Phenomenology and the Social Context

of Psychiatry
ii

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Phenomenology and the Social
Context of Psychiatry

Social Relations, Psychopathology, and

Husserl’s Philosophy

Edited by Magnus Englander

Bloomsbury Academic
An imprint of Bloomsbury Publishing Plc

LON DON • OX F O R D • N E W YO R K • N E W D E L H I • SY DN EY
iv

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 Contents

List of Contributors vi

Introduction: Towards a Phenomenological Social Psychiatry

Magnus Englander 1

1 Transcendental Intersubjectivity as the Foundation for a

Phenomenological Social Psychiatry Larry Davidson 7

2 Schizophrenia, Psychosis, and Empathy Mads Gram Henriksen 27

3 Empathy in a Social Psychiatry Magnus Englander 49

4 On the Empathic Mode of Intuition: A Phenomenological

Foundation for Social Psychiatry Scott D. Churchill 65

5 Research Methods for Person-​Centred Health Science: Fordham

Studies of Suffering and Transcendence Frederick J. Wertz,
Miraj U. Desai, Emily Maynard, Justin R. Misurell, Mary Beth
Morrissey, Batya Rotter, and Nicoletta C. Skoufalos 95

6 A Phenomenological Understanding of Postpartum Depression and

Its Treatment Idun Røseth and Rob Bongaardt 121

7 A Phenomenology of Sensus Communis: Outline of a Phenomenological

Approach to Social Psychiatry Samuel Thoma and Thomas Fuchs 137

8 Husserl’s Ethics and Psychiatry Susi Ferrarello 161

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

Marc Applebaum 183

Names Index 205

Subject Index 209
vi

Contributors

Marc Applebaum, PhD, faculty member in the College of Social Sciences,

Department of Humanistic and Clinical Psychology, Saybrook University,
Oakland, CA, USA.

Rob Bongaardt, PhD, professor at the Faculty of Health and Social Sciences,
University College of Southeast Norway, Porsgrunn, Norway.

Scott D. Churchill, PhD, professor of psychology at the Department of

Psychology at the University of Dallas, Irving, TX, USA.

Larry Davidson, PhD, professor of psychiatry and director of the Program

for Recovery and Community Health, Yale School of Medicine, New Haven,
CT, USA.

Miraj U. Desai, PhD, associate research scientist and faculty member, Program
for Recovery and Community Health, Yale School of Medicine, New Haven, CT,
USA.

Magnus Englander, PhD, associate professor at the Faculty of Health and

Society, Department of Social Work, Malmö University, Malmö, Sweden.

Susi Ferrarello, PhD, faculty member at the Department of Philosophy,

University of San Francisco, San Francisco, CA, USA.

Thomas Fuchs, MD, PhD, Karl Jaspers Professor for Philosophical Foundations
of Psychiatry and Psychotherapy at the University of Heidelberg and the Clinic
for General Psychiatry, Center for Psychosocial Medicine, University Clinic
Heidelberg, Heidelberg, Germany.

Mads Gram Henriksen, PhD, senior lecturer & researcher at Mental Health
Center Glostrup, University Hospital of Copenhagen, and Center for Subjectivity
Research, University of Copenhagen, Denmark.

Emily Maynard, PhD, postdoctoral fellow in clinical psychology, Gevirtz

Graduate School of Education, University of California, Santa Barbara, USA.
newgenprepdf

Contributors vii

Justin R. Misurell, Ph.D. Clinical Assistant Professor of Child and Adolescent

Psychiatry at the Child Study Center at NYU Langone Medical Center, NY, USA.

Mary Beth Morrissey, PhD, Research Fellow, Global Healthcare Innovation

Management Center, Fordham University, NY, USA.

Batya Rotter, PhD, independent practice of psychology, Jerusalem, Israel.

Idun Røseth, PhD, psychologist at the Department of Child and Adolescent

Psychiatry, Telemark Hospital, Skien, Norway.

Nicoletta C. Skoufalos, PhD, GreenTPsychology LLC, New York City, USA.

Samuel Thoma, MD, researcher at the University of Heidelberg and the Clinic
for General Psychiatry, Center for Psychosocial Medicine, University Clinic
Heidelberg (with a PhD project entitled Phänomenologisch-​anthropologische
Grundlagen der Sozialpsychatrie), Heidelberg, Germany.

Frederick J. Wertz, PhD, professor of psychology, Department of Psychology,

Fordham University, New York City, NY, USA.
vi
 Introduction: Towards a Phenomenological
Social Psychiatry
Magnus Englander

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

In other words, to ignore the social world in its relation to mental illness is to
disregard the human condition as constituted by our being-​with-​others.
The prefix social has also become ambiguous in its relation to psychiatry, as
it has become to other related disciplines carrying it, such as, for example, social
psychology and social work. In other words, what does such a prefix really mean?
Does it refer to social as in cultural generative meanings, to society at large, to
community, to family and friends; does it point to the minimal social context of
a face-​to-​face situation; does it represent the social as in social science; does it
signify equality in a political sense, or does it perhaps indicate a critical stance
and opposition towards a biomedical psychiatry? Priebe and Finzen (2002) have
reported that at a 1970 historical debate about social psychiatry in Germany,
the word social was considered unnecessary, because psychiatry was by its very
nature already social. But could we ever reclaim the term psychiatry as automati-
cally including the social or has such a possibility been lost forever because of
2

2 Magnus Englander

psychiatry’s permanent home within the medical sciences and its scientific con-
text within the biomedical model? Perhaps it was a mistake to connect psychia-
try to medicine in the first place, even though one could argue from a historical
point of view that this was necessary in order to free persons suffering from
mental illness and from moral judgement and inhumane treatment. But what
if it is the social world that is the ultimate concern for psychiatry? Erwin Straus
(1969, p. 2) once wrote, ‘While the activities of the physician are directed gener-
ally to man as a living creature, to the organism and its function, the psychiatrist
is concerned with man as a citizen of the historical and social world or worlds.’
From such a point of departure, and as explored in this particular volume, the
prefix social can also constitute a foundation for psychiatry and can guide us
to answers within the deeper levels of transcendental intersubjectivity, to the
problems of interpersonal understanding, and to our being-​with-​one-​another –​
insofar as such notions relate fundamentally to the psyche, to nosology, to the
human condition, and to social justice. Hence, the prefix social becomes not just
essential in order to understand the context in which psychiatry thrives, but also
as a reminder of its praefigere –​or better, its ground.
There is a long tradition of phenomenology within psychiatry dating back to
the work of Karl Jaspers, Ludwig Binswanger, Eugene Minkowski, Erwin Straus,
and many others (Spiegelberg, 1972). This tradition is very much alive in con-
temporary European psychiatry. Two of the contributing chapters of this vol-
ume stem directly from this tradition; that is, from the Center for Subjectivity
Research at the University of Copenhagen and also from the University of
Heidelberg. The emergence of the American tradition in phenomenological
psychiatry has mostly been associated with the 1958 publication of May, Angel,
and Ellenberger’s edited volume Existence. However, in the early 1960s, there
was also an original development of a phenomenological psychology inaugu-
rated by Amedeo Giorgi (1970) at Duquesne University that included a fruit-
ful exchange and collaboration with European phenomenological psychiatrists
such as Erwin Straus, J. H. van den Berg, Viktor Frankl, and several others (for
an overview, see Smith [2010]), many of whom also served as consulting editors
for the Journal of Phenomenological Psychology (Giorgi, 1971). This particular
tradition has had ripple effects, gaining a foothold in several research programs
and universities throughout America and Europe. In our current volume, we
have representatives from American phenomenological psychology and its rela-
tion to phenomenological psychiatry, mental health care, and clinical psychol-
ogy. These authors represent, for example, the recovery-​oriented psychiatric
research program at Yale University, studies in clinical psychology at Fordham
 Introduction 3

University, psychological research at the University of Dallas, phenomenological

psychological research at Saybrook University, as well as interdisciplinary and
psychological research in the Scandinavian Countries (e.g., at Malmö University
in Sweden). As the editor of this volume, it is my belief that a phenomenologi-
cal approach to a social psychiatry requires a reawakening of the collaboration
between European phenomenological psychiatry and American phenomeno-
logical psychology. As Spiegelberg (1972, p. xxxiv) once stated in his histori-
cal introduction to Phenomenology in Psychology and Psychiatry, ‘[A]‌luxuriant
field like ours had better not be cluttered by too many varieties and subdivisions
which may even interfere with growth.’
The first chapter is by Larry Davidson, who explores how social psych-
iatry can find its foundation in Husserlian transcendental intersubjectivity.
Davidson’s contribution builds upon his extensive studies of Husserl’s last years
and the unfinished work The Crisis of the European Sciences and Transcendental
Phenomenology. He frames his chapter based upon the Husserlian argument
that we are only separate from each other after the fact that we are alike, and not
the other (Cartesian) way around. He then brings this argument into the context
of a recovery-​oriented psychiatry, phenomenological psychological research on
schizophrenia, and further into topics such as social justice.
Chapter 2 is written by Mads Gram Henriksen, who takes us through the
topic of psychosis and its problematic connections to contemporary nosology.
Henriksen challenges mainstream views of delusions and hallucinations being
portrayed as poor reality testing and he offers us instead a first-​person perspec-
tive, where he draws from Blueler’s notion of double bookkeeping. He then pro-
vides us with a phenomenological analysis of the self in relation to schizophrenia,
which takes us beyond the surface of symptomology to a disclosure of the lived
experience. In his conclusion, Henriksen makes a plea for the social dimension
of psychiatric practice and our ability to empathize as a means towards clinical,
interpersonal understanding.
In Chapter 3, Magnus Englander connects his roots in American phenomeno-
logical psychology with European contemporary phenomenological philosoph-
ical and psychiatric research on social cognition. He adopts a second-​person
perspective towards empathy and explores interpersonal understanding from
the perception of the other within the face-​to-​face context. Englander works
from his pedagogical and qualitative research on the phenomenological psycho-
logical approach to empathy training and makes a case for an empathic (psycho-
logical) reduction leading to a phenomenological attitude that can be adopted
by the psychiatric professional within the context of the face-​to-​face situation.
4

4 Magnus Englander

In Chapter 4, Scott Churchill covers extensive ground as he takes us through

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

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

References

Giorgi, A. (1970). Psychology as a human science: A phenomenologically based approach.

New York: Harper & Row.
Giorgi, A. (1971). General information (including list of editors and consulting editors).
Journal of Phenomenological Psychology, 1:2.
Jaspers, K. (1913/​1997). General psychopathology, vol II (trans. J. Hoenig & M. W.
Hamilton). Baltimore, MD: Johns Hopkins University Press.
6

6 Magnus Englander

May, R., Angel, E., & Ellenberger, H. F. (1958). Existence: A new dimension in psychiatry
and psychology. New York: Basic Books.
Morgan, C., & Bhugra, D. (red.) (2010). Principles of social psychiatry (2nd ed.).
Chichester, UK: Wiley-​Blackwell.
Priebe, S., & Finzen, A. (2002). On the different connotations of social psychiatry. Social
Psychiatry and Psychiatric Epidemiology, 37: 47–​9.
Smith, D. L. (2010). A history of Amedeo P. Giorgi’s contribution to the psychology
department and phenomenology center of Duquesne University in his
twenty-​five years there. In T. F. Cloonan & C. Thiboutot (eds), The redirection
of psychology: Essays in honor of Amedeo P. Giorgi, pp. 329–​51. Montreal,
Quebec: CIRP.
Spiegelberg, H. (1972). Phenomenology in psychology and psychiatry: A historical
introduction. Evanston, IL: Northwestern University Press.
Straus, E. W. (1969). Psychiatry and philosophy. In E. W. Straus, M.
Natanson, & H. Ey, Psychiatry and philosophy (ed. M. Natanson).
Berlin –​ Heidelberg: Springer-​Verlag.
 1

Transcendental Intersubjectivity as the

Foundation for a Phenomenological Social
Psychiatry
Larry Davidson

Introduction

Even after the transcendental reduction, subjectivity does not cease objectifying
itself as man among fellow men and things; it is just that this continuing self-​con-
stitution is now a transcendentally elucidated process. The horizon of constituted
self-​objectification (even when transcendentally ‘transparent’) determines the legit-
imate problem sphere of psychology.

Eugen Fink’s outline for the continuation of The Crisis (1970, p. 399)

As a Jewish intellectual living in Germany in the 1930s, it is extremely unlikely

that Edmund Husserl held to the self-​contained, or monad-​ological, view of
human subjectivity that seems to permeate much of phenomenology as it has
since applied in the study of psychology and psychiatry. In fact, in his last, and
tragically incomplete, text, The Crisis of European Sciences and Transcendental
Phenomenology (The Crisis), Husserl makes an impassioned plea for address-
ing a crisis that he views as decidedly social and cultural in nature. Yet even
within philosophical phenomenology, more attention appears to have been paid
to the ‘problem’ of establishing the possibility of there being an intersubjective
connection, an empathic relationship, between two self-​contained egos than to
what Husserl may have meant when he –​at least in his later works (e.g., 1970) –​
defined transcendental consciousness as intersubjective in nature.
This chapter is based on the premise that the problem of intersubjectivity at the
psychological level (i.e., how I access the subjectivity of other consciousnesses)
8

8 Larry Davidson

was resolved by Husserl (1970, p. 108) at the transcendental level by conceptu-

alizing consciousness to be fundamentally a ‘living together’ with, as opposed to
a living separately or independently from, others. Human subjects come to con-
stitute themselves as separate, independent egos as a result of, rather than prior
to, their awareness of others like themselves. There is therefore no ‘problem’ of
intersubjectivity, as it is a primary given in our experience, a foundation for, and
context within which, we come to know ourselves as subjects. It is then based on
this intersubjective understanding of the transcendental that we can develop a
phenomenological approach suited to the tasks of a social psychiatry.
Readers who are confused by this very first step in our argument, who have
come to believe, for instance, that ‘the transcendental’ is relevant only to the
work of philosophers, are referred to previous publications in which my col-
leagues and I have argued that the transcendental perspective provides an
invaluable framework for phenomenological investigations at any level of focus.
Otherwise, the core problem of psychologism –​which preoccupied Husserl
throughout his career –​continues to haunt not only philosophy, but also psych-
ology and any other associated human or social science as well (Davidson, 1988,
1994, 2003; Davidson & Cosgrove, 1991, 2002; Davidson & Solomon, 2010;
Davidson et al., 2004). Rather than reiterate that argument here, I will elucidate
how the transcendental is understood both in the text of The Crisis and in Fink’s
authorized outline for the remainder of the book (1970). Note, for example,
how the opening passage above, drawn from the outline Fink had drafted for
Husserl’s (1970, p. 399) approval, states that it is ‘the horizon of constituted self-​
objectification (even when transcendentally “transparent”)’ that ‘determines the
legitimate problem sphere of psychology’. Psychology, and by extension psych-
iatry, are to be concerned with the human subject understood as a constituted
self-​objectification of the transcendental as made transparent through the tran-
scendental phenomenological reduction that occupies center stage in The Crisis.
The first section of this chapter will deal with laying out descriptively what it
means to view human subjects as ‘constituted self-​objectifications’ of the tran-
scendental and how this philosophical understanding overcomes the problem of
solipsism and establishes a foundation for the possibility of empathy. The second
section then describes how, on this basis, the struggles and recoveries of per-
sons diagnosed with ‘schizophrenia’ can be accessed, understood, and supported
by a social psychiatry that takes into serious account –​has as its phenomeno-
logical ‘horizon’ –​the historical, social, political, economic, and cultural con-
text in which these persons live. Illustrative examples for this section will be
 Transcendental Intersubjectivity 9

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

Transcendental Intersubjectivity

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

It has only been since the time of Descartes that philosophers have begun with
the solitary ego, with the givenness of individual consciousness, as their point
of departure. For most of us who do not spend untold hours alone either star-
ing into lit hearths or strolling down country lanes, this might seem like an
odd place to begin. We do not emerge from the womb with a fully developed
and intact sense of ourselves as a solitary, constituting ego. Rather, as we have
learned from Daniel Stern (1985) and others, humans develop a sense of self in
relation to others. I first come to know myself as a person separate from others
through my relationships with them, and come to form a sense of identity that
is heavily influenced by how those others view and treat me. There can be no ‘I’
without at least one ‘you’ that together constitute a ‘we’. This interdependence of
the social and personal –​what has come to be considered a fundamental fact of
infant development discovered through close observation, and taken as the basis
for hypotheses about the neural origins of identity –​was argued on a philosoph-
ical basis by Husserl nearly a century ago.
Beginning as he did in his own reflections with the legacy left by Descartes
and Kant (not surprisingly the two thinkers who also figure most prominently in
The Crisis), Husserl did struggle early in his career with finding a way to escape
a solipsistic view of consciousness. His Cartesian Meditations (1977) is devoted
in large part to this problem, but falls short of coming to any satisfactory solu-
tion. Our seemingly immediate access to others as human subjects does not
appear to rely on imaginative leaps or speculative conjectures about how these
other embodied creatures may or must function similarly to me. So when he
takes up once again the matter of the psychological ego as conceptualized by
Descartes and Kant in The Crisis, Husserl (1970) is driven to a radically different
10

10 Larry Davidson

conclusion. He suggests that the world I experience is not given to me primarily

as ‘my’ world, but rather as ‘our’ world. ‘The world exists not only for isolated
men but for the community of men,’ he writes, ‘and this is due to the fact that
even what is straightforwardly perceptual is communalized’ (p. 163).
What is ‘straightforwardly perceptual’ is perceived not only as something for
me, but as something for others as well. To be a thing, a tree, which is separate
from its infinite appearances or adumbrations, is not only to be a tree for me but
is to be perceived precisely as also being an object that will be perceived in the
same way by others standing next to me. In the case of objects that have socio-
cultural meanings, such as a lamppost, there is the additional aspect, the ‘co-​
consciousness’, that it is perceived as an object that was made by other subjects.
Writes Husserl (1970, p. 370): ‘Every straightforward understanding of [cultural
facts] as an experiential fact involves the “co-​consciousness” that it is something
constructed through human activity.’ The world is always already a shared world.
Even were you and I to disagree about the nature of a given object –​I see a tree
where you see a lamppost –​we still share the same basic world in which both
such a perceived object and such a disagreement can take place.
Descartes’ reliance on the exercise of reason through systematic doubt in the
present fails to account for how things came to be perceived in the way they were
in the first place. In Husserlian terms, the Cartesian/​Kantian approach remained
locked within solipsism because it lacked a ‘genetic’ account of how conscious-
ness comes to understand itself over time. But humans, as Husserl had empha-
sized prior to Heidegger, are temporal creatures; we cannot be fully accessed or
understood through a static or cross-​sectional approach. In other words, life is
simply not lived solipsistically, but within the context of a human community
in which my own personal perspective on the world is engaged in what Husserl
(1970, p. 172) calls a process of ‘reciprocal correction’ with the perspectives of
others with whom I come into contact. I am not left to make sense of the world
by myself. Even if it may appear to be so at a given time, as in sitting alone in
front of a lit hearth, this appearance is only made possible on the basis of innu-
merable other experiences through which I have come to know myself, and my
hearth, to be what they are. The sense that I make now is both based on previous
strata of sense made and made through an active engagement with others who
are likewise engaged in sense making; the consensual ‘reality’ that results is just
that, that is, consensual and contextual, social and historical.
We come to recognize the role that consciousness plays in constituting such a
reality through performance of the transcendental phenomenological reduction.
 Transcendental Intersubjectivity 11

Should we stop short of coming to this transcendental understanding of con-

sciousness as intersubjective and self-​objectifying, we would unwittingly elevate
one perspective on the world above others, resulting in the view that some expe-
riences are more correct or true or directly in touch with ‘the real’ than others,
which would then be considered deficient or deviant in comparison (Davidson
et al., 2004). But all experiences are precisely what they are, that is, experiences,
and as such can be neither deficient nor deviant in and of themselves. These
kinds of distinctions belong to the realm of judgement, reasoning, and sociocul-
tural norms, not to the nature of experiences per se.
This is the radical position that Husserl takes with regard to the transcenden-
tal, and one of the reasons why he insists that it is a necessary foundation even
for the conduct of psychology and other human sciences that deal with how
consciousness is self-​objectified in the lifeworld. To fail to appreciate that all
experiences are valid as experiences, and that the sense a person derives from his
or her experiences is engaged in a process of reciprocal correction with the sense
others in the person’s life (including those from the past) derive from their own
experiences is to fail to grasp the constituted nature of the world we all share. It
is to view the world as an already completed, independently existing ‘thing’ of
a definite nature that remains the same over time (Davidson, Flanagan, Roe, &
Styron, 2006). While such a view might have been acceptable to a seventeenth-​
century religious perspective on the world as having been created out of noth-
ing by an independent, all powerful God, it does not begin to do justice to the
sociocultural lifeworld of self-​objectifying transcendental egos whose world is
constantly being made anew.
For the Husserl of The Crisis, it was an urgent and all-​important matter that
the world that had been created in Europe in the first part of the twentieth cen-
tury was on a path to self-​destruction and that drastic measures were needed
to avoid this fate. What I will argue in the remainder of this chapter is that it is
still an urgent and important matter that the world that is currently being cre-
ated in the first part of the twenty-​first century is continuing to pose significant
risks to the health and well-​being of human beings (as well as to the planet as
a whole). For psychiatry, and the broader mental health field, to become a part
of the solution to this crisis, consciousness must first be understood in both its
transcendental and its intersubjective nature. Only then will the experiences of
all people be given equal weight in the constitution of our shared reality, and
only then will all people, eventually, be valued and accepted as members of a
shared civil society as a result.
12

12 Larry Davidson

Towards a Phenomenological Social Psychiatry

of Schizophrenia

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

Grounding psychiatry in a transcendental phenomenological perspective estab-

lishes a number of important principles for both our research and our practice.
These include: (i) all human beings are to be viewed as constituting subjects,
active agents, in their own lives; (ii) all of the experiences human beings have are
valid as experiences and contribute (in one way or another) to the constitution
of our shared world; (iii) even in the case of psychosis, empathy between human
beings is and remains possible, and is accessible as an essential tool for research
and practice through the intentional interpenetration of souls that form a uni-
tary psychic framework; and (iv) each individual must be approached, under-
stood, and ‘treated’ (a problematic term, as we shall see) within the context of
this unitary psychic framework, that is, as an active, constituting subject whose
identity is formed in and through internal relations with other active, constitut-
ing subjects.
It is important to emphasize, as Husserl does in the passage above, that these
relationships are internal because we tend to perceive others as external to our-
selves due to the fact that consciousness is embodied in human beings, each of
whom thus appears to have an existence independent of the other. To remain
faithful to Husserl’s transcendental insight into the intersubjective nature of
consciousness, we must recognize that a more primordial relationship exists
between subjects through intentionality and empathy prior to, and as the founda-
tion for making sense of, consciousness as belonging uniquely to each embodied
individual within a shared community. It is through this internal connection,
through being part of a ‘unitary psychic framework’, that I come to understand
who and what I am in relation to concrete others, and through which any exter-
nal relationships I may develop then become possible. We are always already
 Transcendental Intersubjectivity 13

belonging together, sharing a basic sense of human community, regardless of

how we then –​based on multiple factors, some of which we explore below –​end
up relating, or not relating, to others. External relationships between embodied
subjects would not be possible, were they not developed on the ground of this
always already internally shared sense of humanity.
While we need not think of the nature of this internal connection as mysteri-
ous, mystical, or paranormal, Husserl’s use of the term ‘soul’ does suggest that it
might be spiritual in nature. Regardless of whether one interprets it to be spirit-
ual or not, what is important for our science of psychiatry is that we understand
it to be deeply implicated in how we develop a sense of personal identity as an
individual human being to begin with, especially because this will also relate to
how we assist others in recovering a sense of self in the aftermath of a serious
mental illness. As Levinas (1969) was to argue a generation after Husserl’s death,
we come to recognize humanity in and through the face of others, coming to
learn about ourselves as subjects through their eyes. It will be extremely diffi-
cult to maintain a sense of human identity, or to regain a lost sense of identity,
should others in my life not recognize in my face, not perceive in my eyes, the
fundamental fact of my belonging to the human race –​despite any of the less
important ways in which I differ from them (e.g., race, ethnicity, diagnosis). Yet
this is precisely what has happened, and in many places continues to happen, in
the lives of persons diagnosed with schizophrenia.
The central importance of this issue has been suggested by several sources,
from the time of Kraepelin to the present. The descriptive psychopathology
and clinical literatures have long noted the loss of a coherent sense of self as
a core characteristic of schizophrenia (Kraepelin, 1904; Bleuler, 1950; Fromm-​
Reichmann, 1950; Jaspers, 1963; Meyer, 1950; Schilder, 1976; Sullivan, 1940).
This observation has been confirmed and expanded on eloquently in first-​
person accounts of schizophrenia; most recently in the autobiography of Elyn
Saks (2007, pp. 46–​7), who writes that the most disabling aspect of this condi-
tion is that ‘consciousness gradually loses it coherence. One’s center gives way .
. . There is no longer a sturdy vantage point from which to look out, take things
in, assess what’s happening. No core holds things together’.
At the same time, there is an increasing body of empirical research pointing
to the role of a loss of a functional sense of self underlying some of the symp-
toms of psychosis (e.g., Bayne & Pacherie, 2007; Frith & Allen, 1983; Frith &
Done, 1986, 1989; Synofzik et al., 2010; Voss et al., 2010). For example, Frith
(1987) attributed delusions and hallucinations to ‘a failure to recognize the self
in action’, while Jeannerod (2009) concluded from a review of neuroscientific
14

14 Larry Davidson

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

A deeply personal, unique process of changing one’s attitudes, values, feelings,

goals, skills, and roles. It is a way of living a satisfying, hopeful, and contributing
life even with limitations caused by the illness. Recovery involves the develop-
ment of new meaning and purpose in one’s life as one grows beyond the cata-
strophic effects of mental illness.

Based on these kinds of highly person-​centric depictions, recovery has come, at

least in the English-​speaking world (Davidson & Tse, 2014), to be understood
primarily as a ‘deeply personal, unique’ individual journey, in which other people
play at best a supporting role. And as a result, the concept has become vulner-
able to misuse and abuse in political and policy circles, with persons who are
having difficulty entering into, pursuing, or sustaining recovery being blamed
for their own suffering and/​or being denied services or supports because they
 Transcendental Intersubjectivity 15

do not appear to be using them efficiently (Rowe & Davidson, in press; Slade
et al., 2014).
But it is possible to preserve an important, even central, role for the per-
son to play in his or her own recovery without having to ignore or deny the
important roles of social, cultural, political, and economic factors as well. With
few exceptions (e.g., Warner, 1985), however, these factors have seldom been
pursued outside of the field of what has been described as ‘anti-​psychiatry’, in
which the reality of schizophrenia as an illness, or even as a personal struggle,
has been rejected altogether in favour of a view of mental illnesses as ‘social
constructions’ used to silence and deny dissenting voices. It has apparently been
extremely difficult to acknowledge the presence of a debilitating condition while
at the same time considering how that condition may be influenced in its nature,
its effects, its course, and its outcomes by the social contexts in which it occurs
(Strauss, 2014).
Returning to our grounding in Husserl and Levinas, though, we recall that
at least in relation to being able to redevelop, and preserve, a sense of self as a
human being –​a core challenge in recovering from schizophrenia –​the role
of others may be crucial as well. This is especially the case when those others
deny, rather than validate or confirm, the basic humanity of the person who
is struggling to recover, as happened broadly within the context of the custo-
dial institutions of the first half of the twentieth century and as continues to
occur, perhaps in a less obvious way, within the context of community-​based
care today. So potent were the effects of these institutions that the first phe-
nomenologically oriented social psychiatrist, Franco Basaglia (1987), declared
at the beginning of the de-​institutionalization movement that it was not possible
to tease out any effects of the illness itself as they were so overlain with what
he described as the ‘secondary illness’ of the hospital context. Unfortunately, so
prevalent do discrimination and dehumanization continue to be within the con-
text of community-​based care that Basaglia’s caution remains warranted.
In terms of previous research and practice, it is true that glimmers of recog-
nition of the interpersonal dimension of the processes of regaining a self may
be found in the work of Fromm-​Reichmann (1950) and Sullivan (1940), but
their work was limited to the role of the psychotherapist in what remained pri-
marily institution-​based treatment. More contemporary efforts have begun to
focus on how social stigma, and its internalization in ‘self-​stigma’, may impede
recovery (Brohan et al., 2010; Chiu et al., 2013; Corrigan, Watson, & Barr, 2006;
Watson et al., 2007; Rüsch et al., 2010), but initial efforts to address this have
16

16 Larry Davidson

remained largely restricted to the level of the individual (Yanos, Roe, & Lysaker,
2011; Yanos et al., 2012). Cross-​cultural studies have provided some clues as to
the possible role of cultural and economic factors in influencing outcome, with
persons living in capitalist, industrial societies faring less well than those in the
developing world (e.g., Davidson, 1988; Lin & Kleinman, 1988; Warner, 1985;
Waxler, 1979). These approaches, though, are limited in their understanding of
the connections between these various factors and, importantly, in their impli-
cations for how best to promote recovery. So what does Husserl’s transcendental
phenomenology have to offer in relation to understanding the intersubjective
nature of recovery?
Phenomenology begins with experience, which might appear on the surface
to be individual in nature as well. But to view experience as entirely individual
in nature is to repeat the Cartesian/​Kantian error of failing to look at the genesis,
the constitution, of the meanings being accessed through, and derived from,
experience. This is perhaps easiest to understand in the case of what Husserl
described as the ‘co-​consciousness’ of social and cultural objects, such as sta-
diums, libraries, or even universities, such as Yale. Where does Yale ‘exist’ as a
university? It is not reducible to the bricks used to construct some of its build-
ings, the office of the university president, or the geographic perimeters of its
campus (which, in the case of Yale, snakes through much of the town of New
Haven). While it is experienced to some degree differently by each person who
comes into contact with ‘it’ (even if virtually through the press or the internet),
it also is experienced as the same to a sufficient degree to maintain its identity
over more than 300 years. What, then, of this experience is individual in nature
and what is not?
The experience of beginning at, or even visiting, Yale is likely to be different
for a third generation ‘legacy’ freshman (a person whose parent and grandpar-
ent also attended Yale) and a first-​time foreign student just arrived from India or
China. Many –​but not all –​of these differences can be traced to their differing
life experiences up to that point, which provide the broader context for their
experiences of Yale per se. What if the same were true of the concept of ‘self ’?
That is, what if a person’s sense of self was likewise largely a result of his or her life
experiences to date? Those life experiences –​like all experiences –​would build
on previously constituted strata of sense passed down through the generations
as mediated by what Husserl (1977, p. 64) describes as the person’s own ‘pre-​
delineative horizon’ of sedimented meanings that are now ‘pre-​given’ to his or
her consciousness. I have no more of a direct route to getting to know myself than
through my own experience, and my own experience, within a transcendental
 Transcendental Intersubjectivity 17

phenomenological framework, necessarily ‘reaches out beyond the isolated sub-

jective processes’ of my own ego (p. 48) to its implicit, pre-​delineated context of
what has been pregiven to me historically, socially, and culturally.
It is in order to capture and understand the role of these pre-​given strata
of sense that have formed through the sedimentation of meanings from prior
experiences –​both my own and those of others in the past and present –​that our
phenomenological approach needs to incorporate the transcendental reduction.
While we must understand the horizon of my experience to be itself a consti-
tuted achievement, it is crucial that we understand that it has been constituted
not by my own (psychological) ego, not by me as an individual, but by others as
well, both by those who preceded me and those who are concurrent to me (and
even perhaps by my imagined future heirs). In no sense do I ‘choose’ to whom
I am born, in what home I grow up, who my ancestors were, or what historical,
social, and cultural context in which I am to experience my formative years as a
human being. Yet all of these factors bear directly on what kinds of experiences
I will have and how I will come to know who and what I am as a person.
It is perhaps because of the role of this historical, social, and cultural hori-
zon in providing the context for individual experience that seeking recourse to
the transcendental has been criticized as absorbing the psychological into the
social (e.g., Giorgi & Giorgi, 2008). It is not so much a matter of losing the psy-
chological, though, as it is appreciating that what comes to be viewed as the
psychological is always already a socially, culturally, and historically constituted
phenomenon. The psychological, in other words, does not exist on its own in
some essentialist, Platonic, form irrespective of the social and cultural context
in which it is being explored or conceptualized. Psychological concepts are not
timeless or universal, but are relative to the context in which they are being
developed. Psychology represents, in Husserlian terms, one ‘regional ontology’
among others.
Due to the fact that consciousness, as embodied, appears to be individual
in nature, though, Husserl affords psychology the status of being the ‘first’ sci-
ence to be established following the ‘return’ from the transcendental (Davidson
& Solomon, 2010). The primacy of psychology may also be due to that fact
that it pertains to the interaction between the individual and his or her inten-
tional horizon, to how persons ‘take up’ the context of meaning into which they
have been born. I suggested earlier that ‘many –​but not all’ of the differences
between individuals’ experiences can be traced to their previous experiences.
Ascribing all such differences to life history would run the risk of falling into
historicism, just as ascribing all differences to individual choice would run into
18

18 Larry Davidson

psychologism. The challenge is to allow for a non-​psychological, non-​historical,

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

Not an Individual Journey

Common courtesy works because it’s common; it’s something every human being
gets just because they’re human. Things like saying ‘excuse me’ when you reach
over someone to reach for a piece of paper, like saying ‘God bless you’ when
someone sneezes, things like asking you if you’d like some water when you get up
to get some for yourself. It’s basic, but it means so much to someone who’s been
treated like an unhuman for decades. It’s basic, and it may seem trivial to you, but
to people like me, it’s water to a dying parched husk of a person. Interactions like
the[se] . . . have more positive impact on the consumer than any elaborate treat-
ment plan ever could. (Quoted in Davidson & Johnson, 2013, p. 258)

What this means concretely is that people neither develop nor recover from
what we currently consider to be schizophrenia on their own. On the surface, or
through the lens of a simplistic approach to neuroscience, it may appear to be
the result of a brain disease that is only very partially ‘treated’ by a combination
of medications and psychosocial interventions. Like Descartes’ doubt, however,
this is at best a static or cross-​sectional account of a present moment in the life
of a person who has both a past and a future. In addition to lacking a scientific
basis, the brain disease model fails to explain or account for the large number
of people who experience significant improvements over time, many of which
occur in the absence of ‘treatment’. Less simplistic, one-​dimensional approaches
to neuroscience may be very helpful in understanding the neuronal underpin-
nings of a sense of agency –​as in the studies conducted by Firth and reviewed
by Jeannerod above –​as one component of a biopsychosocial set of processes,
but these will necessarily be genetic in nature and will be based on a view of
the brain as inextricably intertwined with its social environment, that is, which
includes other embodied brains as well.
 Transcendental Intersubjectivity 19

What would such studies need to explore in terms of the life context of the
person who is developing, or recovering from, schizophrenia? The same terri-
tory as would be explored by a phenomenologically oriented psychologist, that
is, the life experiences that the person is having and the historical-​social-​cultural
horizon in which they take place. In developing schizophrenia, people appear to
have experiences in which their coherent sense of agency is called into question.
Perhaps the sense of agency they developed early in life remained more vulner-
able to such attacks, which other people might better withstand. Or perhaps
they are exposed to experiences other people typically do not have which then
undermine an otherwise solid sense of agency. Earlier theories attributed these
kinds of attacks to ‘schizophrenogenic’ mothers or families (e.g., psychoanaly-
sis) or to society as a whole (e.g., Laing, 1969), while more contemporary stud-
ies are finding a high prevalence of adverse childhood events (e.g., Read et al.,
2005; Rosenberg et al., 2007; Varese et al., 2012). It is also possible, though, that
a compromised sense of self may occur in response to, rather than as the cause
of, such experiences as hallucinations and other neurocognitive impairments
(e.g., Frith, 1987); experiences which make it difficult to maintain a coherent
sense of agency.
Regardless of causes –​which remain to be determined –​we have learned that
the recovery process depends, at least in part, on the opportunities and resources
available to people as they are challenged to reconstruct their sense of self. This
occurs on the macro level in terms of the social determinants of health (e.g.,
poverty, prolonged unemployment, discrimination) as they relate to the onset
of psychosis (e.g., Morgan & Hutchinson, 2009) and the duration of untreated
psychosis (e.g., Morgan et al., 2006). And, as alluded to above (Warner, 1985),
cross-​cultural studies have suggested that persons with schizophrenia fare better
in non-​industrial, non-​capitalist economies in which they can maintain valued
social roles and preserve social support without having to secure and main-
tain competitive employment in a profit-​oriented society. Related issues have
been explored at more length, and in more philosophical depth, by Deleuze
and Guattari in their two volume series on Capitalism and Schizophrenia (1977,
1988). For Deleuze and Guattari, the concept of having a univocal sense of self
is itself problematic and a result of capitalism. One does not have to share their
aspirations for an ego-​less liberation of desiring flows to appreciate how the
expectations for productivity and demands for success of industrial capitalist
economies may make recovery from schizophrenia more difficult.
It is perhaps at the micro level, however, that phenomenology is best posi-
tioned to shed light on the contextual factors at play in what is actually an
20

20 Larry Davidson

extra-​individual ‘journey’ of recovery. The woman quoted above writes elo-

quently of being ‘treated like an unhuman for decades’. We have suggested in
earlier publications that a cornerstone of recovery is having a sense of belonging
with a community of one’s peers (Davidson, 2011; Davidson & Johnson, 2013,
2014). In both cases, this foundation for recovery is not something a person
can provide for himself or herself. I cannot simply will myself to have a sense
of belonging, I cannot make other people accept me within their ranks, I can-
not establish a foundation for belonging for myself by myself. Having a sense
of belonging necessarily requires the caring, compassionate actions of others,
it requires others to treat me like ‘a human’ (as opposed to ‘an unhuman’), it
requires being included in the life of one’s community as a valued and contribut-
ing member rather than being shunned, ignored, or relegated to the margins of
society. As the woman quoted above went on to say:

I can come to recognize that ‘I am a human being’ because I found someone who
can identify me as one . . . I didn’t enter recovery until someone else thought
I was worth recovery, until someone else loved me. I didn’t think I was worth
recovery until someone else did. (Quoted in Davidson & Johnson, 2013, p. 260)

I first learned this lesson many years ago from a woman who was home-
less in San Francisco. As I began to walk past her on the street she asked me
for money, to which I replied: ‘I’m sorry, I don’t have any to spare.’ Expecting
her to be disappointed, if not disgruntled, I was surprised when she smiled and
responded: ‘Thanks for acknowledging me. Most people treat me as if I’m invis-
ible. At least you see me.’ If we think of recovery only as a deeply personal jour-
ney of reclaiming a new sense of self, then we risk losing sight of all the other
things that need to be in place for people to get their lives back. Things like being
seen, being treated as a human being, like having a safe, stable, and affordable
home in a supportive environment, having a job or being in school, having a lov-
ing family and friends, and having a sense of belonging to a community. None
of us achieve or acquire all of these different essentials in life solely or entirely
by ourselves as individuals. We are born into a community, raised in a commu-
nity, play valued roles in a community like parent, tenant, employee, sibling,
and voter. These essentials cannot be placed on hold and reserved for people
until some imagined time in the future when they are considered ‘well’, in part
because they are essential to people becoming well in the first place –​and in part
because they are rights to be acknowledged rather than privileges to be earned.
In the future, we can hope that persons developing a serious mental illness
will not have to lose all of these valued roles –​these ways of engaging and
 Transcendental Intersubjectivity 21

participating actively and meaningfully in all aspects of community life –​as a

result of becoming ill. We can hope that young people early in the course of a
mental illness will be able to stay in school, will be able to keep their friends,
and will be able to go on to learn how to drive, how to date, and, eventually,
how to be a contributing citizen . . . just like most everyone else. But we know
the history of psychiatry, and we know that this has tragically not been the
case for many people. Through a combination of the stigma that accrues to
these conditions, the discrimination those who experience these conditions
face as a result, the lack of material resources that also results from the lack
of social and political will to reverse this long-​standing discrimination, and
the traditional, narrow view of contemporary psychiatry on the management
of symptoms, many people have lost these various indicators, benefits, and,
as it turns out, basic requirements for exercising their citizenship. They have
stopped being a student or employee, they have lost their friends, forgotten
how to drive, and may find it hard to believe that anyone would want to date
them. This has been a tragic loss, not only for the person and his or her loved
ones, but for society as a whole. And it makes the process of recovery all the
more difficult.
It is for this reason that the recovery movement is now evolving to place more
of an emphasis on social inclusion and the restoration of citizenship, on what
society needs to do to make recovery possible and to support people in their
efforts to reclaim their lives (e.g., Rowe & Davidson, in press). Doing so doesn’t
make working with individuals any less crucial, but it provides a needed con-
text in which this work can be effective. While much work remains to be done
in this regard, we can at least derive some comfort, and inspiration, from the
practice Basaglia –​who I suggested was the first phenomenological social psych-
iatrist –​developed in Italy in the 1960s and 1970s. As Basaglia argued, shifting
the frame from an individual’s psychopathology to a community’s opportun-
ities and resources doesn’t ignore or detract from the proper work of psychiatry.
Rather, it secures the foundation necessary for this work to be able to succeed.
Writes Basaglia (1987):

The approach that underlies this work is in no way an attempt to evade the cen-
tral point of illness. In this new context, however, the conflicts which had previ-
ously been regarded as internal to the patient . . . are thrown back on the wider
society from whence they came . . . For the mental health worker, this means an
entirely new role: instead of acting as a go-​between in the relationship between
patient and hospital, he has to enter into conflicts in the real world –​the family,
2

22 Larry Davidson

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

Conclusion

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

Focusing on experiences of everyday life, phenomenology is particularly well-​

suited as a methodology for studying such ‘small places, close to home’. When
returning to those places from the transcendental perspective achieved through
the transcendental reduction, we are able to consider them as constituted con-
texts in all of their historical, social, cultural, political, and economic richness.
Only then are we adequately equipped to explore and understand persons as
self-​objectifications of transcendental intersubjectivity in a way that preserves
their full humanity. This is especially relevant, and especially needed, in the case
of persons whose humanity has been distorted or denied. As Basaglia made
clear, in such a case, our science, as well as our practice, can no longer be viewed
as ‘impartial’. They become instead forces in the fight for social justice. This,
too, was foreseen by Husserl (1970) in the 1930s when he felt compelled to con-
front a crisis in European sciences; disciplines which he perceived as having
become ‘sciences of death’. The answer then, as it is now, is to ground psychiatry
in transcendental phenomenology so that it may become, instead, a ‘science of
life’ (ibid.; Davidson & Solomon, 2010).
 Transcendental Intersubjectivity 23

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 2

Schizophrenia, Psychosis, and Empathy

Mads Gram Henriksen

Introduction

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

The Concept of Psychosis

‘Psychosis’ is a medical term referring to an abnormal condition of the human

mind. The concept first appeared in a medical context in the nineteenth cen-
tury, where Canstatt (1841) introduced it to describe psychic manifestations of
‘neurosis’, which, in the eighteenth century, had been introduced to denote dis-
eases of the nervous system that were not accompanied by fever (Jones, 2015,
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28 Mads Gram Henriksen

p. 3). Since then, the meaning of ‘psychosis’ and ‘neurosis’ has changed dramat-
ically: ‘neurosis’, to the extent that this concept is still used, signifies a range of
mental conditions in which the grasp of reality remains generally unaffected
(e.g. anxiety disorders, obsessive-​compulsive disorders, and personality disor-
ders), whereas ‘psychosis’ signifies mental disorders with an impaired grasp of
reality, frequently reflected in the presence of delusion or hallucination.1
Psychosis may occur in organic disorders (e.g., delirium), substance-​related
disorders (e.g., toxin exposure), affective disorders (e.g., bipolar disorder), and
non-​affective disorders (e.g., schizophrenia). In this context, it deserves to be
mentioned that some studies suggest that psychosis frequently also occurs in
patients diagnosed with non-​ psychotic mental disorders like anxiety (e.g.,
Wigman et al., 2012) as well as in healthy individuals (e.g., Posey & Losch, 1983;
Barrett & Etheridge, 1992), thereby clearing the way for conceiving psychosis
as a continuous or dimensional phenotype (e.g., van Os & Reininghaus, 2016).
While this is not the place to engage in any sort of real debate about this con-
ception of psychosis (e.g., Parnas & Henriksen, 2016a), it is noteworthy that the
clinical and methodological quality of this literature often is debatable.2 Despite
rapid advances in cognitive neuroscience and molecular biology, no robust bio-
marker for psychosis has been identified and there seems to be no immediate
prospect for obtaining it. In other words, diagnosing psychosis continues to
rely on clinical assessment and thus on the psychopathological knowledge and
expertise of the clinician.
The concept of psychosis is pivotal to psychiatry; it plays a crucial role in the
classification of psychiatric disorders and guides the treatment of these disor-
ders. Furthermore, the concept of psychosis has considerable ethical and legal
implications. In some countries, a person may be committed to a mental insti-
tution and undergo involuntary treatment if she is found to be psychotic, and,
in the court of justice in some countries, a person who is believed to be psych-
otic at the time of his crime should not be punished but sentenced to psychi-
atric treatment. The relatively recent debate about the sanity or lack thereof of
the Norwegian mass murderer Anders Behring Breivik, vividly illustrated by
the two conflicting psychiatric reports in his trial,3 stressed the need for a clear
answer to the notoriously difficult question: what is psychosis?
Given the concept’s significance for psychiatric nosology and treatment as
well as its ethical and legal implications, it is unsatisfying that the concept of
psychosis remains undefined in the current diagnostic manuals of ICD-​10
and DSM-​5. These manuals do not even use the noun ‘psychosis’ but only
the adjective ‘psychotic’, which merely indicates the presence of delusions,
 Schizophrenia, Psychosis, and Empathy 29

hallucinations, formal thought disorders or specific abnormalities of behav-

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

The World of Psychosis in Schizophrenia

In the following, I will focus on primary delusions and hallucinations in schizo-

phrenia, leaving aside formal thought disorders and abnormalities of behaviour.
As we shall see, a characteristic feature of primary delusions and hallucinations
is their markedly ‘subjective’ or, more precisely, ‘solipsistic’ quality (Sass, 1994).
They always appear ‘insufficiently objective’, they are never fully inscribed into
the texture of the world but continue to carry a residual layer of subjectivity, and
they seem to implicate another realm or world that looms up before the patient
alone (Parnas & Henriksen, 2016b). The latter will be explored under the head-
ing of ‘double bookkeeping’.
30

30 Mads Gram Henriksen

Delusion
Traditionally, ‘delusion’ is defined as a belief that has the following proper-
ties: (i) its content is false (or highly unlikely), (ii) it is held with certainty, and
(iii) it is incorrigible. With varying additional properties, this definition has
persisted in the diagnostic manuals.4 Bizarre delusion, a subcategory of delu-
sion, is defined as such ‘if they are clearly implausible and not understand-
able to same-​culture peers and do not derive from ordinary life experiences’
(APA, 2013, p. 87; cf. ICD-​10 [WHO, 1992, p. 87]). Nearly all properties of the
definitions of delusion and bizarre delusion have been extensively criticized
(e.g., Spitzer, 1990; Parnas & Sass, 2001; Heinimaa, 2002; Cermolacce, Sass,
& Parnas, 2010; Henriksen, 2013). Instead of echoing this criticism here, let
us note that these definitions focus almost exclusively on the content of delu-
sion. This preoccupation with the content of delusion invariably renders some
delusions incomprehensible or bizarre, that is, their content simply leaves us
baffled –​for example, as Parnas and Henriksen (2013, p. 323) put it, ‘How can
we possibly understand a person who is fully convinced that her neighbour for
no apparent reason is inserting malicious thoughts into her head, [or] a person
who believes that his bodily movements are controlled by external forces.’ If
we are to understand such delusions, they suggest, ‘we must realize that the
content and structure of these experiences are dialectically intertwined, and
therefore we must take into account the altered framework of experiencing
in schizophrenia’ (p. 324). In the following, an attempt is made to shed some
light on the ‘structure’ of delusional and hallucinatory experience and on the
‘altered framework of experiencing’.
The three defining properties of delusion (i–​iii) are often ascribed to Jaspers
(1997). However, Jaspers does precisely not take these properties to define what
a delusion is but merely as external characteristics (‘äußere Merkmale’), suggest-
ing the presence of delusion: ‘To say simply that a delusion is a mistaken idea
which is firmly held by the patient and which cannot be corrected gives only
a superficial and incorrect answer to the problem’ (p. 93). Instead of equating
delusion with a specific type of belief or judgement that possesses certain prop-
erties, Jaspers argues that delusion ‘manifests itself in judgments’ (p. 95; italics in
original). In brief, delusion proper5 is not a belief; rather, the delusional belief is
a secondary product of the primary delusional experience. According to Jaspers,
delusion proper, which he regarded as highly characteristic of schizophrenia, is
not an independent phenomenon, occurring in an otherwise unaffected con-
sciousness, but presupposes and ‘implies a transformation in our total awareness
of reality’ (ibid.; italics in original).
 Schizophrenia, Psychosis, and Empathy 31

A significant late-​prodromal, near-​psychotic aspect of this transformation in

the ‘total awareness of reality’ is visible in the so-​called delusional mood, which
is presumed to precede the onset of primary delusion in schizophrenia. Jaspers
does not offer a full account of delusional mood (see Conrad, 2002; Henriksen
& Parnas, in press) but describes how this predelusional state is permeated by a
global, diffuse, ominous feeling of something (not yet defined) impending –​as
one patient puts it, ‘Something is going on; do tell me what on earth is going on’
(Jaspers, 1997, p. 98). Patients are somehow certain that ‘something’ is going on
or that ‘something’ is about to happen but the nature of this ‘something’ eludes
their grasp; it has not yet materialized into something concrete, into a proper
‘object’, as it were. In fact, the very crystallization of this perplexed state of atmos-
pheric insecurity into a more definable object or quasi-​object marks the onset of
psychosis (e.g., ‘I’m under surveillance’ or ‘they are influencing my thoughts’).
In delusional mood, Jaspers says, patients feel uncanny (‘unheimlich’). In this
unbearable state, patients desperately search for solutions and answers, instinct-
ively seeking ‘some fixed point to which they can cling’ (ibid.). Finally reaching
the fixed point, Jaspers says, ‘is like being relieved from some enormous bur-
den’ (ibid.). The fixed point, lending perspective, certainty, and meaning, is the
delusion.
Most importantly, a primary delusion does not crystalize through a process
of inferential reasoning or a gradual piecing together of parts that progres-
sively solidifies into a delusional belief (as in the case of ‘secondary’ delusions or
‘delusion-​like ideas’, as Jaspers calls them6). Rather, primary delusions have the
experiential structure of an epiphany (Ey, 1973; Conrad, 2002), that is, they are
experientially given as a sudden, striking, and profound realization, manifesting
what it discloses as undoubtedly true –​the experience is given in such way that
it reveals it to be so (Parnas & Henriksen, 2016b). As Gennart (2011, p. 324)
aptly points out, the meaning of (revelatory) primary delusional experience is
not grasped through the patient’s efforts of interpretation but is immediately
articulated through its very manifestation, imposing itself on the patient and
bypassing his potentiality for distance, doubt, and critical reflection. Similarly,
Jaspers (1997, p. 99) speaks of ‘an immediate, intrusive knowledge of the mean-
ing and it is this which is itself the delusional experience’. In other words, the
revelatory givenness of primary delusions is the source of their incorrigibility
and absolute sense of certainty (Müller-​Suur, 1950). From a phenomenological
perspective, primary delusions are not essentially false or dysfunctional beliefs,
determined by certain cognitive biases that distort information processing (e.g.,
‘jumping to conclusions data gathering bias’, ‘externalizing attributional style’, or
‘theory of mind deficits’) as they typically are conceptualized in the influential
32

32 Mads Gram Henriksen

literature of cognitive-​behavioral therapy for schizophrenia (Škodlar et al., 2013,

p. 257). ‘For any true grasp of delusion’, Jaspers (1997, p. 97) stresses, ‘it is most
important to free ourselves from this prejudice that there has to be some poverty
of intelligence at the root of it.’7

Hallucination
In 1817, Esquirol defined ‘hallucinations’ as perceptions that occur with-
out external objects or stimuli (cf. Berrios, 1996, p. 37f.). With little variation,
this definition has endured, for example, DSM-​5 defines ‘hallucinations’ as
‘perception-​like experiences that occur without an external stimulus. They are
vivid and clear, with the full force and impact of normal perceptions, and not
under voluntary control’ (APA, 2013, p. 87). Although Esquirol’s definition has
remained largely unchanged in the history of psychiatry, it is noteworthy that
the meaning of the concept ‘hallucination’ has changed dramatically. Today, hal-
lucination is conceptualized as a disorder of perception, whereas hallucination,
for Esquirol, essentially is ‘a cerebral or psychological phenomenon that takes
place independently from the senses’ (cited in Berrios, 1996, p. 37; italics added).
Furthermore, Esquirol stressed the crucial role of the hallucinating patient’s
‘intimate conviction’ of perceiving something in the absence of a relevant object
(ibid.), which suggests a much closer relationship between hallucination and
delusion than we tend to think of today, where these concepts designate disor-
ders of perception and judgement, respectively.
Despite its long endurance, the definition of hallucination has been widely
criticized (see, e.g., Leudar et al., 1997; Liester, 1998; Lothane, 1982; Stanghellini
& Cutting, 2003). Rather than reiterating this criticism here, let us have a closer
look at the basic element of the contemporary definition, namely, that halluci-
nations are abnormal perceptions or perception-​like experiences. The basic ques-
tion is if this is true? Or differently put, had Esquirol got it all wrong, when he
believed that hallucinations were unrelated to disorders of perception? At a first
glance, a hallucination may seem to be an abnormal perceptual experience –​the
person, who hallucinates, appears to perceive something that is unperceivable
for others, for example, hearing a ‘voice’ that no one else can hear or seeing
something that others cannot see. From a clinical-​phenomenological perspec-
tive, the perceptual quality of hallucinations is ambiguous and it seems to vary
depending on the specific mental disorder. For example, transient hallucination
is a frequent symptom and a diagnostic criterion for alcohol withdrawal –​these
patients will often visually ‘see’ something, say, insects crawling on their skin
 Schizophrenia, Psychosis, and Empathy 33

(which may lead to formication) or rats running on the floor. These hallucina-
tions seem similar to veridical perceptions in the sense that their hallucinatory
object usually is experienced as very real, as right there in the world, and they
tend to provoke adequate behavioural responses (e.g., scratching the skin or
fleeing from the rats). In schizophrenia, by contrast, hallucinations are rarely
experienced in this way.
Although hallucinations may occur in all sense modalities in schizophrenia
(auditory, visual, tactile, olfactory, gustatory), auditory verbal hallucinations
(AVHs) are by far the most frequently encountered type of hallucination in
schizophrenia. In the following, I address only AVHs in schizophrenia, explor-
ing their content and structure. With regard to the content of AVHs, most
patients suffer from ‘voices’ that are demeaning, humiliating, or threatening, but
some patients also hear ‘voices’ that guide them in life. The ‘voices’ may vary on
a number of dimensions, for example, with regard to their clarity (from murmur
to distinct voices), volume (from whispering to shouting), linguistics (words,
sentences, or, though more rarely, dialogues), and form of address (where dis-
cussing voices or running commentary have been considered especially import-
ant in schizophrenia). Even the taken-​for-​granted acoustic quality of ‘voices’
may vary (sometimes ‘voices’ even lack an acoustic or auditory quality) and
patients rarely report that they hear the ‘voices’ through their ears –​for example,
as one of Bleuler’s (1950, p. 114) patients puts it, ‘The voices are unlike spoken
voices but are as if thought.’ In brief, what is referred to as AVHs or ‘voices’ are
not a univocal, well-​defined symptom but probably a wide group of mental phe-
nomena that most likely are etiologically and pathogenetically heterogeneous
(Ey, 1973; Henriksen, Raballo, & Parnas, 2015; Henriksen & Parnas, 2015).
Turning now to the structure or experiential givenness of AVHs in schizo-
phrenia, some interesting features emerge that appear to distinguish AVHs
from veridical auditory perceptions. Unlike the latter, (i) AVHs do often not
involve integration of multiple sense modalities but occur in a single modality;
(ii) AVHs are usually not experienced actively in the sense of being controlled
by a willed attention; (iii) AVHs violate the physical constraints of the sensorial
space and are often experienced as ubiquitous (e.g., if the ‘voice’ is experienced
as coming from the ‘outside’, then its intensity usually remains unaffected by
moving towards or away from its source or by interposition of barriers); (iv)
AVHs do not always have a temporal structure but may be revealed to the patient
as sudden, immediate flashes of meaning (similar to the revelatory givenness of
primary delusion); (v) AVHs are typically experienced as private phenomena,
that is, patients do usually not expect others to be able to hear the ‘voices’ they
34

34 Mads Gram Henriksen

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

Double bookkeeping
Already Bleuler (1950, p. 56), who coined the concept of schizophrenia,
described double bookkeeping as a cardinal feature of schizophrenia: ‘It is espe-
cially important to know that these patients carry on a kind of ‘double entry-​
bookkeeping’ in many of their relationships. They know the real state of affairs
as well as the falsified one and will answer according to the circumstances with
one kind or the other type of orientation –​or both together.’ He further states,
‘As a matter of fact the contradictions with reality are, for the most part, hardly
noted at all . . . Not only do delusion and reality exist consecutively in vari-
ous states of lucidity, but they can also exist simultaneously in conditions of full
consciousness where one would expect that they would be mutually exclusive’
(p. 126). Jaspers also touched upon this issue, considering it a central source of
incomprehensibility and incorrigibility in schizophrenia, but his intuition was
not grasped or expressed as clearly as Bleuler’s. Jaspers (1997, 105f.) writes,

We cannot say that the patient’s whole world has changed, because to a very
large extent he can conduct himself like a healthy person in thinking and behav-
ing. But his world has changed . . . Reality for him does not always carry the
 Schizophrenia, Psychosis, and Empathy 35

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

Unfortunately, Bleuler’s original insight about the quintessential role of double

bookkeeping in schizophrenia sunk into oblivion.
Bleuler himself offers many vivid, clinical examples of double bookkeeping;
a few of them will be explored below. Although they more or less all exemplify
a peculiar tension or mismatch between, on the one side, entertaining a spe-
cific delusion or hallucination and, on the other side, a striking failure to act
upon this very experience, double bookkeeping is not reducible to this mis-
match. Rather, the mismatch is a strong indicator that the patient harbours
double bookkeeping. Following Bleuler’s insight, as elicited in the quotations
above, double bookkeeping has recently been defined as a predicament and abil-
ity to simultaneously live in two different worlds, namely, the shared-​social world
and a private, solipsistic, and, at times, psychotic world (Henriksen & Parnas,
2014, p. 544). On this account, the reason why the two worlds are not ‘mutually
exclusive’ is rooted in their different ontological status, which enables patients to
experience them as two different, incommensurable, and thus not conflicting
worlds, thereby allowing them to coexist and only occasionally to collide (ibid.).
Before further keying in on the nature of double bookkeeping, let us have a look
at some prototypical examples.
The following, quite famous passage is perhaps one of the most illuminating
examples of double bookkeeping: ‘Kings and Emperors, Popes, and Redeemers
engage, for the most part, in quite banal work, provided they still have any
energy at all for activity. This is true not only of patients in institutions, but also
of those who are completely free. None of our generals has ever attempted to act
in accordance with his imaginary rank and station’ (Bleuler, 1950, p. 129). Most
clinicians are familiar with some manifestations of this paradoxical phenom-
enon, though they are not always as spectacular as in Bleuler’s vignettes. For
example, it could be patients who claim that others are automatons or phantoms
but who nevertheless interact with them as if they were real (cf. Sass, 1994, p. 21)
or patients who claim to be God, yet willingly clean their room and sweep the
floor. Double bookkeeping may also be visible in the patients’ attitudes towards
the staff –​as Bleuler (1950, p. 130) puts is, ‘they curse us in the strongest terms
as their poisoners, only to ask us in the very next moment to examine them for
36

36 Mads Gram Henriksen

some minor ailment, or to ask for a cigarette’. Finally, hallucinations may also be
embedded in a form of double bookkeeping. Here is another illustrative exam-
ple from Bleuler: ‘A catatonic patient was in great fear of a hallucinated Judas
Iscariot who was threatening her with a sword. She cried out that the Judas be
driven away, but in between she begged for a piece of chocolate’ (p. 43). What
is enigmatic in these examples is of course the striking incongruity between the
‘intimate conviction’ of the truth or validity of the delusional or hallucinatory
experience and the conspicuous lack of adequate actions. Normally, we tend to
perceive actions as confirmations of beliefs but in these cases we are left wonder-
ing whether or not the patients actually believe what they claim to believe.
Another crucial aspect of double bookkeeping is illustrated in the case of
Renée: ‘Little by little I brought myself to confine to my friends that the world
was about to be destroyed, that planes were coming to bomb and annihilate us.
Although I often offered these confidences jestingly I firmly believed them . . .
Nonetheless, I did not believe the world would be destroyed as I believed in real
facts’ (Sechehaye, 1951, p. 14f.; italics added). Renée fully believes in her escha-
tological delusion (the world is about to be destroyed) but she does not believe
in it in the same way as she believes in real facts (like ‘there is a bottle of water
on my desk’ or ‘this desk is made of wood’). Apparently, she is to some extent
able to differentiate her beliefs pertaining to the shared-​social world (e.g., real
facts) from her delusional belief that somehow pertains to her alone. Sass (2014)
describes another patient, who was ‘absolutely convinced’ that aliens were
gunning in the street, while, at the same time being perfectly aware ‘that oth-
ers would not be affected by the alien bullets and [the patient] was thus utterly
unsurprised to see them walking around unfazed’. Primary delusions seem to
occur in a solipsistic, psychotic world that looms up before the patients alone;
a purely subjective world distinct from the shared-​social world with its meta-
physical constraints and consequentiality. As Sass (1994, p. 46) aptly puts it, the
‘delusional world of many schizophrenic-​type patients is not, then, a flesh-​and-​
blood world of shared action and risk but a mind’s-​eye world’.8 According to
Sass, there is an inherent solipsistic quality, a ‘coefficient of subjectivity’ (p. 27),
to primary delusions, indicating that these delusions, though asserted confi-
dently and held with certainty, may pertain to a solipsistic world rather than to
matter of affairs in the public, consensual world. This lack of any straightforward
referentiality to the shared-​social world may explain why the patients’ behaviour
often is strikingly at odds with what we would expect from someone who firmly
holds such beliefs –​to act in a solipsistic world may, Sass says, ‘feel either unnec-
essary or impossible’ (p. 42) –​as well as why these delusions tend to be immune
 Schizophrenia, Psychosis, and Empathy 37

to counterarguments (we should not expect a primary delusion formed within a

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

Self-​Disorders and the Origin of Double Bookkeeping

How does double bookkeeping come about? In the following, I suggest that double
bookkeeping may be rooted in a constellation of certain typical, non-​psychotic,
and mainly trait-​like anomalous self-​experiences, namely, self-​disorders. During
the past two decades, empirical studies have documented that self-​disorders
aggregate in schizophrenia spectrum disorders but not in other mental disorders
(Parnas et al., 2003; Parnas et al., 2005a; Haug et al., 2012; Raballo & Parnas, 2012;
Nordgaard & Parnas, 2014) and self-​disorders have been found to predict subse-
quent schizophrenia spectrum diagnosis as well as psychosis onset (Parnas et al.,
2011; Nelson, Thompson, & Yung, 2012; Parnas, Carter, & Nordgaard, 2016) (for
a review, see Parnas & Henriksen [2014]). The aggregation of self-​disorders in
schizophrenia destabilizes the framework of experiencing and threatens the tacit,
foundational self-​world structure (the ‘intentional arc’). It has been proposed that
the self-​disorders weaken the ordinary immersion in the shared-​social world and
throw the patient into a new, solipsistic world.9 Unconstrained by the natural
38

38 Mads Gram Henriksen

certitudes concerning causality, space, time, and non-​contradiction that gov-

ern the shared-​social world and make it predictable, ontologically secure, and
homely, the solipsistic world may appear as only apparent, staged, unreal, mind-​
dependent, or prone to non-​causal relations, for example, reflected in experi-
ences of primary self-​reference or magical thinking (Parnas & Henriksen, 2013;
Henriksen & Parnas, 2014). The coexistence of the shared-​social and the solip-
sistic world implies here a kind of ‘pre-​psychotic double bookkeeping’ (Parnas &
Henriksen, 2013, p. 326). Let us now have a look at some of the most frequently
reported self-​disorders in the schizophrenia spectrum.
Typically, patients complain of feeling as if they do not truly exist, of lacking
an inner core, and of being radically, though often ineffably, different from others
(Anderssein). The distinctness of ‘Anderssein’ appears to be a pervasive sense of
feeling ontologically different, that is, it is a feeling of being different in which
one’s very sense of being human is alarmingly at stake and it is often a source
of profound solitude and suffering. Patients also frequently describe a deficient
sense of ‘mineness’ of the experiential field, for example, certain thoughts or
bodily movements may feel as if the patients do not generate them (e.g., ‘my
thoughts feel strange as if they aren’t really coming from me’). Complaints of
thematically unrelated thoughts that break into and interfere with the main train
of thoughts or of rapid, parallel trains of thoughts that occur with a clear loss of
meaning (e.g., ‘my thoughts are like rockets, shooting in all directions at once.
It’s one big chaos’) or of thoughts that suddenly disappear completely are often
encountered. Thoughts may also acquire spatial or quasi-​spatial qualities and
many patients report that they listen to their own thoughts spoken aloud intern-
ally with their own voice (Gedankenlautwerden). Often, patients also complain
of not feeling truly present in the world (e.g., ‘I live in a sort of bubble, where the
world does not matter. I lack synchrony with the people around me’). Problems
with common sense, which have been thoroughly described by Blankenburg
(1971), are also typically reported; these problems reflect an inability to take for
granted what others consider obvious or matter of fact (e.g., reflected in ques-
tions such as ‘why do people say “hello” to each other?’, ‘why is the sky blue?’, or
‘why is the colour code in traffic signals red-​yellow-​green?’) and often patients
hyper-​reflect on the relevant issues in an attempt to decode their meaning. We
may also observe a variety of bodily disturbances (e.g., ‘the body feels awkward
as if it does not really fit. It feels like the body is not really me, as if it is rather
a machine controlled by my brain, as if the body is a mere appendage’), mirror
phenomena (e.g., ‘it is as if the reflected image is not supposed to be me . . . When
I pass by a mirror, I must stop and make sure that there have not been too many
 Schizophrenia, Psychosis, and Empathy 39

changes’), transitivistic phenomena (e.g., feeling radically exposed, too open or

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

Conclusion and a Plea for Empathy

This chapter has strived to illuminate the potential and relevance of phenomen-
ology for grasping essential features of the psychopathology of schizophrenia.
I have argued that the current definition of psychosis, delusion, and hallucin-
ation is at odds with the phenomenology of these experiences in schizophrenia.
Future efforts to redefine the basic concepts of psychopathology in a phenom-
enologically faithful way are of paramount importance not only for obtaining a
more valid description and classification of mental symptoms but also for our
ability to grasp the patients’ experiences and lifeworld, which is crucial for offer-
ing adequate therapeutic support. A therapeutic target, emerging on the basis of
what has been discussed here, could consist both in addressing the vulnerability
involved in the self-​disorders and in helping the patients to balance or nego-
tiate an existence that is exposed to two different worlds (rather than treating
40

40 Mads Gram Henriksen

with the purpose of eliminating the solipsistic and, at times, psychotic world).
Although such a phenomenologically informed psychotherapy for schizophre-
nia remains to be developed, important resources may be drawn from Corin’s
(1990) work on ‘positive withdrawal’ and Davidson’s (2003) work on recovery
in schizophrenia.
Finally, a note on empathy. It has repeatedly been stated that certain patho-
logical experiences in schizophrenia, in particular bizarre delusions, are far
beyond empathic understanding. In this chapter (and elsewhere), I have argued
against this claim (e.g., Henriksen, 2013; Parnas & Henriksen, 2013). The cre-
ation of the category of bizarre delusion in DSM-​III (APA, 1980) was initially
justified by a cursory reference to Kraepelin’s observation that schizophrenic
delusions often are ‘non-​sensical’ and to Jaspers’s claim that primary delu-
sions cannot be understood (Parnas & Henriksen, 2013, p. 323). However, it
seems that the operative notion of comprehensibility is far too restrictive. For
an experience to be understandable, on Jaspers’s (1997, p. 301) account, it must
basically be accessible through empathy in the sense of projecting oneself into
the other’s psychic situation and being able to genetically understand how the
other’s mental states emerge from each other. In other words, Jaspers’s criter-
ion for the comprehensibility of pathological phenomena is that they largely
fall within the range of normal experiences (Henriksen, 2013, p. 110f). I agree
with Jaspers that primary pathological phenomena in schizophrenia –​so often
fraught with coexisting attitudes and inner contradictions –​are psychologically
irreducible, that is, we cannot understand the emergence of a primary delusion
in the same way that we can understand the development of a depressive episode
following the loss of a beloved one. However, the mere fact that primary patho-
logical phenomena are psychologically irreducible does exclude their compre-
hensibility. We have other forms of understanding and empathy at our disposal.
Despite the apparent strangeness and paradoxical qualities inherent in schiz-
ophrenia, we can by means of phenomenological analysis begin to unravel and
understand these experiences and the lifeworlds in which they are embedded.
It is crucial to realize that the schizophrenic lifeworld in various ways is differ-
ent from that experienced in normal conditions, as pointed out by Jaspers and
Bleuler. Crucially, double bookkeeping implies an altered ontological position
or, as Ratcliffe (2008, p. 194) puts is, ‘With an altered sense of reality, patients
cannot take things to be the case in the usual way, as the sense of ‘is’ and ‘is not’
has changed’ (italics in original). Ignoring this fact is to not do justice to the
complexity of the patients’ experiences and challenges. If we are to empathically
understand the core pathological experiences, then the task is to reconstruct the
 Schizophrenia, Psychosis, and Empathy 41

altered framework of experiencing and lifeworld in schizophrenia. Although we

may not be able to imagine precisely what it feels like to, say, have the privacy of
one’s subjectivity compromised (transitivism), we can easily imagine a variety of
consequences of this disturbing feeling of being ‘too open’ such as fear of others
having access to one’s innermost thoughts and inclinations to socially withdraw.
Such an understanding has similarities with what Ratcliffe (2012) terms ‘radical
empathy’ and which I elsewhere have described as a ‘philosophical understand-
ing’ (Henriksen, 2013, p. 125).
Phenomenology enables a form of empathy in the sense that it allows us
to understand something of what it might be like to experience the world as
patients with schizophrenia sometimes do. Although the more precise nature of
this form of empathy remains to be accounted for, it is evident that it requires
effectuation of the phenomenological epochē (i.e., we must suspend our nor-
mally taken-​for-​granted beliefs about the world) and faithfully try to reconstruct
the altered framework of experiencing and lifeworld in schizophrenia –​a life
world usually deprived of the ontological securities and natural certitudes that
ground a normal existence. Effectuating the epochē and adopting a phenom-
enological stance is not something that we by default know how to do, but it is
something that we can learn to do (Englander, 2014).

Notes

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

42 Mads Gram Henriksen

criteria. The implication is that patients, who suffer from more insidious or less
flamboyant forms of psychosis (e.g., hebephrenia), who do not show clear-​cut
psychotic symptoms with a duration of at least one month or who experience
predominately ‘subthreshold’ or ‘attenuated’ positive symptoms, do not fulfil the
diagnostic criteria for schizophrenia and thus receive another diagnosis. These
circumstances seem to blur the clinical picture and eventually invite the illusion
that psychosis is widely present in non-​psychotic mental disorders (Parnas &
Henriksen, 2016a). Second, the self-​rating scales, typically used to demonstrate
the presence of ‘psychotic-​like experiences’ in the general population, have
been found to be entirely uncorrelated with clinician-​rated scales of ‘attenuated
psychotic symptoms’ (Schultze-​Lutter et al., 2014). In another important
study, Stanghellini et al. (2012) demonstrated that hallucinatory experiences
in a nonclinical population are remarkably different from hallucinations in
schizophrenia. More specifically, the nonclinical population reported hypnagogic,
hypnopompic, and pseudo-​hallucinations as single, isolated phenomena or
related to circumstantial stressors, whereas the patients with schizophrenia
reported genuine hallucinations that were intimately intertwined with their self-​
disorders, personal identity, and metamorphosis of self-​world relationship.
3. In 2011, Breivik butchered seventy-​seven civilians in his attacks in Olso and on the
island Utøya. During his trial, two diagnostic reports arrived at remarkably different
conclusions, namely, paranoid schizophrenia and narcissistic personality disorder
with antisocial traits, respectively. On the basis of the latter diagnosis, Breivik was
sentenced to twenty-​one years in preventive custody with a minimum time of ten
years. His case is reminiscent of the case of the French peasant Pierre Marie Rivière,
who, in an act of cruelty, slaughtered his mother, sister, and brother in 1835. Also
in this case, diagnostic reports arrived at conflicting conclusions, namely, again,
sane and insane (psychosis), respectively. Rivière was eventually sentenced to life
imprisonment (for a thorough discussion of the two cases, see Nilsson, Parnas, &
Parnas [2015]).
4. For example, in DSM-​III-​R (APA, 1987), ICD-​10, DSM-​IV-​TR (APA, 2000),
and DSM-​5.
5. Jaspers famously distinguishes between delusions proper (also called true or
primary delusions) and delusion-​like ideas. The latter emerge in a psychological
comprehensible way from preceding experiences and affects, whereas the former
emerge from primary pathological experiences, which are psychologically
irreducible and thus incomprehensible. Jaspers’s distinction between delusions
proper and delusion-​like ideas is echoed in the distinction between bizarre and
non-​bizarre delusion in DSM-​5 and ICD-​10.
6. Delusions of jealousy and (non-​bizarre) persecutory delusions are typical examples
of secondary delusions, which may be seen in all forms of psychoses.
 Schizophrenia, Psychosis, and Empathy 43

7. The following brief exchange between George W. Mackey, a professor of

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

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 3

Empathy in a Social Psychiatry

Magnus Englander

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

Introduction

When we think of social psychiatry, we often think of research and work towards
social justice for persons suffering from mental illness (e.g., Bhugra & Till, 2013;
Davidson, Rakfeldt, & Strauss, 2010). However, we also need to situate social
psychiatry within the minimal social context of the face-​to-​face situation; what
Alfred Schutz (1945, 1967) once emphasized as the basic structure of interper-
sonal understanding. The face-​to-​face context brings out questions of how we
know and understand others in terms of empathy. We often turn to modern psy-
chology, psychotherapy, and even to cognitive neuroscience to find answers to
such questions. I will argue that the foundation of empathy as explicated within
the mainstream perspective in such disciplines is questionable. The purpose of
this chapter is to outline a plausible answer to the following question: Could a
phenomenological psychological approach to empathy have anything specific
to contribute to the minimal social situation of the face-​to-​face (professional)
encounter in a social psychiatry? First, I will make an inquiry into the potential
value of a phenomenological understanding of empathy. Second, I will clarify
how empathy is essential as a means to interpersonal understanding when work-
ing with persons suffering from mental illness. Third, I will make a brief sketch
of the empathic (psychological) reduction that can aid the mental health care
50

50 Magnus Englander

professional and students in training in approaching their work with clients in

terms of interpersonal understanding.

Empathy as Perception of the Other

The field of social psychiatry, just like other related fields, for example, social
work, seems to draw its foundational knowledge about empathy from twentieth-​
century clinical and counseling psychology. The most influential perspective
seems to be the psychoanalytic perspective in psychology, especially Sigmund
Freud’s view on empathy, an interpretation that originated in Theodor Lipps’s
theory of empathy as imitation and projection (Coplan & Goldie, 2011). The
psychoanalyst Heinz Kohut (1981/​2010, pp. 125–​6), representing Self Psychology,
approached empathy together with introspection as ‘informers of appropriate
action’, and suggested that we should do the following: ‘ “put yourself into the
shoes of ”, think yourself appropriately into the inner life of another person, then
you can use this knowledge for your purposes’. The psychoanalytic view has also
had implications for clinical social work, especially in terms of gaining insight
into relational, psychotherapeutic processes. For example, Rohr (2012, p. 452)
acknowledges that empathy is a central concept in psychoanalytic thought and
an important part of ‘counter transference reactions’. Even humanistic psychol-
ogy could not escape the historical trace back to Lipps’s influential account of
empathy as imitation. For instance, Carl Rogers (1989, p. 226) defines ‘empathy’
as ‘To sense the client’s private world as if it were your own, but without ever los-
ing the “as if ” quality –​this is empathy, and this seems essential to therapy.’ From
the perspective of twentieth-​century psychology, the view of empathy within the
face-​to-​face context seems to have been mainly influenced by a type of monado-
logy, in which a type of matching or identification of mental states became the
method towards interpersonal understanding.
However, viewing a human being as a self-​contained monad relating to
other monads externally is a distorted view of human interaction. According to
Merleau-​Ponty (1964, p. 114),
Given the presuppositions with which that psychology works, given the preju-
dices it adopted from the start without any kind of criticism, the relation with
others becomes incomprehensible for it. What, in fact, is the psyche [psy-
chisme] –​mine or the other’s –​for classical psychology? All psychologists of the
classical period are in tacit agreement on this point: the psyche, or the psychic, is
 Empathy in a Social Psychiatry 51

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

Research in contemporary, (mainstream) cognitive neuroscience seems to suffer

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

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

the perception of others (Gallagher & Zahavi, 2012, p. 119), and to then por-
tray empathy as simulation seems unnecessary and beside the point. Gallagher
(2008a, pp. 131–​2), critiquing the phenomenon of empathy as beginning with
simulation, makes a case for the phenomenological argument using the follow-
ing example,

I see a woman in front of me enthusiastically and gleefully reaching to pick up a

snake; at the same time I am experiencing revulsion and disgust about that very
possibility. Her action, which I fully sense and understand from her enthusias-
tic and gleeful expression to be something that she likes to do, triggers in me
precisely the opposite feelings. In this case, neither my neural states, nor my
motor actions (I may be retreating with gestures of disgust just as she is advan-
cing toward the snake with gestures of enthusiasm), nor my feelings/​cognitions
match hers. Yet I understand her actions and emotions (which are completely
different from mine), indeed that is what is motivating my own actions and
emotions, and, moreover, I do this without even meeting the minimal neces-
sary condition for simulation, that is, matching my state to hers. I suggest that
no simulation in any form is involved in this kind of case, and I suggest that this
kind of case is not rare. So that’s the trouble for the universal claim made for
simulation.

In other words, it becomes essential to view our reaction as subsequent to our

direct social perception of the other. To take an imaginative walk in the other’s
shoes in the face-​to-​face context means that one must first have been present
to somebody’s expression –​or more precisely to somebody’s expressive unity
(Zahavi, 2011, p. 10). Hence, empathy as perception of the other indicates a pri-
mary focus on someone other than oneself.
The simulation model would mean that I would have to find a match between
my own state and that of the other. But what if, as we saw in Gallagher’s (2008a)
example above (of the woman picking up the snake), the reaction could not
find a match, even though the perceiver understood the expression? In other
words, our understanding of the other as other could never originate by means
of simulation. According to Gallagher (2012, p. 363), ‘The question is, when we
project ourselves imaginatively into the perspective of the other, when we put
ourselves in his or her shoes, do we really attain an understanding of the other
or are we merely reiterating ourselves?’ This is not to say that empathy as percep-
tion of the other is the only means towards interpersonal understanding; instead
it highlights the a priori of the perceptual act, that is, ‘other perception’, directed
towards the lived body of the other, in order for interaction to be possible in the
 Empathy in a Social Psychiatry 53

first place (as opposed to a ‘robotic monad’ simulating something within its own
closed system). In other words, to portray empathy as simulation would be to
direct our understanding of the other away from the other.
To view empathy as perception of the other means that our understanding
of the other starts with the other, commonly referred to in contemporary phe-
nomenological research as second-​person access (Zahavi, 2010). Zahavi (2007,
p. 197) writes,

The second-​(and third-​) person access to psychological states differ from the
first-​person access, but this difference is not an imperfection or a shortcoming;
rather, it is constitutional. It makes the experience in question an experience of
another, rather than self-​experience . . . To demand more, to claim that I would
have a real experience of the other only if I experienced her feelings or thoughts
in the same way as she herself does, is nonsensical. It would imply that I would
only experience another if I experienced her in the same way that I experience
myself, i.e., it would lead to an abolition of the difference between self and other.
Thus, the giveness of the other is of a rather peculiar kind. We experience the
meaningful behavior of others as expressive mental states that transcend the
behavior that expresses them.

Hence, empathy as perception of the other is not understood as something

decontextualized, disembodied, and limited to the isolated expression of the
other (Gallagher, 2008b), but the second-​person perspective points directly to
the social; namely, our ability to differentiate between a thing and a lived body.
As Fuchs (2012, p. 24) has pointed out, ‘Expressive bodies, meaningful ges-
tures, intentions-​in-​action and contextual background information enable us to
directly perceive the other as a psychophysical unity, without necessary recourse
to first person simulation or third person inference.’ Such an account acknowl-
edges both the importance of the context and the second-​person access as the
point of departure for interpersonal understanding.
Another aspect of the phenomenology of empathy is the importance of the
here-​and-​now, as highlighted in the classic work of Edith Stein (1964), especially
in regard to Stein’s first level of empathy as perception of the other. In a practical
sense, the here-​and-​now becomes important in terms of second-​person access in
following the expression of the other as perception of the other, or ‘empathizing
perception’ as Husserl (2006) would have called it. When someone is expressing
experiential content, professionally we tend to be primarily concerned with the
content itself, as a problem to be solved, and we therefore typically fail to recog-
nize the importance of our direct social perception of the other that takes place
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54 Magnus Englander

in the present moment, that is, in the here-​and-​now, as it unfolds in the face-​
to-​face context (Englander, 2014). Zooming in on the content in itself, perhaps
in an attempt to solve the other’s problem, we fail to include the experiential
other. As I have suggested elsewhere, such ‘naive habits’ can be disclosed in a
phenomenological psychological approach to empathy training in which work-
ing professionals and university students can learn how to remain longer within
‘other perception’ (ibid.).
Let us end this section by taking a look at a recent phenomenological descrip-
tion of empathy. Gallagher and Zahavi (2012 p. 203) write,

Empathy is defined as a form of intentionality in which one is directed towards

the other’s lived experience . . . Any intentional act that discloses or presents the
other’s subjectivity from the second-​person perspective counts as empathy . . .
The phenomenological conception of empathy thus stands opposed to any the-
ory that claims our primary mode of understanding others is by perceiving
their bodily behavior and then inferring or hypothesizing that their behavior
is caused by experiences or inner mental states similar to those that apparently
cause similar behavior in us. Rather, in empathy, we experience the other dir-
ectly as a person, as an intentional being whose bodily gestures and actions are
expressive of his or her experiences or states of mind. (Italics in original)

Thus, empathy as perception of the other means following the meaning-​

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

Psychiatry, Mental Illness, and Empathy

In the face-​to-​face situation within the context of psychiatric practice, staying

in the here-​and-​now and following the other’s meaning-​expression can be seen
as what constitutes the possibility of interpersonal understanding within this
professional encounter. In an interview provided by Davidson (2014, p. 248), a
person suffering from schizophrenia states the following,

I’m not a crazy person, but it’s the point that we go through things that people
can’t even fully imagine. We can tell you certain things, but it’s almost like saying
you’ve never been to prison. I can tell you about prison. I can tell you everything.
 Empathy in a Social Psychiatry 55

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

The first reaction that most of us experience is a sort of agreement with the per-
son. But this agreement is based upon our own common sense reaction and our
positing the content as factual content. If we instead return to our perception
of the other and our presence to the expression of the other in the here-​and-​
now, right before our attention was directed to our own reaction to the content,
we recognize that the person suffering from schizophrenia was telling us that
we will not be able to understand her. If instead, we stay in the here-​and-​now
within the realm of our perception of the other person’s expression, we could
move towards a we-​intentionality (i.e., being present to something together)
and provide the other with a description based upon our presence of the other’s
meaning-​expression, that is, empathy, such as: ‘You feel as if I will never be able
to understand your situation.’1 What did we just do? We understood her. If noth-
ing else, such an example shows us how essential the here-​and-​now is for empa-
thy in a face-​to-​face context.
Following the meaning-​expression of the other in the here-​and-​now (as
exemplified above) also means that one is primarily following the experiential
other, which is to say, from a second-​person perspective, that one is focusing
on the experiential self (e.g., Zahavi, 2014) of the other. Now, such a statement
might at first appear impossible, because it is the experiential self that ultimately
separates me from the other (Zahavi, 2014). However, the experiential self, or
minimal self, is of primary interest in terms of empathy, because it is the pre-​
reflective, first-​person of the other that expresses meaning to us. In his research
on the phenomenology of the self, Zahavi (2007), has made a rough distinction
between the narrative self and the experiential or minimal self that can be of
value for our discussion here.2 The first-​person perspective and the experiential
self have often been portrayed as synonymous with intentionality, internal-​time
consciousness, and the lived body and hence a prerequisite for a narrative self
(Gallagher & Zahavi, 2012). As Zahavi (2007, p. 200) has pointed out, ‘In order
to tell stories about one’s own experiences and actions, one must already be in
possession of a first-​person perspective.’ Starting with second-​person access, fol-
lowing the meaning-​expression of the other also means that one is primarily fol-
lowing the experiential other and the narrative as it unfolds from the other, rather
than following the content of the narrative as the primary object, as an object in
itself, that is, existing independently of the person’s experience of it, analyzing
it, and later returning to the person and serving her with an explanation of her
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56 Magnus Englander

condition. As we can see in our example above, turning to our own reaction to
the narrative content itself would be to turn away from the experiential other.
This experiential (minimal) self is often referred to as ipseity, or a sense of
‘mineness’, indicating the closeness of ownership of one’s experience (Gallagher
& Zahavi, 2012; Parnas et al., 2005). Ownership differs from agency in that one
can maintain ownership of an experience even if one’s sense of agency is lost
(Gallagher, 2005; Gallagher & Zahavi, 2012). For example, if someone were to
push me, I would lose my experience of agency, but I would not lose my own-
ership of whose experience it is. In terms of psychopathology, such a distinc-
tion becomes more complex. Take, for example, hallucinations, such as hearing
voices in schizophrenia. There is clearly a loss of not just agency, but also of own-
ership, because the voices are experienced as belonging to someone else than
oneself (Davidson, 2003; Gallagher & Zahavi, 2012; Gallagher, 2005).
Let us turn to empathy as perception of the other and see how we could
approach this. If the client expresses that the voices are experienced as belonging
to someone else, the professional could be present to the expression of the experi-
ential other as a person who has agency and the ownership of a lived experience
of something, even though the meaning, from the client’s first-​person perspec-
tive, is a loss of both agency and ownership. Within the context of a professional
encounter, such a presence could reflect to the other that there has not been a
complete loss of the experiential (minimal) self, as in you experience something –​
at least not from the context of the interaction. Hence empathy and a descrip-
tion of one’s presence to the other’s meaning-​expression can also be of value as a
means to the client’s own personal reflection. As Stein (1964, p. 82) writes,

Empathy proves to have yet another side as an aid to grasping ourselves. As

Scheler has shown us, inner perception contains within it the possibility of
deception. Empathy now offers itself to us as a corrective for such deceptions
along with further corroboratory or contradictory perceptual acts. It is possible
for another to ‘judge me more accurately’ than I judge myself and give me clar-
ity about myself. For example, he notices that I look around me for approval as
I show kindness, while I myself think I am acting out of pure generosity. This
is how empathy and inner perception work hand in hand to give me myself to
myself.

In other words, empathy as second-​person access could be of importance for

the face-​to-​face context in that it can provide for the possibility to aid the per-
son suffering from mental illness in their own struggle to reflect on their own
experiences.
 Empathy in a Social Psychiatry 57

To clarify my last point, Stein’s (1964) reference to Scheler’s deception does

not imply that the client’s lived experience of the loss of ipseity is the same as lying
to ourselves, or that these types of experiences represent some kind of Freudian
denial. As Davidson (2003) has pointed out, we tend to demand an unrealistic
sense of awareness towards a person suffering from mental illness that we would
never demand for other serious illnesses, and if clients do not have this aware-
ness, they are seen as being in denial or in some sort of stage of self-​deception.
Such reasoning belongs to the stigma surrounding mental illness. Of course,
there are clients who understand that their experience is a hallucination and
also clients who experience a great sense of control and agency over their hal-
lucinations. This means that professionals working in a social psychiatry have to
be able at times to transcend such simplified psychological explanations such as
deception and/​or denial. Schizophrenia provides a good example here because
as Parnas et al. (2005) and Parnas and Henriksen (2014) have emphasized, it is a
self-​disorder in which the experience of loss of ipseity is at the experiential core
of the illness. Empathy in a phenomenological sense follows the expression from
this experiential (minimal) other.
In contrast to emotional contagion, empathy as perception of the other
is preserving the distance between self and other. As Zahavi (2010, p. 291)
has emphasized, ‘The focus is on the other, and not on yourself, not on how
it would be like for you to be in the shoes of the other. That is, the distance
between self and other is preserved and upheld.’ Consequently, staying within
the realm of perception of the other presents us with another possibility, which
is to realize how empathy can be utilized within other layers of the interac-
tion such as in a genuine we-​intentionality within the face-​to-​face, professional
context. According to Zahavi (2015, p. 97), ‘The self-​other differentiation, the
distinction between self and other, consequently precedes the emergence of,
and is retained in, the we.’ This is not to say that ‘preserving the distance’ to
the other is to regress to the medical tradition and the physician’s so-​called
detached concern, but instead we focus our awareness on whose experience we
are attempting to understand. Understanding the other is not about seeking a
collapse of perspectives (as in emotional contagion), but to realize that I can
never have the other’s experience. To recognize that I am not able to have the
other’s experience is not to say that I am not able to understand meanings as
expressed by the other.
Working within the realm of social interaction in the field of psychiatry means
working from the outmost limits of our horizon. Within professional fields such
as clinical psychology and psychiatry, clinical social work, psychiatric nursing,
58

58 Magnus Englander

and recovery-​oriented guidance, one cannot rely only on an everyday ‘mundane

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

The Empathic Reduction

In the section that follows, I will make an attempt at a brief sketch of a modi-
fication of the phenomenological psychological reduction, as it could be uti-
lized by mental health professionals, in their attempt to empathize with clients
in the face-​to-​face context. I have previously described a type of professional
enactment of empathy that is possible by first utilizing the phenomenological
psychological reduction, which has led to a phenomenological psychological
approach to empathy training for university students and working professionals
(Englander, 2014). Also, I have previously suggested this as a modification of
the psychological reduction for the face-​to-​face context and referred to it as the
empathic reduction (Englander, 2015). This will only be outlined here in order to
show its relevance to a phenomenological psychological approach to the face-​to-​
face context in a professional social psychiatry.3
Before I proceed, it is essential to mention that Ratcliffe (2012) has a
similar proposal in which he claims that the phenomenological attitude can
be adopted as a ‘phenomenological stance’ in order to understand experi-
ences of mental illnesses, something that he has referred to as ‘radical empa-
thy’. Ratcliffe’s (2012) argument against simulation theory is similar to that
 Empathy in a Social Psychiatry 59

of Zahavi’s (e.g., 2010), and he follows Stein’s (1964) take on empathy. In

Ratcliffe’s seminal paper Phenomenology as a Form of Empathy (2012), there
are parallels to my own work on a phenomenological psychological approach
to empathy training (Englander, 2014, 2015; Englander & Folkesson, 2014;
Englander & Robinson, 2009). Nevertheless, I will start this section by turn-
ing my attention to my own research tradition in American phenomenologi-
cal psychology (e.g., Giorgi, 1970, 1985, 2009) and psychiatry (Davidson,
2003), and then work with this tradition in a dialogue with Ratcliffe’s (2012)
‘radical empathy’.
So let us begin by looking at the psychological reduction and its relation to
empathy. The psychological reduction is described by Giorgi (2009, p. 98) as
follows, ‘Within this reduction, the objects of experience are reduced (that is,
reduced to phenomena as presented), but the acts of consciousness correlated
with such objects belong to a human mode of consciousness.’ In the context
of a social psychiatry and the face-​to-​face situation, professionals can thus
bracket the existential index of the objects as well as their own presupposi-
tions about phenomena as expressed by the other, in the here-​and-​now. Such
a method could disclose the meanings that I am present to, based upon what is
being expressed by the other; however, the reduction remains partial and within
the realms of a human mode of consciousness. In other words, one follows the
meaning-​expression (i.e., phenomena as expressed by the other) and can treat it
from the psychological reduction as one’s presence to psychological meanings.
As Davidson (2003, p. 100) puts it,

We place in brackets all realities ordinarily presumed to exist outside of this

person’s experience, including the causal context of nature, and focus exclusively
on her experiences themselves as the realities in which we are interested. Rather
than explaining her experience on the basis of the underlying causes, we attempt
to understand its meaning and structure from the perspective of the subject as it
was lived (i.e., experienced) by her. (Emphasis in original)

One is thus considering the objects of the other’s expression as phenomena. If

a client is hearing voices, the lived experience is there for the client, whether
the voices are real or not. Hence, meanings rest on the intentional relation
and one could argue that it is essential to use the psychological reduction
in the face-​to-​face psychiatric context in order to be present to phenomena
such as, for example, hallucinations in schizophrenia. So in using the gist of
the psychological reduction, that is, bracketing the existential index of the
60

60 Magnus Englander

object, we are now able to be present to the other as she is expressing psy-
chological meanings in the world. Instead of engaging our beliefs and judge-
ment about the objects being expressed by the other, we are now treating the
objects as phenomena and thus we are entering the realm of interpersonal
understanding.
The reduction utilized in the face-​to-​face context is the partial psychological
reduction in order to remain within a human mode of consciousness. This is not
to say that transcendental approaches cannot be used in other contexts (e.g., in
a research context) or to rule out the transcendental reduction altogether for the
face-​to-​face context. Rather, it is to situate empathy within the face-​to-​face con-
text and in relation to a human mode of consciousness. This is similar to what
Giorgi (2009, p. 92) in his phenomenological psychology would call a ‘circum-
scribable task’. According to Giorgi ‘What is required is a shift in attitude so that
one can be fully attentively present to an ongoing experience rather than habitu-
ally present to it’ (ibid.). The point of agreement seems to be to consider the acts
within the realm of a human mode of consciousness and to treat the objects of
experience as phenomena. However, it is important to note that we are situated
within the here-​and-​now of the face-​to-​face situation, that is, we are not within
the research context.
Let us then continue our modification of the psychological reduction and sit-
uate it within the face-​to-​face context, with empathy as perception of the other,
and with a second-​person perspective. In order to situate a minimal account of
empathy within the psychological reduction and to make an intentional empathy
possible, we will have to turn to Ratcliffe’s (2012) ‘Radical Empathy’. According
to Ratcliffe, ‘Radical empathy, I propose, is a way of engaging with others’ expe-
riences that involves suspending the usual assumption that both parties share
the same modal space’ (p. 483). As we saw in our account above of the phenom-
enology of empathy, it is essential not to confuse our own state with that of the
other if understanding of the other is what we are aiming for, hence ruling out
attempts to match the other’s mental state. This leaves us with a second-​person
focus following the other’s meaning-​expression in the here-​and-​now within the
face-​to-​face context. We now face the possibility of engaging in an interaction,
in which we can take empathy into the interactional layer of the we and respond
to the other by describing our presence to the psychological meanings in the
expression unfolding right in front of us.
The empathic reduction helps us to be present to the other as other and to
tend more carefully to the other’s expression of psychological meanings, thus
enabling us to differentiate between our own perception and the positing of the
 Empathy in a Social Psychiatry 61

other. This differentiation between perception and positing becomes essential

for understanding others. Giorgi (2009, p. 90) clarifies this point,

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

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

Conclusion

To combine the psychological reduction with empathy as a second-​person per-

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

Notes

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

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Churchill, S. D. (2012b). Teaching phenomenology by way of ‘second-​person

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Davidson, L., Rakfeldt, J., & Strauss, J. (2010). The roots of the recovery movement in
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Englander, M. (2014). Empathy training from a phenomenological perspective. Journal
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Englander, M. (2015). Selfhood, empathy, and dignity. In S. Ferrarello & S. Giacchetti
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Englander, M., & Folkesson, A. (2014). Evaluating the phenomenological approach to
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 4

On the Empathic Mode of Intuition

A Phenomenological Foundation for Social

Psychiatry
Scott D. Churchill

Introduction

If phenomenology is really going to return ‘to the matters themselves’ of

everyday life, and if a phenomenological method for the fields of psychology
and psychiatry is to attain more than a disinterested Cartesian stance towards its
subject matter, then we cannot content ourselves with being a mind that inspects
its data, an ethereal cogito cut off from the Eros of the body. The mistake of
the rationalists was to think that a ‘pure reason’ would be capable of speaking
truth about the lifeworld. Empiricists, however, stress the passivity of percep-
tion, and in the development of scientific method prefer to bracket ‘subjective’
impressions. Phenomenology, in suggesting that the body is one’s point of view
on the world and thereby ‘the psychic object par excellence’ (Sartre, 1943/​1956,
p. 347), invites us to become more attuned to the logos of the body. This means
becoming more sensitive to the lived body as both subject matter and method
of psychology.
Colleagues such as Kenneth Shapiro (1985) in his book Bodily Reflective
Modes: A Phenomenological Method for Psychology, David Abram (1996) in The
Spell of the Sensuous, and Alphonso Lingis (1994) in The Community of Those
Who Have Nothing in Common have advanced our methodological understand-
ing of the body as a mode of access to the meaning of experience, whether our
own or somebody else’s. All three have drawn from the work of Merleau-​Ponty
and other phenomenologists to develop richly embodied approaches to their
6

66 Scott D. Churchill

perception of self and others. My own intrigue with phenomena of bodily

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

Empathy as an Investigatory Posture:

Imitations of Intentionality

Empathy has been described as ‘the process by which one person is able to
imaginatively place himself in another’s role and situation in order to understand
the other’s feelings, point of view, attitudes, and tendencies to act in a given situ-
ation’ (Gorden, 1969, pp. 18–​19). Edmund Husserl (1952) sometimes referred
 On the Empathic Mode of Intuition 67

to it as ‘trading places’, while Alfred Schutz (1973) referred to an ‘interchange-

ability of standpoints’. In contemporary parlance, the term ‘empathy’ is more
often associated with therapeutic than theoretical or methodological literature
in psychology. The notion of empathy has, in fact, been used by many psychol-
ogists in describing the clinician’s presence to a client (Allport, 1937; Rogers,
1951; Sarbin, Taft, & Bailey, 1960; Wiens, 1976; Schafer, 1983). In the early days
of its use, the term ‘empathy’ was used to suggest ‘the imitative assumption of
the postures and facial expressions of other people’ (Allport, 1937, p. 530). In the
clinical context, it has been said that the psychologist ‘puts himself in his client’s
place’ (Combs & Snygg, 1959, p. 254), ‘uses his imagination’ (Hamlyn, 1974), or
‘listens with the third ear’ (Reik, 1948) to understand the client’s experience. It
also has been suggested that the psychologist might ‘try to imitate the changing
positions of a client to try intuitively to infer his unverbalized feelings’ (Wiens,
1976, p. 35). One psychologist went so far as to say, ‘When we cannot imitate an
individual’s behavior we are at a loss to understand it’ (Kempf, quoted in Allport,
1937, p. 530).
When I perceive conduct I am perceiving not only an action that takes place
in the midst of the world, but an intentionality. Intentions do not lie buried deep
within the recesses of one’s cogito; rather they are phenomena of the lived body.
Sartre (1943/​1956, p. 320) writes: ‘I see his gesture and at the same time I deter-
mine his goal.’ It is in this sense that Merleau-​Ponty (1969/​1973, p. 33) can say
‘To imitate is not to act like others but to obtain the same result as others.’ Even
a young child understands that behavior is originally a lived orientation to the
world, an arrangement of means in view of an end. Merleau-​Ponty cites the child
of thirty-​two months, observed by Guillaume, ‘who has been asked to imitate
the movement of turning his eyes from one side to the other. The child begins by
turning his head. This fact effectively proves that the child is imitating the result
and not the means by which the model obtains these results’ (p. 35). Imitation is
itself grounded in empathy as a mode of presence to others –​which, in turn, is a
fully bodily phenomenon, and not some ‘attitude’ that one adopts or even feigns
in the presence of others (see Churchill [in press] for an elaboration of this phe-
nomenon of imitative empathy).
What, then, is this empathy by which I invest myself in other peoples’ gestures,
and they inhabit mine? If my body is indeed my point of view on the world, then
it will be in my body that the other’s body becomes known to me. And since
my own body is first lived and only subsequently known (through reflection), it
requires a phenomenological ‘reduction’ (or style of focusing) to turn our gaze
towards the ‘lived body’ itself as the means which delivers the world over to us.2
68

68 Scott D. Churchill

Just as emotion is lived as a consciousness of the world of emotion, and not as a

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

Apperception and Empathy: Husserl’s Phenomenology

of Intersubjectivity

Husserl made a distinction between Urpräsenz and Appräsenz (1952, pp. 162–​
72). Accordingly, only my own experiences are given to me in ‘originary pres-
ence’; the experiences of another person are not directly presented to me, but
are ‘appresented’. This means that the other’s ‘inner life’ (Innerlichkeit) is given to
me only partially and in conjunction with aspects that are fully present, namely,
bodily presentations. Even prior to the analogical apperception of the other’s
intentional life, there is at first the experiencing of the other’s body (Körper) as
 On the Empathic Mode of Intuition 69

an animated body (Leibkörper)4: ‘The apperception of bodies other than one’s

own as somatic, i.e., as organisms of other persons or animals, requires an appre-
sentative transfer by analogy from our own somatic experience to what is at first
given only as a corporeal thing’ (Gurwitsch, 1974, p. 95; also see Husserl, 1950/​
1960, pp. 110–​11). Thus the other is given to me directly in perception only as a
physical object. I must ‘transfer’ to this other corporeal being the nature which
I originally understood only my own corporeality to embody, namely, the nature
of an ‘organism’ (i.e., a center of intentions).
Husserl elaborated the concept of apperception with the concept of empathy
(das Einfühlen), which we might characterize here as a feeling-​oneself-​into the
intentionality of another. For Husserl (1928/​1997, p. 222), it is important to note
that this is undertaken while adopting the stance of ‘non-​participating onlook-
ers’; that is, we remain as ‘third-​person’ witnesses for Husserl, even, it would
seem, within his phenomenological reduction. It was through this empathy,
which for Husserl amounted to an imaginative transfer or projection or invest-
ment of oneself into the other’s world, that one could co-​perform the other’s
meaning-​bestowing acts and thereby grasp the meaning of those acts. Schutz
(1966) took this idea of accessing the other’s meaning-​contexts a step further
in the direction of ‘motivational contexts’. To fully appreciate the meaning of
human acts, one must grasp the actor’s motives and their context:

I may also in my imagination place myself in possible contexts of motives, in

possible situations, and decide how I would behave under the then prevailing
circumstances. The personal life shows a certain typicality . . . In terms of these
typicalities I comprehend the behavior of my fellow-​man and its motives. When
I co-​perform his acts in phantasy his motives become my quasi motives, and
thus comprehensible. (p. 33)

Schutz (1970, p. 173) characterized the understanding that emerges from

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

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

Empathy as the Spirit’s Way of Knowing

Geisteswissenschaft was the term Dilthey coined to translate into German John
Stuart Mill’s (1872/​1988) ‘moral science’ –​in contradistinction to ‘natural sci-
ence’ (Naturwissenschaft). Dilthey (1894/​1977a, p 27) famously observed, ‘Die
Natur erklären wir; das Seelenleben verstehen wir’ –​nature we can explain;
but the life of the soul is something we must grasp through understanding.
Geisteswissenschaft has been rendered back into English over the course of the
past century more typically as ‘human studies’. Oddly, when ‘Wissenschaft’ is
used in connection with nature, it becomes ‘natural science’; but when used in
connection with Geist (the Spirit), it becomes demoted to ‘human studies.’ It was
Amedeo Giorgi (1970) who reclaimed the term ‘science’ for the ‘human sciences’
in his landmark work Psychology as a Human Science: A Phenomenologically-​
Based Approach.
The idea of a hermeneutical interpretation of others’ expressions was articu-
lated by Dilthey (1927/​1977b) in his discussion of ‘the higher forms of under-
standing.’ Dilthey himself reserved the term ‘hermeneutics’ for the analysis of
written expressions (p. 135), and uses the more descriptive term ‘co-​experiencing’
(Nacherleben, a way of ‘moving towards’ the other in one’s own experiencing) to
 On the Empathic Mode of Intuition 71

refer to the general method of understanding other persons’ expressions. For

Dilthey, the lived reality of the individual was the ultimate referent of a descrip-
tive psychology6; therefore, more general (nomothetic) investigations of human
psychological life would be undertaken ultimately in service of the researcher’s
idiographic interest in the human person. In this way, idiographic investigation
holds in its ‘foresight’ the investigator’s guiding fore-​conceptions about human
life: ‘Its presupposition is knowledge of psychic life and of its relations to milieu
and circumstances’ (p. 129). The goal of this ‘higher understanding’ was to
articulate ‘the relation between another person’s manifold of expressions of life
and the inner context in which they are grounded’ (ibid.). This relation, which is
accessed through interpretation (die Deutung7), Dilthey called ‘the secret of the
person’ (p. 131).
Dilthey’s (1927/​1977b) method was founded upon a ‘transposition’ (sich ver-
setzen) or projection of oneself into the life-​context of the person one is attempt-
ing to understand. This method calls upon the utilization of all one’s powers
of comprehension, including what the researcher knows on the basis of his or
her own familiarity with the vicissitudes of psychological life. ‘If the point of
view from which the task of understanding is undertaken implies the presence
of one’s own experienced psychic nexus, then this is also denoted as the trans-
ferring of one’s own self into a given set of expressions of life’ (p. 132). By this
he means an imaginative recreation of the other’s experience by means of the
researcher’s own ‘projected’ or ‘transferred’ experience, fueled presumably by
sympathy and empathy (p. 133). Although circumstances may limit one’s own
possibilities for experience, one is also able, due to the co-​determination of one’s
possibilities ‘from within’, to experience many others’ existences in one’s imagin-
ation (p. 135).
With Dilthey (1924/​1977) we find a foundation for the understanding of oth-
ers that is elaborated in the works of many subsequent phenomenologists. This
foundation rests on the perceiver’s human giftedness for ‘co-​experiencing’ the
experience of others so that one can begin to grasp how a particular expression
or manifold of expressions signifies the world of the individual.

This apprehension originates from lived experience and remains connected with
it. The processes of the whole psyche operate together in this experience . . . In
the lived experience particular occurrence is supported by the totality of psychic
life and the nexus in which it itself stands, and the whole of psychic life belongs
to immediate experience. The latter already determines the nature of our under-
standing [Verstehen] of ourselves and of others. We explain by purely intellectual
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72 Scott D. Churchill

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

The question, then, is precisely how ‘all the powers of the psyche’ come to play in
the Geisteswissenschaften.
Indeed, the term Geisteswissenschaft can be better translated in other ways
than as ‘human science’ or ‘human studies.’ First (and more obviously, following
the use of the objective genitive), it can be grasped as the science that takes the
spiritual order as its object of study –​the science ‘of ’ the world of Geist (the realm
of humanity, culture, and spiritual phenomena in the broadest sense, which
could include the lives of other sentient beings). However, it might be more
fruitful if we were to consider the subjective (or possessive) genitive, by way of
which this term could be regarded as ‘the spirit’s way of knowing’.8 Furthermore,
the German word for science –​Wissenschaft –​Heidegger tells us is a compound
of two verbs: wissen and schaffen –​knowing and creating –​thus, creating knowl-
edge. The Greek ‘gnosis’ also means ‘knowing’ –​but gnosis is the past participle
of the verb ‘to see’, so it means ‘to have seen’; and thus Brentano’s (1874/​1973)
‘psychognosis’ meant ‘to have seen the psyche,’ and the psychiatric term psycho-​
dia-​gnosis means to have seen ‘through’ to the psyche (presumably, seeing through
the surface of behavior to its depth dimension, ‘character’). This notion of ‘see-
ing’ as an encountering of others in the world is of vital importance to the task of
psychiatry (see Churchill [1998]). Seeing through the surface appearance to the
depths of a person requires something other than the usual empirical method.
It requires empathy, by means of which we are able to resonate with meaning in
the lives of others.
Indeed, compassionate understanding became the basis for the great German
philosopher and psychiatrist Karl Jaspers’s (1913/​1963) idea for a Verstehende
Psychologie –​a field of psychiatric investigation, grounded in empathy as an
investigatory posture, by means of which we come to resonate with the oth-
er’s experience and come to know (or ‘to have seen through to’) something
about the other’s so-​called inner life. One of the greatest early figures9 in the
history of the application of phenomenology to psychology, Jaspers developed
an entire (and quite massive) portion of his General Psychopathology, the sec-
tion entitled Verstehende Psychologie –​in contrast to an equally significant por-
tion entitled Erklärende Psychologie –​as it was his opinion that we needed an
explanatory science to pick up where descriptive science left off.10 There really is
 On the Empathic Mode of Intuition 73

no good translation for what Jaspers (1913/​1963, p. 6) rendered as Verstehende

Psychologie –​he simply referred to it as the ‘empathic’ mode of access to the
object, namely, the expressions of psychological life, in contrast to the ‘empir-
ical’ method, which gave us access to the world of objects (see also pp. 301–​13).
In his magnum opus, Jaspers followed Dilthey (1894/​1927) in constructing a
field for psychiatric investigation that is grounded in two methods: the empir-
ical method, which gives us the patient as an object in the world among other
objects; and the empathic method, which delivers us over to the patient as a sub-
ject for whom the world exists. R. D. Laing (1959, p. 25) echoed Jaspers when he
contrasted the psychiatric modes of relating to the patient ‘as person or as thing’.
Much of Heidegger’s (1987/​2001b) seminars held in Zollikon, Switzerland,
were devoted to an attempt to teach physicians, psychiatrists, and other health
care workers something about this ‘spirit’s way of knowing’ –​this fundamen-
tally different mode of understanding. He wanted to teach them what it would
mean to truly approach their patients as persons. As a philosopher influenced
by Husserl, Heidegger wanted to articulate what would be the proper domain
of philosophy. In his early lecture courses, Heidegger (1923/​1999, 1985/​2001a)
would repeatedly point us in the direction of the affairs of everyday life, or what
he called ‘factical life’ (1922/​1989, pp. 246–​7).11
Indeed, the ‘human’ in ‘human science’ might refer more to the method of access
for this science –​being a uniquely human mode of understanding and encounter
with others –​rather than to the content of this science (i.e., the human realm as
such).12 The question for Heidegger was always the question of access: how could
we bring ourselves to the encounter with human factical life? In one of his pre-
vious lecture courses (1921–​22), Heidegger (1921–​22/​2001, p. 139) observed: ‘At
issue is not the acquisition of new concepts . . . within the old way of understand-
ing; on the contrary, [what is at issue is] to be attentive . . . to an originally different
mode of understanding’ (emphasis added). What, indeed, could be this ‘originally
different’ mode of understanding to which we should be attentive?

Heideggerian Modes of Attending to the Givenness

of Others

For Heidegger, one can never escape as researchers (or even as practitioners)
from the ‘hermeneutic circle.’ The questions one asks determine the answers one
receives, just as the subject matter (if we know how to listen) teaches us how to
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74 Scott D. Churchill

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

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

Here he is admonishing us not to reduce blushing to ‘something else’, for

example, the increased flow of blood in the face. Rather, we are asked to stay
with such phenomena ‘on their own terms’: what does a blush mean? And to
what extent does the blush ‘refer to other phenomena to which they essentially
belong’? Heidegger observes:

In each case the body always participates in the being-​here [Da-​sein], but
how? . . . Perhaps one comes closer to the phenomenon of the body by
 On the Empathic Mode of Intuition 75

distinguishing between the different limits of a corporeal thing [Körper] and

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

Heidegger’s (2002/​2009, p. 17) comments here echo his own Marburg lecture
course of 1924, where he reflected on the deeper meaning of Aristotle’s word
‘ousia’ that is typically translated as ‘substance’ –​for Heidegger, this word would
more properly be rendered as ‘the being in the how of its being’. From the very
start of Heidegger’s thinking, he was inspired by Aristotle to focus not on things
or entities or beings per se; but rather on the how of the ‘be-​ing’ of any entity.
Here, over forty years later in his seminars with Swiss physicians and psychia-
trists, Heidegger was still developing the same theme, except in sometimes more
esoteric language. In 1965 he was asking his audience of physicians, ‘what kind
of being belongs to my body?’ He responded:

[I]‌f the body as body is always my body, then this is my own way of being. Thus,
bodying forth is co-​determined by my being human in the sense of the ecstatic
sojourn amidst the beings in the clearing. The limit of bodying forth is the
Horizon of being within which I sojourn. Therefore, the limits of my bodying
forth changes constantly through the change in the reach of my sojourn. (p. 87)

My bodily experience thus bears direct reference to the ‘sojourn’ of my being

with others.
Here is where we get closer to the matter of dialogue. In the transcripts of his
Zollikon Seminars with physicians, Heidegger (2001b) stated:

Human speaking is saying. . . . According to its ancient etymological meaning,

to ‘say’ is to ‘show’, to let be seen.
Within philosophy we must not limit the word ‘gesture’ merely to ‘expression’.
Instead, we must characterize all comportment of the human being as being in
the world, determined by the bodying forth of the body. Each movement of my
body as a ‘gesture’ . . . is always already in a certain region which is open through
the thing to which I am in a relationship, for instance, when I take something
into my hand. (pp. 90–​1)
What does the word ‘gesture’ [Gebärde] mean? Last time we spoke about
blushing. We usually take blushing as an expression, that is, we immediately take
it as a sign of an internal state of mind. But what lies in the phenomena of blushing
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76 Scott D. Churchill

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

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

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

This interest that Heidegger shows in our bodily relationship with the world is
nowhere more apparent than in his conception of Befindlichkeit, first presented
in Being and Time but reiterated in his later Zollikon Seminars.
 On the Empathic Mode of Intuition 77

Befindlichkeit and Bodying-​Forth

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

In all his discussions of what it means to be human in his seventeen years of

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

Unfortunately, Heidegger did not follow up on this plan in his subsequent ses-
sions. It will remain, therefore, for us to pick up the path of his thinking in our
own retrievals of his thought.
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78 Scott D. Churchill

Heidegger’s Notion of Mitbefindlichkeit

Around the time that Husserl (1973b) was further developing his intersubjectiv-
ity papers (the mid-​1920s), Heidegger was busy at work on Sein und Zeit (1926–​
27).15 There he tells us that in the hearkening that comes from dwelling-​with the
Other, we are able to experience something of who the other person is, through
our mode of attunement to him. In both psychotherapy and psychological
research, as well as in everyday life, this hearkening itself requires a sensitivity
to one’s own attunement (in this case, an attunement to the Other) as well as a
sensitivity to the attunement of Others. When listening to a patient, or reading
qualitative data, this sensitivity requires a bracketing of our own ‘first-​person’
feelings in similar situations so that we can leave our capacity for ‘feeling’ avail-
able to ourselves as our mode of attunement to the mode of Being-​in revealed
in the data. Our own subjective processes thus become ‘instruments’ of our per-
ception of others. Hence, we can only truly understand the Other when we have
been able to feel or suffer with the Other. We are not reminded of our own suf-
fering; this can come later. But for now, we ‘suffer-​with’ as we bear witness to
the Other. We might even become attuned to a suffering that lies just below the
surface of the Other’s expression, somewhere just out of his reach. But we feel
it, we sense its presence, we know that it is there. It is not revealed in ‘what is
said in the talk’ (das Geredete) but rather in what we understand that the talk is
‘about’ (das Beredete). Such understanding requires what I want to develop here
as moments of ‘shared attunement’ that occur quite spontaneously, and which
can only be ‘cultivated’ –​but never ‘made to happen’ in the researcher’s experi-
ence: Being-​with-​one-​another understandingly. This is what we mean by ‘second-​
person’ consciousness: we do not revert to our own world (Eigenwelt); we remain
curious and attentive to the Others’ ‘own’-​world, which is now a ‘shared’ world.
It is worth considering Heidegger’s (1972, p. 162) rarely mentioned concept
of Mitbefindlichkeit as a mode of access to the Other’s experience. In order for
others’ narratives to resonate within my own experience, I must first experi-
ence myself in an attuned relationship to the Other’s experience. This is far from
being a merely ‘intellectual’ relationship to the data. Data analysis –​which we
sometimes call ‘phenomenological description,’ other times call ‘hermeneutic
reading’ –​is not a detached reflection on themes. Nor is it ever a conveying
of experiences ‘from the interior of one subject into the interior of another’
(Heidegger, 1927/​1962, p. 205). It is entering into the other’s being-​in-​the-​world
through a ‘transposing’ of oneself ‘into’ the experience of the other, in such a
 On the Empathic Mode of Intuition 79

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

Towards a Phenomenology of ‘Second-​Person’ Perspectivity

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

(1960/​1964d, p. 168). Merleau-​Ponty (1964/​1968, pp. 138, 180) further describes

this as the ‘reciprocal insertion and intertwining of others in us and of us in
them’. The other is given to me through ‘a sort of reflection’ (Merleau-​Ponty,
1945/​1962, p. 353; 1964/​1968, p. 256) which opens myself to the other and allows
me to ‘invest’ myself in his expression: the reciprocity between self and other is
constituted by the nature of human flesh as touching/​touched, visible/​invisible.
The other’s body provides me with a mirror through which to see the surface of
my own interiority. In one of his more elusive passages, Merleau-​Ponty (1961/​
1964a, p. 168) wrote: ‘The mirror’s ghost lies outside my body, and by the same
token my own body’s “invisibility” can invest the other bodies I see. Hence my
body can assume segments derived from the body of another, just as my sub-
stance passes into them; man is the mirror for man.’
There was no intent by either Scheler or Merleau-​Ponty to articulate this
‘sharing’ or ‘mirroring’ as a mode of ‘thinking about’ others; rather they were
speaking of a nascent perception of others at the level of affective experience. If
there were any thinking going on at all, it would be a ‘thinking from’ the other,
rather than a ‘thinking at’ them. The medium for Scheler’s Seinsteilnahme was
the lived-​body. In his own characterization of this phenomenon, Merleau-​Ponty
(1945/​1962, p. 354) wrote: ‘my body and the other person’s are one whole, two
sides of one and the same phenomenon, and the anonymous existence of which
my body is the ever-​renewed trance henceforth inhabits both bodies simul-
taneously.’ Where Scheler and Merleau-​Ponty depart from Husserl is in their
characterization of this pre-​personal perception not as a form of imagination
or apperception, but as a sense of ‘fellow-​feeling’ (Scheler, 1923/​1954, p. 8) or
‘intertwining’ (Merleau-​Ponty, 1964/​1968, p. 143).
Each grants us that we have only our own view of the other’s corporeal experi-
ence, for it would be impossible to represent to ourselves the way the other feels
his or her own body. In spite of this, the meaning of the other’s experience is
‘given for us in expressive phenomena –​again, not by inference, but directly,
as a sort of primary “‘perception’” (Scheler, 1923/​1954, p. 10). The other’s body
appears ‘as the bearer of a dialectic’ (Merleau-​Ponty, 1942/​1963, p. 204) which
is given to us perceptually, because our spontaneous way of seeing is already the
perception of form, or meaning (1948/​1964b, p. 49). The structure of behavior
as it presents itself to perceptual consciousness already reveals the signification
of behavior. Emotions, for instance, are ‘styles of conduct which are visible from
the outside’ (Merleau-​Ponty, 1948/​1964b p. 53): ‘It is in the blush that we per-
ceive shame, in the laughter joy. To say that “our only initial datum is the body”
is completely erroneous’ (Scheler, 1923/​1954, p. 10).
 On the Empathic Mode of Intuition 81

Fellow-​feeling thus gives us an immediate mode of access to the other’s experi-

ence through a coupling of our embodied selves into one intercorporeal schema.
Even prior to any explicit communicative interactions between myself and the
other, ‘there is initially a state of pre-​communication (Max Scheler) wherein the
other’s intentions somehow play across my body while my intentions play across
his’ (Merleau-​Ponty, 1960/​1964d, p. 119). Scheler described this pre-​personal
access to the other as an ‘inner perception’ through which ‘everyone can appre-
hend the experience of his fellow-​men just as directly (or indirectly) as he can
his own’ (1923/​1954, p. 256). As flesh we are by nature ‘connatural’ (Merleau-​
Ponty, 1945/​1962, p. 217) with each other and thus always already in touch with
each other:

As an embodied subject I am exposed to the other person, just as he is to me,

and I identify myself with the person speaking before me. (Merleau-​Ponty, 1969/​
1973, p. 18)
There is a universality of feeling –​and it is upon this that our identification
rests, the generalization of my body, the perception of the other. (p. 137)

When Merleau-​Ponty spoke of ‘a universality of feeling’, he may have been

articulating an ontological ‘condition of possibility’ for what Scheler simply
called ‘sympathy’. Reflecting on his experience of other people, Scheler (1923/​
1954, p. 245) remarked, ‘nothing is more certain than that we can think the
thoughts of others as well as our own, and can feel their feelings (in sympathy) as
we do our own’. This does not imply that we employ extra-​sensory perception in
our encounters with others, even if Merleau-​Ponty (1964/​1968, p. 244) did make
reference to a kind of ‘telepathy’. Rather, I seize upon the other person’s acts by
‘re-​enacting’ them. In his Phenomenology of Perception, Merleau-​Ponty (1945/​
1962, p. 353) stated: ‘I re-​enact the alien existence in a sort of reflection’ (p. 353).
By ‘reflection’ here, Merleau-​Ponty (1964/​1968) did not mean anything like an
act of intellectual contemplation; rather, the kind of reflection he was referring
to here would be developed by him later as ‘the reversibilities of the flesh’, as
revealed in the mirroring of gestures and intentions.
To summarize, then, the primary datum in our experience of the other is not
the mere appearance of the other’s body, but a stream of experience at first undif-
ferentiated into separate identities. Thus we have immediate perceptual access
to the ‘inner subjective state’ (Innerlichkeit) of the other. To the extent that this
‘fellow-​feeling’, or ‘intertwining’, of myself and the other is not originally based
upon past experiences or typified knowledge of persons, our intersubjective
understanding is not limited to apperception. With Scheler and Merleau-​Ponty,
82

82 Scott D. Churchill

we find a liberation of the other’s experience such that it can be given to us

in direct, spontaneous, pre-​personal perception –​not ‘behind’ but rather ‘in’
the other’s conduct in a situation. This would become relevant in attempting to
understand how one person’s perceptual experience provides access to another
person’s world. That is, to quote Merleau-​Ponty (1961/​1964c, p. 65), ‘Nothing
prevents me from explaining the meaning of the lived experience of another
person, insofar as I have access to it, by perception.’
The important thing here is that what we are talking about here is a percep-
tual moment, within my encounter with the other, in which I feel present to the
other’s being. We do not always feel present to other’s being when we are pass-
ing people on the street; it is, rather, in the up-​close moment of contact where
the other looks me in the eyes, and where we move beyond the momentary
glance, holding the gaze, and studying each other’s face for signs of expression.
In such moments, when the other looks back at me, I can feel a deeper sense of
their attunement –​something that Heidegger called ‘Mitbefindlichkeit’ and that
Scheler (1954, 1973) referred to as ‘sympathy’. This is a ‘shared attunement’, in
which I come to know something about the other, even if I cannot yet put it into
words. And yet, according to Heidegger, we can experience this shared attune-
ment when the other attempts to communicate his or her experience to us, even
without the use of words. An attunement-​with, along with an understanding
of our Being-​with, is ‘shared’ when our Being-​with-​one-​another is constituted
understandingly through encounter (Heidegger, 1927/​1972, p. 162). What is key
to this passage is that he tells us not only an understanding of our being together
gets communicated but also, equiprimordially, we ‘find ourselves’ (sich befinden)
‘tuning in’ to a shared mood or disposition.
The first-​person plural simply establishes a plurality of subjects; it is the
second-​ person experience that puts one in communicative exchange with
another ‘me’ –​with a ‘someone who will listen to me’. It is within this context of
our relational lives that we not only address the other, reaching out to another-
person, but also feel ourselves addressed by the other even if only by an appeal
of the eyes. In this address, we experience a tacit call to respond, to assist, to
share the moment, to offer help. And, it is when we find ourselves on the receiv-
ing side of this communication, when we are addressed or when our own ges-
ture is responded to, that I speak of the second-​person perspective. If I cannot
know your experience the way that you do, I nonetheless am able, insofar as I am
there with you, to experience from this empathic ‘second-​person’ perspective a
glimpse into your own existence.
 On the Empathic Mode of Intuition 83

Notes

Based on a presentation ‘Resonating with Meaning in the Lives of Others: Invitation

to Empathy’ to the ‘Phenomenology, Empathy, and Psychiatry’ Conference,
University of Malmö, 21 May 2015.
1. Indeed, the premise of the ‘Hannibal Lecter’ novels and films is that one can
empathize with evil itself: in Michael Mann’s (1986) Manhunter, a forensic detective
with a talent for ‘feeling his way into’ the evil intentions of unknown serial killers
needs a rest from the stress of resonating with such horrific intentionalities. In this
case, the individual’s ability to empathize can become a burden. It is also worth
noting the character of Hannibal Lecter himself is that of a mad psychiatrist: a one-
time healer, gifted with profoundly empathic sensitivities, which he no longer uses in
the service of healing others; but instead to amuse himself with the frailties of others.
2. Englander (2014, 2015) has developed Husserl’s (1962/​1977, 1928/​1997) notion of
a psychological phenomenological reduction in conjunction with his reading of Stein
(1917/​1989) and Zahavi (2007, 2010, 2011a & b, 2014), who have performed their
own detailed analyses of empathy. Englander’s concept of an empathic reduction
corresponds in part to Husserl’s (1910–​11/​2006) own intersubjective reduction (also
referred to as a ‘double reduction’). Where Husserl only points in the direction of
the process by which we ‘trade places’ and co-​perform the positings of the other’s
ego, Englander (2014, 2015) actually goes on to develop the notion of an ‘empathic
reduction’ in an original and compelling manner. Within my own aforementioned
framework of ‘second-​person perspectivity’ (Churchill 2001, 2006, 2007, 2010,
2012a, b), the empathic reduction would emerge as one among a number of possible
standpoints. The second person perspective is more like a ‘condition of possibility’
for the particular attitudes one can adopt in our spontaneous as well as more formal
efforts to understand the other. Because my own employment of the second-​person
perspective has been primarily empathic (rather than, e.g., defensive or aggressive),
I have been prone in my own writings to refer to the second-​person perspective
almost exclusively in its empathic modality, almost to the point of equivocating them.
But it would be more accurate to refer to the empathic attitude (or reduction) as a
possible modality within the second-​person –​as well as third-​person –​perspective.
3. Lipps’s (1902, 1903/​1935) discussion of die Einfühlung was an elaboration of the
concept as used by Rudolf Hermann Lotze and Wilhelm Wundt in the development
of a doctrine of aesthetics. The English translation ‘empathy’ was coined by Wundt’s
student E. G. Titchener. The original connection of the term with aesthetics owes to
J. G. von Heider’s use of the gerund das Einfühlen to express the artist’s imaginative
insight into individual styles of experience. The concept was also implicit in
Coleridge’s idea of ‘an imaginative union of the percipi and the percipere, the
‘perceived’ and the “perceiver” ’ (Engell, 1981, p. 157).
84

84 Scott D. Churchill

4. In the second volume of the Ideas, as well as in the Crisis, Husserl distinguished
the body as Körper from the body as Leib, corresponding to which there are two
attitudes, which are the noetic correlatives that serve as the conditions of possibility
for these two notions of the body: the naturalistic attitude, and the personalistic
attitude in which ‘our own activity and interest is not in explaining . . . the behavior
of others, but in responding to their movements and gestures’ (Heinamaa, 2003, p
26). Husserl’s thesis is that ‘originally’ we experience both our bodies and the bodies
of others –​including both animals and humans –​as expressive. He writes: ‘Each
movement of the Body is full of soul, the coming and going, the standing and sitting,
the walking and dancing, etc.’ (p. 252).
5. For Schutz, ‘the general thesis of the alter ego’ (1970, p. 166) –​also referred to
as ‘the reciprocity of perspectives’ (Schutz, 1973, p. 11) –​has two correlates: the
interchangeability of standpoints, and the congruence of relevance systems. This
constitutes part of what Husserl called ‘the natural attitude’ –​the belief that the world
actually is the way it appears to me. When in everyday life –​or even in professional
work, including ‘phenomenological research’ –​one begins to interpret the meaningful
expressions of another, one presumes both an interchangeability of standpoints and
a congruence of relevance systems. That is, our own exercise of imagination (ein-​
bilden) in filling-​in the other’s expressive gestures with meaning is itself based upon
this ‘natural presumption’ that we can experience the world in similar ways.
6. The influence of this aspect of Dilthey’s thought on Heidegger has not been
explored, though it seems remarkable that similar to Dilthey’s interest in the
person was Heidegger’s (1923/​1999) interest –​during approximately the same
time period of the early 1920s –​in developing his philosophy in the direction of a
‘phenomenological hermeneutics of facticity’ that would take the ‘jeweilige Wie’ of
individual experience as its ultimate focus. This direction he attributed at the time
to Aristotle; though, it was clear that Heidegger was reading Dilthey as well, as
evidenced by the latter’s inclusion in the introduction to Heidegger’s 1925 Lecture
Course on The History of the Concept of Time (1979/​1985).
7. Bettelheim (1983) explains that the term Deutung means ‘the attempt to grasp
at the meaning’ of something –​and not some heavy-​handed act of theoretical
interpretation, where one would impose meaning or order from the outside to
someone else’s inner experience. This is why Freud’s choice of title for his ‘dream
book’ was not Die Bedeutung der Träume, but rather Die Traumdeutung (which
I suggest might be playfully read as both ‘the attempt to grasp at the meaning of
dreams’ and ‘the dream’s attempt to grasp at meaning’).
8. The great Estonian biologist Jakob von Uexküll (1909, 1934) taught us something
about the ‘spirit’s way of knowing nature’ in his classic 1934 work A Stroll through
the Worlds of Animals and Men: A Picture Book of Invisible Worlds. He writes: ‘These
different worlds, which are as manifold as the animals themselves, present to all
nature lovers new lands of such wealth and beauty that a walk through them is well
worth while, even though they unfold not to the physical but only to the spiritual
 On the Empathic Mode of Intuition 85

eye. So, reader, join us as we ramble through these worlds of wonder.’ (1934, p. 6,
emphasis added). ‘To do so, we must first blow, in fancy, a soap bubble around
each creature to represent its own world, filled with the perceptions which it
alone knows. When we ourselves then step into one of these bubbles, the familiar
meadow is transformed . . . . A new world comes into being –​the Umwelt . . . This
we may call the phenomenal world or the self-​world of the animal.’ (p. 5). Such an
approach to the world of animals would eventually inspire a new generation of
phenomenological psychiatrists to build their own approaches to understanding
the ‘worlds’ of their patients upon von Uexküll’s Umwelt-​research (see May, Angel,
& Ellenberger, 1958). Heidegger (1983/​1995), Binswanger (in May et.al., 1958),
and Merleau-​Ponty (1995/​2003) would eventually credit von Uexküll with having
inspired their own reflections upon worlds and worldhood.
9. Brentano (1874/​1973) was actually first to distinguish the realms of the various
sciences on the basis of access rather than content: that is, he subordinated the
definition of the content or subject matter of one’s science according to the mode of
access that one would utilize to make this content evident. For Brentano, ‘external
perception’ gave us the realm of nature, accessible to us by means of the senses;
whereas ‘inner perception’ (not to be confused with ‘introspection’) gave us the
realm of the psychological, made available to us by means of a species of intuition
(an-​schauen) that is not reducible to the senses. It was Dilthey (1894/​1977a, 1927/​
1977b) who would clarify this ‘inner perception’ as ‘Verstehen’. With this term,
Dilthey (1894/​1977a, p. 55) invoked all of the human powers of understanding: not
just rational thinking, but also feeling, intuiting, imagining, sensing, remembering.
Levinas, following Husserl (1913/​1982, 1952/​1989), would later describe how
this encounter or ‘intuition’ (die Anschauung) constituted a primordial means for
discovering others from within our own personal framework of experience: ‘A
phenomenological intuition of the life of others, a reflection by Einfühlung opens
the field of transcendental intersubjectivity’ (Levinas, 1973, p. 150).
10. Jan van den Berg (1972, p. 124) would later comment wryly that ‘hypotheses
emerge where the description of reality has been discontinued too soon’.
11. Later, in Being and Time, Heidegger’s preferred terms became ‘existence’ and ‘Being-​
in-​the-​world’. With regard to the ‘matters’ (Sachen) on which we should focus,
Heidegger (1927/​1962, p. 33) wrote: ‘The question of existence [Existenz] is one of
Dasein’s ontical “affairs” [Sachen]’ –​and in so referring to these ‘affairs’ it can be
argued that he was making implicit reference to Husserl’s (1901/​1968, p. 6) famous
invocation: ‘wir wollen auf die “Sachen selbst” zurückgehen’. The methodological
question, however, would be that of finding the most appropriate mode of access to
these affairs of everyday life –​and on the question of access, Heidegger would differ
significantly from the approach taken by his mentor Husserl.
12. One might argue, for example, that Jane Goodall’s (1990, p. 8) published
observations of chimpanzees in their natural habitat represent a truly human
86

86 Scott D. Churchill

science approach to animal psychology insofar as she champions empathy and

intuition as her methods of access to her subject matter.
13. Here and throughout this section I will quote at length from Heidegger to give the
reader unfamiliar with his Zollikon Seminars a taste of how he addressed himself to
the phenomenology of the body in relation to Miteinandersein.
14. It should be noted that Heidegger’s criticism here is directed more towards
Husserl’s notions of ‘subjectivity’ and ‘inter-​subjectivity’ and less in regards to the
concept of empathy taken at face value. Heidegger (1927/​1972, p. 162) only objects
to Husserl’s employment of empathy to bridge an alleged gap between otherwise
fundamentally isolated Egos.
15. There, in a dense section in which he formally presents Dasein’s modes of
disclosedness, Heidegger developed a threefold structure in which Befindlichkeit,
Verstehen, and Rede (logos) are identified as the ontological sources of the
understanding of self and others. Understanding is revealed to us first through what
he calls our modes of attunement (Gestimmungen), which are made possible by the
fact that we are fundamentally in the world in such a way that we always first and
foremost ‘find ourselves’ situated (Befindlichkeit) and that it is in and through this
‘finding oneself ’ affectively attuned, that we are able to begin to understand ourselves
and eventually to give expression (Rede) to this self-​understanding. In his all-​
important section on ‘Dasein and Discourse: Language’ [sec. 34], Heidegger (1927/​
1962) made some remarkable pronouncements regarding the very nature of listening,
of hearing, of ‘being-​open’ to oneself and to others, and eventually, of ‘hearkening’:

Listening to . . . is Dasein’s existential way of Being-​open as Being-​with for

Others. Indeed, hearing constitutes the primary and authentic way in which
Dasein is open for its ownmost potentiality-​for-​Being –​as in hearing the
voice of the friend whom every Dasein carries with it. Dasein hears, because it
understands. . . . Being-​with develops in listening to one another [Aufeinander-​
hören], which can be done in several possible ways: following, going along with,
and the privative modes of not-​hearing, resisting, defying, and turning away. It
is on the basis of this potentiality for hearing, which is existentially primary, that
anything like hearkening [Horchen] becomes possible. (pp. 206–​207)
. . . when we are explicitly hearing the discourse of another, we proximally
understand what is said, or –​to put it more exactly –​we are already with him, in
advance, alongside the entity which the discourse is about.
. . . The person who ‘cannot hear’ and ‘must feel’ may perhaps be the one who
is able to hearken very well, and precisely because of this. (p. 207)

So in other words, hearkening can be a deeper kind of listening, in which we listen

in silence. This requires being in the presence of another, whether in actual fact, or
in some virtual reality, such as in watching a film. In the extreme close-​up, Truffaut
showed us that we achieve the most intimate portrait of the Other, precisely
 On the Empathic Mode of Intuition 87

because it is in the face that we find revealed the true ‘subjectivity’ of the Other.
(See footnote 18 below.)
16. The actual passage from Being and Time reads as follows:

In this more general kind of communication [Mitteilung], the Articulation of

Being with one another understandingly is constituted. Through it a co-​state-​of-​
mind [Mitbefindlichkeit] gets ‘shared’, and so does the understanding of Being-​
with. Communication is never anything like a conveying of experiences . . . from
the interior of one subject into the interior of another. . . . In talking, Dasein
expresses itself not because it has, in the first instance, been encapsulated as
something ‘internal’ over against something outside, but because as Being-​in-​the-​
world it is already ‘outside’ when it understands. (Heidegger, 1927/​1962, p. 205)

17. As we watch a film, we begin to feel the characters’ intentionality. For example,
when we observe Scarlett Johansson’s subtle facial expressions in Sofia Coppola’s
(2003) film Lost in Translation, we are able to feel her loneliness, her feelings of
abandonment in the world, her longing for a connection, her delight in the face
of Bill Murray’s playfulness. In her notes to the press, the director suggested that
the film is about ‘one moment’: we can interpret this to mean this moment in their
lives when they were alone together in Tokyo –​or we can interpret it to mean
the final moment that the entire film leads up to. This film is truly an example of
expressionist cinema, to the extent that its theme is not an ‘idea’, nor the plot, nor
the character –​it is about a feeling, a mood. And this mood is revealed to us in a
profound moment of Mitbefindlichkeit which either works or does not work for the
particular viewer. It is not a failing of the film if everyone is not moved by it. But if
the film works at all on the viewer, it works in this expressionist mode of evoking
a mood, and evoking it so strongly, that one longs in the final moments of the film
for a catharsis, and regardless of whether one is man or woman, one finds it in
the look on Scarlett’s face when Bill Murray finally hugs her. We never know what
he says to her; but then, we don’t have to know, because her face says it all. This is
what I mean when I invoke Heidegger’s notion of Mitbefindlichkeit. It is a shared
moment in which we live the moment with the other person. And in this moment
we are touched and transformed.

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 5

Research Methods for Person-​Centred Health

Science

Fordham Studies of Suffering and Transcendence

Frederick J. Wertz, Miraj U. Desai, Emily Maynard, Justin R. Misurell,
Mary Beth Morrissey, Batya Rotter, and Nicoletta C. Skoufalos

Introduction

Phenomenology has had a limited presence in doctorate-​granting departments

of psychology despite compelling works on its potential contributions. The lack
of inclusion is disturbing given over a century of psychological and psychi-
atric research by phenomenological philosophers, psychiatrists, and psycholo-
gists (Wertz, 2006). There has been an increasing emphasis on biological and
‘evidence-​based practice’ research, which privileges randomized, control tri-
als (RCTs) for specialized treatments of mental disorders. Such research aims
to compete with the successes of medicine based on a turn-​of-​the-​twentieth-​
century model of science, with some of its advocates likening much contem-
porary clinical practice to blood-​letting patients with leeches before science
regulated medicine. Contemporary medicine, however, is increasingly turning
from this simple disease model to a ‘person-​centred’ model, not only in psych-
iatry but in general medicine and health care (Mezzich et al., 2010; 2015). This
largely practice-​based movement, which has been endorsed internationally by
dozens of health groups including the World Health Organization, centres hol-
istically on the ‘person who has the disease’. This general approach is applicable
beyond medicine to virtually all human affairs and includes a strong emphasis
on human subjectivity, on the meanings and values in the person’s bodily, psy-
chological, social, and spiritual life. Although this holistic and person-​centred
96

96 Frederick J. Wertz et al.

approach offers much of practical value, it remains in need of a fitting philoso-

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

Research Methods for Phenomenological Psychology

Phenomenology in clinical psychology

‘Back to the things themselves!’ Husserl developed the scientific method called
phenomenology in order to investigate what has variously been called con-
sciousness, lived experience, and existence. With profound admiration for the
great successes of the physical sciences and technologies, Husserl argued that
these methods, which lacked self-​understanding and philosophical grounding,
could not provide a universal scientific foundation for understanding human
life in its fullness. Indeed, reductive, physicalistic science had been unable to
address the deepest problems of human life and death in order to responsibly
shape our collective destiny, which requires additional methods and concep-
tualizations capable of offering knowledge of subjectivity. Husserl (1913, 1925,
1954) developed methods to study consciousness for use in philosophy and the
human sciences. Without a proper scientific approach to the study of subjectiv-
ity, research and theorizing in psychology and related health disciplines remain
riddled with fundamental problems such as a lack of ecological validity, frag-
mentation, and a remote, insufficiently grounded approach to important subject
 Research Methods for Person-Centered Health Science 97

matter –​experience, meaning, values, and action (Giorgi, 1970a). Although

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

Lacking knowledge of ‘what mental disorders are’

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

of forms taken, including ‘symptoms’. However, such informally documented

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

Husserl’s phenomenological method and notion of ‘intentionality’

Husserl’s method for studying mental life involves two intertwined kinds of ana-
lysis, intentional and eidetic. Intentional analysis brings the researcher into con-
tact with the mental life, particularly its meaning function, and eidetic analysis
enables the researcher to grasp what it is –​its essential structure. The researcher
prepares to conduct intentional analysis by adopting a certain necessary atti-
tude that, for purposes of simplicity, we characterize as two ‘epochēs’ that lead to
the ‘phenomenological reduction’. Epochē means abstention, or bracketing, and
the first such operation is to put aside existing theories and knowledge of the
mental life under investigation. This allows the researcher to turn to experience
as it is concretely lived and presents itself in the lifeworld, as opposed to rep-
resentations in relatively abstract words, categories, hypotheses, and research.
The second epochē abstains from the naïve positing of existence that takes place
in experience and instead attends to the way situations present themselves to
experience, their correlative subjective relativity –​the meanings, values, and
utility of situations as given immediately in experience. Each of these epochēs
involves a vocational attention to certain data and inattention to others. The first
epochē shifts the investigator’s attention from extant scientific knowledge to the
lifeworld –​the lived world. The second epochē, by abstaining from concerns
about the independent existence of objects (as well as irrelevant assumptions
on the part of the researcher), reduces the field to the way the world is experi-
enced. This phenomenological reduction allows the researcher to conduct what
is called ‘intentional analysis’, an investigation of the experience-​world correl-
ation, in order to bring to light the subjective processes and meanings of situ-
ations as they present themselves to consciousness.
 Research Methods for Person-Centered Health Science 99

The second major methodical procedure, which is employed in tandem with

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

Giorgi’s contribution: A research method for

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

typically have little to no scientific knowledge of the subject matter, and when
they do, data about the origin and development of their knowledge is gathered.
Descriptions are not structured according to hypotheses, previous research, or
any scientific knowledge (but structured by research participants), thereby oper-
ationalizing the epochē of scientific knowledge and enabling the investigator to
focus on the way the concrete lifeworld is presented through their experiences.
These descriptions provide data expressing empirical examples of the subject
matter, including the contextually situated meanings, goals, values, social rela-
tions, and practices that the participants lived through over time.
Giorgi (2009) has suggested four steps in analysing this data.
¬¬ First, the researcher reads each description openly, gathering a sense of the
whole without posing specific research questions or focusing on the study’s
subject matter.
¬¬ Second, within the phenomenological attitude, the researcher differentiates
meaning units, demarcating shifts in the meaning of the situation as
expressed in the description, in order to identify parsimonious segments for
subsequent analysis.
¬¬ Third, the researcher reflects psychologically on each meaning unit in an
effort to explicate mental life revealed in the description with reference to
the specific research topic, questions, and goals.
¬¬ Fourth, the researcher synthesizes reflections in a description of the general
psychological general structure(s) of the subject matter, thoroughly utilizing
all insights and available data in a coherent description of the research topic
with respect to all research questions.

Between the third and fourth steps, some researchers synthesize reflections
on individual instances of the phenomenon in order to describe idiographic
psychological structures that provide knowledge of particular instances of the
subject matter and to inform the final formulation of more general structures
(Wertz, 1983, 2005; Wertz et al., 2011). It is important to note that Giorgi’s pro-
cedures can be employed beyond psychology, for research in such disciplines as
sociology and political science as well as in such interdisciplinary professions
as nursing and social work, with appropriate modifications of attitude, focus,
and research questions (Giorgi, 2009). Here, these procedures of open read-
ing, differentiating shifts in meaning, explicating the experience-​meaningful
world relations, and describing structures at varying levels of generality (includ-
ing idiographic, typical, and highly general) were all performed in the psycho-
logical phenomenological attitude, wherein the researcher suspended interest in
 Research Methods for Person-Centered Health Science 101

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

Studies of Suffering and Transcendence Using

Phenomenological Psychological Methods

The following six research projects employed phenomenological methods to

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

Bulimia: Fragmented knowledge and the problem of

subclinical symptoms
In a study on the development of bulimia nervosa (BN), Skoufalos (2010)
presented a holistic description of BN by using a comparative phenomeno-
logical psychological analysis of interviews and focus group discussions with
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102 Frederick J. Wertz et al.

individuals with clinically diagnosable BN, subclinical BN (SCBN), and without

BN (NBN). Previous research on BN had brought to light numerous risk factors
and had supported many informative etiological theories. However, knowledge
of such associated factors as sociotropy, dissociation, and anger as well as such
determinants as family, psychodynamic, behavioral, and cognitive processes
were unintegrated. Some researchers (e.g., Gleaves et al., 2000) also debated
whether or not SCBN, which involves clinically significant binging and purging
at frequencies too low to meet diagnostic criteria, is similar to BN and may lead
to BN even though it is not currently a diagnostic category. By tracing the life
historical development of BN and comparing it with those of SCBN and NBN,
Skoufalos provided integrative knowledge of associated and etiological factors
and of the similarities and differences between people classified as having clin-
ical and subclinical BN.
Using validated questionnaires, 322 undergraduates were screened for symp-
toms of BN and SCBN. Participants filled out an extensive battery of question-
naires used to measure the various factors found by previous research, such
as anger, sociotropy, and dissociation. Classification of participants into three
groups (BN, SCBN, and NBN) was confirmed using the diagnostic gold stand-
ard SCID-​I/​NP (First et al., 2002). In individual interviews and focus groups,
four participants classified as having BN and ten participants classified as hav-
ing SCBN were asked to describe the origin (i.e., first episode) and develop-
ment of their binging and purging in the overall context of their life history. Six
participants in the NBN group were asked to describe their eating practices,
also placing these in their overall life-​history. Participants elaborated on some
of questionnaire item responses in order to better tie standard research meas-
urements to their life historical contexts. For example, a participant may have
been asked, ‘You indicated on one of the questionnaires that you ‘always feel
rejected in social situations’. Can you describe a specific situation when you felt
that way?’ The researcher gathered examples from childhood, adolescence, and
college years. Participants in all three groups engaged in a focus group where
they shared life experiences relevant to the research. The interactive spontaneity
of the focus group discussions evoked new data for analysis.
The phenomenological psychological analysis, using Giorgi’s (1985) steps
supplemented by a saturation assessment procedure, yielded two dramatically
different structures for the BN and SCBN groups that applied to all individuals
validly diagnosed without exception. The life-​historical development of BN was
found to be deeply rooted in an experience of loneliness and isolation, in a des-
perate and failing search for refuge in love and bodily comfort. In sharp contrast
 Research Methods for Person-Centered Health Science 103

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

Being diagnosed with bipolar disorder: Acceptance

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

focused on participants’ life historical experiences, beginning before the diagno-

sis and ending with the present acceptance or rejection of the diagnosis. Great
care and effort was devoted to gathering descriptions of experiences before the
diagnosis that were unfettered by concepts and words that had been subse-
quently incorporated, such as ‘a manic episode’, ‘symptoms of depression’, ‘my
illness’, and so on. Participants were able to construct narratives that described
the original experiences, providing a basis for Maynard to analyse meticulously
the process of meaning making that occurred prior to and in the course of being
diagnosed, with all its complex life consequences.
The process begins with experiences Maynard called ‘rising’ and ‘falling’, in
which persons are fulfilling successfully and failing miserably to achieve per-
sonal goals relevant to their becoming adults. The phrase ‘bipolar disorder’
originally signified something alien that belonged to others who were ‘crazy’,
unlike themselves. Participants received their diagnoses in the course of try-
ing to overcome significant developmental challenges, which is how they had
previously understood the experiences that they were now told were ‘bipolar
symptoms’. Although extreme experiences of ‘falling’ and serious interper-
sonal ruptures with important others in the course of ‘rising’ were sometimes,
with guidance by a sympathetic other, reconstrued as a ‘mental disorder’, many
‘rising’ experiences had the meaning of important personal triumphs, leaving
participants profoundly threatened by their reinterpretations as a ‘mental ill-
ness’, with its meaning of being alien to themselves and targeted for elimination
by treatment. Engaging in a complex process of reflection, participants either
opposed or admitted their diagnosis as a possibility, in each case motivated by
a desire to obtain greater agency over the particular situational challenges that
afforded successful forward movement into adulthood. Maynard explicated a
single temporal structure of the transitions from opposition to admittance and
from admittance to acceptance of the diagnosis as contextually situated within
participants’ life historical development. This temporal psychological structure
includes a description of the sense of self and the person’s social/​relational posi-
tioning. Both the rejection and appropriation of the diagnosis had the meaning
of recovering one’s agency in the face of the objectifying and alienating diagnos-
tic process, which included a power inequality with the diagnostician that was
antithetical to the empowerment participants were seeking as emerging adults.
Those who eventually accepted this objectification, not of their ‘selves’ but of
specific moments of suffering through ups/​downs, came to construe past expe-
riences as ‘not me’ or as ‘something I need to overcome’ in order to achieve
their life goals. This structure highlights paradoxical aspects of the experience of
 Research Methods for Person-Centered Health Science 105

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

Autism in India: The introduction of ‘Western’ approaches in a

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

follow-​up interviews provided more in-​depth exploration of parents’ experi-

ences and more comprehensive narratives. The analysis, following Giorgi’s
(1985, 2009) method, discerned the general temporal structure of parenting a
child with ASD from before birth expectations through the present time (Desai
et al., 2012).
One of the most important findings concerned the context of parents’ local
community in the meaning of their child’s life at various developmental junc-
tures. Parents came to struggle with the open question of whether their child
would be accepted, welcomed, and have a valued place in progressively expand-
ing social settings, usually beginning with school and culminating in the adult
world of work and community. These concerns developed over four temporal
phases (substructures): Phase 1: Perceiving their child as having an open future,
and welcoming their child with a nurturing relationship; Phase 2: Perceiving
their child’s unexpected social disruptions as temporary within familiar settings,
and seeking advice when the situation is unmanageable; Phase 3: Unfavorably
comparing their child’s performances to those of other children in pivotal com-
munity settings and seeking help for their child to meet pedagogical goals; Phase
4: Accepting their child’s pervasively limited world-​relations in the present and
future while pursuing alternate adult activities and making the world more wel-
coming for children like their own. When parents saw that their child’s stand-
ing and future success were threatened in social settings, their attitude featured
paradoxes of acceptance and change, with regard to first their child and then the
social world. That is, typically in Phase 3, parents accepted their child’s limita-
tions and then attempted to change them to fit the evident social norms, whereas
in Phase 4, they accepted and attempted to change restrictive social norms in
order to fit with their child’s uniqueness and specialness. These parental con-
cerns about the interdependence of their child’s thriving and potential changes
in the social world influenced how parents experienced, appropriated, and/​or
rejected the concept of ‘autism’, as well as any other diagnoses or interventions
regardless of cultural origin. The notion of ‘autism’ had a range of meanings: As
a guide to possible ways their child would progress towards social aims, as an
organizing concept for collective social action, and as a means of reduction of
parental self-​blame for their child’s situation. Some parents barely considered
‘autism’ but focused on vocational goals for their child. In each variation, the
world and the child’s future remained the primary background of meaning.
Overall, the findings suggest the necessity of scholars, practitioners, and
policymakers to consider the central meaning of the community for parents,
throughout their child’s development and in the future, in affording acceptance,
 Research Methods for Person-Centered Health Science 107

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

Resilience among combat soldiers: Problems generalizing about

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

on the pre-​conscript before combat were developmentally different from those

placed on the veteran after combat; a focus on the spatial dimensions illumi-
nated how soldiers and veterans moved between different spatial spheres (e.g.,
home life vs. military base vs. combat zone) and developed different modes-​
of-​being to adapt and survive within their spatial context; and a focus on the
social dimensions highlighted how different relational factors facilitated the
soldier’s successful adaptation to a military and civilian contexts, respectively.
These various constituents of the soldier cum veteran’s experiences were then
described and organized in a psychological structure of military resilience, one
where characteristics, processes, and outcomes of resilience were presented as
being meaningful lived.
Rotter defined ‘resilience’ as a process of shifting, learning, and changing in
order to align one’s position (or ‘modes-​of-​being’) with life-​context, and an out-
come where one could experience congruence and at-​homeness in each life-​
context. Here, the overarching ability to transition between modes-​of-​being, as
well as to recognize when such shifts were valuable, was an essential character-
istic of success in both military and civilian life. For example, a soldier found a
home and considered himself a ‘good soldier’ in combat when he was able to
shift into, and embody Soldier Mode –​where he aligned with the goals and pro-
tocols of military life, a complete subordination to commanding others, a sense
of belonging and solidarity with comrades, and a physical and mental readi-
ness to seamlessly engage in his combat activities. The veteran found a home
in civilian life when he was able to diminish the wounds of his combat past and
align himself with the goals of civilian life, such as starting a family, finding
a career path, and ‘moving forward’, which he did initially through a process
of ‘unscripting’ from the military structures of his past to build a new civilian
identity. In addition, Rotter identified different pathways of resilience in civilian
life, where veterans either walled off their past, or integrated past suffering into
a new understanding of selfhood and life mission. She noted that resilient vet-
erans could still feel emotional pain from their military past, as well as question
morally ambiguous situations they were placed in throughout service, as long
as they were additionally able to find meaning and support in civilian life that
allowed them to achieve a sense of wholeness, pride, and achievement in their
call to service.
By mapping the temporal substructures through which Israeli soldiers and
veterans move through conscription, combat service, and homecoming, Rotter’s
study highlights that military resilience is not just the absence of pathology but
a complex constellation of characteristics, processes, and outcomes that the
 Research Methods for Person-Centered Health Science 109

soldier and veteran engage in throughout their military service. Moreover, by

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

‘Psychosis’: Recovery among African Americans in urban

community context
Misurell’s (2007) predoctoral research, with findings developed for presentation
by Olbert et al. (2013), focused on recovery from serious mental illness among
African Americans living in urban communities. The literature on ‘schizophre-
nia’ suggests that symptom remission is only a partial treatment goal. Although
ethnic and cultural factors have been recognized as important in treatment,
little research focused on ethnic minorities and on African Americans, who are
disproportionately diagnosed with schizophrenia in comparison to Caucasians.
This underserved minority population also faces the dual pressure of racial
and mental health stigma in their recovery. Misurell’s study investigated the
intersectionality of ethnicity, poverty, and severe mental illness in the recovery
process.
Misurell’s research was embedded in a larger clinical trial, the Culturally
Responsive Person-​Centered Care for Psychosis project (Tondora et al., 2010).
This randomized outcome study, which assessed the additive impact of peer-​
assisted person-​centred care planning, allowed Misurell’s phenomenological
investigation of experiences of ten participants (five male, five female) with
DSM-​IV-​TR diagnoses of schizophrenia (paranoid type; n = 5), schizoaffective
disorder (n = 3), or major depressive disorder with psychotic features (n = 2).
These participants, ages ranging from 23 to 57 (M = 42.4, SD = 10.7), were
receiving peer support services and had been living outside the hospital for at
least six months. In in-​depth interviews, Misurell asked participants to ‘walk
10

110 Frederick J. Wertz et al.

him through’ the series of events that led to their first hospitalization and diag-
nosis and then to describe their experiences in recovery, including those con-
cerning their mental health services. Misurell’s analysis of the recovery process
included individual psychological structures for each of the ten participants as
well as one general structure that reflected a series of five temporal stages that all
participants lived through.
Although utterly unique in its details, the individual structure found in the
life of Marvin, a forty-​eight-​year-​old African American male diagnosed with
‘schizophrenia, paranoid type,’ revealed more general meanings and provided
an introduction to the explicitly general knowledge that followed (Olbert et al.,
2013). The description begins with (i) Marvin’s secure, protected world in which
he was raised by his loving but dominating grandmother, followed by ten years of
highly structured life in the military and police academy. In a series of life events
including the death of his grandmother, the loss of his job, and a life-​threatening
cardiac condition followed by a series of surgeries, Marvin’s life unraveled.
His hospital experiences included preferential treatment of white patients and
bloody, mutilating surgeries by uncaring doctors. Out of the hospital, feeling
badly injured and unable to work, Marvin began to have terrifying visions of
blood flowing down walls and evil people sitting on his shoulder, commanding
him to kill other people. Within this first stage of the individual structure, ‘bro-
ken and bloody’, Marvin wandered homelessly and consistently feeling threat-
ened with annihilation. In rage and despair, Marvin attempted to kill himself
to finally achieve peace. Common meanings of detrimentality pervaded racial
discrimination, coronary and psychiatric health services, anomalous visions and
his suicide attempt. Recovery (ii) began in a dramatically different encounter
with a ‘white lady’ (hospital receptionist) who ushered Marvin into a new world
that revived the safety and security of his childhood but allowed him to develop
autonomous, collaborative agency.
When I first got here, I met this sweet, nice, lady downstairs. She told me –​I’ll
never forget it, she said, ‘We gotta work together on this. You work with me
and I’m gonna work with you.’ She said it like a momma. I said ‘Yes maam.’
She said, ‘First off, we’re gonna get you some medicine, medicine’s that’s gonna
work for you, not against you.’ I came back here the next day and I told that
lady the medicine sure helped. I ain’t dream about nothing last night. I ain’t
seen nothing on the wall. I ain’t thinking about killing myself or nothing.
I don’t look back. I don’t think about when I was seeing the blood on the walls
or people on my shoulder talking to me about killing people. I can go home
 Research Methods for Person-Centered Health Science 111

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

This second substructure of ‘homecoming’ included nurturing, accepting others

who valued Marvin, treated him as a person of value without racial discrimina-
tion, and collaborated with him reciprocally. Within this kind of relationship,
Marvin received help, began to ‘breathe easier’, heal, and develop his efficacious
agency, achieving a new, comfortable body-​world integration in which he began
to emerge as an independent adult who was in charge of his health and life.

I listen to the doctor, and I’m taking my medication because it is helping me,
but when it comes down to it, I’m gonna be the one who tells them what to do
when it comes to my health. I ain’t trying to be mean and ugly about it, but when
it comes down to me, I’m gonna have it the way I want to because, I look at it
this way–​they ain’t gonna die for me. I can make a whole lot of decisions about
my life. Living my life the way I wanna live it, at least, the little part that I got to
live of it.

With new comfort, social solidarity, and self-​determination, Marvin re-​

entered the community, still in a protective home-​like program but now (iii)
attempting to master dynamic challenges such as continuing health problems,
lonely isolation, financial impoverishment, and unemployment as he extended
his agency towards health, solidarity, work, and enjoyment of life.

It’s the people here that make the difference. Race and color doesn’t make a dif-
ference to them. The people treat you the way that you wanna be treated. They
don’t have no grudge against you if you’re black, white, Puerto Rican, whatever
color you is. That’s a lie if they say these people care about that. The way I feel
about them, they brighten up my day everyday. They’ve been real nice to me.
They’re some nice people.

This third phase was called ‘centrifugal movement from the safe, nurturing
home toward increasing independence’. As Marvin actively engaged in recovery
in his community program, he found ‘new models for love and care’ (iv), includ-
ing leaders who had emerged from suffering like his own as well as brothers and
sisters who were similarly struggling. Of crucial importance was his peer sup-
port worker, Jim, who was himself in the process of recovery and was the first
faithful father-​like carer in Marvin’s life.

I talk to Jim and he helps my days a lot. He’s like a mentor. I had a job (interview)
a month ago and I went to Jim and I said, ‘Yo, Mr. Jim, I need to talk to you.’ He
12

112 Frederick J. Wertz et al.

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

Marvin’s religious experience was essential: ‘My religion plays a large part in it
because I have faith in God. If you ain’t got faith in God, you ain’t got nothing.
I believe God is healing me right now.’ In his final phase of recovery (v), Marvin
moved from being cared-​for to caring-​for others: He extended his love in pater-
nal fidelity to his own family and then to his community. He became a mentor
to his nephew and anticipated helping others through the recovery program.
His aim in life was equality, dignity, and a bright future in the face of the world’s
turmoil for coming generations of his fellow African Americans. Regarding the
research, Marvin said, ‘I enjoyed this interview. You’re about the third person
I been open with about my life.’
The general psychological structure of recovery from serious mental ill-
ness showed five stages. Stage I: Precarious community: Social detrimentality,
indifference, and mistrust. Stage II: Homecoming: Re-​experiencing familial
care as a ground of personal agency. Stage III: Enlarging community: Forging
social connections in the face of challenges beyond the secure home. Stage
IV: Appropriating generative models of love and care. Stage V: Extending one’s
emerging love and leadership to others: Contributing to world peace.
The psychological structure of recovery is fundamentally a teleological pro-
cess that requires collaborative others through a series of temporal stages that
depends on economic and social support, including the acquisition and mainte-
nance of material resources; negotiating health and treatment choices; building
or rebuilding fulfilling family life and social communities; and working with
others to achieve satisfying and esteemed social positions. Environmental and
societal situations take on meanings of constricting or supporting the person’s
emergence from suffering though efficacious agency that eventually makes the
world a better place –​giving back. Barriers to successful action such as rac-
ism, medical paternalism, and lack of work opportunities in the urban environ-
ment may preclude or complicate recovery despite strong and resolute striving
towards these goals. Shattered urban communities –​crucibles of the pain, rage,
and terror of racism and severe mental illness in a unitary structure call for
social justice as integral to the person’s recovering, maintaining health, and con-
tributing to the betterment of the world.
 Research Methods for Person-Centered Health Science 113

Suffering and decision-​making in serious illness and at the end of

life: Resilience and recovery of agency through care transitions
The experience of suffering among older adults is a neglected area of scientific
inquiry. In Morrissey’s (2011) study, frail, nursing home residents described
their situations, including the traumatic losses of home and familiar surround-
ings upon their transitions to facility care. The central research interest was the
study of suffering in serious illness and related decision-​making. Data collection
for the study was conducted in an urban nursing home setting over a period of
six months. Purposive sampling was used to select eight study participants who
met the following eligibility criteria: Women; seventy-​five years of age or older;
with at least one family caregiver; eligible for Medicare and Medicaid; resid-
ing in the nursing home; and clinical assessment of frailty. Exclusion criteria
were: Cognitive incapacity or a legal determination of incompetence by a court.
Of the eight participants, two males served as comparison cases. The study fea-
tured in-​depth descriptions of the lifeworlds of elderly women that revealed the
unexamined complex social structure of suffering and decision-​making in its
temporal and developmental moments. Phenomenological analysis conducted
at both the individual and general levels yielded individual structures and one
general structure of suffering and decision-​making.
The study findings identified the maternal, described as the ‘Maternal Ground’
(Morrissey, 2011, 2015), in a first temporal moment of meaning prior to suffer-
ing experiences. This Maternal Ground served as the foundation for the devel-
opment of embodied agency, sociality, and spirituality in the person’s life. As that
which was lost in suffering, this most significant meaning horizon was retained
from the lived past. It was profoundly implicit in the second moment of present
suffering –​the specific losses of their previous home, family, friends, and bodily
health/​comfort, as well as in the third moment of the structure –​the decision-​
making efforts aimed at a better future in the nursing home. A genetic ana-
lysis identified and located the Maternal Ground as the first, founding temporal
moment and horizon of suffering and decision-​making that began at the origin
of the participants’ life history. Sedimented meanings constellating maternal ori-
gins from which participants lived had rich social dimensions reaching from the
earliest moments of care that were developed over the life course. A merged and
entangled support system in the home, family, community, work, and caring for
specific others –​a retained past built on and extending maternal foundations –​
was implicated in the present nursing home life, which included the promise
and yet uncertainty of the future. The essential constituents of the first temporal
14

114 Frederick J. Wertz et al.

moment for participants were unconditional loving care, empathy, a welcoming

and generative home, mutual desire, and diffuse well-​being. The original home
was experienced by participants as a protective place of dwelling and welcoming
hospitality that was pain-​free and palliating –​providing nourishment, comfort,
security, and soothing. The maternal was also the foundation of powerful spirit-
ual intentionalities and movements for participants rooted in faith and fidelity, a
life-​affirming context affording strength for participants in their suffering.
The study revealed the loss of maternal foundations and loss of agency in
a central temporal moment of care transitions to the nursing home as invari-
ant in the structure of suffering and the context of decision-​making. In contrast
with the genetic Maternal Ground, the central moment of suffering involved
participants’ pain, illness, social discord, and isolation –​the loss of the maternal
foundation of agency, social mutuality, and bodily well-​being. Participants suf-
fered cascading specific losses that threatened not only their personhood but
their relationship with the world and their futural horizon –​the very promise
of the future flourishing to the moment of death. This moment of lost maternal
foundations involved no relief, no rescue from the accumulation of burden and
the multiple afflictions that assailed the chronically ill persons and undermined
the very foundation of their self and relations with others at the end of life.
In a third temporal moment, an agentic, life-​affirming, and empathic care-​
seeking struggle towards well-​being was revealed as a type of suffering and
decision-​making supported by palliative and maternal care practices, nurtur-
ance, and security. In this temporal moment of ‘Struggling toward Well-​Being’,
participants were living through suffering, living with serious illness, and coping
with approaching the end of life. They engaged in decision-​making processes
that were relational and social, involving not only family, but other residents
and their caregivers. Decisions were valued and action was undertaken based
on whether they helped to re-​establish maternal foundations; to restore trust
and empathic care; to foster agentic growth, resilience, and well-​being; and to
fashion a welcoming home even if in an imagined future. In this last temporal
moment, suffering and well-​being co-​existed in light of the transcendent life-​
goals of seriously ill elderly persons.
These study findings have implications for practice, policy, research, and the
growing impetus for a paradigm shift in nursing homes away from the domi-
nant medical model of disease diagnosis and symptom management to a more
relational, palliative care ethics (Morrissey, 2011, 2015) among professional car-
egivers, especially hands-​on staff, that provides seriously ill elderly with oppor-
tunities for development and growth even at the end of their lives. Psychologists
 Research Methods for Person-Centered Health Science 115

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

Findings and methods in phenomenological clinical psychology

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

Finding psychological life to be essentially changing and temporal, phenomeno-

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

Phenomenological Science for Health and Humanity

Our phenomenological psychological studies show that the meaning and value
of health care is to be understood in the context of the sufferer’s transcend-
ent goals and commitments. The relationship with carers, from receptionists
to nurses, physicians, psychologists, counselors, family, as well as diagnoses,
 Research Methods for Person-Centered Health Science 117

treatments, institutions, policies, and research have meaning only in their rela-
tion to persons’ agentic striving for a good life, as defined by such worldly ends
as a better life for grandchildren, a dignified job that does good, a world without
racism, moral and spiritual resolution in a flawed life filled with love and care.
Phenomenology provides health science with methods to research the phenom-
ena and problems of the health care field –​‘diseases’, ‘interventions’, and ‘pre-
vention strategies’ –​with regard to their meanings as related to personal ends
that intrinsically implicate community and culture. Informed by this knowledge,
health care can take advantage of psychological services as well as community
advocacy, resources, and activism in solidarity with those combating stigma,
eliminating gender-​based violence and sexist ideals, providing maternal institu-
tions for the elderly and the severely incapacitated, creating spaces of belonging
for differently abled children, and generating peer-​led egalitarian learning for
persons in recovery, part and parcel of which is the recovering person’s giving
back to and even transforming the world.
The problems of clinical psychology, including psychiatric concepts, diagnos-
tic criteria, interventions, and policies lead directly to a much larger reality of
which scientific knowledge is readily achievable through phenomenology, as a
multidisciplinary science of the lifeworld. Its study of subjectivity, which features
the analysis of meaning, offers knowledge that is both complementary and criti-
cal of research that abstracts from the complex constitution of the subjectively
given lifeworld as do the physical and biological sciences. The focus on suffer-
ing and transcendence in person-​centred clinical psychological research offers
knowledge that implicates meanings in the larger worldly context, affirming
the need for comprehensive interdisciplinary science of the lifeworld, including
health, education, politics, and other related areas of human endeavour. Person-​
centred science requires knowledge of the interdependencies of psychological
and the biological, social, and spiritual in order to inform practices and poli-
cies that support and impede the holistic flourishing of persons. Health science
requires not only natural science but a broader foundation for knowledge of
human strengths and transcendence as well as human suffering, with a compre-
hensive understanding of the world in all its meanings for the humans engaged
in it. Phenomenology, employed in psychology along with biology, sociology,
economics, political science, environmental science, anthropology, history, the-
ology, and philosophy, offers a broad scientific foundation necessary for trans-​
and interdisciplinary, person-​centred science within a universal science of the
lifeworld.
18

118 Frederick J. Wertz et al.

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 6

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

Introduction

In 1985, Amedeo Giorgi wrote that it is ‘no secret that the field of psychology
is not at one with itself ’ (p. 20), a quotation that still rings true today. The rap-
idly growing neuro-​biological paradigm and the psychiatric diagnostic system
that govern much of clinical practice in psychiatric hospitals reveal a large gap
between diagnostic descriptions and neuro-​biological causal theories on the one
hand, and the actual experience of an illness on the other. Phenomenologists
are critical of the strong tendency to reduce our minds to our brains and to
isolate illness from its embeddedness in a social world. After all, brains do not
perceive, think, or feel, but persons do, and they are continuously engaged in
interpersonal situations. Advancing beyond a sheer critical stance, phenomenol-
ogy offers psychiatry a humanistic perspective by which to conduct research on
phenomena as they are experienced subjectively, and to perform clinical work
that gives primacy to a patient’s subjective experience. This is what we want to
show through our research on postpartum depression and clinical experience of
treatment of mothers.
Transitioning into motherhood can be said to represent an existential cri-
sis, where the body, interpersonal relationships, and daily life are most intim-
ately intertwined. Most mothers live through this transformational experience
without encountering serious challenges to their mental health, but for some
mothers this is a time of despair or depression. In the dominant psychiatric
tradition, postpartum depression is primarily treated as something inherent
in the individual, but at the same time something separate from the person.
12

122 Idun Røseth & Rob Bongaardt

For example, when a depressed mother describes a deeply troubling lack of

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

Foundational Phenomenological Principles and Insights

Since a thorough description of the phenomenological method and its founda-

tional insights is beyond the scope of this chapter, we will present a sketch of
some of its essential features.
 Postpartum Depression and Its Treatment 123

Epochē and the eidetic reduction

One main objective of phenomenologists in both research and therapy is to
uncover the world as it is lived by a person. Our lived experience is presented
to us as meaningful, that is, we experience relations or objects in the world that
somehow make sense to us. The experienced world is ordered in meaningful pat-
terns or Gestalts (Merleau-​Ponty, 2012). In everyday life, we treat these patterns
as existing in the world independently from us, but phenomenology teaches us
that we can only know the world as it appears to us. All phenomena are thereby
a product of both the intentional act of consciousness (noesis) and the intended
object (noema) (Husserl, 1913/​1962). Consciousness can be directed towards
immanent objects (e.g., memories, fantasies, or hallucinations) or transcendent
objects (in the physical world). The intentional act is perhaps best understood as
constitutive: ‘consciousness makes objects come present, it actualizes presences’
(Giorgi, 2009, p. 105). It follows that in mental illness, for instance, symptoms
do not reflect defects that reside within the mind or brain. Rather, they point to
a disturbance in how a person constitutes the world, including other persons, his
or her body, time, and sense of self. Phenomena are thus in essence constituted,
relational, and embedded in a sociocultural world.
Of central importance for the phenomenological method are the so-​called
epochē and the ensuing reduction (Giorgi, 2009). The epochē is the suspension,
or bracketing, of all knowledge that comes from the natural attitude: all facts,
theories, common sense, and personal experience concerning a phenomenon.
Only what presents itself to one’s consciousness, and the manner in which it
presents itself, is regarded as permissible knowledge. The (phenomenological)
reduction is the suspension of our affirmation of the existence ‘out there in the
world’ of what presents itself to consciousness; we reduce our experiences of the
world to phenomena. Underlying the epochē and the reduction is thus a deep
realization that we constitute the world that is presented to us by us; our (ap)
perceptions are gestalt composites of our conscious acts and the world (Husserl,
1964). The phenomenological method is not merely a matter of making con-
scious and reflecting on one’s own subjectivity but rather a matter of entering
another attitude entirely. ‘The epoché is an action that involves one’s total exist-
ential position toward the world and it is profoundly personal’ (Morley, 2010,
p. 225; italics in original).
The epochē and the reduction form the starting point for any phenom-
enological study in which one seeks to find the essence of a phenomenon, its
124

124 Idun Røseth & Rob Bongaardt

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

Intersubjectivity and empathy

Husserl proposed that we are constitutive subjects in a world that is in essence
intersubjective (Zahavi, 2003). Between persons there is an embodied attune-
ment with unreflective adjustment and synchronization of posture and move-
ment, and the pitch and tone of voices. We develop implicit and habitual ways
of being with and reacting to other persons, which create a feeling of familiarity
(Shusterman, 2012; Stern, 1985). When perceiving an other person, my body
and the other’s are coupled, there is ‘the transfer of my intentions to the other’s
body and of his intentions to my own’ (Merleau-​Ponty, 1947/​1964a, p. 118). We
interlink our constitutive functions, as Gurwitch (1966) puts it. We are not sol-
ipsistic egos closed in on ourselves, doomed to never really know the feelings
and thoughts of others; we have the ability to experience directly the feelings and
intentions of the other. Admittedly, this is not as the other experiences herself,
but nevertheless we have direct access to important aspects of his emotions and
intentions through his bodily behavior (Zahavi, 2010). This is further explained
by Scheler (1970), who described empathy as a specific mode of consciousness
that is different from perceiving an inanimate object. Our experiences with oth-
ers are subject-​subject relations; we immediately recognize the other as having
a separate consciousness that is partly accessible and partly inaccessible to us.
It is this asymmetry which Husserl described as essential in intersubjectivity;
without it we would have an undifferentiated collectivity (Husserl in Zahavi,
2003, p. 114).
‘[T]‌he other’s intentions somehow play across my body, while my inten-
tions play across his’; this is experienced as a range of possibilities for social
interaction (Merleau-​Ponty, 1947/​1964a, p. 119; italics in original; Froese &
Gallagher, 2012). We perceive not only another person’s gestures as ‘observable
behavior’, but also their ‘inward formulation’, that is, we see things in terms of
how they feel (Whitney, 2012). Our interactions with others are sedimented in
 Postpartum Depression and Its Treatment 125

the environment; together we leave an imprint on nature. ‘Just as nature pen-

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

The Meaning Structure of Postpartum Depression

Following hints from Husserl, Giorgi (2009) appropriated the philosophical

phenomenological method in order to make it more suitable as a scientific and
psychological method. He transformed the method in order to study other
people’s experiences and to get descriptions in the middle range, sensitive to
social and cultural contexts. Limiting the phenomenological reduction to the
objects of consciousness, his method involves a partial and psychological reduc-
tion and not a transcendental one. Giorgi’s method also involves the epochē and
the eidetic reduction, and is systematized through a four-​step analysis (ibid.).
Our phenomenological study of postpartum depression was based on Giorgi’s
126

126 Idun Røseth & Rob Bongaardt

method. It describes how mothers, after birth, experienced an alienation and

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

This meaning structure reveals the invariance within the various experiences of
postpartum depression that women may have. A main facet of the structure is
the disintegration of the habitual world and an existential crisis. While we used
the epochē and imaginative variation to derive the meaning structure of post-
partum depression from what mothers told us about their experiences, we now
‘remove the brackets’ and facilitate a dialogue between our findings and other
phenomenological insights. We do so to deepen and broaden our understanding
of the phenomenon under study.
Transitioning into motherhood involves adjusting to a new and often radically
different world (Røseth, 2013) –​a new world that integrates earlier life with that
of being a mother of a totally dependent and vulnerable infant. With the birth of
the baby, the world has acquired a different sense. Often, the baby integrates well
into the mother’s world; the daily care of her child quickly becomes an interper-
sonal and bodily habit, which creates a sense of familiarity when being with the
baby. Their bodies become coupled, adjusting habitually and pre-​linguistically
 Postpartum Depression and Its Treatment 127

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

Phenomenological Therapy

In clinical practice, the therapeutic focus is on the mother-​child or the mother-​

therapist relationship, or both. For some mothers, the act of re-​establishing
familiar patterns of interaction within their world, such as exercise, being with
friends, or getting back to work, is essential in their recovery. The process of
128

128 Idun Røseth & Rob Bongaardt

synchronization in any of these lifeworld dimensions can involve other dimen-

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

The mother in focus

An important aspect of postpartum depression is the disintegration of the habit-
ual world, so an essential part of therapy should involve facilitating and estab-
lishing a new order and sense of stability, security, and ‘at home-​ness’ in the
world. As a therapist, being informed by a phenomenological understanding of
intersubjectivity, empathy, and the epochē, one may help the mother in the pro-
cess of synchronization or coupling with the baby.
When in therapy, the establishment of an open, accepting, and secure atmos-
phere that enables an affective coupling and synchronized encounter with a ther-
apist is the first step that may spur a positive change in the mother’s relationship
with the world and other people, as it aids the transition from crisis to stability
and a habitual feeling of ‘at home-​ness’. To be met with acceptance, warmth, and
empathy involves the therapist being emotionally flexible and tuned in to the
specific patient’s emotions and her mode of being. The experience of an emo-
tionally attuned and synchronized encounter may also reduce self-​sustaining
and negative self-​appraisals and encourage the mother’s own capacity to grow
and heal (Hart, 2011; Stern, 1995; Winnicott, 1965).
Through this open presence, the therapist helps the mother to endure and
regulate negative feelings, and makes it possible to explore and integrate trau-
matic memories in the patient-​therapist encounter. Merleau-​Ponty (1945/​1962,
pp. 182–​3) explained that expression does not translate meaning, but rather
brings meaning into being. To express experiences opens up new dimensions of
the lifeworld, which in itself implies a change for the mother. Once experiences
are expressed, their meaning can be explored and reflected upon, which helps
her to achieve a greater understanding of her history and of her self (Brudal,
2014; Fonagy et al., 2005).
The methodological step of the epochē and the reduction, when appropriated
in a therapeutic context, can be understood as a form of disciplined empathy
 Postpartum Depression and Its Treatment 129

where the therapist engages in a specific mode of consciousness, transporting

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

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

The mother-​child dyad in focus

When working with postpartum depressed mothers and the mother-​child dyad,
we often address the mother’s depression first. As therapy proceeds, the focus
enlarges to also include the mother’s interaction with the infant. The ‘still face’
experiment of Ed Tronick et al. (1978) reveals the importance of an emotion-
ally available caregiver for the well-​being and development of the infant; already
from birth, the baby is dependent on a sensitive, fine-​tuned, and synchronized
interaction with a primary caregiver to help regulate its internal states (cf. also
Trevarthen, 1979a, b; Stern, 1985, 1995). In Winnicott’s (1965) terms one can say
that the child needs ‘good enough mothering’ and a ‘holding environment’ for a
healthy development. If the infant is left in a disorganized and stressful internal
state over longer periods of time, this may lead to a chronic heightened stress
response than can have a detrimental effect on the child’s development (Hart,
2011; Schore, 2003; Stien & Kendall, 2004). Recent developmental research on
child neglect and abuse shows that the quality of caregiving the infant received
in the first years of life impacts not only its psychological but also its physical
health, because a heightened stress response makes it more vulnerable to cardio-
vascular diseases, cancer, diabetes, and so on (Hart, 2011). This naturally makes
it pertinent to work directly with the mother-​child interaction, and imperative
to find good methods in order to both study and treat relational disorders.
Depressed mothers have described feelings of alienation from the baby and
other people. A pertinent question is how this sense of alienation affects their
interaction with the child and its well-​being. Another question is how we should
understand and possibly treat interactional disorders between mother and child.
 Postpartum Depression and Its Treatment 131

The phenomenological insights into intersubjectivity and empathy imply that

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

nature as a thing perceived and accessible to all’ (Merleau-​Ponty, 1945/​1962,

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

Conclusion

In this chapter we showed how research and therapy grounded in descrip-

tive phenomenological principles could come together and create unity in the
clinical psychological practice with postpartum depressed mothers and their
infants. Adopting the mindset of the epochē enables the therapist to be with the
mother in her lifeworld. The eidetic reduction and research based on these same
phenomenological principles enables the therapist to be there for the mother
and her relationship with her child. The resulting clinical conversations are
anchored in the fundamental intersubjectivity of human beings, which supports
emotional resonance and verbalized confirmation of mutual understanding and
new insights.
 Postpartum Depression and Its Treatment 133

Note

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

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 7

A Phenomenology of Sensus Communis

Outline of a Phenomenological Approach

to Social Psychiatry
Samuel Thoma and Thomas Fuchs

Introduction

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

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

General Remarks on Sensus Communis

The psychopathology of common sense initiated by Wolfgang Blankenburg (2012)

is one of the main research-​domains of contemporary phenomenological psych-
iatry4 and is in our view the most useful one to be linked to social-​psychiatric
questions. Hence, we follow Stanghellini’s idea that the concept of common sense
can be easily linked with questions about the minimal self and pre-​reflective self-​
affection in mental illness (Sass & Parnas, 2003; Parnas et al., 2005; Stanghellini,
2004). However, we prefer the term ‘sensus communis’ for such an integrative use
of the concept, which we will explain below.
A brief historical outline will allow us to distinguish three dimensions of the
sensus communis concept: (i) koinē aísthēsis as a fundamental intermodal capac-
ity to sense the world and oneself through the medium of the lived body; (ii)
social sense, derived from primary social interactions with others, enabling a
habitual, pre-​reflective and confident relation with the social world; (iii) com-
mon sense, as the capacity to think in accordance with intersubjectively shared,
self-​evident rules, and to apply them to specific situations.
Clifford Geertz (1983, p. 76) once remarked that common sense is ‘perhaps
the central category in a wide range of modern philosophical systems’ (emphasis
in the original). One might even say that in contemporary philosophy common
sense has itself become a commonsensical motive of different philosophical
schools and of the humanities in general.5 Etymologically the term goes back to
the ancient Greek koinē aísthēsis, which was later translated into Latin as sensus
communis from which the modern term common sense is derived. This etymo-
logical evolution was accompanied by important semantic changes. Aristotle
described koinē aísthēsis as the capacity of living beings to integrate different
sensory modalities along with the ability to sense oneself in perceiving the sur-
rounding world (Aristotle, 2008; Heller-​Roazen, 2009; Gregoric, 2012). The
Romans often conceptualized sensus communis as the ability to act humanely
and with kindness towards the community,6 a meaning that in the end of the
seventeenth century was taken up by Gianbattista Vico and Anthony Shaftesbury
(2000, p. 50), who described sensus communis as a ‘social feeling or sense of
 A Phenomenology of Sensus Communis 139

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

The Phenomenology of Sensus Communis

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

Koinē aísthēsis –​sensing oneself and the world

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

Straus (1956) speaks of sensing (Empfinden) as a fundamental communication

of a bodily subject with the world, a communication that we share with animals.
With Straus we may conceive of aísthēsis as an interaction in its most basic, bod-
ily form. Moreover this sensing of the world should always be taken as a holis-
tic structure: it is not the sum one ends up with by adding the different senses
or sensory modalities, but an indivisible layer of sense-​experience, a sensorium
commune,8 through which we communicate with the world.
Hence, the different sensory modalities are only accentuations of that com-
munication and not its atomistic elements. In the modalities of touch and
taste the world is sensed as especially near to our body: we feel touched when
touching something else and vice versa. The sense of smell is closely linked to
atmospheric impressions such as familiarity or uncanniness, freshness or decay
(Tellenbach, 1968). Hearing and seeing enable us to sense things very distant
from us. Whereas hearing depends on sounds appearing over time (melodies or
utterances), seeing enables us to discern something from a certain perspective
and by moving around it. As Straus puts it, none of these senses ‘plays in only
one tonality’.9 If, for instance, we visually see a withered bouquet of flowers from
a certain distance and smell its insipid odor as intrusively close, we at the same
time also see this odor on the withered blossoms, and we smell its withered
look in its insipid odor. Another example would be a concert where we not only
hear the music but also see it in the movements of the orchestra’s conductor and
musicians (cf. von Weizsäcker, 1950, p. 79). Hence, we might also call this senso-
rium commune an intermodal sense. Intermodality or coenesthesia consequently
is not a rare or even pathological case of our sensory perception but constitutes
its very essence.
But koinē aísthēsis not only includes the intermodal perception of the sur-
rounding world, but also the capacity of vital self-​sensing (Aristotle, 2008;
Heller-​Roazen, 2009). According to Straus (1956, p. 373), self-​sensing and
sensing of the world must always be seen as a unity for which he uses the term
‘sympathetic sensing’: ‘The “with” [“sym” of sympathetic] means that by sensing
I don’t experience myself and additionally the world, but that the experience of
sensing unfolds in two directions, towards the world and towards the I. Sensing
is sympathetic experience, i.e. by sensing I experience transformations of my
relation to the world –​a relation that outlasts and unifies all particular moments
because it is one.’ In terms of sympathetic sensing, self-​sensing is never static
but in a constant state of becoming in relation with the world. This reciprocal
articulation of self-​sensing and sensing of the world may be best understood
as rhythm. Rhythm is, as the French phenomenologist Henri Maldiney (2012,
 A Phenomenology of Sensus Communis 141

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

Social sense –​sense for shared habitualities

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

the world is essentially gained through others by gaining confidence in them,

at first in the course of successful dyadic interactions. From here, this confi-
dence extends to joint attention on objects, co-​operative practices of interacting
with the environment, and finally to the seemingly solitary interaction with the
material world during which others are only potentially co-​present.
As we can see, the familiarity of others and the familiarity of the world are
closely interrelated; both are ultimately based on intercorporeal interactions and
shared practices experienced early in life. Therefore we may speak of a unitary
social sense, which covers our ‘knowledge by acquaintance’ (James, 1890, p. 221)
both with others and with the shared world. Social sense, like koîné aísthēsis,
is a resonant faculty. Through it, we respond to situations in accordance with
implicit, socially shared habits. But social sense is not a fait accompli, a mere
repetition of habits, but something that has to be re-​founded in every new situa-
tion. We have to accommodate to unfamiliar situations, persons, or objects, and
transform our habits in the face of new environmental affordances. Hence, we
must not only retrieve what is and has been a common habit before, but must
also continuously strive to recreate it.
This becomes especially evident in the phenomenon of tact (cf. Gadamer,
1990, p. 20 ff.). Tact cannot be reduced to the capacity of applying rules of eti-
quette to a social situation. Rather, it is needed in situations where the applica-
tion of rules is limited. It is a sense for what is socially demanded in concrete
situations within the implicit horizon of interactive habits. An example would
be meeting an acquaintance who just suffered the death of a family member. Our
knowledge of social etiquette would help us to have a small talk with her but it
is limited as it doesn’t tell us if, when, and how she would want us to address the
loss of her family member. We may only sense it in that very situation and attune
our familiar ways of interaction to it. Hence tact is not a cognitive or rule-​based
faculty; rather, it can be defined as the intuitive capacity to maintain interactive
familiarity in unfamiliar social situations.
The relevance of the social sense for the constitution of intersubjectivity also
comes to the fore in cases where it is disturbed. People with autism and also
schizophrenic autism often suffer from not being able to rely on shared habits and
empathy in social encounters, making it hard for both sides to establish a feeling
of familiarity. Thus, instead of intuitively attuning with the other, high-​functioning
autistic individuals have to use strategies of explicit mentalizing and inferring
from social cues in order to compensate for the lacking capacities of intercorporeal
understanding (Zahavi & Parnas, 2003). This is described in Oliver Sacks’s (1995,
p. 270) report on Temple Grandin, a woman with Asperger’s syndrome:
 A Phenomenology of Sensus Communis 143

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

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

Common sense –​rule-​guided and pragmatic thinking

The last aspect of sensus communis is common sense which we take as a basic
human capacity of thought and reflection. However, when speaking of common
sense we generally prefer the term ‘thinking’ to ‘reflecting’ since the latter implies
a rather distanced and disengaged relation towards one’s experiences. While such
a reflective stance may be part of common sense, especially in critical situations,
common sense is in most cases characterized by aware and engaged thinking in
concrete situations. Hence, following Sutton et al. (2011, p. 95) we take thought
not as ‘an inner realm behind practical skill, but [as] an intrinsic and worldly
aspect of our real-​time engagement in complex physical and cultural activities’.
Commonsensical thinking is guided by fundamental and commonly shared
rules and axioms, as outlined by James Beattie (1915, p. 217): ‘I exist, things
equal to one and the same thing are equal to one another, the sun rose today,
. . . the three angles of a triangle are equal to two right angles, etc. –​I am con-
scious that my mind admits and acquiesces in them.’ These axioms of common
sense constitute, in Wittgenstein’s terms, our bedrock of unquestioned certain-
ties (cf. Wittgenstein, 1972, pp. 94–​9, 245–​54). Yet despite the fact that these
axioms seem so evident to us, it would be wrong to conceive of them as cultur-
ally irrelative.15 One should rather stress the social validity of common sense
rules than ask for their general truth. In other words, common sense know-
ledge primarily is not true, but shared knowledge that connects us with a cer-
tain sociocultural group and the viewpoint of its ‘generalized other’ (Mead, 1972,
p. 172 ff.). This becomes even more evident with other aspects of common sense
knowledge such as the cultural corpus of proverbs and idiomatic expressions,16
14

144 Samuel Thoma & Thomas Fuchs

the knowledge of conventions and finally social role-​knowledge. Here common

sense not only functions as a general ‘bedrock of unquestioned certainties’ but
has a more specific and normative function. Through common sense, we know
how one has to behave, that is, we know and expect a certain role, a role-​other,
and a role-​set17 with rules that everyone follows in concrete social situations.
This also implies a fundamentally pragmatic significance of common sense
knowledge. Applying general rules of interaction helps us to maintain coherent
social interactions in cases of insufficient habitualities. Relying on our knowl-
edge of roles and rituals, we do not have to reflect on how to interact when our
embodied habits do not match or could not yet accommodate to one another.
When interacting with strangers in public places or at official meetings there is
always a rule, both general and anonymous, of how one should greet or thank
each other, and how one should talk or apologize to each other, and so on.
This rule-​guided regulation of social interaction mostly occurs on an implicit
level but may also be made explicit, especially in cases of misdemeanor where
we remind ourselves or others that certain things are ‘just not done’, like, for
instance, not excusing oneself when stepping on a stranger’s toe.
Spontaneously referring to common sense rules corresponds to referring one’s
situation to the ‘generalized other’ and to localize oneself in it. But despite the
certainty and smoothness with which we do so, this general reference is some-
thing we must acquire throughout our lives and which repeatedly conflicts with
our habitual experience.18 The anthropological condition for such an acquire-
ment of general rules and their almost natural application in everyday life is
what Helmuth Plessner (1975, p. 288 ff.) calls ‘eccentric positionality’, through
which we are able to conceive of our own experiences from a general perspective
and in the light of societal meanings and demands (Heinze, 2009). We could say
that in common sense, this ‘eccentric’ interchange between general rules and our
‘centric’ situation has become a ‘second nature’ and ‘goes without saying’.
Finally, this commonsensical interchange of general rules and concrete situ-
ations always necessarily implies a kind of creativity: As Immanuel Kant (1998,
p. 268 f.) points out, there can be no rule for the application of a rule if one
is to avoid an infinite regress. Thus it is not enough for a doctor, a judge, or a
statesman to know the rules of his or her profession, but he or she is also in
need of what Kant calls ‘power of judgement’, that is, a creative capacity to inter-
pretatively apply these rules to concrete situations (ibid.; Kant, 2000, p. 15 f.,
66 f.; Gadamer, 1990, p. 43 ff.; Summa, 2016). Accordingly, in everyday life we
all resemble Kant’s example of a judge since with common sense we constantly
 A Phenomenology of Sensus Communis 145

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

The Relation between Koinē Aísthēsis, Social Sense,

and Common Sense

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

we habitually behave in coherence with the situation.20 Hence, sensus communis

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

Psychopathological Aspects of Sensus Communis

In the following we restrict ourselves to the description of schizophrenia in rela-

tion to sensus communis.23 Wolfgang Blankenburg was the first to stress the rela-
tion between common sense and schizophrenia from a phenomenological point
of view by describing schizophrenia as a loss of natural self-​evidence or as a loss
of common sense. Ever since, this issue has been extensively discussed and we
will only give a short summary of it here.
The conception of schizophrenia as a loss of common sense seems particularly
convincing, when looking at delusions, one of the most prominent schizophrenic
 A Phenomenology of Sensus Communis 147

symptoms. Karl Jaspers (1997, p. 96) famously defined delusions as extraordinar-

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

In any case, disturbances of sensus communis are always forms of disturbed

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

Therapeutic Consequences

One could think of many therapeutical implications of our theory of sensus com-
munis. We can only indicate a few that are essential to social psychiatric therapy.
If schizophrenia essentially implies a loss of sensus communis then phenom-
enology could be said to have a special affinity to it since its methodological
approach includes precisely the ‘bracketing’ of the taken-​for-​grantedness of
everyday experience which is lost in schizophrenia. By actively distancing oneself
 A Phenomenology of Sensus Communis 149

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

Conclusion/​Discussion

A phenomenological approach to social psychiatry should take into account the

social and potentially psychopathological dimension of human experience. More
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150 Samuel Thoma & Thomas Fuchs

precisely, the question is not so much if subjective experience is social or if the

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

Notes

We would like to thank Andi and Daniel Haskett, Allan Køster, Johanna Thoma,
and Zeno Van Duppen for their helpful suggestions.
 A Phenomenology of Sensus Communis 151

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

as concrete, embodied, and interactive dispositions that frame our subjective

experience (for instance, as a white, male, middle-​class academic). For Bourdieu
this embodiment of the social is not just a passive process of social imprinting.
The agent’s habitus also has an active and creative side, which is why Bourdieu
(1977, p. 72) defines the habitus as both ‘structured’ and ‘structuring structures’.
The same goes for what we just termed social sense, whose task is not only
to retrieve our acquired habits in new situations, but to creatively adapt and
transform them, turning our familiarity with the world into a dynamic and
potentially fragile process.
14. Cf. Schneickert (2013). Besides, especially the concept of common sense plays an
important, though unsystematic role in Bourdieu’s theory (cf. Holton, 2000).
15. Even if we would subscribe to Beattie’s (1915, p. 217) aforementioned claims,
another claim of the citation, ‘there is a God’, might in secular societies seem much
less evident.
16. Cf. Feilke (1994). The use of common idioms like ‘how are you doing?’ seems all
evident to us although nobody can explain why in English one must say ‘how are
you doing?’ and not –​as in French, German, or Australian English –​‘how are you
going?’ (‘comment ça va?’, ‘wie geht’s?’).
17. Cf. Goffman (1972, p. 75). Despite recent criticism of role-​theory (Davies & Harré,
1990, p. 51 ff.; Krais & Gebauer, 2002, p. 66 ff.) it is in our view still useful for a both
phenomenological and social-​psychiatric understanding of mental illness (Kraus,
1977, 1980).
18. Jean-​Paul Sartre (1971, p. 17 ff.), for instance, describes Jean Genet’s experience as a
little child habitually stealing from other people and all of a sudden being judged as
a thief and as having trespassed a social norm –​a norm he then continually tries to
integrate into his experience.
19. Cf. Binswanger (1994a), Jaspers (1997), Blankenburg (2007b), Fuchs (2013b,
p. 206 ff.).
20. Of course, this also works in the other direction: how we play a role and what roles
we get to play (in terms of profession, consumer, etc.) depend on our primary,
habitual familiarity with the world, our habitus.
21. We don’t mean to say either that reflection is all but guided by common sense rules.
But this aspect of critical and emancipatory thinking goes beyond the scope of
common sense. Nonetheless the relation between critical thinking and common
sense is important not only for political questions (Rosenfeld, 2011) but also for
psychiatric and psychopathological ones.
22. Hence, in rule-​guided social thinking interaction comes close to a pattern of action
and reaction, as epitomized in Schütz’s (2008, p. 315 ff.) ‘general thesis of the
reciprocity of perspectives’ where social agents spontaneously apprehend their own
and the other’s perspective merely as reciprocal elements of a common project (for
instance, selling and buying something in a shop).
 A Phenomenology of Sensus Communis 153

23. When speaking of schizophrenia or other mental disorders we follow the

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

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 8

Husserl’s Ethics and Psychiatry

Susi Ferrarello

Introduction

In this chapter I will focus on Husserl’s ethics and its potential use for psycho-
therapy and psychiatry. In particular I will examine the notion of volitional
body in relation to time and society. As I argued in Husserl’s Ethics and Practical
Intentionality (2015), Husserl’s phenomenology of ethics is a science grounded
in the ontological region of the volitional body, and a praxis experienced in the
form of practical intentionality.
As a science phenomenological ethical practice can provide psychotherapists
and psychiatrists with empathetic tools to observe the worldview of the client;
as an approach it represents an ethical stance that social workers can adopt as a
way to deepen their relating to their clients. Both aspects of this ethical practice
can be employed to expand the intersubjective sense of how ‘normality’ or nor-
mativity is defined within the society and to enhance ethical awareness in social
practice and daily life.
In the first part of the chapter I will use Rogers’s and Gendlin’s (1962) phe-
nomenological studies of schizophrenia conducted as an example of the effect-
iveness that such ethics can have in this area. Generally, if the mental disease is a
natural response to a sick environment and if the language of the client is more
important than that of the therapist, then it follows that a real cure can occur
when the therapist does not use diagnostic concepts, but makes herself avail-
able to the client’s ethical environment. This is possible through an empathetic
approach that genuinely explores the sense of normality implied in the client’s
ethical worldview and suspends all pre-​existing ethical assumptions. For that
to occur it is necessary that both the therapist and client develop a capacity to
recognize their ethical assumptions and describe the limits of action dictated
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by these assumptions. In the second part of the chapter I will examine Husserl’s
notion of volitional body in relation to time and society, and explain how it can
be useful in phenomenological practice.

Ethics in Practice

Spiegelberg’s (1972) volume on phenomenology and psychiatry is an excellent

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

Gendlin and Rogers’s client-​oriented approach

In an article written in 1962 Gendlin summarized the results of a study of hos-
pital patients diagnosed with schizophrenia he conducted in collaboration with
Rogers. The main tenets of the client-​oriented approach they used for this study
can be summarized as follows: (i) increasing emphasis on the personal relation-
ship with and empathetic understanding of the client; (ii) the therapist’s sponta-
neity and genuine expressiveness; (iii) the sub-​verbal, affective, pre-​conceptual
nature of the basic therapeutic communication (Rogers, 1957, 1959a & b).
The three tenets imply, of course, an ethical stance that the researcher decides
to take in relation to the client. Indeed, if the therapist decides to adopt such
an approach in a responsible way, she would face a number of moral ques-
tions: What are my assumptions in relation to my client? Am I truly in contact
with her worldview or am I using my unreflected-​upon worldview to interpret
her story? Are my narrative and morals influencing my view of her case in a dis-
tortive way? If so, am I sharing with her the moral dilemmas that this influence
 Husserl’s Ethics and Psychiatry 163

produces, or am I just passively framing her within the assumptions comprising

my moral world? What am I instinctively and spontaneously feeling in relation
to her? What meaning am I bringing to this experience? Am I paying attention
to the sub-​verbal meanings that my patient brings to our relationship?
Concerning the first tenet, on the basis of Rogers and Gendlin’s ethical obser-
vation the healing process is not a solipsistic process but rather an intersubjective
one. The therapist’s private and shared ethical observations constitutively shape
the experiencing that the patient lives in an immediate manner (Gendlin, Jenney,
& Shlien, 1960). The more open and aware the therapist is, the more space there
will be for the client to expand. As we know, the passive life of the therapist is as
important as the active one; the therapist’s pre-​conceptual and conceptual life are
in some way inevitably shared with the patient at the moment of their encounter.
For Rogers and Gendlin, the therapist seeks to communicate as fully as possible
her feelings in response to the patient as part of the treatment. For them, sharing
with sincerity the therapist’s experiences in the relationship with the client is piv-
otal to building a trustworthy common ground. If the therapist enters into the rela-
tionship with expectations, assumptions, methodical criteria that need to be met
by the client, then she will sabotage the therapeutic relationship (Gendlin, 1962).
Therefore real empathetic understanding takes place when the therapist exer-
cises her awareness in relation to her present feelings so that she can verbalize
her experiences in a free and transparent way without artificiality. She is with
the client without confusing her emotional life with the client’s. It is true, as
Gendlin (1961a, 1962) noted, that the therapist may not always reach a deep
level of awareness in grasping her feelings. Gendlin argues that if the therapist is
livingly in contact with her feelings, the client may nevertheless perceive them.
That is why empathy does not equate to enmeshment or emotional confusion;
rather, empathy requires awareness and emotional responsibility.
The second tenet, genuineness as unconditional positive regard, reinforces
the unbiased attitude that the therapist seeks to adopt in observing herself and
her client. This approach invites the therapist to fully acknowledge the feelings
elicited within the intersubjective exchange. On my reading, ‘positive regard’
does not imply that the therapist selects positive feelings only; any such selection,
in fact, would entail a moral attitude that does not contribute to the genuine-
ness of the exchange. The word ‘positive’ here refers to the Latin root, positum,
which means ‘that which is set or given’. The therapist is invited to fully recog-
nize the feelings that are given to and elicited from her in the exchange with
the client. If the therapist is free from moral judgement and abandons her diag-
nostic attitude, then the awareness of the client’s pre-​conceptual and pre-​verbal
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language can be maximized and intensified (Rogers, 1959a). Gendlin (1961b)

elaborated four casuistic ways in which schizophrenic clients might respond to
therapy: non-​motivation, silence, non-​exploration, and intense sub-​verbal inter-
action. A therapist who usually centers her therapy upon the client’s motivations
and feelings would certainly feel strongly affected by the client’s unwillingness
to meet with her. Such a therapist might feel deprived of the ground upon which
her practice is based.
The majority of the clients diagnosed with schizophrenia considered in
Gendlin’s study did not desire to do therapy and most of the time refused to
meet the therapist. They responded to therapy with continuing silence. Often
the lack of verbal communication was accompanied by a refusal to own their
feelings and explore them, even though they have already been expressed in
an intense sub-​verbal interaction. Gendlin argues that the genuineness of the
therapist’s interaction and her unconditional regard would allow the client to be
listened to on every level of expression.
As Betz and Whitehorn (1956) remarked, in a hospital setting interpersonal
and physical contact is often narrowed; consequently, the client can become for-
getful of the human and personal conventions used before the hospitalization
occurred. If therapists were to carve out the space for the client to occupy a
human role within a hospital setting and give the client the freedom to fill or
not fill this human role, this would be the strongest inter-​subjective bridge that
could be built between the client and her surrounding society. The human role
is constantly there as a full presence, but this presence can be overshadowed
by professional or social roles. On my interpretation of Gendlin and Rogers’s
approach, in the therapeutic encounter, neither the therapist nor the client iden-
tifies with their pre-​given professional and conventional roles.
Last, in order to help the client to live in an intersubjective and human envi-
ronment, the therapist should be able to share her own answer to the environ-
ment in which the relationship between the two takes place in a genuine way.
The normative, implicit ethical stance of the therapist critiqued by Gendlin is
that of a treating professional who is accustomed to value as human only a lim-
ited range of communicative responses from the client, which leads the therapist
to accept only a truncated range of answers as valid possibilities. Therefore, she
would interrupt the client’s silences in order to seek a normative form of encoun-
ter that does not meet the client’s language and passive world. In contrast, the
approach proposed by Gendlin calls the therapist to take seriously the clients’
spontaneous responses to their environment as they present themselves, whether
 Husserl’s Ethics and Psychiatry 165

they communicate irritation, frustration, joy, or silence. Rather than requiring

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

Ethics as a Science

In 1889 Husserl began reflecting upon his project of founding a science of

ethics parallel to a science of logic. He worked on this project throughout his
life: logic and ethics were conceived as two complementary parts of a single phe-
nomenological study of consciousness (Hua XXVIII) within which conceptual
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166 Susi Ferrarello

and emotional lived-​experience were understood as completing each other.

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

Owning the volitional body

In this section I will describe the process through which the client becomes
the subject of her own body and establishes a meaningful relationship with it.
Husserl describes the volitional body as the connecting bridge (verbindende
Bruecke, Hua-​Mat IV, 186) between nature and spirit, matter and reflection. It
represents the region of being in which it is possible to locate an ego, a subject of
actions (Handlungen), and creative acts (poietische Akte) (Hua-​Mat IV, 104) that
generates habits and, accordingly, ethical layers. This volitional layer constitutes
an ethical subject, that is, an en-​worlded person exercising her will and choice.
 Husserl’s Ethics and Psychiatry 167

The layers of the volitional body

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

which their lived-​bodies are constituted. At this level the job of the therapist
consists in awaking the sensory experience of the clients to the next layer so that
they recognize themselves as a living body among other living bodies.
The Körper is the zero point of apprehension. As Husserl shows in Cartesian
Meditations the physical body brings with itself ‘there-​ness-​for-​me’ (Hua I,
124). The physical body, perceptually given in an open and infinite horizon of
undiscovered internal features, is a primordial transcendence that is there for
the natural animated thing, that is, ‘us’. We discover ourselves as primordially
embedded in this there-​ness, but at the same time the shock of this discovery
makes us aliens to ourselves. The therapist can help the client to recover from
this shock and feel the connection between the still there-​ness and the living
alien. By the living alien I mean the body as a living thing over which the subject
has not yet claimed ownership.
The primordial response to the alien, which transcends our own physical
body, is feeling our lived-​body (Leib) but not yet inhabiting it. Becoming alive
means seeing our own alienation and engaging this alien in a dialogue. How are
we treating our body? What part of it is in pain? Where does the place of our
pleasure reside? Are we breathing? It is from this encounter that we become liv-
ing things; we awaken from a condition of thing-​hood to one of subject-​hood.
‘As perceptively active, I experience (or can experience) all of Nature, including
my own animate organism, which therefore in the process is reflexively related
to itself. That becomes possible because I “can” perceive one hand “by means
of the other” . . . a procedure in which the functioning organ must become an
Object and the Object a functioning organ’ (Hua I, 128).
Moreover, it is through my lived body (Leib) that I realize my sphere of
owness in contrast with the alienness of my physical body. Nature brings to light
my Leib, ‘my animated organism, reduced to what is included in my owness .
. . I as this man . . .. If I reduce myself as a man, I get “my animate organism”
and “my psyche”, or myself as psychophysical unity –​in the latter, my personal
Ego, who operates in this animate organism and, by means of it’ (Hua I, 128).
As Biceaga (2010, p. XXIII) rightly remarks, Husserl introduced the distinction
between Leib and Koerper (the body as objectified; the body of medical science)
precisely with the intention of explaining the constitution of objective nature
and securing a region of owness within which the subject is intersubjectively
constituted. The sphere of owness indicates that space in which we live as sub-
jects of our matter; this sphere stems from the moment of realization in which
we understand that we own a specific body and are responsible for its actions.
The intersubjective process of healing mentioned in Gendlin and Rogers’s work
 Husserl’s Ethics and Psychiatry 169

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

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

in Husserl’s theory of the emergence of ego there is first an ego-​less primitive

layer of consciousness in which drives, affections, sensuous tendencies of associ-
ations, and reproductions are mixed together; then a layer of nows emerges and
forms a primitive unit in the continuum of the present.
As Husserl wrote in the later C-​Manuscripts, the living present of conscious-
ness is the substratum, the original flow through which what comes to light is
luminous (Hua XIV, 45, 301). This ‘lebendige Gegenwart (living present) is a kind
of ongoing filling of intentions/​protentions. . . . It is a creative primal presenting’
(Hart, 1992, pp. 25 26)
This substratum is conceivable only if we consider the primitive layer of
objects as a layer of absolute consciousness (Husserl, 1973b, § 29). This layer is
not that of transcendental constituting flow; instead it is the layer that enables
this constituting layer to arise. On this level no cognitive or world-​time with its
apprehension, or attentional retentions or egological acts take place, but only a
flow of perceptual time with its undifferentiated material data. This is the layer
of stream that we encounter before any reduction, theoretical reflection on, or
attentive returning to an original process.
In C-​I 17 4 Husserl distinguishes three layers of ‘stream’. In the first layer
stream means the stream of life: a pre-​temporal and egoless form of stream. In
the second layer, stream stands for the stream of immanent experience such as
hyletic data and passive experience. In the third layer, stream indicates world-​
time constituted through the acts of consciousness, in which everything streams
for consciousness. This layer is primordial and combines with the first sense
of streaming in terms of pre-​temporal and egoless flow that can be disclosed
through the questioning-​back of the transcendental ego and through a reflex-
ive act directed upon the third sense of streaming. While this third layer is the
realm of cognition and world-​time and is therefore characterized by temporal-
ity’s ‘before and after’ and causal connections unfolding within time, in the first
layer time is an absolute, meaning that strictly speaking it is inconceivable for us.
We cannot conceive of the first sense of streaming because we are constrained to
the third form of streaming time, the time of ‘befores’ and ‘afters’, when we seek
to explain the data we perceive.
The first sense of streaming cannot be captured within ‘befores’ and ‘afters’; it
is the interconnection of different senses of time, hence it is absolute in the Latin
sense ab-​solutus: loose, ‘untied’, or freed from our mind.
Indeed, this first original stream is not yet an I, rather, it is the original pres-
ence that underlies the I, a living presence as a ‘standing-​streaming present’ (C3,
III 88) on which my-​being for myself is constituted as my living self-​presence.
 Husserl’s Ethics and Psychiatry 171

This pre-​temporal stream is not yet intentional; rather, it is this stream that
‘awakes’ or ‘irritates’ the ego and makes it a ‘wache Ich’, an awoken I ready for
intentional activity. From the perspective of Husserl’s egology, within the ‘nor-
mal’ or (from a psychological perspective) relatively integrated human being’s
ongoing life the three layers of time flow in a more or less harmonious way, or
at least that life is not characterized by drastic ruptures between the streams. In
other words, in the ‘normal’ case, the pre-​egoic streaming, hyletic or passively
lived bodily experience, and self-​thematizing actively intentional egoic life are
generally aligned in such a way that the life of the self-​reflective ego is character-
ized by this alignment. As we saw with Gendlin and Rogers, the alignment of
these three streams of time is particularly problematic for schizophrenic clients.
As showed in the third tenet, sub-​verbal language is more meaningful than any
meaning expressed through words. The loss of a strong sense of self as a subject
equates to a certain extent to a loss of grasping the personal stream of time as
one’s own. Clients lose themselves, so to speak, in primal original streaming
and therefore are unable to grasp as their own their present in which the hyletic
syntheses of their matter acquires causal meanings within a flow of ‘befores’ and
‘afters’.
It is on this layer, between the first stream (pre-​temporal and egoless) and
second stream (immanent experience), that a particular form of intentionality
operates which is closely linked to the life of the volitional body; Husserl named
it practical2 and operating intentionality (Hua VIII, 34; Hua XI, 61; Hua XIV,
172). On this level the first stream of hyletic data relates to ego in the form of
stimuli (Reize) and generates a number of egoless affections, drives, and reac-
tions. At this stage the flow of the world is absolute (in other words inconceiv-
able, ungraspable by personal subject) and not yet interrupted by my presence in
the stream. It is only when the absolute presence of consciousness interacts with
the passive stream of hyletic data and stimulates my ego that the third stream,
that of the life-​world, is finally disclosed with a meaning that we assign to it. The
clients described in Gendlin and Rogers’s study seem to be stuck in the tran-
sition from the first to the second stream of time in such a manner that they
cannot assign a meaning to what their now means for them as living subjects in
the world.
Unfortunately, most of the time linguistic descriptions of the interrelation
between these three streams are inadequate, because our language is enslaved
to world-​time. It is practically impossible to narrate our experiences outside
of the flow of befores and afters. We need to tell our stories and order our
knowledge according to a before and after, a cause and an effect, while events
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172 Susi Ferrarello

themselves are just e-​venientes (‘coming-​from’), hyle (matter) occurring in

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

Daseinswert and the volitional body

Being able to fully inhabit and own your body in your lived-​time enables the
emergence of what Husserl called Daseinswert (value of being). Daseinswert is
the concretization of practical intentionality, in the sense that it refers to the
volitional body’s primordial axiological functioning (wertvoller Leistungen). In
other words, this primordial axiological Being represents the most basic level of
embodied choosing, prior to self-​reflection. This level of human living occurs
pre-​egoically, on the margins so to speak of reflective self-​awareness, as the locus
of consciousness. This ‘selfless’ and pre-​reflective being is affected by hyletic
 Husserl’s Ethics and Psychiatry 173

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

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

Being in the society

Thus far I have examined the process of ownership per se. It is true, though,
that this process always takes place within a community, and it is true, as well,
that every community has its own way of interpreting time and body. Owning
our body and time in an originary way within our community is a difficult task,
because the community already holds pre-​interpretations of temporality and
bodily life. Nevertheless, every time we fail in the endeavour of owing our body
and time, we lose touch, a little bit more, with an authentic sense of our self and
its living boundaries.
The three tenets of Gendlin and Rogers’s approach reflect the relationship
between the individual and the community, since these tenets are embedded
in an intersubjective context. The therapist is one who, in society, is recognized
as mediating individuals’ process of differentiation and individuation within a
community. Empathy is the key term for understanding this mediation. In par-
ticular, in Stein’s (1917/​1989) doctoral dissertation on empathy supervised by
Husserl, she points to a specific form of empathy, iterated empathy, by which she
means the self-​imagining of the other as being with her own self. This iterated
empathy allows the therapist to ascribe the intentional acts of others to herself
as if she were to live their intentional lives. The therapist chooses to be with4 the
client in order to lend her eyes and show her different ways to look at the inter-
subjective community.
According to Husserl, the steps to live the other are the following: I live in the
world according to a natural attitude. In this attitude I do not recognize myself
as a sphere of owness (i.e., I have no ownership over my body, my time and my
 Husserl’s Ethics and Psychiatry 175

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

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

Conclusions

In the first part of the chapter I presented Gendlin and Rogers’s approach and
discussed its three tenets.6 According to Gendlin the third point pertaining to
the sub-​verbal, affective, pre-​conceptual nature of the basic therapeutic com-
munication (Rogers, 1957, 1959b) is the most problematic. For this reason,
I used Husserl’s descriptions of the volitional body, practical intentionality and
the three layers of time in order to show how phenomenology explores the
 Husserl’s Ethics and Psychiatry 177

pre-​conceptual and affective dimension of human relationships. Re-​envisioned

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

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

Notes

1. ‘That my own essence can be at all contrasted for me with something else, or that
I (who am I) can become aware of someone else . . . presupposes that not all my own
modes of consciousness are modes of my self-​consciousness’ (Hua I, 135).
2. In his works Husserl mentioned multiple forms of intentionality: instinctive
(Yamaguchi, 2001), vertical, longitudinal (section 3.2.4 & ­chapter 6XXX),
collective, intersubjective, social, affective (cf., e.g., Hua XIV, 196ff. and Husserl,
1923), vitally flowing intentionality (lebendig strömende Intentionalität) (Hua VI,
259), intentional will (Willensintention or Willensmeinung). All these forms of
intentionality stand for the tension that connects us with what seems to be outside
of us. In his paper ‘Practical Intentionality and Transcendental Phenomenology as
Practical Philosophy’ Nam-​In Lee (2000, p. 50) defines practical intentionality as the
form of intentionality that determines every other form of intentionality. This is so
because practical intentionality represents the whole stream of consciousness that
fulfills willing intentions and determines every conscious act, even transcendental
ones (p. 55). In particular, practical intentionality is the hyletic continuum that
is embodied by a volitional subject. The subject is a locus for the living of that
continuum. According to Lee this continuum is characterized by always seeking
to be, and the horizon of this being is intersubjective and historical (p. 56). Ethical
science clarifies the motivations that are at the basis of this ‘seeking to be’. As Crowell
(2013, p. 275) put it with admirable clarity: ‘Practical intentionality ultimately
 Husserl’s Ethics and Psychiatry 179

depends not on the individual conscious acts of perceiving, feeling, and willing
but on a certain ability-​to-​be –​namely, to be rational, to take responsibility for
normative assessment.’ As Crowell and Melle (1997) remark, for Husserl all acts
that can be considered ‘willing’ are modes of practical intentionality; furthermore,
Husserl distinguishes acting intentionally –​Entschlußwille (decision-​will) –​from
the intentionality of action –​Handlungswille (action-​will). While the former is the
intentional ‘deciding’ (fiat) that comes after a deliberation, the latter is more properly
named practical intention, because it indicates the intention that precedes and
accompanies the action itself.
3. In Manuscript E III 5 (Hua XV, pp. 593–​7), Husserl introduces the expression
‘impulsive intentionality’ (Triebintentionalitaet) as a pre-​direct, non volitive,
and essentially Ego-​less form of intention. ‘I have introduced it not as an egoic
<intentionality> (characterized in the widest sense intentionality of willing) <but>
as founded in a Ichlose passivity’ (Universale Teleologie).
The primal hyle (Ur-​hyle), which Husserl calls Stoff (stuff), corresponds to
undifferentiated material, which accompanies the development of hyle into an egoic
matter (Manuscript C IV, 18). For example, a house appears to me in a manifold of
appearances that gather chaotic hyletic matter into an intelligible form (Hua XVI,
49–​50). ‘The proper appearance and the improper appearance are not separate
things; they are united in the appearance in the broader sense’ (Hua XVI, 49). Real
and ideal, the intuitive and the conceptual are given all at once. ‘This <the real>
appearance is not presentational, although it does indeed make its object known in a
certain way’ (Hua XVI, 50).
What Husserl calls ‘hidden intentionality’ (Hua XVI, 21) is a part of that practical
intention that comes into being as the primal hyle presents itself and gives itself
intuitively. This form of intentionality, properly speaking, is not phenomenological
because it prepares the ground for phenomenological reflection, as it is both pre-​
reflective and passive (Hua XL, 366; En tr. 21). Yet, we cannot conclude that it is
not intentional at all or does not relate to what is phenomenologically intentional.
We would not be able to reflect on any meaning or intentional essence if the matter,
both hyletic and essential, did not present itself. This is the form of intentionality
through which we can become living bodies; this is the form of force that impinges
on the matter that our body is as Koerper and awakes us into a living body. ‘Purely
through their (prehyletic data) own essence and in passing from one mode to the
other, they found the consciousness of the unity and of the sameness of what is given
to consciousness in them’ (Hua XL, 366; En tr. 21). There is ‘a background lived-​
experience’ that ‘finds’ a way to become ‘sameness’ or ‘unit’ or ‘present’ (Hua XL,
366; En tr. 21). Becoming a subject means commitment to be responsible for one’s
unity. The living thing becomes a living subject when its material body becomes a
volitional body and commits itself to own its matter.
180

180 Susi Ferrarello

‘Primordiality is a system of impulses. This intentionality has its transcendent

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

References

Betz, B., & Whitehorn, J. C. (1956). The relationship of the therapist to the outcome of
therapy in schizophrenia. Psychiatric Research Reports of the American Psychiatric
Association, 5: 89–​106.
Biceaga, V. (2010). The concept of passivity in Husserl’s phenomenology. London and
New York: Springer.
Carr, D. (1999). The paradox of subjectivity. Oxford: Oxford Press.
Donohoe, J. (2004). Husserl on ethics and intersubjectivity. Amherst,
NY: Humanity Books.
Englander, M. (2015). Selfhood, empathy, and dignity. In S. Ferrarello & S. Giacchetti
Ludovisi (eds), Values and Identity. Cambridge: CSP.
Ferrarello, S. (2015). Husserl’s ethics and practical intentionality. London &
New York: Bloomsbury.
Gendlin, E. T. (1961a). Experiencing: A variable in the process of therapeutic change.
American Journal of Psychotherapy, 15: 233–​45.
Gendlin, E. T. (1961b). Initiating psychotherapy with ‘unmotivated’ patients. Psychiatric
Quarterly, 35: 134–​9.
Gendlin, E. T. (1962). Experiencing and the creation of meaning. New York: The Free
Press of Glencoe.
Gendlin, E. T., Jenney, R. H., & Shlien, J. M. (1960). Counselor ratings of process and
outcome in client-​centered therapy. Journal of Clinical Psychology, 16: 210–​13.
Hart, J. (1992). The entelechy and authenticity of objective spirit: Reflections on
Husserliana XXVII, in Husserl Studies, 9, pp. 91–​110.
Husserl, E. (1973a). Phänomenologie der Intersubjektivität. Texte aus dem Nachlass.
Zweiter Teil. 1921–​28 (ed. I. Kern). The Hague: Martinus Nijhoff (Hua XIV).
Husserl, E. (1973b). Experience and judgment: Investigations in a genealogy of logic
(trans. J. Churchill and K. Ameriks). London: Routledge & Kegan.
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Husserl, E. (1988). Vorlesungen über Ethik und Wertlehre. 1908–​1914 (ed. U. Melle) .
The Hague: Kluwer Academic Publishers (Hua XXVIII).
Husserl, E. (2002). Natur und Geist. Vorlesungen Sommersemester 1919 (ed. Michael
Weiler). Dordrecht, Netherlands: Kluwer Academic Publishers (Hua-​Mat IV).
Laing, R. D. (1960). The divided self: An existential study in sanity and madness.
Harmondsworth: Penguin.
Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality
change. Journal of Consulting and Clinical Psychology, 21:95–​103.
Rogers, C. R. (1959a). A theory of therapy, personality, and interpersonal relationships
as developed in the client-​centered framework. In S. Koch (ed.), Psychology: A study
of a science, vol. III. Formulations of the person and the social context, pp. 184–​256.
New York: McGraw-​Hill.
Rogers, C. R. (1959b). A tentative scale for the measurement of process in
psychotherapy. In E. A. Rubinstein, and M. B. Parloff (eds), Research in
psychotherapy. Washington, DC: American Psychological Association.
Spiegelberg, H. (1972). Phenomenology in psychology and psychiatry. Evanston, IL:
Northwestern University Press.
Stein, E. (1917/​1989). On the problem of empathy. Washington: ICS Publications.
182
 9

The I and the We

Psychological Reflections on Husserl’s Egology

Marc Applebaum

Introduction

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

Husserlian sense of the ‘we’ by exploring the layers of the ‘I’ and its origins and
embeddedness, for Husserl, in I-​You relations –​that is, within the we-​world of
companionship (socius) and community.
Sociality refers to our companionship (Latin: socius) with fellow human
beings, the living-​together-​with within which the work of psychiatry and psy-
chology is situated. To shed light on the meanings of socius for psychiatry and
psychology, I will not address the ‘we’ or we-​intentionality in isolation –​as
might be an appropriately sharp focus for philosophical phenomenologizing –​
but rather seek to ground a sense of the we in a Husserlian understanding of the
‘I’s’ that encounter each other in living the ‘we’.
My guiding assumption is that in order to grasp the ‘we’ phenomenologically,
it is necessary to first grasp who and what are the subjects who encounter each
other in an already-​given intersubjective world as persons. Consequently, I will
seek to situate we-​intentionality within phenomenology’s overall account the
constitution of egos. A reader who is new to Husserl or the tradition he initiated
might imagine that a phenomenological understanding of consciousness, ego,
and community could be easily grafted onto mainstream psychological concep-
tions –​for example, the assumptions held by psychodynamic, object-​relations,
or cognitive-​behavioral theory. However, this would be a fundamental flatten-
ing and impoverishing of the phenomenological tradition, neglecting its radical-
ity, and therefore miss what it can offer social psychiatry. Without bracketing
mainstream psychological assumptions about the origins and meaning of the
‘I’ –​that is, without bracketing, one might say, the natural theoretical attitude
of mainstream clinical psychology –​we are likely to replicate the hegemonic
occidental conception of ego within which as Cushman (1995, p. 69) writes,
the ego is envisioned and indeed idealized as individualistic, ‘bounded’, and
‘masterful’, in a manner inseparable from systems of diagnosis and social con-
trol. Phenomenology demands that we regard such normative scientific concep-
tions as constituted and historically situated, rather than accept them as givens,
because to take this conception as given would be to lapse into a kind of naïveté
towards which Husserl (1970, p. 48) wrote, every methodical science tends,
observing in the Crisis that ‘to the essence of all method belongs the tendency to
superficialize itself in accord with technization’. To leave unquestioned domin-
ant theoretical conceptions of ego in a phenomenological approach to psychiatry
would amount to colluding with an impoverished psychological praxis lived as
τέχνη (techne). Instead, phenomenology has a radical task in relation to egology
and sociality; as Hart (1992) has written, this task does not stop at bracketing
the natural attitude in order to unfold how that which appears appears for us; in
 The I and the We 185

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

En-​worlded Relationality and Primordial Relationality

For Husserl our relational life is complex and multilayered. Phenomenologically,

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

appresented to me (ibid.); an analogy is the way in which I see a whole house

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

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

Here we must take the word community quite seriously: it is not meant meta-
phorically, but rather, practically and foundationally, because the genuine
meaning of community –​of socius or companionship in living –​is founded
upon the shared living of a common world, not merely formal correspond-
ences between my perceptions conceived of as ‘my reality’ and ‘yours’; as if we
 The I and the We 187

inhabit private universes within which we each possess a kind of Lordship!

Furthermore, Carr (1987) observes, fidelity to the phenomenon of ‘we-​ness’
means that we cannot describe community as an ‘it’ without falsifying the
lived-​experience. Our meeting in the intersubjective field is an event, a co-​
living the implicates our subjectivities, that can only be named an ‘it’–​as in, ‘It
was a moving funeral service’, through a distanciation that falsifies the lived-​
meaning of the event itself.
For Husserl the implications of we-​intentionality are so far-​reaching that as
Carr (1973, p. 30) writes, they lead ‘to a whole theory of experience, constitu-
tion and the world whose point of departure is no longer individual conscious-
ness but such a community at whatever level it may be found’. For example, as
Carr (1986, pp. 290–​1) explored in a chapter entitled ‘Cogitamus ergo Sumus’,
communities ‘can be considered intentional subjects, analogues in some ways
to individual subjects’, hence the ‘we’ can be understood as a kind of ‘subject or
agent’, and just as a person has her own narrative, so can a community; ‘certain
groups we call communities are subjects for themselves of a kind of life-​story,
just as an individual is’. The implications for social psychiatry of the first kind
of relationality I mentioned above, en-​worlded relationality, begins to stand out
as it becomes clear that a phenomenologically informed social psychiatry can
examine both the co-​constitution of communal experience and life at multiple
levels –​in intimate relations, families, cultures, and subcultures, in a way histor-
ically and linguistically situated –​as well as examining the breakdowns or rup-
tures in communality, the obstacles or fissures in co-​constitution and co-​living
that makes full use of Husserl’s work, largely neglected by psychologists thus far
on affective intentionality, which will be addressed below.
Everything we have traced so far in terms of relationality is centered upon the
layer of everyday lived experiences in which ‘I’ am already named for myself as
‘this person’, with a personal history, identity, name, and so on –​I have termed
relationality so situated an ‘en-​worlded relationality’. As we will see, Husserl
(1989, p. 128) refers to this layer of being-​an-​I who has relations with others as
the ‘personal ego’ or the ‘empirical ego’, and this is the layer of the ego properly
named ‘the real psychic subject’. But for phenomenology this is but one layer of
being an individuated locus of consciousness. It is clear that en-​worlded rela-
tionality already offers a perspective on the life of consciousness that emphasizes
its embeddedness in communities and shared narratives as constitutive of psy-
chological life not centered on the individual human person in isolation. Perhaps
even more radical a shift away from the solus ipse is pointed to by Husserl’s work
on primordial relationality and its place in constituting the ‘I’.
18

188 Marc Applebaum

While phenomenological philosophical inquiry is rightly regarded as

emphasizing a first-​person perspective, it is sometimes for this reason miscon-
strued as neglecting intersubjectivity and narrowly focusing on ‘private’ experi-
ences in a way that risks solipsism and a fatal devaluation of interrelatedness
(cf. Zahavi, 2003).2 Were it the case that phenomenology exclusively grounds
its claims in the private experiences of a self-​contained, solitary I, and from
this solus ipse proceeds to deduce the alter ego as a mere analogue to its own
primacy, phenomenology would invite the charge of solipsism, since it would
reduce the otherness of the Other to, as Hart (1992, p. 179) puts it, ‘simply a
declension of me’. In fact as Hart maintains, rather than inviting the charge of
solipsism, Husserl argues that the core of one’s sense of being an ‘I’ –​by which
is meant in this instance being an empirical, personal ego –​derives from the
originary, primary experience of being recognized by an Other: ‘in a genetic-​
constitutional sense I am, first of all, The Other to Others’ (ibid.). That is, I-​ness
arises within a relational matrix; moreover, Hart argues, for Husserl the ego’s
primordial sense of its ‘I’ is in a sense given to the ego through its encounter
with the Other as ‘the first personal “I” (ibid.). That is to say: the You is the first
‘I’, I ‘learn’ my ‘I’ through the encounter with the You. As Hart puts it, ‘the ori-
ginal sense of “I” is not what I refer to but to what I perceive the Other to refer
when self-​referring’ (ibid.).
More specifically, being seen by the Other –​being recognized as an Other by
the Other, is that which grants me a full sense of my ‘I’, the Other’s extending
himself toward me in what Hart (1992) refers to as ‘gracious regard’, because in
this view, I-​ness is a kind of gift given through a caring, even a primorially lov-
ing relationship. Hart describes this as occurring developmentally in infancy, for
an ‘I’ who has not yet arrived at self-​reflecting and position-​taking acts of con-
sciousness (ibid., p. 180). Here, we are engaging with the genetic dimension of
Husserl’s phenomenology, because we are seeking to reconstructively trace our
way back (the Rückfragen) to the grounds of lived intentionality in its ongoing
flowing between passivity and activity –​in Hart’s words, to ‘the awareness of an
infant or waking monad’, which static phenomenology, focused exclusively upon
the examination of active intentionality’s cognitive achievements, cannot access
(p. 185). Hart’s linking of the infant to the ‘waking monad’ alerts us that the I’s
reliance upon the Other is in principle not limited to infancy, but also is embed-
ded at a primordial level in all relating-​in-​awakening, since as we will see below,
for Husserl every monadic, streaming locus of consciousness that awakens to
‘find’ itself as this person in the world is simultaneously, at a deeper stratum, an
anonymous, pre-​reflective, and not-​yet-​self-​recognizing hyletic flow.
 The I and the We 189

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

that for an inquirer to discover the primordial ground of his or her empathic
relations would require genetically tracing the instinct back to its pre-​egoic
ground. Moreover, I would like to argue that the primordiality of the finding
oneself in relating to the Other has a strong purchase on the human person pre-
cisely because its ground is pre-​egoic in the sense of prior to and constitutive of
personal selfhood. For this reason the call to attend to the empirical Other is
never solely a factual one, it is always also a primordial call: it calls to the per-
son at a level that is prior to the constitution of the narrative so often taken, in
a natural attitude, as his or her essential self.5 Or, otherwise put, the You is not
something encountered by an already self-​aware ‘I’: instead I-​ness arises for a
locus of consciousness finding itself as an I in the midst of its encounter with a
You, a finding prompted by the presence of that You. Husserl questions precisely
what kind of identity, if it is an ego-​identity at all, can be associated with the
ground of empathy? ‘Is it already I?’ he asks, ‘Is it not rather the case that only
through the transcending of its subjectivity in the non-​memorial represencings,
those of empathy, that the “I with the Others”, I and Others as existing, comes
to be?’ (D 10 IV, 18, cited in Hart, 1992, p. 186). So the ground of community
and human interrelatedness for a phenomenologically informed social psych-
iatry is to be found in this direction –​the inquirer’s genetic tracing back beyond
the empirical ego to her pre-​egoic source. Hart’s argument, strongly relevant for
social psychiatry or psychology, is simultaneously ontological, axiological, and
erotic: ‘there is a basic analogy and symmetry of love as self-​displacing and self-​
communalization which are the conditions for self-​consciousness (wakefulness)
and the presence of Others through empathy’ (p. 231). Drawing out the implica-
tions of these three intertwined levels is a matter for future work.
If we shift our focus from the primordial to the context of everyday life in a
natural attitude, the I’s embeddedness within a world given to me with my fel-
low men and women is so emphasized by phenomenology that Merleau-​Ponty
(1996, p. xi) remarks in the Phenomenology of Perception, ‘[T]‌there is no inner
man, man is in the world’, and it is helpful to consider that the world meant
here is in Husserl’s words a ‘we-​world’, a Wir-​Welt, or a ‘with-​world’, a Mitwelt
(Moran, 2012, p. 288). Hence being in contact with world cannot be conceived
of as a private affair; rather, Husserl (1973, p. 91) claims phenomenological
praxis discloses that ‘I experience the world (including others) –​and, accord-
ing to its experiential sense, not as (so to speak) my private synthetic formation
but as other than mine alone [mir fremde], as an intersubjective world, actually
there for everyone, accessible in respect of its Objects to everyone’ (emphases in
the original). I will next examine in greater detail the layers of the ‘I’ discussed
 The I and the We 191

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

Husserl’s Egology: The Pure and the Personal Ego

Husserl (1989) frequently describes consciousness using the metaphor of geo-

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

Thus the layers of pure and the personal or empirical ego are in constant inter-
play as constituting and constituted; as the pure ego intentionally grasps its liv-
ing as the life of an empirical identity, the layer of personal subjectivity coalesces
as the person names her objects and herself, with the world-​for-​consciousness
emerging in simultaneous and differing ways for each layer. In relation the world
as spacio-​temporal setting, Husserl (1989, pp. 116–​17) notes, ‘the empirical Ego
in the form, I as man, functions as the phenomenal-​real central member for the
constitution, in appearances, of the entire spatio-​temporal world’.
For Husserl (1989, p. 264), the arising of the personal ego within the streaming
life of a given monad does not occur in a self-​contained, solipsistic way through
self-​perceptions and self-​experience, nor is it assembled so to speak associatively
through actively intended actual experiences. Rather, the personal ego arises ‘out
of life’ –​in Husserl’s words; life ‘is what it is not for the Ego, but it is itself the
Ego’ (ibid.). In other words, the ego is a locus of living and located empirically
in time and space –​it is not a composite of associations about life. This living is
not solitary, hence the development of the personal ego is shaped by one’s inter-
relationships with others, both individual others and the communal context in
which one lives, including ‘the demands of morality, of custom, of tradition’,
which can be taken on either passively, or through active position-​taking –​that
is to say, through the reasoning and ethical choices one makes in relation to the
social context in which one finds oneself (pp. 281–​2). The ego’s choices are for-
mative in that through its chosen behaviors ‘the Ego exercises itself, it habituates
itself, it is determined in its later behavior by its earlier behavior, the power of
certain motives increases, etc. The ego “acquires” capacities, posits goals, and, in
attaining these goals acquires practical skills’ (p. 265). Hence the personal ego ‘is
constituted out of one’s own (active) position-​taking, and out of one’s own habits
and faculties, and consequently is an externally apperceptive unity, the kernel of
which is the pure Ego’ (p. 278; emphasis in the original).
Simultaneously the pure layer of the ego is a strata of one’s conscious life that
demonstrates unity and uniqueness, in that ‘[t]‌he pure Ego is . . . numerically
one and unique with respect to “its” stream of consciousness’ (Husserl, 1989,
p. 117). We can say the pure ego is individuated in that there is a sense in which
‘every human-​ego harbors its transcendental ego’ (Husserl, 2001, p. 471). In itself
the pure layer of ego is not a person with a personal identity; rather, it is the con-
stituting source of that personality: it is the ongoing ‘nucleus’ of a conscious life
that is required for the sense of a personal ego to continue to arise and change as
an identity that undergoes changes in time. In contrast to this mutability:
 The I and the We 193

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

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

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

Descriptive Example of the Interplay of Pure

and Personal Ego

As noted above, we would misunderstand Husserl if we were to view the pure

and personal egoic layers as walled-​off from each other or strictly separable,
since as the center of constitutive life, the transcendental layer of ego is dynamic
and ongoingly constitutes the personal ego and its world.9 As modes of the flow-
ing life of the monad, the pure and personal layers of ego are co-​present in vary-
ing degrees in everyday experience. To give an example of their interrelatedness
and constant intertwining, I will describe an actual experience of the following
phenomenon: struggling to remember something that felt important. In so doing
I will rely on Husserl’s accounts of active and passive intentionality, affective
intentionality and awakening, and hence both the static and genetic dimensions
of Husserl’s phenomenological praxis. My aim is to convey the complex layers
of Husserl’s egology, the dynamism characterizing individual egoic life –​a life
always situated among and in relation to others –​and begin to suggest the way
individual agency is grasped phenomenologically. Now, to the description:
During a period of time in which my family was struggling to cope with my
father’s deepening Alzheimer’s, one day the image of an actress came to mind,
but I was unable to remember her name. In trying to remember the name of this
actress, a remembering which felt emotionally compelling, I began to search in
a memorial way for her name, which was present to me as a kind of frustrating
absence. It was as if the name of the actress was somehow ‘in’ me but I could
not grasp it: her image both as a young girl and a woman was easily available to
me in memory, yet the name eluded me. Searching in an associative way, I ran
through multiple roles she played in film: as a young girl opposite Jean Reno in
Leon the Professional; as a princess and mother of Luke Skywalker in several of
the Star Wars sequels, even as a ballet dancer in Black Swan, a film I have never
actually seen! More than that, I remembered easily that like me she is of Jewish
background, and I had some additional associations of her having married
 The I and the We 195

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

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

capacity to remember, just as his father was increasingly losing it. Importantly,
that fearful horizon is present even though it is not being fully reflected upon
in that moment –​because the personal ego always brings with it its context, its
horizon, and its history, which is not merely a cognitive horizon and history but
an affective one as well.
Indeed, the faintly fearful quality of being unable to remember something
was a fairly recently sedimented habitual way of living the phenomenon of fail-
ing to remember something, in his life, because it was only the past seven years
since his father’s Alzheimer’s diagnosis, and as he approached the age of fifty
himself, that the meaning of being unable to remember had become something
fearful for him rather than merely inconvenient and unremarkable, a mere fact
that would likely trigger nothing more than Googling ‘Leon the Professional’!
Previously he might simply have pulled out his phone or asked a friend for the
actress’s name; now remembering becomes its own task. Thus far we have seen
a moment in the passive flow of consciousness in everyday life in which the lay-
ers of ego are present but the personal ego is only indistinctly so, followed by a
shift to an emphasis on active intentionality and the personal ego as the subject
that so to speak coalesces in facing an obstacle, and in relation to that object of
consciousness his ego-​identity as a subject is evoked. As we will see, remember-
ing is seized upon as a task by the personal ego, yet the inability to remember is
subjectively frustrating because it points to an act which transcends the personal
ego’s capability and is beyond the scope of the personal ego’s agency.
I will now return to the first-​person narrative:
I discovered no matter how much I searched memorially, I could not grasp the
name of the actress. I withheld myself from solving this problem technologically
or socially; instead, I chose to live with the absence of the name indefinitely in
order to find out if I remembered later. I then let go of the struggle and, for days
and maybe weeks I would occasionally recollect the actress’s image and return
to the question of her name, which continued to evade me. An indefinite num-
ber of days later, again in the midst of the flow of everyday life, with the ques-
tion coming in and out of my awareness, the name ‘Natalie Portman’ suddenly
came to me, I think not even in a moment in which I was aware of searching
for it. Once the name was there, I felt relief and joy! The way the name stood
out was precisely not as the outcome of my effort in that moment; on the con-
trary, it seemed that her name was suddenly present for me, disclosed to me, and
I merely witnessed it and felt the ongoing question answered and the absence
fulfilled by a meaning which had somehow been present with me all along, but
absent. To say that ‘I remembered’ is only partially descriptive of my experience,
 The I and the We 197

because ‘remembering’ was not an experience of ‘my’ accomplishing ‘my’ task.

Instead, an answer was given to me.

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

stage the intentionality of feeling is yet ‘without active egoic participation’; so

there is a ‘turning towards in feeling’ which is not yet actively intentional, hence
not yet egoic, and becomes actively intentional and egoic as the pre-​egoic locus of
consciousness awakens as this ego amid its feeling-​ful turning-​toward its object
(pp. 280–​1). Contrasting the sleeping and wakeful states, Husserl (1989, p. 265)
writes: ‘In contrast to the waking ego, the sleeping [Ego] is complete immer-
sion in Ego-​matter, in the hyle, is undifferentiated Ego-​being, is Ego-​sunkenness,
whereas the awake Ego opposes itself to the matter and then is affected, acts,
undergoes . . . the Ego unceasingly constitutes its “over and against”, and in this
process it is motivated and always motivated anew, and not arbitrarily’ (emphasis
in the original). Since ‘Ego’ refers to two distinct layers, pure and personal, the
use of ‘Ego’ can be confusing. Since it is the pure layer of the Ego that constitutes,
and the personal Ego that is among the constituted, Husserl’s statement above of
necessity refers to objects exercising affection upon the pure Ego. Regarding this
aspect of the passive life of the pure Ego, which is pre-​egoic in the sense of being
prior to the personal Ego, Husserl (2001, p. 278) writes: ‘[W]‌hat is constituted
within passivity . . . as an object, can lead to a feeling already within this passiv-
ity.’ This is to say, the passive life is already an affective life, because its objects
are grasped ‘as pleasurable or unpleasurable, as agreeable or disagreeable’, which
‘founds a novel consciousness: a layer of consciousness of the intentionality of
feeling’, and ‘sedimented in it, or rather, in the noema, is a new moment precisely
as the character of feeling, for instance, as ‘pleasurable’, or in the case of frustra-
tion, as ‘painfully lacking’, and the like’ (ibid.). Hence, ‘the object is constituted in
and through the objectivating that underlies the intentionality of feeling’ (ibid.).
The implications of this claim for the psychology of embodiment far exceed the
scope of the present inquiry, but in reading Husserl here, we are clearly not in
the presence of a cognitivist: affect (Gemüt, sometimes translated as ‘heart’) and
affect-​consciousness (Gemütbewusstsein) are foundational. Embodiment is cen-
tral here: as Husserl notes in the midst of discussing affect-​consciousness, ‘sen-
suous consciousness underlies all valuing . . . matter, and in a higher level . . .
nature’ (note 166, p. 277).
The descriptive example we have taken up exemplifies affective intentional-
ity in a case of a frustrated inability to remember, and the reawakening of the
memorial object. Clarifying his use of the term ‘awakening’, Husserl (2001, p. 221)
writes, ‘[B]‌y awakening we understand and distinguish two things: awakening
something that is already given to consciousness as for itself, and the awakening
of something that is concealed.’ The awakening occurring here is of a mean-
ing that was given to consciousness, retained, but then became concealed, and
 The I and the We 199

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

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

All of this can be said to be present in the descriptive data –​in particular, the
coming into play of both passive and active intentionality, stimulated by desire,
and joy at the fulfillment of that desire.11
 The I and the We 201

Conclusions

The aim of this chapter was to convey a sense of the complexity of Husserl’s egol-
ogy and its implications for the psychology of everyday life, and to point to the
way in which for Husserl even the most seemingly solitary sense of ‘I’ is already
indebted to a You, that is, to a primordial communalization. To offer descrip-
tions illustrative of lived relationality will be the aim of future research.
This chapter sought to convey that, in contrast to the misreading of phe-
nomenology as verging on solipsism, a careful reading of Husserl demonstrates
both that the ego is neither strictly bounded nor ever accurately described as a
solus ipse –​either in its everyday living or in its originary encounter with others
and the world. As the phenomenologizing I, I discover I am not the absolute
owner of my actions, though as the actively intending ‘I’, I face ongoing choices,
ongoing and intrinsically ethical position-​takings –​as the ‘I’ of ‘I can’ and ‘I do’
(Ferrarello, 2016). Yet the personal Ego, the ‘I’ who finds himself as the I who can
or the I who must, is already given to himself in a bodily and affective stream-
ing that transcends his personal, narrative identity because it is already given
hyletically, already in the flow of an affective, bodily, socially, historically situ-
ated life –​and it is precisely within this pregiven horizon that the ‘I’ awakens.
It is as the life of a locus of consciousness already engaged in the world that the
personal Ego awakens in moments of choice, including choosing how I name
(predicate) an object of consciousness. Similarly, the attributes with which I can
predicate myself in a given moment –​as a diligent or a lazy piano student, a
loyal or unreliable friend, a grateful or ungrateful son –​are each named or rec-
ognized by the personal Ego in the flow of an already-​present life, in a life shaped
not only by the personal Ego’s sedimented habits which lead me to repetitive
actions in a semi-​asleep way, and by the sedimented, shared habits of the mul-
tiple communities I inhabit –​familial, friendly, communal, cultural –​but also by
the Transcendental Ego’s habitus, its habitual way of finding itself in the world,
the ‘it’ which is the constituting nuclear core of the ‘me’ that I name as a personal
Ego.12 Hence the attributes I can name as mine are only relatively so –​I am never
the absolute owner of my acts or attributes as a personal Ego; rather, I discover
them always already in motion. Finally, as the phenomenologizing ‘I’, I like-
wise discover that the constituting kernel of my I-​ness transcends my personal
Ego, transcends all the ways in which I narrate my life story or describe myself,
because the source of my living as this monad, this locus of consciousness, tran-
scends my ability to grasp or name it or assign predicates to it –​the ground of my
20

202 Marc Applebaum

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

Notes

1. The phrase ‘pre-​egoic’ can be confusing because it refers to the pure or

transcendental egoic layer of consciousness that is ‘prior’, so to speak, to the personal
or empirical ego. So the ‘pre’ is in relation to the personal, empirical ego.
2. Zahavi (2003, p. 109) notes that ‘Husserl’s phenomenology has very frequently been
accused of being solipsistic’, that is, ‘a position that either claims that there only
exists one single consciousness, namely one’s own, or that argues that it is impossible
to know whether there are in fact any other subjects besides oneself ’.
3. For a phenomenological psychological discussion of empathy as following the other,
see Englander (2014).
4. Hart (1992, p. 225) argues Husserl’s assertion that ‘our self-​presence is analogously
empathic’ in its primordial deference to the Other ‘occasioned Husserl once to claim
that love is a chief problem of phenomenology’, by which Husserl meant that love ‘is
a universal problem for phenomenology because it embraces the depths and heights
of intentionality as a driving and productive force’.
5. For a useful phenomenological critique of an exclusively narrative account of
selfhood, see Zahavi (2007).
6. For example, Husserl (1989, p. 313) writes, ‘The Ego . . . is not an empty pole but
is the bearer of its habituality, and that implies that it has its individual history’.
Donohoe (2004, p. 182) summarizes the late Husserl’s account of ego development
in the following way: ‘The ego adopts positions on the basis of its preexisting
culture. Those positions evolve into habits, thus providing an identity for the ego.
The instinctual connection of the ego with the Other(s) lays the groundwork for the
higher-​order we that takes on an identity of its own.’
7. Cf. Luft’s (2011) discussion of Husserl’s concept of the ‘transcendental person’ and
the response to Heidegger’s critique of transcendental subjectivity.
8. Husserl (2001, 481) writes, ‘[W]‌e can say with respect to the primordial present
that “unconsciousness” is consciousness in the primordial present; the sensible
object of which we are unconscious along with all the other objects of which we
are unconscious are “given to consciousness” in an undifferentiated manner in a
zero-​consciousness.’
 The I and the We 203

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

References

Applebaum, M. (2014). Intentionality and narrativity in phenomenological

psychological research: Reflections on Husserl and Ricoeur. Indo-​Pacific Journal of
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Buber, M. (1970). I and thou (trans. W. Kaufmann). New York: Charles Scribner’s Sons.
Carr, D. (1973). The ‘fifth meditation’ and Husserl’s Cartesianism. Philosophy and
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Carr, D. (1986). Cogitamus ergo sumus. The Monist, 69(4):521–​33.
Carr, D. (1987). Interpreting Husserl: Critical and comparative studies.
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Englander, M. (2014). Empathy training from a phenomenological perspective. Journal
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Husserl, E. (1989). Ideas pertaining to a pure phenomenology and to a phenomenological

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Luft, S. (2011). Subjectivity and lifeworld in transcendental phenomenology. Evanston,
IL: Northwestern University Press.
Merleau-​Ponty, M. (1996). Phenomenology of perception (C. Smith, Trans.).
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Moran, D. (2012). Husserl’s crisis of the European sciences and transcendental
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(ed.) Narrative and understanding persons. Royal Institute of Philosophy Supplement
60, pp. 179–​201. New York: Cambridge University Press.
 Names Index

Aaltonen, J. 149 Churchill, S. D. 4, 62, 65–​7, 72, 83

Abram, D. 65 Combs, A. W. 67
Aggernæs, A. 34 Conrad, K. 31
Alakare, B. 149 Coplan, A. 50
Allport, G. W. 67 Coppola, S. 87
Angel, E. 2, 85 Corin, E. 40
Applebaum, M. 5, 180, 183, 203 Corrigan, P. W 15
Arendt, H. 151 Cosgrove, L. 8
Aristotle 75, 84, 138, 140 Cushman, P. 184, 191
Cutting, J. 32
Bailey, D. E. 67
Banner, N. F. 151 Davidson, L. 3, 7, 8, 11, 14–​16, 18, 20–​2,
Barr, L. 15 40, 49, 54, 56–​9, 61
Barrett, T. R. 28 Davies, B. 152
Basaglia, F. 15, 21–​2, 137 Deegan, P. E. 14
Basso, E. 151 De Jaegher, H. 131
Bayne, T. 13 Deleuze, G. 19
Beattie, J. 143, 152 Depraz, N. 153
Berrios, G. E. 32 Desai, M. U. 4, 95, 105–​6
Betz, B. 164 Dewey, J. 151
Bhugra, D. 1, 49 Dilthey, W. 4, 70–​1, 73, 84–​5
Biceaga, V. 168 Donohoe, J. 169, 202
Binder, P.-​E. 126, 129 Dörner, K. 149
Binswanger, L. 2, 85, 137, 145, 152
Blankenburg, W. 38, 138, 146–​7, Ellenberger, H. F. 2, 85
150, 152–​3 Engel, G. L. 97
Bleuler, E. 13, 33–​6 Engell, J. 83
Bongaardt, R. 4, 121, 129 Englander, M. 1, 3, 41, 49, 54, 58, 61, 83,
Bourdieu, P. 143, 148, 151–​2 153, 180, 202
Bovet, P. 58, 153 Etheridge, E. 28
Brentano, F. 72, 85 Ey, H. 33
Brohan, E. 15
Brudal, L. 128 Feilke, H. 151–​2
Buber, M. 189 Ferrarello, S. 4–​5, 161–​2, 197,
Bugter, S. E. W. 151 201
Finzen, A. 1
Canstatt, C. 27 First, M. B. 102
Carr, D. 169, 186–​7, 189 Flanagan, E. 11
Carter, J. 37 Folkesson, A. 59
Cermolacce, M. 30, 39 Fonagy, P. 128
Charbonneau, G. 34 Frith C. D. 13, 19
Chiu, M. Y. L. 15 Froese, T. 124
206

206 Names Index

Fromm-​Reichmann, F. 13, 15 Innocenti, G. M. 153

Fuchs, T. 4, 53, 129, 131, 137, 141, 143,
147, 151–​2 James, W. 142
Jaspers, K. 1–​2, 4, 13, 30–​2, 34, 40, 42–​3,
Gadamer, H. G. 142, 144, 151 58, 72–​3, 147, 152
Gallagher, S. 51–​6, 61, 124 Jeannerod, M. 13, 18
Gallese, V. 51 Jenney, R. H. 163
Gamma, F. 153 Johnson, A. 18
Gammell, D. J. 122 Jones, S. M. 27, 41
Gebauer, G. 152
Geertz, C. 138, 151 Kant, I. 9–​10, 16, 144
Gendlin, E. T. 5, 161–​8, 171, 173–​4, Kendall, J. 130
176 Kleinman, A. M. 16
Gennart, M. 31 Kohut, H. 50
Giorgi, A. 2, 4, 17, 59–​61, 70, 96, 97, Kraepelin, E. 13, 40
99–​100, 102, 106, 121–​5, 129–​30, Krais, B. 152
133 Kraus, A. 147, 152
Giorgi, B. 17 Krueger, J. 51
Gleaves, D. H. 102 Kulenkampff, C. 151
Goldie, P. 50
Goldman, A. I. 51 Laing, R. D. 19, 73, 137, 175, 177
Goodall, J. 85 Langdridge, D. 129
Gorden, R. L. 66 Lemos, N. 151
Gregoric, P. 138 Leudar, I. 32
Guattari, F. 19 Levinas, E. 13, 15, 85, 96
Gurwitsch, A. 69 Liester, M.B. 32
Lin, K. M. 16
Halbreich, U. 122 Lingis, A. 65
Hamlyn, D. W. 67 Lipps, T. 4, 50, 68, 83
Handest, P. 43 Losch, M. E. 28
Hart, J. 170 Lothane, Z. 32
Hart, J. G. 184–​5, 188–​90, 202 Luft, S. 58, 202
Hart, S. 128, 130 Lysaker, P. H. 16
Haug, E. 37
Heidegger, M. 4, 10, 62, 72–​9, 82, 84–​7, Mahy, G. E. 153
96, 202 Maldiney, H. 140–​1, 147, 153
Heinamaa, S. 84 Malt, U. F. 126
Heinze, M. 144 Mann, M. 83
Heller-​Roazen, D. 138, 140, 151 Marazia, C. 151
Henriksen, M. G. 3, 27–​31, 33–​5, 37–​43, May, R. 2, 85
57, 153 Maynard, E. 4, 95, 103–​5
Henry, M. 147 Mead, G. H. 143
Hickling, F. W. 153 Merleau-​Ponty, M. 4, 34, 50, 61, 65, 67, 76,
Holton, R. 151 79–​82, 85, 96, 123–​5, 127–​9, 131, 141,
Husserl, E. 3–​5, 7–​13, 15–​18, 22, 49, 51, 53, 151, 190
58, 62, 66, 68–​70, 73, 78–​80, 83–​6, 96–​9, Merz, P. 149
123–​5, 151, 153, 161–​2, 165–​79, 183–​94, Meyer, A. 13
197–​203 Mezzich, J. 95
Hutchinson, G. 19 Mezzich, J. S. 95
 Names Index 207

Mill, J. S. 70 Røseth, I. 4, 121, 126–​7, 129

Minkowski, E. 2, 141 Rusch, J. 149
Mishara, A. 151 Rüsch, N. 15
Misurell, J.R. 4, 95, 109–​10
Moore, G. E. 151 Sacks, O. 142, 151
Moran, D. 190 Saks, E. 13
Morgan, C. 1, 19 Sarbin, T.R. 67
Morley, J. 123, 129 Sartre, J.-​P. 65, 67, 96, 127, 152
Morrissey, M.B. 4, 95, 113–​14, 116 Sass, L. A. 29–​30, 35–​7, 39, 43,
Müller-​Suur, H. 31 137–​8, 147–​8
Schafer, R. 67
Nasar, S. 43 Scheler, M. 4, 51, 56, 57, 62, 79–​81,
Naudin, J. 39 124
Nelson, B. 37, 39 Schilder, P. 13
Nilsson, L. S. 42 Schlimme, J. E. 58, 147, 153
Nischk, D. 149 Schneickert, C. 152
Nordgaard, J. 37, 43 Schore, A. 130
Schreber, D. P. 43
Olbert, C. 109 Schultze-​Lutter, F. 42
Overgaard, S. 51 Schutz, A. 4, 49, 67, 69–​70, 84
Schwartz, M. A. 147, 153
Pacherie, E. 13 Sechehaye, M. 36
Parnas, J. 28, 29, 30, 31, 33–​4, 37–​9, 41–​3, Seikkula, J. 149
56–​8, 61, 138, 142, 147, 153 Shapiro, K. J. 65
Pienkos, E. 37 Shlien, J. M. 163
Plessner, H. 144 Shusterman, R. 124
Plog, U. 149 Škodlar, B. 32
Posey, T. B. 28 Skoufalos, N. C. 4, 95, 101–​2
Priebe, S. 1 Slade, M. 15
Smith, D.L. 2
Raballo, A. 33, 37 Snygg, D. 67
Rashed, M. A. 153 Solomon, L. A. 8, 17, 22
Ratcliffe, M. 40–​1, 58–​60 Sontag, S. 66
Read, J. 19, 153 Sowa, R. 99
Reich, W. 68 Spiegelberg, H. 2–​3, 162
Reik, T. 67 Spinelli, E. 129
Reininghaus, U. 28 Spitzer, M. 30
Robinson, P. 59 Stanghellini, G. 32, 42, 138, 151, 153
Rodgers-​Johnson, P. 153 Stein, E. 51, 53, 56–​7, 59, 83, 174
Roe, D. 11, 16 Stern, D. N. 9, 124, 127–​31
Rogers, C. R. 5, 50, 67, 161–​4, 166–​8, 171, Stien, P. T. 130
173–​4, 176 Stoppard, J. M. 122
Rohr, E. 50 Straus, E. W. 2, 140–​1, 147, 151
Romano, C. 153 Strauss, J. S. 14–​15
Roosevelt, E. 22 Styron, T. 11
Rosenberg, S. D. 19 Sullivan, H. S. 13, 15
Rosenfeld, S. 139, 151–​2 Summa, M. 144, 150–​1, 153
Rotter, B. 4, 95, 107–​9 Sutton, J. 143
Rowe, M. 15, 21 Synofzik, M. 13
208

208 Names Index

Taft, R. 67 Warner, R. 15–​16, 19

Tellenbach, H. 140, 151 Watson, A. C. 15
Thoma, S. 4, 137, 151, 153 Waxler, N. E. 16
Till, A. 49 Weise, K. 151
Tondora, J. 109 Wertz, F. J. 4, 95, 99–​100
Toombs, K. S. 131 Whitehorn, J. C. 164
Trevarthen, C. 129–​31 Whitney, S. 124
Tronick, E. Z. 130 Wiens, A. 67
Tse, S. 14 Wiggins, O. P. 153
Wigman, J. T. 28
van den Berg, J. H. 2, 85 Winnicott, D. W. 128, 130–​1
Van Duppen, Z. 141, 150 Wittgenstein, L. 143, 146, 151
Van Os, J. 28 Woods, A. 148
Varese, F. 19 Wulff, E. 151
Vassos, E. 148
Vester, M. 153 Yanos, P. T. 16
von Gebsattel, V. E. 151 Yung, A. R. 37
von Weizsäcker, V. 140
Voss, M. 13 Zahavi, D. 51–​9, 61, 83, 124, 142, 147,
188, 202
Waldenfels, B. 146 Zutt, J. 153
 Subject Index

abnormal 27, 32, 177 culture 1, 18, 30, 72, 105, 107, 115, 117,
abnormalities 29, 176 125, 187, 202
anxiety 28, 41, 99, 126–​7, 195 cultural, 1, 7–​8, 10, 14–​17, 19, 22, 103,
105, 107, 109, 116, 124, 125, 131, 143,
being–​in–​the–​world 77–​8, 147–​8 148, 151, 191, 201
biology 28, 117, 166 cross–​cultural 16, 19
body socio–​cultural 10–​11, 123, 127, 143, 148
lived 4, 38, 52–​3, 55, 65, 67–​9, 74–​7,
79–​81, 83–​4, 86, 103, 108, 111, 121, Dasein 77, 85–​7, 174
123–​6, 131, 138, 140–​1, 145, 165, Daseinswert 172–​3, 177
167–​8, 194 delusion 3, 13, 27–​37, 39–​42, 101,
volitional 161–​2, 165–​9, 171–​2, 174, 141, 146–​7
176–​7, 179–​80 delusional 30–​1, 35–​6, 145, 147
boundaries 41, 167, 174 predelusional 31
bracketing 59, 78, 98, 123, 148, 184–​5 depersonalization 141
(see also Epochē) depression 4, 96–​7, 99, 101, 104, 121–​2,
125–​31, 141
child 22, 67, 106, 116, 126, 128–​32, 176 despair 79, 110, 121
childhood 19, 102, 110, 129, 141, 153 dissociation 102–​3
children 76, 105, 106–​7, 117
grandchildren 117 ego 4–​5, 7–​9, 11, 17–​19, 77, 83–​4, 86, 124,
mother–​child 127–​8, 130, 132 166–​72, 175–​7, 179, 183–​5, 188–​202
citizen 2, 21–​2, 148 emotion 68, 80, 103, 124–​5, 128
citizenship 21 emotional 51–​2, 57, 108, 126, 128,
cognition 3, 52, 170 130–​2, 162–​3, 166, 172, 176, 178,
cognitive 31, 102, 113, 139, 142, 149, 170, 194–​5, 199–​200
178, 188, 196 empathy 3–​4, 8, 12, 27, 39, 40–​1, 49–​62,
cognitive–​behavioral 32, 184 66–​72, 76–​7, 79, 83, 86, 114, 122,
cognitive neuroscience 28, 49, 51 124–​5, 128, 130, 142, 153, 163, 174,
cognitive science 29 176, 178, 180, 189–​190, 202
cognitivist 197–​8 empathic reduction (see reduction,
neurocognitive, 19 empathic reduction)
community 1, 5, 10, 12–​13, 15, 20–​1, 65, phenomenological empathy
105–​7, 109, 111–​13, 117, 138, 149, training 54, 58
150, 174–​7, 184–​7, 190–​1 Epochē 41, 98, 100, 122–​3, 125–​6, 128–​9,
consciousness 7–​13, 16–​17, 30, 34, 49, 55, 132 (see also Bracketing)
59–​60, 62, 68, 76, 78, 80, 96, 98–​9, ethic 4–​5, 114, 161–​2, 165–​6, 172, 177
123–​5, 128, 165, 170–​2, 178–​9, 183–​5, ethical 5, 28, 161–​4, 166, 169, 172–​4,
187–​93, 195–​9, 201–​2 178, 192, 201
counseling 50, 62 existence 2, 12, 38–​9, 41, 51, 71, 80–​2, 85,
creative 107, 144, 152, 166, 170 96, 98, 101, 115, 123, 127, 131, 147,
creativity 144, 146, 150, 152 167, 176–​7, 189
210

210 Subject Index

existential 4, 58, 59, 86, 121, 123, 126, narrative 55–​6, 78, 103–​4, 106–​7, 115,
129, 174 162, 183, 185, 187, 190, 195–​6, 201,
expression 52–​3, 55–​60, 62, 66–​8, 70–​1, 73, 202, 203
75–​6, 78–​80, 82, 84, 86–​7, 128, 131, norm 11, 106, 116, 152, 176
141, 143, 147, 164–​5, 173, 178, 179 normal 32, 35–​6, 39–​41, 101, 126, 143,
meaning–​expression 54–​6, 59–​60 149, 161, 171, 175–​8
normalization 146
faith 112, 114 normalizing 146
perceptual faith 141 normative 144, 164, 177, 179, 184
normativity 161, 177
Gestalt 123
psychoanalysis 19, 50
hallucination 3, 13, 19, 27–​9, 32–​6, 39, psychologism 8, 18
41–​2, 56–​7, 59, 97, 99, 123 psychosis 3, 12–​13, 19, 27–​9, 31, 37, 39,
hermeneutic 70, 73, 78, 84 41–​2, 96, 109, 145
hermeneutical 70 recovery 4, 14–​16, 19–​21, 40, 101, 109–​13,
hope 126 117, 122, 127, 200
hopeful 14, 79 recovery–​oriented 2, 3, 58, 61 (see also
Movement, historical)
identity 9, 12–​14, 42, 70, 97, 108, 176, 187, reduction (phenomenological) 67, 69,
190, 192–​3, 195–​6, 201–​3 98, 123, 125, 128–​9, 153, 169, 170,
imagination 29, 67, 69–​71, 80, 84 189
intentionality 5, 12, 49, 51, 54–​5, 57, 61–​2, eidetic reduction 99, 122–​5, 129, 132
66–​7, 69–​70, 87, 98–​9, 115, 161, 171, empathic (psychological) reduction 3,
172, 176–​80, 184–​5, 187–​8, 191, 49, 58–​62, 83, 153
194–​200, 202–​3 intersubjective reduction 83
interpersonal 2, 3, 5, 15, 49–​54, 58, 60, 62, psychological reduction 58–​62, 125
104, 121, 126–​7, 164 transcendental reduction 7, 8, 10,
intersubjectivity 2–​3, 7–​9, 22, 68, 78–​9, 17, 22, 60
85, 86, 122, 124–​5, 128, 130, 132,
141–​2, 188 qualitative research 3, 14
intuition 34, 65–​6, 85–​6, 97, 99, 197
Schizophrenia 3–​4, 8, 12–​15, 18–​19, 27–​31,
memory 141, 145, 194, 195, 199 33–​5, 37–​43, 54–​9, 109–​10, 146–​9,
mood 31, 82, 87, 145, 147 153, 161–​2, 163, 177
moral 2, 70, 108, 117, 162–​3, 192 second–​person 3–​4, 53–​6, 60, 62, 66,
Motivation 164, 178 79, 82–​3
non–​motivation 164 sociality 99, 113, 116, 184–​5
motivational 69 Socius 184, 186, 202
movement sympathy 62, 71, 79, 81–​2
bodily 30, 38, 67–​8, 75, 84, 124–​5, 140
development 104, 111, 114 values 14, 95, 97–​100, 166
historical 15, 21, 70, 95, 115
21
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