While the preceding chapter has pointed out new thematic possibilities of the ontological analysis of human existence, the aim of the following chapter is to make use of these possibilities in the area of psychopathology. Suffering conditioned by the temporal disintegration of the self and accompanied by the collapse of the order of experience needs to be illustrated on concrete clinical studies. For the sake of such exemplification, some case studies presented by Binswanger, Blankenburg and Laing are here analyzed; they provide a material that is to be reinterpreted by the post-existential analysis. In this way we arrive at a new understanding of hebephrenic schizophrenia, paranoid delusions, as well as schizoid structure of personality. All these pathological states are understood not as privative forms of existence related to some normative ideal, but as positive phenomena which have their own logic. Yet, this is not to say that they are advantageous or enviable. On the contrary, the suffering that speaks through the psychopathological phenomena is even more terrible if seen in its own light, and not from the perspective of some normative ideal. Since suffering is connected with the very finitude of human existence, it cannot be simply eradicated from human life. It can be only alleviated, but the temporal rupture from which human existence suffers can never be healed. And it is precisely this rupture that ontologically enables mental disorder as well as oldness that inseparably belongs to the finitude of human existence, even though Heidegger does not pay any attention to this phenomenon.

We have already seen that the ontological project of being-there as adumbrated in Erläuterungen zu Hölderlins Dichtung is not grounded on the idea of an a priori unity of the three temporal ecstasies. The ecstatic unity of the having-been, the future and the present that joins and unites the ontological structure of being in disclosedness is here replaced with the abysmal disunity of the having-been and the future in which the gaping openness of chaos heralds itself. In its light, one’s own belonging to the gaping chaos appears neither integral nor unified; one’s own existence is not unified by the ecstatic unity of temporality, but on the contrary falls apart in the tension between the having-been and the future. In its deepest foundation, being-there is disunited and disintegrated, since it is disturbed by the temporal rupture that must be incessantly reintegrated, an action which being-there performs by anchoring itself in the present. By virtue of its sense of the present that binds it to things of concern, being-there can maintain its individual being in integral unity. However, our existence can corroborate its belonging to openness, which opens itself as chaos, only by accepting the essential disunity in which its individual structure is torn between having-been and the future. Thus, our temporal disjointedness appears as the source of the deepest suffering. However much we can alleviate or cover up the suffering by clinging to the seemingly unshakeable reality of the everyday world, we can never fully rid ourselves of it.

As long as we are to thematize the phenomenon of mental disorder, we must take into account suffering, which consists in our vulnerability to the bottomless abyss of chaos and turn it into a point of departure of our meditations. Understanding mental disorder on the basis of suffering from chaos does not imply a return to interpretations that explain it as an organic disorder of the brain or as a disorder in the functioning of the psychic apparatus. Rather, this approach is much closer to the view of mental disorder offered by John Caputo, who in his More Radical Hermeneutics claims madness to be a “disturbance” in a twofold sense of the word.¹

Madness is firstly that which disturbs us, the “normal” ones, from the established order of the everyday being-in-the-world by reminding us of what we would rather know nothing about. It is a mirror that lets us peer inside the deep rupture in human existence, telling us who we are. When facing madness, we have to realize that our perfectly organized, conventional existence is a mere cloak of a deep dissonance that resounds from within the heart of our being. The madman who tells of this dissonance by his whole being coerces us to encounter what we suppress inside ourselves in order to exist “normally”, even though it can never be suppressed completely.

The madman, however, can bear witness to the irrevocable rupture in human existence only at the cost of his own suffering. Thus, what unveils itself in the madman’s suffering is the other meaning of disturbance Caputo speaks of. In this respect, Heidegger’s explication of the essence of suffering implies a disturbance in the sense of a rupture in the ecstatic unity of temporality, thanks to which we, the “healthy,” are capable of finding the proper place and sense of our existence in that with which we occupy ourselves, i.e., not only in our work, but also in our interests and hobbies, in which we become naturally bound with those around us. The madman, on the contrary, finds the primary sense not in his occupations, but in his suffering; his behavior is led not so much by practical interest as by the need to escape suffering that follows from the temporal rupture in his existence. His experience is permeated by suffering that we others sense only indistinctly beyond the dark horizon of our world.

Let us not therefore be deceived. There is no idealized figure of the madman who knows more than all wise men here. What the madman gives us to understand in his suffering, what we can learn from him, is nothing but the tidings of the radical finitude of our being. As long as we want to hear and truly understand these tidings, we must bracket all scientific knowledge which gives us the false impression that we know what mental disorder is when we are able to explain its causes or reveal the correlative changes in the functioning of brain centers; instead, we must regard mental disorder as the expression of our finitude consisting in our belonging to chaos.

Mental disorder is to be viewed from the perspective of chaos in whose openness the sense, order and cohesion of experience dissolve. Suffering which permeates mental disorder is essentially the suffering from chaos in whose abyss the temporal unity of the individual existence disintegrate. To approach the essence of psychopathological disorders is therefore possible only when we conceive of them on the basis of suffering, which in itself is nothing but the suffering from the disintegration of the individual being. This is not to say that the suffering patient must be understood directly as impersonal chaos; rather, it is necessary to understand him/her from what he/she has to face, i.e., from the imminent threat of the disintegration of his/her individual being. Only thus is it possible to thematize psychopathological disorders in a non-normative way.

The concept of psychopathological disorder that puts the primary focus on the suffering from chaos cannot be normative already because, instead of the standpoint of normality or adequacy to norm, it chooses a standpoint of the extreme. From the perspective of chaos, mental disorder appears as neither a deficiency of openness, nor a privation of the ontological unity of individual existence. In comparison with the normal, socialized mode of existence, mental disorder does indeed display many deficient features, but their mere enumeration does not help us to attain an understanding of its inner logic. Even though it does entail the loss of many possibilities, mental disorder is no mere relative disability, since it opens way for new modes of behavior that respond to the terrifying nearness of chaos. Even a disorder as severe as schizophrenia cannot be sufficiently understood merely in negative terms. The suffering of the schizophrenic manifests itself not only in the derealization and depersonalization, but mostly in a multitude of defense mechanisms that are to forestall the frightful onslaughts of chaos. Already the first attack of schizophrenia with its delusions and hallucinations encompasses the effort to consolidate individual being, re-establish order of experience and reconstruct a world in which one could exist. Nothing can be changed about it even in the case of paranoid schizophrenia where the individual being becomes a desperate outcast in a world full of omnipresent intrigues and threats which reflect the bottomless awesomeness of chaos. Since the familiarity with the intrigues of the pursuers and enemies that people the schizophrenic’s world is merely a different expression of the awesomeness of chaos, its original sense can emerge only against the background of the uncanny awesomeness to which human existence is essentially exposed. The example of schizophrenia, more than any other, corroborates that the uncanny awesomeness of chaos allows suffering to be seen as an original phenomenon, and not merely as a privation of health.

What necessarily changes together with the image of suffering is also the image of health. Since the gaping openness of chaos makes it possible to understand that health does not mean a total absence of suffering, but is rather substantially related to it, the relation between health and suffering gains a completely new dimension. It is obvious that the effort to do away completely with suffering would, having attained its fulfillment, necessarily lead to the elimination of health, for it would create a human being who wouldn’t be confronted with chaos at all, thus remaining imprisoned in one situation whose order could be neither changed, nor abandoned. However, since health proves itself not only in the tranquil and easy existence within a firmly given order, but especially in situations where the old order disintegrates, succeeded by a new one, suffering must be inseparably connected with it.

Health understood as absence of suffering or indubitable awareness of the world order is a mere caricature of health. Such a caricature can be found within the framework of Boss’s psychiatric conception, where health is presented as maximal ability to respond to the significative givens of the world combined with the “bovine peace of mind,” as Nietzsche would say. Since by choosing some possibilities we necessarily lose others, one cannot even say that health would be given by maximum amount of possibilities accessible for the individual.

Conceived of in the light of chaos, health appears rather as the ability to lose sense, to face non-sense, the absurdity of the world and the contingency of our existence. It is the ability to bear chaos out of which arise a new sense and order, the ability to undergo the disintegration of one’s own self and reintegrate it again. To be healthy means to be able to die and be born again in the chaotic field of individuation. It is clear that health thus understood is not only permeated by suffering, but also harbors a whole plethora of traps that can turn it into unbearable suffering at any moment. The moment when the heady desire to abandon the given circumstances and one’s own self turns into a total ruin of the world and self is difficult to predict and can be determined with certainty only when it is only too late.

Knowing this, it is all the more necessary to remember the rift dividing the healthy development, in which the accepted and habitual forms of thought, perception and action are destroyed, from the pathological breakdown that leads to schizophrenic derangement out of the familiar sphere of relevance and significance. Even though the schizophrenic derangement out of the sphere of meaningfulness, and thus also of a certain restraining obligation, can at first appear very inconspicuously, it still presents an essential change in the way in which human existence exposes itself to chaos. In the case of a healthy development the disruption of the established order of the world is a mere transitional phenomenon followed by the re-consolidation of the sphere of relevance and significance, whereas what occurs in the case of schizophrenic alienation is an interruption of this development.

This is why Wolfgang Blankenburg, who focused in his clinical studies especially on various forms of disorganized schizophrenia, speaks in connection with schizophrenic alienation of the loss of “natural self-evidence” (die natürliche Selbstverständlichkeit), in whose atmosphere the everyday being-in-the-world goes on.² In his opinion, “hebephrenic” patients lose the feeling of security and safety provided by the anchoredness in the significative and referential context of the everyday world, and they behave accordingly. Restlessness and inattention, so typical of these patients, result from the disturbance of the self-evident certainty with which individual existence relates to the surrounding beings and to its close ones. The surrounding beings and people don’t vanish, but rather appear in their peculiar strangeness that hampers any meaningful activity. The loss of natural self-evidence thus becomes manifest as a loss of the sense of reality, or more precisely, as a primary disturbance in concerned being-together-with beings. The total loss of being-together-with beings, however, is opposed by the effort to amend the disintegration of the significative and referential context of the everyday world by means of persistent control over every situation in which the schizophrenic finds himself/herself. The immoderate meticulousness and “neatness” which can be noticed in many schizophrenic patients are expressions of a desperate need to avoid all unexpected surprises which could evoke the invasion of chaos into the preordained order. The fact that these patients must, so to speak, pre-prepare every situation in which they find themselves, nevertheless, attests to the fragility of the provisory order of their world: this order is not something self-evident and immediately given, but something which is to be constantly re-built and defended. The referential and significative connections on which this order relies result from an intentional act which requires an enormous effort, whereas a healthy individual finds a whole order of the referential and significative connections without having to think about it explicitly.

Another risk is hidden in a self-destructive strategy of people in situations where they have no way out, where they find themselves in checkmate, as they are bound by mutually contradictory requirements. Schizophrenia then appears as a specific strategy which the individual puts into effect in a situation that cannot be endured, nor abandoned. This strategy consists in the interiorization of mutually contradictory requirements, which nevertheless leads in the end not to the overcoming of the pathogenic situation, but merely to its shift from the interpersonal to the personal level. Such a strategy can be observed in the behavior of Binswanger’s patient Ilsa, who oscillates between a raving love, an almost venerating respect for her father and deep disapproval of his tyrannous way of dealing with his wife and children.³ Since this discrepancy can be solved neither by redressing the father’s behavior, nor by his abandoning the family, it becomes the discrepancy between Ilsa’s mood and understanding. For her, the dissonance between understanding and mood is the fundamental existential rupture that cannot be overcome even by a desperate gesture of sacrifice (burning of arm), and thus brings about her psychotic breakdown.

Although the dissonance between mood through which the individual is thrown into the world and the understanding through which individual existence projects itself to its possibilities is felt to some extent by everyone, for it reflects our ambiguous position in the world, this discrepancy also harbors the possibility of a psychotic breakdown, which can best be explained on the temporal level of being-there where it becomes clear that the existential project involves openness to the future, whereas thrownness falls back into the past. The discrepancy between thrownness and existential project is thus essentially a temporal rupture, and unless individual existence overcomes it in its relation to the people around it and to beings that address it in the dimension of the present, it can precipitate even a schizophrenic disintegration of its being.

The outbreak of schizophrenia has a rather different course in the case of Binswanger’s patient Suzanne Urban, whose mental collapse occurs upon her hearing about her husband’s cancer. The news of her husband’s incurable disease evokes in her a paranoid fear of police conspiracy and the persecution of her family. This, however, could not happen unless this woman had already been jeopardized by the uncanny awesomeness. Paranoid delusions are mere concretizations of the awesome abyss over which Suzanne Urban has insecurely balanced her whole life. If we reinterpret Binswanger’s description of her life history against the background of the gaping openness of chaos, we can find the fundamental theme of this pathogenesis: it is the vulnerability to the uncanny awesomeness of chaos in which the integrity of the patient’s individual being as well as the overall order of her world disintegrate. Chaos as such, however, is not the cause of this mental disorder, but rather its enabling condition. The immediate impulse that precipitated the change of Suzanne Urban’s life into the “awesome stage” of madness was her husband’s disease and the ensuing disintegration of the whole system of safety guarantees that were to protect her against the horrible onslaught of chaos.⁴ One could say that the deadly disease of her husband shattered her hitherto considerably neurotic model of experience, which then had to be superseded by the martyrdom of paranoid schizophrenia where the awesome abyss of chaos substantiated itself.

Another example of psychotic breakdown is the fate of the 14-year-old Phillip mentioned by R. D. Laing in Wisdom, Madness and Folly.⁵ His psychosis broke out after he had lost both his parents within a brief period of time: first, he found his mother lying in a pool of blood (she had suffered from lung tuberculosis and choked on her own blood), and 2 months later he found his father hanged, for he had not come to terms with her death. Prior to his suicide, however, he had managed persistently and repeatedly to blame his son for his mother’s death, for having exhausted her during pregnancy, childbirth and throughout his whole life. This resulted in Phillip’s psychotic breakdown marked by “autistic” behavior and “catatonic” stupor, at times replaced by hectic, uncoordinated motion. Phillip “was broken up, shattered to pieces by what had happened. He was staggering. He had been through a literally staggering experience. He was staggered. He had been struck – not quite dumb. He could utter sounds, but nothing coherent came out of his mouth. Just scraps, shreds, drivel, a sudden bellow, a moan, a laugh.”⁶ All this was accompanied by utter inertia to the surrounding world and permanent reek (the patient suffered also from the incontinence of urine and excrement) that escalated the impression of total ruin and decline. The boy’s acute psychosis had reached a degree at which the presence of the surrounding beings no longer concerned him; he himself remained utterly outside reality, whereas his body was just “a smelling reminder of his own story.”

Of course, Laing concedes, it was a reactive psychosis that probably wouldn’t have broken out had there not been the drastic life experience, under whose onslaught Phillip’s world broke apart. Not everyone must react to a catastrophic loss by psychotic collapse. But therein lies the rub: we never know in advance where the threshold of our resistance is, how far we can go and how much we can bear. That something is beyond our strength we learn usually when it is all too late.

Yet, Phillip’s case is interesting also for another reason – its happy denouement. Despite his grave diagnosis, since both his parents were probably psychotic and the boy himself was weakened so much that one could only predict chronic schizophrenic, the worst case scenario did not occur. What was to be given credit here wasn’t the appropriately chosen medication, insulin or electric shocks, but the proximity of another human being despite the boy’s repulsive condition. In spite of evoking the feeling of primary, pre-reflexive revulsion that distanced from him even those who wanted to take pity on him, Phillip’s state was first and foremost a call for the proximity of someone else. Not for compassion, but for real proximity. Without it, Phillip could never have extricated himself from his “isolation” and gradually have attained a normal, stabilized state, which he eventually managed to do.

The very first couple of sessions in Laing’s consulting room allowed the patient to re-establish after many months the contact with his surroundings and turned him into a person who quietly related his visions, hallucinations and the mysterious hyperspace in which he found himself most of the time. As Laing remarks, had this effect been achieved by means of medication without any undesirable side effects, it would present a momentous breakthrough in medical psychiatry, and the discoverer of such a drug could right away be nominated for Nobel prize. Even if it were to be discovered one day, and this day may not be too far, such a drug could never substitute for the help that a madman can be provided with by the proximity of another human being.

This is why it is of essence to consider the way in which the encounter between the mentally deranged and the therapist takes place. What is the condition and precondition of such an encounter? At the beginning there is always the doctor’s confrontation with a human being displaying certain features of behavior that are perceived in the common, everyday world as unreasonable and nonsensical. In order to understand nonsensical behavior, however, it is by no means enough to take these behavioral features for pathological symptoms that refer to this or that category of the nosological system. As long as the encounter between the doctor and the patient (perceived not as an object of a therapeutic treatment, but as someone in suffering) is to take place at all, the therapist must be able to see in the mental disorder a possibility that has bearing also on himself. The therapist must be aware that what has happened to the patient can happen to anyone, for what is at work here is not some external danger, but a fundamental jeopardy that establishes and determines the character of human existence. As Caputo says, what is at stake is not to regard mental disorder as an objective process that does not pertain to us, but to understand it as a principal possibility of human existence of which the suffering patient “knows” more than the whole medical science. If the therapist really wants to approach the patient, he/she cannot do this solely with a professional erudition – what he/she needs most of all is the capacity for listening sym-pathy that enables him/her to discern in the psychopathological disorder the expression of the unstableness and insecurity of human existence as such. This art of sympathy needs to be distinguished from sentimental pity for the madman which does not surpass the barrier of his primordial otherness, and thus can never lead to a real proximity.

Quite special claims are made on the therapist by the care for the schizophrenic patients who don’t remain within the one commonly shared world and whose behavior often gives the impression that there is no one behind it any more. These patients can be approached only if the therapist temporarily forsakes his/her own judgments about what is real or unreal, trying to transport himself/herself into the order of their experience. In claiming to have been long dead, to be unreal or threatened by hostile alien forces, the psychotic need not be wrong, but can be absolutely right, and not only in the metaphorical sense. To understand similar statements, however, it is necessary to leave the significative order of the everyday world and learn to orientate oneself within the significative structures of the schizophrenic experience. The capacity for such de- and re-orientation is, as Laing claims in his The Divided Self, a prerequisite indispensable for therapeutic work with psychotics.⁷ Without it, all theoretical knowledge about schizophrenia as a specific illness is utterly worthless, since it does not suffice for breaking through the wall of isolation behind which the schizophrenic dwells. If, on the contrary, one manages to surmount the barrier of misunderstanding, which the schizophrenics oftentimes build for themselves in order not to jeopardize their own integrity by an open conversation with another human being, the first step toward successful cure has been taken. Similarly to Jung, Laing believes that the schizophrenics are able to consolidate and integrate their being once they have the feeling that they have encountered someone who understands their suffering. But as long he/she is to approach the schizophrenic’s situation, the therapist must “draw on [his/her] own psychotic possibilities.”⁸

In other words, the prerequisite for the therapist’s encounter with a psychotic patient is his/her own experience with the ungraspable and uncontrollable chaos that gives him/her the opportunity to understand the behavior which appears bizarre and nonsensical in the common everyday world. Chaos is the shaky ground which eventually enables the encounter between the doctor and the patient: without having experience with chaos, the therapist couldn’t approach the suffering of another human being, since he/she would lack elementary knowledge of what imbues all pathological forms of behavior with their content. This is confirmed both in the case of paranoid delusions whose structure substantially diverge from the significative context of the common world of everyday existence, as well as in the cases of “hypochondria” or pathological jealousy. Without a primary insight into the awesome character of chaos, all these forms of experience could easily seem certain variants of fallacious understanding or error. The vulnerability to chaos in its abysmal immensity enables the realization that “hypochondria”, pathological jealousy or “paranoia” have their own logic that has nothing to do with the categories of fallacy or error. The therapist himself should therefore at least once go through the disintegration of the structure of being-there that would lead him/her away from the common everyday experience to the possibility of a delirious experience, thus enabling him/her to recognize the awesomeness from which the madman strives to escape as the essential possibility of his/her own being.

But unlike the madman, the therapist must be capable of reverting from this journey back into the significative context of the everyday world, and not to repeat it hopelessly in the fear of enemies, abandonment or illness. In this respect, the therapeutic role is akin to the role of the poet who exposes himself to chaos in order to return from it to the familiarity of home. Both the poet and the therapist must set out for an unknown terrain where a new order arises out of chaos. Whereas the former does this in order to bring about a work out of chaos which shall put familiar things in an utterly new light, the latter does so in order to lead his/her neighbor out of chaos.

The similarity between the poet and the therapist that lies in the necessity to advance beyond the boundaries of the familiar world and to experience the excess of awesomeness did not remain hidden to Binswanger, although he did not manage to grasp the openness of chaos as such. He was also well aware of the significance that the knowledge of the Awesome and the Annihilating to which the madman is exposed in his/her whole existence has within the field of psychotherapeutic communication.⁹ As long as we renounce the idea of the principal ontological unity of individual being borne by the unity of the three temporal ecstasies, not speaking of the concept of the infinite moment of being-beyond-the-world, we can thus use a certain part of Binswanger’s clinical observations as documentary material.

What is clear from Binswanger’s description of paranoid schizophrenia is that paranoid systems of delusions cannot be sufficiently explained as mere products of lively unrestricted fantasy, but rather must be perceived against the background of that to which the schizophrenic is exposed, that is, the awesome and annihilating chaos. The pathological nature of the fear of omnipresent chasers lies not so much in its exorbitance or inappropriateness to the real circumstances as in the overall atmosphere of jeopardy and danger that ensue from the awesomeness of chaos. Conspiracy, persecution and sadistic orgies prepared by one’s enemies are not primary in their essence; the irrefutable certainty with which the schizophrenics expound on their theories of conspiracy and persecution is merely a secondary moment of the disruption and disintegration of the order of their experience. The role of paranoid delusions consists in covering and filling up the holes that arise once the order of experience has fallen into chaos. The need to reintegrate the disintegrating order of experience leads the schizophrenic to constructions by means of which the uncanny awesomeness of chaos changes into the impending presence of the Enemy. What follows in lieu of the indefinably and unutterably awesome are the “well known” intentions of thieves and murderers. In this way, the inconsistency of experience turns into the absolute consistency of a delusion.