Louis Sass obtained his B.A. (English literature) at Harvard University in 1970 and his Ph.D. (psychology) at the University of California Berkeley in 1979. He then completed an internship in clinical psychology in the psychiatry department of Cornell University Medical Center in 1981. Around the same time, he landed at the College of the Holy Cross, where I (Mark Freeman) currently teach. It is the same position, basically, because (presumably) they would only allow a certain number of theoretical philosophical-psychology scholars to work in that department.

Eventually, Louis Sass made his way to Rutgers University. He’s been a visiting professor at Leiden University in The Netherlands, the University of Chicago, Universidad Michoacana de San Nicolás de Hidalgo in Morelia, Mexico, the Center for Subjectivity Research at the University of Copenhagen, the Institute for History and Philosophy of Science and Technology in Paris, and also the philosophy department of the National University of Colombia in Bogotá.

Louis has collaborated on research and writing projects with folks in Denmark, Spain, France, Germany, England, Mexico, Australia, Italy, Colombia, and, of course, the United States. He has been a featured lecturer in these countries and elsewhere. His work has also been featured in a number of films on the subject of schizophrenia.

From 1998 to 1999, Louis Sass was President of the Division of Psychology and the Arts of the American Psychological Association and subsequently (2006–2007) was President of the Division of Theoretical and Philosophical Psychology. In 2010, he was awarded the Joseph Gittler Award from the American Psychological Foundation, “in recognition of his longstanding commitment to using philosophy to advance psychology research and scholarship.”

Among his many writings are the books, Hermeneutics and Psychological Theory, which he co-edited with Messer and Woolfolk; Madness and Modernism: Insanity in the Light of Modern Art, Literature and Thought (which will appear in a revised edition in 2017); and The Paradoxes of Delusion: Wittgenstein, Schreber and the Schizophrenic Mind.

It’s an extraordinary profile. We are very fortunate to be able to have this conversation with him, and to top it off, Louis Sass is a good man with a great mind. It’s actually been a long time since I’ve seen him. He’s gone his way and I’ve gone mine, and we just haven’t had the opportunity in recent years to meet up with one another to share ideas and to find out what’s been happening. But Louis is someone whose questions and ideas and ways of encountering the world are so familiar to me that, even after a too-long lapse of time, we can connect. It’s quite remarkable, actually, to find this sort of intellectual kinship. Among other reasons, it helps one see that, through it all, we can sometimes look out on a common world. Either that or we partake of similar illusions! One way or the other, it’s my great pleasure to introduce Louis Sass.

Mark Freeman (MF): :

I want to begin today with a quote. It’s from a review of the book I just mentioned, Madness and Modernism.

Madness and Modernism possesses extraordinary richness, depth and profundity. It is truly a work of thought, a work that not only explodes received wisdoms, but also allows its readers to see the world anew. In this respect, the book itself is a prime example of one of the fundamental theses it seeks to articulate. To become ensnared in the labyrinth of our own constructions is to become blind to the otherness of the world. It’s to become autistically enclosed, hermetically sealed, such that everything appears to be quite other than what it is. More than anything, therefore, Sass is urging us to see, to look again in the hope that we might learn something new about our situation.

As you know, those words are mine from a review of the book. I had to look up the review; that was about 20 years ago from the journal Theory and Psychology (1996). And I must say, they reminded me of how extraordinary your work has been. That book, I think, is a classic in the field, but even beyond the field. It’s just an amazing work of thought. I mean, even the endnotes, 160 pages of them! Very, very intimidating—but a great book.

In any event, those words seem especially pertinent to the conference here today: the relationship to otherness. What happens when that otherness becomes eclipsed? What happens when one turns inward in such a way that the world becomes veiled? So, I’m going to eventually ask you to talk about it.

It was almost 30 years ago in conjunction with a conference on development in the arts, run by our friend and colleague, Bernie Kaplan, that we first met. And it was there, I think, that we felt an affinity. We felt that we were fellow travelers of a sort, especially when it came to thinking about the assets and liabilities, so to speak, of post-modernism in the arts and beyond. How did it all begin? I realize that’s a very broad question. How did you enter the discipline and what did you make of it at the time? If you could just kind of sketch out a narrative of those formative years and help us see how you got to be you.

Louis Sass (LS): :

I’ll do that in just a second. But first, I want to thank you, Mark, for being here and doing all this preparation when you have so much else to do, including being an interviewee yourself at this conference. Thanks also to Heather and David for inviting me, and to all of you for coming. It’s really a pleasure to be here talking with you.

So you asked me how did I get into the field?

MF: :

How would you get into the field? Or what led you to the discipline of psychology?

LS: :

Well, it was a sort of strange journey in a sense because I started out as an undergraduate majoring in literature, English literature. And only took a couple of psychology courses and then wandered into psychology, for graduate school, having very little sense of what the field really involved. Wandered into it because of several things I had read as an undergraduate and the couple of courses I did take; two books were particularly important: David Shapiro’s Neurotic Styles (1965), one of the classics of our field, clinical psychology; and also R. D. Laing’s The Divided Self (1960), which also impressed me very much.

So I…I wasn’t very career oriented, not in any focused way, and thought, well, maybe there would be more options in psychology than going on to graduate school in literature. And so it was mainly on that basis. I went to Berkeley because I wanted to be somewhere different (I had majored in English at Harvard College) and I figured California would be an exciting place to live for a while.…not knowing much about who was on the psychology faculty there, or anything serious of that nature. So it was really all a bit random—I certainly wasn’t a savvy 21 year old.

But I had gotten interested in certain things like schizophrenia because of Laing, among other reasons, and also in phenomenology because, almost by accident, I ended up in a philosophy course on Husserl and Merleau-Ponty toward the end of my college career. And I can say that I did read every word of Ideas 1 by Husserl, though I think I probably understood almost nothing of it. But I did read it. It’s an interesting question, what does it mean to read? Because I, in some sense of the word, did read that book, that is, passed my eyes over every sentence, even though I didn’t understand anything really. But I also read Merleau-Ponty’s Phenomenology of Perception, which I think I understood some—maybe quite a bit of.

MF: :

Who was the teacher, I’m curious, do you remember?

LS: :

Yes. It was Frederick Olafson. He left Harvard about a year later, for the philosophy department at the University of California San Diego. He wrote a lot on phenomenology, mostly on Heidegger, I believe.

I found—there’s a lot of psychology in Merleau-Ponty’s Phenomenology of Perception (1945/2012), and I thought, “Wow, this is really interesting stuff.” So I expected to arrive in Berkeley, where I went to graduate school, with everyone in the psychology department knowing all about Merleau-Ponty and being eager to talk about these things. And of course it wasn’t at all like that. No one seemed to have even heard of Merleau-Ponty; and hardly anyone, at least in psychology, was interested in talking about the things that interested me. So that’s what happened.

Then in graduate school, I had a difficult time in some ways. I was always thinking about dropping out, and I did drop out a couple of times because I really didn’t know that the field was for me. Much of the time I thought there was something very wrong with the field. But there were many other times when I thought maybe it was me: maybe I was just too stupid to appreciate the subtleties of something like mainstream theories in social psychology, a subfield that particularly irritated me. So I certainly had moments when I thought, “Well, I must just be missing something, I don’t understand it. I just don’t understand what people see in this to take it so seriously.”

It was a difficult time. But fortunately, I met Margaret Singer, a clinical psychologist who studied schizophrenia and then I managed to find some direction and a dissertation topic. So that’s kind of how it went for me.

MF: :

I also sort of stumbled into phenomenology by accident. It was a course in phenomenological psychology in the philosophy department. I really had no idea what that meant. But I knew that I wasn’t getting fed, so to speak, in the way that I wanted to from the courses I was taking. And in encountering phenomenology…I had a couple of thoughts. One of them was I thought this was what psychology actually is in its essence, or should be anyway. So, it was a kind of natural—a natural thing. Did you feel the same way? Did you find a kind of home there in a way?

LS: :

Absolutely. Because, well, I think psychology should be largely about human subjectivity—including of course the relational or intersubjective and the bodily-based or corporeal aspects of human subjectivity. Those are certainly part of it. And there are always other possibilities as well. But the main thing that should be at the core of psychology, in my view, is human consciousness, human subjectivity. And, of course, phenomenology—with all its complexities, with all its internal divisions and dissensions—is the royal road to that.

MF: :

Sure. It’s amazing how many different iterations there have been in the history of psychology of avoiding encountering subjectivity, from the behaviorists on up, in some ways, to contemporary neuroscience. I mean, there are some neuroscientists who are interested in subjectivity, but oftentimes they’re more interested in the material foundations of it as if we could safely sidestep subjectivity.

LS: :

Absolutely, yes.

One more thing about that period: I think getting interested in schizophrenia was a very natural thing for that period of time. You know: the late’ 60s, everyone speaks of “sex, drugs and rock-and-roll.” But actually, it was sex, drugs, rock-and-roll—and madness, in terms of the themes that really were passionately interesting to people of my generation, in that phase of our lives at least. And these were, well, the cool things—so to be interested in schizophrenia was a very natural thing; and it was kind of, in the late’ 60s and into the’ 70s, it was sort of ‘the’ disorder.

MF: :

Right.

LS: :

Yes, in a way that is not really true now, either in the mental health professions or in the culture at large. It’s still important, obviously, but it’s not “the” thing. So in that sense, I suppose I was, in a way, very much a product of the passions and enthusiasms of my era.

MF: :

I understand that. I mean, rereading R. D. Laing’s The Divided Self, which I’ve done in recent years, it’s kind of a trip. It’s an amazing, amazing book and I think it’s been set aside in many ways. But you look at those chapters on ontological anxiety and the false-self system and so on, they’re amazing. I think of some phrases from The Politics of Experience when Laing, for instance, talks about socialization as “the indoctrination of recruits”; those are still important.

LS: :

Yes, I agree.

MF: :

And a lot of that was about liberation in a way.

LS: :

True. I was influenced by The Divided Self, though.

MF: :

Same here.

LS: :

And I was—I have always been very dubious about almost everything else written by Laing. Although it’s interesting—he was, as you know, often brilliant—but I would make a sharp distinction between The Divided Self, which is in the phenomenological tradition, and other things written after Laing began to think of himself as a guru with all that that implied, and when lots of problems began to happen in his life and with his work.

MF: :

Quick comment on The Divided Self: I’ve had a number of students who wanted to study things like eating disorders through the years. And one of the first books I had them read was The Divided Self even though there’s no explicit mention of that.

LS: :

Yes.

MF: :

The whole idea of what one puts out, so to speak, for consumption and what gets negated and impoverished internally and so on, is spelled out in quite extraordinary detail in that book.

LS: :

Yes, I agree.

MF: :

A number of years after we met, we gathered again at a symposium at the APA convention. The topic was “Post-Modernism and Its Malcontents”; I mentioned it yesterday. We were among the malcontents and our friend, Ken Gergen, was our discussant. I’m actually not sure whether “malcontent” was quite right. By all indications, you were, and remain, attracted to certain aspects of post-modern and post-structuralist thinking. You’ve talked about how it is that our own self-understanding might be enriched by at least certain aspects of schizophrenic experience. But you clearly had misgivings, too, about what you were seeing in terms of intellectual currents in psychology. What were the problems that you had? What is it that concerns you most about those bodies of thought? Why is it that you became a skeptic of the skeptics?

LS: :

Right. Well, as you well know, Mark, as well as anybody does, words like post-modernism have lots of different meanings.

MF: :

Sure.

LS: :

As does modernism, by the way. But post-modernism, if by that you mean a kind of relativistic position, a dogmatic relativism, which denies the project of seeking truth, then I’m certainly anti-post-modernist because that just seems to me a naïve position, and one that is basically “metaphysical” in the pejorative Wittgensteinian sense of insisting on some grand generalization (in this case, a skeptical one) that cannot be justified either by science or by common sense.

So, in that sense I’m anti-post-modernist. I mean, as I said, it seems to me that, as an epistemological position it goes against common sense. It goes against the fact that you and I are speaking with each other now, and that this fact presupposes that we, each of us, believes and is necessarily committed to the idea that each can indeed have some idea of what the other means. With all sorts of possibilities of error, obviously.

MF: :

Right, and ambiguities.

LS: :

And ambiguities, certainly.… But if there weren’t some possibility of understanding, and in that sense of seeking truth—like I can try to figure out: what does Mark mean by his last question?—then there would be no possibility of our even talking. And if there’s no possibility of talking, there’s no possibility of thinking. So I find that position doesn’t make sense to me. It seems to me it’s more a kind of posturing than a serious intellectual stance. And, of course, there are also the familiar arguments against skepticism, for example regarding the self-contradictory nature of absolute skepticism itself. So no, I don’t find that version of postmodernism, at least as a general epistemological stance, to be at all appealing, or even reasonable.

But of course, the rubric “post-modernism” can include a lot of things. If by that you mean to include what’s called post-structuralism, people like Michel Foucault, for example, well obviously then, there’s a lot of interesting stuff there. Foucault, to my mind, is perhaps the most important thinker of the last 50 years or so. But I do think that there’s a strong tendency to think very simplistically about who fits with whom. And part of that is fostered by people like Foucault himself—who, after an early phenomenological period, attacked phenomenology, and allowed himself to be seen…indeed supported the idea that there was a radical separation between the sort of work he did and what phenomenology was all about.

Which I think is completely misleading. I’ve written about this recently, discussing both Foucault and Lacan in this light. Despite the fact that both of them are overtly anti-phenomenological, judged by what they say explicitly, I do think an important way of reading both of them is as, in a way, secret phenomenologists—of a specifically Heideggerian sort (Sass 2014a, 2015).

MF: :

Yes. Why do you suppose they had to keep it secret? In other words, why the disavowal?

LS: :

Parisian politics…Parisian intellectual politics, to a large extent, and also the need to, well I guess you could call it a kind of anxiety of influence: the need to present oneself—to others but to oneself as well—as radically different, truly novel, even revolutionary. Also, the fact that they were, indeed, influenced by Claude Levi-Strauss, whose own position was in fact more truly anti-phenomenological.

MF: :

Right, for sure.

LS: :

And Levi-Strauss presented that in very sharp terms, for example in his book The Savage Mind. So they got on that bandwagon—and then there were also all the Americans who were influenced by the Parisians and followed (perhaps a bit slavishly) that same line, assuming that that must be the right way to look at things. In fact, if you read almost all of the major histories of recent French thought, which I reviewed recently, they all assume that there was a major bifurcation—between existentialism and phenomenology versus the poststructuralism that followed. But I don’t think that really makes a great deal of sense, not, at least, once you recognize or accept the crucial role of Heidegger. Because Heidegger is obviously a central figure of the phenomenological tradition. And yet, Heidegger is also, I think you’d have to say, a very major influence on both—on Foucault (along with Nietzsche) and on Lacan (along with Freud).

So, when you think about it, the standard historical narrative doesn’t make an awful lot of sense. And then you begin to think about, well, what is Heidegger really all about and in what direction did Heidegger take phenomenology? And the answer, I think, is that the direction he took phenomenology (beginning at least with Being and Time) is very consistent with a lot of what both Foucault and Lacan have to say. Indeed, we should not underestimate the extent to which they are influenced by Heidegger’s brand of phenomenology—especially by his crucial emphasis on not “forgetting the ontological difference,” which shows up, I think, in key notions like Foucault’s “epistemes,” in his book The Order of Things (originally: Les mots et les choses), or Lacan’s three registers (Imaginary, Symbolic, Real). (On Heidegger’s notion of ontology and the ontological difference, see Sass 1992a, 1992b, 2017)Footnote 1 That’s my argument, anyway. So I’m against relativistic postmodernism yet, at the same time, very interested in some of the post-structuralist postmodernists.

And one more thing I should say perhaps: which is that I’m also very sympathetic to the skeptical moves of postmodernism so long as they’re used as intellectual strategies and not taken to an absolutist extreme. I mean, I do think that postmodernist psychology, in questioning the mainstream, has had many interesting things to say. By bracketing the truth-value of psychological theories, and saying instead, “let’s look at these psychological positions in terms of how they reflect the culture, hidden intellectual presuppositions, and things like that.” This can certainly be an interesting project—certainly it is one that I respect, and that in my view has generated a lot of important writing.

I do recognize that such a project does require skepticism, a bracketing of truth claims, or at least of many such claims, within a certain domain. So you see, there are indeed several ways in which I’m actually very sympathetic with much of the work that is considered part of postmodernism.

MF: :

It would be great if you could clarify one thing. I think I know where you are on this, but some people might be taken aback in some ways by the fact that you—or I, for that matter—don’t subscribe in a wholehearted way to the kind of constructionist wing of postmodernism and so on. In reading some of your work, one could be led to assume that you’re something of a realist, which I don’t think is necessarily as pejorative a term as it’s sometimes made out to be.

At the same time, of course, you self-identify as a hermeneutic thinker. This came up yesterday in the talk with Ken. I mean, how do you square, or how do you reconcile, your concern about…how shall one put it?…preserving the real, or even more to the point for this conference, preserving the otherness of the real? How do you square that with the hermeneutic perspective—which is itself sometimes seen as a constructionism, right?

LS: :

Right, right. But as you yourself commented yesterday in that interview with Ken Gergen, hermeneutics need not be seen as a relativism, and I don’t think that’s the proper or best way of understanding, for example, Gadamer. And Gadamer comes right out of Heidegger, and clearly it’s not the right way to interpret Heidegger because he’s obviously making truth claims all over the place (see Messer et al. 1988; Sass 1988; Sass and Woolfolk 1988).

So, I think that’s a distorted, oversimplified view of hermeneutics: to say that it’s fundamentally relativistic. Of course, hermeneutics recognizes all sorts of things that are related to a recognition of perspectivism and ways in which—

MF: :

Context shapes the perspective.

LS: :

Or that one’s position could be constructed and maybe even distorted by cultural or epistemic formations of different kinds. But that doesn’t mean that it’s dramatically skeptical or ultimately skeptical about truth. (We should remember, after all, that the very act of recognizing these supposedly determinative cultural or epistemic formations is itself fraught with truth claims—that is, with claims about the very nature or existence of these formations.) Of course we’re talking in psychology, hopefully, and certainly in phenomenology, about a realism that is not concerned with something that is real in quite the same way that physical objects are real. It’s about subjectivity. And what it is to study subjectivity is, of course, a fascinating and difficult problem in itself.

We obviously need to recognize the difficulty of pursuing this project, and the phenomenological tradition is full of reflections on that issue, often with one phenomenologist criticizing another such as when Heidegger criticizes Husserl, for example. So we need to recognize all of the difficulties inherent in being, in a certain sense, realists about the, in a way, very unreal real thing that is subjectivity.

MF: :

Yes. And in one of the pieces that you sent along, which I very much appreciated, you talked about, in a sense, the possibility of taking something like an objective stance toward subjectivity.

LS: :

Right.

MF: :

Which I’m very sympathetic to. Say a little bit more, though, about what that means, because on the face of it, it sounds kind of paradoxical. How can one be objective about the subjective? But it seems to me that in some measure, that’s what phenomenology’s about and that’s certainly what much of your work is about.

LS: :

Here I am reminded of the quotation from Eugene Minkowski (the French phenomenological psychiatrist who published La Schizophrénie in 1927) (Sass 2001b) that appears as a motto at the beginning of The Divided Self, which you may or may not remember. Laing quotes it in French, as I recall, but basically it says something like the following: “I am engaged in a subjective project here, but one that nevertheless strives, with all its powers, toward objectivity.” I think that’s a beautiful statement—like so much of Eugene Minkowski, who has been a great inspiration to me.

So that, I would say, is my project—and indeed it is the project of most of us who are phenomenologists. That is, we are trying as best we can to get it right—like in my case about schizophrenia. We’re not claiming we have it right, of course; but nevertheless that’s the goal we’re aiming for. Obviously, our project is not just to make up interesting things about this or that illness that might be fun to think about. The point, of course, is to reflect, as best we can, what it really is, which is to say, what it really is like to be this or that kind of person. And I think every phenomenological psychopathologist would agree with that. That’s our project; and that’s why we consider it a serious project—and one that is, in part, a scientific project.

But it’s a difficult project especially if you think about something like schizophrenia because, well, if you consider what are the criteria of truth in understanding subjectivity, one criterion is—it’s a hermeneutic criterion—what is known as the principle of charity in interpretation. And the principle of charity in interpretation, as you well know, states that, other things being equal—which they aren’t always—but other things being equal, the construal of what the other person is saying that ascribes to him or her the greatest rationality and coherence, is probably the best one.

We rely on that all the time—even in everyday conversation. And certainly we need to use that when we’re attempting to understand, say, psychiatric patients. But what happens when you’re dealing with something like schizophrenia—where our notions of coherence (and of rationality, for that matter), those of the average or normal person, might be different, first of all, from theirs? Also, there may be certain things in their point of view that are actually not coherent, that may be paradoxical.

So, that means that a straightforward attempt to make the patient make as much sense as possible—at least in our own terms—can very easily be misleading. And so, in order to carry out the hermeneutic phenomenological project properly, one has to be extremely self critical and self aware of what one is doing in the act of interpreting. And that’s what I’ve tried to do in, for example, postulating certain kinds of paradoxes in schizophrenia—because to do this is to acknowledge forms of incoherence that may nevertheless make a kind of sense—paradoxical though it may be. (See, e.g., Sass 1992b, 1994a, 2004a, 2007, 2014d, 2017; Sass and Byrom 2015b.) So, my project is not simply to say, straightforwardly, that whatever the patient says makes perfect sense—full stop. What I am saying is, rather, that it may make a certain kind of sense within a strange world, the horizons or dimensions of which have been altered from the normal, and which may well involve forms of self-contradiction.

MF: :

Yes, I see what you are saying.

LS: :

But when do you know—just one more point—when do you know to apply the principle of charity in a straightforward way, versus when to look rather for something paradoxical? Well, obviously there’s no rule for that. You try things out, you try to figure out what interpretation fits the phenomenon best. And one of the things that I take into account in doing that—it’s also one of the reasons there were so many pages of endnotes in my book Madness and Modernism (1992b/2017)—is the empirical research that is available, insofar as that is relevant. Just how it can be relevant to a phenomenological project is a complicated question. But often it is. For instance: what do we know from the empirical literature about the specific nature of the formal thought disorder that is most characteristic of schizophrenia—as opposed to forms common, say, also in mania?

And ultimately, what do we know about neurobiological alterations that might or might not be consistent with a phenomenological account—or that might suggest a different one? So, what I advocate is certainly not phenomenology to the exclusion of these other approaches.

MF: :

I must say, your willingness to make significant contact with the empirical work, including the neurobiological, is something I very much admire. Quite honestly, I don’t do it as much in my own work as you do and I think you’re a model for how to have a more inclusive sense of things.

So let me ask you one difficult question having to do with much of what you just said. To what extent do you feel at this point that you “know” the inner world of the schizophrenic person? Or would you have to be it to know it?

LS: :

Well, I—that’s a really interesting question, and another complicated one. I have a friend, a very good friend, Rupert Read, who’s a Wittgensteinian philosopher in England: we get along very well; I always learn a lot from him; and he’s a critic of my point of view in a way that’s very relevant to what you’re saying. Because Rupert says that what I and other phenomenologists say about schizophrenia is all a fantasy.—We can’t really know what it is like to experience such a form of psychosis. And, in fact, even understanding, the very possibility of understanding is itself limited by the common sense point of view that we have. That’s his—that’s Rupert’s view of Wittgenstein; but it’s not mine.

And so, almost by definition (according to Rupert) a normal person—whose speech and conceptual structure is necessarily grounded in normal common sense and normal usages of language—cannot truly get outside that structure in order to understand a different one. So Rupert—he says he admires my work because he thinks it’s the best phenomenological interpretation available, but at the same time he also thinks that the whole project is probably a grand illusion. So as you can see, Rupert and I have an interesting conversation.

But I don’t think—to me, that position just doesn’t make sense. For one thing, it is contradictory. Just to give a very simple answer, or the beginning of one: I’m in contact with quite a few people with schizophrenia and quite a few of them tell me that what I and some other phenomenologists have written about the lived world of schizophrenia is largely correct. And I do always ask them what might be wrong in what I have written. And sometimes they say, “Well, you’ve exaggerated this, you got this a little bit wrong, or you neglected that.” But overall, I felt quite vindicated by their reactions—and vindicated in my critique of mainstream views of the psychological nature of the condition. By the way, I myself have worked quite a bit on Wittgenstein (Sass 1994a/1994b, 2001a, 2001c, 2003a), and my own views about the implications of Wittgenstein’s thought clearly differ from Rupert’s.

MF: :

Good.

LS: :

Maybe it’s not surprising that I have felt vindicated by the reactions I have had from people with schizophrenia—because, after all, it’s not as if I wrote these things without previously talking to people with schizophrenia, and reading what some of them had written. I was already consulting with them, obviously; so what I say is partly a reflection of those conversations. And then I meet other people with schizophrenia later in my career and they also confirm it, while also sometimes pointing toward some new lines of thought about it. So I feel…well, I guess I don’t think of course that any of us can fully understand any other person.

MF: :

Right, of course not.

LS: :

Another thing I wanted to say about all this is that, as you know, my book is titled Madness and Modernism. The whole argument is that, if you understand something of what modernism is, especially in its hyperreflexive and alienated aspects (this would include a fair bit of what is also sometimes called postmodernism), well then, you may be in a position to have a better understanding of many aspects of schizophrenia (Sass 1985, 1992a, 1992b, 2017). You don’t have exactly the same thing as schizophrenia, of course. There’s a great line from Coleridge about the necessary inadequacy of all comparisons: no metaphor, no likeness, goes on all fours. So it’s obviously not identical.

But nevertheless, there are a lot of things that you—that you can at least approach, or understand partially; and especially, perhaps, if you have a little bit of a schizoid quality to your own personality—which many intellectuals do have. When I say schizoid, I don’t mean it in the DSM sense, but in the sense of Fairbairn, Guntrip and Laing—the British object-relations theorists. These thinkers understand schizoid detachment not as a deficit of social interest or capacity but as an, in part, defensive reaction that goes together with forms of sensitivity and felt vulnerability—also with awareness of the solitary nature of the human condition; and finally, with a propensity to stand back from conventional frameworks or taken-for-granted assumptions, to float outside one’s own stance, to see things from afar or adopt a meta-perspective. And I think that, in that sense, most really interesting philosophical minds, like Wittgenstein’s, to take one clear example, do have a considerable schizoid streak (Sass 2001a). So, I guess I’d like to think I might have a little bit of a streak myself.

MF: :

Yes, a little hyperreflexivity comes in handy once in a while. [laughter]

LS: :

That’s right, when it’s not tripping you up.

MF: :

Exactly. I’m sympathetic to your response. You know, in a similar way I mentioned my mother yesterday, who’s a 92-year-old woman with dementia, and I’ve written extensively about her. And the only challenge there is that she can’t confirm for me whether what I say is valid. So that’s difficult. But the idea that by degrees you might be able to, in some sense, enter—enter into that world and at least imagine what it’s like seems to me to be plausible.

LS: :

What you say, reminds me that one of the great problems that we have, one that can’t really be surmounted fully in phenomenology, in the phenomenology of schizophrenia certainly, is that we are probably more dependent on a certain kind of patient’s account than we might like to be. But understanding the subjectivity of another is not, of course, wholly dependent on their personal reports.

MF: :

Of course not.

LS: :

Because we have other kinds of data as well, from experimental psychology, cognitive science, and neurobiological research; but still, verbal reports from the patients themselves are really quite crucial. And so you have to keep asking yourself, “Am I describing things that are only true for the most articulate patients—the ones likely to have the greatest influence on our phenomenological accounts? Or are the most articulate patients articulating what the others are experiencing but can’t describe?” Having any certitude about how to answer that question is pretty unlikely. But we do our best.

MF: :

Yes. Let’s go back to your work Madness and Modernism. What we have in the relationship between the two is a correlation, so to speak, right? Elements of the former and elements of the latter seem to be somehow of a piece. So how do you really understand this correlation? And why should it be? Why is it that we have large cultural trends that mimic the kinds of pathologies that we see in schizophrenia and related maladies? Are there aspects of contemporary culture that are simply “ill”? What do you make after all these years of this correlation?

LS: :

Well, what I would make of it now is no different from what I said in 1992 in Madness and Modernism. Actually, I often think that almost everything I have said since has its roots there, and is even stated in that book. (I realized this recently when I went through the entire book again to prepare a revised and updated edition—which is scheduled to be published in 2017 by Oxford University Press.) In any case, in Madness and Modernism I have an epilogue on schizophrenia and modern culture, at the outset of which I state that this book is not about causal associations—it’s about structural formal affinities; but that I am going to raise the causal question nevertheless, here in this epilogue. And I’m still not sure quite what to say about those affinities except that, well, I do think there are things about modern culture that encourage hyperreflexivity. You know, one can understand that aspect of modern culture in a, let’s call it, Hegelian fashion—in the sense that there may be some kind of intrinsic press toward self awareness (as well as toward an associated self-alienation) on the part of the human mind or spirit, a trend that, perhaps, reached a certain kind of culmination in Kant and later when we began really to understand the sense in which the very world in which we live is constructed by us—and that of course leads into phenomenology.

You can also understand it in a more Foucauldian way in terms of concepts like “panopticism,” where the social and institutional structures of society are such that they involve the encouragement of self-consciousness on the part of the subjects in that culture as part of the “disciplinary” movement of modern society. And all that could certainly have its effect on people with schizophrenia—who are, of course, members of the society, and members who may also have a genetic vulnerability toward psychosis or something like that. And so, the difficulties take this particular form in modern culture, which may be different from the forms they typically took in pre-modern culture. (See Sass 1992b, epilogue, 1994a/1994b, 2004b, 2017, epilogue; also McGilchist 2009.)

MF: :

What do we know about the history of those forms?

LS: :

Well I go into all of that in detail in the Epilogue to Madness and Modernism, and there I survey and analyze what’s been said about the issue. The question of whether there was schizophrenia, or much of it, before around 1800 is a contested issue. But it is at least plausible to say that it was much less common before 1800. I don’t claim that we can say that with great confidence, though. This would get us into a lot of technical arguments, because you are looking back at descriptions of patients before the advent of modern psychiatry, and it can be difficult to know what to make of those descriptions, et cetera, et cetera. But I don’t think it’s at all unlikely that schizophrenia was indeed less common before around 1800—and indeed, several experts who have looked into the issue most carefully, like Richard Warner and Edward Hare—that’s exactly what they do argue based on their careful examination of the historical evidence.

MF: :

Interesting.

LS: :

So, you see, the empirical data might well be consistent with the possibility that we don’t see specifically schizophrenic forms of psychosis, or at least, not very many instances of them, until after around 1800. (This of course raises the question of just how we define schizophrenia.) So, it could be the case that things like an increase in certain forms of self-consciousness—of hyperreflexivity and alienation—on the part of members of modern culture might manifest itself in schizophrenia.

Of course it could also be that there are certain things that are more neurobiologically determined that simply mimic modernism. And probably it’s a bit of both.

MF: :

Yes. It’s interesting to begin to think about how it is that certain forms of cultural life can make manifest certain forms of pathology that come to acquire precisely the kind of objectivity and so forth that you’ve spoken of. So, let me ask a question. At the beginning of your answer to that question you mentioned a kind of Hegelian idea where, you know, maybe this has to do almost with the kind of self-realization of individual autonomy or something like that. So let’s continue the dialectic for a moment. Is it possible that there will be another swing somehow away from this? In other words—and I’m not just thinking about schizophrenia here, I’m also thinking about, you know, the various theses proclaiming the end of art and so on— is it possible that at some point there will be some sort of reclamation of otherness that’s been lost through this hyper-reflexive mode?

LS: :

Reclamation of otherness?

MF: :

Reclamation of otherness, that’s right. Reclamation of more of a living relation to the real than what one finds in the hyperreflexivity of schizophrenia and in certain forms of modern and postmodern art and literature and so on.

LS: :

Yes. Perhaps so. But not being a futurologist, I’m not sure quite what to say. And I know that you’ve thought about this as much as anyone because of the fascinating things you wrote about the postmodernist artists, which I think should be much better known, in your book Finding the Muse: A Sociopsychological Inquiry into the Conditions of Artistic Creativity (1994). And the.…

MF: :

You take what you can.

LS: :

Right. One should consider the weird position in which people who follow what one might call the Duchampian trend find themselves, as you well know, even if they’re successful in some fashion.

MF: :

That’s right.

LS: :

When art is just about art is about art is about art, you know? And—

MF: :

And many of them eventually leave that mode. That’s kind of where I’m going. In other words, that reaches a kind of dead end for some people and in some cases they’ll ask themselves, Does this have anything for me or am I out?

LS: :

Well, you know, some of the influential younger novelists—whom I have mostly not read in any depth and don’t know well, like David Foster Wallace and David Eggers—seem to have been writing about this, and criticizing the overemphasis on irony, and seeking something else. Probably some of the younger people here in the audience know these writers better than I do.… How much they really transcend the hyperreflexive trap: that I don’t really know.

I guess I’m still fixated in my own cultural moment, with its cultural memory and its icons—which is before they wrote, and I’m more interested in that; maybe I’m stuck in my ways. Anyway, when I think of people who have a way of overcoming the bad aspects of hyperreflexivity, two people come to mind. One is Louis Armstrong: especially if you listen to Louis Armstrong singing, and especially some of the earlier singing by Louis Armstrong (“When you’re smiling,” “Jeepers creepers,” “A kiss to build a dream on,” to mention just a few examples—but also the sublime, erotic/ironic duos with Ella Fitzgerald, which come a bit later, I believe). Well, the combination of irony and self-mocking amusement at himself together with love of the other—love that is deeply felt and authentically expressed—is just unbelievable. I mean, what a genius—and more.… I mean, it’s like—when you recognize that in him, it can be a very deep spiritual experience, I think, to recognize that. And that’s a sort of quintessential example: I mean, the birth of jazz—obviously one of the greatest contributions of modernism is jazz. So there you have it: this fantastic combination—of something incredibly vital, but that can also be supremely ironic and self-aware. And I think it’s no accident that it’s also linked to the erotic—to the erotic at its highest and most sophisticated level: which is partly playful and self-mocking, but also deeply engaged, and tuned in to the tragic.

So I think of that as a sort of direction that one could follow. The other example I would mention is the poet Wallace Stevens, in a completely different style where you have some amazingly intellectual and self-conscious poetry, often about poetry—very meta, in fact—but that also retains so many elements of heartfelt romanticism, with all its commitment to authenticity of expression and love of the world (think, for instance of a poem like “Sunday Morning”). So I think it is possible to not let hyperreflexivity take over even though it remains present; I mean, there’s just nobody more sophisticated than Louis Armstrong or Wallace Stevens, in their essential sensibility and point of view. And so it’s possible to be extremely hyperreflexive, without losing touch, or connection with the other.

MF: :

Let’s get back to your own career. You know, one of the things I’ve always been really amazed by in some ways is just the range and distinctiveness of your intellectual project. You range, as we know, over phenomenology and hermeneutics, but also esthetics and art history, literature, literary criticism, psychoanalysis, photography, and so on. That’s hard to do. What were some of the challenges that you faced in becoming the kind of psychologist—and, more broadly, the kind of intellectual—you’ve become? I mean, there’s not as much room for the likes of you in the academy, especially, as there might be. Somebody who is truly venturesome and willing to explore the boundaries of things and so on. What’s it been like? Has it been an easy ride, tough ride, bumpy?

LS: :

Both, both. It’s been bumpy at times and I’ve had a lot of luck in a lot of ways. But, I mean, the biggest problem, really, I mean, this is no surprise, is just being in the field of psychology, 98 percent of which—at least in academic psychology in this country—is not attuned to the kind of work that I do or am deeply interested in. But a lot of people in this room, I’m sure, feel that as well. Well, there were times when I thought I must be stupid. And there were times when I thought the field was stupid and I had better get myself out of it. I’ve gone through a lot of different thoughts like that, especially when I was younger.

But I’ve also had a lot of good luck. And I think one of the major sources of good luck was at a certain point when I was seriously considering getting out of psychology, I got a fellowship at the Institute for Advanced Study in Princeton, New Jersey…really mostly because of [the cultural anthropologist] Clifford Geertz, who was a professor there and who was, and remains, one of my intellectual heroes. And Geertz liked my proposal, which was a proposal for writing Madness and Modernism, which I thought I would write in about a year. Ten years later, the book comes out.

MF: :

Exactly.

LS: :

And so I also had people like that who gave me an opportunity, and then I got the job at Rutgers and my fellow department members in the Department of Clinical Psychology at Rutgers are people who, for the most part, have been open to other options—sometimes in some of their own work, sometimes in the sense of live-and-let-live. And so, even if that’s not their interest, they have let me do my own thing. So I think a lot of people would not have that, you know—often, one doesn’t have that kind of good luck.

MF: :

No kidding.

LS: :

So. There are a lot of things I could say about that, but maybe—

MF: :

The luck thing is key. You know, you’ve got to be in the right place at the right time.

LS: :

Yes indeed.

MF: :

So just a quick question about psychology. So if you had to do it over again, would you still be a psychologist? You’ve mentioned a number of times the temptation to flee. Is there enough in this discipline? I mean, I deal with this question with my students all the time; many of them are tempted to flee because the discipline isn’t what they imagined it to be. It’s often alienating and difficult, and so on. I’m able to say to them for the most part, “You know what? At its best, it’s still a really cool discipline. Hang in there, it’s going to be a tough road, but let’s see if we can make it work.” Where are you on that issue?

LS: :

I think the same place you are, that’s just what I would say and do say. And, I mean, after all, the phenomena that we’re, so to speak, licensed to talk about as psychologists, are very interesting phenomena. For example, psychopathology. And, you know, if you’re interested in those phenomena, there aren’t too many other options. When I was younger, I often thought that I would have been happier if I’d gone into philosophy or literature; that I would have been much happier if I were a professor in one of those two fields. But over the years, I’m not sure I think that anymore.

MF: :

Same here.

LS: :

Because I look at what—well, for example, literary studies, which—I mean, there are a lot of people I greatly admire and things being done there that I have taken from. But there are lots of problems with these fields as well. And the fact that in psychology, we’re really talking about real-world phenomena, subjective though they may be—indeed, subjectivity itself—I’m very happy about that because I feel that at some level, I’m like a scientist confronting reality. What I mean by that is that I’m talking about something in the real world—not mainly about representations of the real world, which is what literary studies is, largely. (I realize, of course, that representations are also quite real, in their own way—but still.…) And philosophy is so, you know, well, there are such problems with contemporary analytic philosophy that I don’t even want to go there—even though there are certain thinkers I greatly admire and have been much influenced by. (For critical reflections on analytic philosophy on the topic of delusions, see Sass 2004c.)

But even continental philosophy tends to be so abstract and sometimes overly historical in its focus. I prefer talking about something in the—something that’s real, you know, like psychopathology for example.

MF: :

Or a person.

LS: :

Yes, a person. Or, groups or types of people or something like that. So I feel more legitimate because of that. I guess I’m enough of an anti-intellectual intellectual to feel that I would—I would have a lot of doubts about what I was doing if I’d gone into some of those other fields. I like the sense that this, clearly, is something real we are talking about, and ultimately, you know, even of practical importance—even if the latter has not been my own immediate focus.

MF: :

I sympathize with that response. You know, students will ask, why didn’t I go into philosophy? And my simple answer is often that rather than studying “man” or “consciousness” or “Being,” I’m interested in this person and to see what can be extracted from this life with all the tools that philosophy and psychology and anthropology and all the rest bring. We just have a minute or two.

About the discipline, it’s still fraught. In many ways, I think you’d probably agree, it’s stopped short of realizing its potential. What might the discipline of psychology do to somehow right its course? And I would ask that in two ways. What should it be doing that it’s not, and what shouldn’t it be doing that it is?

LS: :

Well, first of all I think maybe, at least in the field of psychopathology, which brings together clinical psychology, psychiatry, philosophy, cognitive science, and some other fields, I think there’s reason to think that things are getting better.

MF: :

Good.

LS: :

The phenomenological movement of phenomenological psychopathology is actually having some—compared to the past anyway—having significant impact now, especially outside the U.S.A.. There are quite a few people now working on phenomenology, in philosophy, psychiatry, and psychology (among the most prominent I might mention Josef Parnas, Matthew Ratcliffe, Giovanni Stanghellini, Thomas Fuchs, and Iain McGilchrist); and some of us are also working on intersections between phenomenology and neurobiology, or thinking about it. So, maybe in some sense, some part of the profession of psychology, at least the part that has to do with mental illness, I won’t say it’s righting its course because this is still very much of a minority movement…but our minority movement is certainly gaining more of a voice.

MF: :

Yes, I noticed that from even the places where you’re publishing your stuff. They’re in schizophrenia journals, you know.

LS: :

Right, some of it.

MF: :

Truthfully, as opposed to theoretical and philosophical psychology journals.

LS: :

Some of it, yes.

MF: :

Or not to the exclusion of, but in addition to.

LS: :

Right, and other people as well are publishing in those kinds of journals. And so we phenomenologists, we phenomenological psychopathologists anyway, are being heard, to some extent—perhaps especially in Europe and Latin America; how much of an influence we’re actually having on the Anglophone mainstream, I don’t know. The mainstream in psychiatry, though, is pretty moribund. Some of you may know that the head of the NIMH, Thomas Insel, a few years ago basically said that there had been no real progress in research on or treatment of severe mental illness for the last several decades. And that’s the head of the NIMH—former head now. Now, his own prescription for that is not phenomenology, it’s more neurobiology.

But, at least there was a recognition, an acknowledgment that things are not progressing as one might have hoped or expected. So, the fact that one is not part of the mainstream is, under these circumstances, perhaps something to be a little bit proud of. But the question is: how does psychology right its course?

MF: :

Grow, flourish, become more of what it might be for our students…

LS: :

Well, I think being more open to so many of the things that, well, this conference, “Psychology and the Other,” is all about, that’s what psychology has got to do. I mean, my thing is phenomenology, but that’s not the only thing, obviously. Forms of psychodynamic or psychoanalytic psychology, which have been losing their influence within the academy, need to be recuperated, recognized for their importance; there also needs to be more true openness to other fields like cultural anthropology and literary theory, and some parts of philosophy of course, and to a much richer interdisciplinarity overall. All that is very important.

I know that I’m preaching to the choir here, I’m sure everyone in this room will agree that the scientism of psychology is a considerable problem. And, you know, a lot of people—a lot of hard-nosed people recognize that. For just one such example, there’s that great statement from Richard Feynman about “cargo cult science,” do you know that one?

MF: :

No.

LS: :

This is what he thought of psychology. He called psychology “cargo-cult science” because, he said, it’s like a cargo cult, in which people…(whether, from an ethnographic standpoint, this is really true of what cargo cults do is beside the point, by the way). Well, apparently in some South Sea Pacific islander cultures, they had gotten used to Western goods which had been brought to their islands by the navy and air force, and so, after World War II they wanted to get the planes to land on their islands, and to do so they would build fake runways, visible from above, and would wear headphones carved out of wood and bamboo antennae, and then hope that the planes would land so they could get all the stuff—the material goods—that they had come to appreciate.

Richard Feynman, the great physicist, describes all this, and then says that’s kind of what psychology looks like to him. We psychologists, according to Feynman, we seem to follow all the trappings of experimental method, the ostensible experimental procedures of the hard sciences—at least overtly—but, as Feynman put it, for us at least: “The planes never land. The planes never land” (Gleick 1988). So, you could ask: am I anti-science or even anti-measurement?

MF: :

No, no, no.

LS: :

Of course not. But I do think, for example, that for neurobiological research to progress on something like schizophrenia or psychotic disorders more generally, there has to be a sophisticated awareness of what the correlates in subjectivity might be to the things being studied on the neurological plane. (On phenomenology’s relevance for explanation as well as description, see Sass 2010, 2014b; Sass and Borda 2015.) Neurobiology may be doing lots of interesting things, but it is not making nearly as much progress as is often claimed, at least regarding mental illness—which was clear from what Thomas Insel said. And this was also clear to me when I went back to my neurobiological appendix in preparing the revised edition of Madness and Modernism (which will appear in 2017): I did of course have to update some things, but basically I found that not all that much has changed. The essential—the essential things being said 25 years ago about the neurobiology of schizophrenia, at least the interesting ones, are pretty much the same. The labels have changed a bit, some details have been added; but there are not a lot of new, revelatory ideas, that’s for sure.

So, you know, contrary to the hype, there hasn’t been all that much progress recently in neurobiology, at least regarding severe mental illness. But in my view, for there to be interesting progress, there needs to be a combination. There needs to be what the philosopher Shaun Gallagher nicely termed a relationship of “mutual enlightenment” between phenomenology and neurobiology. So, I think that that’s something that we need to work toward.

By the way, I’m not trying to fetishize neurobiology or neurobiological research as some sort of ultimate standard, as if we had to measure ourselves by our relevance for neurobiology, not at all—I’m just giving it as an example, as a way of saying that even doing that will require a sophisticated appreciation of subjectivity.

MF: :

The distinction you’ve made between scientism and science is particularly important and it led me a short while ago to a kind of paradox. And that is that psychology in its scientism has paradoxically and ironically not been scientific enough

LS: :

Right. Amen. Amen.

MF: :

So any final comments, Louis, before we conclude? Did we miss—we probably missed some stuff.

LS: :

Well, I wrote a lot of notes based on some of your advance questions and we didn’t get to all of those issues—but, of course, that’s fine. It’s impossible to get to everything. Still, there are a few points, some of them brought up by members of the audience here, that I would like to address, if I may.

One issue was brought up by Brent Slife, who is sitting here in the audience; and this is the question as to how we can understand others, even others who are not so obviously different from oneself as may be the case with schizophrenia. Brent suggested that, not only people with schizophrenia, but also normal individuals, even persons one might know very well, such as one’s spouse, can also come to seem enigmatic; and he said that he had drawn inspiration from my interpretation of schizophrenia for the understanding also of people who do not have schizophrenia.

This made me reflect a bit of the whole question of different and same—which of course is always complicated. There are ways, certainly, in which schizophrenia can involve a radically different point of view from the perspective within which most of us live our lives. And Karl Jaspers was the person who insisted that it was, in fact, so extreme you couldn’t even hope to understand it.

But there’s another sense in which much that occurs in schizophrenia is also all very familiar—so long as one learns to recognize those aspects or those affinities. (One way of doing so, I argue, is to contemplate the phenomena of modernism and postmodernism—as a way of understanding the self-undermining and alienating effects that hyperreflexivity can have.) But, of course, one cannot say everything all at once, so there are times when one needs to emphasize the radical difference between the normal or commonsense position and that of schizophrenia, but also other times when one has to emphasize the other side, namely, the similarities or affinities. The latter, I think, is what Harry Stack Sullivan was getting at with his statement that people with schizophrenia are “more human than otherwise.”

Brent Slife pursued his point by noting that, in fact, as another person comes to be better known, more familiar, one may actually come increasingly to recognize the possibility of a dramatic difference, perhaps even an unknowability; and he suggested that awareness of this difference, of this perhaps insurmountable gap, can actually be a crucial prerequisite for intimacy in general.

Brent was making (and, I am sure, was well aware of making) what could be described as a deeply Levinasian point: noting that you can find yourself falling into the abyss of an infinity that you cannot totalize (the philosopher Emanuel Levinas’s most famous book is titled Totality and Infinity). And that, of course, is very true. To think you have totally understood someone else is probably to prove that you have missed something important. But I do think a lot of people would agree that there are also many tendencies in other people that are either very similar to our own reactions, or else that we may recognize from clinical knowledge. I think it’s hard to deny, for instance, that very narcissistic people turn out to be very predictable in certain ways, all too predictable, in fact. Also borderline individuals, or with paranoid or obsessional traits or character styles, just to mention some additional examples. When I was much younger, I was very skeptical about all these categories. I remember, in fact, that when I first heard about borderline personality disorder and theories about its psychological structure, I almost laughed out loud; I just thought: how utterly absurd. How could you possibly think you could make these generalizations about people? It just seemed totally ludicrous to me.

It doesn’t anymore, alas. I am afraid I would say that I have found that there just are quite a few people who fit into, who resemble these ideal types—remarkably so. And in that sense, we can sometimes know almost too much, and too readily about other people—especially as we get older and more experienced. Sometimes, in fact, it’s almost scary how predictable other people can be. Which probably goes for myself as well, I realize.… But I don’t think this contradicts what Brent Slife was saying, either. I mean, these are both truths that have their place.

Brent made still another point, asking whether I would agree that the people who are not considered schizophrenic might be described just as being people who are able to collude together in a kind of a rational or seemingly rational realm, and that people with schizophrenia just seem to have less ability to do that, or less tendency to do that. He suggested that what we define as sanity is really more a kind of collusion, a way of pretending that we are part of the same world when, in fact, we’re not.

Brent’s remark reminded me of a famous line from Jacques Lacan about psychosis, which is “les non-dupes errent”—a line that means, liberally translated, that those who are not duped wander lost and in error (Sass 2009). Roughly it means that. And so the people with schizophrenia are—they’re not duped. In other words, often they don’t buy into all of the conventional views that the rest of us buy into, and may need to accept in order to survive.

But as a result of not being duped, in the ways all the rest of us are, they end up being lost. Because it’s not just a matter of not buying into a conventional belief or a prejudice here and there: language itself is called into doubt, and so are virtually all conventions and conventional concepts—and with that the very possibility of social cooperation and of many forms of valid thinking. And I think it’s an incredible sentence, Lacan’s, because it brings together the fact that there is indeed a kind of true insight, in a certain sense of that word, that people with schizophrenia can have, probably more acutely than the rest of us, but that, at least partly as a result of that, they’re also wrong in some way—and lost in many ways. Well, it’s just one sentence; also it’s a pun in ways that make it even more complicated, but that’s enough to make my point here.

Another person who is sitting in the audience, a man who identified himself as a psychoanalyst, asked whether I would agree that what we designate as psychotic is in fact highly context-dependent and perhaps culture-specific: if Jesus were now to be found walking about in the world, he said, would he not be viewed as psychotic and taken away by the EMT? My interlocutor suggested that there might be no essential structure, no “thingness” to schizophrenia that is invariant and transcends any social or cultural context; and he reminded us that various studies over the years have indeed demonstrated rather poor reliability in the application of the diagnosis.

This, of course, is also a highly complicated issue, and one that raises many questions. One thing to note is that, at least with the recent DSMs, you can in fact get rather good inter-rater reliability, meaning agreement between those making the diagnosis—so long as they truly stick to the criteria offered. But it seems that you may have terrible validity. So it may not be so much that professionals disagree when they use these criteria, it’s that the individuals who are considered as having schizophrenia according to the current DSMs, the most recent DSMs, may not always be the patients that should be so designated. As is well known, some decades ago an embarrassing study demonstrated massive discrepancy in the application of the diagnosis of schizophrenia in the US and the UK, and this led to a tremendous focus on achieving interrater reliability, culminating I believe in DSM III. But it seems that such reliability was achieved at the expense of validity—with validity more or less thrown out the window in favor of clear-cut criteria that strove to minimize the role of clinical judgment. In a way, there may have been a more subtle and more valid diagnostic conception prior to DSM III, at least in Europe or parts of Europe.

But the real question is, I believe: is there any kind of essence to the condition or set of conditions that we tend to group together under the term schizophrenia? Does it make any sense to try to seek or attempt to define a kind of psychological essence to schizophrenia? And I guess my answer to that question is that yes, I think we do need to do that, or at least to attempt to do so—albeit not in a blind or rigid fashion. (As we explore it, we may need also to redefine the diagnostic boundaries—as often happens in scientific investigation.) And as you know, I’ve been one of several people suggesting that we might define schizophrenia in terms of a disorder of so-called “ipseity,” which means a disorder of minimal or basic self that can be characterized fairly specifically by a combination of what we have termed “hyperreflexivity,” “diminished self-presence,” and “disturbed grip or hold” on the perceptual and cognitive world. (My work on self-disturbance in schizophrenia goes back a long way, and has developed in various ways over the years; see Sass 1987a; 1987b, 1992b, Chapter 7, 2000, 2001b, 2003b, 2014c, in press; Sass and Parnas 2001, 2003.)Footnote 2 Yet to say that there is an essence that’s clear-cut and fully invariant over time has a ring to it that I probably wouldn’t agree with. I often refer to the idea that—and I often cite Schwartz and Wiggins on this (the psychiatrist Michael Schwartz is sitting here with us in the audience)—that we should think of diagnosis in terms of something more like Weberian ideal types. (See Parnas et al. 2013; Wiggins and Schwartz 1991) And I think that, if you make that move, you can have a much more sophisticated and much more defensible way of talking about what schizophrenia is or might be. Does it have absolutely sharp boundaries? No, not any more than “capitalism” or “socialism” or “charisma” do. [These are classic examples of “ideal types” for the sociologist Max Weber, who formulated the notion of ideal types.] But is it completely a fantasy? No, just as capitalism, socialism, and charisma are not fantasies, but things that exist in the real world—things we need to recognize and to investigate, even if they can vary over time and perhaps sometimes even overlap with related notions in some respects

And so that’s the kind of direction that I would go. And, as you may know, there are also attempts to operationalize the notion of ipseity disturbance through an interview technique, and so on and so forth (Nordgaard et al. 2013; Parnas et al. 2005). We have recently developed a similar semi-structured interview, known as the “EAWE: Examination of Anomalous World Experience,” that is intended to focus less on self than on aspects of the lived-world, including the experience of space, time, language, and other persons (Sass et al. 2017). Also we have suggested ways of studying what might well be the neurobiological correlates of hyperreflexivity, of diminished self presence, of all of these phenomenological hypotheses. (On the neurobiology of self-disorder in schizophrenia, see Borda and Sass 2015; Nelson et al. 2014a, 2014b; Sass 1992b, appendix, 2014c, 2017, appendix; Sass and Borda 2015; Sass and Byrom 2015a.). We are also attempting to explore the notion by considering both affinities and discrepancies in the forms of abnormal self-experience that can be found in schizophrenia-spectrum as compared with other conditions, including mania and severe depression, Depersonalization Disorder, the forms of dissociation found in Panic Disorder, and also intense forms of introspection. (See Madeira et al. 2017; Sass and Pienkos 2013a/2013b/2013c; Sass et al. 2013a, 2013b; also Sass and Pienkos 2013a/2013b/2013c.)

So, yes, I do think that ipseity-disturbance, this disturbance of minimal or core self-experience, should be considered something real: we should think of it as a real, albeit also problematic, multi-faceted, and ambiguous phenomenon that we’re trying to study.

A final question that arises concerns the therapeutic implications of the phenomenological, or more specifically, of the ipseity-disturbance approach to schizophrenia. This too is a complicated issue, impossible to summarize here. I would refer any reader to several articles on that topic which I have helped to co-author (Nelson and Sass 2009; Pérez-Álvarez et al. 2010; Skodlar et al. 2013). One single point I would mention is the fact that one may need to beware of exacerbating hyperreflexivity through certain kinds of overly intellectual approaches to the patient. That can be a danger. But that’s just part of it, and a lot of things that I and others in the phenomenological tradition would say about the treatment issue are quite congruent with what others writing about psychotherapy have said, for example, about the need to have a healthy relationship with the person with schizophrenia, to bring them back into the social encounter and so forth—but to do so in a way that is both non-coercive and genuinely respectful of both the nature and the potential validity of the patient’s own, often idiosyncratic point of view.

MF: :

Let’s thank Louis Sass for a fascinating set of ideas. Thank you so much.