, p. 288 ff.) calls ‘eccentric positionality’, through which we are able to conceive of our own experiences from a general perspective and in the light of societal meanings and demands (Heinze, 2009). We could say that in common sense, this ‘eccentric’ interchange between general rules and our ‘centric’ situation has become a ‘second nature’ and ‘goes without saying’. Finally, this commonsensical interchange of general rules and concrete situations always necessarily implies a kind of creativity: As Immanuel Kant (1998, p.  268 f.) points out, there can be no rule for the application of a rule if one is to avoid an infinite regress. Thus it is not enough for a doctor, a judge, or a statesman to know the rules of his or her profession, but he or she is also in need of what Kant calls ‘power of judgement’, that is, a creative capacity to interpretatively apply these rules to concrete situations (ibid.; Kant, 2000, p.  15 f., 66 f.; Gadamer, 1990, p. 43 ff.; Summa, 2016). Accordingly, in everyday life we all resemble Kant’s example of a judge since with common sense we constantly

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and tacitly take an eccentric position towards ourselves and decide about the adequacy and applicability of common sense rules to our interactions. But despite this continuous refurbishment of common sense rules, it is still to these ‘flimsy rules’, as Goffman (1972, p. 72) says, ‘that we owe our unshaking sense of realities’. This is well illustrated by situations where people fall out of line with the rules and lose their sense for them, which according to Goffman means to be ‘ungrasped by immediate reality’, thus loosening ‘the grasp that others have of it. To be awkward or unkempt, to talk or move wrongly, is to be a dangerous giant, a destroyer of worlds. As every psychotic and comic ought to know, any accurately improper move can poke through the thin sleeve of immediate reality’ (ibid.). But it is first and foremost not for others but for people with psychosis themselves that this ‘immediate reality’ of everyday experience is endangered: In cases of delusional mood (Wahnstimmung), they experience their world as stripped of its shared background certainties and as filled with an all-permeating uncanniness. This may finally lead to delusional beliefs of persecution that, despite their idiosyncrasy, at least allow for a provisional reestablishment of a certain and coherent reality.19 Consequently, the therapeutic task then must be to achieve communication between the delusional ‘ídios kósmos’ and the commonly shared ‘koinós kósmos’ (cf. Binswanger, 1994b) through an empathic and reciprocal process, as we will indicate below.

The Relation between Koinē Aísthēsis, Social Sense, and Common Sense Our distinction between the three forms of sensus communis is only analytical. In our everyday experience we never sense the world with pure koinē aísthēsis, without being in some ways familiarized with it through our social sense and without regulating our behaviour through rule-guided thinking. On the one hand, the way we initially sense the world determines the habits we develop and the rules by which we think about the world; on the other hand, these roles and rules in turn become embodied habits and transform our way of sensing the world. An example would be acquiring social roles: in a new and unfamiliar situation we initially need to reflect upon social roles to behave adequately, for instance, when being a doctor or a patient in a hospital for the first time. Then through repetition these roles shape our implicit body memory so that every time we enter a hospital, wear a doctor’s white coat or a patient’s gown,

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we habitually behave in coherence with the situation.20 Hence, sensus communis should be seen as a tripartite unity in which koinē aísthēsis, social sense, and common sense are mutually interwoven. Still one might wonder about the conditional interdependence of the three aspects:  In his famous notes On Certainty, Ludwig Wittgenstein (1972) poses the question of why we are usually convinced of the truth of the beliefs and axioms that guide us through everyday life although they have very rarely been proven to us. From a phenomenological perspective, these beliefs are actually not constituted by reasoning and proof but by the embodied familiarity and continuity of our experience. Moreover, this experiential familiarity is only possible if we sense ourselves and the world in rhythmical interchange and resonance. Moreover, it is also possible to sense the world without being socially familiar with it or being able to commonsensically apply social rules to it. Consequently, rhythmical bodily sensing (Empfinden) both underpins and potentially exceeds social familiarity and rule-guided thinking, or, to put it differently, our bodily and resonant con-tact with the world is a necessary condition for the social sense of tact which again lays the grounds for tactical and rule-guided thinking.21 Finally, this order of interactive dispositions is also an order of normalization: the more we are able to apprehend our experience in social rules, the more we perceive it as an ordinary case and merely an example of a rule.22 This process is what Waldenfels (1998, p.  141) calls normalization. But as we have shown, even pragmatic rule-guided thinking is in need of creativity. The normalizing effect of common sense and its rules is never definite. It remains open for both refurbishments and derailments, which give birth to a certain vulnerability of sensus communis. This is why we will finally take a closer look at psychopathological and therapeutic questions.

Psychopathological Aspects of Sensus Communis In the following we restrict ourselves to the description of schizophrenia in relation to sensus communis.23 Wolfgang Blankenburg was the first to stress the relation between common sense and schizophrenia from a phenomenological point of view by describing schizophrenia as a loss of natural self-evidence or as a loss of common sense. Ever since, this issue has been extensively discussed and we will only give a short summary of it here. The conception of schizophrenia as a loss of common sense seems particularly convincing, when looking at delusions, one of the most prominent schizophrenic

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symptoms. Karl Jaspers (1997, p. 96) famously defined delusions as extraordinarily certain, uncorrectable, and impossible judgments. Their difference from commonsensical beliefs about the world appears obvious when Jaspers determines these beliefs as essentially incomprehensible for others (p. 98). However, Jaspers did not consider delusions as mere disturbances of judgement or erroneous beliefs but as being ultimately rooted in a profound transformation of human existence (cf. Kraus, 2014). This loss not only appears in relatively acute experiences of delusional mood (see above) but also in more persistent experiential transformations described by Blankenburg (2007a, 2012). In his comprehensive study on his patient, Anne Rau, he shows that this loss is not only about commonsensical thinking and the correlative background certainties, but also about sensed intercorporeal interaction, mediated through what we have described as social sense and tact. People with schizophrenia have problems practically apprehending the affordances of social situations and to intuitively ‘read between the lines’ of the other’s utterances and expressions (Blankenburg, 2012; Fuchs, 2002, 2014). Finally, as Louis Sass (2001) points out, this disturbance of habitual beingin-the-world is rooted in an even more profound disturbance of what Michel Henry (2011) calls auto-affection, that is, a profound, pre-intentional, and pathic self-experience, being diminished in schizophrenia. However, we do not conceive of this most profound level of pathic affection only in terms of auto-affection. One should also consider disturbances in our intermodal sensing of the world that may occur early in life.24 Consequently, following Straus’s and Maldiney’s concept of ‘sympathetic sensing’, we propose a model of rhythmical integration of auto- and hetero-affection, both of which should be taken into account in schizophrenia.25 To summarize: schizophrenia can be seen as an impairment of all three dimensions of sensus communis, from primary (auto- and hetero-)sensing to habitual familiarity with the world up to rule-guided thinking.26 But it would be misleading to think that the schizophrenic disturbance of sensus communis should always be complete and occur on all three levels. For instance, self-affection could certainly not be entirely lost in schizophrenia (cf. Zahavi, 2001). Moreover, Sass argues that the capacity to reflect upon the world might even be hyper-intact (though still not commonsensical) in schizophrenia (hyper-reflexivity; cf. Sass & Parnas, 2003). Finally, Schlimme and Schwartz (2012) have shown that people with schizophrenia often compensate a loss of familiar and social being-in-the-world by intentionally playing certain social roles that allow for unfamiliar social behavior and thereby regain ‘social cover’ through an ‘idionomic habituality’.27 Hence, a certain understanding of social roles is still maintained in schizophrenia.

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In any case, disturbances of sensus communis are always forms of disturbed social interaction and hence may never be ascribed to a single individual, but must always be analysed as part of a social context. Consequently, we should always ask which specific aspect of sensus communis – that is, the sensed rhythmical interaction of self and world, its habitual familiarity, or the demanded rules – is providing the backdrop for a socioculturally specific form of schizophrenia. This leads to an analysis of our modern and postmodern zeitgeist and the cultural framework in which schizophrenia is situated (Sass, 1992; Woods, 2011). Apart from this general point of view, we may ask for more specific social conditions leading to schizophrenia. One must, for instance, consider the significantly higher rates of schizophrenia amongst urban citizens (Vassos et al., 2012) and migrants.28 These epidemiological findings should be correlated with phenomenological research. As Bourdieu would say, urbanity, low socio-economic status, and migratory background lead to a certain habitus of interacting with the world  – they consequently shape a specific form of sensus communis which may include a vulnerability and risk for schizophrenia. Migrants, for instance, may lack the habitual attunement and sense of belonging to their social surroundings in a way that does not allow them to actually inhabit29 these surroundings. This may increase their risk of losing an already fragile familiarity of being-in-the-world. How, in return, would such a loss be aggravated by social stigma and mechanisms of exclusion, when their environment lacks the tolerance and comprehension for deviations of sensus communis? In what sense does urban life contribute to a fragility of our habitus and what would such a fragility of habitus look like? These are open questions that until now haven’t been treated by phenomenological psychiatry.30 Nonetheless they have immediate therapeutic consequences that we would like to sketch out in the last part of our analysis.

Therapeutic Consequences One could think of many therapeutical implications of our theory of sensus communis. We can only indicate a few that are essential to social psychiatric therapy. If schizophrenia essentially implies a loss of sensus communis then phenomenology could be said to have a special affinity to it since its methodological approach includes precisely the ‘bracketing’ of the taken-for-grantedness of everyday experience which is lost in schizophrenia. By actively distancing oneself

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from commonsensical experience, one may learn to empathize with people who have passively lost it.31 Moreover, by our phenomenological description of sensus communis, we have tried to show that sensus communis is in itself a structure constituting not only the normality of our experience, but also the possibility of its loss. Such an understanding of sensus communis and schizophrenia should make it possible to enter into an empathetic dialogue with people with schizophrenia by questioning both the certainty of common sense and the fatality of its loss, thereby showing that To Err Is Human, as the German social psychiatrists Klaus Dörner and Ursula Plog (1978) famously called their textbook (‘Irren ist menschlich’). This is an essential step not only for working against social stigmatization of schizophrenia, but also for its treatment since it is the very loss of a dialogically constituted world that in our view defines the core of schizophrenia. From here the relevance of assertive community treatment (ACT) and open dialogue comes to the fore. The presented phenomenological concept of schizophrenia is one way to make sense of the therapeutic impact of these approaches. If the disturbance of sensus communis is to be seen in the context of a concrete social milieu, the therapeutic task should be extra-mural work with and in that milieu and not merely intra-mural health care. This is precisely what ACT is about. Our theory of sensus communis may emphasize that one shouldn’t apply general and pre-conceived definitions of schizophrenia to patients, but look for the specific habitus and generalized other of a concrete social milieu that an individual has lost contact with. The aim then, should be, as in open dialogue, to establish a dialogue between that common habitus and the individual, which transforms and reconnects both sides and hereby helps to prevent schizophrenia (cf. Seikkula, Alakare, & Aaltonen, 2011). Last but not least we would like to mention Soteria-therapy. According to a phenomenology of sensus communis, people with schizophrenia may well be able to re-appropriate commonsensical ways of interaction and to reinhabit their social world not by critical reflection or cognitive training but by a daily and collective practice of living together in a safe and acknowledging communal space (cf. Nischk, Merz, & Rusch, 2013).

Conclusion/Discussion A phenomenological approach to social psychiatry should take into account the social and potentially psychopathological dimension of human experience. More

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precisely, the question is not so much if subjective experience is social or if the social is subjective but how it is. With our outline of a phenomenology and psychopathology of sensus communis we have tried to answer this question. Sensus communis is a holistic phenomenon stretching from the capacity to think and judge by means of socially shared rules, to being implicitly and bodily familiar with the world and, on a more basic level, to the capacity to rhythmically sense oneself in relation to the world. This world is inherently social, and all three capacities are ways in which subjectivity is mediated with the social, be it as commonly shared rules, be it as implicit and practical familiarity, or finally as an anonymous and dynamic rhythm, which is not even necessarily experienced as social. Nevertheless, even the most fundamental level of koinē aísthēsis is already an implicit social sense, for it enables the intermodal, resonant and holistic perception of others in early intercorporeality. Consequently, and in accordance with Blankenburg (2007a, p. 109), we can say that in all three aspects sensus communis is an ‘organ developed in community for community’ (emphasis in the original). In all three aspects of sensus communis unpredictability and therefore the need for creativity plays an integral part. Bodily sensing, habits, and social reflection must respond to unpredictable situations. Therefore, creativity seems to be an essential part of our ordinary experience, or as Michela Summa (2016) puts it:  ‘[C]reativity, being grounded in the structures of transcendental experience, becomes itself a condition for some central aspects of our ordinary experience.’ One could conclude that what constitutes the taken-for-grantedness of our world – i.e our capacity to intuitively respond to unpredictable situations – is not itself something taken for granted. This gives rise to a certain vulnerability of sensus communis. This vulnerability is necessarily a vulnerability of subjectivity in relation to the social because sensus communis is the mediation between both. Thus, when studying the experience of a mentally ill person as disturbed sensus communis, one is always referred to the social context that this person is enmeshed in – one should always ask which specific forms of disturbed sensus communis this context makes possible. This being a core matter of social psychiatry, our theory of sensus communis brings phenomenological psychiatry and social psychiatry into very close connection – a connection we consider worthy of further investigation.

Notes We would like to thank Andi and Daniel Haskett, Allan Køster, Johanna Thoma, and Zeno Van Duppen for their helpful suggestions.

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1. Cf. Banner and Thornton (2007). For a historical perspective, cf. Marazia and Thoma (2015). 2. Cf. Basso (2012). 3. First to mention would be Caspar Kulenkampff, chairman of the German National Expert Commission (1971–75) framing the reform process of West-German psychiatry, who was first an internationally known phenomenological psychiatrist (cf. Thoma, 2012). In East Germany the psychiatrist Klaus Weise (2014) justified his socio-psychiatric reform between 1960 and 1990 by the phenomenological and anthropological approach. 4. Cf. Mishara (2001), Stanghellini (2004), Fuchs (2002), Summa (2012), Wulff (2014). 5. For analytical philosophy, see Moore (1959), Wittgenstein (1972), and more recently Lemos (2004). For continental philosophy, see, for instance, Husserl (1973, pp. 165–233), Gadamer (1990), and Arendt (1994). In social science, see Schütz (2008), Bourdieu (Holton, 2000), and Geertz (1983) and in linguistics Feilke (1994). Of course these indications are all but exhaustive. 6. Cicero’s use of sensus communis, for instance, is tightly linked to the concept of humanitas (see Bugter, 1987). Other examples would be Seneca and Horace. 7. Thus it would be wrong to see this history as a mere sequence of the aforementioned aspects, since often there were different meanings of common sense in use at the same time and many authors of different disciplines kept questioning and redefining them. For a historical summary, see Gadamer (1990), Heller-Roazen (2009), and Rosenfeld (2011). 8. von Weizsäcker (1950, p. 79); Herder quoted after Merleau-Ponty (2005, pp. 273, 277). 9. Straus (1958, p. 53); all quotations from non-English languages are our own translations. 10. Because of this resonance, rhythm must not be confused with a mechanical tic-tac but on the contrary as an inherently vital and dynamic phenomenon (cf. Dewey, 1980, p. 162 ff.). 11. Cf. von Gebsattel (1954), Tellenbach (1961), and Fuchs (2001, 2013c). 12. The ‘social conventions and codes’ and ‘cultural presuppositions’ that Sacks is mentioning will be thematized in the following paragraph. Here we rather want to emphasize the intuitive and interactive aspect of our experience with others that is disturbed in autism. 13. As is generally known, Bourdieu (1977, 1984) referred to habitus as a person’s familiar style of interaction with the world. For Bourdieu habitus is acquired through primary social interactions and allows us to identify a social agent as a member of a social group with different social categories such as class, race, or gender. With Bourdieu it is possible to conceive of these categories not as signifiers of social discourse, assigned to subjects ‘from the outside’, but

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16.

17.

18.

19. 20.

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Samuel Thoma & Thomas Fuchs as concrete, embodied, and interactive dispositions that frame our subjective experience (for instance, as a white, male, middle-class academic). For Bourdieu this embodiment of the social is not just a passive process of social imprinting. The agent’s habitus also has an active and creative side, which is why Bourdieu (1977, p. 72) defines the habitus as both ‘structured’ and ‘structuring structures’. The same goes for what we just termed social sense, whose task is not only to retrieve our acquired habits in new situations, but to creatively adapt and transform them, turning our familiarity with the world into a dynamic and potentially fragile process. Cf. Schneickert (2013). Besides, especially the concept of common sense plays an important, though unsystematic role in Bourdieu’s theory (cf. Holton, 2000). Even if we would subscribe to Beattie’s (1915, p. 217) aforementioned claims, another claim of the citation, ‘there is a God’, might in secular societies seem much less evident. Cf. Feilke (1994). The use of common idioms like ‘how are you doing?’ seems all evident to us although nobody can explain why in English one must say ‘how are you doing?’ and not – as in French, German, or Australian English – ‘how are you going?’ (‘comment ça va?’, ‘wie geht’s?’). Cf. Goffman (1972, p. 75). Despite recent criticism of role-theory (Davies & Harré, 1990, p. 51 ff.; Krais & Gebauer, 2002, p. 66 ff.) it is in our view still useful for a both phenomenological and social-psychiatric understanding of mental illness (Kraus, 1977, 1980). Jean-Paul Sartre (1971, p. 17 ff.), for instance, describes Jean Genet’s experience as a little child habitually stealing from other people and all of a sudden being judged as a thief and as having trespassed a social norm – a norm he then continually tries to integrate into his experience. Cf. Binswanger (1994a), Jaspers (1997), Blankenburg (2007b), Fuchs (2013b, p. 206 ff.). Of course, this also works in the other direction: how we play a role and what roles we get to play (in terms of profession, consumer, etc.) depend on our primary, habitual familiarity with the world, our habitus. We don’t mean to say either that reflection is all but guided by common sense rules. But this aspect of critical and emancipatory thinking goes beyond the scope of common sense. Nonetheless the relation between critical thinking and common sense is important not only for political questions (Rosenfeld, 2011) but also for psychiatric and psychopathological ones. Hence, in rule-guided social thinking interaction comes close to a pattern of action and reaction, as epitomized in Schütz’s (2008, p. 315 ff.) ‘general thesis of the reciprocity of perspectives’ where social agents spontaneously apprehend their own and the other’s perspective merely as reciprocal elements of a common project (for instance, selling and buying something in a shop).

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23. When speaking of schizophrenia or other mental disorders we follow the phenomenological tradition of taking mental illness as a way of experiencing the world and not as biological and extra-conscious mechanisms or deficiencies. For an analysis of the relation between common sense and other disorders, especially affective disorders, see Stanghellini (2004). 24. Gamma et al. (2013) identify young infants’ disturbed intermodal integration as a risk factor for schizophrenia. On disturbed intermodality in schizophrenia, see also Parnas, Bovet, & Innocenti (1996), Müller et al. (2012), and Liu et al. (2016). 25. One way to conceive of this would be a phenomenological psychopathology of trauma, especially early childhood trauma (cf. Read et al., 2005). In Maldiney’s (2007) philosophy but also in more recent developments of French phenomenology (Romano, 2010) one finds interesting concepts that point into this direction. 26. This is also a claim Stanghellini (2004) makes in his seminal work on the issue. 27. See also Schlimme and Brückner (2015), and Schlimme (2015). 28. Hickling and Rodgers-Johnson (1995), and Mahy et al. (1999). 29. Habitus, habit, and inhabit are not only etymologically linked but have an anthropological common ground: we inhabit the world with our habits (cf. Zutt, 1963). 30. In our view, an analysis similar to the Bourdieusian one (Bourdieu, 1984; see also Vester et al. [2001]) linking objective social data such as socio-economic status and so on with a phenomenological psychopathology of experience is needed to advance further exchange between phenomenological and social psychiatry. In addition we don’t mean to imply that social factors are the only factors leading to schizophrenia. For a comprehensive etiological theory of schizophrenia biological factors should also be taken into account. 31. For this issue, see the articles of Magnus Englander and Mads Gram Henriksen in this book. The analogies and differences between phenomenological reduction and schizophrenic experience have been subject to long-lasting dicussions (cf. Depraz [2003], Blankenburg [2012], Summa [2012], Thoma [2014], Rashed [2015], and Schlimme, Wiggins, & Schwartz [2015]). For a phenomenological approach to empathy with schizophrenic experience, we believe the reduction to be very useful. Still, one should keep in mind that a tool of psychological understanding is something different from using the reduction as a shibboleth for a first philosophy, as did Husserl.

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Husserl’s Ethics and Psychiatry Susi Ferrarello

Introduction In this chapter I will focus on Husserl’s ethics and its potential use for psychotherapy and psychiatry. In particular I  will examine the notion of volitional body in relation to time and society. As I argued in Husserl’s Ethics and Practical Intentionality (2015), Husserl’s phenomenology of ethics is a science grounded in the ontological region of the volitional body, and a praxis experienced in the form of practical intentionality. As a science phenomenological ethical practice can provide psychotherapists and psychiatrists with empathetic tools to observe the worldview of the client; as an approach it represents an ethical stance that social workers can adopt as a way to deepen their relating to their clients. Both aspects of this ethical practice can be employed to expand the intersubjective sense of how ‘normality’ or normativity is defined within the society and to enhance ethical awareness in social practice and daily life. In the first part of the chapter I will use Rogers’s and Gendlin’s (1962) phenomenological studies of schizophrenia conducted as an example of the effectiveness that such ethics can have in this area. Generally, if the mental disease is a natural response to a sick environment and if the language of the client is more important than that of the therapist, then it follows that a real cure can occur when the therapist does not use diagnostic concepts, but makes herself available to the client’s ethical environment. This is possible through an empathetic approach that genuinely explores the sense of normality implied in the client’s ethical worldview and suspends all pre-existing ethical assumptions. For that to occur it is necessary that both the therapist and client develop a capacity to recognize their ethical assumptions and describe the limits of action dictated

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by these assumptions. In the second part of the chapter I will examine Husserl’s notion of volitional body in relation to time and society, and explain how it can be useful in phenomenological practice.

Ethics in Practice Spiegelberg’s (1972) volume on phenomenology and psychiatry is an excellent resource for readers to explore the dialogue between psychiatry and phenomenology. Spiegelberg enumerates a long list of thinkers, psychologists, and psychotherapists, who drew upon Husserl’s phenomenology not only to improve their understanding of mental diseases, but also to fine-tune their methods in actively working with patients. Among these practitioners Gendlin and Rogers have primary importance for the focus of this chapter. Although not familiar with Husserl’s ethical manuscripts, Gendlin acknowledged the value of Husserl’s Logical Investigations and recognized the ethics underlying Husserl’s phenomenology (Spiegelberg, 1972, p. 155). Since as I have argued (Ferrarello, 2015) Husserl’s phenomenology is focused not only on an intellectual effort to grasp the world but also on an affective, emotional one, Gendlin and Rogers’s approach exemplifies how the twofold, intellectual and affective orientation of Husserl’s phenomenology can be realized in clinical praxis.

Gendlin and Rogers’s client-oriented approach In an article written in 1962 Gendlin summarized the results of a study of hospital patients diagnosed with schizophrenia he conducted in collaboration with Rogers. The main tenets of the client-oriented approach they used for this study can be summarized as follows: (i) increasing emphasis on the personal relationship with and empathetic understanding of the client; (ii) the therapist’s spontaneity and genuine expressiveness; (iii) the sub-verbal, affective, pre-conceptual nature of the basic therapeutic communication (Rogers, 1957, 1959a & b). The three tenets imply, of course, an ethical stance that the researcher decides to take in relation to the client. Indeed, if the therapist decides to adopt such an approach in a responsible way, she would face a number of moral questions: What are my assumptions in relation to my client? Am I truly in contact with her worldview or am I using my unreflected-upon worldview to interpret her story? Are my narrative and morals influencing my view of her case in a distortive way? If so, am I sharing with her the moral dilemmas that this influence

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produces, or am I just passively framing her within the assumptions comprising my moral world? What am I instinctively and spontaneously feeling in relation to her? What meaning am I bringing to this experience? Am I paying attention to the sub-verbal meanings that my patient brings to our relationship? Concerning the first tenet, on the basis of Rogers and Gendlin’s ethical observation the healing process is not a solipsistic process but rather an intersubjective one. The therapist’s private and shared ethical observations constitutively shape the experiencing that the patient lives in an immediate manner (Gendlin, Jenney, & Shlien, 1960). The more open and aware the therapist is, the more space there will be for the client to expand. As we know, the passive life of the therapist is as important as the active one; the therapist’s pre-conceptual and conceptual life are in some way inevitably shared with the patient at the moment of their encounter. For Rogers and Gendlin, the therapist seeks to communicate as fully as possible her feelings in response to the patient as part of the treatment. For them, sharing with sincerity the therapist’s experiences in the relationship with the client is pivotal to building a trustworthy common ground. If the therapist enters into the relationship with expectations, assumptions, methodical criteria that need to be met by the client, then she will sabotage the therapeutic relationship (Gendlin, 1962). Therefore real empathetic understanding takes place when the therapist exercises her awareness in relation to her present feelings so that she can verbalize her experiences in a free and transparent way without artificiality. She is with the client without confusing her emotional life with the client’s. It is true, as Gendlin (1961a, 1962) noted, that the therapist may not always reach a deep level of awareness in grasping her feelings. Gendlin argues that if the therapist is livingly in contact with her feelings, the client may nevertheless perceive them. That is why empathy does not equate to enmeshment or emotional confusion; rather, empathy requires awareness and emotional responsibility. The second tenet, genuineness as unconditional positive regard, reinforces the unbiased attitude that the therapist seeks to adopt in observing herself and her client. This approach invites the therapist to fully acknowledge the feelings elicited within the intersubjective exchange. On my reading, ‘positive regard’ does not imply that the therapist selects positive feelings only; any such selection, in fact, would entail a moral attitude that does not contribute to the genuineness of the exchange. The word ‘positive’ here refers to the Latin root, positum, which means ‘that which is set or given’. The therapist is invited to fully recognize the feelings that are given to and elicited from her in the exchange with the client. If the therapist is free from moral judgement and abandons her diagnostic attitude, then the awareness of the client’s pre-conceptual and pre-verbal

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language can be maximized and intensified (Rogers, 1959a). Gendlin (1961b) elaborated four casuistic ways in which schizophrenic clients might respond to therapy: non-motivation, silence, non-exploration, and intense sub-verbal interaction. A therapist who usually centers her therapy upon the client’s motivations and feelings would certainly feel strongly affected by the client’s unwillingness to meet with her. Such a therapist might feel deprived of the ground upon which her practice is based. The majority of the clients diagnosed with schizophrenia considered in Gendlin’s study did not desire to do therapy and most of the time refused to meet the therapist. They responded to therapy with continuing silence. Often the lack of verbal communication was accompanied by a refusal to own their feelings and explore them, even though they have already been expressed in an intense sub-verbal interaction. Gendlin argues that the genuineness of the therapist’s interaction and her unconditional regard would allow the client to be listened to on every level of expression. As Betz and Whitehorn (1956) remarked, in a hospital setting interpersonal and physical contact is often narrowed; consequently, the client can become forgetful of the human and personal conventions used before the hospitalization occurred. If therapists were to carve out the space for the client to occupy a human role within a hospital setting and give the client the freedom to fill or not fill this human role, this would be the strongest inter-subjective bridge that could be built between the client and her surrounding society. The human role is constantly there as a full presence, but this presence can be overshadowed by professional or social roles. On my interpretation of Gendlin and Rogers’s approach, in the therapeutic encounter, neither the therapist nor the client identifies with their pre-given professional and conventional roles. Last, in order to help the client to live in an intersubjective and human environment, the therapist should be able to share her own answer to the environment in which the relationship between the two takes place in a genuine way. The normative, implicit ethical stance of the therapist critiqued by Gendlin is that of a treating professional who is accustomed to value as human only a limited range of communicative responses from the client, which leads the therapist to accept only a truncated range of answers as valid possibilities. Therefore, she would interrupt the client’s silences in order to seek a normative form of encounter that does not meet the client’s language and passive world. In contrast, the approach proposed by Gendlin calls the therapist to take seriously the clients’ spontaneous responses to their environment as they present themselves, whether

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they communicate irritation, frustration, joy, or silence. Rather than requiring the client’s verbal self-exploration in order to fulfill preconceived parameters, this therapeutic attitude would be manifested in interactive behaviors through genuine self-expression; this open interaction would affect the nature of the client’s present experiencing so that in spite of threat and withdrawal the client might open her experiencing to fuller and more human interaction. As Gendlin (1961a) remarks, this last point leaves the problem of verbalization unresolved. The third tenet of this approach is based on pre-verbalization and on the analysis of the felt-lived experience. With schizophrenic clients (not only) the inward data, as they are concretely felt are more important than their verbal elaboration. Words are only a pale concretization of that inner turmoil. Felt experiencing is a pre-conceptual flow. According to Gendlin, in contrast to the richness of lived-experience, concepts are a mimicry of the real world. Felt experiencing can be endlessly differentiated and conceptualized, yet for the patient its primary meaning and aliveness lies in its pre-conceptual flow as felt experience, and only secondarily in reflective, conceptual meanings. The schizophrenics studied by Gendlin were so often lost, selfless, and alone in their pre-conceptual experience that their few statements arose from momentous occurrences. The open question is: How can the therapist reach the realm of felt experience that is mostly pre-conceptual and therefore more immediately meaningful for the patient? How can the therapist establish an empathetic understanding of the client’s lived-body rather than of the verbal organization of the client’s feelings? How can the therapist extend herself in a positive regard that enhances the patient’s contact with both her passive and active life? I will use Husserl’s ethics, in particular the notion of the volitional body and its relation to time and society in order to respond to these questions and hopefully provide clinicians with another key to accessing the preverbal realm of the client.

Ethics as a Science In 1889 Husserl began reflecting upon his project of founding a science of ethics parallel to a science of logic. He worked on this project throughout his life: logic and ethics were conceived as two complementary parts of a single phenomenological study of consciousness (Hua XXVIII) within which conceptual

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and emotional lived-experience were understood as completing each other. As Husserl wrote in Logical Investigations, Ideas and later in the Crisis, science is a ‘unity of foundational connections’ (Hua XVIII, 14; En. tr. 18). This unity requires ‘systematic coherence in the theoretical sense, which means finding grounds for one’s knowing and suitably combining and arranging the sequence of such groundings’ (Hua XVIII, 14–15; En. tr. 18). The ground for this unity is both an emotional and a practical one. The ground is, in fact, our life meant as a coherent and systematic conceptual order that we lay over our felt life. What we know cannot be known if we do not sort out the inner currents of our feelings and percepts according to ‘befores and afters’, ‘causes and consequences’. Science is a unity of layers that we ultimately interpret as meanings and values. Husserl envisioned ethical science as a part of phenomenological science as a whole. Similarly to physics or biology, ethics is grounded in a smaller portion of being, which Husserl calls an ‘ontological region’ in the Ideas. The ontological region upon which ethics is based is the volitional body (Hua XXXI, 478). Husserl conceives of ethical science as the systematic knowledge of human actions grounded upon what makes actions what they are; as a method, ethical praxis is dedicated to the clarification of the meaning of actions. Hence ethics is the science of the volitional body and is the method that clarifies its contents. The limits pointed out by Gendlin and Rogers in the third tenet of their approach relating to sub-verbal communication, refers precisely to the difficulty of accessing the volitional body of the client. Pre-verbal lived-experience is the scientific given upon which Husserl’s ethics is grounded and is at the same time the core of a useful client-oriented approach. In what follows I will describe what Husserl means by volitional body in relation to actions and time, and I will focus on two specific ethical principles that Husserl’s ethics promotes in order to live a fulfilling life: owning the volitional body, and taking ownership on time.

Owning the volitional body In this section I  will describe the process through which the client becomes the subject of her own body and establishes a meaningful relationship with it. Husserl describes the volitional body as the connecting bridge (verbindende Bruecke, Hua-Mat IV, 186) between nature and spirit, matter and reflection. It represents the region of being in which it is possible to locate an ego, a subject of actions (Handlungen), and creative acts (poietische Akte) (Hua-Mat IV, 104) that generates habits and, accordingly, ethical layers. This volitional layer constitutes an ethical subject, that is, an en-worlded person exercising her will and choice.

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The layers of the volitional body Nature is the very first and pre-subjective layer observable by a reflective subject. Lived subjectivity results from the ‘natural’ encounter between synthesized natural matter and the subjective understanding of it. Here I use Husserl’s term ‘matter’ in order to indicate the undifferentiated layers that constitute our existence not as subjects but as things among other things. ‘Something’ becomes a subject first because it recognizes itself as a thing, and second because through this recognition it questions its ontological status as a living thing. What Husserl calls matter (Stoff), the very first stratum of a spiritual subject, is its physical body (Koerper) meant as ‘a thing among other things’ (Hua-Mat IV, 182), that manifests itself first of all as an inanimate thing. In Ideas II, § 36 Husserl describes the physical body as a whole comprised of hyletic syntheses, a form of primitive otherness (§ 44) upon which the not-yet-clarified traits of the ego depend. In Gendlin and Rogers’s study the clients mostly seem to be living in a material state or pre-subjective manner; the therapist, in fact, encounters difficulty in interpreting the client’s pre-conceptual language because the client herself is at odds in recognizing it as her own. From the authors’ perspective the client perceives her verbal intentional language as restrained and artificial; the true language is the language that comes from the living body that is striving to become a subject. According to the authors, leaving the human role open is conducive for this metamorphosis to truly happen; the therapist’s world of feelings is a bridge to that of the clients. Put in Husserl’s words, the therapist should use her feelings and thoughts in response to the client as guidance to assist her in unfolding something that is not yet subjective for the client. The encounter between natural matter (the client’s body as not yet owned by her) and the client’s subjective understanding of it has no precise boundaries for the client. Since the therapist is part of client’s matter and there are no boundaries yet, the therapist’s preverbal language is the language of undifferentiated matter that can help the client’s verbal language to take shape and become more real. Through therapist’s understanding of her own matter she can help the client to see herself and transform her undifferentiated conceptual thoughts and feelings into subjective ones. At this layer the physical body is, for us, just a motionless thing that is not yet fully constituted. As merely inanimate physical bodies, we cannot yet perceive ourselves. This is the primordial level in which some of the clients in Gendlin and Rogers’s work appear to get stuck. They are their own field of perception; in other words at this stage (as Körper) they are the sensory instruments through

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which their lived-bodies are constituted. At this level the job of the therapist consists in awaking the sensory experience of the clients to the next layer so that they recognize themselves as a living body among other living bodies. The Körper is the zero point of apprehension. As Husserl shows in Cartesian Meditations the physical body brings with itself ‘there-ness-for-me’ (Hua I, 124). The physical body, perceptually given in an open and infinite horizon of undiscovered internal features, is a primordial transcendence that is there for the natural animated thing, that is, ‘us’. We discover ourselves as primordially embedded in this there-ness, but at the same time the shock of this discovery makes us aliens to ourselves. The therapist can help the client to recover from this shock and feel the connection between the still there-ness and the living alien. By the living alien I mean the body as a living thing over which the subject has not yet claimed ownership. The primordial response to the alien, which transcends our own physical body, is feeling our lived-body (Leib) but not yet inhabiting it. Becoming alive means seeing our own alienation and engaging this alien in a dialogue. How are we treating our body? What part of it is in pain? Where does the place of our pleasure reside? Are we breathing? It is from this encounter that we become living things; we awaken from a condition of thing-hood to one of subject-hood. ‘As perceptively active, I experience (or can experience) all of Nature, including my own animate organism, which therefore in the process is reflexively related to itself. That becomes possible because I  “can” perceive one hand “by means of the other” . . . a procedure in which the functioning organ must become an Object and the Object a functioning organ’ (Hua I, 128). Moreover, it is through my lived body (Leib) that I  realize my sphere of owness in contrast with the alienness of my physical body. Nature brings to light my Leib, ‘my animated organism, reduced to what is included in my owness . . . I as this man . . .. If I reduce myself as a man, I get “my animate organism” and “my psyche”, or myself as psychophysical unity – in the latter, my personal Ego, who operates in this animate organism and, by means of it’ (Hua I, 128). As Biceaga (2010, p. XXIII) rightly remarks, Husserl introduced the distinction between Leib and Koerper (the body as objectified; the body of medical science) precisely with the intention of explaining the constitution of objective nature and securing a region of owness within which the subject is intersubjectively constituted. The sphere of owness indicates that space in which we live as subjects of our matter; this sphere stems from the moment of realization in which we understand that we own a specific body and are responsible for its actions. The intersubjective process of healing mentioned in Gendlin and Rogers’s work

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begins at this primordial level when the client draws her first boundary: between herself as a sphere of owness and her body as a thing. This is the very first act of will that lays down the foundation for her real verbal communication with an alterity1: she feels her body and feels the space that can allow her to own that body; that body as a first alterity becomes her own. As Husserl shows in Cartesian Meditations § 37, the bodily attitude of the ego yields a Leibhaftig (bodily) functioning for which the physical body is no longer something in the world but rather is part of the world (see also Carr, 1999, 90– 7). For Husserl (2002) this transition happens through the evidence with which the body as a ‘living organ of the subject’ or an ‘underground of spiritual life’ (p. 122) realizes itself to be an instrument of perceptions (p. 56) and bearer of sensations (p. 183). This evidence triggers a change of attitude thanks to which the physical body becomes personally animated and fully transformed into an ‘aesthesiological body’ (p. 284; i.e., a body that can perceive its own feelings and sensations). The Body meant as Fungierende Leiblichkeit (functioning corporeality) (Husserl, 1988, § 50) mediates between the realm of material syntheses (or subpersonality) and the world of animate things that are there for us (Donohoe, 2004). Working with the body and its functioning can be the first step for the therapist to help the client to awake her volitions and sense of ownness. Awakening its senses through physical exercise and other sensuous activities like listening to or playing music, drawing, acting could be a strategy conducive to this goal. Becoming dumb to our own body is the first symptom of a dysfunction at any level. The basis of the ethical attitude is embedded in the birth of the volitional body: affection (Gemuet) awakens the as-yet inanimate thing as a subject, calling it (beruft) to wakefully live a goal which previously had been lived only at a sub-personal or material layer (Hua XXXI, 478).

Owning time Taking ownership over lived-time is a second way of inhabiting our livedexperience that contributes to psychological integrity. If owning a body is already an enterprise, owning time becomes a restless challenge that we are called to face every moment of our practical life. In phenomenology it is only when I apply the phenomenological reduction that I find my stream of experience (Hua III, §43) emerging from what Husserl calls the ‘sphere of irritability’. The sphere of irritability is the layer of reactions and affections from which the ego emerges. As we saw in the previous section,

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in Husserl’s theory of the emergence of ego there is first an ego-less primitive layer of consciousness in which drives, affections, sensuous tendencies of associations, and reproductions are mixed together; then a layer of nows emerges and forms a primitive unit in the continuum of the present. As Husserl wrote in the later C-Manuscripts, the living present of consciousness is the substratum, the original flow through which what comes to light is luminous (Hua XIV, 45, 301). This ‘lebendige Gegenwart (living present) is a kind of ongoing filling of intentions/protentions. . . . It is a creative primal presenting’ (Hart, 1992, pp. 25 26) This substratum is conceivable only if we consider the primitive layer of objects as a layer of absolute consciousness (Husserl, 1973b, § 29). This layer is not that of transcendental constituting flow; instead it is the layer that enables this constituting layer to arise. On this level no cognitive or world-time with its apprehension, or attentional retentions or egological acts take place, but only a flow of perceptual time with its undifferentiated material data. This is the layer of stream that we encounter before any reduction, theoretical reflection on, or attentive returning to an original process. In C-I 17 4 Husserl distinguishes three layers of ‘stream’. In the first layer stream means the stream of life: a pre-temporal and egoless form of stream. In the second layer, stream stands for the stream of immanent experience such as hyletic data and passive experience. In the third layer, stream indicates worldtime constituted through the acts of consciousness, in which everything streams for consciousness. This layer is primordial and combines with the first sense of streaming in terms of pre-temporal and egoless flow that can be disclosed through the questioning-back of the transcendental ego and through a reflexive act directed upon the third sense of streaming. While this third layer is the realm of cognition and world-time and is therefore characterized by temporality’s ‘before and after’ and causal connections unfolding within time, in the first layer time is an absolute, meaning that strictly speaking it is inconceivable for us. We cannot conceive of the first sense of streaming because we are constrained to the third form of streaming time, the time of ‘befores’ and ‘afters’, when we seek to explain the data we perceive. The first sense of streaming cannot be captured within ‘befores’ and ‘afters’; it is the interconnection of different senses of time, hence it is absolute in the Latin sense ab-solutus: loose, ‘untied’, or freed from our mind. Indeed, this first original stream is not yet an I, rather, it is the original presence that underlies the I, a living presence as a ‘standing-streaming present’ (C3, III 88) on which my-being for myself is constituted as my living self-presence.

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This pre-temporal stream is not yet intentional; rather, it is this stream that ‘awakes’ or ‘irritates’ the ego and makes it a ‘wache Ich’, an awoken I ready for intentional activity. From the perspective of Husserl’s egology, within the ‘normal’ or (from a psychological perspective) relatively integrated human being’s ongoing life the three layers of time flow in a more or less harmonious way, or at least that life is not characterized by drastic ruptures between the streams. In other words, in the ‘normal’ case, the pre-egoic streaming, hyletic or passively lived bodily experience, and self-thematizing actively intentional egoic life are generally aligned in such a way that the life of the self-reflective ego is characterized by this alignment. As we saw with Gendlin and Rogers, the alignment of these three streams of time is particularly problematic for schizophrenic clients. As showed in the third tenet, sub-verbal language is more meaningful than any meaning expressed through words. The loss of a strong sense of self as a subject equates to a certain extent to a loss of grasping the personal stream of time as one’s own. Clients lose themselves, so to speak, in primal original streaming and therefore are unable to grasp as their own their present in which the hyletic syntheses of their matter acquires causal meanings within a flow of ‘befores’ and ‘afters’. It is on this layer, between the first stream (pre-temporal and egoless) and second stream (immanent experience), that a particular form of intentionality operates which is closely linked to the life of the volitional body; Husserl named it practical2 and operating intentionality (Hua VIII, 34; Hua XI, 61; Hua XIV, 172). On this level the first stream of hyletic data relates to ego in the form of stimuli (Reize) and generates a number of egoless affections, drives, and reactions. At this stage the flow of the world is absolute (in other words inconceivable, ungraspable by personal subject) and not yet interrupted by my presence in the stream. It is only when the absolute presence of consciousness interacts with the passive stream of hyletic data and stimulates my ego that the third stream, that of the life-world, is finally disclosed with a meaning that we assign to it. The clients described in Gendlin and Rogers’s study seem to be stuck in the transition from the first to the second stream of time in such a manner that they cannot assign a meaning to what their now means for them as living subjects in the world. Unfortunately, most of the time linguistic descriptions of the interrelation between these three streams are inadequate, because our language is enslaved to world-time. It is practically impossible to narrate our experiences outside of the flow of befores and afters. We need to tell our stories and order our knowledge according to a before and after, a cause and an effect, while events

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themselves are just e-venientes (‘coming-from’), hyle (matter) occurring in our lives from a ‘nowhere’ space. Consequently, a sense of time deprived of the third stream might be more genuine than the full crossroads of the three streams because it translates the spontaneous and primordial flow of the emotional life. Practical intentionality3 is the tool that Husserl’s ethics provides us to follow and unfold the process of personal awakening in a time, a process that is absolute and conventional at once. The horizon of passive possible awakening, of continuing memories and attentional modifications of what is apprehended (the second layer of the stream) can interact with the newly awoken horizon of the ego (the third layer) due to a substratum (the first layer) that underlies that interaction. At this crossroads the I  discovers its primordial ethical core: that is, its ability to decide whether to be or not part of the world and then act in it. The transition from the dormant to the awake ego is always characterized by an act of will in which the ego decides to be responsible for the strata that pertain to it. In the connection between this second and third layer the I  finds itself as an Ich-fremd (other than my Ego’s own) because the hyletic is foreign to the ego, but at the same time hyle awakens it and brings it to determine itself with full awareness as intentional. The I and the other than the I (Ichfremd) are inseparable and both are alive and intentional (C16, VI, I, VII). The pre-I (vor-Ich) is nameless but operating (fungierende) and always engaging with the world (Hua XXXIII, Text 15, 277–8). In being able to recognize and distinguish between these three streams in the client’s conscious life and use practical intentionality the therapist would provide a model for the client’s process of ownership of its lived-time. Being subjects of time opens a space through which we can fully recognize our lives as ontologically present.

Daseinswert and the volitional body Being able to fully inhabit and own your body in your lived-time enables the emergence of what Husserl called Daseinswert (value of being). Daseinswert is the concretization of practical intentionality, in the sense that it refers to the volitional body’s primordial axiological functioning (wertvoller Leistungen). In other words, this primordial axiological Being represents the most basic level of embodied choosing, prior to self-reflection. This level of human living occurs pre-egoically, on the margins so to speak of reflective self-awareness, as the locus of consciousness. This ‘selfless’ and pre-reflective being is affected by hyletic

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matter within a specific temporal horizon and as a result this being discovers itself as an ‘I’ with abilities (Ich kann) and desires (Ich wille) (Hua-Mat IX, 137– 43). By self-less I mean the undifferentiated matter that has not yet been owned by the subject. The condition of Daseinswert thus enables the constitution of the ‘I can’ (Ich kann) and ‘I will’ (Ich wille), the two basic coordinates of ethical life. Husserl also refers to the I  as a Gutwert (good-value) since it represents what originally comes into being and is ‘there’ for us. Primitive being equates to a primitive value since it represents an ontological stratum that is there for us. In Gendlin and Rogers’ study the Daseinswert is represented by the human role that the therapist leaves open in order to give the client the choice to more fully own her humanity and recognize herself as a subject worthy of being valued. In other words, the Daseinswert is the space that the therapist leaves or holds open for the client to discover, expand into, and occupy in the midst of the therapeutic dialogue. This primitive being-a-value-for represents an ethical call in response to which the client’s scattered hyletic matter are gathered together and raised to prominence, that is, into wholes of meaning. Its product is a Wertsein (beingvalue), meaning a unit valued exactly because it comes into being and is perceivable as prominent among other beings. Becoming a subject is an accomplishment that is valued as such by the person who discovers herself as more fully present and whole. Ultimately, the Daseinswert as axiological core, in its there-ness or wertvoller Leistung (full value functioning), calls for the constitution of prominent units of axiological meaning. We live our lives as material things whose parts are scattered in different functions: our stomachs process food, our hearts beat, our brains sort out information. There is a moment when all these parts come together as a functioning whole that we call the subject. This moment is what I referred to, with Husserl’s term awakening. When the will decides to take ownership over these functionings, then each part acquires a value whose goal is addressed in a specific direction. The Daseinswert represents that affective necessity which expresses itself as an entelechy or an infinite system of goals all of which are based upon one’s Lebensziele (life goals) (Hua-Mat IX, 140). On a psychological level the goals correspond to the vocation that each person has in life: becoming a writer, a mother, a social worker, and so on. Along these lines, for Husserl ‘Let us act!’ (‘So Ich tue!’) is the most basic expression of the categorical imperative flowing directly from the affective force of the Daseinswerte. Moreover, it is the most primitive formulation of the ‘I can’ (Ich kann) through which one acts and therefore is, as an ‘I’: without the primitive ‘I can’ there would not be an Ich in the first place. Thus the very first moment

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of the ethical and existential I as such is its functioning as Being or Dasein (and therefore as a value) in the flow of time (Hua-Mat IX, 133). A person can become a subject if she perceives ‘her’ ethical ability to be through a full inhabiting of her own acts and her own lived-time; those are the places or topoi for the event of awakening that the therapist can continuously stimulate in the clinical dialogue which I am arguing is primarily a pre-verbal dialogue because it speaks to that which precedes articulation and the fully formed articulate subject. Reaching towards the highest level of her ethical life, the client becomes able to attend to the affective force of her hyletic matter and decide to accomplish the original vocation (Beruf) to which that matter calls her. The job of the therapist is to understand how to facilitate the transition from a dormant matter to an awoken responsible subject.

Being in the society Thus far I  have examined the process of ownership per se. It is true, though, that this process always takes place within a community, and it is true, as well, that every community has its own way of interpreting time and body. Owning our body and time in an originary way within our community is a difficult task, because the community already holds pre-interpretations of temporality and bodily life. Nevertheless, every time we fail in the endeavour of owing our body and time, we lose touch, a little bit more, with an authentic sense of our self and its living boundaries. The three tenets of Gendlin and Rogers’s approach reflect the relationship between the individual and the community, since these tenets are embedded in an intersubjective context. The therapist is one who, in society, is recognized as mediating individuals’ process of differentiation and individuation within a community. Empathy is the key term for understanding this mediation. In particular, in Stein’s (1917/1989) doctoral dissertation on empathy supervised by Husserl, she points to a specific form of empathy, iterated empathy, by which she means the self-imagining of the other as being with her own self. This iterated empathy allows the therapist to ascribe the intentional acts of others to herself as if she were to live their intentional lives. The therapist chooses to be with4 the client in order to lend her eyes and show her different ways to look at the intersubjective community. According to Husserl, the steps to live the other are the following: I live in the world according to a natural attitude. In this attitude I do not recognize myself as a sphere of owness (i.e., I have no ownership over my body, my time and my

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being), but rather as one with a community in which others affect my way of living. This first step can already be problematic: clients are not always aware of the ways in which their lives are shaped by their community, and they progressively lose touch with their self or, even worse, they never establish contact with it. At this level, clients can set in motion a process that Husserl would call ‘communalization’ (Vergemeinschaftung) in which a second ego appears to one’s first primordial ego to be similar to hers. In the process of communalization the person realizes that she is a community of persons; she became a we. She might use analogical apprehension through which the other, via the phenomenon that Husserl terms pairing (Paarung), is mirrored in her own lived-experience, meaning that she can represent the other because the other is both similar and dissimilar to her. The other appears via a pairing (Paarung), that is, via its external presence of an animate organism (Leib) similar to mine. When the client perceives the other organism as analogous to her, she lives an analogical apprehension that makes her recognize herself as a human being analogous to others. In fact, Husserl speaks of the harmonious synthesis (Einstimmigkeitssynthese) by which the person can confirm or deny the always changing presentations she can have of the other. Through the harmonious synthesis each part of the synthesis is responsible for the share of reality that will be integrated in the synthesis. Taking a class of dance, being part of a religious group, going to school, all these activities require a synthetic effort for which we feel part of the group because we decide how much of our self we want to put into the group. We recognize our self in the group,5 although sometimes only in a compartmentalized way. Laing (1960) argued that in the case of schizophrenics it is most often the community that is the cause of psychological problems attributed to the individual. As noticed by Laing, the healthy response to a poisonous system is a mental disease. In a sick family-system the schizophrenic will not be seen as an individual responding authentically to the system; instead he is taken as the sick one. He is seen as sick mostly because he does not allow the harmonious synthesis to take place. Even if healthy, a person can be labeled and seen as sick because she prevents the synthesis from taking place as normally expected by the group. This stance would actually make her appear sick in the other’s eyes. From a Laingian perspective in the case of the schizophrenic it is the alter egos living in a sick environment that are the cause of the disease attributed to the schizophrenic. That is why the therapist’s empathic relating can allow the client to recover the perspective of a healthy otherness. Therapist’s empathetic acts would help the client to re-constitute a new meaning of her self within a community of others. In a family system this apprehension can even lead to the

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client being treated as non-human by her family; we can think of cases of child abuse, for example, in which the child is considered an object rather than a sentient human being. Therefore, the objective world and mutual existence of the others can be attained by virtue of a harmonious confirmation of apperceptive constitution. I intend the other and represent her to myself according to a specific horizon of functionings and peculiarities that are to be continuously confirmed or corrected by my new intersubjective experiencing of them. The confirmation is harmonious because it does not conflict with the synthesis of other parts and aims belonging to the whole group, and the synthesis can be emotionally sustained in time. Harmoniousness is also reserved by virtue of ‘a recasting of apperceptions through distinguishing between normality and abnormalities (as modifications thereof), or by virtue of the constitution of new unities throughout the changes involved in abnormalities’ (Hua I, § 55, 125 sq.). If this harmony erases identity, it generates a sick system that needs to be worked therapeutically so that it allows for the family members’ exercise of a new form of iterated empathy. The mutual relations linking the members of a community involve an ‘objectivating equalization’ (Gleichstellung) (Hua I, § 56, 129) of the existence of the ego and the others. ‘I, the ego, have the world starting from a performance (Leistung), in which . . . constitute myself, as well as my horizon of others and, at the same time (in eins damit), the homogeneous community of “us” (Wir-Gemeinschaft)’; this constitution is not a constitution of the world, but an actualization which could be designated as ‘monadization of the “ego” – as actualization of personal monadization, of monadical pluralization’ (Hua VI, 417). The therapist’s interventions aim at facilitating the establishment of new relational norms within the family system, such that the client can more fully and authentically function within that system in a manner that is more ‘harmonious’ in Husserl’s sense.

Conclusions In the first part of the chapter I presented Gendlin and Rogers’s approach and discussed its three tenets.6 According to Gendlin the third point pertaining to the sub-verbal, affective, pre-conceptual nature of the basic therapeutic communication (Rogers, 1957, 1959b) is the most problematic. For this reason, I used Husserl’s descriptions of the volitional body, practical intentionality and the three layers of time in order to show how phenomenology explores the

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pre-conceptual and affective dimension of human relationships. Re-envisioned phenomenologically, the main goal of the therapeutic relationship is to invite the client to discover herself as a Daseinswert, that is, as an intrinsically worthwhile valuing and willing being who is able to become the subject of her body, time, and existence in fully inhabiting the human role that is left open to her by the therapist. The scope of therapy should enhance the constitution of the Daseinwert such that one’s personal will can find its voice within the community of wills (Willensgemeinshaft; Hua-Mat IX, 111–14). Of course, any living system, whether it be a family or the political community, will represent a significant challenge for this kind of constitutive process. As in all of Husserl’s phenomenology, a fully harmonious state is envisioned as an aim to be striven for in an endless series of relative accomplishments. The goal of Husserl’s ethics is the ongoing clarification of the web of interconnected lives within community in order to reactivate the authentic meanings of sedimented ego-less habituations (i.e., habits that take place without any active intervention from the ego). A phenomenologist who receives an adequate training in this approach should be able to explore through the analysis of practical intentionality the cycle of passive, ego-less, and active personal life and describe what are the meanings that need to be brought to light in the life of the client as an individual and as individual within the interrelationships that constitute her community. It is necessary for the therapist to be keenly aware of the part she plays in the cycle and be responsible for that. The language the therapist uses, her expectations as communicated verbally or non-verbally, the normative expectations she conveys may already be or become part of the problem the client is living. The person who is suffering from a mental disease is an opportunity for each of us to expand our sense of normativity and gain a deeper understanding of our community and its dynamics. Most of the times the ‘insane’ responses to society are the most obvious ones. Figuratively speaking, if a glass is put under a high amount of pressure, the glass would be likely to shatter. There is nothing abnormal in that reaction. Nevertheless, for some reason we consider schizophrenia as an abnormal and insane reaction to a high-pressure system. As we know from Laing, it is not the response, but the system that is insane. We – clinicians, scholars, teachers, or artists of any sort – have the task to see with clear eyes all the hidden layers that constitute human beings and find the right words, actions, images to name them. This process of naming can help people to see what is still invisible. If our sense of normality remains enslaved to an empty and meaningless number of oughts that cannot be named or cannot keep the pace with

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a continuously changing reality, then we would lose our battle to discover and rediscover our own authenticity. Form-less matter compels us to find an adequate form; yet until the form finds an adequate expression in our lives, any form is simultaneously possible and unconceivable. Similarly, the perceptual data that make a pen a pen have no name until we find the right name for them. Mental diseases are form-less matter that pushes for recognition in a new acceptable form. They point to an infinite number of forms that do not necessarily indicate a problem or a disease, but rather a new shape that calls for new meaning. Foucault’s analyses of the history of madness, or the history of supposed mental illnesses that are today no longer regarded as pathological, like homosexuality, are illustrative of the problematic relationship between matter and form within society. The correspondence of form and matter that conveys an emotional and cognitive felt sense of adequacy is what becomes labeled as ‘normal’. In order to reach this sense of adequacy we need to develop empathy, and the ability of seeing the infinite possibilities of this correspondence.

Notes 1. ‘That my own essence can be at all contrasted for me with something else, or that I (who am I) can become aware of someone else . . . presupposes that not all my own modes of consciousness are modes of my self-consciousness’ (Hua I, 135). 2. In his works Husserl mentioned multiple forms of intentionality: instinctive (Yamaguchi, 2001), vertical, longitudinal (section 3.2.4 & chapter 6XXX), collective, intersubjective, social, affective (cf., e.g., Hua XIV, 196ff. and Husserl, 1923), vitally flowing intentionality (lebendig strömende Intentionalität) (Hua VI, 259), intentional will (Willensintention or Willensmeinung). All these forms of intentionality stand for the tension that connects us with what seems to be outside of us. In his paper ‘Practical Intentionality and Transcendental Phenomenology as Practical Philosophy’ Nam-In Lee (2000, p. 50) defines practical intentionality as the form of intentionality that determines every other form of intentionality. This is so because practical intentionality represents the whole stream of consciousness that fulfills willing intentions and determines every conscious act, even transcendental ones (p. 55). In particular, practical intentionality is the hyletic continuum that is embodied by a volitional subject. The subject is a locus for the living of that continuum. According to Lee this continuum is characterized by always seeking to be, and the horizon of this being is intersubjective and historical (p. 56). Ethical science clarifies the motivations that are at the basis of this ‘seeking to be’. As Crowell (2013, p. 275) put it with admirable clarity: ‘Practical intentionality ultimately

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depends not on the individual conscious acts of perceiving, feeling, and willing but on a certain ability-to-be – namely, to be rational, to take responsibility for normative assessment.’ As Crowell and Melle (1997) remark, for Husserl all acts that can be considered ‘willing’ are modes of practical intentionality; furthermore, Husserl distinguishes acting intentionally – Entschlußwille (decision-will) – from the intentionality of action – Handlungswille (action-will). While the former is the intentional ‘deciding’ (fiat) that comes after a deliberation, the latter is more properly named practical intention, because it indicates the intention that precedes and accompanies the action itself. 3. In Manuscript E III 5 (Hua XV, pp. 593–7), Husserl introduces the expression ‘impulsive intentionality’ (Triebintentionalitaet) as a pre-direct, non volitive, and essentially Ego-less form of intention. ‘I have introduced it not as an egoic (characterized in the widest sense intentionality of willing) as founded in a Ichlose passivity’ (Universale Teleologie). The primal hyle (Ur-hyle), which Husserl calls Stoff (stuff ), corresponds to undifferentiated material, which accompanies the development of hyle into an egoic matter (Manuscript C IV, 18). For example, a house appears to me in a manifold of appearances that gather chaotic hyletic matter into an intelligible form (Hua XVI, 49–50). ‘The proper appearance and the improper appearance are not separate things; they are united in the appearance in the broader sense’ (Hua XVI, 49). Real and ideal, the intuitive and the conceptual are given all at once. ‘This appearance is not presentational, although it does indeed make its object known in a certain way’ (Hua XVI, 50). What Husserl calls ‘hidden intentionality’ (Hua XVI, 21) is a part of that practical intention that comes into being as the primal hyle presents itself and gives itself intuitively. This form of intentionality, properly speaking, is not phenomenological because it prepares the ground for phenomenological reflection, as it is both prereflective and passive (Hua XL, 366; En tr. 21). Yet, we cannot conclude that it is not intentional at all or does not relate to what is phenomenologically intentional. We would not be able to reflect on any meaning or intentional essence if the matter, both hyletic and essential, did not present itself. This is the form of intentionality through which we can become living bodies; this is the form of force that impinges on the matter that our body is as Koerper and awakes us into a living body. ‘Purely through their (prehyletic data) own essence and in passing from one mode to the other, they found the consciousness of the unity and of the sameness of what is given to consciousness in them’ (Hua XL, 366; En tr. 21). There is ‘a background livedexperience’ that ‘finds’ a way to become ‘sameness’ or ‘unit’ or ‘present’ (Hua XL, 366; En tr. 21). Becoming a subject means commitment to be responsible for one’s unity. The living thing becomes a living subject when its material body becomes a volitional body and commits itself to own its matter.

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‘Primordiality is a system of impulses. This intentionality has its transcendent “goal,” in the primordiality as proper goal’ (E III 5, cit. in Paci 260–2). This I-ness intentionality comes to being as a Triebsystem (system of impulses). It strikes the I – first as a biological body and then as a volitional one – in the form of impulses that animate the matter and stimulate its interpretive side. In this way, the hyletic matter becomes given (F I 24, 41 b). 4. See on empathy, Englander (2015). 5. This idea is surprisingly close to Rousseau’s ‘General Will’ as it is expressed in the ‘Social Contract’. 6. I want to thank Marc Applebaum for his help in reading my chapter and making my ideas clearer and Magnus Englander for our discussions on the problem of empathy.

References Betz, B., & Whitehorn, J. C. (1956). The relationship of the therapist to the outcome of therapy in schizophrenia. Psychiatric Research Reports of the American Psychiatric Association, 5: 89–106. Biceaga, V. (2010). The concept of passivity in Husserl’s phenomenology. London and New York: Springer. Carr, D. (1999). The paradox of subjectivity. Oxford: Oxford Press. Donohoe, J. (2004). Husserl on ethics and intersubjectivity. Amherst, NY: Humanity Books. Englander, M. (2015). Selfhood, empathy, and dignity. In S. Ferrarello & S. Giacchetti Ludovisi (eds), Values and Identity. Cambridge: CSP. Ferrarello, S. (2015). Husserl’s ethics and practical intentionality. London & New York: Bloomsbury. Gendlin, E. T. (1961a). Experiencing: A variable in the process of therapeutic change. American Journal of Psychotherapy, 15: 233–45. Gendlin, E. T. (1961b). Initiating psychotherapy with ‘unmotivated’ patients. Psychiatric Quarterly, 35: 134–9. Gendlin, E. T. (1962). Experiencing and the creation of meaning. New York: The Free Press of Glencoe. Gendlin, E. T., Jenney, R. H., & Shlien, J. M. (1960). Counselor ratings of process and outcome in client-centered therapy. Journal of Clinical Psychology, 16: 210–13. Hart, J. (1992). The entelechy and authenticity of objective spirit: Reflections on Husserliana XXVII, in Husserl Studies, 9, pp. 91–110. Husserl, E. (1973a). Phänomenologie der Intersubjektivität. Texte aus dem Nachlass. Zweiter Teil. 1921–28 (ed. I. Kern). The Hague: Martinus Nijhoff (Hua XIV). Husserl, E. (1973b). Experience and judgment: Investigations in a genealogy of logic (trans. J. Churchill and K. Ameriks). London: Routledge & Kegan.

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Husserl, E. (1988). Vorlesungen über Ethik und Wertlehre. 1908–1914 (ed. U. Melle) . The Hague: Kluwer Academic Publishers (Hua XXVIII). Husserl, E. (2002). Natur und Geist. Vorlesungen Sommersemester 1919 (ed. Michael Weiler). Dordrecht, Netherlands: Kluwer Academic Publishers (Hua-Mat IV). Laing, R. D. (1960). The divided self: An existential study in sanity and madness. Harmondsworth: Penguin. Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting and Clinical Psychology, 21:95–103. Rogers, C. R. (1959a). A theory of therapy, personality, and interpersonal relationships as developed in the client-centered framework. In S. Koch (ed.), Psychology: A study of a science, vol. III. Formulations of the person and the social context, pp. 184–256. New York: McGraw-Hill. Rogers, C. R. (1959b). A tentative scale for the measurement of process in psychotherapy. In E. A. Rubinstein, and M. B. Parloff (eds), Research in psychotherapy. Washington, DC: American Psychological Association. Spiegelberg, H. (1972). Phenomenology in psychology and psychiatry. Evanston, IL: Northwestern University Press. Stein, E. (1917/1989). On the problem of empathy. Washington: ICS Publications.

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The I and the We Psychological Reflections on Husserl’s Egology Marc Applebaum

Introduction This chapter seeks to contribute to answering the following question: How can a Husserlian phenomenology, which at first might appear to focus exclusively on first-person meanings given to the consciousness of individual subjects, contribute to psychiatry’s understanding of and ability to work within the field of social interrelatedness – that which is lived by a we, not merely by an I? The approach I will take is to begin with first-person description in an interpretive dialogue with Husserl’s writings on egology and its relationship to the ‘you’ and thus the ‘we.’ In explicating the data so given, I will rely upon both Husserl’s static and genetic phenomenology. I will work with personal, experiential data because the data of phenomenological psychological research is intimate – and in seeking to bring Husserlian insights down into the soil and messiness of everyday psychological lived-experience, we work in a primary way with raw, first-person narratives. This chapter is not intended as a full-fledged psychological study – for example, eidetic findings are not sought – it is intended in part to exemplify how data opens to the phenomenological eye. In this case the narrative material is my own, but the data might just as easily come from an Other – in any case, our personal lives are the flesh without which the εἶδος (eidos) would be disembodied, lacking life and warmth. For psychological researchers, the embodied lived-experiences given to us in the form of narratives are more than mere raw material for the scholarly ascription of essences – they are the human setting through which the eide are clarified in order to return to us, incarnate, pregnant with meaning for future living. This chapter aims to contribute to illuminating a

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Husserlian sense of the ‘we’ by exploring the layers of the ‘I’ and its origins and embeddedness, for Husserl, in I-You relations – that is, within the we-world of companionship (socius) and community. Sociality refers to our companionship (Latin:  socius) with fellow human beings, the living-together-with within which the work of psychiatry and psychology is situated. To shed light on the meanings of socius for psychiatry and psychology, I  will not address the ‘we’ or we-intentionality in isolation  – as might be an appropriately sharp focus for philosophical phenomenologizing – but rather seek to ground a sense of the we in a Husserlian understanding of the ‘I’s’ that encounter each other in living the ‘we’. My guiding assumption is that in order to grasp the ‘we’ phenomenologically, it is necessary to first grasp who and what are the subjects who encounter each other in an already-given intersubjective world as persons. Consequently, I will seek to situate we-intentionality within phenomenology’s overall account the constitution of egos. A reader who is new to Husserl or the tradition he initiated might imagine that a phenomenological understanding of consciousness, ego, and community could be easily grafted onto mainstream psychological conceptions – for example, the assumptions held by psychodynamic, object-relations, or cognitive-behavioral theory. However, this would be a fundamental flattening and impoverishing of the phenomenological tradition, neglecting its radicality, and therefore miss what it can offer social psychiatry. Without bracketing mainstream psychological assumptions about the origins and meaning of the ‘I’ – that is, without bracketing, one might say, the natural theoretical attitude of mainstream clinical psychology  – we are likely to replicate the hegemonic occidental conception of ego within which as Cushman (1995, p.  69) writes, the ego is envisioned and indeed idealized as individualistic, ‘bounded’, and ‘masterful’, in a manner inseparable from systems of diagnosis and social control. Phenomenology demands that we regard such normative scientific conceptions as constituted and historically situated, rather than accept them as givens, because to take this conception as given would be to lapse into a kind of naïveté towards which Husserl (1970, p.  48) wrote, every methodical science tends, observing in the Crisis that ‘to the essence of all method belongs the tendency to superficialize itself in accord with technization’. To leave unquestioned dominant theoretical conceptions of ego in a phenomenological approach to psychiatry would amount to colluding with an impoverished psychological praxis lived as τέχνη (techne). Instead, phenomenology has a radical task in relation to egology and sociality; as Hart (1992) has written, this task does not stop at bracketing the natural attitude in order to unfold how that which appears appears for us; in

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a sense this would render us mere spectators. Rather, Hart writes, ‘phenomenology’s ultimate task is to uncover this anonymous pre-personal, pre-egological “to which” – to which appears all that appears’ (p. 194). That this more radical task has immense importance for psychology should be immediately clear.1 This chapter seeks to introduce the reader to Husserl’s investigations of consciousness that provide the context for the field of I-You relations within which sociality arises. I hope to provide readers with a basis for progressively bracketing mainstream psychological assumptions concerning conscious contents as the exclusive possession of egos envisioned as enduring and strictly bounded entities whose selfhood is entirely narrative, and the view that the social realm is an amalgamation of interrelated but fundamentally divisible, isolated egos.

En-worlded Relationality and Primordial Relationality For Husserl our relational life is complex and multilayered. Phenomenologically, the encounter with otherness is critical in two quite different ways: in the active shared constitution of a common world by subjects, which I will refer to as enworlded relationality, and in a primordial, passive manner close to the very origin of the ‘I’, which I will refer to as primordial relationality. The term ‘collective intentionality’ is most frequently used in reference to the former: the intentional relations and co-intending lived by subjects in community. I will begin with a short discussion of we-intentionality as co-perceiving, en-worlded relationality, and then move to the primordial origin of the ‘I’ in relationship. From a phenomenological perspective, in everyday consciousness experience objects are given to a perceiver both directly and indirectly. In biting into an apple, its taste is directly given to me as a presence. In contrast the genuine manner of the givenness of some objects of consciousness is indirect, and this applies to my consciousness of the ego of the Other: for phenomenology, the conscious life of the Other transcends my consciousness (Husserl, 1973). The alter ego is given to me in worldly life as alter precisely because I encounter her as a fellow being whose conscious interiority I do not access and live with the same kind of immediacy as I do my own (ibid.). This is not to say that the Other is not encountered genuinely and in a compelling way – my interiority is not privileged in this view, the Other’s presence as Other is not deficient compared to my self-presence. However, what is given to me is by necessity only a partial view of the Other. Yet despite this partiality I nevertheless encounter her as a whole being – in her entirety as an Other, in Husserl’s terms, she is both presented and

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appresented to me (ibid.); an analogy is the way in which I see a whole house before me, even though all that’s given to me is the facade. The facade is presented, the back of the house is appresented. As Carr (1973) explains, for Husserl, we-perception and the grasping of intersubjective objects occurs when two or more people share overlapping presentations and appresentations. For example, if my friend and I watch Sorrentino’s film La Grande Bellezza and discuss it afterwards, what occurs is a co-seeing, each from our own angles, with different but related presences and absences – features of the film that he sees I may not have seen, and vice versa, yet there is a we-seeing. It is not that we have two fundamentally separate perceptions, each sealed hermetically so to speak within our skulls  – that each of us sees so to speak a ‘different’ film, and we ‘compare notes’ to identify commonalities between these two different films, ‘mine’ and ‘his’. Rather, we are engaged in a shared act of perceiving La Grande Bellezza as such, an intersubjective object, each from our own perspectives – the unity of the act contains its multiplicity. Hence in Carr’s words, [F]rom the point of view of either presentation – mine or the other’s – it is the same act that is constituted. And, if we take the concept of sameness seriously here, the perception ‘as such’, which corresponds to ‘the whole intersubjective object’, can only be considered our perception. The perception is a constituted act that cannot be ascribed totally to either of us, but only to both of us, to the we. (p. 30; emphases in the original)

We need not agree in the least regarding our interpretations of the film to nevertheless co-see it; it is an object that invites a multiplicity of readings, but the film is the object of our perception and our conversing. Furthermore – and this is particularly important for the present investigation – Carr writes, The establishment of the we in common perception is the simplest form of what Husserl calls the Vergemeinschaftung der Monaden [communalization of monads] when two subjects confront one another and stand in relation to the same objects they form, to that extent, a rudimentary community that can itself be considered as performing an act (cogitamus) through ‘its’ diverse (and in this case simultaneous) presentations. (p. 30; emphases in the original)

Here we must take the word community quite seriously: it is not meant metaphorically, but rather, practically and foundationally, because the genuine meaning of community – of socius or companionship in living – is founded upon the shared living of a common world, not merely formal correspondences between my perceptions conceived of as ‘my reality’ and ‘yours’; as if we

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inhabit private universes within which we each possess a kind of Lordship! Furthermore, Carr (1987) observes, fidelity to the phenomenon of ‘we-ness’ means that we cannot describe community as an ‘it’ without falsifying the lived-experience. Our meeting in the intersubjective field is an event, a coliving the implicates our subjectivities, that can only be named an ‘it’– as in, ‘It was a moving funeral service’, through a distanciation that falsifies the livedmeaning of the event itself. For Husserl the implications of we-intentionality are so far-reaching that as Carr (1973, p. 30) writes, they lead ‘to a whole theory of experience, constitution and the world whose point of departure is no longer individual consciousness but such a community at whatever level it may be found’. For example, as Carr (1986, pp. 290–1) explored in a chapter entitled ‘Cogitamus ergo Sumus’, communities ‘can be considered intentional subjects, analogues in some ways to individual subjects’, hence the ‘we’ can be understood as a kind of ‘subject or agent’, and just as a person has her own narrative, so can a community; ‘certain groups we call communities are subjects for themselves of a kind of life-story, just as an individual is’. The implications for social psychiatry of the first kind of relationality I mentioned above, en-worlded relationality, begins to stand out as it becomes clear that a phenomenologically informed social psychiatry can examine both the co-constitution of communal experience and life at multiple levels – in intimate relations, families, cultures, and subcultures, in a way historically and linguistically situated – as well as examining the breakdowns or ruptures in communality, the obstacles or fissures in co-constitution and co-living that makes full use of Husserl’s work, largely neglected by psychologists thus far on affective intentionality, which will be addressed below. Everything we have traced so far in terms of relationality is centered upon the layer of everyday lived experiences in which ‘I’ am already named for myself as ‘this person’, with a personal history, identity, name, and so on – I have termed relationality so situated an ‘en-worlded relationality’. As we will see, Husserl (1989, p. 128) refers to this layer of being-an-I who has relations with others as the ‘personal ego’ or the ‘empirical ego’, and this is the layer of the ego properly named ‘the real psychic subject’. But for phenomenology this is but one layer of being an individuated locus of consciousness. It is clear that en-worlded relationality already offers a perspective on the life of consciousness that emphasizes its embeddedness in communities and shared narratives as constitutive of psychological life not centered on the individual human person in isolation. Perhaps even more radical a shift away from the solus ipse is pointed to by Husserl’s work on primordial relationality and its place in constituting the ‘I’.

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While phenomenological philosophical inquiry is rightly regarded as emphasizing a first-person perspective, it is sometimes for this reason misconstrued as neglecting intersubjectivity and narrowly focusing on ‘private’ experiences in a way that risks solipsism and a fatal devaluation of interrelatedness (cf. Zahavi, 2003).2 Were it the case that phenomenology exclusively grounds its claims in the private experiences of a self-contained, solitary I, and from this solus ipse proceeds to deduce the alter ego as a mere analogue to its own primacy, phenomenology would invite the charge of solipsism, since it would reduce the otherness of the Other to, as Hart (1992, p. 179) puts it, ‘simply a declension of me’. In fact as Hart maintains, rather than inviting the charge of solipsism, Husserl argues that the core of one’s sense of being an ‘I’ – by which is meant in this instance being an empirical, personal ego – derives from the originary, primary experience of being recognized by an Other: ‘in a geneticconstitutional sense I am, first of all, The Other to Others’ (ibid.). That is, I-ness arises within a relational matrix; moreover, Hart argues, for Husserl the ego’s primordial sense of its ‘I’ is in a sense given to the ego through its encounter with the Other as ‘the first personal “I” (ibid.). That is to say: the You is the first ‘I’, I ‘learn’ my ‘I’ through the encounter with the You. As Hart puts it, ‘the original sense of “I” is not what I refer to but to what I perceive the Other to refer when self-referring’ (ibid.). More specifically, being seen by the Other – being recognized as an Other by the Other, is that which grants me a full sense of my ‘I’, the Other’s extending himself toward me in what Hart (1992) refers to as ‘gracious regard’, because in this view, I-ness is a kind of gift given through a caring, even a primorially loving relationship. Hart describes this as occurring developmentally in infancy, for an ‘I’ who has not yet arrived at self-reflecting and position-taking acts of consciousness (ibid., p. 180). Here, we are engaging with the genetic dimension of Husserl’s phenomenology, because we are seeking to reconstructively trace our way back (the Rückfragen) to the grounds of lived intentionality in its ongoing flowing between passivity and activity – in Hart’s words, to ‘the awareness of an infant or waking monad’, which static phenomenology, focused exclusively upon the examination of active intentionality’s cognitive achievements, cannot access (p. 185). Hart’s linking of the infant to the ‘waking monad’ alerts us that the I’s reliance upon the Other is in principle not limited to infancy, but also is embedded at a primordial level in all relating-in-awakening, since as we will see below, for Husserl every monadic, streaming locus of consciousness that awakens to ‘find’ itself as this person in the world is simultaneously, at a deeper stratum, an anonymous, pre-reflective, and not-yet-self-recognizing hyletic flow.

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When the ‘I’ awakens in meeting an Other, the way in which the Other transcends my consciousness of her is most fully realized when I relate to the Other as a You rather than as a thing, an it (Hart, 1992, p. 40; cf. Buber, 1970). The Other’s presence for me is characterized by a kind of absence of my perceiving ego’s centrality and self-immediacy – instead, the Other is privileged.3 Hart (1992, p.  179) names this shift  – which is constitutive of the Other as other and thus makes interrelatedness possible – a ‘self-displacement’. This selfdisplacement is not affectively neutral, but reflects a primordial love; in making this case Hart (1992) draws upon Husserl’s discussions of love – a dimension of his phenomenology foreign to most phenomenological psychologists.4 Love require alterity, and Phenomenology’s examinations of otherness do not imply an undifferentiated, muddy merging of ego and alter, but rather, a primordial interdependence that requires we abstain from reifying the boundary between ego and its Other. As Carr (1973, p. 29) notes, for Husserl, ‘the alter ego is not posited outside my own experience; rather, he is brought into the sphere of my own experience through the broadening of the concept of experience and of the concept of a monad’ (emphasis in the original). It is beyond the scope of this chapter to offer a full presentation of the primordial reliance of the ‘I’ on the ‘You’ in Husserl’s phenomenology; a brief discussion of Hart’s (1991) work on primordial communalization and primordial empathy will serve as a provisional indication of the implications. As Hart (1992, p. 186) writes, Husserl concluded that at the limits of phenomenologizing, if the inquirer attempts to perform the most radical, primordial reduction possible by stripping away every trace of alterity from the passive streaming life of consciousness, leaving only owness, the attempt to fully bracket Otherness proves impossible in principle. Hence the co-presence of the Other is an inescapable constituent of consciousness as such. Husserl likewise proposes the existence of a ‘primal empathy’ or ‘instinct of empathy’ that is a form of communalization occurring on the transcendental egoic layer and underlying the empathic perceptions of personal egos in everyday life. In 1932 Husserl writes, ‘in the primordial sphere we have already empathy – but disengaged from functioning and itself anonymous’ (C 16 IV, 28; cited in Hart, 1992, p. 185). Husserl calls ‘the communalization (analogous to retention) prior to empathic perception a primal empathy or instinct of empathy’ (ibid., p. 236). Another way to say this might be that what we observe as lived-experiences of empathy between en-worlded, personal egos have, for the empathizing empirical ego, an anonymous, pre-empirical nucleus that is enfolded within the actively intending and self-narrating flow of the personal ego. This would also imply

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that for an inquirer to discover the primordial ground of his or her empathic relations would require genetically tracing the instinct back to its pre-egoic ground. Moreover, I  would like to argue that the primordiality of the finding oneself in relating to the Other has a strong purchase on the human person precisely because its ground is pre-egoic in the sense of prior to and constitutive of personal selfhood. For this reason the call to attend to the empirical Other is never solely a factual one, it is always also a primordial call: it calls to the person at a level that is prior to the constitution of the narrative so often taken, in a natural attitude, as his or her essential self.5 Or, otherwise put, the You is not something encountered by an already self-aware ‘I’: instead I-ness arises for a locus of consciousness finding itself as an I in the midst of its encounter with a You, a finding prompted by the presence of that You. Husserl questions precisely what kind of identity, if it is an ego-identity at all, can be associated with the ground of empathy? ‘Is it already I?’ he asks, ‘Is it not rather the case that only through the transcending of its subjectivity in the non-memorial represencings, those of empathy, that the “I with the Others”, I and Others as existing, comes to be?’ (D 10 IV, 18, cited in Hart, 1992, p. 186). So the ground of community and human interrelatedness for a phenomenologically informed social psychiatry is to be found in this direction – the inquirer’s genetic tracing back beyond the empirical ego to her pre-egoic source. Hart’s argument, strongly relevant for social psychiatry or psychology, is simultaneously ontological, axiological, and erotic: ‘there is a basic analogy and symmetry of love as self-displacing and selfcommunalization which are the conditions for self-consciousness (wakefulness) and the presence of Others through empathy’ (p. 231). Drawing out the implications of these three intertwined levels is a matter for future work. If we shift our focus from the primordial to the context of everyday life in a natural attitude, the I’s embeddedness within a world given to me with my fellow men and women is so emphasized by phenomenology that Merleau-Ponty (1996, p. xi) remarks in the Phenomenology of Perception, ‘[T]there is no inner man, man is in the world’, and it is helpful to consider that the world meant here is in Husserl’s words a ‘we-world’, a Wir-Welt, or a ‘with-world’, a Mitwelt (Moran, 2012, p. 288). Hence being in contact with world cannot be conceived of as a private affair; rather, Husserl (1973, p.  91) claims phenomenological praxis discloses that ‘I experience the world (including others)  – and, according to its experiential sense, not as (so to speak) my private synthetic formation but as other than mine alone [mir fremde], as an intersubjective world, actually there for everyone, accessible in respect of its Objects to everyone’ (emphases in the original). I will next examine in greater detail the layers of the ‘I’ discussed

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by Husserl, which appears to resemble less and less the strongly bounded ego Cushman (1995) characterizes as postulated by mainstream American clinical psychology.

Husserl’s Egology: The Pure and the Personal Ego Husserl (1989) frequently describes consciousness using the metaphor of geological strata or layers. The two layers we are interested in here are the Pure or Transcendental layer of the ego, and the personal or empirical ego, the individual psychic human subject with his or her personal habits, characteristics, history, surrounding community, and cultural context.6 Husserl argues that these layers of conscious life can be discerned and described by phenomenology, and it is precisely for this reason that ‘[w]e distinguish, ever faithful to what is given intuitively, between the pure and transcendental ego and the real psychic subject’ (p. 128; emphasis in the original). However precisely in making these distinctions Husserl warns against conceiving of them in a naive way, as if the layers of ego were disconnected or strictly separable. On the contrary, ‘as transcendental ego, after all, I am the same ego that in the worldly sphere is a human ego’ (1970, p. 264; cf. 1973, p. 37).7 For Husserl (1989, pp. 116–17), ‘pure Ego’ designates the unique locus of a streaming conscious living, ‘the center of all intentionality whatsoever’, that constitutes a given personal ego and her world through the intentionality of consciousness. Hence flowing life of the pure ego is a layer of conscious living that exists ‘prior’ to its constituting (finding) itself as a personal ego with her habits, character, autobiography, history. To express the constitutive event as a finding is consistent with Husserl’s own language of ‘encounter’: the constitutive relationship between the pure and personal layers of ego is such that, he writes, ‘I must encounter myself constituted as personal Ego’, because ‘the course of the lived experience of pure consciousness is necessarily a process of development in which the pure ego must assume the apperceptive form of the personal ego, hence must become the nucleus of all sorts of intentions’ (p. 263). I find myself as a personal ‘I’, yet it is the pure, pre-subjective layer of my ‘I’ that is the nucleus of ‘my’ ongoing intentional acts. That the pure ego as a layer of conscious life is ‘prior’ to the empirical ego is meant ontologically, not temporally, because temporality is constituted along with and therefore only arises for the personal ego: it is only an ‘I’ who awakens and recognizes herself as existing in this spacial location at this time, for whom temporality exists.8

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Thus the layers of pure and the personal or empirical ego are in constant interplay as constituting and constituted; as the pure ego intentionally grasps its living as the life of an empirical identity, the layer of personal subjectivity coalesces as the person names her objects and herself, with the world-for-consciousness emerging in simultaneous and differing ways for each layer. In relation the world as spacio-temporal setting, Husserl (1989, pp. 116–17) notes, ‘the empirical Ego in the form, I as man, functions as the phenomenal-real central member for the constitution, in appearances, of the entire spatio-temporal world’. For Husserl (1989, p. 264), the arising of the personal ego within the streaming life of a given monad does not occur in a self-contained, solipsistic way through self-perceptions and self-experience, nor is it assembled so to speak associatively through actively intended actual experiences. Rather, the personal ego arises ‘out of life’ – in Husserl’s words; life ‘is what it is not for the Ego, but it is itself the Ego’ (ibid.). In other words, the ego is a locus of living and located empirically in time and space – it is not a composite of associations about life. This living is not solitary, hence the development of the personal ego is shaped by one’s interrelationships with others, both individual others and the communal context in which one lives, including ‘the demands of morality, of custom, of tradition’, which can be taken on either passively, or through active position-taking – that is to say, through the reasoning and ethical choices one makes in relation to the social context in which one finds oneself (pp. 281–2). The ego’s choices are formative in that through its chosen behaviors ‘the Ego exercises itself, it habituates itself, it is determined in its later behavior by its earlier behavior, the power of certain motives increases, etc. The ego “acquires” capacities, posits goals, and, in attaining these goals acquires practical skills’ (p. 265). Hence the personal ego ‘is constituted out of one’s own (active) position-taking, and out of one’s own habits and faculties, and consequently is an externally apperceptive unity, the kernel of which is the pure Ego’ (p. 278; emphasis in the original). Simultaneously the pure layer of the ego is a strata of one’s conscious life that demonstrates unity and uniqueness, in that ‘[t]he pure Ego is . . . numerically one and unique with respect to “its” stream of consciousness’ (Husserl, 1989, p. 117). We can say the pure ego is individuated in that there is a sense in which ‘every human-ego harbors its transcendental ego’ (Husserl, 2001, p. 471). In itself the pure layer of ego is not a person with a personal identity; rather, it is the constituting source of that personality: it is the ongoing ‘nucleus’ of a conscious life that is required for the sense of a personal ego to continue to arise and change as an identity that undergoes changes in time. In contrast to this mutability:

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In itself the pure Ego is immutable. It is not the kind of identical something that would first have to manifest and prove itself as identical by means of properties remaining permanent throughout manifold states as these are determined by changing circumstances. Therefore it is not to be confused with the Ego as the real person, with the real subject of the real human being. It has no innate or acquired traits of character, no capacities, no dispositions, et cetera. It is not changeably related, in real properties and states, to changing real circumstances, and thus it is not given in appearance with reference to appearing circumstances. In order to know what human being is or what I myself am as a human personality, I have to enter into the infinity of experience in which I come to know myself under ever new aspects. (Husserl, 1989, p. 110)

‘Immutability’ might appear otherworldly; instead I would argue that, since the pure ego has its own habitus, it is not envisioned as frozen: stasis is by no means Husserl’s intention here – what does not change is the wholeness characteristic of the monad. In contrast to this unity, the ego as the real person, real subject, is always living changing circumstances and its life is in constant flux. And it is largely at this layer of the ego that I name, recognize, and know myself as a subject having a kind of endurance and describable character: Husserl writes, ‘I know what my own character is like: I have an ego-apperception, an empirical “self-consciousness”. Each developed subject is not just a stream of consciousness with a pure ego, but each has accomplished a centralization in the form, “Ego” ’ (p. 277). The pure layer of ego does not disappear when the personal ego is constituted; instead, a wide range of daily phenomena are the lived experiences that belong to this or that pure ego. Hence the bodily experience of warmth of the sun upon my arm is not exclusively lived by the personal subject – on the contrary, in the breadth of human experience the widest range possible is in the flow of the pure ego, and only a limited constituted subset of that flow pertains to the personal subject. Hence from this perspective, most of what we live is lived in its foundations pre-personally, and only a sliver of our lives, which are already personally being lived, are further constituted as feature of the life of ‘I the man’, or ‘I the woman’, with all the distinctness of my life. The life of the psychic subject is highly fluid and dynamic, yet this does not mean that the psychic ego itself, for Husserl, is nothing but a locus of flow lacking enduring qualities. The personal, psychic ego is a unity-in-change, an identity which, while always being constituted by the pure ego, is nevertheless characterized by an important degree of unity:

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What is meant by this psychic Ego . . . is not the monadic flux belonging to this Body experientially, nor it is something that occurs as a real moment of this flux, but rather is a unity indeed essentially related to the flux, though in a certain sense transcending it. The subject is now a substrate of properties (personal properties in a determinate, very broad sense) analogous to the way a material thing is a substrate of thingly-real properties. (Husserl, 1989, p. 129)

Descriptive Example of the Interplay of Pure and Personal Ego As noted above, we would misunderstand Husserl if we were to view the pure and personal egoic layers as walled-off from each other or strictly separable, since as the center of constitutive life, the transcendental layer of ego is dynamic and ongoingly constitutes the personal ego and its world.9 As modes of the flowing life of the monad, the pure and personal layers of ego are co-present in varying degrees in everyday experience. To give an example of their interrelatedness and constant intertwining, I will describe an actual experience of the following phenomenon: struggling to remember something that felt important. In so doing I  will rely on Husserl’s accounts of active and passive intentionality, affective intentionality and awakening, and hence both the static and genetic dimensions of Husserl’s phenomenological praxis. My aim is to convey the complex layers of Husserl’s egology, the dynamism characterizing individual egoic life – a life always situated among and in relation to others – and begin to suggest the way individual agency is grasped phenomenologically. Now, to the description: During a period of time in which my family was struggling to cope with my father’s deepening Alzheimer’s, one day the image of an actress came to mind, but I was unable to remember her name. In trying to remember the name of this actress, a remembering which felt emotionally compelling, I began to search in a memorial way for her name, which was present to me as a kind of frustrating absence. It was as if the name of the actress was somehow ‘in’ me but I could not grasp it: her image both as a young girl and a woman was easily available to me in memory, yet the name eluded me. Searching in an associative way, I ran through multiple roles she played in film: as a young girl opposite Jean Reno in Leon the Professional; as a princess and mother of Luke Skywalker in several of the Star Wars sequels, even as a ballet dancer in Black Swan, a film I have never actually seen! More than that, I remembered easily that like me she is of Jewish background, and I  had some additional associations of her having married

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a Frenchman . . . but with all that, her name still escaped me. This ongoing inability was not a neutral experience – I was troubled; feeling stuck and unable to remember was worrisome, though at first I  was only vaguely aware of the emotional tone of faint anxiety in the background of my frustrated efforts to remember, and which I only later connected to fears provoked in me for my own future memorial health by my father’s worsening dementia. In fact, I chose not to pull out my smartphone and use Google, which would have instantly given me her name, because the presence of the missing name for me convinced me that somehow I ‘had’ it, but was unable to grasp it, and I did not want to shortcut ‘really remembering’. Instead I chose to struggle with the present absence.

Let’s pause in this narrative and reflect on the layers of ego that are already evident, which I  will consider as if it is an Other’s story, using the third person. What’s most evidently highlighted is the personal ego, I the man, the individual subject, the son of a father who was in the midst of losing his memory. It’s the subject’s personal ego who is striving to accomplish an action: to remember a name. But did this task and all the urgency that surrounds it  – which clearly relates to the story of that personal ego, his identity, and questions about his identity and mortality in relation to intimate others in his life – arise from the personal ego in the first place? In other words what was occurring before he recognized and seized upon the task of trying to remember the actor’s name, as an emotionally laden task? There was a flow of streaming consciousness in a natural attitude in which only at a certain point self-reflection entered, when the flow was obstructed by his inability to remember her name. Prior to the obstacle being encountered and recognized as an obstacle, he was in was a largely hyletic, passive flow – a series of associations which were almost entirely un-reflected upon. The personal ego in this condition was largely latent, while the constitutive streaming which is the life of the pure ego was of course ongoing and mostly passive, a largely anonymous moment in a natural attitude. In the moment an obstacle was encountered, the personal ‘I’ named itself and the problem he faced and came to the fore in so doing – that is, the personal ego came to the forefront as he named the problem he faced and his sense of himself arose with that obstacle: the elusive object of consciousness, the missing name. All of this marks a shift from largely passive intentionality to active intentionality, with the frustrated ‘I’ as the subject of consciousness over and against the object, the unremembered name. And as that personal ego shifted to the foreground, a history, a narrative, and a horizon all come into play – his horizon in this case is colored by the fear of a far more serious losing of his

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capacity to remember, just as his father was increasingly losing it. Importantly, that fearful horizon is present even though it is not being fully reflected upon in that moment – because the personal ego always brings with it its context, its horizon, and its history, which is not merely a cognitive horizon and history but an affective one as well. Indeed, the faintly fearful quality of being unable to remember something was a fairly recently sedimented habitual way of living the phenomenon of failing to remember something, in his life, because it was only the past seven years since his father’s Alzheimer’s diagnosis, and as he approached the age of fifty himself, that the meaning of being unable to remember had become something fearful for him rather than merely inconvenient and unremarkable, a mere fact that would likely trigger nothing more than Googling ‘Leon the Professional’! Previously he might simply have pulled out his phone or asked a friend for the actress’s name; now remembering becomes its own task. Thus far we have seen a moment in the passive flow of consciousness in everyday life in which the layers of ego are present but the personal ego is only indistinctly so, followed by a shift to an emphasis on active intentionality and the personal ego as the subject that so to speak coalesces in facing an obstacle, and in relation to that object of consciousness his ego-identity as a subject is evoked. As we will see, remembering is seized upon as a task by the personal ego, yet the inability to remember is subjectively frustrating because it points to an act which transcends the personal ego’s capability and is beyond the scope of the personal ego’s agency. I will now return to the first-person narrative: I discovered no matter how much I searched memorially, I could not grasp the name of the actress. I withheld myself from solving this problem technologically or socially; instead, I chose to live with the absence of the name indefinitely in order to find out if I remembered later. I then let go of the struggle and, for days and maybe weeks I would occasionally recollect the actress’s image and return to the question of her name, which continued to evade me. An indefinite number of days later, again in the midst of the flow of everyday life, with the question coming in and out of my awareness, the name ‘Natalie Portman’ suddenly came to me, I think not even in a moment in which I was aware of searching for it. Once the name was there, I felt relief and joy! The way the name stood out was precisely not as the outcome of my effort in that moment; on the contrary, it seemed that her name was suddenly present for me, disclosed to me, and I merely witnessed it and felt the ongoing question answered and the absence fulfilled by a meaning which had somehow been present with me all along, but absent. To say that ‘I remembered’ is only partially descriptive of my experience,

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because ‘remembering’ was not an experience of ‘my’ accomplishing ‘my’ task. Instead, an answer was given to me.

To shift perspectives again, it appears that one for whom the name was suddenly present was indeed the personal ego  – or swiftly became constituted as the personal ego – but the agent who found that name, to whom the name was disclosed, was not the personal ego, because the subject experiences the name as ‘given to him’, as if something already presented to him is then recognized as fulfilling the previously unfulfilled intuition – and this is phenomenally different from the personal ego’s so to speak ‘owning’ the entire process of remembering. Instead it seems that the name Natalie Portman was pre-egoically retained and sedimented; hence it is a passive, pre-subjective, and pre-objectified locus of consciousness that regains contact with this retained memorial object via passive intentionality, making it disposable to being grasped by active intentionality. And as the name Natalie Portman is grasped by active intentionality, the subject, the personal ego, co-arises but as if slightly afterwards, since the name appears first and then there is an ‘I remember!’ To explicate the meanings of this description for our inquiry, I will turn to Husserl’s account of awakening through affective intentionality. Why specifically affective intentionality? Ferrarello (2016) has argued that Husserl is frequently misread as offering an exclusively cognitivist conception of consciousness life, whereas Husserl in fact asserts that affective and sensuous consciousness are the ground of constitution. In refuting the cognitivist reading in favour of a broadly hyletic account, Ferrarello (2016) turns to Husserl’s discussions of affect consciousness (Gemütsbewustsein) and affective intentionality (see Husserl, 2011, p. 277). Taking seriously Husserl’s claim that ‘affect-consciousness’ plays a ‘constant role in the passivity of the life of consciousness’ (ibid.), some brief comments will be offered here in order to prepare the way for a description and explication of an example of the centrality of feeling (Gemüt) in awakening. Husserl (2011, p.  277) argues that whenever consciousness constitutes an object through its intentional acts, that object ‘exercises an affection on the ego’. Husserl claims affect-consciousness is the sphere of presentation, specifically, ‘the sphere of objectivating consciousness’ (ibid.). This is because the way an object is felt pre-egoically stimulates consciousness, immersed and so to speak ‘sleeping’ in its hyletic flow, to turn towards that object. Once this turning has begun, wakefulness arises, then the object’s ‘objective sense has emerged from the obscurity of passivity’ (ibid.). In other words, through the passively intentional constituting of predicate layers, what Husserl calls feeling arises. At this

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stage the intentionality of feeling is yet ‘without active egoic participation’; so there is a ‘turning towards in feeling’ which is not yet actively intentional, hence not yet egoic, and becomes actively intentional and egoic as the pre-egoic locus of consciousness awakens as this ego amid its feeling-ful turning-toward its object (pp. 280–1). Contrasting the sleeping and wakeful states, Husserl (1989, p. 265) writes:  ‘In contrast to the waking ego, the sleeping [Ego] is complete immersion in Ego-matter, in the hyle, is undifferentiated Ego-being, is Ego-sunkenness, whereas the awake Ego opposes itself to the matter and then is affected, acts, undergoes . . . the Ego unceasingly constitutes its “over and against”, and in this process it is motivated and always motivated anew, and not arbitrarily’ (emphasis in the original). Since ‘Ego’ refers to two distinct layers, pure and personal, the use of ‘Ego’ can be confusing. Since it is the pure layer of the Ego that constitutes, and the personal Ego that is among the constituted, Husserl’s statement above of necessity refers to objects exercising affection upon the pure Ego. Regarding this aspect of the passive life of the pure Ego, which is pre-egoic in the sense of being prior to the personal Ego, Husserl (2001, p. 278) writes: ‘[W]hat is constituted within passivity . . . as an object, can lead to a feeling already within this passivity.’ This is to say, the passive life is already an affective life, because its objects are grasped ‘as pleasurable or unpleasurable, as agreeable or disagreeable’, which ‘founds a novel consciousness: a layer of consciousness of the intentionality of feeling’, and ‘sedimented in it, or rather, in the noema, is a new moment precisely as the character of feeling, for instance, as ‘pleasurable’, or in the case of frustration, as ‘painfully lacking’, and the like’ (ibid.). Hence, ‘the object is constituted in and through the objectivating that underlies the intentionality of feeling’ (ibid.). The implications of this claim for the psychology of embodiment far exceed the scope of the present inquiry, but in reading Husserl here, we are clearly not in the presence of a cognitivist: affect (Gemüt, sometimes translated as ‘heart’) and affect-consciousness (Gemütbewusstsein) are foundational. Embodiment is central here: as Husserl notes in the midst of discussing affect-consciousness, ‘sensuous consciousness underlies all valuing . . . matter, and in a higher level . . . nature’ (note 166, p. 277). The descriptive example we have taken up exemplifies affective intentionality in a case of a frustrated inability to remember, and the reawakening of the memorial object. Clarifying his use of the term ‘awakening’, Husserl (2001, p. 221) writes, ‘[B]y awakening we understand and distinguish two things: awakening something that is already given to consciousness as for itself, and the awakening of something that is concealed.’ The awakening occurring here is of a meaning that was given to consciousness, retained, but then became concealed, and

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hence was present as a lack. What is this lack, for Husserl, and what kind of ‘affective accomplishment’, in his words (p. 222), is exemplified in the preceding description? It is seizing upon an object of consciousness, a retention – meaning an object that was present in the subject’s consciousness multiple times before in the flow of his daily life and retained therein, in this case the name Natalie Portman, but which had no particularly strong affective meaning for him, until the experience described above. However, that previously unremarkable object, the actress’s name, became important for him in the context described above – namely, as a seemingly lost memorial object that in its lost-ness, perhaps precisely as an unimportant but widely known datum, the name of a famous actress – seemed to challenge his ego-image of himself as someone healthy, with intact memory capable of easily recollecting such daily details, in the shadow of his father’s failing memory and decline towards death. Remembering something previously unimportant to him – Natalie Portman’s name – suddenly became emotionally charged for him – he now had feelings about the name, due to the emotionalimpressional horizon within which he was living the forgetting. Husserl (2001, p. 222) writes that this ‘influx of affective force, which naturally has its primordial source in the impressional sphere, can enable a retention (which is poor in or completely empty of particular affective content) to restore what is concealed in it concerning an overcast content of sense’. Husserl (2001, p. 222) refers to this kind of shift in the affective meaning of a previously innocuous object when he notes, ‘[I]f the object constituted in the flux has taken on a special affective force, then the process of the retentional transformation may continue to progress, the process of affective clouding over going hand in hand with it is halted’ (emphasis in the original). A new force is directed by consciousness towards the object because it now matters to me emotionally, and ‘so long as the new force lasts, the objectlike moments that have attained a special affection are affectively preserved in the empty form of the presentation, thus sustained longer than without this new force’ (ibid.). Here we have Husserl’s precise way of describing the lack – as the empty form of a presentation, and his accounting for the way in which the subject’s repeated seeking for the name occurred intermittently for days, due to the ‘[r]adiating back of affective force into the empty consciousness . . . and with this a tendency toward the identifying transition of the empty presentation into a self-giving, which renews “after a fashion” the constitutive process in the mode of remembering, and therefore “re”-covers the identical objective sense in its explicit differentiation’ (ibid.). The re-emergence of the name this way is in the ‘form of a disclosive

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awakening’ (p. 224), which is why remembering the name was not merely the presence of a neutral datum but had the sense of disclosure and greater awakeness, with ‘awakening’ characterized as a moment in which ‘what is implicit becomes explicit once more’ (p. 223). So what sort of affective accomplishment is the remembering of Natalie Portman’s name? It is ‘the accomplishment of awakening the element shrouded in implicit intentionality’ (p. 222) thanks to the emotional reaching towards the object, which was lost to the personal Ego, retained in passive intentionality, and thus implicitly intended. An implicit intentionality is lived passively, and this means pre-egoically, in a felt and bodily way that is not yet grasped by an ‘I’ who in that instant awakens as a personal Ego. And as we have seen this awakening from pre-egoic passivity is lived in dialogue with the impressional life of the personal Ego: stimulated or ‘irritated’ by the failure to remember, there is an affective turning-back towards the passively retained ground of sense, which in turn can in a certain way renew constitution.10 Husserl (2001, p. 125) carefully qualifies his statements: there is a tendency towards the transition from empty presentation to self-giving in the present; awakening is never guaranteed, nor is remembering a literal/factual recovery of a past sensing in the sense of a factual repetition; as he points out, ‘an absolutely complete remembering’ is an ‘ideal limit-case’. Husserl emphasizes that ‘waking up sedimented sense’ is motivated, and ‘the motives must lie in the living present where perhaps the most efficacious . . . are “interests” in the broad, customary sense, original or already acquired valuations of the heart [Gemüt], instinctive or even higher drives, etc.’ (pp. 227–8). It is impossible to conclude the discussion of the description without commenting briefly on the desire that animated the subject’s struggle, and the relief that followed its fulfillment. In his discussion of striving and desire in Analyses Concerning Passive and Active Synthesis Husserl (2001, p. 282) describes desire as not simply a ‘turning toward’ but a ‘striving after’. ‘Desire’, for Husserl, is a tendency that occurs in the way that both passivity as well as activity are carried out, everywhere an intentionality of feeling in the mode of striving… [and] has its positivity and negativity, like feeling in general. Its fulfillment is a relaxation that results from realizing [the striving, etc.], in the change into the corresponding joy of fulfillment: At root, joy lies in the arrival of what was lacking. (Ibid.)

All of this can be said to be present in the descriptive data – in particular, the coming into play of both passive and active intentionality, stimulated by desire, and joy at the fulfillment of that desire.11

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Conclusions The aim of this chapter was to convey a sense of the complexity of Husserl’s egology and its implications for the psychology of everyday life, and to point to the way in which for Husserl even the most seemingly solitary sense of ‘I’ is already indebted to a You, that is, to a primordial communalization. To offer descriptions illustrative of lived relationality will be the aim of future research. This chapter sought to convey that, in contrast to the misreading of phenomenology as verging on solipsism, a careful reading of Husserl demonstrates both that the ego is neither strictly bounded nor ever accurately described as a solus ipse – either in its everyday living or in its originary encounter with others and the world. As the phenomenologizing I, I discover I am not the absolute owner of my actions, though as the actively intending ‘I’, I face ongoing choices, ongoing and intrinsically ethical position-takings – as the ‘I’ of ‘I can’ and ‘I do’ (Ferrarello, 2016). Yet the personal Ego, the ‘I’ who finds himself as the I who can or the I who must, is already given to himself in a bodily and affective streaming that transcends his personal, narrative identity because it is already given hyletically, already in the flow of an affective, bodily, socially, historically situated life – and it is precisely within this pregiven horizon that the ‘I’ awakens. It is as the life of a locus of consciousness already engaged in the world that the personal Ego awakens in moments of choice, including choosing how I name (predicate) an object of consciousness. Similarly, the attributes with which I can predicate myself in a given moment  – as a diligent or a lazy piano student, a loyal or unreliable friend, a grateful or ungrateful son – are each named or recognized by the personal Ego in the flow of an already-present life, in a life shaped not only by the personal Ego’s sedimented habits which lead me to repetitive actions in a semi-asleep way, and by the sedimented, shared habits of the multiple communities I inhabit – familial, friendly, communal, cultural – but also by the Transcendental Ego’s habitus, its habitual way of finding itself in the world, the ‘it’ which is the constituting nuclear core of the ‘me’ that I name as a personal Ego.12 Hence the attributes I can name as mine are only relatively so – I am never the absolute owner of my acts or attributes as a personal Ego; rather, I discover them always already in motion. Finally, as the phenomenologizing ‘I’, I  likewise discover that the constituting kernel of my I-ness transcends my personal Ego, transcends all the ways in which I narrate my life story or describe myself, because the source of my living as this monad, this locus of consciousness, transcends my ability to grasp or name it or assign predicates to it – the ground of my

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‘I’ is always a surprise to me in this sense, because ‘its’ living always exceeds the grasp of my cogitaciones. This ‘it’, if we take seriously Husserl’s late discussions of alterity, is not a strictly bounded, solitary ‘I’, but a locus of consciousness that finds itself as an I within the relational matrix designated by socius, discovering itself primordially in the eyes of the You.

Notes 1. The phrase ‘pre-egoic’ can be confusing because it refers to the pure or transcendental egoic layer of consciousness that is ‘prior’, so to speak, to the personal or empirical ego. So the ‘pre’ is in relation to the personal, empirical ego. 2. Zahavi (2003, p. 109) notes that ‘Husserl’s phenomenology has very frequently been accused of being solipsistic’, that is, ‘a position that either claims that there only exists one single consciousness, namely one’s own, or that argues that it is impossible to know whether there are in fact any other subjects besides oneself ’. 3. For a phenomenological psychological discussion of empathy as following the other, see Englander (2014). 4. Hart (1992, p. 225) argues Husserl’s assertion that ‘our self-presence is analogously empathic’ in its primordial deference to the Other ‘occasioned Husserl once to claim that love is a chief problem of phenomenology’, by which Husserl meant that love ‘is a universal problem for phenomenology because it embraces the depths and heights of intentionality as a driving and productive force’. 5. For a useful phenomenological critique of an exclusively narrative account of selfhood, see Zahavi (2007). 6. For example, Husserl (1989, p. 313) writes, ‘The Ego . . . is not an empty pole but is the bearer of its habituality, and that implies that it has its individual history’. Donohoe (2004, p. 182) summarizes the late Husserl’s account of ego development in the following way: ‘The ego adopts positions on the basis of its preexisting culture. Those positions evolve into habits, thus providing an identity for the ego. The instinctual connection of the ego with the Other(s) lays the groundwork for the higher-order we that takes on an identity of its own.’ 7. Cf. Luft’s (2011) discussion of Husserl’s concept of the ‘transcendental person’ and the response to Heidegger’s critique of transcendental subjectivity. 8. Husserl (2001, 481) writes, ‘[W]e can say with respect to the primordial present that “unconsciousness” is consciousness in the primordial present; the sensible object of which we are unconscious along with all the other objects of which we are unconscious are “given to consciousness” in an undifferentiated manner in a zero-consciousness.’

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9. As Husserl (1989, p. 196) remarks, the intended surrounding world is ‘in a certain sense always in a process of becoming, constantly producing itself by means of transformations of sense and ever new formations of sense along with the concomitant positings and annullings’. The same is true for the intended ‘I.’ 10. For his use of ‘irritation’, see Husserl (1989 p. 148). 11. As I have argued elsewhere (Applebaum, 2014), the researcher’s inviting natural attitude description from a research participant yields data that is in contact with the participant’s ongoing flow of both active and passive intentionality. Such data may be said to be both descriptive and ineluctably interpretive in a very particular sense, in that it demonstrates ‘interpretive determination’ (Auffassung) in the Husserlian sense of that term, and emplotment and the representation of the participant’s narrative identity, in a Ricoeurian sense. 12. See Husserl (1989, p. 118) for an example of his discussion of the pure ego’s habitus.

References Applebaum, M. (2014). Intentionality and narrativity in phenomenological psychological research: Reflections on Husserl and Ricoeur. Indo-Pacific Journal of Phenomenology, 14(2):1–19. Buber, M. (1970). I and thou (trans. W. Kaufmann). New York: Charles Scribner’s Sons. Carr, D. (1973). The ‘fifth meditation’ and Husserl’s Cartesianism. Philosophy and Phenomenological Research, 34(1):14–35. Carr, D. (1986). Cogitamus ergo sumus. The Monist, 69(4):521–33. Carr, D. (1987). Interpreting Husserl: Critical and comparative studies. Dordrecht: Martinus Nijhoff Publishers. Cushman, P. (1995). Constructing the self, constructing America: A cultural history of psychotherapy. New York: Da Capo Press. Donohoe, J. (2004). Husserl on ethics and intersubjectivity: From static to genetic phenomenology. Amherst, NY: Humanity Books. Englander, M. (2014). Empathy training from a phenomenological perspective. Journal of Phenomenological Psychology, 45(1):5–26. Ferrarello, S. (2016). Husserl’s ethics and practical intentionality. New York: Bloomsbury. Hart, J. G. (1992). The person and the common life: Studies in a Husserlian social ethics. Boston: Kluwer Academic Publishers. Husserl, E. (1970). The crisis of European sciences and transcendental phenomenology: An introduction to phenomenological philosophy (trans. D. Carr). Evanston, IL: Northwestern University Press. (Original work published 1954.) Husserl, E. (1973). Cartesian meditations: An introduction to phenomenology (trans. D. Cairns). The Hague: Martinus Nijhoff.

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Husserl, E. (1989). Ideas pertaining to a pure phenomenology and to a phenomenological philosophy: Second book (trans. R. Rojcewicz and A. Schuwer). Boston: Kluwer Academic Publishers. Husserl, E. (2001). Analyses concerning passive and active synthesis: Lectures on transcendental logic (trans. A. J. Steinbock). Boston: Kluwer Academic Publishers. Luft, S. (2011). Subjectivity and lifeworld in transcendental phenomenology. Evanston, IL: Northwestern University Press. Merleau-Ponty, M. (1996). Phenomenology of perception (C. Smith, Trans.). New York: Routledge. Moran, D. (2012). Husserl’s crisis of the European sciences and transcendental phenomenology: An introduction. New York: Cambridge University Press. Zahavi, D. (2003). Husserl’s phenomenology. Stanford: Stanford University Press. Zahavi, D. (2007). Self and other: The limits of narrative understanding. In D. D. Hutto (ed.) Narrative and understanding persons. Royal Institute of Philosophy Supplement 60, pp. 179–201. New York: Cambridge University Press.

Names Index Aaltonen, J. 149 Abram, D. 65 Aggernæs, A. 34 Alakare, B. 149 Allport, G. W. 67 Angel, E. 2, 85 Applebaum, M. 5, 180, 183, 203 Arendt, H. 151 Aristotle 75, 84, 138, 140 Bailey, D. E. 67 Banner, N. F. 151 Barr, L. 15 Barrett, T. R. 28 Basaglia, F. 15, 21–2, 137 Basso, E. 151 Bayne, T. 13 Beattie, J. 143, 152 Berrios, G. E. 32 Betz, B. 164 Bhugra, D. 1, 49 Biceaga, V. 168 Binder, P.-E. 126, 129 Binswanger, L. 2, 85, 137, 145, 152 Blankenburg, W. 38, 138, 146–7, 150, 152–3 Bleuler, E. 13, 33–6 Bongaardt, R. 4, 121, 129 Bourdieu, P. 143, 148, 151–2 Bovet, P. 58, 153 Brentano, F. 72, 85 Brohan, E. 15 Brudal, L. 128 Buber, M. 189 Bugter, S. E. W. 151 Canstatt, C. 27 Carr, D. 169, 186–7, 189 Carter, J. 37 Cermolacce, M. 30, 39 Charbonneau, G. 34 Chiu, M. Y. L. 15

Churchill, S. D. 4, 62, 65–7, 72, 83 Combs, A. W. 67 Conrad, K. 31 Coplan, A. 50 Coppola, S. 87 Corin, E. 40 Corrigan, P. W 15 Cosgrove, L. 8 Cushman, P. 184, 191 Cutting, J. 32 Davidson, L. 3, 7, 8, 11, 14–16, 18, 20–2, 40, 49, 54, 56–9, 61 Davies, B. 152 Deegan, P. E. 14 De Jaegher, H. 131 Deleuze, G. 19 Depraz, N. 153 Desai, M. U. 4, 95, 105–6 Dewey, J. 151 Dilthey, W. 4, 70–1, 73, 84–5 Donohoe, J. 169, 202 Dörner, K. 149 Ellenberger, H. F. 2, 85 Engel, G. L. 97 Engell, J. 83 Englander, M. 1, 3, 41, 49, 54, 58, 61, 83, 153, 180, 202 Etheridge, E. 28 Ey, H. 33 Feilke, H. 151–2 Ferrarello, S. 4–5, 161–2, 197, 201 Finzen, A. 1 First, M. B. 102 Flanagan, E. 11 Folkesson, A. 59 Fonagy, P. 128 Frith C. D. 13, 19 Froese, T. 124

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Names Index

Fromm-Reichmann, F. 13, 15 Fuchs, T. 4, 53, 129, 131, 137, 141, 143, 147, 151–2 Gadamer, H. G. 142, 144, 151 Gallagher, S. 51–6, 61, 124 Gallese, V. 51 Gamma, F. 153 Gammell, D. J. 122 Gebauer, G. 152 Geertz, C. 138, 151 Gendlin, E. T. 5, 161–8, 171, 173–4, 176 Gennart, M. 31 Giorgi, A. 2, 4, 17, 59–61, 70, 96, 97, 99–100, 102, 106, 121–5, 129–30, 133 Giorgi, B. 17 Gleaves, D. H. 102 Goldie, P. 50 Goldman, A. I. 51 Goodall, J. 85 Gorden, R. L. 66 Gregoric, P. 138 Guattari, F. 19 Gurwitsch, A. 69 Halbreich, U. 122 Hamlyn, D. W. 67 Handest, P. 43 Hart, J. 170 Hart, J. G. 184–5, 188–90, 202 Hart, S. 128, 130 Haug, E. 37 Heidegger, M. 4, 10, 62, 72–9, 82, 84–7, 96, 202 Heinamaa, S. 84 Heinze, M. 144 Heller-Roazen, D. 138, 140, 151 Henriksen, M. G. 3, 27–31, 33–5, 37–43, 57, 153 Henry, M. 147 Hickling, F. W. 153 Holton, R. 151 Husserl, E. 3–5, 7–13, 15–18, 22, 49, 51, 53, 58, 62, 66, 68–70, 73, 78–80, 83–6, 96–9, 123–5, 151, 153, 161–2, 165–79, 183–94, 197–203 Hutchinson, G. 19

Innocenti, G. M. 153 James, W. 142 Jaspers, K. 1–2, 4, 13, 30–2, 34, 40, 42–3, 58, 72–3, 147, 152 Jeannerod, M. 13, 18 Jenney, R. H. 163 Johnson, A. 18 Jones, S. M. 27, 41 Kant, I. 9–10, 16, 144 Kendall, J. 130 Kleinman, A. M. 16 Kohut, H. 50 Kraepelin, E. 13, 40 Krais, B. 152 Kraus, A. 147, 152 Krueger, J. 51 Kulenkampff, C. 151 Laing, R. D. 19, 73, 137, 175, 177 Langdridge, D. 129 Lemos, N. 151 Leudar, I. 32 Levinas, E. 13, 15, 85, 96 Liester, M.B. 32 Lin, K. M. 16 Lingis, A. 65 Lipps, T. 4, 50, 68, 83 Losch, M. E. 28 Lothane, Z. 32 Luft, S. 58, 202 Lysaker, P. H. 16 Mahy, G. E. 153 Maldiney, H. 140–1, 147, 153 Malt, U. F. 126 Mann, M. 83 Marazia, C. 151 May, R. 2, 85 Maynard, E. 4, 95, 103–5 Mead, G. H.  143 Merleau-Ponty, M. 4, 34, 50, 61, 65, 67, 76, 79–82, 85, 96, 123–5, 127–9, 131, 141, 151, 190 Merz, P. 149 Meyer, A. 13 Mezzich, J. 95 Mezzich, J. S. 95

Names Index Mill, J. S. 70 Minkowski, E. 2, 141 Mishara, A. 151 Misurell, J.R. 4, 95, 109–10 Moore, G. E. 151 Moran, D. 190 Morgan, C. 1, 19 Morley, J. 123, 129 Morrissey, M.B. 4, 95, 113–14, 116 Müller-Suur, H. 31 Nasar, S. 43 Naudin, J. 39 Nelson, B. 37, 39 Nilsson, L. S. 42 Nischk, D. 149 Nordgaard, J. 37, 43 Olbert, C. 109 Overgaard, S. 51 Pacherie, E. 13 Parnas, J. 28, 29, 30, 31, 33–4, 37–9, 41–3, 56–8, 61, 138, 142, 147, 153 Pienkos, E. 37 Plessner, H. 144 Plog, U. 149 Posey, T. B. 28 Priebe, S. 1 Raballo, A. 33, 37 Rashed, M. A. 153 Ratcliffe, M. 40–1, 58–60 Read, J. 19, 153 Reich, W. 68 Reik, T. 67 Reininghaus, U. 28 Robinson, P. 59 Rodgers-Johnson, P. 153 Roe, D. 11, 16 Rogers, C. R. 5, 50, 67, 161–4, 166–8, 171, 173–4, 176 Rohr, E. 50 Romano, C. 153 Roosevelt, E. 22 Rosenberg, S. D. 19 Rosenfeld, S. 139, 151–2 Rotter, B. 4, 95, 107–9 Rowe, M. 15, 21

Røseth, I. 4, 121, 126–7, 129 Rusch, J. 149 Rüsch, N. 15 Sacks, O. 142, 151 Saks, E. 13 Sarbin, T.R. 67 Sartre, J.-P. 65, 67, 96, 127, 152 Sass, L. A. 29–30, 35–7, 39, 43, 137–8, 147–8 Schafer, R. 67 Scheler, M. 4, 51, 56, 57, 62, 79–81, 124 Schilder, P. 13 Schlimme, J. E. 58, 147, 153 Schneickert, C. 152 Schore, A. 130 Schreber, D. P. 43 Schultze-Lutter, F. 42 Schutz, A. 4, 49, 67, 69–70, 84 Schwartz, M. A. 147, 153 Sechehaye, M. 36 Seikkula, J. 149 Shapiro, K. J. 65 Shlien, J. M. 163 Shusterman, R. 124 Škodlar, B. 32 Skoufalos, N. C. 4, 95, 101–2 Slade, M. 15 Smith, D.L. 2 Snygg, D. 67 Solomon, L. A. 8, 17, 22 Sontag, S. 66 Sowa, R. 99 Spiegelberg, H. 2–3, 162 Spinelli, E. 129 Spitzer, M. 30 Stanghellini, G. 32, 42, 138, 151, 153 Stein, E. 51, 53, 56–7, 59, 83, 174 Stern, D. N. 9, 124, 127–31 Stien, P. T. 130 Stoppard, J. M. 122 Straus, E. W. 2, 140–1, 147, 151 Strauss, J. S. 14–15 Styron, T. 11 Sullivan, H. S. 13, 15 Summa, M. 144, 150–1, 153 Sutton, J. 143 Synofzik, M. 13

207

208

208 Taft, R. 67 Tellenbach, H. 140, 151 Thoma, S. 4, 137, 151, 153 Till, A. 49 Tondora, J. 109 Toombs, K. S. 131 Trevarthen, C. 129–31 Tronick, E. Z. 130 Tse, S. 14 van den Berg, J. H. 2, 85 Van Duppen, Z. 141, 150 Van Os, J. 28 Varese, F. 19 Vassos, E. 148 Vester, M. 153 von Gebsattel, V. E. 151 von Weizsäcker, V. 140 Voss, M. 13 Waldenfels, B. 146

Names Index Warner, R. 15–16, 19 Watson, A. C. 15 Waxler, N. E. 16 Weise, K. 151 Wertz, F. J. 4, 95, 99–100 Whitehorn, J. C. 164 Whitney, S. 124 Wiens, A. 67 Wiggins, O. P. 153 Wigman, J. T. 28 Winnicott, D. W. 128, 130–1 Wittgenstein, L. 143, 146, 151 Woods, A. 148 Wulff, E. 151 Yanos, P. T. 16 Yung, A. R. 37 Zahavi, D. 51–9, 61, 83, 124, 142, 147, 188, 202 Zutt, J. 153

Subject Index abnormal 27, 32, 177 abnormalities 29, 176 anxiety 28, 41, 99, 126–7, 195 being–in–the–world 77–8, 147–8 biology 28, 117, 166 body lived 4, 38, 52–3, 55, 65, 67–9, 74–7, 79–81, 83–4, 86, 103, 108, 111, 121, 123–6, 131, 138, 140–1, 145, 165, 167–8, 194 volitional 161–2, 165–9, 171–2, 174, 176–7, 179–80 boundaries 41, 167, 174 bracketing 59, 78, 98, 123, 148, 184–5 (see also Epochē) child 22, 67, 106, 116, 126, 128–32, 176 childhood 19, 102, 110, 129, 141, 153 children 76, 105, 106–7, 117 grandchildren 117 mother–child 127–8, 130, 132 citizen 2, 21–2, 148 citizenship 21 cognition 3, 52, 170 cognitive 31, 102, 113, 139, 142, 149, 170, 178, 188, 196 cognitive–behavioral 32, 184 cognitive neuroscience 28, 49, 51 cognitive science 29 cognitivist 197–8 neurocognitive, 19 community 1, 5, 10, 12–13, 15, 20–1, 65, 105–7, 109, 111–13, 117, 138, 149, 150, 174–7, 184–7, 190–1 consciousness 7–13, 16–17, 30, 34, 49, 55, 59–60, 62, 68, 76, 78, 80, 96, 98–9, 123–5, 128, 165, 170–2, 178–9, 183–5, 187–93, 195–9, 201–2 counseling 50, 62 creative 107, 144, 152, 166, 170 creativity 144, 146, 150, 152

culture 1, 18, 30, 72, 105, 107, 115, 117, 125, 187, 202 cultural, 1, 7–8, 10, 14–17, 19, 22, 103, 105, 107, 109, 116, 124, 125, 131, 143, 148, 151, 191, 201 cross–cultural 16, 19 socio–cultural 10–11, 123, 127, 143, 148 Dasein 77, 85–7, 174 Daseinswert 172–3, 177 delusion 3, 13, 27–37, 39–42, 101, 141, 146–7 delusional 30–1, 35–6, 145, 147 predelusional 31 depersonalization 141 depression 4, 96–7, 99, 101, 104, 121–2, 125–31, 141 despair 79, 110, 121 dissociation 102–3 ego 4–5, 7–9, 11, 17–19, 77, 83–4, 86, 124, 166–72, 175–7, 179, 183–5, 188–202 emotion 68, 80, 103, 124–5, 128 emotional 51–2, 57, 108, 126, 128, 130–2, 162–3, 166, 172, 176, 178, 194–5, 199–200 empathy 3–4, 8, 12, 27, 39, 40–1, 49–62, 66–72, 76–7, 79, 83, 86, 114, 122, 124–5, 128, 130, 142, 153, 163, 174, 176, 178, 180, 189–190, 202 empathic reduction (see reduction, empathic reduction) phenomenological empathy training 54, 58 Epochē 41, 98, 100, 122–3, 125–6, 128–9, 132 (see also Bracketing) ethic 4–5, 114, 161–2, 165–6, 172, 177 ethical 5, 28, 161–4, 166, 169, 172–4, 178, 192, 201 existence 2, 12, 38–9, 41, 51, 71, 80–2, 85, 96, 98, 101, 115, 123, 127, 131, 147, 167, 176–7, 189

210

210

Subject Index

existential 4, 58, 59, 86, 121, 123, 126, 129, 174 expression 52–3, 55–60, 62, 66–8, 70–1, 73, 75–6, 78–80, 82, 84, 86–7, 128, 131, 141, 143, 147, 164–5, 173, 178, 179 meaning–expression 54–6, 59–60 faith 112, 114 perceptual faith 141

narrative 55–6, 78, 103–4, 106–7, 115, 162, 183, 185, 187, 190, 195–6, 201, 202, 203 norm 11, 106, 116, 152, 176 normal 32, 35–6, 39–41, 101, 126, 143, 149, 161, 171, 175–8 normalization 146 normalizing 146 normative 144, 164, 177, 179, 184 normativity 161, 177

Gestalt 123 hallucination 3, 13, 19, 27–9, 32–6, 39, 41–2, 56–7, 59, 97, 99, 123 hermeneutic 70, 73, 78, 84 hermeneutical 70 hope 126 hopeful 14, 79 identity 9, 12–14, 42, 70, 97, 108, 176, 187, 190, 192–3, 195–6, 201–3 imagination 29, 67, 69–71, 80, 84 intentionality 5, 12, 49, 51, 54–5, 57, 61–2, 66–7, 69–70, 87, 98–9, 115, 161, 171, 172, 176–80, 184–5, 187–8, 191, 194–200, 202–3 interpersonal 2, 3, 5, 15, 49–54, 58, 60, 62, 104, 121, 126–7, 164 intersubjectivity 2–3, 7–9, 22, 68, 78–9, 85, 86, 122, 124–5, 128, 130, 132, 141–2, 188 intuition 34, 65–6, 85–6, 97, 99, 197 memory 141, 145, 194, 195, 199 mood 31, 82, 87, 145, 147 moral 2, 70, 108, 117, 162–3, 192 Motivation 164, 178 non–motivation 164 motivational 69 movement bodily 30, 38, 67–8, 75, 84, 124–5, 140 development 104, 111, 114 historical 15, 21, 70, 95, 115

psychoanalysis 19, 50 psychologism 8, 18 psychosis 3, 12–13, 19, 27–9, 31, 37, 39, 41–2, 96, 109, 145 recovery 4, 14–16, 19–21, 40, 101, 109–13, 117, 122, 127, 200 recovery–oriented 2, 3, 58, 61 (see also Movement, historical) reduction (phenomenological) 67, 69, 98, 123, 125, 128–9, 153, 169, 170, 189 eidetic reduction 99, 122–5, 129, 132 empathic (psychological) reduction 3, 49, 58–62, 83, 153 intersubjective reduction 83 psychological reduction 58–62, 125 transcendental reduction 7, 8, 10, 17, 22, 60 qualitative research 3, 14 Schizophrenia 3–4, 8, 12–15, 18–19, 27–31, 33–5, 37–43, 54–9, 109–10, 146–9, 153, 161–2, 163, 177 second–person 3–4, 53–6, 60, 62, 66, 79, 82–3 sociality 99, 113, 116, 184–5 Socius 184, 186, 202 sympathy 62, 71, 79, 81–2 values 14, 95, 97–100, 166

21