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Delusion, Reality, and Intersubjectivity: A Phenomenological
and Enactive Analysis
Thomas Fuchs, Thomas Fuchs
Philosophy, Psychiatry, & Psychology, Volume 27, Number 1, March 2020,
pp. 61-79 (Article)
Published by Johns Hopkins University Press
DOI: https://doi.org/10.1353/ppp.2020.0009
For additional information about this article
https://muse.jhu.edu/article/751756
[ This content has been declared free to read by the pubisher during the COVID-19 pandemic. ]Delusion, Reality,
and Intersubjectivity
A Phenomenological
and Enactive Analysis
Thomas Fuchs
Abstract: According to current representationalist Normal convictions are formed in a context of
concepts, delusion is considered the result of faulty social living and common knowledge. Immediate
information processing or incorrect inference about experience of reality survives only if it can fit into
external reality. In contrast, the article develops a the frame of what is socially valid or can be criti-
concept of delusion as a disturbance of the enactive cally tested …. Each single experience can always
and intersubjective constitution of a shared reality. A be corrected but the total context of experience
foundation of this concept is provided by a theory of is something stable and can hardly be corrected
the objectivity of perception, which is achieved on two at all. The source for incorrigibility therefore
levels: 1) On the first level, the sensorimotor interaction is not to be found in any single phenomenon
with the environment implies a mobility and multiplicity by itself but in the human situation as a whole,
of perspectives that relativizes the momentary point of which nobody would surrender lightly. If socially
view. 2) On the second level, the social interaction with accepted reality totters, people become adrift.
others implies a virtual shifting and contrast of perspec- (Jaspers, 1968, 104)1
tives which helps to overcome a merely subject-centered
worldview through participatory sense-making. On this
basis, the alteration of experience in beginning psychosis
A
is phenomenologically described as a subjectivization
s Jaspers indicates in this quotation
of perception, resulting in an overall experience of self-
centrality and derealization. Delusion then converts
on incorrigibility, delusions may not be
the disturbance of perception into a reframing of the regarded as mere disorders of thinking,
perceived world, namely an assumed persecution by reasoning or reality-testing. Rather, they can only
mundane enemies. Through this, a new sense-making be explained on the background of the totality
is established, yet in a way that is fundamentally of a patient’s situation which is characterized by
decoupled from the shared world. The possibility of a dissolution of “socially accepted reality.” In
intersubjective understanding is thus sacrificed for the contrast, the currently predominant psychiatric
new coherence of the delusion. Further implications of
paradigm is based on a conception of the patient as
the loss of the intersubjective co-constitution of reality
are analyzed, in particular related to disturbances of an enclosed individual with a more or less clearly
communication. defined brain dysfunction. On this view, delusions
seem to be the product of faulty neuronal infor-
Keywords: Delusion; Perspective-taking; Shared back-
mation processing, or of “broken brains.” After
ground; Enactivism; Subjectivization; Self-centrality
all, delusions misrepresent reality, so they must
© 2020 by Johns Hopkins University Press62 ■ PPP / Vol. 27, No. 1 / March 2020
somehow be “in the head,” usually being defined to be in principle psychologically motivated and
as “false beliefs based on incorrect inference about understandable: In paranoia, for example, it is
external reality” (American Psychiatric Associa- mainly suspicion and anxiety that lead to delu-
tion, 2000, 765). sion of persecution; in mania, grandiose delusions
On the other hand, this can hardly be the whole are an expression of the underlying mood, and
story, for even the current definitions of delusion so on. In contrast, primary delusions involve a
contain a cultural clause: convictions that seem “transformation of basic experience which we
bizarre from a Western viewpoint may well be have great difficulty in grasping” (p. 95). In recent
shared with others in a corresponding cultural phenomenological psychopathology, this differ-
background and then give no justification for a ence has been interpreted in Heideggerian terms,
diagnosis of delusion (American Psychiatric As- contrasting “ontic delusions” (i.e., mundane
sociation, 2013, 103). This already shows that the delusions, belonging to the experienced world,
essence of delusion cannot be just a wrong content such as in paranoia) with “ontological delusions”
or representation of reality. In this article, I argue (referring to altered structures of subjectivity as the
that delusions should rather be considered as in- transcendental basis for experience itself) (Sass,
tersubjective phenomena. Instead of reifying them 1992, 2014; Sass & Byrom, 2015; Parnas, 2004).
as localizable states in the head of the patient, a It is the latter kind of delusions that I deal with
phenomenological and enactive approach regards in the following.
delusions as disturbances of intersubjectivity, To develop an intersubjective and “inter-enac-
namely on two levels: tive” concept of delusions, I first give an account
of a) the constitution of reality through enactive
(1) Delusions manifest themselves primar-
perception, b) its co-constitution through “inter-
ily as failures of communication: While
enaction,” that means, through the communicative
interacting with the patient, one realizes
negotiation of viewpoints and mutual perspective-
that it is not possible to arrive at a shared
taking on the one hand, and through implicit or
definition of the situation through the
transcendental intersubjectivity on the other hand.
usual giving and taking of reasons or
For this account, I use both phenomenological and
mutual perspective-taking.
enactive concepts. The guiding question is how the
(2)
On a deeper level, delusions may be objectivity of perception and the shared reality are
regarded as a failure to co-constitute (co-)constituted. This serves as a foundation for
reality, that means, they are character- analyzing the disturbance of reality constitution
ized by a disturbance of transcendental in schizophrenic delusion.
intersubjectivity as the condition of The account I offer here is thus closely linked
possibility for mutual understanding. with recent work on the enactive constitution of
This has been variously interpreted in a shared world (Durt, Tewes, & Fuchs, 2017;
terms of a loss of background certain- Stewart, Gapenne, & Di Paolo, 2011) and the
ties, common sense, we-intentionality, application of enactivism to psychopathology
or basic trust (Fuchs, 2015a,b; Rhodes (Colombetti, 2013; Drayson, 2009). Traces of such
& Gipps, 2008; Stanghellini, 2004), or an intersubjective view can be found in various,
in the concept of schizophrenic quasi- twentieth-century authors (e.g., Glatzel, 1981, 167
solipsism (Sass, 1994). ff.; Janet, 1926). It is also present in more recent
works by Louis Sass (1992, 1994, 2014), who
The second characterization applies in particu-
applies concepts from William James, Heidegger,
lar to the delusions found in schizophrenia, which
and Wittgenstein to analyze the subjectivistic na-
Jaspers (1968, 96) called “delusions proper” or
ture of schizophrenic delusions as a fundamental
“primary delusions” (p. 98), and which he con-
withdrawal from the shared practical world.
trasted with the “delusion-like ideas” of patients
Drawing from these authors, my approach puts
with paranoia (today delusional disorder), psy-
particular emphasis on the assumption that the
chotic mania or depression. The latter he regardedFuchs / Delusion, Reality, and Intersubjectivity ■ 63
sense of reality is inherently bound up with our ongoing sensorimotor interaction and embodied
sensorimotor interaction with the environment coping with the environment (O’Regan & Noë,
and our interactions with others, that means, on 2001; Thompson, 2005, 2007; Varela et al., 1991).
the enactive and interenactive constitution of the Hence, to “perceive” (from the Latin per-cipere =
shared world. to grasp through) is only possible for a living be-
ing that is able to actively move and to grasp for
The Objectivity of Perception something. Even in seemingly pure perception, a
living organism is not in opposition to the world,
Embodied Engagement in the World but always already entangled with it. But if the
The standard account of delusions regards world is constituted for us through our own em-
them as “mistaken beliefs” about objective facts bodied and interactive sense-making, how can this
in the world that are held with incorrectable cer- entanglement result in the objectivity of perception
tainty. The underlying assumption is that there which, after all, apparently presents us the objects
is an external reality which is only given to us themselves? How does perception overcome mere
through representations in our mind. This applies subjectivity?
to perceptions (which are only images produced An essential presupposition for this objectivity
by the brain and could therefore also be called is the constant shifting of perspectives through
“true hallucinations”) as well as to beliefs about self-movement (such as moving around an object,
external states of affairs. This fundamental as- grasping and turning it, etc.) which creates changes
sumption of an internal representational domain and contrasts depending on one’s own action.2 For
separated from an external reality is challenged by this, the body’s movement has to be accounted for
the enactive approach to cognition (Thompson, in perception, that is, it has to be self-referential
2007; Varela, Thompson, & Rosch, 1991). From or self-given. Thus, the movements of the eye
an enactive point of view, reality is not something are taken into account and compensated by the
predetermined and external, but continuously sensory system through “efference copy” mecha-
brought forth by a living being’s sensorimotor nisms, for otherwise the perceived surroundings
interaction with its environment. In the case of would start to sway with every eye movement.3
humans, this includes the constitution of a shared Self-referential movement combined with the
reality through social interactions such as taking active shifting of one’s point of view, is a crucial
part in conversations, mutual understanding and means of establishing an objective relation to the
cooperative action. Importantly, both kinds of in- environment, namely through an interconnection
teraction over time also create fundamental bodily of the organism’s spontaneity and receptivity
and mental structures, habits and certainties, which mutually relativize and specify each other
which serve as a background of each encounter (on this, see also Blankenburg, 1991).
with concrete situations and enable our immediate, Importantly, this skilled sensorimotor interac-
pre-reflective and practical grasp of the world. Let tion with the environment over time becomes
us look at these processes more closely. part of the body’s habitual knowledge and an-
According to the enactive approach, living ticipations. With growing familiarity, the objects
beings do not passively receive information from wished and searched for are already prefigured
their environment which they then translate into by the sensory system as perceptual schemas
internal representations. Rather, they constitute (Vorgestalten), which are projected into the envi-
or enact their world through a process of sense- ronment, so to speak, to facilitate the identifica-
making: By actively searching and probing the tion of the objects. (This may sometimes lead to
environment for relevant cues—moving their head illusions, for example when expecting to meet an
and eyes, touching a surface, walking towards a acquaintance and mistaking another person in
goal, grasping a fruit, etc.—they make sense of the distance for him.) Moreover, what the envi-
their surroundings. In other words, they constitute ronment enables and affords, and how it changes
their experienced world or Umwelt through their depending on our actions, is already anticipated64 ■ PPP / Vol. 27, No. 1 / March 2020
in our perception. Thus, as Husserl (1950, 91 ff.) spectives. Husserl also speaks of an “apperceptive
has shown, we perceive a house not just by look- horizon of possible experiences, my own and those
ing at its visible side, but also by “appresenting” of others,” which turns the mere subjectivity of
its invisible aspects, which we implicitly anticipate my experience into an “open intersubjectivity”
to behold once we move around the house. The (Husserl, 1973b, 107, 289; see also Zahavi, 1996,
actual aspect thus includes and reflects the totality 39 ff.). Thus, there is again a horizon of perception,
of possible aspects making up the unity of the full but one that is shared with others. The plurality
object. Therefore, my experience of the reality of of possible subjects corresponds to the plurality
an object depends on a horizon of possible further of aspects that the objects afford. Moreover, in
experiences of this object—a horizon that is de- perceiving the objects, I implicitly rely on their
rived from my former dealings with it, but which meaningfulness for others, that means, on the
is now implicitly given or “appresented.” Object general structure of significances and affordances
permanence as acquired through sensorimotor of our shared world. In perceiving, we always en-
interaction in early childhood (Piaget, 1955) is a act and inhabit a space that we share with others.
crucial part of this: The objects will continue to More fundamentally, according to Husserl,
exist also during my absence. This always pres- objectivity depends on transcending my private
ent horizon enables my perception of the object sphere of subjectivity which primarily occurs in
itself instead of a merely momentary impression the encounter with the other (Husserl, 1973a,
or image. Of course, my anticipating perception 110, 1973b, 277; on this, see also van Duppen,
is constantly either confirmed or corrected by the 2017). The other is always beyond my imma-
ongoing interaction with the objects, that is, by nence, another sphere and center of perspectival
further shifts of my perspective. consciousness which remains inaccessible to me
and thus constrains my own subjectivity. It is this
Intersubjective Reality alterity of the other which grounds my experi-
As we have seen, perception does not present ence of objectivity, indeed my “perceptual faith”
images or appearances, but the full objects, for it is (Merleau-Ponty, 1968, 19) in a world that exists
part of our embodied engagement in the world and independent of my own perception. Because this
not just passively being impressed. However, there intersubjectivity is implicit or transcendental (the
is still another level of objectivity which is charac- “condition of possibility” of an objective reality to
teristic of human perception. For in perceiving the exist), the others need not be explicitly present—
house, we experience it not only as an object of even Robinson Crusoe on his island saw it always
our possible engagement or skilled coping (mov- “with others’ eyes.” In a fundamental sense, the
ing towards it, opening the door, going upstairs, objects and events in the world are always public,
and so on), but also as independent of our present not private (Husserl, 1973c, 5); they belong to a
perception. The objects are not only there “for shared world, even if they are only perceived by
me,” in the immanence of my subjectivity, they myself in the concrete case. This is also emphasized
are given as such. Berkeley’ s “esse est percipi” by Sartre, summing up Husserl’s view:
certainly does not correspond to our experience The Other is present in it [i.e., in the world]
of perception: Nobody would get the idea that the not only as a particular concrete and empirical
objects only emerged through his perception, and appearance but as a permanent condition of its
without it would vanish into nothingness. How is unity and of its richness. Whether I consider this
this independence possible? table or this tree or this bare wall in solitude or
with companions, the Other is always there as a
Husserl’s later answer to this question referred
layer of constitutive meanings which belong to the
to the intersubjectivity of perception: The house very object which I consider; in short, he is the
that I see is also a possible object for others who veritable guarantee of the object’s objectivity…
could see it simultaneously from other sides. Thus, Thus each object far from being constituted as for
the object gains its actual objectivity, that is, its Kant, by a simple relation to the subject, appears
independence from my own perspective, through in my concrete experience as polyvalent; it is given
the implicit presence of a plurality of other per- originally as possessing systems of reference to anFuchs / Delusion, Reality, and Intersubjectivity ■ 65
indefinite plurality of consciousnesses; it is on the flexibility. Intersubjectivity in its full sense is thus
table, on the wall that the Other is revealed to me based on the ability to oscillate between one’s ego-
as that to which the object under consideration is centric perspective and an allocentric or decentered
perpetually referred—as well as on the occasion
perspective. This crucial step of human cognitive
of the concrete appearances of Pierre or Paul.
(Sartre, 1956, 233) development may also be summarized as reaching
the “excentric position,” a term coined by German
In enactive terms, this implicit or transcendental philosopher H. Plessner (1928) to denote a third
intersubjectivity may be interpreted as resulting or higher-level stance from which the integration
from a history of “participatory sense-making” of the ego- and allo-centric perspective is possible.
(De Jaegher & Di Paolo, 2007). From birth on, It is also the position which enables a shared or
both the presence and the meaning of objects is “we-intentionality” of the members of a group,
continuously established through social interac- as being jointly directed towards a common ob-
tions, particularly including situations of joint ject or action goal (Elsenbroich & Gilbert, 2014;
attention and joint practices of coping with the Searle, 1995).
world. We learn to perceptually distinguish, to This position is not only based on perspective-
recognize and to handle objects be witnessing how taking and decentering, but also includes an
others relate to them (Gallagher, 2008; Tomasello, implicit, taken for granted background as the
1999). Thus, reality is co-constituted or “interen- presupposition for a shared reality. It consists
acted” from the beginning. This intersubjective of the fundamental assumptions, “axioms of
constitution has become a part of our habitual or everyday life” (Straus, 1958) or bedrock certain-
implicit relation to the world, just like the senso- ties (Wittgenstein, 1969) that are shared by the
rimotor interaction with the objects has become members of a culture without necessarily being
part of our embodied knowledge and perception made explicit or verbalized. Common sense may
(Fuchs, 2016).4 be regarded as an expression of those basic certain-
On this level of reality constitution, the equiva- ties, but it also includes the shared habitualities,
lent to the self-referential movement and contrast forms of interaction and “rules of the game” that
of spatial viewpoints is social perspective-taking. are embodied rather than explicitly taught in the
Seeing the world with others’ eyes extends the process of socialization. In the affective dimension,
bodily self-movement by adopting virtual perspec- this background corresponds to a basic trust in the
tives and thus multiplies the possibilities of con- world and in others that develops from infancy
trasting. Social situations with their multifarious through the interaction with the caregivers. The
meanings and ambiguities are in particular need of co-constitution of a shared reality, indeed our most
mutual exchange, communication and correction fundamental “perceptual faith” in the experienced
of viewpoints through taking the others’ perspec- reality (Merleau-Ponty, 1968) crucially depends
tive. Thus, the principle of the intersubjective on this habitual and pre-reflective background
constitution of reality is the relativization of one’s that carries and supports all specific communica-
subjective point of view through social interaction tion and negotiation of viewpoints within the life
with its alignment of perspectives. Although this world.
alignment never comes to a definite conclusion, Let me summarize the above considerations:
the possibility of further interaction opens up the Perception transcends the centrality and bounded-
horizon of achieving a mutual understanding that ness of the subjective perspective by a decentering
we anticipate in every encounter with others. that occurs on two interrelated levels:
The presupposition for these processes is obvi-
ously the human capacity of shared intentionality • On the first level, the sensorimotor in-
and perspective taking—that means, to transcend teraction with the environment implies a
one’s own perspective and to grasp others’ inten- mobility and multiplicity of perspectives
tions and viewpoints. This suspends the individu- that relativizes the momentary coupling
al’s primary self-centrality and enables perspectival of organism and environment.66 ■ PPP / Vol. 27, No. 1 / March 2020
• On the second level, the social interac- Through open intersubjectivity, human beings
tion with others implies a virtual shifting definitely transcend the subjectivity of their centric
and contrast of perspectives which helps perspective and gain access to the shared, objective
to overcome a merely subject-centered reality. For “objectivity” ultimately indicates that
worldview through participatory sense- the objects are experienced as intersubjectively ac-
making. cessible, “as actually there for everyone” (Husserl,
1960, 91). This is why we implicitly perceive a
Thus, the single, momentary and subjective
given experiential object as transcending its mo-
perception is put into perspective, receives depth
mentary appearance. Human reality is therefore
and objectivity through a horizon of multiple other
always co-constituted or interenacted through
perspectives that is opened up and realized both
participatory sense-making, both implicitly and
through one’s sensorimotor and social interactions
explicitly.
with the environment.
On both levels, the self-referentiality or self-
givenness of the subject’s spontaneity and activ- Subjectivization of
ity is crucial for gaining an objective view on the Perception in Schizophrenia
world, and that means, for the constitution of The significance of this analysis for various
reality (Blankenburg, 1991). On the first level, psychopathological phenomena seems quite obvi-
a living being’s sensorimotor processes become ous. For example, from an enactive point of view,
transparent for reality inasmuch as it takes its hallucinations are only pseudo-perceptions which
own position and activity into account. This self- lack the sensorimotor cycles necessary for realistic
referentiality of movement enables the “mediated perceiving on the first level. They may thus be
immediacy,” to use Hegel’s term, of the body’s regarded as products of the prefiguring activity of
relation to the environment. On the second level, sensory or other brain systems which are projected
the view of human beings on the shared world is into the field of awareness without resulting in
clarified to the extent that they become aware of sensorimotor interactions or perspectival change
themselves in relation to others. For it is precisely (this is why they are frequently experienced by
the knowledge of myself in my relation to the envi- the patients as “not really perceptions”). In other
ronment, which enables me to distinguish what is words, hallucinations are the result of a decoupling
“for me” and what is “in itself,” and to grasp the of brain activity and normal body-environment
objects as well as the others in their independence feedback. On the other hand, the second level of
from my own subjectivity. sense-making is concerned as well, inasmuch as
Finally, on both levels an individual’s history the perceived (pseudo-) objects do not take part in
of interactions is sedimented in his or her im- the reality that is in principle accessible to others.
plicit memory, resulting in fundamental habitual Turning to delusions, I start my analysis by
structures: looking at the characteristic phenomena at the be-
• On the first level, the body acquires the ginning of schizophrenic psychosis which amount
capacities of skillful coping and thus, a to a radical subjectivization of perception. As is
fundamental familiarity with the world. well known, in the predelusional atmosphere or
The horizon of possible perspectives “delusional mood” (Fuchs, 2005; Jaspers, 1968;
and dealings with the objects is already Sass & Pienkos, 2013), the patients experience
anticipated or implied in each present their surroundings as strangely unreal, as if they
perception. were seeing only artificial images instead of real
objects. Objects look spurious, somehow manu-
• On the second level, early socialization factured or contrived; people seem to behave un-
establishes the habitual structure of being- naturally, as if they were actors or impostors. It all
with-others, which manifests itself in an feels like being in the center of an uncanny staging
implicit or open intersubjectivity as well or pre-arranged scenes:
as in a basic trust in the common world.Fuchs / Delusion, Reality, and Intersubjectivity ■ 67
Wherever you are looking, everything already ap- existence of the objects or the world as a whole
pears unreal. The whole environment, everything depends on the perceiver—as it were, a pathologi-
becomes strange, and you get terribly fright- cal form of Berkeley’ s “esse est percipi” (see also
ened… Somehow everything is suddenly there
Sass, 1992, 277 ff.):
for me, like being arranged for me. Everything
around you suddenly refers to you. You are in Whenever I took my eyes of them [the hospital
the center of a plot like in front of backdrops. guards], they disappeared. In fact, everything
(Klosterkötter, 1988, 69; own transl.) at which I did not direct my entire attention
seemed not to exist. (Landis, 1964, 90; quoted
I’m constantly worrying about me. I would not
from Sass, l.c.)
say I’m persecuted, but everything feels oppres-
sive. Take this table or these walls—they are At a party, everything seemed to originate from
strange. I guess everything looks phony! But it’s him or depend on him. (Parnas et al., 2005, 255)
not only here, the walls in my living room also
If I perceive a door and then look away, then it’s
feel paper-like as if I was in a set. (Madeira et
almost as if the door ceases to exist. (Henriksen,
al., 2016)
2011, 24)
Such “Truman Show” or “Matrix” symptoms, as
The last patient sometimes had the impression that
they are frequently called by the patients them-
she was the only person who really exists and that
selves (Madeira et al., 2016), point to a radical
she was “responsible for the world moving on”—a
change of the structure of perception, although
form of solipsistic self-centrality which frequently
no obvious disturbance of the sensory field may
leads to a kind of “passive omnipotency,” as if
be detected. Instead, it is the intentional direction
the patients were able to determine the course
of the field that is reversed: Whereas the perceived
of events or to move the world, yet without even
objects formerly had their independent existence
knowing how (Conrad, 1958, 74; Fuchs, 2000,
and kept their distance, they now start to refer to
143). The explanation is quite obvious: If percep-
the patient, approaching him in an uncanny and
tion has lost its objectivity, and this means, its
oppressive way.5 Everyday objects and situations
implicit or open intersubjectivity, then the objects
lose their familiar meanings and seem to hint at
seem to move or even to exist only for me, or “by
something novel, yet still enigmatic and puzzling—
my grace.” Object permanence, acquired in early
perplexity, anxiety and increasing agitation is the
childhood and having become a transcendental
patient’s usual reaction. The reason for all this is
condition of perceiving, is lost again.6 Moreover,
that perception no longer grasps the objects as
as the German psychiatrist Matussek (1987) has
such, but only presents their appearances (Fuchs,
shown in his analyses of delusional perception,
2005). It has lost its intentional and decentering
patients are frequently captivated by minor details
structure, and this is why the patient becomes
of the perceptual field and may fall into a veritable
the “center of the world.” The derealization he
“rigidity of perception” (Wahrnehmungsstarre),
experiences is thus quite different from a mere
unable to detach themselves from the object. This
alienation of the surrounding world, as it may
means that the cycles of sensorimotor interaction
occur in neurotic or affective disorders. On the
with the environment are impaired or arrested,
contrary, having lost their independent reality
thus contributing to the subjectivization of per-
and neutrality, the objects are only there for the
ception. Feelings of unreality usually deepen with
patient or seem arranged because of him. In other
increasing inaction and passivity (Sass, 1992,
words, they lack their intersubjectively shared
297). This may culminate in the experience of
meanings and are no longer consensually given
being enclosed in one’s own perceptions, like in a
to everybody—which is, as Sass (1992, 283) also
subjective camera movie: “I saw everything I did
notes, one crucial mark of the real. Indeed they
like a film-camera” (Sass, 1992, 286).
are no longer objects in the strict sense at all, but
only pseudo-objects, appearances or images, set For me it was as if my eyes were cameras, and my
up for an unknown purpose. brain would still be in my body, but somehow as
if my head were enormous, the size of a universe,
Not infrequently, this subjectivization of per-
and I was in the far back and the cameras were
ception culminates in the impression that the68 ■ PPP / Vol. 27, No. 1 / March 2020
at the very front. So extremely far away from the no longer my familiar environment … it might be
cameras. (de Haan & Fuchs, 2010, 329) no longer our house. Someone might set this up
for me as a scenery. A scenery, or maybe it could
Here the subject gets into a position outside the be transmitted to me as a television play. … Then
world; he literally becomes a homunculus within I touched the walls in order to check whether this
the head looking at his own perceptions like at was really a surface. (Klosterkötter, 1988, 64 ff.
projected images. own transl.)
In all these cases, we can see that perception Again, the patient’s perception is subjectivized and
does no longer transcend itself and reach the ob- thereby derealized: The natural attitude towards
jects as such. Instead of perceiving the world, the the world, the normally unquestioned “perceptual
subject experiences his experiences themselves; faith” is called in doubt. Since she is not aware
thus, he seems to be the “constituting center of the disturbance of perception as such, it is the
of the experiential universe” (Sass, 1992, 294) objects that seem to have changed, and she is test-
which revolves around him. The objectivity, that ing their surface quality. In addition, however, the
is, the implicit intersubjective givenness of the inversion of the intentional field already creates the
world is lost, and the patients are enclosed in impression of an external power being responsible
their own pseudo-perceptions like in a solipsistic for it. Getting more and more terrified, the patient
inner world. The intersubjective constitution of was finally struck by the sudden evidence that a
objective reality is thus replaced by a radically foreign secret service abused her for experimental
subjectivist or idiosyncratic experience. purposes and projected fake images into her brain
An interesting analogy may also be seen in the via rays (Klosterkötter, 1988). This insight felt like
structure of dream consciousness: here too, the “scales falling from her eyes” and at least reduced
subject is the ‘center of the world.’ All things and the tension and terror she felt before, if only at the
events are displayed for him instead of being inde- price of a growing sense of persecution.
pendent entities; they appear “out of the blue” and The subjectivization of perception already pre-
yet “just in time,” only to vanish into nothingness figures the loss of intersubjectivity that we find in
in the next moment. Moreover, the subject is de- full-blown delusion. For it fundamentally shakes
livered to the dream appearances in characteristic the basic trust in the shared, constant and reliable
passivity—the practical sensorimotor interaction world—a shake whose terrifying effect may hardly
of body and environment is missing.7 At the same be overestimated. On this background of an in-
time, all situations show a self-referential signifi-
tolerable “ontological uncertainty,” the relieving
cance (tua res agitur), even though this significance
and restabilizing effect of the delusion is based
often remains enigmatic and mysterious. Although
on the fact that it converts the transcendental
other persons usually play a major role in dreams,
disturbance of perception into an inner-worldly
open intersubjectivity is lost: the dreamer has no
happening, namely an assumed persecution by
excentric position from which he could relativize
mundane enemies or powers. In other words,
what happens by regarding it from another’s point
the disturbance of perception is converted into a
of view. He is not able to distinguish what is ‘for
reframing of the perceived.
me’ and what is ‘in itself,’ because he lacks the
With this, however, a new (pseudo-)objectivity
higher order knowledge of himself in relation to
is created: Precisely what had seemed uncanny,
his environment.
spurious and “made” before is now turned into
the new reality of an actual, though concealed
Transition into Delusion persecution and machination. Whereas before the
As a typical example for the transition of these perceived had lost its meaningful coherence, now
disturbances into delusion, we can take the fol- everything is purposefully meant and arranged
lowing case: for the patient: Gazes observe her, secret cameras
take shots of her, and the like. The inversion and
It seemed ever more unreal to me, like a foreign
self-centrality that resulted from perception losing
country …. Then it occurred to me that this wasFuchs / Delusion, Reality, and Intersubjectivity ■ 69
its decentering returns in the omnipresent self-ref- self-givenness of one’s own activity: Actions or
erence of alien powers that is typical for delusional thoughts appear in consciousness like alien frag-
ideation. Sense-making is thus reestablished (as the ments, only experienced in a deferred manner or ex
German Wahnsinn or “deluded sense” indicates), post (on this, see Fuchs, 2013b, 2015c). The loss
yet in a way that is fundamentally decoupled from of self-agency results in an experience of disem-
the shared world.8 powerment and passivity which again implies an
We can summarize these fundamental changes inversion of intentionality and a self-centrality of
in two steps, leading from (1) derealization to (2) the experiential field; instead of acting or thinking,
delusion: the patient is being acted upon, or his thoughts
are inserted. Delusions of control now turn these
(1) Reality turns into appearance: Percep-
experiences into a mundane impact of external
tion is subjectivized and presents only
agents: The patient’s movements are steered by
pseudo-objects.
means of rays, thoughts are inserted through brain
control, and the like. Such delusions usually in-
(2)
→ Appearance turns into new reality:
volve a loss of boundaries between self and other,
Delusion converts this appearance into
also termed Ich-Störungen or “ego-disorders” in
a new objectivity, implying that there is
German psychopathology. Frequently, patients
a reason for the changed environment
use a physicalistic, technical or spatial vocabu-
(namely, the semblance is in fact created
lary to describe these impacts, corresponding to
on purpose).
the reification of their self-experience (e.g., the
(1) Inversion of the perceptual field: The well-known “influencing-machines,” Hirjak &
loss of decentering perception leads to Fuchs, 2010).
solipstic self-centrality. Regardless whether being based on perceptual
or more self-related disorders, with the formation
(2)
→ Inversion of intentionality: Delusion and crystallization of the delusion a coherent and
converts this self-centrality into self- meaningful kind of reality is reestablished. Delu-
referential intentions of hidden agents in sion “makes sense,” however, in a fundamentally
the world. In other words, subjective or solipsistic way; for it turns the radical subjectiv-
“transcendental” self-centrality is turned ization and passivity of experience into a new,
into mundane or social self-centrality. purposefully staged reality that is incompatible
with the worldview of others. I now further in-
Not every schizophrenic delusion is based vestigate this aspect.
on the centralization of perceptual experience,
however. Another, though related route to delu- The Loss of Open
sion derives from self-disturbances that affect the
pre-reflective experience of one’s body, actions and
Intersubjectivity
stream of consciousness (Sass & Parnas, 2003; Breakdown of the “As If”
Parnas et al., 2005). Among these, I mention in The transition to the full-blown delusional con-
particular experiences of passivity, namely the viction is marked by a typical change of attitude
alienation of movements and thoughts: Bodily and language, namely a loss of the “as if.” At first
movements occur that are not initiated by the self, the patients still maintain a critical distance to
or thoughts emerge in the patient’s mind as if gen- their experiences which is usually expressed in “as
erated from outside. Patients may then experience if”-clauses: It only seems as if something extraor-
themselves as robots or human machines, becom- dinary is going on (see also the above examples:
ing the passive spectators of their body’s actions “as if I was in a set,” and “as if the door ceases
or their own thoughts (De Haan & Fuchs, 2010). to exist”). This implies the preserved capacity to
From an enactive point of view, this may be shift one’s perspective and take an external point
explained by a loss of the self-referentiality or of view from which what seems to be the case70 ■ PPP / Vol. 27, No. 1 / March 2020
“cannot actually be true.” It indicates that the in fact it was only coincidence.” This presupposes
“excentric position” (Plessner, 1928) is still at- shifting my primary, egocentric perspective on the
tainable. I quote another case vignette: situation to a neutral frame of reference in which I
I could no longer think the way I wanted to… do not play a role. For the schizophrenia patient,
It was as if one could no longer think oneself, however, the opposite is the case: It is precisely
as if one were hindered from thinking. I had the the normally irrelevant background elements that
impression that all that I thought were no longer adopt a “telling,” sinister and threatening signifi-
my own ideas at all … as if I wouldn’t be the one cance. They all manifest a concealed intentionality
who is thinking. I began to wonder whether I am which aims at him. He can no longer neutralize
still myself or an exchanged person. (Klosterköt-
these salient elements by attributing them to co-
ter, 1988, 111; own transl., emphasis added)
incidence or to the “as if,” because the excentric
Again, the patient finally dropped the reservation position from which the principle of coincidence
of the “as if” and came to be convinced that a could even be taken into account is no longer at-
criminal organization had implanted a chip in tainable. One could also say that with the transi-
her brain to control her thoughts. The onset of tion to delusion, the ‚as if‘ is given up as a formal
delusions is thus marked by the breakdown of reservation and instead shifts into the content of
the “as if.” This implies not only a change in the the delusion: What first seemed unreal, staged or
degree of certainty but also the definitive loss of artificial on the level of perception now becomes
open intersubjectivity. For the possibility of calling the actual staging, play-acting, and machination
one’s experience into doubt is still based on taking of the enemies—an intended ‘as if.’
the perspective of the “generalized other” (Mead
1934), that means, on an implicit intersubjectivity Loss of the Shared Background
or common sense. The “as if” is the last connection If we now turn to the specific interaction with
to the shared world. a deluded patient, we find a peculiar structure
However, the ambiguity of the “it seems as if” of non-understanding which is ultimately not
is too disturbing and tantalizing for the patient to due to a disagreement on particular statements
be maintained for a longer time. Before long, the or facts but to the fundamental assumptions on
existential anxiety and the overwhelming urge for which the conversation itself is based. In normal
coherence of the perceptual field enforce disam- verbal interactions, mutual understanding is
biguation, and the delusional conviction finally achieved through reciprocal utterances, taking
locks in place.9 The loss of the “as if” is therefore each other’s perspectives, misunderstanding and
tantamount to a breakdown of the perspectival correction, clarifying meanings, and the like. In
flexibility which would still enable the patient the process, we continuously shift between the
to take a general point of view and thus to gain ego- and the allocentric perspective. Deeper dis-
a distance from the situation. It means a loss of agreement requires the give and take of reasons
the excentric position. Thus, the possibility of which may then lead to an increasingly consensual
intersubjective understanding is sacrificed for the understanding or otherwise at least to an “agree-
new coherence of delusional sense-making in an ment to disagree.” However, in the conversation
otherwise incomprehensible, deeply disturbing with a deluded patient, all these processes remain
world. Once locked, this new and rigid coherence strangely futile. When confronted with doubts
is further fortified through delusional elaboration: or objections, the patient does not adequately
looking for additional evidence as well as system- respond. On the contrary, he will either assume
atically neglecting counter-evidence.10 a consensually perceived situation even though
A manifestation of this rigidity is the exclusion this is not at all the case from the other’s point of
of coincidence (Berner, 1978). The principle of view (Fuchs, 2015a ; McCabe, Leudar, & Antaki,
coincidence normally allows us to neutralize a 2004); or he will justify his claims in a way that is
seemingly purposeful arrangement or simultaneity not in the least sufficient for the interlocutor (“But
of events: “It seemed as if it was meant for me, but how do you know they implanted a chip in yourFuchs / Delusion, Reality, and Intersubjectivity ■ 71 brain?”—“Well I just can feel it.”). He may even luded patient, this background has fundamentally not attempt to make himself understood at all changed. With the radical subjectivization of his (“It’s pointless. I just know it, that’s all”). In any perception in delusional mood, the basic trust in case, the psychiatrist will experience what may be the shared world has been shattered; common called a “gap of plausibilization,” that means, a sense has lost its validity. As shown above, the blatant disproportion between the improbability emergence of delusion turns precisely this radical of the patient’s statements and his attempts to subjectivization and passivity of experience into justify them. a new objectivity, that means, into a new self- If we then ask ourselves how it is possible evidence. Now the patient cannot doubt these that someone can maintain a belief as unusual as new certainties either—this would just not make that (believing that a chip has been implanted in sense for him. He literally lives in a different world: his brain, or that his biological sex has changed Moving far away trains is normal in a world where overnight, and the like), the question itself al- everything revolves around the self. Chips in brains ready shows that we have lost common ground. are self-evident in a world of radical passivity. As Jaspers stated above, a delusion corresponds Changed biological sex is expectable in a world not to a single belief, but to a “total context of in which the self has lost its continuity. The new experience” which “can hardly be corrected at all. certainties are outside of any possibility of doubt The source for incorrigibility therefore is not to or justification, no different from the certainties be found in any single phenomenon by itself but we rely on in our world. in the human situation as a whole, which nobody From this follows that the patient’s delusional would surrender lightly” (Jaspers, 1968, 104). convictions are not rational conclusions or ex- However, this applies to our own situation as well, planations. Delusions are not based on correct for it is always based on a bedrock of fundamental inferences from distorted primary experiences, certainties (Wittgenstein, 1969) or background as the so-called “empiricist” theory would have assumptions that we rely upon without explicitly it (Maher, 1988, 1999). No abnormal experience awareness, but which we “would not surrender whatsoever could make it rational to belief in lightly.” This shared background is part of our thought insertion or brain chips, not because of everyday conduct of life, consisting of all the lived the unusual content as such, but because the very regularities, dispositions and assumptions that notion of rationality implies the excentric point are neither of the propositions, representations of view of the “generalized other,” and thus, in nor rules. It is based on accumulated experience principle, intersubjective communicability. How- which has sedimented into our implicit knowl- ever, this general viewpoint is lost in delusion, and edge and expectations, resulting, for example, in there is no private or solipsistic rationality instead. an everyday physics, which tells us that humans On the other hand, delusions are not based on just cannot fly out of windows in the air, or move irrational, faulty reasoning or wrong inferences far away trains by the power of their mind; or in either, as the “rationalist” approach assumes an everyday biology which simply excludes that (e.g., “jumping to conclusions” on an insufficient people’s sex could change overnight (Schreber, evidence basis; Campbell, 2001; Garety & Hems- 1903/1988), or that chips in their brains could be ley, 1994). Such wrong conclusions are far too sending thoughts into their mind. widespread to constitute the essence of delusion. We live and act on the background of these Delusions are neither rational nor irrational; they certainties not because we have ever concluded or are not theories, inferences or judgments about made sure that they are true. They are just self- reality at all but self-evident revelations, which are evident—part of our implicit intersubjectivity or only attained through a leap, and which first and common sense. To call them into doubt would be foremost establish a new coherent reality. a pointless endeavor; indeed we would not—or This means, however, that the communication even could not—rationally argue against it, but with a deluded patient, inasmuch as the delusion simply deem it “nonsense.” However, as Rhodes is concerned, has lost the background of implicit and Gipps (2008) have rightly argued, for the de- intersubjectivity and common sense on which
72 ■ PPP / Vol. 27, No. 1 / March 2020
mutual understanding is ultimately based.11 No to the phenomenological epoche, that means, a
rational argument whatsoever is valid any longer methodic bracketing of our everyday assumptions
once the shared frame of reference is lost within about the world.
which it could be claimed—it is just pointless. It
is also for this reason that a psychiatrist usually Failure of the Excentric Position
does not need to falsify the patient’s statements Finally, we can also conceive the disturbance
to make a diagnosis. Their incongruence with our of communication in delusion as resulting from a
shared basic assumptions about the world suffices failure of the excentric position that I have already
to recognize the delusional conviction as such—an described above as loss of the “as if.” For the
incongruence that we realize with an unsettling, alignment of different perspectives in the course
“vertiginous feeling” (Rhodes & Gipps, 2008, of a conversation presupposes perspectival flexibil-
299), but of which the patient himself may not ity—transcending one’s own and taking the other’s
even be aware. perspective to grasp his intentions and making
Because the objects and situations that delu- oneself understood. This flexibility is based on the
sional language refers to are not intersubjectively excentric position. Granted, the patients are still
co-constituted but rather solipsistic (pseudo-) able to imagine what others could think or intend
objects, one may even argue that we are dealing (there is no basic defect of a “theory of mind”);
here with a kind of “private language.” For its they even take their presumed perspectives exces-
meanings are no longer co-intended or shared sively, but in a way that all these perspectives seem
but only valid within the idiosyncratic delusional to be directed back to the patients themselves.12
framework. Correspondingly, Spitzer (1990) sug- What they lack with regard to their delusion is
gested that schizophrenic delusions should actually the higher-order independent position from which
be considered as self-reports about private or inner they could relativize their experience of self-
states, and not as epistemic statements on factual centrality (being alluded to, observed, persecuted
matters in the public world (often the patients do by others, etc.). Taking the perspective of the real
not even claim intersubjective validity for their other is replaced by an illusionary self-referential
experiences). As is well-known, Wittgenstein perspective. The others are indeed only pseudo-
(1953/1968) considered a private language impos- subjects, figures or stereotypes for the delusional
sible, and one might indeed question whether the narrative rather than real counterparts whose
notion of language as an intersubjective realm of perspective the patient could take.
meaning is still applicable in this case. This would Another result of losing the excentric position
mean that delusions are indeed fundamentally is the phenomenon of transitivism described by
“incomprehensible,” as Jaspers argued (1968, 98). Bleuler (1911/1950). Here, becoming “conscious
Jaspers’s claim seems too strong, however: of another consciousness” may threaten the
It would be overstated to say that the loss of patient with a loss of his or her self, as in the fol-
co-intended meaning implies absolute incompre- lowing cases:
hensibility. After all, it is still possible to translate
When I look at somebody my own personality
the patient’s utterances into our own language, is in danger. I am undergoing a transformation
provided that we take the transformation of the and myself is beginning to disappear. (Chapman,
patient’s world into account, as I have tried to 1966, 232)
describe here. As Rhodes and Gipps have pointed
out, to understand the patient’s delusional world, The others’ gazes get penetrating, and it is as if
we have to “pursue the imaginative exercise of there was a consciousness of my person emerging
temporarily suspending those certainties that con- around me … they can read in me like in a book.
Then I don’t know who I am any more. (Fuchs,
stitute the bedrock of our reason itself, certainties
2000, 172)
that are implicitly challenged by the delusional
belief” (Rhodes & Gipps, 2008, 299). Blanken- As I mentioned at the beginning, perspectival
burg (1971) likened this task of the psychiatrist flexibility needs to be self-referential or self-givenFuchs / Delusion, Reality, and Intersubjectivity ■ 73
to present the perceived object or the other in in- his extended delusional system with utter convic-
dependence from oneself. In transitivism, however, tion and zeal, while, on the other hand, denying
the patients are passively drawn into the other’s that it claimed ordinary commonsensical realness:
perspective and overwhelmed by their gazes or “I could even say with Jesus Christ: ‘My King-
their mere presence (see Fuchs, 2015a). Having dom is not of this world’; my so-called delusions
lost the independent position which mediates are concerned solely with God and the beyond;
between ego- and allocentric perspective, they they can therefore never in any way influence
are caught in a short circuit of perspectives, as it my behavior in any worldly matter” (Schreber,
were, resulting in a melting of self and other. They 1988, 301 ff.).
are entangled in a self-referential and delusional In his thorough analysis of the “Memoirs,”
view from the outside that dissolves their ego- Sass notes:
boundaries. This short circuit may also lead to
“Schreber’s claims seem, then, to involve two
the experience of thought-broadcasting: All the
attitudes: one in which he accepts the essential
patient’s thoughts are known to others; there is innerness and privacy of his own claims, the
no difference between his mental life and that of other in which he assumes that they have some
others any more. kind of objectivity and potential consensuality”
Finally, a seemingly paradoxical result of a (Sass, 1994, 55; see also Sass, 2014).
failure of the excentric position is the phenomenon
One may conclude that in double bookkeeping,
of “double book-keeping,” also first identified
subjectivity and intersubjectivity have separated,
by Bleuler (1911/1950, 378): Here, the everyday
yet the claim of the “generalized other” cannot
reality and the delusional reality are juxtaposed
be completely neglected. This confirms once more
instead of one being sacrificed for the other. The
that delusions may not be understood without
patient now lives in two worlds at the same time,
reference to the open intersubjectivity from which
as it were: on the one hand the world of voices
they have detached. It is important to note that
and delusions, and on the other hand the world
psychotherapeutic approaches to schizophrenia
as shared with others. For example, a patient may
may use the ambiguity of double bookkeeping as
hear voices as clearly as the voice of the psychia-
a starting point for gradually loosening the rigid-
trist and believe them just as real, yet at the same
ity of delusional conviction and reestablishing the
time acknowledge that the psychiatrist does not
commonality of perspectives (see e.g., Moritz et
hear them. A patient with grandiose delusion may
al., 2013).
be fully convinced that his coronation is imminent
yet continue to do humble services on the ward,
feeling little if any conflict between the two stances Summary and Conclusion
(Sass, 2014). As I have shown in the first part, the constitu-
In these cases, the integrating excentric position tion of reality is based on a polarity or a dialectical
is lacking too, but the delusional view does not relation that we find on two levels:
replace the commonsensical perspective—they
just coexist in different ontological domains (1) the dialectic between receptivity and
without contiguity or overlap. However, this spontaneity which mutually relativize
does not mean that the patient’s private reality each other, played out in the sensorimo-
would lose its delusional character and become tor interaction of organism and environ-
a mere realm of his imagination or phantasy—on ment, and
the contrary, its authority for the patient is even (2) the dialectic between subjectivity and in-
greater than that of consensual reality. Hence, the tersubjectivity, as played out in social in-
patients remain ambiguous, wavering between teraction or participatory sense-making.
the demands of both domains. Thus, Daniel Paul
On both levels, the self-referentiality or self-
Schreber, in his famous “Memoirs of my nervous
givenness of one’s own relation to the environment
illness” (1903/1988), on the one hand, developsYou can also read
