Dialogues in Philosophy, Mental and Neuro Sciences

Crossing Dialogues

ORIGINAL ARTICLE
Association

Disturbances of interpersonality in depression, mania and schizophrenia

O D -Z
Faculty of Medicine of the University of Chile and of the Diego Portales University, Santiago (Chile)

One of the central features of the group of diseases we call “endogenous” (schizophrenia,
melancholic depression, mania) is the alteration of interpersonal relationships. This topic is here
addressed from a phenomenological perspective. It is studied the way three fundamental elements
of intersubjectivity, namely appresentation, temporality and intentionality, are altered in manic,
depressive and schizophrenic psychoses, respectively. It is shown that in mania there is a failure of
the shared appresentation of the role of persons, and that while failing in the constitution of the alter-
Ego, the maniac patient also fails in the constitution of own Ego. In depression the interpersonal
detachment is related to the serious alteration of the way the living time is experienced, with a
self-confinement into the own body. Finally, in schizophrenia it is a weakening of intentionality that
leads to a failure in the constitution of the other and of the common and shared world.

Keywords: Schizophrenia, mood disorders, phenomenology, intersubjectivity.

DIAL PHIL MENT NEURO SCI 2019; 12(1):1-9

INTRODUCTION AND CLINICAL

OBSERVATIONS
Nobody could question that one of the
central features of this group of illnesses we
call schizophrenia is the alteration at the level
of interpersonal relations or, expressed in more
abstract terms, the alteration of intersubjectivity.
Autism, considered by Bleuler (1911) as one of
the fundamental symptoms of the illness, and the
difficulty in attaining rapport, already noticeable
years before being manifested (a topic about
which Minkowski (1927) wrote memorable
pages), are only two illustrations of the
importance of this perturbation. Beside autism,
other symptoms of schizophrenia may be seen
from the same perspective. Let us think about
the paranoid syndrome, for example, where
the other appears as having enormous power,
by means of which the patient is persecuted,
harassed and, finally, invaded in the intimacy
of his own consciousness through the syndrome
of influence. But hearing voices and other
sounds, which at a cursory glance can appear as
a so “objective” symptom, that could even be
attributed to alterations of the complex hearing
function, can also be seen as a very peculiar
perturbation of the relationship with the other,
transformed here into a virtual presence, in an
anonymous, timeless, aggressive and invasive
being. And what has been affirmed until now
is not only true for paranoid, hebephrenic and
catatonic forms, where the listed symptoms
appear with high frequency, though in different
combinations. In a 1965 paper (Doerr-Zegers
and Diebold, 1965), republished in a book
(Doerr-Zegers, 2017), we were able to show
how at the basis of hypochondriac forms of
schizophrenia, those fundamentally centred on
the own body and usually classified within the
“simpler” forms of the illness, there was also an
alteration of interpersonality, of the relationship
with the other, with the you.
The patient we analysed at that time, who
was a very intelligent student and had a great
capacity for introspection, wrote in his diary
in the period just prior to the eruption of the

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Doerr-Zegers, 2019
psychosis impressive things like the following:
“My failure is not enough love for myself. I have not yet
found the way toward the you. Except for a short period
in Waldheim (a school), I always have been enclosed in
myself, deaf when faced with the exterior world. What I
have to achieve is an unselfish inclination toward what
is outside me … I need to venture toward another phase,
that of love of my neighbour”
And at the beginning of the psychosis he was
reporting strange things like that his brain was
atrophied and had been deviated toward the
thorax, but in any case it was unable to fill the
skull. His own body had become strange for
him; in order to be sure that his arms and legs
were his own, he observed them, he moved and
bit them. He felt that his body was flat and that
things came down on him and penetrated into
him. And in his diary he wrote;
“The world is very distant, empty and without meaning.
For example, if I observe a farm, I see very clearly,
in all their details, the house and persons, but only as
something material. Beyond that, everything is poor,
barren and meaningless”
And later he wrote:
“The world comes directly to me; there is no distance
between the world and me. And that is true both for
persons and for things. The nearness reaches the point
of identification with things and persons. It can even
happen that in the worst states I consider myself at times
like the other, like the person I am looking at”
He himself also describes the concrete
difficulty he had of approaching the other person,
in this case to a young girl with whom he had
fallen in love:
“It was something very sad. When the encounter with
her took place, I would have needed only to greet her,
but in that moment I completely closed myself like a
pocket knife. I still see her coming toward me. Suddenly
everything turned cloudy, as if it had been erased. I
began to tremble, I turned around and kept going”
This inability to meet someone becomes more
and more marked, to the point where Federico is
not even able to recognize persons as individual
subjects and this is how he writes in his diary:
“For a while I cannot remember the individual who
owns the faces of persons known to me anymore. When
I look at them, I see only their legs”
Walter von Baeyer (1955) defined with
extraordinary acuteness the characteristics
of this deformed interpersonal encounter of
schizophrenics, but relying almost exclusively
2 DIAL PHIL MENT NEURO SCI 2019; 12(1): 1-9
on cases of paranoid patients. This form of
encounter is characterized by lack of reciprocity,
anonymization and mediatisation. In an
amorous delusion, for example, especially when
it involves hallucination, the patient cannot
defend him or herself from amorous voices or
from the cenesthetic hallucinations linked to
the sexual sphere, that is, it is a unreciprocated
encounter. It is common that what is invading
the patient, which at first has a name, begins
to lose its individuality and finally is imagined
as part of a group. All the young people of the
city, and even all men, harass the female patient.
Finally, that contact with the hallucinated other,
that at the beginning the patient hears or sees is
lately mediated through devices such as radios,
television sets, etc. We could demonstrate that
such a phenomenon also occurred in forms
of schizophrenia simplex with cenesthetic
characteristics. The difference between early
and later phenomena lies only in the fact that
in the latter the invading other appears more
and more as a mere body without soul, totally
depersonalized.
In the case of depression and although the
claims of the patients generally do not refer to the
other, but to the feeling of oneself and to changes
in their own body, the fundamental alteration
could also be conceived from the perspective
of interpersonality. Two forms of essentially
different depressions could be distinguished,
up to the point that it has been often discussed
if they are not different nosological entities. I
refer to delusional and non-delusional forms.
The second, which is the most frequent, shows
as fundamental phenomena, as we have tried to
show in other papers (Doerr-Zegers, 1979, 1993;
Doerr-Zegers and Tellenbach, 1980), such as
negative change of the body experience (decay,
lack of interest, anxiety, pain, feeling of cold,
etc.), “not-being-able” (to concentrate, to decide,
to act, to feel pleasure, etc.) and alteration,
inversion or suspension of vital rhythms. In
the first, in the delusional form, by contrast,
symptomatology is driven by delusion (of guilt,
ruin or illness); although in the background the
same phenomena common in classic depression
can also be seen. The differences do not only
refer to symptomatology, but also to previous
personality, biography and triggering situations.
However, from the perspective of the encounter
the two conditions have something in common,
namely the increasing lack of interest in the
other and its replacement by the predominant
theme: the body in the first case and the delusion
in the second. It is frequent to observe that the
depressive patients cannot divest themselves
from their somatic symptoms, such as lack of
force, decay, anxiety, insomnia, pains, etc. In
an old empirical-phenomenological paper about
the deeply rooted depressive or melancholic
syndrome (Doerr-Zegers et al., 1971) we found
that somatic symptoms were present in 100%
of the depressive episodes of 55 patients who
in a period of five years had been admitted
for this reason to the Psychiatric Hospital of
Concepción. In a way, the depressive patient
becomes unreachable behind that body that
entirely occupies him, and at the same time he
becomes unchangeable. Kraus (1998) describes a
particular feeling of irritation that the depressive
patient causes in the examining psychiatrist,
when he feels unable to influence in some way
the mood of these patients. Kranz (1972) also
maintained, many years before, that depressive
patients were “more autistic than schizophrenic
patients”, pointing to the same phenomenon
we had already stressed: how unreachable and
unchangeable is the depressive other in the
encounter.
This incomprehensible character of depressive
mood (unlike what occurs with sadness)
acquires its maximum expression in stupor. In
another paper (Doerr-Zegers and Tellenbach,
1980) we tried to make a phenomenological
analysis of depressive corporality, starting from
the experience of the examiner when he is faced
with a case of depressive stupor. In another
publication (Doerr-Zegers, 2002) we wrote
that in a way the patient is not in front of us,
since that natural polarized tension occurring
in interpersonal encounters, and called antikry
by Greeks, does not take place. And later we
emphasized that the patient remains insensible to
the clinician’s attempts to bring her to something
like a contraposition. The feeling she begins to
produce in the clinician is more and more unlike
sadness and compassion; the impression of
something disagreeable and foreign results from
the experience of emptiness.
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The perturbation of interpersonality in non-
delusional depressive patients is observed in all
the degrees of this illness, from those in which
it is manifested only through the almost unique
preoccupation with a symptom, almost always
a somatic one such as insomnia or constipation,
passing on to those where the invasion of the spirit
by the body is complete (process of becoming
a thing), as in the case of stupor. In delusional
depressions we find again the resistance to
the interpersonal encounter, the patient being
dominated by the central idea constituting his
delusion. We have also worked this theme with
respect to a patient with Cotard syndrome (Doerr-
Zegers, 2002). In this case there was not only the
examiner’s strong impression of the inaccessible
nature of the person of the patient, but she
herself, who was very intelligent, was able to
describe in an ideal fashion this confinement in
her body and her total inability to meet the other:
“What happens with me is that everything is dead inside
me; let us say that I am dead, that I am in vegetative
state from head to toe. I have no sense of touch, no
smell, no taste for food. My body feels as light as if it
did not exist… When I take my children in my arms,
I do not feel them… If my daughters knew they loved
an artificial mom… I feel no direct contact with things
or with others… Now, when I speak, the words go
automatically out of me, but the words of others do not
enter into my head...The only thing I want is to die, but I
go on living because, apparently my heart beats, though
I do not feel it either…”
And what happens with mania? The most
evident thing in them is without doubt euphoria,
hypervigilance, hyperactivity, ideas that come
and go suddenly and inexplicably, and insomnia.
Being attracted by all the stimuli, naturally
including the persons close to him/her, one may
initially think that the manic has an excess of
capacity to encounter and communicate with
the other. In fact, the “vibration” of the patient,
the capacity of transmitting his feelings and
emotions to the other is employed as a differential
diagnostic criterion with respect to schizophrenic
psychoses. However, if we observe with greater
attention, we see here a deep alteration at the
level of interpersonality. These patients treat
the other with excessive confidence and they
lose the social distance up to the extreme of
disrespectfulness. Taking the other “by his weak
side”, as Binswanger says, i.e. laughing at the
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Doerr-Zegers, 2019

defects of the other, as well as indicating with

illnesses, schizophrenia, melancholy and mania,
inappropriate laughs any dissonance in the a deep alteration of intersubjectivity is hidden.
environment, are all examples of how the manicNow the task is to interpret these facts in the
patient is unable to build a harmonic and authentic
light of Edmund Husserl’s phenomenology
relationship with the other. One personal and of intersubjectivity. We owe a similar attempt,
recent example: a 70-year-old bipolar patient,though shorter and limited to affective disorders,
of high socioeconomic and cultural level, after
to the Spanish author Antón Saiz (1985). We
going out of a deep depression, cycled to a slight
will try to summarize first the more important
hypomania, perceivable by the family only in her
elements of this theory. It would be, certainly,
irritability and in early awakening. In the middle
impossible to reproduce here all the content
of the interview in which I observe her brilliant
of the fifth Cartesian meditation (Husserl,
look, her greater mobility and excessive makeup,
1963, 1999), where the Husserlian theory of
she says: “The pen you are using is too vulgar.
intersubjectivity is found, but we will focus on
I will give you a better one for Christmas”. one of his fundamental concepts, which is that of
Now, the comment was a realistic descritpion: “appresentation”. Husserl calls “appresentation”
some days before I had lost my usual pen at first that experience which is added to the corporal
the airport and I had no time to buy another, so
presentation of the other, and with which it is
in the meanwhile I was using an ordinary one. merged in a unity, allowing the experience of
Nevertheless, nobody would doubt that what alter Ego. This is an experience of the essence
the patient said was in a way inappropriate. The
of a real entity that is not my own, but that is
question would be, then, what is failing here?not added to my own as integral part, that is,
Because perhaps her words would have been that totally transcends my own being, though “it
justified if I had been her son or her brother, but
only can acquire sense and justification from it”.
I am her physician and we are involved in a soIt is then a special case of the great Husserlian
serious and transcendent situation as it is the
problem, of showing how the transcendent in
physician-patient relationship. general can become “immanently transcendent”.
A very good example of this error of The solution of this problem is the constitution,
assessment of what must be done or said in a constitution both of the temporal objectivity, of
given social situation, of this real failure in the
the own world, and also of the alter Ego, of the
constitution of an adequate relationship with the
other and his world.
other, is reported by Binswanger (1960) in his To clarify the question of the constitution of
book Melancholie und Manie: a manic patient the alter Ego it is necessary first of all to clarify
leaves the clinic where she is hospitalized, roams
the problem of the constitution of the Ego and of
the streets and goes into a church where at that
the own world.
moment a religious service is taking place and The question Husserl (1963, 1999) asks himself
an organist is playing. She goes up to where the
is the following: What is proper for me as pure
organ is, congratulates the organist for playing
self, and in that extent not permutable, and what
so well and asks him with an irritating manner to
is that part which, in spite of this non permutable
begin to give her lessons at that very moment. A
something, is communicable? Husserl calls
very simple example, but how telling! Nobody the first sphere, original or primordial sphere.
could fail to think here that there is something
It is the sphere of my internal vital flowing,
inappropriate. Because the real context of theof my own and non permutable “internal vital
situation is being ignored. history” (Binswanger, 1947). In the order of the
constitution of an external world foreign to the
HUSSERLIAN THEORY OF Ego, that internal vital flowing is in itself the first
INTERSUBJECTIVITY world and for that reason called primordial. My
Up to this point and through clinical body (or body-subject) is the only soma (or body-
observations we have suggested the hypothesis object) that is and can be primarily constituted
that behind these mysterious endogenous as body or corporality. Where another body is

4 DIAL PHIL MENT NEURO SCI 2019; 12(1): 1-9

created as a likeness of mine it is clear that it has
to receive its meaning from mine. The question
posed then is the following: What causes the
second body to be derived from the first and be
the other’s, rather than just a second own body, a
copy? We already know the answer: it is the fact
that nothing of that other body can be integrated
into my own vital flow as mine.
The problem becomes more serious if one
poses the question, how is it that, in spite of
the impossibility of an actualization of the
foreign body and with it, of the foreign psyche,
one can come to an experience of the other?
The answer to this question represents one of
Husserl’s (1999, p. 149) most ingenious analyses
and clearly demonstrates the constitutive
organization of the experience of the other from
the presentation or perception of a real body,
that is, something belonging to nature, to the
apperception of it as body-subject (Leib) and
then finally the “appresentation” as alter Ego.
The three intentionalities are intertwined in the
most intimate way in the perception of the other.
In this intertwining, the body of the other and the
Ego of the other appear to be given in a unitary
and transcendent experience. Each experience
is disposed over other experiences that fill and
confirm the “appresented” horizons. The result
is then that the “appresentation” presupposes
“a nucleus of presentation” or, stated more
accurately, that it is an actualization associated
with the authentic perception (of the strange
body). Both, perception and actualization,
are here in the functional community of one
perception that is presented and “appresented”
at the same time, creating the awareness of its
self-existence for the entire object. That is how
my Ego constitutes in itself the other Ego.
After having shown the constitution of
the perception of the other upon the base of
intersubjectivity, we will move on to explain the
problem of intersubjectivity or of the constitution
of the common world. It is usual that the layman
uses the expression: “The mental patient lives
in a different world than us”. However, even
for us psychiatrists, it is not very clear what
is the scientific meaning of this expression, or
of what is the anomaly, in mental patients, of
the constitution of that different way of being
of the world. Szilasi (1959) has clearly shown
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that the constitution of the common world is
also realized through “appresentation” and that
this action is based on the presentation with
the corresponding retentions and protensions.
The intentional references conducting to
“appresentation” are on one side of objective
type and on the other, of historical biographic
type. While the presentations, as we already
know, belong to our vital flow with its immanent-
transcendent moments in the sense of Husserl’s
primordial world, my Ego constitutes a piece of
the common world through the “appresented”.
Szilasi (1959) gives a very illuminating example
that can be summarized as follow: As I-life
(Lebens-Ich), I am present to myself in every act
of consciousness. But I can also be present to
myself accompanied by “appresentations”. For
example, in this moment I am present to myself,
but at the same time, I am “appresent” to myself
as a philosophy teacher who is giving a class.
For you, as listeners, I am present in a different
way than the way I am present for myself, but in
the same “appresentation”, that is, as somebody
who is giving a class. Our presentations are
different, but they are accompanied by the same
“appresentation”. The identically “appresented”
by you, who are foreign alter Egos for me, and
by me, who is a foreign alter Ego for you, is in
common and it is what constitutes the common
world (the objectively transcendent). While
you concentrate on the content of the class, this
constitutes the theme of your current reflection.
For you it is present, and constituted in multiple
retentions and pretension,s the world proper for
you, in your own flowing of your respective
lives. In this process you are “appresent” for
yourselves as listeners or students. You are
“appresent” for me in the same quality (but not
present as own Egos, since your psychic life is
inaccessible for me).
PHENOMENOLOGY OF
INTERSUBJECTIVITY AND MANIC
PSYCHOSIS
Let us return to Binswanger’s example
(1960) of the manic patient who goes into a
church where a religious service takes place
and she interrupts the organist. For the layman,
the attitude of the patient can be judged as
inappropriate, inconsiderate, incomprehensible,
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Doerr-Zegers, 2019
etc. The psychiatrist will speak here of “action
facilitation” and loss of inhibitions. But neither
of these two opinions sheds light on what is
really happening there. Somatic medicine
has the theory of the body as the framework
within which it can “measure” the deviations
with respect to the norm. Similarly, psychiatry
should be able to do it as well. But this basic
science is not sufficiently developed and to
our knowledge that place must be occupied,
following Binswanger, by the phenomenology
of intentional consciousness.
The organist and the patient who bothers
him also bear in mind something different,
that is, their own internal vital flow, with its
own primordial world. But these different
presentations are not accompanied here by the
same “appresentation”. The organist is present
for himself like the flowing of awareness of
contents, the feelings coming from his body,
including those of his fingers playing the organ.
These presentations are accompanied by the
“appresentation” that he is an organist who has
been hired to play for the religious service and
he shares that same “appresentation” with the
community attending the church. The patient,
instead, does not share this “appresentation” and
she does not “take part” in it by any means. In the
patient’ perception it is only present an organist
playing, but she does not “appresent” that it is a
concert in the framework of a religious service.
After leaving the church, the patient went into a
football field where some boys were playing a
match, causing among them, besides perplexity,
anger and a comic situation. She did not manage
either to have the same “appresentation” as them
or constitute a world in common. The fact that
she has brusquely changed from one scenario
to another is not a simple consequence of her
pathological hyperactivity, but of the fact of
living in mere isolated presences, without a
connection between them. They are consequently
unexplainable from her biography, because this
patient has not been able to order these presences
in the continuum of her internal vital history.
This means also that protensions and retentions
have failed. Only by anticipating the future and
retaining the past we can actualize the present.
When this perfect interaction between past,
6 DIAL PHIL MENT NEURO SCI 2019; 12(1): 1-9
present and future, between retentio, protentio
and presentatio becomes loose, life itself is
transformed in the awareness of fragments of
world without pattern.
From Husserl’s theory, presented at the
beginning, it can be inferred that if one fails
in the constitution of the alter Ego, if one is
not capable of real understanding of the other,
the constitution of oneself, of the own Ego,
also fails. Binswanger’s patient is unable to
“appresentatively” seize the organist (in his
context), because she herself cannot experience
herself “appresentatively” as an Ego. Both in
the church and on the football field the patient
is present for herself in her primordial world (or
internal vital flow), but she does not manage to
“appresent herself” as Mrs. so and so, as wife
and mother of four children, as a well-educated
person, society lady and even more to the point,
as a patient who ran away from a psychiatric
clinic. And this happens because her life passes
from presence to presence, disconnected from
retentions and protensions, that is, as a result
of the total collapse of temporalisation. This
explains why the manic patient fails in the
constitution of the common world, although,
unlike the depressive one, the tendency to turn
herself toward the others is observed in her. But
this sort of “being busy” with the others is not
directed toward an authentic communication,
but is rather the consequence of an escape from
herself, from the proper I. And when the proper I
moves away the other loses the character of alter
Ego and becomes an alius, a strange and foreign
being. It is not very different from what happens
to my patient, who, not knowing the situation
of psychiatric interview and the peculiarity of
the physician-patient relationship, makes me
a reproach that would be only suitable in the
context of the greatest intimacy: “You are using
a pen that is too common; I am going to give you
a better one for Christmas”.
PHENOMENOLOGY OF
INTERSUBJECTIVITY AND
MELANCHOLIC DEPRESSION
Now the flowing of my internal life is,
certainly, inseparable from the original or
primordial temporality, with respect to which
objective or chronological time is only a
derivate. And that original temporality is given
as the permanent intertwining of three instances
called (Husserl, 1999) retentio (past), protentio
(future) and presentatio (present). To understand
the fundamental role these temporal instances
play both in the constitution of the own I (Ego)
and of that of the other (alter Ego), it is enough
to think that each person who is talking in a
given moment (presentatio) could not say what
he is saying without: a) knowing exactly what
he already said, that is, without retaining the past
(retentio), and b) what he is going to say, that is,
without anticipating the future (protentio). And
this is not true only for the case of a speech or of
a lecture, but for any conversation.
Now then, in endogenous depression the
alteration of intersubjectivity is not in the failure
of “appresentation”, as we saw in mania. To the
contrary, we know how normal and respectful
are the personalities disposed to depression, as
Tellenbach (1961) early intuited and von Zerssen
(1969, 1970, 1982) demonstrated through a series
of empirical investigations. So, they would never
ignore the sense of the situational context in the
relationship with the other. But at the beginning
we described in which way the depressive patient
confined himself in his body or in his delusion,
becoming unreachable for the other. What
then fails in the relationship of the depressive
patient with the other, from a phenomenological
point of view? In the first place, it is that sort
of enclosure in the body and that inaccessibility
we mentioned in the introduction. But there are
other two characteristic phenomena that could
be also interpreted as related to intersubjectivity,
and that have been highlighted by Binswanger
(1960). They are self-reproaches and delusional
depressive ideas. When a depressive patient
reproaches himself, for example, “if I had not
sold the house, then I would not have been
ruined...” or “if I would have not organized that
excursion where the accident occurred, that
person would have not died...”, etc., what he is
doing is placing empty possibilities in the past,
which is itself immovable. In other words, what
happens in the depressive patient is that retentio
(the past) is invaded by protentio (the future),
with which all temporality is detained and one
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does not come to any actualization in presentatio
(the present). This would explain all the forms
in which it is present an inhibition, which is a
central symptom of depression, that we have
characterized in previous investigations as one
of the three fundamental phenomena of the
“nuclear depressive syndrome” (Doerr-Zegers,
1979, 1993; Doerr-Zegers and Tellenbach, 1980;
Doerr-Zegers et al., 1971). But there is also,
certainly, the fact that the entire existence of the
depressive patient remains detained and when he
goes out from the depressive phase, he returns to
the previous moment, that is, to the beginning of
his illness, without managing to incorporate this
period into his vital history.
With respect to depressive delusion, we must
say first that, as has been always recognized,
the themes to which it refers are not abstruse,
extravagant or impossible, as it is the case with
schizophrenia. In depression, the themes are
those of daily life, i.e. the relationship with
oneself and particularly with the own body in
hypochondriac delusion; the relationship with
others in delusion of guilt; and the relationship
with society in general, in delusion of ruin.
The patients say they already have an incurable
illness (and in extreme cases such as Cotard
syndrome, that they are already dead), or are
guilty of something that could possibly occur in
the future (for example, that the Internal Revenue
Service finds a failure in his annual statement,
or that some tragedy can occur to one of their
children, etc.) or, finally, they state that they are
already ruined (although it is only a possibility
in the future, there is no certainty that it will
occur). In all these cases there is a phenomenon
exactly inverse to what occurred with self-
reproaches, that is, that possible situations in the
future are lived as if they had already occurred:
i.e. pretensions or anticipations are invaded by
retentions.
This contamination of the past or retentio with
elements of the future (self-reproaches) and of
the future with elements of the past (depressive
delusions) is, according to Binswanger (1960),
part of the basis of every true depression and
explains the depressive phenomenon described
by von Gebsattel (1954) as Werdenshemmung
(inhibition of becoming).
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INTENTIONALITY AND
SCHIZOPHRENIA
The most fundamental concept of
phenomenology is without doubt that of
intentionality. In its most generic meaning
intentionality points to the fact that every psychic
phenomenon is essentially characterized by its
reference to another thing than itself. Expressed
in the words of Husserl (1962):
“in the simple acts of perceiving we are directed to the
perceived things, in remembering to the remembered
things, in thinking to the thoughts, in evaluating to the
values, in desiring to the objectives and perspectives”
The case that best shows the importance
of intentionality is perception, of an object or
of a person. Every perception is necessarily
perspectivist, that is, one always perceives only
certain aspects of the object and “apperceives”
the rest. “Apperception” is a particular form
of “appresentation”, phenomenon to which we
referred previously, both being ruled by the same
laws. Through intentionality and by means of
the processes of perception/apperception or of
presentation/appresentation, the Ego constitutes
the object in its totality and with it, the common
world or koinos kosmos. In schizophrenia,
instead, there is a weakening of intentionality,
as a result of which the objects are not (using
a neologism) “intended” or intentioned with
the corresponding force of intensity. This
phenomenon has the following consequences:
1. Objects acquire a strange, foreign aspect,
with multiple meanings arising from them that
do not appear when intentionality functions
correctly. This is characteristically observed in
delusional mood and in delusional perception
(Blankenburg, 1962).
2. The emotional weakening of the intentionality
arc leads, at the level of thought and of speech,
to the lassitude of associations described by
classical authors (Bleuler, 1911).
3. On occasions, what Fuchs (2005) has
described as “inversion of intentionality” can
be produced. In schizophrenia the harmonic
exchange of intentionalities and perspectives
between the Ego and the other is inverted and
this occurs as follows: the patient is not able to
take on the perspective of the other to look at
reality (Blankenburg, 1991) and on the other
8 DIAL PHIL MENT NEURO SCI 2019; 12(1): 1-9
hand the “other”, when the intentionalities lose
their balance, is necessarily transformed into
a persecutor and invader, since he (the other)
“intentionates” the schizophrenic, while he/she
is not able to be “intentioned”. Expressed in
other words, the schizophrenic patient’s ability
to address the other is so weakened that he is
not able to counteract the force of the “address”
or intentionality of the other, leaving the field of
intersubjectivity under the total dominion of the
other. This phenomenon is the phenomenological
basis of the delusion of persecution.
4. Finally, this weakening of intentionality, at the
basis of both the constitution of intersubjectivity
and of the objective temporality of these patients,
also explains the “obstruction” of the “way of
life” of the schizophrenic. Every experienced
psychiatrist who has seen seriously ill patients in
acute patients departments, or has followed the
evolution of others for decades, will remember
the emptiness and the sorrow of these lives,
where impulse and initiative are missing, where
the objects of the world do not attract, but
rather invade the consciousness field with the
multiplicity of their meanings, where there is no
perseverance and, consequently, achievements.
But it would be a mistake to call this “laziness”
or “apathy”. The schizophrenic patient cannot
do another thing, because the driving force of
life itself, which is intentionality, has failed in
the constitution of the other and of the common
and shared world.
It has been a task of phenomenology to
discover within the complex architecture of the
human being the place of the failure which is at
the basis of the symptoms and syndromes we
face in daily clinical practice, and particularly of
the so called endogenous psychoses. It will be
the job of neurobiology to determine the somatic
mechanisms underlying these fundamental
failures and of biological psychiatry and
psychopharmacology to find the medicines
that together with psychotherapeutic and
rehabilitating techniques will help to overcome
them.
Acknowledgments: an early Spanish version of this study
has been published in the journal Salud Mental (Doerr-
Zegers, 2011).
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Corresponding Author:
Otto Doerr-Zegers
Faculty of Medicine of the University of Chile and of
the Diego Portales University, Santiago (Chile)
Avenida La Paz 841, Santiago (Chile)
e.mail: odoerrz@gmail.com
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