The Problem of Mental Disorder




(1)
Philosophical Institute of the Czech Academy of Sciences, Charles University, Prague, Czech Republic

 



Keywords
Mental illnessMental healthAuthenticityInauthenticityPrivationNormativity



4.1 The Concept of Illness in Zollikoner Seminare



Abstract

This chapter returns to Zollikoner Seminare and to its sketch of the notion of illness. Considering the fact that every illness deprives human existence of some possibilities, Heidegger explains every pathological state as a phenomenon of privation. This applies not only to mental disorders, but also to somatic disorders. As to the notion of privation, Heidegger explains it with a reference to Plato’s concept of relative non-being (TO ME ON), which appears in the dialogue Sophist, but it seems that his usage of the term “privation” owes much more to Aristotle’s notion of STERESIS. It is perhaps no accident that in his Metaphysics Aristotle explains the meaning of STERESIS on the example of illness (blindness). In any case, Heidegger concretizes his view of the psychopathological phenomena suggesting that they bear all signs of the entanglement in the world, and thus of the inauthentic existence. Saying this, he actually makes an analogy between mental illness and the inauthentic existence on the one side, and the mental health and the authentic existence on the other. The authentic existence is, thus, placed in the position of the normative ideal of health, while the inauthentic existence serves as a model explaining all psychopathological phenomena. Nevertheless, it is questionable whether the same applies to the somatic sphere of existence, as well.


Keywords

Mental illness, Mental health, Authenticity, Inauthenticity, Privation, Normativity

This chapter returns to Zollikoner Seminare and to its sketch of the notion of illness. Considering the fact that every illness deprives us of certain existential possibilities, Heidegger explains every pathological state as a phenomenon of privation. This applies not only to mental disorders, but also to somatic disorders. As to the notion of privation, Heidegger explains it with a reference to Plato’s concept of relative non-being (τò μη ’òν), which appears in the dialogue Sophist, but it seems that his usage of the term “privation” owes much more to Aristotle’s notion of στέρησις. It is perhaps no accident that in his Metaphysics Aristotle explains the meaning of στέρησις by means of the example of illness (blindness). In any case, Heidegger concretizes his view of psychopathological phenomena suggesting that they bear all signs of the entanglement in the world, and thus of the inauthentic existence. Saying this, he actually makes an analogy between mental illness and the inauthentic existence on the one side, and mental health and the authentic existence on the other. The authentic existence is thus placed in the position of the normative ideal of health, while the inauthentic existence serves as a model explaining all psychopathological phenomena. Nevertheless, it is questionable whether the same applies to the somatic sphere of existence, as well.

Since Zollikoner Seminare and Sein und Zeit are divided by more then 30 years during which Heidegger’s thought went through a substantial change, it is logical that the ontological structure of being-there is viewed in a different light and with different accents. Above all, Zollikoner Seminare reconsiders the phenomenon of disclosedness in which being-there dwells. In contrast with Sein und Zeit, where disclosedness of being is thought from the viewpoint of the temporal unity of individual existence, disclosedness is no longer understood in the later work from the viewpoint of being-there. On the contrary, being-there is perceived from the perspective of disclosedness, called the clearing of being in Zollikoner Seminare. Thus, the statement that the disclosedness of being is not a quality or a component of individual existence gains its full force. “Clearing is not an existentiale,” claims Heidegger; rather, the open being-there “stands out into the clearing.”1 Being-there “is not the clearing itself … nor is it identical with the whole of the clearing as such.”2 At the same time, being-there is incessantly determined and focused, as it is always open for the concrete surrounding world.3 Being-there is thus to be conceived of as “standing-within the clearing, as sojourn with what it encounters, that is, as disclosure for what concerns it and what is encountered.”4

In its relatedness to encountered beings, being-there always maintains the structure of Jemeinigkeit, and therefore the question of its individuality can be answered only by demonstrating certain modes of its behavior.5 But even though the turn in the understanding of the openness of being involves revisions in the view of being-there, the ontological project of individual existence does not change in every respect. Heidegger does not feel any need to challenge the ontological unity and constancy of individual existence. On the contrary, Zollikoner Seminare again emphasizes that the “self (das Selbst) is what constantly endures as the same in the whole, historical course of [being-there], [it is] what exists precisely in the manner of being-in-the-world.”6 Naturally, the existential constancy of the self is not to be confused with the identity of a substantial self. “The constancy of the self is proper to itself in the sense that the self is always able to come back to itself and always finds itself still the same in its [existence].”7 However total the alienation from itself and however deep the falling prey to what is available may be, individual existence cannot be kept from being itself.

In Heidegger’s opinion, a classic example demonstrating the constancy of individual existence is the experience of awakening in which an individual returns to itself and its everyday world.8 Individual existence could not awaken into the state in which the world maintains its referential structure along with the innerworldly beings retaining their persistent identity and the discernability of others, unless it were still the same even in sleep. In dreaming one can turn to something else, but this dream world does not change the fact that every dream is “always someone’s”. It follows that even the dream world forms an integral component of historicity in which the permanence and constancy of individual existence is maintained. Despite their structural difference, the waking and dream modes of being-in-the-world are significantly related, both belonging to one single whole of the existential historicity. On no account can one surmise that apart from the waking mode of existence, there is also one more historicity of the dream existence.9 In that case it would be utterly incomprehensible how someone in a waking state could speak of one’s dreams and try to understand their meaning.

The very historicity of the individual existence, however, is ontologically grounded in the ecstatic unity of temporality. Being-there can exist historically only because it is always expecting, making present and retaining (gewärtigend, gegenwärtigend, behaltend).10 What manifests itself in the unity of this expecting, making present and retaining is the original interrelatedness of the future, the present and the having-been. As long as being-there exists, it temporalizes itself in the integral unity of three temporal ecstasies, from which none can be missing. Heidegger puts it in the following way:

All three dimensions of time are equiprimordial, for one never occurs without the other. All three are open to us equiprimordially [gleichursprünglich], but they are never open uniformally [gleich-förmig]. First, one dimension is predominant, then the other in which we are engaged, or in which, perhaps, we are even imprisoned. In this way, each of the other two dimensions have not just disappeared at any given time but have merely been modified.11

Thus, whether we aim to address the waking or the dream state of being-in-the-world, we must depart from the temporal unity of individual existence, observing how the specific temporal ecstasies are modified in each given case. The same applies also to the pathologically altered modes of being-in-the-world. “In all pathological phenomena too, the three temporal ecstasies and their particular modifications must be taken into consideration,” stresses Heidegger.12 The worst mistake one can commit here is to expound the disturbed relation to time, characteristic of some psychopathological states, from the viewpoint of the conventional concept of time founded upon the idea of time as an infinite uninterrupted sequence of single “nows.” It follows from the temporal analysis undertaken in Sein und Zeit that this traditional view of time, in which time figures as a calculable quantity, is a mere leveling out of the primordial, ecstatic temporality of being-there, which is in itself utterly unquantifiable.

How misleading the interpretation relying on time understood as a measurable sequence of consecutive “nows” can be Heidegger demonstrates by the case of a young schizophrenic treated in the subacute stage of his illness.13 According to the clinical record, one patient watching a clock on the wall feels a strong urge incessantly to follow the movement of the clock-hand. For him, the moving clock-hand presents an enigma as unsolvable as Zeno’s paradox of the flying arrow. The patient becomes so absorbed in this enigma as to “lose the thread to himself.” The difference between him and the clock disappears, which brings him under the impression that he himself is the clock. What he experiences is a “running away from himself,” while his being is so volatile as to cease totally to be here and now. What occurs in addition to this is the disintegration of the overall structure of his surrounding world that once clearly articulated the referential relations and differences among various beings ready-to-hand. Therefore, the disoriented patient falls into sheer confusion, out of which he returns to the clock.

If we want to understand this state properly, claims Heidegger, we must not let ourselves be misled by the fact that the ill man’s eyes are fixed on the clock hand. His attention is directed not to the measured time or time data, but rather to the clock that is, at first, located on the wall, but immediately goes adrift from its place and from the connected referential context. What is especially peculiar here is the compulsiveness of the patient’s relation to the clock which goes so far as to cancel any possibility of a practical detachment. The schizophrenic is absorbed in the clock to the extent that he literally loses himself therein. Together with losing the contact with himself, the schizophrenic is torn out of the familiar surrounding world, in which things have their sense, shape and place. Only when he manages to keep his distance from the wall clock again, can he acquire some certainty that enables him, at least for a brief moment, to rest in the familiar world of practical matters. Therefore, what is crucial for the understanding of the given case is neither the question of the measured time, nor a meditation on time passing, but the difference between the relation to the clock that remains part of the referential context of the surrounding world, and the relation to the clock torn out of the surrounding context. Instead of examining the patient’s cognitive relation to time, it is necessary to scrutinize his relation to innerworldly beings that address him and to their referential interconnectedness.

Nevertheless, how are we to interpret this pathological mode of being-in-the-world if we have to expound it on the basis of the inseparable unity of three temporal ecstasies? How are we to understand the disintegration of the schizophrenic personality that loses “the thread to itself”, if it is necessary to depart from the integral unity of ecstatic temporality? Since the schizophrenic loss of one’s own self cannot lead to a total disintegration of the ontological structure of being-there, it must be, in Heidegger’s opinion, understood as a certain mode of individual existence.

With regard to the fact that the fragile and insecure individual being characteristic of schizophrenics is often accompanied by signs of compulsive behavior and of desperate clinging to things that can endow the ill with at least an elementary feeling of security and stability, it is not difficult to conclude that schizophrenia condemns the patient to a considerable loss of freedom. The schizophrenic is substantially restricted in his/her relation to possibilities offered by the world, which applies, albeit to a much smaller extent, to other types of psychopathological disorders as well. The agoraphobic is incapable of entering an open space, whereas a closed room is unbearable for the claustrophobic. Other neurotics are largely limited in their relations to possibilities offered by their being-with others. Accordingly, every mental illness means a restriction of a free and full realization of certain possibilities.

However, the same can be said of pathological disorders of a primarily somatic character. “Each illness,” claims Heidegger, “is a loss of freedom.”14 Moreover, the division between psychic and somatic disorders is as such unacceptable from the phenomenological viewpoint, since it is grounded upon the Cartesian dualism of res extensa and res cogitans. Refusing to divide human existence into the corporeal and the spiritual part, Heidegger perceives every illness on the basis of the psychosomatic whole given by being-in-the-world. His notion of the lived body (der Leib) makes it possible to understand that illness does not afflict only the corporeal or the spiritual sphere, but the whole being-in-the-world, which is prevented by illness from implementing this or that possibility. The sense of the doctor’s question: “Was fehlt Ihnen?” lies in the ascertainment of which possibility of the individual being-in-the-world is precluded and what impact this has on one’s own relation to the open realm of the world.

The restriction of freedom which characterizes all pathological states brings Heidegger to the view that both somatic and psychic disorders can be subsumed under one common denominator, the phenomenon of privation.15 Every pathological disorder is viewed in Zollikoner Seminare as a specific lack, as a specific privation of health. To be ill basically means not to be healthy. Insofar as health is understood as the ability to freely avail oneself of all possibilities shown in the open realm of world, illness represents a certain negation of this ability. The phenomenological interpretation of illness is thus grounded upon the definition of health which is, in one way or another, negated by a specific illness.

This negation, however, is no utter denial and exclusion of the healthy state, but rather a privative form of health which is, in this view, attributed to an entirely positive sense. Since every privation encompasses the essential relatedness to the positive that is lacking, Heidegger claims that everyone dealing with an illness is „actually dealing with health in the sense that health is lacking and has to be restored.”16

When elucidating the peculiar character of the phenomenon of privation, Heidegger refers to Plato’s dialogue Sophist, where this phenomenon is revealed in the connection with the question of the relative non-being (τò μη ’òν). Apart from the absolute non-being that simply does not exist, this Platonic dialogue addresses, for the first time in the history of Western philosophy, the possibility of the relative non-being that still in some sense is. In other words, the non-being is grasped here not only as the mere opposite to the existent, but also as that which has its own reality. The essence of the relative non-being is found in difference, that is to say, in that by means of which specific beings differ from each other. Every existent manifests itself as the non-being once viewed in relation to other beings, that is, to that which it is not.

Yet, in comparison with Plato’s concept of the relative non-being, Heidegger’s exposition of the privative negation is much narrower, as it emphasizes lack and shortage instead of difference. At least, that is what all the examples adduced in connection with privation attest to: rest is the privation of motion, shade is the lack of light, shard is the privation of tumbler. The same supposition is also corroborated by the following statement: “If we negate something in the sense that we don’t simply deny it, but rather affirm it in the sense that something is lacking, such negation is called a privation.”17 This clearly posits that privation means not just a difference but above all a deprivation.

Using the notion of privation thus determined, Heidegger’s exposition evinces its debt not so much to Plato’s concept of the relative non-being, but rather to Aristotle’s notion of privation (στέρησις), placed in Metaphysics into the focal point of the hyle-morfic doctrine.18 In the frame of this conception, privation is expounded as lack in which the specific being is short of what it could or should have. For example,

blindness is a privation, but one is not blind at any and every age, but only if one has not sight at the age at which one would naturally have it. Similarly, a thing suffers privation when it has not an attribute in those circumstances, or in that respect and in that relation and in that sense, in which it would naturally have it.19

Although illness is not the only case of privation, one cannot fail to notice the fact that in Metaphysics it receives mention as a typical example thereof: “The substance of a privation is the opposite substance, e.g. health is the substance of disease; for it is by its absence that disease exists.”20

This is precisely how the essential character of illness is interpreted in Zollikoner Seminare: illness is explicated as privation that immediately refers to the healthy mode of existence. That this reference is not fully reciprocal is confirmed by the fact that what Heidegger says of illness he does not admit in the case of health; in other words, whereas illness, according to him, is the privation of health, health can hardly be the privation of illness. Even though it might be said that healthy is he/she who is not ill, this changes nothing about the fact that in comparison with health, illness is a deficient mode of being.

The privative conception of illness does not, however, relate only to ontic symptoms of pathological disorders, but defines the ontological status of illness as such. Illness conceived of as a privative mode of existence is understood as an “ontological phenomenon” of being in disclosedness. As a lack of health, illness presents a certain possibility of being-there, i.e. a certain modus of its being.21

In this manner, Heidegger demarcates the ontological status of illness without having to produce a taxonomical table of all pathological disorders and their symptoms. Since every pathological disorder has, in addition, got an individual character that reflects the factual mode of being-in-the-world, Zollikoner Seminare mentions, instead of a summarizing enumeration of specific illnesses, only a couple of roughly sketched illustrative examples. It would certainly be a mistake to assume that a specific illness is the same in all individuals; an illness is always different in that it is determined by means of possibilities whose realization is limited in an ill individual.

The view that illness is a “privative mode of existence,” which renders its essence ungraspable without a preliminary definition of what it means to be healthy, is nevertheless not as self-evident as it might seem at first sight. By taking this view, Heidegger stands in opposition to those who understand illness as a point of departure for comprehending health. Not the least of them is Freud who derives methodical impetuses for normal psychology from psychopathology. The concept of illness adumbrated in Zollikoner Seminare is by contrast grounded in the phenomenon of health, against which illness stands as a certain deficiency. This deficiency does not in the least mean only the objectively ascertainable failure of this or that vital function; rather, it is a deficient mode of existence, in which individual existence is deprived of one of the essential possibilities of its being-in-the-world.

Be that as it may, one still cannot resist the impression that such an approach to illness is possible only at the cost of a certain simplification. Is it really certain that illness always brings only a decrease of possibilities that are otherwise normally accessible to us? Could not illness also open up certain possibilities that would remain forever inaccessible without it? To take the example of a blind man Aristotle speaks of: it is obvious that a blind man loses the possibilities opened by means of sight, but he adapts to this disorder by compsensating in his capacity for hearing or a tactile orientation that is much more acute and differentiated than in those who see. As far as the possibilities connected with the senses of hearing and touch are concerned, a blind man is much better off than a person with good eyesight, in whom these possibilities are dimmed and pushed into the background. In the case of a blind man, one can thus say that just as illness is deficient as compared to health, health is also deficient in relation to illness.

Heidegger, however, is by no means willing to concede this. For him, illness is nothing but a deficient mode of being and, as such, cannot bring any new possibilities. How a deficient mode of being-in-the-world is to be understood Heidegger demonstrates by the example of the phenomenon of the immaterial and insubstantial openness constitutive of being-there. Unlike things present-at-hand, being-there exists in that it always stands open in the relation to present beings. This standing-open (die Offenständigkeit), thanks to which all beings can become evident and understandable, is the basic ontological peculiarity of its existence. As long as being-there stands amidst the clearing of being so that it is open for the encounter with beings, it can nevertheless close itself off from the impulses and claims of the present, which is particularly evident in the case of psychopathological disorders, where certain possibilities of being-in-the-world are factually blurred. In this respect, perhaps the severest disorder of being-open to present beings is represented by schizophrenic unapproachability. But even though the schizophrenic may close himself/herself off from the impulses and claims of the surrounding things so much as to cease to be affected by anything, one still cannot conclude that his/her existence has no longer the character of being-open. “In schizophrenia the loss of [this] contact is a privation of being-open, which was just mentioned. Yet this privation does not mean that being-open disappears, but only that it is modified to a ‘lack of contact,’” observes Heidegger.22 Even when he/she entirely loses contact with his/her surrounding, the schizophrenic does not cease to exist openly, but rather fulfils this openness in a deficient way.

As long as being-there is characterized by its being-open to beings encountered in the frame of the significative context of the surrounding world, the schizophrenic is capable thereof only to a very restricted extent. Unlike the healthy individual who is so intimately bound with surrounding things and his/her loved ones that they immediately address him/her and motivate his/her behavior, the schizophrenic is not able to come to terms with his surrounding and adequately respond to it in his/her behavior. The deficient mode of schizophrenic existence is marked by the impossibility to relate to the beings one encounters without helplessly falling prey to them. The schizophrenic in the acute stage of his disease is at the mercy of all he/she encounters to the extent of being totally absorbed and overwhelmed by it. Thus, every contact with the surrounding things or others presents for him/her a direct jeopardy of his/her own being. In order to save himself/herself, to preserve integrity of his/her individual being, the schizophrenic closes himself/herself off from everything that could subjugate him/her by its requirements. This explains the “autistic” traits shown by the schizophrenic being-in-the-world. Yet, since individual being cannot be realized unless one relates to others as well as to surrounding things, the schizophrenic closing-off offers no real recourse from the illness, but merely deepens the ongoing self-alienation and depersonalization.

Despite the far-reaching depersonalization occurring in schizophrenic individuals, however, the radical loss of one’s own self is barely thinkable within the framework of the phenomenological project of being-there. Therefore, Heidegger insists that some rudimental individuality is still preserved even in the severest cases of schizophrenia. Just as the schizophrenic unapproachability is a privative mode of openness to present beings, the schizophrenic disintegration of personality is a privation of the original individual being. In the case of schizophrenics, one can thus speak only of their incapacity for integrating their being-in-the-world to a self-collected and self-subsistent existing, but not of the end of their individual existence.

When the schizophrenic whom Heidegger refers to, “loses the thread to himself,” he does not cease to be himself, but rather experiences his individual being in a way so alienated that he can mistake himself for the clock he watches. Even this deficient mode of individual existence is a certain modification of being-there that temporalizes itself in the inseparable unity of the three temporal ecstasies. It is precisely the ecstatic unity of the future, the having-been and the present that ultimately forestalls the total disintegration of individual existence. As long as sojourning in disclosedness is carried by the ecstatic temporal unity, the absolute disintegration of its individual being is utterly impossible. Once, however, the ecstatic unity of temporality has fallen apart, being-there draws to its definitive end. Once being-there has turned into no-longer-being-there, the openness of being turns into impenetrable closedness whose ungraspable otherness stands in contrast to all that is familiar and commonly accessible. Since schizophrenia itself must necessarily perish together with being-there, Heidegger cannot comprehend it against the background of the absolute closedness brought forth by death. Therefore, schizophrenia can be nothing but a deficient mode of open standing in the clearing of being.

If schizophrenia is viewed in Zollikoner Seminare as a deficient mode of open being-in-the-world, there also must be a correspondent explanation of such phenomena as hallucination and delusion. Many schizophrenic patients in the acute phase of their illness are exposed to uncontrollable hallucinations whose intensity surpasses the impressions and perceptions of everyday being-in-the-world. This does not mean, however, that hallucination couldn’t be interpreted as a certain mode of being-in-the-world. Heidegger demonstrates how hallucinatory experiences are to be expounded by the example of a schizophrenic whose illness reached its acute phase when he woke up in the middle of the night to find the rising Sun with a man lying underneath it on the opposite wall.23 In order to understand such a hallucination, it is necessary to be aware that even a schizophrenic exists in a certain significative and referential context, albeit a highly insecure and unstable one. Therefore, Heidegger claims that “in understanding hallucinations, one must not start with the distinction between ‘real’ and ‘unreal,’ but rather with an inquiry into the character of the relationship to the world in which the patient is involved at any given time.”24

The way the above mentioned schizophrenic relates to his world is marked primarily by extreme un-freedom. What the hallucinating encounters in his world, subjugates him and deprives him of his freedom.25 But even this utter un-freedom resulting from the inability to move within the polarity between the presence and the absence of something must still be understood as reflection of primordial openness. Only in the light of the original openness and freedom characteristic of being-there is it possible to explicate the deep deficiency of free will to which the schizophrenic is doomed by his illness.

If what Heidegger says about pathological states of the schizophrenic type is valid, it is only logical that the same should also be applied to those mental disorders that pose a far less serious threat to a free and independent existence. As long as the open being-in-the-world and integral individual being don’t perish even in the uttermost form of mental disorder, it is clear that other psychopathological states can be explicated only on the basis of a primary openness and individual constancy of existence, either. Whether they be disorders of the psychotic or the neurotic character, it is necessary to view them as privative forms of integral individual being and as deficient modes of open being-in-the-world.

The defining difference among various pathological disorders thus lies in the extent to which the patient lacks the independence of individual being and in the degree of deficiency displayed by the essentially open and free being-in-the-world. From an ontic viewpoint, compulsive behavior could seem to have nothing to do with openness or freedom; on the ontological plane, however, we can see that even this unmanageable compulsiveness does express the fundamental openness and freedom that open the very possibility of the lacking free will. All compulsive action, obsessive rituals, and actually every inability to behave differently in a given situation must therefore be approached as deficient forms of the essentially open and free being-in-the-world.26

Unless someone “mentally ill” preserves, at least to a rudimentary degree, his/her individual being, unless this human being has the ontological character of open standing in the cleared area of the world, the therapeutic help will stand no chance of opening a way out of his deficient mode of being. Both the pharmaco-therapeutic and the psychotherapeutic help can be, according to Heidegger, beneficial only to someone who remains essentially the same and who retains an elementary openness to possible impulses. In order to be cured, the ill individual must always have the ability to return to itself and make use of the possibilities offered by the world. Only thus can the individual existence in the course of its treatment obtain a freer relation to what it encounters, learn how to accept this relation and bear responsibility for it.27 As all psychopathological disorders are “disturbances in adjustment and freedom,” the aim of the therapeutic intervention is to help the patient to overcome the deficit of adjustment and freedom and to bring him/her to free existence within the requirements given by his/her factual situation.28 Thus, in Zollikoner Seminare the phenomenologically understood treatment proves to be both adaptation and liberation.

In Zollikoner Seminare, however, pathological un-freedom and dependence gain their distinct contours only when brought into connection with the inauthentic existence which flees its very own possibilities, alienating itself from its original individual being. What can serve as an illustrative example thereof is Heidegger’s exposition of compulsive behavior occurring in patients with bipolar affective disorder.29 Manic states in which the patient is compelled to incessant euphoric activity, in which he wants to throw himself in ten directions at once, are understood as expressions of the inauthentic existence. The ceaseless fluttering about and headlong seizing of whatever is available at the moment tends to be accompanied in these cases by the feeling of absolute happiness and fullness of life, but that is possible only because “the inauthentic always has the appearance of the authentic. Therefore, the manic human being believes that he is authentically himself or that he is [really] himself.”30

Inauthenticity escalated into the utmost extreme, in which individual existence deprives itself of a free and independent realization of its possibilities, is an importunate guide of other mental disorders as well. This is best corroborated by the unusually high degree to which the phenomenon described in the context of fundamental ontology as falling prey (das Verfallen) asserts itself in these. Both neurotically and psychotically burdened people are affected, to a larger or lesser extent, by falling prey that encloses individual existence into the subjugation to inherited prejudices, ready-made opinions and family schemata governed by nobody and everybody. The oblivion of the original and unique individual being that occurs amidst public anonymity is also accompanied by the tendency to fall prey to the surrounding world and its parts.

Heidegger documents the way falling prey to the innerworldy beings impacts the concrete character of pathological behavior in the case of a girl suffering from a phobia of the possible breaking of her shoe heel.31 The panic that renders the girl dependent on something as banal as her high heels is to be understood in the light of entanglement in beings ready-to-hand that are disclosed within the referential structure of the surrounding world. The existence of this girl “is absorbed in a particular, everyday world,” but this does not mean that her individual being should disintegrate. “It is a question of [being] an uninterrupted self” whose entanglement in things sentences it to the inauthentic existence.32

Under the given circumstances, therapeutic treatment must be directed toward enabling the patient to overcome the inauthentic mode of existence and obtain an open relation to beings that address her in the significative context of the surrounding world without falling prey to them. However, does not the freedom and independence of a healthy existence acquire the status that is reserved in Sein und Zeit for the authentic mode of being? Is not health put on a par with the authentic existence? If mental illness represents a privative phenomenon, it is viewed as an inauthentic mode of existence that is, as follows from the existential analytic of being-there, also a privative form of being-in-the-world. Against the inauthentic existence stands the authentic mode of existence in which the primordial form of being in disclosedness manifests itself. In relation to the inauthentic mode of being, the authentic existence plays the same role that health plays in relation to illness.

In this context, one must not forget that the phenomenon of privation, according to Heidegger’s conception, is connected not with a value-based devalorization but rather with ontological derivation that manifests itself against the backdrop of the primordial unity and integrity of individual existence. The incoherence and inconsistency of individual being that mark the inauthentic existence is a mere modification of the unity and integrity achieved by the authentic individual being. The same applies to the dependence and lack of freedom of pathological modes of individual existence, whose deficiency is reflected against the background of a free, open relatedness to beings that marks the healthy existence.

If, however, health is put on a par with the authentic way of being in Zollikoner Seminare, this cannot occur without a change in the understanding of some constituent moments connected with the free, self-subsistent and self-consistent existence. Unlike the authentic mode of existence as described in Sein und Zeit, health is not grasped as heroic readiness for anxiety or as obedience to the voice of one’s own conscience. Health as such is entirely extricated from the relation to the uncanniness and existential guiltiness heralded in the voice of conscience. The point is that the relation to the world stripped of all pathological constraints and blocks must be primarily joyful and relaxed. “The being-free for something is a serene and joyful mood in itself,” claims Heidegger.33 Insofar as anxiety does appear in Zollikoner Seminare, it is only in the forms of sheepishness and imbalance that mark the pathologically narrowed relation to the world. Anxiety is no longer the key to the free and independent existence, but, rather on the contrary, a proof of un-free and dependent existence. The anxiety a young woman suffers is perceived as an expression of hysterical un-freedom, but once the patient has supplanted the anxiety by a joyful mood it is regarded as the proof of her having been cured, i.e. of her having managed to overcome pathological inhibitions and attain a truly free relation to the world.34 Hence, anxiety is no longer to be regarded as the ontological foundation of individual existence, but rather to be done away with by therapeutic means.

Nevertheless, the fact that anxiety is understood as a pathological phenomenon does not mean that Heidegger explicates psychopathological phenomena in the light of temporality whose defining dimension is the having-been. This possibility remains beyond the horizon of his meditations which imply nothing more than the link between psychopathological disorders and the unauthentic existence whose temporality temporalizes itself primarily out of the dimension of the present. More than to anything else, the shift in the understanding of anxiety attests to the change Heidegger’s thought underwent between Sein und Zeit and Zollikoner Seminare. Even though a more or less identical terminology is used in both texts, the ontological project of being-there undergoes a certain change, which is revealed also by the fact that the phenomenon of anxiety loses the preeminent position it used to have within the existential analysis of being-there and becomes utterly marginal. The only ideas that remain unaltered within the ontological project of being-there are the concept of the existential constancy of individual being, maintained on the ground of the ecstatic unity of temporality, and the phenomenon of privation that is connected with illness and inauthentic existence.


4.2 Boss’s Daseinsanalytic Concept and Its Critique



Abstract

With respect to Boss’s therapeutic Daseinsanalysis one can say that it is nothing but a reflection and specification of the notion of mental disorder that is outlined in Zollikoner Seminare. Boss fully adopts Heidegger’s view on mental disorder and further elaborates on it in detailed clinic studies. He also accepts the idea of the elementary unity of the human existence that can be disrupted by no psychopathological disorder. All disruptions of the individual existence including the schizophrenic dissociation of the self are, then, viewed as mere privations of the fundamental integrity of the self. Yet, even though Heidegger himself affirmed Boss’s psychiatric conception, this conception has met with a considerable critique. Recently, it has been especially Alice Holzhey-Kunz who criticized Boss’s therapeutic Daseinsanalysis because of its normative character. In opposition to Boss, Holzhey-Kunz has created her own hermeneutic concept of psychopathology, in which she stresses the finitude of human existence as the basic ontological character that makes possible a non-normative approach to psychopathological phenomena. Since the finitude of human existence has – in Heidegger’s eyes – no positive counterpart, it can be used as the ontological fundament explaining all sorts of psychopathological phenomena. However, even Holzhey-Kunz is not able to put question mark over the individual integrity of human existence, as she sticks to the common understanding of Sein und Zeit. This is why she can explain merely the psychopathological disorders of neurotic character leaving the psychotic disorders aside.


Keywords

Therapeutic Daseinsanalysis, Mental health, Mental illness, Privation, Normativity, Individuality

With respect to Boss’s therapeutic Daseinsanalysis which is to be discussed in this Chap. 1 can say that it is nothing but a reflection and specification of the notion of mental disorder that is outlined in Zollikoner Seminare. Boss fully adopts Heidegger’s view of mental disorder and further elaborates on it in detailed clinical studies. He also accepts the idea of the elementary unity of human existence that cannot be disrupted by any psychopathological disorder. All disruptions of individual existence including the schizophrenic dissociation of the self are then viewed as mere privations of the fundamental integrity of the self. Yet, even though Heidegger himself affirmed Boss’s psychiatric conception, this conception has met with a considerable critique. Recently, it has been especially Alice Holzhey-Kunz who criticized Boss’s therapeutic Daseinsanalysis because of its normative character. In opposition to Boss, Holzhey-Kunz has created her own hermeneutic concept of psychopathology, in which she stresses the finitude of human existence as the basic ontological character that makes possible a non-normative approach to psychopathological phenomena. Since the finitude of human existence has – in Heidegger’s eyes – no positive counterpart, it can be seen as the ontological foundation explaining all sorts of psychopathological phenomena. However, even Holzhey-Kunz is not able to put a question mark over the individual integrity of human existence, as she sticks to the common understanding of Sein und Zeit. This is why she can explain merely the psychopathological disorders of neurotic character leaving the psychotic disorders aside.

If we are to grasp the viewpoint professed by Zollikoner Seminare in its entirety, we must not neglect Heidegger’s friend, organizer of the Zollikon seminars and subsequent editor of the seminar proceedings – Medard Boss. Although Boss met such personages as Freud, Goldstein or Jung during his studies and his ensuing professional career, the direction of his scientific development was particularly influenced by Binswanger’s psychiatric Daseinsanalysis. Later, he abandoned this theory as well, when he created his own psychotherapeutic conception of “therapeutic Daseinsanalysis,” which consisted in the rigorous effort to understand the ontic phenomena manifested in the realms of psychopathology and psychotherapy on the basis of Heidegger’s philosophical views.

Just as psychiatric Daseinsanalysis, therapeutic Daseinsanalysis relies on the ontological project of being-there, but unlike Binswanger’s concept, it is firmly grounded upon the foundations established during the Zollikon lectures and seminars. It is especially by virtue of these that Boss managed to evade the anthropological schemata by which psychiatric Daseinsanalysis obfuscated the original sense of the ontological analysis of being-there. Conversations with Heidegger and attendance at his lectures enabled Boss not only to grasp the significance of the fundamental notion of disclosedness, but also to comprehend the change in the concept of the ecstatic being in disclosedness that occurred once this disclosedness had been understood out of itself as the clearing of being. This is corroborated already by the fact that Boss’s view on the ontological constitution of being in disclosedness derives much more from Zollikoner Seminare than from Sein und Zeit.

Correspondingly, in therapeutic Daseinsanalysis the disposition of anxiety plays almost no role at all. Instead, what becomes the primordial disposition that reveals the true character of sojourning in disclosedness is cheerful calmness (die heitere Gelassenheit) or calm cheerfulness (die gelassene Heiterkeit) in which the individual experiences the original openness and freedom of its being. Unlike all other moods by which being-in-the-world is both opened and closed, the disposition of cheerful calmness brings the openness and freedom of sojourning in the clearing of being to their full revelation. Being-there is always already somehow situated within the frame of significative and referential relations between beings, but only the disposition of cheerful calmness enables it to face all uncovered beings without closing itself off from them or wanting to subjugate them to its power. Individual existence attuned to calm cheerfulness lets everything be what it is and thus is addressed by it. By enabling it to remain in the broadest responsiveness, calm cheerfulness brings to individual existence consummate happiness. Boss understands this happiness as a feeling that appears when the realization of all essential possibilities of behavior has been opened for individual existence.

Although such a disposition opens individual existence for grasping the immediately revealed givens, the majority of moods also closes it off in a certain manner. In extreme cases this is conspicuous in affects such as anger and wrath, in which human existence becomes blinded to certain aspects of its present situation. As disposition offers us specific possibilities of behavior, being-in-the-world is always more or less open in a given disposition. Insofar as being-in-the-world is understood as an open comprehension of the significative richness of the world, the individual differences in the maintenance of the open and cleared area of the world can be detected and described. The ideal is thus seen in the maximum openness by virtue of which being-there can encounter the significative richness of beings, and thus completely fulfill its “standing-open.” A specific individual can exist in a way adequate to being-there (daseinsgemäß) only when it stands open to the challenges and claims of what is announced in the significative and referential context of its world.

Specific individuals differ from each other especially in the degree and extent of reduction in their open relation to the significative richness of the world. This extent highlights the individual norm, marked by both natural constitution and the personal history. The specific individual exists normally as long as it realizes possibilities available to it in an adequate way. The differentiation of the individual extent of openness to the possibilities of perception and action, however, is sensible only provided that, on the ontological plane, being-there still maintains its individual being. Should it not exist as individual being, it couldn’t avail itself of the possibilities of maturing and growing, and thus of broadening the field of its own possibilities. The psychotherapeutic help whose sense is seen by Boss in removing restraints created by pathogenic upbringing in the childhood, as well as in giving access to the possibilities hitherto excluded, would thus also become impossible.

Since an instrumental part of the therapeutic Daseinsanalysis is played by the interpretation of dreams, it must, understandably, also reflect the structure of individual being. In “Es träumte mir vergangene Nacht…,” Boss departs from the presupposition that being-there preserves its individuality both in waking and dreaming. Even the dreams of schizophrenics, who experience in them the world’s doom and disintegration of their existence, present no exception. Even though they indicate the dreadful loss of one’s self, these dreams cannot, in Boss’s opinion, cast doubt on the fact that even schizophrenics, who witness their own psychophysical undoing, still preserve their individual being. For, “even waking schizophrenics retain some rudimentary sense of self, and of their dwelling in the world, for otherwise they could never experience a loss of those things, waking or dreaming. And if the loss of those essential human traits were in fact total, such persons would no longer be human beings.”35 Thus, the fact that both dreaming and waking belong to one whole of individual existence is not refuted, but rather corroborated by the extreme experience of these patients.

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Jun 12, 2017 | Posted by in NEUROLOGY | Comments Off on The Problem of Mental Disorder

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