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Lost inDialogue
International Perspectives in Philosophy and Psychiatry
Series editors:Bill (K.W.M.) Fulford, Lisa Bortolotti, Matthew Broome, Katherine Morris,
John Z. Sadler, and Giovanni Stanghellini
Mind, Meaning, and Mental Disorder2e
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Oxford Handbook of Philosophy and Psychiatry
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Psychopathology of CommonSense
Lost in Dialogue:Anthropology, Psychopathology, andCare
One Century of Karl Jaspers Psychopathology
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Stanghellini and Rosfort
Essential Philosophy of Psychiatry
Naturalism, Hermeneutics, and Mental Disorder
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Lost inDialogue
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Anthropology:What is a humanbeing?
We are dialogue

e primacy of relation

e life-

world of the I–

You relation

e innate ‘You’:the basic package

e dialogue with alterity:narratives and the dialectic
of identity

A closer look into alterity:eccentricity

Epiphanies of alterity:drive

Habitus:the emergence of alterity in social situations

A closer look at moods and aects:intentionality and

Emotions and the dialectic of narrative identity

Alterity and the recoil of one’s actions

Alterity and the other person:the anatomy of recognition

e basic need for recognition

An anthropology of non-


Part Two
Psychopathology:What is a mental disorder?
First steps towards the person-

centred, dialectical model of
mental disorders

What is a symptom?

e truth about symptoms

Symptom as cypher

Conicting values:the case with post partum depression
e body as alterity:the case with gender dysphoria
e trauma of non-
Erotomania and idolatrous desire
Depression and the idealization of common-
sense desire
Borderline existence and theglorication of a thrilledesh
Schizophrenia and the disembodiment of desire
Part Three
Therapy:What iscare?
e portrait of the clinician as a globally minded citizen
e chiasm
Empathy and beyond
order empathy
What is a story?
Personal life-
e question ‘What is it to be human?’ is at the core of philosophical anthro
pology. Rationality, language, self-
awareness, self-
knowledge, and moral sense
have been indicated as the distinctive features of being human. In this book,
Iwill build on and develop the assumption that
to be human
to be in dia
. Dialogue is a unitary concept that will guide me in attempting to address
in a coherent way three essential issues for clinical practice:‘What is a human
being?’, ‘What is mental pathology?’, and ‘What is care?’. Iwill argue that to be
human means to be in dialogue with alterity, that mental pathology is the out
dialogues take place whose aim is to re-
enact interrupted dialogue with alterity
within oneself and with the externalworld.
We are a dialogue—
of the person with herself, and with other persons. In
brief:we are a dialogue with alterity. We encounter alterity in two main domains
of our life:in
, and in the
external world
. In the rst case alterity is in the
involuntary dimension of ourselves, our un-
chosen ‘character’, including needs,
desires, emotions, and habits. In the external world, alterity is encountered in
that constellate ourlife.
Alterity manifests itself when Iam at odds with my needs and my desires,
manifest, or nally, when my feeling-
states surprisingly disclose my situated
ness. Alterity also manifests itself in the course of my action, as every action
involves a
of unintended meanings and intentions back upon the actor.
intended by me. is throws me, or my
, into question. e question is about
tary. And the answer is the story Ican tell about myself when confronted with
this entanglement. Only aer Irecognize alterity as an incoercible datum of the
involuntary dimension of my existence can Ibegin to use it in my service.
e encounter with alterity may oer the vantage from which a person can
see herself from another, oen radically dierent and new, perspective. us,
alterity kindles the progressive dialectics of personal identity. Narratives are the
principal means to integrate alterity into autobiographical memory, combining
personal experiences into a coherent story related to theself.
disorder is the interruption of this dialogue through which we strive to build
and maintain our personal identity and our position in the world. It is the cri
sis of the dialogue of the person with the alterity that inhabits her, and with
the alterity incarnated in the other persons. Human existence is a yearning for
ity, that is, with all the powers of the involuntary:unwitting drives, uncontrolled
passions, and automatic habits leading to unintended actions, as well as needs,
desires, impulses, and dreams. And nally, a further source of dissatisfaction is
the awareness that the other person can only be approximated, not appropri
ated, and that our need for reciprocal recognition is an unlimited struggle and
a spring of frustration.
ues:private conscience and social customs, desire and reality, one’s values and
the others’ values, nature and culture. All this generates feelings of estrange
ment. Mental pathologies may be read as miscarried attempts to struggle for a
sense of reconciliation, to heal the wounds of disunion.
e production of a symptom is the
extrema ratio
for alterity to become dis
cernible. e symptom is the last chance for the person to recognize alterity
in herself. Mental symptoms are not simply the direct outcome of some kind
of dysfunction or of a ‘broken brain’. Aperson’s symptom is not generated as
as it was in the case of Minerva, who sprang fully armed from Jupiter’s
head. Rather, it is the outcome of the need for self-
person has with respect to her encounter with alterity, that is, with challeng
ing, unusual, or abnormal experiences. e psychopathological congurations
which human existence takes on in the clinic are the outcome of a dispropor
ing experiences that stem from it. e person is engaged in trying to cope with,
solve, and make sense of the basic disturbing experiences stemming from her
clash with alterity. Alterity is made manifest as a kind of estrangement from
oneself and alienation from one’s social environment. Faced with new, puzzling
experiences the person tries to make sense of them. e attempt to achieve
a self-
attitude, alongside a comprehending appropriation, that is, the constant search
for personal meaning.
We live out a traumatic existence, stained by the tragic experience of our
failed encounter with the Other. Trauma is not merely an accident that took
place in a remote past, an episode in our life that cannot be appropriated in
our narrative identity and remains without a semantic inscription, relegated
in our dynamic unconscious. Trauma is part and piece of everyday existence,
an experience we live by that is one with our need and desire to establish rela
tionships. e kind of teleology at play in human relationships is the
desire for
reciprocal recognition
. Our existence is inescapably You-
oriented and as such is
conditioned by the spiritual value of recognition, alongside the organic values
stronger than other needs rooted in our organic values. Recognition is a task,
rather than an automatism. It is a kind of emotional and intellectual readiness
experience of relatedness or ‘We-
experience’ in which Iam aware of the Other’s
emotional distress and Itry to attune with it. We desire to be recognized by
the Other to such a degree that our being-
so is acknowledged by the Other as
a value in itself. Our deepest need and desire is to be loved
as we are
, notwith
standing our limitations, weaknesses, faults, and culpabilities.
is book is an attempt to re-
establish such a fragile dialogue of the soul with
herself and with others. Such an attempt is based on two pillars:a dialectic,
centred understanding of mental disorders, and values-
based practice.
Building on and extending these two approaches, it aims to improve therapeu
tic practice in mental healthcare.
e dialectic understanding of mental disorders acknowledges the vulner
ability constitutive of human personhood. It assumes that the person is engaged
in trying to cope with, solve, and make sense of new, disturbing, puzzling expe
riences stemming from her encounter with alterity. Each patient, urged by the
drive for the intelligible unity of her life-
construction, with her unique strengths
and resources, plays an active role in interacting with these experiences and
thus in shaping her symptoms, as well as the course and outcomes of her illness.
e forms of human life are inherently plural. In values-
based practice, value-
pluralism and recognition are the basis for clinical practice. is statement
reects the ideal of
modus vivendi
that aims to nd terms in which dierent
forms of life can coexist, and learn how to live with irreconcilable value con
icts, rather than striving for consensus or agreement.
take place whose aim is to re-
enact interrupted dialogue with alterity within
and practices that belong both to
Other’s life-
world and to rescue its fundamental structure—
the readiness to oer oneself as a dialoguing person, and the capacity to reso
nate with the Other’s experience and attune/
regulate the emotional eld. ese
two complementary sides of therapeutic dialogue are called ‘logocentric’ and
‘anthropocentric’, respectively. Whereas the rst is the search for the precise
description of a given phenomenon of experience and a mutual understanding
about it, the second consists in a shared commitment to transcend the space
sharing of an intention whose transcendental referent is not a fact, but the rela
tionship itself.
As citizens who are trained to confront human vulnerability, the evidence of
mas of autonomy and authority, and the conicts of inclusion and exclusion,
and in general with the encounter with Otherness that characterizes human
life, we as clinicians need to develop special virtues. As ‘ideal citizens’ we should
have the capacity to conceive of what it might be like to be in the shoes of a
person dierent from oneself, to be an intelligent reader of that person’s story,
and to understand the emotions, wishes, and desires that someone so placed
might have. Also, we should possess the ability to have concern for the lives of
life as it unfolds, and to understand human stories not just as aggregate data.
is epitome of the human being should be able to see other persons, especially
marginalized people, as fellows with equal rights and look at them with respect.
is is an overly optimistic portrait of ‘real’ clinicians, who are obviously not
it is suggested that it should be taken as a challenge to current educational cur
ricula. On one side, there are those who radicalize the view that mental health
professionals must be(come) members of the biomedical community, and thus
should rene their scientic knowledge (chiey in the eld of the neurosciences)
and technical skills. On the opposite side, there are those who reject the former
view and embrace the party of psychiatry as a ‘human discipline’. is con
troversy, as it is clear, is abstract and sterile. All clinicians know very well that
mental health care. Taking for granted that practitioners need a thorough sci
entic education, the question is what kind of humanistic learning is needed,
and why. e concept of
makes a good starting point.
mately means cultivation or formation—
rather than education restrictively
understood as skill training—
that cannot be achieved by any merely technical
means. It is a process of ‘forming’ one’s self in accordance with an ideal image
of what it is to be human. Cultivating one’s self is a complement—
a necessary
to acquiring skills, as
provides the indispensable ground for
technical skills to be developed and put to use in a proper way.
participation rather than indoctrination, and questions rather than assertions.
It is a process of appropriation through which what is formed becomes com
a self-
understanding, a sense of where one stands in relation to theworld.
ere are two general characteristics of
. e rst is keeping oneself
open to what is other. is embraces a sense of proportion and distance in rela
tion to oneself. e second is that it contributes to developing a sense, rather
than acquiring an explicit, cognitive knowledge. An example of this is
a piece of knowledge, but rather a kind of sensitivity, namely the sensitivity
to what is appropriate in dealing with others, for which knowledge from gen
eral principles does not suce. Tact touches upon the very origin of the moral
law, as it is a form of connection released from an instrumental relationship. It
expresses a kind of contact that is not that of possession—
physical (e.g. to take
grasp the signicance of the Other’s behaviour). Rather, it is a kind of grace, an
implicit promise, and the capacity to wait until the moment is ripe for making
explicit what Isensed. Without tact, the other person is stripped of his possibil
ity to signify his uniqueness. Lack of tact is at the basis of any politics of exclu
sion. Tact as the capacity to feel the atmospheric, to attune with it, not to intrude
manifest his uniqueness is an essential quality of the clinician.
Campolungo, in front of Fiesole
August 2016
Anthropology:what is
a humanbeing?
Man has experiencedmuch,
Many Heavenly he hasnamed,
Since we are a dialogue
and we can listen to one another
(Friedrich Hölderlin,
Conciliator, you who never
We are dialogue
To Hölderlin we are human because we can dialogue. Hölderlin’s ditto con
denses ve essential aspects of being in dialogue:experience, the Heavenly,
naming, history, and listening.
Dialogue is a kind of ‘experience’:it is not merely a verbal exchange, an
exchange of information; rather, dialogue
. What emerges
in dialogue is neither mine nor yours and hence transcends the interlocutors’
subjective opinions. Dialogue moves in unpredictable directions to experience
about in dialogue.
is is the case with what Hölderlin calls ‘the Heavenly’. If we engage in dia
logue, we stand in the presence of alterity, including other persons, things in the
world, and even the radical alterity personied by gods. e Heavenly here is
the hyperbolic personication of what is other from oneself. Alterity claims us.
and remain identical to ourselves. Or we can engage in confronting ourselves
with alterity and take the route of becoming.
designation. Dialogue is the very opposite of monadic language, as it takes place
in a public space and is a confrontation with alterity rather than its labelling.
In dialogue, we inhabit alterity. We as human beings are grounded in language.
designate something
we take distance from it, in dialogue we
let ourselves be
touched by alterity
Dialogue implies ‘listening’. As suggested by Heidegger (1971), in dialogue the
Heavenly call us and we respond. Dialogue is based on the possibility to listen
to each other. Being able to listen is the presupposition of speaking. Listening is
the original phenomenon, answering comes aer; it is a consequence of attend
Gadamer reminded the assembled psychiatrists of the United States in their
annual convention in 1989)is more than merely the application of knowledge.
Language happens authentically only in dialogue. Dialogue is the essential hap
pening of language, since through dialogue we use language to encounter alter
All this can occur ‘since’, that is,
the time we became a dialogue. To be
in dialogue is to have lost a sense of self-
that sense that only belongs
to gods.
the time we realized that we are human, we realized that we
are inhabited by alterity. Dialogue is what situates us in a world inhabited by
alterity. To be in dialogue overcomes a-
historical time, that is, a time without
becoming. To be a dialogue and to be historically belong to each other. Being in
dialogue with alterity is the root of becoming. It is to have lost the sense of self-
another feature that only belongs to gods. Also, to be in dialogue
with alterity overcomes being immersed in mere now-
moments or in “torren
tial time” (Heidegger, 1971). Dialogue paves the way to a third-
time, the time of
narration, the time of beinghuman.
Are Hölderlin’s lines enough to persuade us that the ground of human exist
ence is dialogue and that from this, human existence receives its signicance
more substantial. Iwill attempt to substantiate this claim with the help of more
prosaic arguments taken from philosophy as well as evidence from develop
clarity, to preliminarily address one basic question that will be fully answered in
the course of this book:‘What is a dialogue?’.
Dialogue is so ubiquitous in philosophy that perhaps the highest philosophi
cal principle consists in holding oneself open to the dialogue. Gadamer (1996)
is obviously one of the philosophers who made the greatest contribution to
establishing a philosophy of dialogue through his understanding of herme
dialogue, according to Gadamer, informs phenomenology—
“in the exchange
of words, the thing meant becomes more and more present” (Hahn, 1997,
p.22); philosophy of mind—
“thinking is the dialogue of the soul with itself”
(Gadamer, 1996, p.167); philosophy of language—
“language has its true real
ity in dialogue” (Hahn, 1997, p.274); philosophical anthropology—
ing Hölderlin) “dialogue is what we are” (Gadamer, 1996, p.166); history of
the “hermeneutical reorientation of dialectic (which had been
living dialogue
genuine partner in dialogue, and we belong to it, as does the Iwith the ou”
(Gadamer, 1989, p.358).
Some preliminary remarks are needed to delimitate the concept of ‘dialogue’.
Dialogue is not conversation, as what happens in everyday informal
exchanges, or mere idle chat. Whereas idle chat conrms and strengthens com
mon sense assumptions, dialogue provides the conditions for the emergence
of a new understanding from a manifold of voices. Whatever understanding
really is, many things can be said of dialogue that are equally appropriate to
the case with Socratic dialogues—
is oen
, that is, characterized by lack
Dialogue is not merely an exchange of pre-
given information about some
about the subject matter
to the interlocutors. It functions like Husserl’s
phenomenological reduc
:in the genuine dialogue, the participants’ initial assumptions are chal
lenged and become evident and thus they can be scrutinized, challenged, and
modied. us, dialogue is the means by which it becomes possible for the per
son to become aware of her own prejudices and for things to show themselves.
It is likewise in the experience of art that in dialogue
subjectivity is displaced
(Gadamer, 1989). One enters into dialogue, but one does not control the pro
gression of the dialogue. Dialogue forces the participants at a certain point to be
taken by surprise and nally to see things in a newlight.
Also, genuine dialogue is not simply a discussion about a subject matter that
is external to the interlocutors. Rather, it is a genuinely social act. At a given
moment the interlocutors themselves become the subject matter. In dialogue
about the interlocutors themselves
The primacy ofrelation
Buber is perhaps the one who most impacted recent philosophy of dialogue in
the sphere of the ‘I–
You’ relation. In the
I and ou
(1958), Buber’s main thesis
may be summed up as follows:ere is no ‘I’ taken in itself. e ‘I’ of the ‘I–
combination is dierent from the ‘I’ of the ‘I–
It’ combination. When a person
says ‘I’ he refers to one or other ofthese.
and her attitude to things. In the personal relation an ‘I’ confronts a ‘You’. In
the connexion with things an ‘I’ connects with an ‘It’. ese two attitudes con
stitute respectively the world of the ‘You’ and the world of ‘It’. e ‘You’ cannot
be appropriated. So long as the ‘I’ remains in the relationship with the ‘You’ it
cannot be reduced to an experienced object—
In more recent times, we speak of ‘third-
person’ (I–
It) and ‘second-
You) relations. What distinguishes these two modes is not the object per se.
We can relate to an object (say, the Moon) as to a ‘You’ (as for instance children
the object. is change of attitude may occur across time, as in one moment we
may address a person as a ‘You’ (for instance, in the ‘openness’ of the therapeutic
interview) or as an ‘It’ (for instance, in the course of an assessment interview).
I and ou
(1958) paves the way to a radical philosophy of dialogue
imbued with mysticism. His opinions are not immune from criticism. Iwill not
engage in evaluating and censoring Buber’s views, although some points are
divergent from my own. Rather, Iwill focus on two main issues that contribute
to the development of my argument.
First, Buber’s understanding of the ‘I’ as originally and ontologically relational
is the precursor of the ‘second-
person’ approach to intersubjectivity. As such, it
history of human subjectivity that will be developed in the next chapters.
Second, Buber’s description of the ‘I–
You world’ can be expanded in such a
way as to capture the ontological implications of establishing an ‘I–
You’ relation
Rather, it may generate a profound transformation of the basic structures of the
world in which both the ‘I’ (the therapist) and the ‘You’ (the patient)live.
“In the beginning is relation” (Buber, 1958, p.18). Buber supports his thesis of
the relational character of the ‘I’ by arguing that this character of human exist
ence was even more pronounced in the primitive life. e ‘I–
You’ relation, he
argues, precedes the ‘I–
It’ relation in the primitive human and the child. “In the
actual development of the human person, entering into relation precedes the
thickening of distance that obstructs relation” (Friedman, 2002, pp.82–
3). Buber
suggests that we consider the speech of primitive people, “whose life is built up
within a narrow circle of acts highly charged with presentness. e nuclei of this
speech, words in the form of sentences and original pre-
grammatical structures
(which later, splitting asunder, give rise to the many various kinds of words)—
he argues—
mostly indicate the wholeness of a relation” (Buber, 1958). e
spirit of what he calls the “natural man” is awakened by impressions and emo
tions that arise from incidents and in situations that are relational. e elemen
tary impressions and emotional stirrings that waken the spirit of the natural
man proceed from incidents—
experience of being confronted with—
and from
life with a being confronting him—
that are relational in character
(ibid.). Buber mentions Mana, Orenda, and the whole Pantheon of momentary
gods as characteristic of the most primitive stage of mythical thinking. Gods
do not arise out of inherited tradition, writes Buber, but out of the fusion of
a number of “moment Gods” that are the personications of those decisive,
surprising, or threatening situations in which the primitive human encounters
Otherness. Language grew out of mythical thinking. Usener (1896) explains
a signicant event is experienced as a momentary god (
) and
originates a name. Events of special importance were divinized. All the names
of gods were initially names for special actions or momentary events. At a later
stage, special gods (
) were created and nominated for situations
or activities that were deemed particularly important (Cassirer, 1946, p.75).
emerging and vanishing mental content. Every impression that man receives,
every wish that stirs in him, every hope that lures him, every danger that threat
ens him can aect him thus
(Buber, 1958). Momentary gods stand
in stark uniqueness and singleness; they exist only
here and now
, in one indi
visible moment of experience. In Buber’s terms, they only exist within the I–
You relation. Only at a later stage, and on a somewhat higher plane than these
momentary daemons, which come and go, appearing and dissolving like the
subjective emotions from which they arise, we nd a new series of divinities.
ese new divinities are called by Usener “special gods” (
). Within
their respective spheres these divinities have attained a permanent and de
nite character, and therewith a certain generality. e relation toward the outer
world changes proportionately from a passive to an active attitude. Man ceases
to be a mere shuttlecock at the mercy of outward impressions and inuences
evaporate withthem.
Agamben (2010) highlights the sacred character of language in this context.
In it, the distance and inadequacy that separate the signier (word) from the sig
nied (thing or event) tend to vanish. Aword is generated by an event. Aname
is an emergent phenomenon, as words emerge from worldly situations. Here
a word that names an event is directly connected to it and fully corresponds
to it. Agamben may speak of the ‘sacrament of language’, since pronouncing
a name here has the value of an oath that bonds the speaking person with the
event itself and with other persons. Names acquire a performative character.
Extending Agamben’s argument, we say that the I–
You relation connects the
two partners through names in a kind of promise, a sacred bond. In the I–
relation, names may acquire a sacred and bonding character.
The life-world of the I–You
Does this suce as an evolutionary foundation of the dialogic principle? “In
the beginning is relation—
as category of being, readiness, grasping form,
mould for the soul; it is the a priori of relation, the inborn ou” (Buber, 1958,
p.27). Events, namely signicant events, are encountered as I–
rather than as Its that one observes from without. is relation has the tempo
ral character of presentness. Some of these ‘present moments’ are so charged
‘momentary gods’ generate names. ese names are not simply attributes for
the god that are imposed to it from without, but are one with the god itself.
Only at a later stage, language breaks up the ‘I–
You’ relation and creates an
It’ experience:‘ere is a tree’. “e primary word I–
It, the word of separa
tion, has been spoken” (ibid., p.23). Language grows out of a more primitive
stage of human development in which words are used to indicate phenomena
that are relational in nature. In this stage, the primitive ‘You’ precedes the con
sciousness of individual separateness. We will come back to this in the chapter
entitled ‘e innateYou’.
To sum up:establishing an I–
You relation in the context of care may gener
ate a profound transformation of the basic structures of the life-
world shared
by the therapist and the patient, since the ‘I–
You’ relation radically aects the
structures of subjectivity of the two partners. Atransformation of
(presentness), and
bonding) is involved.
confused with a naïf nostalgia of
Paradise Lost
in which the ‘I’ and the ‘You’ are
tives and children is not an ideal condition to be regained through an inane
categorical imperative or moral ideal to adhere to a symbiotic, pre-
stage considered as the origin and the fullment of human existence. e prim
itive ‘We’ precedes true individuality. e structure of ‘modern’ selood would
make of the eort to re-
join this type of we-
ness a catastrophic route to mental
pathology. Buber’s dialogic principle indicates the route to an ideal we-
ness that
proceeds from the awareness of individual separateness and tries to reconcile
it with the basic reality and value of the ‘I–
You’ relation, given the vital neces
sity for a restructuring of the broken ‘We’. is can only be done by establishing
isolation, of a more genuinely dialogical nature. rough this ‘We’ can man
escape from the “impersonal one of the nameless, faceless crowd. Aman is truly
saved from the ‘one’ not by separation but only by being bound up in genuine
communion” (Friedman, 2002, pp.208–
e ‘I–
You’ relation is not simply a special kind of epistemological status of
the ‘I’ when it is confronted with an ‘object’, or merely a way to cognitively relate
to it. e ‘I–
You’ relation radically aects the
ontological status
of both the ‘I’
and the ‘You’, deeply modifying the structures of subjectivity of the two part
ners. e ‘I–
You’ relation originates a special kind of life-
world, dierent from
the one originated by the ‘I–
It’ relation. Buber speaks of the ‘primary World’
of the ‘I–
You’ relation and by this he means that the way one is related to the
Other creates the World they are both going to live by. e life-
world in which
the ‘I–
You’ relation takes place has specic ontological features that need to be
First of all, the relation to the ‘You’ is
. Buber claims that no system of
ideas, no foreknowledge, no fancy, no aim, no lust, and no anticipation must
be involved. Aradical
must be performed for the ‘I–
You’ relation to
happen. It is a kind of mystical encounter during which memory and desire
are transformed. Desire “plunges out of its dream into the appearance” (Buber,
1958, pp.11–
12). Aprofound transformation of
is thus involved, as
no screens or lters are allowed. “Only when all these means have collapsed
dependent on the ‘I–
You’ relation as “I become through my relation to the
as Ibecome
, Isay
” (ibid., p.11).
A transformation of
is also involved. e ‘I–
You’ relation is mutual.
Both parts are at the same time aected and aecting, passive and active. “e
You’] relation means to be chosen and choosing, suering and action in
one” (ibid., p.11). “Concentration and fusion into the whole being can never
take place through my agency, nor can it ever take place without me” (ibid.,
p.11). In the ‘I–
You’ relation subjectivity is displaced:one cannot control the
development of the dialogue. What happens when one engages in the ‘I–
relation is irreducible to one person’s activity.
An experience arises
an ‘I’, not
an ‘I’ and the world. “e man who
the world that the experience arises” (ibid., p.4). e ‘I–
, as it takes place
the ‘I’ and the ‘You’. e
specic attention because, in distinction from the individual soul and its con
text, it does not exhibit a smooth continuity, but is ever and again re-
Temporality is also deeply aected. In the ‘I–
You’ relation, Buber writes, situ
ations do not always follow one another in clear succession, but oen there is a
happening profoundly twofold, confusedly entangled (Buber, 1958). e merg
ing of the ‘I’ and the ‘You’ takes place in a special kind of
, as the ‘I–
You’ relation is
. e temporality of the primary ‘I–
You’ world is the
the ‘I–
You’ relation, depths and intensity give breadth and extension to the rela
tion itself. is present here is not fugitive and transient, but a real, lled present
(ibid.). True beings—
writes Buber—
are lived in the present, the life of objects
is in the past (ibid.). Quite a dierent temporality as compared to instantane
ousness, in which the ‘I’ experiences and ‘uses’ the other as an ‘It’. In the ‘I–
relation what counts is not duration itself, but cessation and suspension (ibid.)
that creates the wholeness of a relation charged with the quasi-
ter of presentness. e concept of ‘present moment’ was fully developed some
experiences not formatted in language are intrinsically shareable with others
since they relate to an innate primary system of motivation.
To sum up:the way Irelate to the Other aects my way of being a Self. Buber
quite convincingly shows that the relation aects the ontological status of the ‘I’.
But what about the ontological status of the Other? It is reasonable to think that
this may happen, at least, when both partners agree to engage in an ‘I–
You’ rela
tion. Obviously, the fact that Italk to the moon does not make the moon change its
ontological status and turn into an ‘I’. e moon turns into a person
for me
, not
. Can relating to a person (say, a patient) as a ‘You’ aect her ontological status,
that is, the structures of her subjectivity? Can this happen if the patient is reluctant,
or incapable, of engaging in an ‘I–
You’ relation? In short, does my attitude towards
the ‘You’ aect the ‘You’? Buber writes that “[m]
y ou aects me, as Iaect it”
(Buber, 1958, p.15). e mode Irelate—
he argues—
includes an eect on what
confronts me (ibid.). Do we have evidence for that? What happens, then, if this
occurs? How does my relation to the Other aect the way she experiences herself?
ese are obviously crucial questions for psychotherapy. Remember that, in
order to achieve a sound foundation for psychotherapy we need three basic ele
ments:a theory about how the human person is constituted; a theory about the
way the person breaks down in mental pathology; and nally, a theory about
the way care may positively aect the destiny of a broken person. Buber’s phi
primacy of
The innate ‘You’:thebasic
ere is strikingly copious and converging evidence that attests to the intrin
sic relational nature of human beings—
the news is that such relational nature
also transpires at the neural, subpersonal level (Ammaniti and Gallese, 2014).
Nature has designed our brain to directly recognize that other people are spe
cial kinds of ‘objects’, that is, persons like ourselves capable of sharing mental
states, of directly intuiting the others’ intentions by watching their goal-
actions, and of seeking out the others’ experiences so that we can resonate with
them (Stern, 2004). ere is evidence for such an intersubjective matrix com
ing from the neurosciences, developmental psychology, and psychopathology.
e ‘You’ could be initially viewed as the crystallization of the outcome
Solms and Panksepp, 2012)coupled with a relational programmed motor
system (Gallese, 2000; Rizzolatti and Gallese, 1997; Rizzolatti and Sinigaglia,
2007, 2010). is
basic package
(Ammaniti and Gallese, 2014)is eective in the
development of the primary matrix of intersubjectivity, that is, in establishing
attachment bonds, in the constitution of the Other as an alter-
Ego (i.e. in expe
riencing him as another person like myself), and in the feeling of growing up in
a shared world of emotions and sensations. All these are necessary prerequisites
for survival and for mental health.
Intersubjectivity is an innate, primary system of motivation that organ
izes human behaviour towards valued goals felt as need and desire by human
beings. ere are two such valued goals for the intersubjectivity motivational
system:the rst is the need to read the feelings and intentions of another; the
second is the need to establish or re-
establish self-
cohesion and self-
(Stern, 2004, p.105). We need orientation in the intersubjective eld, that is, we
need to know where we are situated and what the others are going to do. When
we are intersubjectively dis-
the Other’s regard:the other’s look is constitutive of our selood and person
hood. We need a ‘You’ who looks at us to form and maintain our basic self and
personal identity. We need the
of a ‘You’ to become and remain an‘I’.
Perhaps it is not possible to conceive oneself as a human Self without rooting
such appraisal in an early developmental stage in which sharing prevails over
isolation. Mother and infant create a pre-
verbal communication context that
forges a dynamic system based on an aective lexicon. In this context, Self and
Other appear to be intertwined because of the intercorporeality linkingthem.
“We live our life from the beginning with the other (
) we literally inhabit
the body of the other, our mother” (ibid., p.1). Evolutionary psychology shows
how human mothers learnt to care for immature and helpless infants by becom
ing attuned to their aective expressions, and that infants who are more attuned
cally motivated to be attracted to and seek contact with one another, and human
beings are born as social persons who “constantly seek other persons in order to
engage in reciprocal imitation and in mutual emotional regulation” (Ammaniti
and Gallese, 2014, p.141; see Trevarthen, 2009). At birth, humans already
Neonates are innately prepared to link to their caregivers through imitation and
aective attunement. is is the intersubjective matrix from which human life
arises. is matrix is non-
symbolic, non-
verbal, procedural, non-
and not reectively conscious (Ammaniti and Gallese, 2014; see Stern, 2004). It
has a “protoconversational turn-
taking structure” (Stern, 2004, p.21).
grasping others’ intentions. Mother–
infant interaction research has shown that
mother and infant create a pre-
verbal communication context based on aec
tive attunement. is implicit code—
that develops hand in hand with a basic
sense of self—
is aective and pre-
reective. Embodied simulation, challeng
ing purely mentalistic views on intersubjectivity, provides a neurobiological
account based on intercorporeality and aective communication. e capacity
to understand the others’ actions relies on mechanisms that exploit the intrinsic
organization of our motor system. Humans reuse their own non-
engrams encoded in bodily format in their brain to functionally attribute inten
tions to others while observing their intentional behaviours as if one were per
forming a similar behaviour or experiencing a similar emotion.
Recent investigation on the neural bases of the human capacity to be attuned
to others is ecologically plausible, as it includes real persons’ narratives and not
merely lab experiments. Mainstream approaches to social cognition (e.g. eory
the role of an inner representation of the other’s behaviour in order to make
sense of it. e ‘attunement’ paradigm presupposes interaction. e prerequi
site for understanding others, and for intersubjectivity in general, is an experi
ence of
engagement and interest, rather than a merely spectatorial
and of
the mutual regulation of aects, that is, the mutu
my own body and the other’s body (and especially my own emotions and the
emotions of other people) provides the basis for intersubjectivity. Attunement
is a pre-
reective, pre-
verbal, and tacit bridge linking the emotional lives of
other persons with my own. My understanding of the actions of other people
is rooted in my capacity to resonate with another person’s emotions. We don’t
need to furnish others’ behaviours with meanings; rather they are intrinsically
meaningful. No introspection or explicit simulation is needed. Rather, inter-
aectivity and intercorporeality are playing a role here. What is implied is a
circular process of resonance and mutual inuence that is at the basis of partici
patory sense-
making (De Jaegher and Di Paolo,2007).
To understand others is to know how to deal and interact with them.
Attunement creates dyadic emotional states that bring about implicit rela
tional knowing (Lyons-
is paradigm explicitly builds on Buber’s ideas. Avery stimulating aspect of
Buber’s book lays in the suggestion that the I–
You relation is primal to the I–
since the latter presupposes the existence of an I.According to Buber, the full-
blown Ionly emerges once one perceives oneself as a You, when interpersonal
dialogue turns into self-
centered inner dialogue. ey suggest that we should
abandon the Cartesian view of the primacy of the Ego and adopt a perspective
emphasizing that the Other is co-
originally given as theSelf.
What is really new about this research is that it studies the developmental
and neurobiological underpinnings of intersubjectivity without eliminating
the experiential dimension of social behaviours. It looks at intersubjectivity
from a phenomenological angle. It delves into ‘what it is like’ to be with another
representational, third-
person perspective, as is the case with mainstream
approaches to social cognition. In this perspective, the other person appears
in a quite dierent light than that of a ‘mentalizing monad’ or a disembodied
representational system; the Other ‘becomes a bodily self, likeus’.
The dialogue withalterity:
narratives and thedialectic
e connection with the ‘You’, the openness to it, and the capacity to dialogue
with it are necessary for establishing and maintaining selood and person
hood. Apreliminary clarication of the meanings of ‘selood’ and ‘person
hood’ is needed.
e phenomenological notion of
serves to explore the fact that we
live our conscious life in the rst-
person perspective, as an embodied, self-
present, single, temporally persistent, and demarcated being, who is the subject
of his perceptions, feelings, thoughts, volitions, and actions. is basic form of
experience is implicitly, pre-
reexively, and non-
observationally manifest.
e notion of
is markedly more comprehensive than the notion
of selood. ‘Personhood’ helps to clarify the ways pre-
reective self-
is structured as an embodied and situated experience inextricably entan
gled with an experience of a
basic otherness
. Hermeneutical phenomenology
explores how the person reectively relates herself to, and tries to make sense of,
this basic experiential fact that she is a self whose self-
awareness is constantly
challenged by that which is not herself. Iexperience myself as more than my
sense of being a self. e feelings of otherness at the core of my self-
make my sense of identity fragile, prompting questions about who and what
(ontologically) Iactually am, and how Ishould cope with this intimate sense of
otherness (normatively).
e ‘You’ may take several forms in human life that are essential for personal
these forms
of the ‘You’. Our identity as a human person is a narrative identity that stems
our life. In this chapter, Iwill try to introduce the concept of ‘narrative iden
tity’ as one basic form of dialogue with alterity. In the next chapters Iwill try
to elucidate the concept of ‘alterity’. Ricoeur (1992) calls the dialogical process
through which human existence develops the dialectic of sedimentation and
through the encounter with one’s un-
chosen, ‘involuntary’ disposition or with
an event, and the capacity of the person to cope with, modulate, appropriate
and make sense of them. First and foremost, this dialectic progresses silently
and implicitly. Some other times, it becomes explicit and progresses in a reex
ive form. Narrative identity can contribute to the unfolding of this dialectic. Its
to balance, on one side, the immutable traits which this identity owes to the anchoring
of the history of a life in a character [
l’ancrage de l’histoire d’une vie dans un caractère
and, on the other, those traits which tend to separate the identity of the self from the
sameness of character. (ibid., p.123)
Narratives help unfold the dynamics of our identity in that they are able to artic
ulate the reasons for our character and dispositions, as well as the meanings of
the events that we encounter in our life. e narrative dees, so to speak, the
immutability of the character and the traumatic potential of the event, because
it makes the otherwise inalterable part of our personhood (the same or Idem)
and the alterity contained in the event a dynamic (thus ‘healthy’) part of our
personal history.
e concept of narrative identity is rst introduced in relation to the tem
poral character of human existence. Temporality is critical for the question
about personal identity. We cannot ask about the identity of the person without
dealing with the temporal dimension of human existence (ibid., pp.113–
Unlike what it is the case for an object—
say, this book—
whose identity relies
on remaining the same over time (
identity), the identity of a person is a
dynamic process that both implies sameness and change. For instance, your
identity as the reader of this book will (hopefully) slightly change while con
fronting with it. It would not make sense to read this book if not for gaining
some new ideas that may aect your professional or personal identity. Aperson
changes over time, gains new insights about herself, transforms and loses old
lematic simply to assert that the person remains the same person over time,
in terms of an intrinsic process of appropriation and armation (or restora
tion) of the self (Stanghellini and Rosfort, 2013a).
Experiencing oneself as a person involves more than a sense of self-
Ricoeur introduces the notion of narrative identity in order to cope with the
problematic temporal character of human identity in the sense that the notion
tence and diversity over time. e concept of narrative identity is part of the
hermeneutic approach to this conict inherent in human subjectivity. e
hermeneutic answer to the question ‘Who am I?’ understands human exist
Self. e person engages with alterity by means of symbolic media
tions:the person continuously tries to come to an understanding of what aects
it (alterity).
e identity of a person cannot be reduced to what happens to the person
over time, to the way events in time work on the self (cosmological time), but
must necessarily include how the person herself acts on her being aected
by these events that happen in time (lived time). e problem of persistence
diversity of dierent temporal states or simply disintegrates into a mere ow of
dierent ‘nows’ with nothing but a contingent connection, is mitigated when
we approach the identity of a person as “regured by the reective applica
tion of narrative congurations” (Ricoeur, 1988, p.246 [Translation slightly
Personhood makes evident the problem of identity over time. We are the same
person throughout our life, but the sameness of our identity as a person is con
tinuously challenged by the changes that all persons undergo over time. To be a
person may be a fact, but it is also a task. We experience ourselves not merely as
selves, but as persons who are both a unique person and an anonymous organ
ism. Human beings constantly question their being the peculiar beings that
they are. To be human has an unavoidable
character. Aperson is
what we are (e.g. our past), but also how we make sense of what we are through
the stories we tell about ourselves, and who we want to become (our project).
To be a person is to strive for an identity that is constantly challenged by bio
logical and historical factors. How can we talk about being the same person
e notion of personhood emphasizes the alterity which is at the heart of being
a person, that is, those aspects of my existence that are constitutive of the person
that Iam, but over which Ihave no immediate control (e.g. my body, other peo
my particular way of being a person is continuously challenged by other people.
Again, Iam who Iam, but Imight feel that Iam not myself, or that the person
that others take me to be is not the person that Ireallyam.
My choices and actions when done leave my control and may result in unex
pected, happy, or unfortunate results that in some way or other inuence the
person that Iam. e responsibility for my words and deeds does not end when
they are out of my mouth or hands, so to speak. My body changes, becomes
dierent as the years go by, and Imay become alienated by these transforma
tions. Ican accept such changes, despair because of them, or ght them, but
every one of those attitudes aects the person that Iam. In short, to be a person
involves the inescapable struggle with the otherness that constitutes the person
that Iam (Stanghellini and Rosfort, 2013a).
I feel that Iam not myself, and at times Isay and do things that Ido not
less mine. It is
who feel and act, although my feelings and actions may be
disturbing to my understanding of who Iam. e notion of narrative identity is
introduced to make sense of these intimate feelings of otherness at work in my
sense of being a self, and to articulate the normative implications of selood.
our experience of being a person. is tension is experienced in who and what
we care about, and is inescapably connected to the ontology of the peculiar
beings that we are, namely, human beings who are inuenced and shaped both
by a-
rational factors (we are organisms) and rational factors (we are persons).
In other words, to make sense of and deal with what we care about, we need to
take into account both the anonymous biological factors and the personal fac
tors that constitute our identity as persons overtime.
is inescapable struggle with alterity is the reason why Iboth
a person. In other words, to experience myself as a person is to experi
ence the fragility of my autonomy. Being a person is characterized by the inde
nable and restless autonomy that makes each person the individual person
that he or she is; that is, Iam the person Iam, but Iam also faced with the
constant task of becoming who Iam through the alterity that constitutes my
life as a person. Alterity challenges my life not only from without, for instance,
as an unexpected event, but also from within in the form of the sedimented,
obscure texture of my identity (my brain, my past, my parents, my nationality,
my character). Being a human person is trying to exist as myself in and through
the challenges of innumerable features that make up what Iam, but which can
not entirely dene who Iam. Two major factors of the alterity that constitute
the person that Iam are my body and other people. My body is an ambiguous
thing. It represents an intimate aspect of the challenge of alterity:“To the extent
that the body as my own body constitutes one of the components of mineness,
the most radical confrontation must place face-
face two perspectives on the
the body as mine, and the body as one body among others” (Ricoeur,
1992, p.132). My body is the most intimate part of my identity as a person,
about what Iwant and who Ifeel Iam. Because Iam embodied, Ilive with feel
ings, sensations, and needs that produce values that are not of my making and
with which Ihave to live my life. Values are anything positively or negatively
weighted as a guide to action (for example, needs, wishes, and preferences)
Need is the primordial spontaneity of the body; as such it originally and initially reveals
without my having posited them in my act-
generating role [
] Before Iwill it, a value
already appeals to me solely because Iexist in esh. (Ricoeur, 1966,p.94)
My body is the organ of my autonomy, and as such it is permeated and
shaped by my intentional engagement with the world, but it also challenges
this autonomy through the a-
rational factors at work in the physical organism
that Icall my body. My body ages, becomes sick, and eventually dies in spite
of everything Ido. e incomprehensible character of my feelings and emo
tions, my urges and desires, reveals the challenge of the a-
rational, anony
mous character of the What constitutive of who Iam. My body expresses the
pathic character of my autonomy by making me aware that my relation to the
world, other people, and myself is felt before it is understood (Ricoeur, 1987,
or do makes this biological aspect of who Iam an inescapable problem in
my life as a person. My dreams and hopes are realized through my body, but
they also shatter against this impermeable alterity with which Ilive my life.
In this sense, my body is one major expression of what is seemingly the most
stable, thing-
like aspect of personhood involving the physical characteristics
and long-
and convictions.
My dispositions to act are shaped by how Iam brought up and by our social,
geographical, and cultural context. e formation of habits and seemingly
implicit or automatic dispositions to act is our most obvious and docile tool
to cope with alterity, since these internalize otherness and make it a part of our
person. But even our own choices may become habits and long-
term disposi
Imay become aware of how Icame to have such a nervous character or such
violent dispositions, instead of accepting that, in the end, this is just how we are.
rough narratives Ican work through the meaning of an event that involves
my body, the world, or other people, as for instance an event of loss, and mean
ingfully integrate it in my personal identity.
we know that this encounter may become pathogenic. We call ‘vulnerability’
the alterity that we nd in ourselves (in our involuntary disposition) when Ias a
person cannot dialogue with it (that is, when Ifail to
it, to cope with,
modulate, and make sense of it). We call ‘trauma’ the alterity that Iencounter in
my dealings with the external world when Ias a person cannot dialogue with it
(that is, when Icannot
it, cope with, modulate, and make sense of it).
us, vulnerability is the underside of an involuntary disposition, and trauma
is the underside of an event. Avulnerable trait and a trauma are the eect of a
as well as the eect of the incapacity of the person to dialogue with them.
Narrative identity is a practical category, which means that it deals with the
the person acts and suers in the actual coexistence with alterity. Ricoeur would
in no way deny that narrative identity has its limits with regard to the explana
tion of both time and identity. Also, he would in no way subscribe to the thesis
that the identity of a person is nothing but the story he tells about himself, as
radical constructivists hold. In fact, he explicitly points to the limits of narra
tivity in relation to the unrepresentability, inscrutability, or inappropriability
of certain aspects of alterity, and further emphasizes that “[n]arrative identity
thus becomes the name of a problem at least as much as it is that of a solution”
(Ricoeur, 1988, p.249).
Acloser look intoalterity:
At the heart of alterity lies a double paradox.
First, alterity speaks of
, of the non-
coincidence of the Self with
itself. Most of the philosophical anthropologies of the last hundred years
emphasize that the phenomenon of eccentricity is indigenous to human exist
ence, and characterize Man as an eccentric being; he is never entirely what he
‘is’ (Plessner, 1964). As a person the human being is a
homo duplex
. e term
‘homo duplex’ was originally elaborated by Maine de Biran (1852). We are pas
sive in our nature as sentient beings because we are shaped by our physiologi
virtue of being persons. On the one hand, we are a part of nature, and therefore
and emotions (a core sense of self, sexual and survival instincts, fear of danger,
ment. On the other hand, Man is a being who poses problems and raises ques
tions (Ricoeur, 1966, 1987; Stanghellini and Rosfort, 2013a).
Fundamental to the understanding of human subjectivity is clarifying the
ways self-
awareness is structured as an experience inextricably entangled with
an experience of a
basic otherness
. Irelate myself to, and try to make sense of,
this basic experiential fact that Iam a self whose self-
awareness is constantly
challenged by that which is not myself. In other words, Iexperience myself
as more than my sense of being a self. e feelings of otherness at the core
of my self-
awareness make my sense of identity fragile, prompting questions
about who and what Iactually am, and how Ishould cope with this intimate
sense of otherness. Hermeneutical phenomenology introduces the notion of
personhood to explore this fragile sense of identity involved in our troubled
selood, making use of the notion to systematically examine and make sense
of the ontological and normative implications of this entanglement of selood
and otherness.
A human person is both a rationally governed self and a biological organism
subjected to the a-
rational biophysical laws of nature. us, human thinking,
feeling, and actions are shaped and formed by two kinds of causality:an a-
rational biological causality and a rational causality. is peculiar ontological
character of human personhood becomes manifest primarily in the strangely
ambiguous character of bodily experience. is ambiguity produces a dialec
impersonal laws of a nature that involuntarily and a-
rationally generates bodily
phenomena, and the voluntary, rational elaboration of those phenomena on the
part of the person who lives in and through her body (Ricoeur,1992).
Part of this complex dialectic can be traced back to the fact that Man is a
1977, p.458), but Ido not coincide with it. is obscure and involuntary side
remains “an ineluctable partiality” (ibid., p.458), not the totality of mySelf.
To paraphrase Pierre Bourdieu, to be a human being is to be in
in front of which we need to voluntarily take a
. e complexity of my
identity as a person consists in the fact that besides the impersonal changes
that Iundergo as the consequence of the sheer fact of being a developing bio
logical organism, Ialso autonomously relate myself to these changes, and these
, in turn, aect the person that Iam. Or, as Arnold Gehlen
as a person, am not simply situated in the world in a given way; Ialso have the
privilege and responsibility to take a position with respect to my being-
taking (Plessner, 1928/
vividly expresses the essence of a person as a
homo duplex
and questioning
being. Man is that being that among his most important tasks has to take a posi
tion with respect to himself (Gehlen, 1988), that is, with respect to his instincts,
emotions, past history, social constraints, and so on. He also has the task to
Duplicity is just one of the paradoxes of being a person. e second, and per
haps most striking paradox is that alterity is not felt as totally extraneous to
Alterity is extraneous and familiar at the same time. It comes as a surprise
from the most intimate and proper region of the Self. Indeed, what is experi
enced as most extraneous is also what is most proper to the Self. Extraneous
and essential are the two sides of a
, that is, a zone of continuity—
even of
rather than of discontinuity. is is the literary as well as
philosophical and psychological
of the Double (
) and the
Uncanny (
), since only what is so extraneously familiar can touch
me in such a deep way. Only what is so genuinely mine can impose on myself,
can make me wonder as to shake my innermost certainties, can produce such a
vertigo bringing my Self to the very edge of itself. Lacan (1992) coined the term
) to represent this paradox. is neologism was created by
Lacan from the term ‘intimacy’ (
) to designate the exterior that is pre
sent in the interior. e most interior has a quality of exteriority, since the most
intimate is at the same time the most hidden. Paradoxically, the most intimate is
not a point of transparency but rather a point of opacity. e intimate is other-
like, a foreign body in the context of the person. e experience of extimacy is
tied to the vacillation of the subject’s identity to himself (Miller,1994).
It is worth listening to Freud’s (e ‘Uncanny’, 1919)discussion of the Uncanny.
e German word
is clearly the opposite of
, which means
‘homely’, that is, what is ‘familiar’. One would be tempted to conclude that the
Uncanny is frightening precisely because it is not familiar. Obviously, not eve
added to novelty and unfamiliarity in order to make it uncanny. Aer an in-
depth analysis of the several shades of meaning of
, Freud points out
being contradictory, are very dierent.
means what is familiar and
agreeable, but also what is concealed and out of sight (ibid., pp.224–
5). Quoting
Schelling, he suggeststhat
everything is
to light (
) us
is a word the meaning of which develops in the direction
of ambivalence, until it nally coincides with its opposite,
is in
some way or other a sub-
species of
. (ibid., pp.225–
e experience of the Uncanny may be the appearance of some element of
the ego, harking back to particular phases in its development in which “the ego
people” (ibid., p.236).
On one side, we may understand the impression of uncannyness as the eect
of the temporary suspension of repression, that is, as the re-
appearance of
repressed memories. But on the other, it also seems that what emerges from
ter addressed as the experience of my Double. e
secretly familiar double
Iexperience in the Uncanny is not necessarily a part of the Unconscious that
was previously repressed.
It is important to note from the start that alterity does not coincide with the
Freudian Unconscious as the product of repression and other defence mecha
nisms. An example of non-
repressed alterity is my experience of myself as a
biological organism. Ilive by an impersonal and pre-
individual element that
is at the same time the closest to and the remotest from myself. It is my very
life in as much as it does not belong to me. Iobscurely feel it in the intimacy
of my physiological life; it is at the same time the most intimate and proper to
myself and the most extraneous. My thinking, feeling, and action are shaped by
two kinds of causality:an a-
rational biological causality and a rational causal
ity. is peculiar ontological character of human personhood becomes mani
fest primarily in the strangely ambiguous character of bodily experience. is
conditioned by the a-
rational, impersonal laws of a nature that involuntarily
and a-
rationally generates bodily phenomena, and the voluntary, rational elab
oration of those phenomena on the part of the person who lives in and through
Alterity and the person belong to each other. e good life is rst and fore
most based on the dialogue with alterity, and this dialogue presupposes the
awareness of the fact that the individuated Self is not entirely individuated. In
ancient Rome this pre-
individuated alterity was named the
genius. Genium
suum defraudare
meant to cheat oneself, to deceive oneself (Agamben, 2004,
p.9). is part is “the most intimate and proper”, “the closest and remotest”
(ibid., p.11). is very intimate and personal part is what in myself is the most
impersonal. ‘Genius’ is my very life, in so far as it was not originated by myself,
but gave origin to myself. It is my own life in as much as it does not belong
to me. Iobscurely feel it in the intimacy of my physiological life as “the force
that drives blood in our veins
and loosens or contracts our muscles” (ibid.).
Emotions are also part of “the impersonal in ourselves
in touch with the pre-
individual” (ibid., p.14).
is impersonal and not individuated part is not a chronologic past that Ile
behind myself. It is not repressed. It is the obscure side of my own existence as
in nature:“If Genius is our own life in as much as it does not belong to us, then
Imust listen to and honour this part as “one honours one’s debts” (ibid., p.10).
e complexity of my identity as a person consists in the fact that besides the
impersonal changes that Iundergo as the consequence of the sheer fact of being
a developing biological organism, Ialso autonomously relate myself to these
changes, and these personal
, in turn, aect the person that Iam. us
Imust learn how to establish a dialogue with this extraneous being, to live in
the intimacy of it, and to keep myself in relation with this non-
knowledge zone
Freud, in his own terms, spoke of the need for a
of alterity that
becomes manifest in symptoms as
my own alterity
, that is, as an integral part of
the person that Iam. e recognition of alterity as an indiscernible part of the
person that Iam paves the way to the
own alterity:
He [the patient] must nd the courage to direct his attention to the phenomena of his
illness. His illness itself must no longer seem for him contemptible, but must become
its existence and out of which things of value for his future life have to be derived. e
way is thus paved from the beginning for a reconciliation with the repressed mate
rial which is coming to expression in his symptoms, while at the same time a place is
found for a certain tolerance for the state of being ill. If this new attitude towards the
illness intensies the conicts and brings to the fore the symptoms which till then had
been indistinct, one can easily console the patient by pointing out that these are only
necessary and temporary aggravations and that one cannot overcome an enemy who is
absent or not within range. (Freud, 1914, p.152)
Epiphanies ofalterity:drive
We encounter alterity in two main domains of our life:in
, and in
external world
. In the rst case alterity is in the involuntary dimension of
ourselves, as (for instance) our un-
chosen ‘character’, including needs, desires,
emotions, and habits. In the external world, alterity is encountered in the chal
constellate ourlife.
A good way to further approximate the meaning of the alterity we encounter
in ourselves is to see it from the angle of Ricoeur’s notion of the ‘involuntary’
Whatness of Who we are. Ricoeur denes the involuntary as ‘experienced neces
sity’, that is, the experience of necessity, of what we did not and cannot choose.
is notion comes close to that of sheer biological life (Ricoeur, 1966), but also
to what Heidegger calls ‘thrownness’ (
), in the sense of being stuck
with the particularity of my being-
so. rownness expresses our being cast into
inuence of thrownness. Notions like ‘drive’, ‘emotions’, ‘habitus’, ‘character’, the
e involuntary dimension of my being the person that Iam includes
a priori given in my existence, the raw material that constitutes the sedimented
tary is the un-
chosen, implicit possibilities limiting my actions and reactions,
the dark side of the person, and its obscure and dissociated spontaneity. e
roots of the involuntary are my
, my
, and the
into which Iam
operative and almost implicit in my life:historical values (e.g. my family’s val
rules and roles). Just as Ihave not chosen my historical situation, Ihave not
chosen my body and the world in which Iam embedded. History, body, and
world situate and ‘incline’ me in an un-
chosen way. e receptivity to these val
decision to consent to or dissent from them. For instance, Icannot choose my
emotions, desires, or habits. Iam simply thrown into them, though Iam not
at their mercy. Iam responsible for them—
I can approve, or disapprove and
refuse, them.
Iam stems from the fragile, complex, and obscure dynam
ics of the voluntary and the involuntary
inherent in human personhood.
e involuntary must be clearly dierentiated from the Freudian ‘dynamic’
unconscious, that is, the unconscious that is generated by repression
as we have done already with Genius and our biological life.
Drive, emotion, and habitus—
the three emblematic components of the obscure
and dissociated spontaneity that make up the involuntary dimension in human
are forgotten not forbidden, implicit not rejected, automatic not
censored. is impersonal part of ourselves is not a repressed chronologic past
that we le behind ourselves.
A relevant part of the involuntary is
. Drive is the principle of all obscu
rity in my will. Its two basic proles,
, aect me coming from the
deepest regions of my being. Especially need seems to leave no other escape
but its satisfaction. Need is the primordial spontaneity of the body; as such it
of motives. rough need, values emerge without my having posited them in
my act-
generating role. “[B]
read is good, wine is good. Before Iwill it, a value
already appeals to me solely because Iexist in esh” (ibid., p.94).
It’s not easy to trace a sharp line dividing needs from desires. Need embodies
organic values
gladly dissolve into mechanism and attribute it to the body” (ibid., p.378).
Desires, as the very word seems to suggest, are felt as coming from above, rather
than from the subsoil where we posit the roots of need. Perhaps, the paradig
matic manifestation of desire is the desire for
the craving for being
is also another experience of need:a kind of need unsaturated with a precise
object that makes me ask myself ‘What is it that Ireally want?’. e teleology of
is an intrinsic possibility when experiencing need. is is also the case with
desire. is is a structural possibility inherent in need and desire, embedded
in their very nature. ey are not like a
, a reaction following a stimulus
in a rigid pattern. ey are not like an
that “leaves no organic problems
unresolved and renders invention unnecessary, making the animal a constantly
resolved problem” (ibid., p.95). Ican reject my drive as a reason for action,
and in this Ishow my humanity. Also, and even more important, at dierent
times Ican forge dierent representations of the object of my drive:now it is
food, later it will be crude sex, earlier it was the tenderness of a smile. In need
Idiscover myself
(and in desire
specic or aspiring to it. Need and desire have an inherent plasticity; they can
Even in its most organic and biological dimension as is the case with need,
the involuntary is matter, whereas the voluntary is its form. e involuntary
has no specic form; the voluntary has no substance in itself. e voluntary is
rather than a substantive, as it is the mode, the way the person gives
form to the involuntary.
of alterity insocial situations
My habits seem to be what is most distant from alterity as they pertain to order
proper way to act under given circumstances. us, acting on the basis of habit
means to act unreectively and involuntarily. e ‘habitual self’ is opposed to
in a psychodynamic sense. It is not repressed:rather it is a form of unreecting,
practical Cogito. As such, it is another form of dissociated spontaneity, next to
drive and emotion, that may surprise me, especially when it prescribes me a
Habits are parts of procedural memory, distinct from semantic memory, and
as such they become manifest while performing some kind of action. ey are
incorporated schemes of action acquired in the course of individual life trajec
tories. Simply put, habits focus on my way of acting, feeling, thinking, and being.
e concept of ‘habit’ captures how Icarry within me my personal history, how
Ibring this history into my present circumstances, and how Ithen make choices
to act in certain ways and not others. Family upbringing and social and educa
tional circumstances are the principle roots of habits. Pierre Bourdieu (1990a,
1990b) denes
individuals, groups, or institutions). Our arms and legs, our entire body, are
full of mute imperatives. ese imperatives include ‘Sit up straight!’ and ‘Don’t
put your knife in the mouth’. ey select the range of aordable perceptions
and actions. ese corporeal orientations that people acquire through their
rearing in a given culture constitute the track of our action and perception.
In particular, they orientate my social relations. ey are non-
conceptual in
nature:embodied schemas that are out of one’s voluntary control and are dif
cult to make explicit.
e habitus is a disposition, that is, a tendency, a propensity, or an inclination
that generates practices, beliefs, perceptions, feelings, and so forth in accord
ance with its own structure. is disposition is durable in that it lasts over time,
social theatres of action. Bourdieu’s habitus comprises a “structured and struc
turing structure” (Bourdieu, 1994, p.170). It is ‘structured’ by one’s past and
present circumstances, such as family upbringing and educational experiences.
It is ‘structuring’ in that one’s habitus helps to shape one’s present and future
practices. It is a ‘structure’ in that it is systematically ordered rather than ran
dom or unpatterned. is ‘structure’ comprises a system of dispositions that
generate perceptions, appreciations, and practices.
aware that Ibase everyday decisions on implicit assumptions about the predict
able features of social interactions based on my pre-
reective understanding
of the character, behaviour, and attitudes of others. e phenomenon of ‘habit’
transports the involuntary into the social dimension of human existence. My
schemes of interaction.
e mode by which Iexperience and represent others, and accordingly the
way Iexperience and represent myself in the context of social situations, are
an essential part of my own life-
world. e repeated experience of being with
another person, especially a signicant Other, contributes to gradually shap
ing a prototype of a self-
other relation. Once this prototype is formed, it
becomes a generalized and encoded habitus (Stern, 2000, p.111). e habitus is
an experience of being-
attributes of the relation that gave origin to it is present. is may occur out of
awareness, that is, the person is neither aware that what is going on is the recall
of an actual past happening, nor that she is exploiting a pattern of interaction
stored in her implicit procedural memory.
ese schemes of being-
with form a coherent and persistent structure that
consists in a form of practical, implicit Cogito that drives my body to behave in a
given way under given circumstances. It is an endless invitation to repeat the same
schemes of actions, perceptions, and interactions. e victim–
accusatory schemes of interaction are examples of that. ese schemes
are reproduced automatically and may surprise me, since their origin remains in
with little or no reection. It exonerates me from thinking and reecting each
time about the suitable behaviour under similar circumstances. Habitus is not
based on a kind of reasoning by analogy mechanism, but on embodied schemas
that orientates me in the ongoing social state of aairs and situates me accord
tions, my position in a given situation, and my position-
taking with respect to
both of them. Good practices are not simply the result of my habitus, but rather
In some occasions the spontaneity of habitus is pointless and inappropriate. It
surprises me, as it makes me act mechanically, disrupting my voluntary actions
and leading me to
. e actual Other is not recognized in its
individuality. My self-
other habitus distracts me from understanding the
specicity of the present situation, as it
it with the bias of preconcep
tions. It forces me to behave inadequately, as it reiterates a standard scheme of
interaction inappropriate to the actual circumstances. is is typically the case
when the present situation is felt as analogous to a traumatic interaction that
Iexperienced in the past. My past literally materializes ‘right now’ in front of
me, becoming an obstacle to experience the present situation dierently from a
essential part of my own Self. Acknowledging this ontological complexity, and
tary factors poses to our sense of identity, allows us to explore and make sense
of the
problems involved in being a person.
is is experienced as the challenge that to be a person is not a fact, but a
. We are the same person throughout our life, but the sameness
of our identity as a person is continuously challenged by the alterity that all
persons experience through time. Emotions are part of this emerging alterity.
Being a person is trying to exist as myself in and through the challenges of all
those features that make up
Iam (e.g. my anonymous biology, my past,
my present uncanny experiences, the way Ifeel dened by people while they
look at me), but which cannot describe
Emotions are the most embodied of mental phenomena. Emotional experi
ence is permeated with feelings and sensations that constantly
elicit and chal
my attempts to make sense of and cope with it. Although human emotions
that Iassess and comprehend my emotional experiences by means of inten
tional and conceptual analysis, there is more to my emotional experience than
is disclosed and explained by intentional and conceptual analysis. Moreover,
there is more to the person that one is than the emotions that one feels. To
short, to be a person involves a permanent confrontation with the alterity that
becomes manifest in emotional experience, that is an inescapable part of the
person thatIam.
with the environment. is understanding of ‘emotion’ focuses on the embod
ied nature of emotions, but rejects its reduction of the body to the object–
or physiological mechanism (like visceral changes mediated by the autonomic
nervous system). It obviously also rejects the conceptualization of emotions as
pure ‘mental’ phenomena because an emotion is not a purely and primarily
cognitive phenomenon aecting the mind, but a phenomenon rooted in one’s
lived body. Emotions are characterized by their connection to motivation and
movement. Emotions are functional states, which motivate and may produce
movements. is view is held by contemporary evolutionary psychologists
1999a, 1999b). As functional states that motivate movement, emotions are pro
tentional states in the sense that they project the person into the future, provid
ing a felt readiness for action (Gallagher,2005).
take:aects and moods (Smith, 1986). is distinction is merely incipient in
Husserl’s writings and is made explicitly by Scheler (1966, 1970), Heidegger
(2010), Sartre (1971), and Ricoeur (1966, 1987). Whereas aects are responses
to a phenomenon that is grasped as their motivation, moods do not possess
such directedness to a motivating object. Although their terminology dif
fers, and oen confusingly (Scheler:
; Heidegger:
; Sartre:
; Ricoeur:
sentiments schematisés
timents informes
), their analyses of the phenomena concur in the general
Aects are focused and intentional, and possess directedness. Aects are felt
Aects do not open up a horizontal awareness, but occupy all my attentional
me). When Iam aected, a relevant feature of the world captivates me, irrupts
into my eld of awareness without me having decided to turn my attention to it.
Ibecome spellbound by it and all my attention is captured by it. Typical exam
ples of captivating aects are grief (when the death of a beloved person occupies
all my attentional space) or phobias.
Moods, on the contrary, are unfocused and non-
intentional. ey do not pos
sess directedness and aboutness. ey are felt as unmotivated, and there are no
and are oen inarticulate. Moods have a horizontal absorption in the sense
that they attend to the world as a whole, not focusing on any particular object
or situation. Moods oen manifest themselves as prolonged feeling-
states as
opposed to the more instantaneous nature of aect. Whereas most aects ll up
the whole eld of awareness for a brief period (e.g. in fear or anger), moods con
vey a constellation of vague feelings that permeate my whole eld of awareness,
and they oen last for a longer period than aects. Moods are global feeling-
states that do not focus on any specic object in my eld of awareness. When we

are in a certain mood we relate ourselves to the world and to ourselves through
In euphoria, the perception of my body is diminished and may even vanish.
Ifeel absorbed in my concerns; my self-
awareness, my body, and the world
to the foreground; Imay feel my body as an obstacle, a hindrance separating
me from the world and perhaps even from myself. us, moods are atmos
pheric and oen corporeal in that they permeate my perception of the environ
ment. ey can bring me closer to or distance me from the world in that they
elicit a certain atmosphere that becomes the tonality through which Iperceive
the world and myself. When Iam feeling happy, the world and other persons
appear in a so light of possibility and openness. Ifeel dierently from when
Iam jealous. In this case, things appear as prowling perils; even the most sincere
smile might be perceived as false and dangerous to my person.
Acloser look atmoods
and affects:intentionality
and temporality
e standard phenomenological view on moods and aects is more or less clear
on one fundamental dierence:moods are experienced as unintentional and
aects intentional. However, this view may be modied by relating the two
states to the person. It is correct to say that an aect such as fear is about
the particular object of fear (e.g. the bear), and that an anxious mood does not
point to any specic intentional object, but manifests itself as an unarticulated
background tonality or atmosphere that contaminates my whole eld of aware
ness. Nevertheless, my mood seems to contaminate the way Irelate to the world
in the sense that it is accompanied by a certain atmosphere in my perceptions.
Asituation that beforehand would not intimidate me at all now lls me with an
irresistible desire to run away and look for protection. e feelings involved in
the intentional attitude of my aects are indeed changed by my current mood.
My mood is expressed by how perceptions or thoughts aect me. Moods mate
rialize in aects in that Iam aected through my mood. is may suggest a
covert intentionality in moods. Whereas aects have a direct and clear inten
tional object (an object of perception or a thought), moods are characterized by
multiple objects (Siemer, 2005). Whereas aects point to an explicit experience
such as a dangerous situation, a happy smile, a beautiful landscape, a dicult
task, and so on, moods, on the contrary, point to my being the person Iam in
a given situation.
Moods can be compared with what Ricoeur calls ‘ontological sentiments’ in
that “[t]
hey denote the fundamental feeling
namely, man’s very openness to
being” (1987, p.105). We can say that whereas aects point forward towards a
specic object, moods point inward towards my being the person Iam. More
precisely, moods contain a bipolar intentionality in the sense that they oen
materialize in a certain aect owing to an explicit object. But at the same time
they point to my being the person Iam, and thereby in moods alterity manifests
itself and awakens questions, doubts, considerations, evaluations, and nally
deliberations about my-
One way to ascertain a mood from an aect and, perhaps even more impor
consider temporality. Temporality is understood as how the person experiences
time and how the existence of the person is inevitably formed and developed in
time. e person changes through time and experiences how the world, other
people, and herself change in time. Temporality is not time as an exclusively
private (solipsistic) or pure cosmological (objective) phenomenon, but both
time as experienced and lived by the person and time as working on and with
the person.
Moods and aects display dierent temporal patterns. Aects are oen
briefer thanmoods. ey captivate me, occupy my whole eld of awareness,
Moods, on the contrary, may last for days, weeks, or even years in that they
weird actions without any thoughts of the past or the future (euphoria). e
happy smile, work on the dicult task, and so on. Obviously, we oen do not
the aect by cognition. For example, the irresistible desire to insult or thump
a malicious boss may be suppressed by the fear of losing my job. e intensity
of the aect then gradually subsides, and Iturn my attention on other matters.
as a bitter memory that brings forth unpleasant feelings every time it pops up in
my mind (Goldie, 2000/
2002, pp.149–
e dialectic of moods and aects is complex. Aects may transform them
selves into moods and nally become a permanent part of our ‘character’; moods
thoughts. Last, but not least, a given mood may become an aect when in reec
tion Ican articulate it and nd its motivations and ‘felt causes’, that is, the way
it roots me in a given situation. An aect may transform itself into a mood
that imposes itself on me for days or longer (grief can transform into a gen
eral sadness, anger into dysphoria, boredom into tedium). us, a mood may
develop out of an aect as the aect itself loses its instantaneous, focused, and
motivated character. Also, a mood might not be the product of a single aect
and the following action or suppression of action, but a constellation of feelings
elicited in several episodes. Moods (e.g. irritability, sadness, tedium, euphoria)
change the way Iam aected by the world (and my own thoughts) in that they
predispose my eld of attention (thus my conscious experience) in a certain
way. And in the course of time, moods may—
in virtue of being dispositional—
transform themselves into an inherent and permanent part of my self. An aect
can develop into a mood, and a mood can develop into a basic emotional tonal
ity. For instance, a dysphoric state can gain such a hold on my person that it
turns into a certain trait, for example an irritable, hostile, mean, polemic, mis
anthropic, or adverse character. is basic emotional tonality is a permanent,
implicit protention, or readiness to (re)act and be aected in a given way, and
probably also to develop certain moods more than others. In this way, emotions
become an essential part of a person, of one’s sense of personal identity. is
feeling of sameness comes close to what Ricoeur (1992) calls ‘character’. is
basic emotional tonality is usually tacit and Inotice it only when it is not there.
It is important to notice that all these transformations from aects to moods to
character occur pre-
reectively and without a deliberate and thematic involve
ment of the person in the process, whereas the transformation of a mood into
an aect involves reection.
Emotions and thedialectic
ofnarrative identity
e theory of narrativity comes in endless variations and inuences a vast array
of disciplines (e.g. philosophy, psychology, sociology, theology, economy).
Narrativity, here, indicates that a signicant part of a person’s self-
and self-
understanding is based on self-
an ongoing process of
establishing coherent formulations about who Iam, who Iwas, and where Iam
going. rough self-
narratives Iseek to understand my actions and experiences
as a semantically coherent pattern of chronologically ordered elements, and to
grasp the way Irelate myself to that understanding and to the world. In the pre
sent context, Irestrict myself to a narrow concept of narrativity to clarify how
the emotional experiences of moods and aects play a crucial role in the life and
experience of the person.
In virtue of being linguistic animals characterized by ontological ambiguity
as well as position-
and perspective-
taking we tend to constitute our experi
ences and our identity through self-
narratives. e temporal aspect of our being
becomes emphasized in the narrative approach to personhood. Iam changing
sense of
personal identity
is not mere sameness. Personal identity is formed
through a dialectic of two forms of identity:Being-
Same (idem/
and Being-
Oneself (ipseity/
selood). e fundamental trait of Being-
reidentication of a human individual (1992). My character is that in which my
feeling of remaining the same in time and through change is rooted, and that by
which other people identify and describeme.
A person, however, does not coincide with her character traits; being who she
is involves another kind of identity. Whereas my character is formed involun
contingent factors that are now out of my control (Ricoeur, 1966), my identity,
on the contrary, depends on how Ivoluntarily relate my self to this particular
character, constituted by a certain past, and situated in a world of other persons.
My identity is constituted by the active relation of the
Iam with the
Iam (including my character). It is Iwho have the responsibility for my being
this person, that is, for deciphering my moods and for evaluating my character,
and then take a position of front of them. Here enters the question of respon
sibility involved in being a person. As Teichert (2004, pp.177–
8) eloquently
puts it, “[i]
dentity as selood is linked to a realm where actions are ascribed to
the past, even though it would not cross my mind to do anything like that today.
Personhood entails a kind of self-
continuity that implies responsibility not as
a contingent, but as an essential component of personhood. is dimension of
continuity is mainly shaped through self-
How, then, do moods and aects gure in the dialectic of character and per
sonhood developed in the narrative structure of self-
experience? Agiven mood
can develop itself into a character trait, that is, a permanent part of one’s sense
of personal identity; this transformation occurs pre-
reectively and without a
deliberate and thematic involvement of the person.
rough narratives, moods can also be incorporated actively, reectively, and
thematically into a person’s identity. Moods are connected to self-
Iunderstand who Iam in the context of my practical engagement, as embed
ded in a certain world (private or social), and this engagement is primordially
enveloped in a certain feeling-
state. My questioning about myself is oen elic
ited by my mood before my identity becomes an explicit problem.
Moods may
disclose to me what word and deeds do not
. Feeling-
states are no hindrance to
‘cognitive’ knowledge, but the
via regia
to understand myself as embedded in
the world. When confronted with a given mood, Iask myself what has gener
ated that feeling-
state. Ahuman person is that being that spends much of his
time in trying to make an (intentional) aect out of a (non-
intentional) mood.
Focusing on the intentional object of my mood and understanding its origin,
Ican incorporate that feeling-
state into my existential situation, and thus into
my personal life-
history. e possibility of self-
disclosure, which belongs to
moods and aects, is fundamental for cognition in that a given mood can point
to a breach in the way I, reectively, understand myself. Ican be locked up in my
own way of thinking, chained to my thoughts in such a way that my formula
tions about myself reect a wrong or at least problematic understanding of my
In summary:emotions are an essential feature of alterity. e human expe
rience of emotions is drastically dierent from that of other animals. Human
emotional experience cannot be understood without considering the nature of
the entities that have this particular experience—
namely, persons. Aperson is
a contextualized self with intentional attitudes capable of position-
taking, i.e.
evaluation and deliberation, with respect to alterity. e feeling that an emotion
elicits is an essential component of the emotion itself because we, as persons,
need to acknowledge this feeling to fully access the emotion. To dierentiate
among various emotional experiences we need to pay attention to the diuse
and vague constellation of feelings involved in our interaction with the world.
Feelings fundamentally contribute towards uncovering a person’s situatedness
in the world. I, as a person, can understand myself and the world in which
Iam situated through the awareness of my practical engagement, and this
engagement is primordially enveloped in a certain feeling-
state. Personhood is
anchored in a continuity that entails a demand for taking responsibility for one’s
choices. is normative feature becomes emphasized in a narrative structure
wherein we seek to connect past, present, and future. Emotions are fundamen
tal in this process since they may disclose problems in the stories Iformulate
about myself. ey disclose the fact that my formulations can be right or wrong
according to my being this specic person.
Alterity and therecoil
Alterity manifests itself when Iam at odds with my needs and my desires, or
manifest, or nally when my feeling-
state surprisingly discloses my situated
ness. Only as Irecognize alterity as an incoercible datum of the involuntary
dimension of my existence can Ibegin to use it in my service.
Alterity may also manifest itself in the course of my action. is is not merely
the case with tics, slips of the tongue, or forgotten acts. All human experiences
can be produced or reproduced as a text. e text—
be it oral or written—
is a
work of discourse that is produced by an act of intentional exteriorization. One
of the main characteristics of a text is that once it is produced, it is no more a pri
vate aair, but is of public domain. It still belongs to the author, but it also stays
there “independent with respect to the intention of the author” (Ricoeur, 1981,
p.165). e externalization of one’s experiences via the production of a text
implies their objectication; the objectication of a person’s experiences entails
a distanciation from the person herself and an autonomization of the meaning
of the text from the intentions of the author of the text. Once produced, the text
intentions do not exist simply for-
himself, but also for-
is process of objectication and of autonomization is nicely described in
action since, as explained by Ricoeur (1981, p.206), “in the same way as a text
consequences of its own”. In the same way that every action involves a
) of unintended implications back upon the actor, every text implies
a recoil of unintended meanings back to its author. In a paragraph entitled “e
Anatomy of Un-
Intentionality”, Berthold-
Bond (1995) elucidates Hegel’s basic
theory of the structure of action as involving a recoil of consequences back
upon the intentions of the actor. “All action”, he explains, “is a circle wherein
our conscious purposes are projected outwards, in a deed whose consequences
recoils back upon the purpose, throwing it into question, exposing the disparity
p.123). is happens because the deed immediately establishes a train of
circumstances not directly connected to it and not contained in the design
of the person who committed it. All conscious intentions—
of consequences, unable through any sheer exertion of will to force the world to
become a simple mirror of our purposes” (ibid.).
e upshot of this is that whenever Iact, via the externalization of my
unwilled intentions, Iexperience a kind of alienation from myself. Iexperi
ence “estrangement, division, self-
doubt” (Berthold-
Bond, 1995, p.124) and
“consciousness, therefore,
has really become a riddle to itself” (Hegel, 1975,
1). e text exposes its author to this very tragic destiny (see Ricoeur,
2004; in particular, the second study on self-
recognition). Once produced, an
tended consequences. e action recoils back upon its author exposing the dis
e action as a text, as the tangible result of a linguistic act, with its unintended
consequences, reects the ‘mind’ of the author much more faithfully than a
simple act of self-
reection. To paraphrase Hegel, a person cannot
herself until she produces a text objectifying herself in a social act. is objec
tication includes the externalization of alterity. Since all conscious intentions
Aperson cannot know what he really is until he has made of himself an exter
nal reality by producing a text, and then reecting upon it. With Jaspers (1919/
1960) we could say that a person can only understand herself
in a situation
knowledge is not to be achieved through abstract self-
reection, but in the
act of self-
recognition in the mirror of one’s action.
Recognition, in the case of the recoil of the unintended consequences of
my actions, implies both
knowing myself as reected in my
acknowledging that Iavow
the consequences
of my actions, although they are unintended, and Iam ready to respond for
Iimplicitly attest that Iwas
of doing it. is implies that that action,
including both its intended and unintended consequences, reects the per
son that Iam, including both my selood and alterity. Recognizing myself as
the agent of that given action, including its unintended consequences, implies
from a part of myself that can only become manifest in action.
Alterity and theother person:
theanatomy ofrecognition
ere is another kind of teleology at play in human emotional experience that
we could call the
desire for recognition
. Idesire that my being-
so is acknowl
edged by the Other as a value in itself. Ilong for the Other to appreciate me as
Iam rather than how Ishould be. My deepest need is to be loved
as Iam
, not
withstanding my limitations, weaknesses, faults, or culpabilities.
e dynamics of recognition are represented in the way Sonia responds to
Raskolnikov’s confession of his murder in
Crime and Punishment
2011, p.729):
‘What have you done—
what have you done to yourself?’ she said in despair, and, jump
ing up, she ung herself on his neck, threw her arms round him, and held him tightly.
Raskolnikov drew back and looked at her with a mournfulsmile.
‘You are a strange girl, Sonia—
you kiss me and hug me when Itell you about that
You don’t think what you are doing.’
‘ere is no one—
no one in the whole world now so unhappy as you!’ she cried
in a frenzy, not hearing what he said, and she suddenly broke into violent hysterical
A feeling long unfamiliar to him ooded his heart and soened it at once. He did not
struggle against it. Two tears started into his eyes and hung on his eyelashes.
‘en you won’t leave me, Sonia?’ he said, looking at her almost withhope.
‘No, no, never, nowhere!’ cried Sonia. ‘I will follow you, Iwill follow you everywhere.
Oh, my God! Oh, how miserable Iam!
Why, why didn’t Iknow you before! Why
didn’t you come before? Oh,dear!’
What animates Raskolnikov’s action, the desire to confess, is the desire for
the Other’s recognition. Sonia fully senses, acknowledges, and corresponds to
Raskolnikov’s desire for recognition. Her compassion encompasses his ambiva
lence. Recognition is neither mere understanding, nor simple approval of the
Other’s actions. It is not understanding since it is not mere identication of the
mental state that causes his actions. It is not merely approval or consent, since
much more complex emotional and intellectual readiness to acknowledge the
ness or ‘We-
experience’ in which Iam aware of the Other’s emotional distress
and try to attune myselftoit.
Recognition is not an easy task—
as Sonia’s spontaneity seems to suggest. It is
not a default mode of a generic empathic attitude. Recognition can be split into
two complementary phenomena, the rst chiey emotional in nature, and the
second of a more intellectualkind.
Recognition rst and foremost presupposes
with the Other. It is a
mode of being with the Other, a kind of intimacy with the Other, a modulation
of the emotional eld in-
Making music together
, Alfred Schütz (1976) explains that the experi
ence of the ‘We’ that is at the foundation of all possible communication is a
mutual tuning-
in relationship, a sharing of the Other’s ux of experiences simi
lar to that of two co-
instrument) who have to execute a piece of music. Each co-
performer’s action
own part, which as such remains necessarily fragmentary, but he has also to
more, the Other’s anticipations of his own execution. Either has to foresee by
listening to the Other, by protentions and anticipations, any turn the Other’s
in a true face-
face relationship. e Other’s facial expressions, his gestures
in handling his instrument, in short all the activities of performing, gear into
the outer world and have to be grasped by the partner in immediacy. Even if
him as indications of what the Other is going to do and therefore as sugges
tions for his own behaviour. e face-
face relationship is this dimension that
unies the uxes of inner time and warrants their synchronization into a vivid
experience do the Other’s body and his movements become meaningful to the
partner tuned in tohim.
e We-
relationship presupposes in the rst place a You-
orientation, that is,
the mode in which Iam aware of another human being as a person, the recogni
tion of the Other as a fellow man to whom Iimmediately and without reection
attribute life and consciousness. e You-
orientation, that is, the default mode
in human existence (as we are all born and raised within a social world), makes
it possible to coordinate temporally the series of my own experiences with
a series of yours. While Iam living in the We-
relationship, Iam living in
stream of consciousness. It is like an undivided stream, and every experience is
coloured by this involvement. It is an experience of
, an “interlocking
of glances”, a “thousand-
is intimacy is not observed, but
lived through
. e greater my awareness of
the We-
relationship, the less my involvement in it, and the less Iam genuinely
related to my partner.
is experience of simultaneity and of temporal coordination that Ishare
with you is, in its own turn, the necessary precondition for apprehending your
subjective experiential contents and meanings. Understanding another person
mode of relatedness that requires a training entailing ve basicsteps.
First, Imust acknowledge that the life-
world of the other person is not like my
own. Second, Ineed to grant the meaningfulness of the other person’s actions as
embedded in the other person’s life-
world. ird, Imust learn to neutralize my
natural attitude that would make me evaluate and judge the other’s experience
as if it took place in a world like my own. Fourth, Imust try to reconstruct the
existential structures of the world the other lives in. Fih, Ican nally attempt
to understand the other’s experience as meaningfully situated in a world that is
indeed similar to my own, but also constantly and indelibly marked by the other
person’s particular existence.
The basic need forrecognition
Recognition, thus, requires a preliminary emotional attunement in which, in
my You-
oriented attitude, Iexperience my stream of consciousness as coor
dinated temporally with yours—
exactly as it is in the case of making music
ing step, intellectual in nature, in recognizing the other person is to acknowl
edge the existential dierence, the particular autonomy, which separates me
this dierence will be an obstacle to recognition since the Other may live in a
world whose structure is (at least in part) dierent from my own. Ineed to
world as Iwould do while exploring an unknown and alien country. Ineed
to be interested in the invisible semantic ordering of the world the Other lives
in. Ialso must acknowledge that it belongs to my ownmost possibilities as a
vulnerable human being. Finally, Ineed to concede that the way of being in the
herself and can thus be envisioned as a universal phenomenon since it belongs
to human existence assuch.
e constitution of the person as a ‘healthy’ person can only be realized
within an intersubjective framework:the Other is needed to achieve basic trust,
respect, and integrity. ese realizations can only be achieved through the
experience of the Other’s recognition. Self-
recognition, that is, the recognition
of oneself as capable of certain realizations, requires at any step the recognition
of the Other (Ricoeur,2004).
e need and the desire to be recognized as an individual person, and as
damental disposition in human existence—
as well as eating and staying alive.
My existence is conditioned and articulated by the value of social recognition
can even be stronger than other needs rooted in my organic values:
No doubt the passion to achieve recognition goes beyond the animal struggle for
preservation or domination; the concept of recognition is not a struggle for life;
it is a struggle to tear from the other an avowal, an attestation, a proof that Iam an
autonomous self-
consciousness. But this struggle for recognition is a struggle in life
against life—
by life [
] is is the sense in which desire is both surpassed and unsur
passable. e positing of desire is mediated, not eradicated; it is not a sphere that we
could lay aside, annul, annihilate. (Ricoeur, 1977, pp.471–
renounce, at least in part, our material gains (e.g. a part of one’s salary) in order
to achieve social recognition (e.g. respect, dignity, and the acknowledgement of
one’s capacities). His analyses of recognition, from a sociological and political
standpoint, show that the experience of recognition is indispensable to achieve
basic trust, a sense of autonomy, the condence that is necessary to articulate
one’s needs and desires, and to put into use one’s own skills and capacities.
e rst is Love, whereby the person experiences the recognition of his par
ticular needful nature in order to attain that aective security that allows him to
articulate his needs. e prototype of this is the experience of parental care. is
form of recognition is necessary to achieve ‘basic trust’, that is, to trust oneself.
e second is Law:the subject experiences that juridical institutions guar
antee the recognition of his autonomy. is form of recognition is necessary to
achieve ‘respect’, that is, to respect oneself.
e third is Solidarity:the subject experiences the recognition of the value of
his own capacities. is form of recognition is necessary to achieve ‘integrity’,
to sustain other subjects and, reciprocally, to be sustained bythem.
ese three forms of recognition are basic requirements for the good life.
ey cannot be achieved by the subject as an individual separated from the oth
ers. ey can be only achieved through
, that is, through the
of recognition.
Alogic forrecognition:
What is the intellectual condition for the possibility of recognition? On which
kind of logic is recognitionbased?
We discussed the role of position-

and the alterity that inhabits her. e alterity that inhabits me is at the same time
extraneous to my person and part of it. It is an indomitable fold of my being,
which, as such, encloses a space that is at the same time external and internal
(Deleuze, 1988). It is external since it belongs to the involuntary dimension of
my being the person that Iam, the raw material that constitutes the sedimented
worldly rules and values that Ihave introjected. At the same time, this involun
tary alterity that dwells in me is part of my self and Iam responsible for it, since
only as Irecognize my involuntary aspect as an incoercible datum can Ibegin
to use it in my service. e logic of alterity, in fact, contradicts the principle of
the excluded third. It is ‘me’ and ‘not-

me’ at the sametime.
A similar logic aects my relation with the alterity embodied by the other per
son. e other person is alien to me but she is also like me. e other is
like me
as he is aware of the space that separates him from the Other as he is about to crossit.
thesis arming that the need/

desire for recognition is a basic motivational system
in human existence with a second thesis that can be summed up as follows:
the essence
of human existence is the tragic awareness of the fragility of the reciprocal recognition
is thesis builds on and extends a distinctly Jaspersian statement:
the essence of
man is the tragic awareness of the inaccessibility of the Other
. Jaspers has addressed
this problem several times and has made it the anthropological foundation of his
knowledge is the unknowable. e foundation of all practice—

especially, social

is the awareness of such horizons of unknowability. “All practice on
the basis of knowledge must rely on the unseen encompassing”, Jaspers writes in

1971, p.24). Shortly aer, in a consequential but no
less paradoxical way, he adds:“medical treatment must rely on un-

life” (ibid., p.24). Jaspers is referring to medical treatment and to the practice of
psychotherapy, but it is obvious that his perspective is that of care in general, the
care of oneself, as well as the care of the Other. Once puried from any spiritual,
religious, or theological overtone, Jaspers’ sentence can be rephrased as follows:
e essence of man is the tragic awareness of the inaccessibility of the Other—
the other
toward which hetends.
e theme of the inaccessibility of the Other becomes intelligible only when
the Other is seen not only as unreachable, but also as the destination of a move
ment that attempts to reach the Other and invariably unfolds within a horizon
of unattainability.
We may call
the logic that posits the Other as radically other, in
contrast to a conception of the relationship with the Other based on the cat
as analogous to me. e Other’s experiences, its world, are not grasped if Irely
on my own experiences under similar circumstances as the way to understand
what happens to her. Rather, as radically dierent from me, the Other remains
unknowable to me. e Other’s
that is, the ordering principle behind the
meaningfulness of the Other’s world—
is not reducible to mine. e Other is
’. Of course, the following question remains open:what is the
and what kind of discourse can be made about theOther?
is experience of the otherness of the Other can be described in dierent
ways:as a failure in the encounter with the Other, as the unknowability of the
the Other and my desire—
and these are only a few of the possible descriptions.
In this sense, the inaccessibility of the Other is the mark of being human, not
a aw or a subjective inability. Mental pathology from this angle is seen as an
awkward attempt to deal with the suering that results from this tragic experi
ence. In the next section, Iwill argue that what we call ‘mental pathology’ can
be seen as the eect of the intolerability of the awareness of the Other’s radical
that is, as the eect of the reciprocal non-
and the Other. In my tending towards the Other Iexperience the Other as
unattainable. Ibecome mentally ill when Icannot bear the irreducibility of the
Other to my own categories, when the Other is not compatible with the forms
of relationship imposed on me by my own prejudices and desires.
I do not mean that mental pathology develops every time the Other is not
encountered. Rather, mental pathology manifests itself when this failure in
encountering the Other leads to a state of suering such as to generate defensive
existential movements, alternatives, compensations, escape routes, or shelters
that later develop into xed forms of miscarried existence and become part of
the spectrum of what we regard as mental pathology.
An anthropology
To become (and remain) a ‘healthy’ person, Ineed to be recognized by the oth
ers. Ineed the others to recognize me in my being-
so, that is, in my otherness
with respect to them, and at the same time Ineed their acknowledgement of the
value of the otherness that Iam. Also, to establish ‘healthy’ relationships, within
which Ican feel recognized by the Other, Ineed to be able to recognize the
otherness of the Other—
and this, we have seen, is not an easy task. us, recog
nition is at the same time a necessary precondition for mental health, as well as
for the ‘good life’, and an extremely dicult achievement. Non-
recognition, in
milder or more severe forms, is the norm and not the exception in humanlife.
What kind of reaction can generate in me my awareness of non-
be it a kind of emotional dis-
attunement, or misunderstanding; or, in general,
what could be the outcome of my failed dialogue with theOther?
In order to adequately answer this question it is necessary to make a further
premise:rst and foremost, we are
the Other. Imagine that at this very
feeling (regardless of how mistaken this feeling might be):we are gathered in
one place, and we feel that we are engaged in the same activity, we are working
on the same theme, and we are all paying attention to each other. We feel that
our focus is converging on a particular task, on a shared goal. Implicitly and
reexively, we experience that—
rst and foremost—
we are sharing a situa
tion, and this leads us to feel that we understand eachother.
However, the slightest incident is enough to turn such a feeling of mutual
tial feeling of mutual closeness inevitably turns into the painful awareness of
the illusory character of such closeness. Suddenly, we have the feeling of losing
ourselves:you have the impression of losing me, and Ihave the impression of
Several philosophers have regarded the failed encounter with the Other as
typical of human existence. Some believed it to lie at the basis of our social
life:think of the notion of “idle chatter” in Heidegger (Heidegger, 2010,
the foundation of our being with the others is nothing more than the
mere illusion of a mutual understanding, of a common discourse.
Encountering the Other on the ground of mutual understanding is nothing
but a misconception. However, it is a welcome one, since it appeases one’s anxi
Ishould say that if initially we have the impression of being with each other, in
the sense of a mutual understanding (which is a form of pre-
understanding, of
reexive understanding), sooner or later
experiences this annoy
what follows Iwill describe the various ways in which each of us reacts to such
painful misalignment.
But before describing the existential movements generated by this painful
experience it is important to note that this no longer naïf consciousness can still
of misalignment. e desire and the need for recognizing the Other and being
recognized by him can serve as a kind of elastic strap that brings one back to
the initial state. is distressing experience can simply be repressed. ereby
one can regain the reassuring path of
common sense
, that is, a “judgment with
out any reection” (Vico, 1998, p.57), which is nothing but a strategy for the
domestication of alterity. For the most part, common sense relies on implicit
shared by everyone, representing the rock of knowledge and truth. Common
sense is essential to experience mutual understanding and to achieve social
adaptation (Schütz, 1962, 1970).
A good mother should take care of her children;
from kids, it is expected that they respect their parents; etc.
such are the abiding
certainties of common sense. Common sense relies on two basic dispositives.
First, it
the Other to an impersonal (
Das Man
, in Heidegger’s terms)
entity and to a general role (that is, an external and stereotyped representa
tive of personal identity). Common sense is what one thinks that all the others
think. Alternatively, it
the Other’s behaviour by connecting it to one’s
own personal experience:
I understand the Other because Iwould have done the
same thing in such circumstances
. Each case is subsumed under an impersonal
or a personal rule. And when this is not possible, any anomaly is normalized
as, in fact, an
which means that it is classied as an anomaly. Such
anomaly is attributed to another general category—
that of the abnormality.
Common sense is just one way to recover from the failed encounter with
the Other. Dierent to common sense, but homogeneous to it with respect to
strategies and outcomes, is the domain of
scientic knowledge
(and especially
of its commonly accepted beliefs) as another strategy for the domestication of
the alterity. Scientic knowledge reduces the Other to a particular instance of
a general category. Scientic knowledge, in the area of psychology and psycho
pathology, builds on and formalizes naïf knowledge about the Other:the other
acts in a certain way because he is shy, outgoing, impulsive, paranoid, or halluci
nating. Scientic psychological and psychopathological knowledge has laid the
foundations of our knowledge of abnormality, thereby complementing com
mon sense in its task of domesticating our experience of the Other. Common
sense knowledge may also appropriate scientic knowledge. An example of this
is the concept of ‘unconscious motivation’ that common sense has drawn from
depth psychologies in order to make sense of the Other’s irrational behaviour.
Obviously, since it works through generalizations, this kind of knowledge can
do so only at the price of ignoring the individuality of the Other and the unique
ness of the relationship that one has with theOther.
Common sense and the vulgate of scientic psychology usually coexist and
cooperate in the process of domestication of the experience of the Other that
takes place in our everyday existence. However, in case these strategies prove
not suciently eective, alternative defensive strategies may emerge, which
devised for more sophisticated—
because supported by speculative and quasi-
philosophical arguments—
strategies for the domestication of the alterity of the
Other. People assume a ‘philosophical’ stance to nd their way in relating to the
others and in coping with the frustrating experience of the missed encounter
with theOther.
ese quasi-
philosophies are
, defensive housings with respect to my
failure in dealing with the aporias of recognition. Imay enter into such hous
ings when Iam exasperated by my incapacity to understand the Other, as well
as when Iam frustrated by my experience of not being recognized by the Other.
In general, Ienter into one of these shelters when commonsensical assumptions
are jeopardized. When Ienter into one of these shelters, a given kind of path
way to non-
recognition becomes a structured and structuring organization for
me. My shelter protects me from the moral pain produced by the experience of
recognition, but endlessly produces other experiences of non-
It cannot be overseen—
I cannot see beyond my shelter. It is extremely dicult
to become aware of the housing Ilive in, of its precariousness, and of the way it
structures my relationships. My shelter is a habitus, a disposition that generates
practices, beliefs, perceptions, feelings, and so forth about social encounters.
From the vantage of my shelter, the Other is no more an event that impresses
me, stirs my emotions, and awakens my spirit—
as Buber would say. Rather, it is
an anomaly to be normalized.
For example, there is one of these shelters that could be dened as
Asceptic is someone who believes that the words of the Other may well hold
some sense, but that such sense is not accessible, and the meaning of the Other’s
discourse is incomprehensible. By adhering to a philosophy that proclaims the
Other’s incomprehensibility, and without attempting any further approach
towards the Other—
in other words, by taking for granted the emptiness and
futility of any real dialogue with the Other—
the sceptic nds relief from the
anguish caused by his incapacity to recognize theOther.
e irreducibility of the discourse of the Other to one’s own can also originate
a second kind of movement, which consists in a withdrawal from this uncanny
feeling of misalignment. We could dene such a disdainful estrangement from
the Other as
:the discourse of the Other, according to this view, is sense
less, and therefore it is pointless to look for its meaning. It is not even a dis
course. Actually, it is regarded as situated outside the realm of meaning and
meaningfulness. erefore, any eort to understand such discourse, to dialogue
with it, is in vain. Recognition cannot even be contemplated when the discourse
of the Other is deemed senseless. erefore, other modes of interaction should
be taken into consideration (incidentally, the
mode of interaction with
the Other is that of technology, which represents an objectifying knowledge
slightly more sophisticated and presumptuous than the one described earlier).
ere is also a third mode of distancing oneself from this painful and uncanny
failure in understanding the Other, which we might call the
way of the
failed encounter. According to this view, when Imove towards the Other Iam
still wrapped and trapped in my own vestments and prejudices:these encrusted
layers of theory do not allow me to understand and encounter the Other. Such
encounter becomes possible only once all these layers are shaken o:a mystical
sible only through this process of purication.
However, the mystical way does not belong to the dimension of an authentic
encounter with the Other, but is to be placed next to the domains that Ihave
dened as sceptical and cynical. Even assuming that the mystical option could
really lead to an encounter with the Other, its results would be uncontrollable—
especially as regards its eects on the Other, whose autonomy is only partially
preserved. is makes the very shiny expectations of this approach appear
under a dierent light. Besides, the presumption of authenticity typical of this
and also a spurious one epistemically (in fact, it is assumed here that the most
authentic experience is that of the encounter with the Other rather than the
awareness of the failure, contrary to what we assumed).
Other approaches could of course be added to the list. Everyone can give
his personal contribution:for example, someone may propose an
(whose motto is
I don’t care
about the problem of recognition), and so on. Ishall
simply add another one:the way of
. According to this view, while
it is impossible to recognize the Other, it is possible to contemplate it. e Other
cannot be recognized through the process that we earlier described:one’s atti
tude towards the Other must be and remain a purely contemplative one. Here
there is no real encounter, because this is impossible, but the authenticity of
the experience is preserved as long as Istay
and the Other stays
. e
Other is
, exerting a strong and enchanting pull on the one who contem
plates; however, any pragmatic move from both sides is excluded. e Other
and Istand face-
face as the antithesis to the thesis.
is a mental disorder?
What has turned us around like this, sothat,
Whatever we do, we always have theaspect
Of someone who leaves?
is is what Fate means:to be opposite,
And to be that nothing else, opposite forever
Lovers are close to it, in wonder,if
e Other were not always there closingo theView
(R. M.Rilke,
Eighth Elegy
First steps towards theperson-
centred, dialectical model
ofmental disorders
We are dialogue:of the person with herself, and with other persons.
Mental disorder is the crisis of the dialogue of the person with the alterity
that inhabits her, and with the alterity incarnated in the other persons. Human
the encounter with alterity, that is, with all the powers of the involuntary. A fur
ther source of dissatisfaction is the awareness that the other person can only be
approximated, not appropriated, and that our need for reciprocal recognition is
an unlimited struggle and a spring of frustration.
ues. All this generates feelings of estrangement. Mental pathologies may be
read as miscarried attempts to struggle for a sense of reconciliation, to heal the
wounds of disunion.
Care is an eort to reconstruct such a vulnerable dialogue of the soul with
herself and with others based on two pillars: a dialectic, person-centred com
prehension of mental pathology, and values-based practice.
e dialectic understanding of mental disorders assumes that the person is
engaged in trying to cope with and make sense of puzzling experiences stem
ming from her encounter with alterity. Each patient, urged by the drive for the
intelligible unity of her life-
construction, plays an active role in interacting with
these experiences and thus in shaping her symptoms and the course and out
come of her illness.
In values-
based practice, value-
pluralism and recognition are the basis for
clinical practice. is statement reects the ideal of
modus vivendi
that aims to
nd terms in which dierent forms of life can coexist, and learn how to live with
irreconcilable value conicts, rather than striving for consensus or agreement.
Mental symptoms are not the direct eects of a psychological or biological
dysfunction. A person’s symptom is the outcome of her need for self-inter
the person and the disturbing experiences that stem from her encounter
with alterity. Alterity is made manifest as a kind of estrangement from one
self and alienation from one’s social environment. e person’s attitude is
ing and perplexing experiences, alongside a constant search for personal
e encounter with alterity may oer the vantage from which a person can
see herself from another, oen radically new, perspective. us, otherness kin
dles the progressive dialectics of personal identity. Narratives are the principal
means to integrate alterity into autobiographical memory, providing tempo
ral and goal structure, combining personal experiences into a coherent story
symptoms. e production of a symptom is the
extrema ratio
for alterity to
become discernible. Psychopathological symptoms are the outcome of miscar
ried attempts to give a meaning to distressing experiences, to explain and cope
tal disorders and an exclusively neurobiological model is that in the latter the
patient is conceived as a passive victim of her symptoms, whereas the former
attributes to the patient an active role in shaping her symptoms, course, and
outcome. Urged by the painful tension that derives from the drive for the
intelligible unity of life-
construction (Mayer-
Gross, 1920), each patient, as a
directed being’, plays an active role and stamps her autograph onto the
raw material of her basic abnormal experiences. When a clinical syndrome
emerges, the line of the pathogenic trajectory is the following:(1)a dispro
portion of alterity and the person’s resources for understanding, of emotions
and rationality, of
, of otherness and selood bringing about a
hermeneutics or self-
transformations of the life-
world that they bring about; (3)the xation in a
is person-
centred, dialectic approach helps us to see the patient as meaning-
making entity rather than passive individual. e patient “can see himself,
judge himself, and mould himself” (Jaspers, 1997, p.424). His attempts at self-
understanding are not necessarily pathological and are potentially adaptive.
understanding the diversity of psychopathological structures, including symp
tom presentation, course, and outcome as a consequence of the dierent ways
patients seek to make sense of and value the basic changes in self and world
experiences. It also contains a framework for engaging with human fragility by
means of a person-
centred, dialectic therapy.
e person-
centred, dialectic approach involves two fundamental attitudes
to mental illness:
It is a therapeutic approach that acknowledges the subjective fragility consti
tutive of human personhood.
It also insists, however, on our responsibility to care for this fragility for
becoming the person that weare.
To become the person that we are, we must become aware of what we care about
because being a person is to take upon oneself the responsibility involved in
what one cares about. is approach is sensitive to the constitutional fragility of
‘who’ and ‘what’ we are and thus conceives psychopathological structures as the
result of a normative vulnerability intrinsic to being a human person. It insists
that to help a suering person is to help that person to responsibly deal with the
obscure entanglement of freedom and necessity, the voluntary and involuntary,
and with her suerings as the result of the collapse of the dialectic of selood
and otherness.
Handbooks of psychiatry and clinical psychology usually present a list of phe
nomena that should be assessed and treated. By doing so, they establish a sys
tem of relevance concerning what should attract the clinician’s attention. ese
relevant phenomena are called ‘symptoms’.
Of course, there are dierent psychopathological paradigms (among which
adigm has its own hierarchy of priorities (what should be the clinician’s focus of
attention) as well as its own concept of symptom. As a consequence of that, the
concept of symptom covers a vast array of indexicalities. In biological medicine,
a symptom is the epiphenomenon of an underlying pathology.
panied by itchy ears and buzzing sound, itchy and sore throat, cough and post-
dripping are known to be the manifestation of an inammation of the respiratory
But long before we found out what was the cause of these disturbing phenom
ena (namely, rhinovirus infection), we all knew that they were the symptoms
of a mild, although distressing and untreatable, disorder called the common
‘cold’. Within the biomedical paradigm, a symptom is rst of all an index for
diagnosis, i.e. it is used by clinicians to establish that the person who shows
that symptom is sick (rather than healthy), and that he or she is aected by a
particular illness or disease.
e principal utility of any system of medical taxonomy relies on “its capacity
to identify specic entities to allow prediction of natural history and response
to therapeutic intervention” (Bell, 2010, p.1). e biomedical understanding of
‘symptom’ is clearly coherent with this. Biomedical research aims to sharpen its
tools to establish increasingly more reliable and valid diagnostic criteria. Its real
ambition is not simply to establish a diagnosis through the assessment of clini
cal manifestations (i.e. symptoms), but to discover the causes of these symptoms
esis). “Ultimately, disease specication should be related to events related to
causality rather than simply clinical phenotype” (ibid., p.1). It is assumed that
progress in medicine is dependent on dening pathological entities as disease
dromes based on symptom recognition. In the biomedical paradigm the truth
about a symptom is its cause. e main, more or less explicit, assumptions in
the biomedical paradigm are the following:(i)each symptom must have at least
one cause; (ii) this cause lies in some (endogenous or exogenous) noxa aecting
the living organism; (iii) the presence of a symptom causes some kind of dys
function (cause  symptom  dysfunction). Also, (iv) if we want to eliminate a
us, the biomedical paradigm is a knowledge device based on the concept of
(in our example, the presence of a virus), to symptom(s) (breathing diculties),
to dysfunction (poor physical performance due to blood hypo-
and thus reduced adaptation of the person to his or her environment).
An important, implicit assumption is also that symptoms are considered
accidental, i.e. non-
essential (
, as in the sense stipulated in Aristotle’s
) to the living organism, whereas the absence of symptoms
is considered essential—
i.e. normal to living organisms. In other terms, health
is considered normal, whereas disease is considered abnormal.
Many of these assumptions—
if we apply this paradigm to the eld of psychic
are at least controversial, or even counterfactual. What is of utmost
interest here is the fact that in the biomedical paradigm, symptoms have causes,
not meanings. is assumption has been challenged by the psychodynamic
paradigm. But before we analyse the shi from the biomedical to the psychody
symptom and dysfunction with the help of the criticism of the biomedical para
digm that arises from evolutionary (Darwinian) medicine. Diagnosis, in the
biomedical paradigm, puts emphasis on symptom proles, as symptoms are
considered the most proximal indicators of a disorder. From an evolutionary
viewpoint, a clinical assessment that focuses exclusively on signs and symp
toms limits itself to explaining only partial features of disorders. According to
Darwinian psychiatry, clinical assessment should focus primarily on functional
capacities and person–
environment interactions (Troisi and McGuire, 1998).
health than the absence of symptoms because it is an indication that the indi
vidual possesses those optimal functional capacities that promote biological
From an evolutionary perspective, not only do symptoms cause dysfunction,
but also dysfunction or maladaptation may generate symptoms. When classi
ed from an evolutionary perspective, symptoms can be divided into two broad
categories:symptoms as defects in the body’s mechanisms, and symptoms as
useful defences. For example, seizures, jaundice, coma, and paralysis have
apparently no adaptive function and arise from defects in the organism. But
many other manifestations of disease are defences. Vomiting eliminates toxins
from the stomach. e low iron levels associated with chronic infection limit the
growth of pathogens. Coughing clears foreign matter from the respiratory tract
(Troisi, 2011). In the eld of mental pathology, it is argued by evolutionary psy
chiatrists that some depressive symptoms may have adaptive functions serving
in the regulation of behaviour and psychological processes. For instance, crying
elicits comforting behaviours and strengthens social bonds, whilst pessimism
withdraws the individual from current and potential goals. Also, absence of
positive emotions discourages approach behaviour and risk-
taking. More gen
erally we could explain depressive behaviour by saying that someone withdraws
depressively in order to protect himself socially. us, the Darwinian concept
of disorder—
including mental disorder—
encourages clinicians to consider re-
prioritizing their selection of diagnostic criteria to ensure that the focus shis
away from mere symptom proles and towards a comprehensive data collection
that includes functional capacities.
Early psychodynamic conceptualizations of ‘symptom’ address both the cause
of a symptom and its meaning. Before Freud, no one asked about the mean
rigorously. However, since the main aim of early psychoanalytic thinking is to
answer the question ‘What is the origin or cause of this psychical symptom?’, it
still represents a mechanistic view in touch with the biomedical model. But at
the same time early psychoanalysis paved the way for the quest for the meaning
of the symptom:‘What does that symptom mean?’.
Psychodynamic thinking develops its genealogy of symptoms around two
of trauma was rst posed by a French neurologist—
Martin Charcot. We
are in the year 1885.
Charcot examines a group of patients who underwent a physical shock and developed
a series of motor or sensory symptoms—
typically some sort of paralysis or anaesthe
sia. Charcot’s careful medical assessment established that:(i)the physical shock was
very mild and le no traces in the patient’s organism, whereas symptoms still persist—
these symptoms are (so to say)
sine materia
; (ii) the motor and/
or sensory symptoms,
their localization, the way they are correlated with each other, do not correspond to an
organic lesion of the nervous system; that is these symptoms do not correspond to the
symptoms one could expect as a consequence of any given lesion of an area of the nerv
ous system. e localization of these symptoms—
namely hysterical symptoms—
in the
patient’s body does not reect the rules of anatomy; rather, these symptoms mirror a
kind of imaginary anatomy that imitates true anatomy.
From these observations Charcot concludes that these symptoms are the out
come not of a physical, but of a
, trauma. Hysterical symptoms are not
the epiphenomena of a neurological lesion, but rather the manifestation of a
psychopathological syndrome. Hysterical symptoms force Charcot (and later
Freud) to see behind the neurological body another kind of body—
the “sexual
body” (Foucault, 2003). Medicine in general, and psychopathology in particu
lar, from Charcot and Freud onward, must consider the existence of another
kind of body next to the neurological one:this new body is the psychologi
cal representation of the body or “representational body” (Leoni, 2008, p.18),
whose imaginary anatomy does not correspond to the anatomy prescribed by
the cortical homunculus discovered by neurology.
e representational body, according to Charcot (as explained by Foucault),
enters into the mind of a person during a traumatic event and will be inscribed
in his cortex “as a kind of permanent injunction” (Foucault, 2003, p.274).
Some neurotic symptoms are the outcome of a conict—
usually a conict
prohibition by theEgo.
According to classic psychodynamic theory (Freud, 1905), this conict gen
symptom:a symptom is therefore a compromise that at the same time defends
the patient from the desire that emerges from the Id, and satises this desire in
a masked form. Freud (1926, p.91)wrote:
The main characteristic of the formation of symptoms have long since been stud
ied and, Ihope, established beyond dispute. Asymptom is a sign of, and substitute
for, an instinctual satisfaction which has remained in abeyance; it is a conse
quence of the process of repression. Repression proceeds from the ego when the
it may be at the behest of the super-
refuses to associate itself with an
instinctual cathexis which has been aroused in the Id. The ego is able by means of
repression to keep the idea which is the vehicle of the reprehensible impulse from
becoming conscious. Analysis shows that the idea often persists as an unconscious
It is clear that psychodynamically oriented clinicians cannot avoid delving
into this profound dimension of abnormal behaviours entailing the reconstruc
tion of traumatic events and the unearthing of conicts.
Psychodynamic thinking has a number of basic assumptions or postu
lates. Brackel nicely sums up these underlying assumptions (2009). First,
all psychological events have, at least as one of their causes, a psychologi
cal cause, and can thereby be at least in part explained on a psychological
basis. Second, all psychological events can be understood as psychologically
meaningful to the person who displays them. ird, there exists a dynamic
unconscious that must be posited because without such a postulate many
psychological events are neither psychologically explicable nor psychologi
cally meaningful.
As a consequence of these postulates, psychodynamically oriented clini
cians will not merely focus on conscious phenomena like overt symptoms,
but will try to elicit unconscious or pre-
conscious mental phenomena (e.g.
associations (as well as by asking open questions, leaving certain kinds of
will focus on unconscious defence mechanisms (e.g. displacement, ide
attachment styles, self-
and other-
patient’s personal life-
history (not merely the medical anamnesis) and inter
Psychodynamic Diagnostic Manual (PDM Task Force, 2006)clearly states
that symptom patterns can only be understood in the context of the person
ality of the patient and of his mental functioning, since symptom patterns
are the explicit expressions of the ways patients face and cope with their life
experiences. e reason for this extended assessment beyond mere symp
toms or isolated behaviours is exquisitely practical:treatments that focus
only on symptoms are deemed ineective in producing changes and recov
In a symptom, as we saw earlier, an unconscious desire seeks to make itself
manifest. What is at stake within a symptom is a repressed desire repugnant
to the consciously accepted self-
conception and values of the person. is
desire, if it is to gain satisfaction, needs to be expressed indirectly. Whilst
some symptoms function to express repressed desire (or are a product of
defence mechanisms other than repression, such as projection, projective
For instance, one way of understanding a patient who somatizes is conceiv
the patient and instead is experienced merely bodily. It is as if the meaning
ful aective component is not simply repressed, but never had the chance to
because of an inadequate early environment, for example.
In contrast to the biomedical paradigm, in the psychodynamic approach
the symptom asks to be heard and deciphered—
rather than to be explained
and removed. Lacan’s conceptualization of ‘symptom’ is a good example of the
turn from searching for the causes of a symptom to searching for its mean
ing in psychoanalytic thinking. According to Lacan (2005), a symptom (that
he spells
) is a special kind of speech act through which the uncon
scious is made manifest. e unconscious itself is structured as a language,
and a symptom is a meaningful event. Asymptom is a signier that takes the
the biomedical concept. Aperson’s symptom is not accidental (
to that person; rather it is the manifestation of his or her true identity. Lacan
even held that someone’s symptom could be the most authentic thing he pos
sesses. Asymptom has a similar structure to Heidegger’s
hiddenness). Although obviously Heidegger’s concept is much broader than
the notion of symptom Iam discussing here, both play a kind of revelatory
role. e symptom as
is the place where truth about oneself manifests
while hiding itself.
Symptom ascypher
e symptom is not an accident to that person; rather it displays his true essence.
person and alterity. Symptoms are the
via regia
to recognition, as they express
the person’s vulnerability. Someone’s
displays what is most personal and
intimate to him.
“Come inside—
says Eumeus to Ulysses when he arrives at his hut—
and when
you have had your ll of bread and wine, tell me where you come from, and
about your misfortunes
” (Homer, 2005, XIV, p.47). Only aer Odysseus has had
a hearty meal of pork does Eumeus ask about hisstory:
And now, old man, tell me your own story; tell me also, for Iwant to know, who you
are and where you come from. Tell me of your town and parents, what manner of ship
you came in, how crew brought you to Ithaca, and from what country they professed to
for you cannot have come byland.
e recognition of Ulysses in the episode of Euryclea—
comes with the recognition of his
it as the scar that he received when he went boar hunting with his grandfather
As soon as Euryclea had got the scarred limb in her hands and had well hold of it,
she recognized it and dropped the foot at once. e leg fell into the bath, which rang
out and was overturned, so that all the water was spilt on the ground; Euryclea’s eyes
Ulysses by the beard and said, ‘My dear child, Iam sure you must be Ulysses himself,
only Idid not know you till Ihad actually touched and handled you.’ (ibid., XIX, p.392)
is has a clear correspondence in Karl Jaspers’ concept of ‘cypher’ (2003).
What stays beyond the limit of our knowledge, which in Jaspers’ parlance is
named the
das Ungreifende
), manifests itself through cyphers.
reading is the primary requisite of manhood” (ibid., p.50). Cypher-
reading is an essential character of being a man. Cyphers show what with
out them would remain implicit for us. Symptoms are a special category of
ing, or disturbing) dimension of our existence, is made manifest. Like a patient’s
symptom, which is not accidental to that patient but is rather the manifestation
of his or her true identity, cyphers are the contingent opportunity of recogni
dimension of her existence.
e cypher must keep on an inexhaustible signication with which no de
and denite and turns into an object, then it loses its essential force. It col
lapses into a sign” (ibid., p.49). Cyphers must not be crystallized into a kind
of denite, categorical concept. e meaning(s) of the cypher must be kept “in
suspension” (ibid., p.38)—
. e defection from the cypher
to the pure concept (as occurs when the cypher grows a single meaning), as well
Phenomenology is essentially concerned with laying bare the structure
of the life-
world inhabited by a person. Asymptom is a feature of a person’s
world whose meaning will be deciphered by grasping the deep architec
ture of the life-
world itself and the person’s invisible transcendental structure
that projects it. Life-
world, in Edmund Husserl’s sense (1970), is the original
domain, the obvious and unquestioned foundation of our everyday acting and
dence. Although the majority of people are situated within a shared life-
there are several other frameworks of experience—
for example, fantasy worlds,
dream worlds, and “psychopathological worlds” (Schütz and Luckmann, 1989).
Abnormal mental phenomena are the expression of a modication of the onto
logical framework within which experience is generated. e overall change in
the ontological framework of experience transpires through the single symp
toms, but the specicity of the core is only graspable at a more comprehensive
structural level (Parnas, 2004; Stanghellini and Rosfort, 2013a; Stanghellini and
Rossi, 2014). e experience of time, space, body, self, and others, and their
modications, are indexes of the patient’s basic structures of subjectivity within
which each single abnormal experience is situated.
Before we proceed in this direction, Ineed to clear the ground of a possible
misunderstanding. To consider phenomenology as a purely descriptive science
of the way the world appears to the experiencing subject is a serious mistake,
although it is true that phenomenology sponsors a kind of seeing that relates to
what is existent. “Making the invisible visible” can instead be taken as the motto
of phenomenology, just as it was the passion that possessed many of the artists
the “invisible century”, including Einstein and Freud, in their search for hidden
universes (Panek,2005).
Phenomenology shares with Modernism, and with the
of the twen
things are seen in the natural attitude, that is, in straightforward cognition.
It sponsors a sui generis kind of seeing—
of familiar things. But, especially in its hermeneutic
, it is also resolutely
tied to hearing and the spoken word since—
as Gadamer (2004, p.458) has
“the primacy of hearing is the basis for the hermeneutical
e symptom is conceived as a part of a discourse, to be deciphered and ana
lysed as a text. e issue, then, is how to rescue its invisible and unintended
meaning. All human deeds can be produced or reproduced as a text. As dis
cussed in Part One, Chapter 11, the text is produced by an act of exteriorization.
Once it is produced, it is no more a private aair, but stays in a public space
independent with respect to the voluntary and conscious intention of its author.
An example of this is the following:
A patient is overcome by a feeling of estrangement from himself when he recounts an
event of his life during a therapy session:‘Doctor, Ihave repeated to myself this story
bored with this way of telling my story over and over again that now it appears totally
Another, even more explicit, example is the parapraxis, that is, the emergence of
an unintended meaning while putting a fact into words.
pist:‘You know, one evening Ieven took a photo with the sex of them’ (of course, what
he meant to say was ‘with the six of them’).
e externalization and objectication of oneself via the production of a text
implies a distanciation from oneself. e meaning of the text becomes autono
mous with respect to the intentions of his author. Now, the author’s meanings
and intentions do not exist only for-himself, but also for-another.
is process of autonomization of the text was explored in Part One,
its agent and develops consequences of its own. Just as every action involves a
recoil of unintended implications back upon the actor, every text—
implies a recoil of unintended meanings back upon its author.
Whenever we act, via the externalization of our intentions, we experience a
kind of alienation and estrangement from ourselves. We discover alterity within
ourselves. e symptom deployed as a text exposes its author to this very des
tiny (see Ricoeur, 2004; Stanghellini, 2011). Atext is the product of an action—
linguistic action. Like all actions, once produced the text shows the disparity
symptom exposed like a text recoils back upon its author, displaying the dis
text, as the tangible result of a linguistic act, with its unintended consequences,
makes visible—
the ‘mind’ of the author much more faithfully than a
simple act of self-
reection. To paraphrase Hegel, the ‘mind’ cannot see itself
until it produces a text objectifying itself in a social act. Because all conscious
knowledge. Aperson cannot discern alterity within himself until he has made
of himself an external reality by producing a text, and aer reecting uponit.
e production of a symptom is simply a particular case of this general rule.
As a text, in the symptom alterity becomes manifest. Asymptom is the outcome
nothing but a text by which an unrecognized alterity is made manifest. When
alterity is no more integrated into the narrative the person fabricates about her
self, a symptom is produced as an
extrema ratio
for alterity to become discern
ible. e symptom is the last chance for the person to recognize herself.
To note, the essential question is not to recover,
the text, the lost inten
tion of the author (as it is oen the case with the psychodynamic paradigm) but
rather, to unfold “in front of the text, the world which it opens up and discloses”
(Ricoeur, 1981, p.111). Alterity comes into sight, materializing in the pleats of
a panoramic view of how the parts of the text are articulated. To paraphrase
Ponty (1964), the mystery is exposed in the exteriority of things per
ceived in their reciprocal intertwining.
A patient in his ies is going through a rather dicult period in his life. He says
that he feels ‘anxious, unstable, precarious, and Idon’t know why.’ His mood is almost
inscrutable and unintelligible to him, and this makes him more and more insecure,
tense and nervous. During a session he tells the following story:‘You know, this may
sound irrelevant to you; none the less Iwill tell you what happened to me this week.
Ihave been travelling a lot, and every morning Iwoke up in a dierent place. One day
very early in the morning Itook the elevator to the breakfast room, my eyes still half
shut. All of a sudden Isee a shadow in the elevator and Ithink:‘What’s my father doing
here?’ Of course, it was my image in the mirror of the elevator.’ During the following
sessions he remembers that when he was about 10, and his father about 50, his parents
had a horrible conjugal crisis apparently caused by their indelities. His father, who was
a businessman, was oen away from home and—
he says—
‘he could not take care of his
his situation and that of his father when he was about his age, and a warning to take
bonds that tie each element of the story with the others.
is patient could now see himself, his own present situation, from the vantage point
of his father’s story. He could also discover in himself his father as the alterity that was
haunting him—
his father as a destiny to be avoided. ‘Only aer making these connec
he once said—
‘I realized that my bad mood was the way through which all
this was revealed. My feeling shaky, wobbly, unsteady was indeed an admonition:‘Give
yourself a form, a form dierent from that of your father!’
is is a kind of understanding that “seeks to nd the logos of the phenom
ena in themselves, not in underlying subpersonal mechanisms” (Fuchs, 2008,
p.280). e symptom, then, in the phenomenological–
hermeneutic paradigm
is an anomaly, but not an abnormal, aberrant, or insane phenomenon in a strict
sense. Rather, it is a salience, a knot in the texture of a person’s life-
world, like
a tear in the matrix. It is a place that attracts someone’s attention, catches one’s
eyes, and awakens one’s care for oneself in a double sense. e symptom reects
and reveals alterity in oneself—
in it alterity becomes conspicuous. From the
vantage oered by the symptom one can see oneself from another, oen radi
cally dierent and new, perspective.
Conicting values:thecase
withpost partum depression
What we can learn from a psychodynamic understanding of the concept of
‘symptom’ can be summed up as follows:(1)symptoms are not accidental to a
person, rather they express a fundamental trait of her vulnerability; (2)symp
ence and the person; (3)these disturbing experiences arise out of a conict or
a trauma; (4)symptoms have meanings to be deciphered next to causes. In the
previous chapter Ifocused on the rst point and on the last one. In this chapter
A young woman develops a kind of palsy that mimics paraplegia a few days before she
cal decit. Imagine that through careful interviewing we can ascertain that she suers
ried at all), and that she cannot manifest this desire, not even to herself. Her symptom,
which impedes her walking to the altar, satises her desire in a masked form, and at the
same time it speaks on behalf of her desire.
is can be taken as a paradigmatic example of the understanding of the rela
angle. e patient’s symptom (‘paraplegia’) has a psychological cause (conict)
In this case, one of the desires is unconscious—
it belongs to the dynamic
Conicts do not inevitably involve an unconscious desire—
they involve
intrinsically plural, as we are inhabited by alterity, and the forms of human life
are inherently plural too. ere is an inner cleavage in man’s innermost nature:
whatever he thinks of himself, he must think against himself and against what is not-
himself. He sees everything in conict or in contradiction [
]. e decisive point is
which he overcomes it, the way in which he transcends it, reveals the conception he has
of himself. (Jaspers, 2010, p.146)
scribes to an
anthropology of disunion
. Disunion does not amount merely to
internal conicts in a strict psychoanalytical sense; rather, it is the ubiquitous
presence of non-
coincidence and eccentricity. Human existence constantly
escapes any coinciding with an essence. is is the signature of the human
condition:its perennial duality, otherness-
haunting selood, complexity-
challenging one-
sided concepts, antithesis-
troubling, so that we are condemned
Jaspers takes up in his studies on tragedy (Jaspers, 1952), epitomized in Iago’s
lament “I am not what Iam” (Shakespeare,
, I). Disunion also means
that the human condition is one of radical homelessness, of diaspora, and of
nostalgia. Iam away from myself. But Icannot rest content in my condition of
separateness. Icannot nd peace by simply dening myself an outcast, some
my condition of disunion. Domesticating disunion, dialoguing with alterity,
and reaching a condition of intimacy with it is a task in human existence. e
way man faces this task reveals the conception he has of himself.
Disunion, nally, means that Iam called to take a position in front of myself,
and more specically in front of the otherness Iexperience in my existence. I
logos out of my pathos. To be human is to deal with this reective duplicity by
taking upon myself the responsibility for articulating, making sense of, coping
with, and appropriating experiences—
well aware that the
is always restless
and fragile (Stanghellini and Rosfort,2013).
‘I thought it was right to have a baby in this moment of my life. My husband had had
a promotion and Ihad my job. We had a beautiful house
only a child was missing!
So we decided to have a baby. e baby arrived soon aerwards and Ifelt euphoric.
restrictions; the training course for pregnant women; the proper arrangements for the
arrival of the baby
everything that needs to be done during the pregnancy. When
the baby arrived nothing was like Ihad planned and imagined. Iwas terribly afraid
Ihad to give up my job, or that they could re me because Ihad to look aer my baby.
Idid not know what to do. Icould not make a decision. Ifelt guilty for that. My mother
gave up her job to raise me, but if Ihad decided to stay home Ithought Imight go
crazy! My husband helped me a lot, but aer a while Istarted thinking he had a story
with another woman as Idid not feel like making love with him at all and he did not
inadequate for that too! Iended up having no interest in sex, but also in my husband as
a person. Irealized Idid not love him. And the bond to my baby seemed to lessen too.
Iever had in my life. My mother too was very helpful. But that made me realize that
Iwas totally unable to be a “really good mother” as she used to be with me. Ican’t man
age everything, Iam not able to be a mother!’
is is an example of conicting values that led to a severe form of depres
sion, namely post partum depression (Ambrosini and Stanghellini, 2012).
Motherhood presents itself as an intrinsically conicting situation. Women
with a particular constellation of values (referred to in psychopathological
literature as
typus melancholicus
) experience motherhood as a social duty to
perform in conformity with the dictates of tradition. e adoption of this atti
tude is likely to turn motherhood into a traumatic event. e traditional values
that shape this person’s social behaviour may have a pathogenic valence. is
mother seems over-
identied with social representations of a woman’s role that
reect time-
honoured beliefs and have become for her embodied dispositions
that full the others’ expectations. Being a mother, a working woman, a good-
enough wife, and a daughter faithful to her mother’s legacy who re-
enacts her
mother’s values and puts them into practice are obviously conicting values
and goals, especially in the post partum period. is person’s system of values,
which shape the inner core of her personal identity, heightens her psychopatho
logical vulnerability and leads to a clash of roles that paves the way to feelings of
guilt and exhaustion—
to the key symptoms of major depression.
As explained by Tellenbach (1980), the pre-
melancholic situation is charac
terized by a self-
contradiction of the person, insistent in the attempt to maintain
an unchanged order. is constellation is called ‘includence’ since it includes
the person in the unattainable project of maintaining her order and, at the same
time, in the need to overcome it, exceeding her own limits. e person cannot
transcend the order rigidly established by her values and the social roles that
ensue from them. is is the moment in which the undesired is manifested and
imposes on one’s existence (ibid., pp.181, 192). e constellation of ‘includence’
is followed by a ‘remanence’ constellation that, in its own turn, is characterized
by the impossibility of bringing one’s own duties to a successful conclusion and
thus feeling in debt with oneself and with the others. Includence and remanence
lead the person to a situation called
(a term that is inappropriately
cates feeling pushed through the incompatible or totally exorbitant objectives,
leading to a kind of paralysis of action. Indeed, the primary symptom of major
depression that follows the pre-
melancholic situation is psychomotor inhibi
tion, accompanied by aective anaesthesia and guilt. Psychomotor inhibition
is experienced as a sensation of loss of vitality, of physical and psychic integrity,
of strength, of vivacity, as well as a feeling of tiredness (dejection), of weakness,
aective resonance, of an aective void. Guilt feelings and delusions of guilt are
ing the faith of someone, having infringed the commandments of God or of a
superior moral authority.
ese values, or some of them, need not be repressed, or distributed across
a line that divides consciousness from the unconscious. Rather, they reveal the
lling social expectations. Among women who tend to abide by social norms,
play established social roles, and hide their inner conicts, the contradiction
that is intrinsic to motherhood itself make this contradiction uncontrollable
and potentially devastating.
To be a good-
enough woman in the post partum period is a highly dicult
task that consists in accepting that one will imperfectly perform each of these
roles without over-
identifying with any of them. Mental pathology is not the
presence of conicts; rather, it is their cessation. It is a crisis of the internal
capacity to transcend them, to attune them with the current situation, Iam a
mere What or Idem—
a person that is nothing but its involuntary dispositions—
or a groundless Who or Ipse—
a person that is nothing but its projects. Without
this dialectic, a disposition ceases to be a neutral characteristic and becomes a
The body asalterity:thecase
withgender dysphoria
Another illustration of the vulnerable duplicity inherent in the human con
dition can be taken from gender dysphoria, where the person suers from a
sex, for instance, a person living with a man’s body who struggles to shape her
body as a femalebody.
e point Iwant to make becomes clearer if Ireformulate the dialectic
matter. Iam not merely the matter of which Iam made. Rather, Iam that matter
plus the form that Iimpose upon it. Obviously, the matter of which Iam made
(into which Iam thrown) delimits the possibility for me to assume the form that
Iwould like to impose upon it as an autonomous person. In trying to shape my
matter, Iexperience myself as an autonomous person and, simultaneously, as a
person whose autonomy is limited by the matter itself.
Matter, in this case, is the body itself, the body into which Iam thrown, its
haps the most intimate part of the person that Iam, but at the same time it
can turn out to be the most extraneous. My material body is transcendental to
me. At a certain moment in my life, Imay realize that Ihave a material body
that is clumsy, vulnerable, and mortal, and that impedes my ability to be what
Iwant to be. My body manifests itself as alterity. is paradigmatically happens
through the experience of shame. Shame is an aect that awakens and focuses
my attention. When Ifeel ashamed, Iam aware of being seen by another per
son whose gaze uncovers a part of who Iam, usually a part that makes me feel
embarrassed, inadequate, and humiliated. e eect of shame is that it reduces
the complexity of the person that Iam to one single aspect of it:when Ifeel
ashamed Iknow that for the other Iam nothing but that specic feature of
the complexities of who Iam. With the appearance of the Other’s look—
Sartre (1986)—
I experience the revelation of my being-
object. e upshot of
this is a feeling of having my being outside:the feeling of being an
. us,
one’s identity may become reied, and reduced to the external appearance, to
the matter or Whatness of one’s ownbody.
In a famous movie by Pedro Almodovar,
All about my mother
, the transvestite Agrado
oers a monologue about her becoming who she chose to be as an alternative to what
she was born to be. ‘Aside from being pleasant’, she says, ‘I am also very authentic’,
and she lists the various kinds of surgical operations she has undergone to become so
rather she shapes that body according to her experience of being the person that she is.
She ironically says:‘It costs a lot to be authentic’ and continues, ‘All Ihave that is real
are my feelings and these pints of silicone’. Gender, according to Agrado, is not simply
a physical fact, rather an accomplishment.
Gender to her has a moral value, since it is not conned to the physical mani
festation of one’s natural body, but entails a choice. In other terms, gender is a
more complicated thing than what we consider to be more readily stipulated
natural kinds, such as an apple, a pear, or a person’s biological sex. Gender is a
personal experience heavily sensitive to socio-
cultural norms and conventions,
matter we are ‘thrown into’ and give it the form we desire, obviously within the
boundaries delimited by matter itself and by our capacity for autonomy. Being
the person that Iam is a task and a responsibility that consists in becoming
Iam through
Being a person, that is, achieving personal identity, for Agrado is a fragile dia
as aected by gender dysphoria. Dysphoria is an emotional state saturated with
state of tension that may lead to spontaneously vigorous outbursts as well as
devoid of the moderating power of language and representation that reects
the person’s fragmented representations of herself and of others, and induces
painful experiences of incoherence and inner emptiness, a threatening feeling
of uncertainty and inauthenticity in interpersonal relationships, and an excru
ciating sense of the insignicance, futility, and inanity of life. Persons aected
by dysphoric mood experience their own self as dim and fuzzy, feeling deprived
of a dened identity, and unable to be steadily involved in a given life project or
social role. Also, they may see others as cloudy, and their faces as expression
less. But it also entails a sense of vitality, although a disorganized, aimless, and
explosive one—
a desperate vitality. Dysphoric persons experience their mood
as a disordered ux, an overwhelming power that is at the same time a disturb
ing, disorganizing, and compelling source of vitality. Dysphoric mood is felt
as creative and destructive at the same time:a vigour that brings life as well as
annihilation. On one side, this power is a violent spasm that takes control of
the body and destroys the organizing embodied structure of the intentional
engagement with the world. On the other side, it is also a power that expresses
vitality in touch with the source of all sensations. It augments the sense of being
alive through an unmediated feeling of life in all its dynamic potentiality, before
being committed to the structure and representation that shape and orient what
we consider to be a ‘normal’ humanlife.
Dysphoria, that is, in the case of gender dysphoria—
uneasiness and con
cern with one’s body facticity—
is the symptom of the fragility of the dialogue
especially in early phases of this disorder. e interruption of this dialogue
might have caused Agrado to fall into being what she does not feel and want to
a man—
or vice versa to identify with what she is not and she cannot be—
two poles. Falling into her Whatness, that is, not recognizing her uneasiness
with being thrown into a male body and her desire to be a woman, will seem
ingly originate some sort of neurotic symptom, for instance a kind of phobia
(e.g. so-
called social phobia), or else more severe psychotic phenomena such as
a delusion of reference.
Her remaining unaware of her desire may originate a distressing kind of bad
mood like dysphoria and its
. Unless she recognizes her desire to be a
woman, she will be unable to decipher these disturbing experiences as expres
sions of the non-
coincidence with herself; thus, she will be unable to appropri
ately make sense of and cope withthem.
At the other extreme, the exalted xation on being, or fully becoming, a
rather than the awareness that her desire will never become com
phenomena. For instance, it may originate dysmorphophobia (body dysmor
phic disorder) and (as the culture of late modernity promises that one can
modify one’s own material body at one’s own will) an escalation of medical con
sultations and surgical interventions.
e fullment of Agrado’s desire consists on her satisfaction for having
to become a woman (gender), based on her recognition of her desire,
and for striving to achieve a female
that reects her desire, rather than on
a woman (assigned sex). In other terms, Agrado’s satisfaction is based
on her mature awareness that she will never fully appropriate her identity as a
woman, that for her it will remain a perennial task. In this sense, her satisfaction
for her being-
so with respect to her wished-
for identity is by no means dierent
from that of any other humanbeing.
is is conrmed by the real case of Kate Bornstein, a transsexual (M toF)
person who says about herself that she does “deceive herself about being a
woman” (Bornstein, 1998). To her, being a woman is a ‘performance’, a continu
ous task, rather than a fact. is is the case with all gender identity—
she holds—
and for all identity in general. “e bipolar gender system”, she writes, “serves as
a kind of safe harbor for most of us, and I’m denitely including myself in that,
even though Idon’t personally identify as either a man or a woman, because
Iwalk through this world appearing to be a woman for the most part. Ipass as a
woman. Ican do that. And Ido because it allows me to rest for a moment” (ibid.,
p.37). is is nicely encapsulated in the followinglines:
I grew thisbody.
It’s a girl body. Allofit.
Over the past seven years every one of these cells became a girl, so it’s minenow.
It doesn’t make me female.
It doesn’t make me awoman.
(ibid., p.233)
In a similar vein, gender identity is considered ‘performative’ by Ricky Wilkins
(2004). ese two seem to be cases
of well-
(rather than miscarried)
transsexual existence—
and, in general, of mature dialogue with alterity.
e challenge facing the clinician is how to oer the patient an insight into her
fragile personhood, that is, into the alterity she experiences in herself—
e.g. her
feeling dysphoric about her ‘natural’ sex—
as well as helping her to understand
the way she tries to make sense of this and, moreover, to acquire the appropriate
means to cope with her unease. Hermeneutical phenomenology is a resource
when dealing with this challenge of therapy because of three basic features of
this philosophical approach to human personhood.
cal framework to assess and explore the patient’s experience of troubled per
is open to an unusual extent, in that it reveals aspects of experience that other
emerge in their peculiar feel, meaning, and value for the patient, thus making
every eort to focus on the patient’s suering as experienced and narrated byher.
Second, the hermeneutical articulation of the dialectics of selood and oth
erness gives the clinician an epistemic tool with which to understand how the
struggle with one’s involuntary dispositions makes personhood not just a fact,
but also a problem. e vulnerable character of personhood that is so dra
matically expressed in mental disorders is closely connected with the problem
of the fragility of human identity, that is, with the problem of our cares and
concerns. Making sense of what we care about and how we care about being
the particular person we are involves the responsibility for one’s being-
so, that
is, for one’s vulnerable and troubled personhood. is responsibility implies
how to respond to the challenges involved in discovering alterity in one’s own
self, how to make sense of one’s troubled personhood, and how to become the
person that oneis.
ird, the hermeneutical character of this approach provides a framework by
means of which the clinician can make sense of norms and values involved in
a person’s struggle with her involuntary dispositions. We care about being per
sons, and the hermeneutical emphasis on both the
of the person
that we care about being and becoming—
that is, both the a-
rational, biological
values and the rational, personal values at work in our care—
provides the clini
The trauma ofnon-
We live out a traumatic existence stained by the tragic experience of our failed
encounter with the Other. Trauma is not just an episode that took place in the
past, relegated by repression in our dynamic unconscious. Trauma is part and
parcel of everyday existence, an ordinary experience that is one with our need
and desire to establish relationships.
As argued in Part One, the kind of teleology at play in human relationships
is the desire for reciprocal recognition. Our existence is inescapably condi
tioned by the spiritual value of recognition, alongside the organic values of
our biological life. We desire to be recognized by the Other, that our being-so
is acknowledged by the Other as a value in itself. Our most profound desire
of the Other’s concern and I try to attune with it. e capacity for recognition
is a kind of emotional and intellectual readiness to acknowledge the reasons
of the Other.
Also, the inaccessibility of the Other, that is, our incapacity to recognize the
Other, is the mark of being human, not a aw or a subjective inability. In our
tending towards the Other we experience the Other as unattainable. My desire
of the Other, as well as my pre-
understanding of the Other, do not correspond
to the Other as it is. We realize with despair that the essence of the Other is
. We experience the autonomy of the Other, that is, the fact that
the Other can never be fully appropriated, but only approximated, as a frus
trating limitation for our desire and of our capacity for understanding. “e
writes Levinas—
“is neither initially nor ultimately what we grasp
or what we thematize. For truth is neither in seeing nor in grasping, which
are modes of enjoyment, sensibility, and possession; it is in transcendence, in
which absolute exteriority presents itself in expressing itself, in a movement
at each instant recovering and deciphering the very signs it emits” (Levinas,
1969, p.172).
e way in which the Other presents itself is what Levinas calls the ‘face’.
totality because he overows every containing
Ican have of him. e Other
cannot and should not be reduced to the same—
that is, to my knowledge of
him, or to my desire for him. Rather, the Other calls
into question. e
deployment of this peaceful relation with the Other is produced in language.
Language “is contact across a distance, relation with the non-
touchable, across
a void. It takes place in the dimension of absolute desire by which the same is
in relation with an other that was not simply lost by the same” (ibid., p.172).
We cannot bear the irreducibility of the Other to our own categories, when
the Other is not compatible with the forms of relationship imposed on our
selves by our own prejudices and desires. Mental pathology from this angle is a
miscarried attempt to deal with the suering that stems from the intolerability
of the awareness of the Other’s radical alterity—
that is, as the eect of the recip
rocal non-
ing the Other generates defensive shelters which later develop into xed forms
of miscarried existence and become part of one’s personal identity.
“e good outcome of the relation with the Other expresses itself as a kind
. Only through the impossibility-
power (
) the Other can
manifest itself” (Byung-
Chul, 2013, p.22). Crucial to man is his attitude to
the failure of grasping, or possessing, or knowing the Other. “e way man
2003, p.22). Instead of falling prey to the aphasia of scepticism, or to the imper
(Arendt, 1948)—
he takes the risk of building, in the void that separates him
absolutes which were aer all illusory becomes an ability to soar; what seemed
an abyss becomes space for freedom; apparent Nothingness is transformed into
that from which authentic being speaks to us” (Jaspers, 2003, p.38). Here is an
being, aer Ihave appropriated its full portent” (ibid.)—
and what we might
call the
leap to the Other
:deliberately striving to navigate the innite space that
separates me from theOther.
e failed encounter with the Other may generate dierent kinds of existen
tial ‘shelters’. e sceptic nds relief from the anguish caused by the inacces
sibility of the Other by arguing that the discourse of the Other may well hold
some sense, but that any real attempt to reach the Other is futile. To the person
who nds a shelter in cynicism the discourse of the Other is situated outside the
realm of meaning and meaningfulness. e mystic is convinced that the reason
why we cannot reach the Other is that, when we move towards the Other, we
are still wrapped and trapped in our own prejudices. Contemplation is another
kind of shelter. e Other cannot be appropriated through the process of
understanding. e Other and Istand face-
face as the antithesis to the thesis.
ese shelters, as well as several others that could be added to the list, repre
sent the norm when compared to the spectrum of mental pathology.
Mental pathology is the incapacity to risk this leap to the Other. As Ihave
argued, it can be seen as the eect of the intolerability of this painful awareness
of tending towards the Other and at the same time of the inaccessibility of the
Other. Some of the most vulnerable ones among us, tormented by this painful
awareness, attempt to solve the problem of the inaccessibility of the Other in
more drastic ways. ey try to do so in a more or less explicit and voluntary way
by dissolving the riddle of the identity of the Other, that of one’s own identity
and, nally, that of the authentic encounter with the Other. e clinic of men
tal disorders oers a spectrum of possibilities, a full nosology of defeat and of
failed encounters with theOther.
note that values have a central importance in the description of these miscar
ried modes of existence. But before doing that, a few more words about the tele
Erotomania and idolatrousdesire
Our desire for the Other is not the desire for the esh-
blood Other. Rather,
it is the desire for the
of the Other. It is an
idolatrous desire
the case of a woman named Léa-
Anna aected with erotomanic delusion.
Anna is a 53-
old lady who believes that George V King of England is in
conviction. e rst intimation dates back to twenty years before she could fully
as a milliner in Paris when she received the visit of a lady who talked to her about
her loneliness. is lady was the concubine of the duke of York and she wanted Léa-
Anna to become the lover of the King of England. at evening, aer Léa-
Anna went
to bed, someone knocked at her door and disappeared. Certainly it was the Prince
of Wales who had, at that exact time, become George V.Once an English ocer was
sitting in a restaurant just in front of her. He was handsome and looked like Queen
Victoria. He was certainly an emissary of the Queen who came all the way to Paris to
harm her reputation.
e problem was—Léa-Anna thought—that she could not immediately realize all
this, and comprehend that the King was in love with her. It took many years before she
could make sense of the meaning of that lady’s confessions, or of all the other strange
and thrilling events that happened to her during that period of her life. Obviously she
was not indierent to the King’s advances. By that time she simply did not understand
what was going on. is was taken by the King as an insult. From that moment onward
the King, feeling oended, started persecuting her. George V loved her and hated her
at the same time. e King could hate her, but in no case could he be indierent and
moving. She was sure that the King was spying on her. Another time she saw a gentle
man dropping the newspaper on the oor. at meant that the ‘aair was down’, that
Her basic ‘postulate’, that is, the ideational and aective element at the basis of Léa-
Anna’s behaviour, is that she and King George are in a state of ‘special communion’ with
each other. De Clérambault stresses that her basic emotion was not love, namely erotic
love, but a mix of pride, desire and hope. ‘Erotic pride’ makes her build an image of the
King as a person in love (although ambivalently) with her. With this image in mind,
Anna takes all events that happen to her as a conrmation of the King’s sentiments.
e paradoxical character of the King’s sentiments, and of his behaviour stemming
from them, can be explained as a consequence of his disappointment following her
initial misunderstanding.
Anna, we could say, is aected by a kind of idolatrous desire. Not in the
sense that she believes she is in a ‘special communion’ with an outstanding,
divine person. Rather, in a much more literal sense, her desire is idola
trous since its object is not a person, the person of George V King of England,
but an
, a phantasm, an unreal object. We learn from her story that she never
aected by erotomanic delusions, and this is not by chance. ese people are
not aware that the object of their desire is an image. She, although involuntarily,
built this image out of a series of clues. e genesis of erotomanic delusion is no
dierent from that of many other delusions. e cloud of a series of fragmented
sudden revelation of a previously concealed meaning. As nicely described by
novelist Robert Musil in
e Man without Qualities
(1996), in his description
of the genesis of serial murderer Moosbrugger’s delusion, the patient’s “experi
ence and conviction were that no thing could be singled out, because things
in the manifold of experience shape up into a full-
1922, pp.422–
it suggests that this phenomenon of hanging-
by desire. It is desire that makes us build, although involuntarily, a picture of the
world. is picture reects our desire, rather than mirroring the world itself.
We do not immediately relate to the world, rather we relate to our representa
tion. Iam not arguing here for the thesis that we relate to the world
representation. is is, in some sense, quite trivial, common-
sense philosophy.
What Iwould like to discuss is that we merely focus
on our representation
. is
is especially what happens in the case of our desire for the Other. e question
is:Is focusing on the image of the Other, rather than on the esh-
Other, only the case with erotomanic desire, or rather a general rule of the tel
eology of desire?
e myths of Narcissus and Pygmalion have a lot to say about this chiasm of
desire and image. Narcissus falls in love, not with himself, but with the image
that he sees on the water. Narcissistic love is, strictly speaking, not love for one
self, but love for an icon, a picture, or a representation. Pygmalion fabricates
cate that the
is the real ‘object’ of desire? Desire and imagination go hand
imagine it.
Eyes Wide Shut
, the title of Stanley Kubrick’s posthumous movie,
class people, Alice and Bill, and about all of the obscure forces that inuence
their relationship. Promotional images for the movie feature Alice kissing Bill
but looking at herself in the mirror, almost as if she was more interested in the
image than in reality. Does this mean that what we call ‘love’ is an
(Agamben, 2011, p.96), that is, a kind of disease, endemic in human
existence, consisting in an immoderate contemplation of the products of our
own imagination?
Kubrick’s swan song is explicitly inspired by Arthur Schnitzler’s
A dream
verbalizing memories as well as concealed desires. e confessions aect them, and
jealousy emerges. e husband, preoccupied with his wife’s disclosure, dris further
and further away from reality into a dreamlikestate.
Is our love for an image, rather than for a person, a shelter from the suering
generated by the failed encounter with theOther?
Or is it the ultimate obstacle that obstructs our leap to the Other? Are Narcissus
and Pygmalion so distant from de Clérambault’s erotomanic patient? e three
of them are in love with an image. eir desire is directed to an idol fabricated
by their mind. is idol impedes their relation to ‘real’ people and brings about
a ‘phantasmatic’ satisfaction of their desire that, in Léa-
Anna’s case, is clearly
and the Other. is phantasm stands in the way of an accurate awareness and
understanding of the Other’s (and one’s own) desire. Our focusing on this phan
tasm, rather than on the esh-
blood Other, disregards the Other’s freedom
not to correspond to our own desire, and our incapacity to toleratethis.
Depression and theidealization
e main thing is that from the very rst, though she tried to hold back, she threw
evening, told me in her prattle (the charming prattle of innocence!) all about her
childhood, her infancy, her parental home, her father and mother. But Iimmediately
doused all this ecstasy at once with cold water. It was in this that my idea lay. To her
raptures Iresponded with silence, benevolent, of course
but all the same she
quickly saw that we were dierent, and that Iwas—
a riddle. (Dostoevsky,
In Dostoevsky’s short story
A Gentle Creature
(also translated as
e Meek
), a young woman devoutly incarnates the common-
sense idea of the wife.
Her burning desire to honourably play the ideal representation of the wife of
a man who stands before her not as a husband, but as an enigma, ends with
a mystery in order to frustrate his wife’s naïve intention to build a respectable
bond. e Gentle’s creature’s husband is resolute in his intention to conrm
his nihilistic thesis of the impossibility of a real bond. is makes the equally
obstinate attempt of the Gentle’s creature to conform to the stereotype of the
devoted wife even more futile. is stereotyped understanding of the conju
gal relationship is assumed by her as a taken-
granted, universally shared,
It must be emphasized that such an attempt is not rooted in the love for the
Other seen as an individual person. Rather, it is xed on an
, on a common-
sense prototype of the exemplary marriage. It is an idealization of common-
sense desire. is is the rst, and perhaps easiest to explicate, form that mental
disorders oer as a vulnerable shelter as a defence from the missed encoun
ter with the Other. Dostoevsky’s Gentle creature tries to solve the riddle of the
Other by emptying the Other of his personal identity and reducing him to a ste
reotype. e complexity of the meaning of the Other’s actions is erased and the
Other is identied with an external representative or surrogate of personal iden
tity. e Gentle creature is aected by
:she is unable to appreciate
the individuality of the Other. She distorts and takes to the extreme the device
of common sense that already operates in normal life. e Other is
nothing but
a priori
image of the Other that coincides with its social role:a husband, a
wife, as well as a child, a parent, a friend, a pupil, a teacher—
and nothing but a
the complexity of the Other. It also lessens the intricacy of the relationship with
the Other, since such patterns of simplication also apply to the Self. Akind of
universal matrix for the Self–
Other relationship is built that takes the form of an
which literally means the incapacity to know (
) the
Other as an individual person (
can be taken as the essential symptom in
the melancholic type of existence. It makes of the melancholic person’s shelter
a highly vulnerable asylum. e Gentle creature’s story speaks of the inability
to relate to the Other as otherness, the total loss of confrontation, and thus of
recognition of the Other. It speaks of self-
kind of narcissism, not in the sense of love for oneself, but in the sense of being
in love with one’s own representation of the Other. In this sense, love is love for
an image—
as explained by Agamben (2011). Love is idolatrous—
. Passion proceeds from an image placed in the mind of the lover. e
phantasm is the real object of love. Love is a dangerous mirror (
miroërs peril
). “e place of love (
) is a fountain or a mirror” (ibid., p.97)—
a at
session of a representation of the Other. Rather, it is “the sharing of this non-
appropriable” (Agamben, 2014, p.130)—
exactly the opposite of the kind of love
professed by the Gentle creature. Love is not an estate, but a landscape. e
Gentle creature’s way of loving her husband embodies what Byung-
Chul (2013)
named the
agony of Eros
. e Gentle creature’s love is love for the same, for the
already known, the already appropriated; it is a cramp in herself that does not
allow her to see the Other as a stranger. Based on the need for
recognition of
Other, this kind of love is a mortal one, as it does not allow her to see the world
from another perspective. It connes her in the inferno of sameness.
sider the phenomenon of
, that is, the anthropological marker of the
melancholic type of existence. e melancholic person continually follows in
the footsteps of the faded image of her own existence. It is ensnared by common
sense, seeking order, and consensus rather than being open to alterity. e mel
ancholic person submits to the pressure of public opinion, to the icons of iden
tity taken from common-
sense stereotypes, and to the gravitational force of
social norms as external guidelines for actions. e Other in question is never
the here and now, esh-
blood Other. Rather, he is a generalized Other, an
abstract and absolute source on impersonal social norms and values. e mel
she over-
welded (hypernomia) to its surrogate, namely her socialrole.
e melancholic crisis is a special kind of depersonalization characterized by
the melancholic person’s incapacity to continue incarnating her own role. She is
not able to experience otherness as an event that shows another face of herself.
She undergoes the event as a trauma that throws o her mask and reveals her
the person and the otherness revealed by the event cannot be any dialogue, any
narrative continuity. No dialectic relationship can develop out of the encounter
with alterity since the melancholic person cannot tolerate any dissonant aspect
within herself and with the Other. Her desperate complaint of not being able
to love, although it may seem simply one of the many self-
accusations that are
typical during acute melancholic crises, indeed represents the melancholic per
son’s overdue awareness of her incapacity to encounter theOther.
Love is a feeling whereby we feel displaced. It forces us to see ourselves and
the others from another perspective. Love hurts (Illouz, 2011)because of its
power to be an event in our life that forces us to reconsider our habits and jeop
ardizes our narcissistic identity. Our life is challenged by the experience of love,
as in Lars von Trier’s movie
in which the stagnating life of Justine is
impending collision apparently rescues her from her melancholic existence.
Contrary to Justine, the Gentle creature is unable to take the collision with her
husband as a reason to emerge from her timeless and eventless existence. From
and to learn from experience. Existences of this kind, in their apparent gentle
ness, spontaneity, innocence, devotion, and apparent You-
orientation, are any
thing but submissive. Rather, they are inexible, they lack nuance, and they are
incapable of compromise and conciliation. ey are rigorous, in the most literal
sense of the term. And this rigour, sooner or later, leads them to clash with the
enigma embodied by every person, by every human relationship.
Borderline existence
and theglorication of
a thrilledesh
ere is also a second mode of vulnerability, typical of another emblematic
form of existence called ‘borderline existence’. e kind of simplication of the
teleology of desire that we nd here is to a certain extent the reverse of the pre
ceding one. It lies in the glorication of an oceanic encounter with the Other,
it takes place outside of the social roles:the mystical encounter of a esh with
another esh, of a thrilled esh with another thrilled esh. Emotions, for such a
vulnerable mode of existence, represent life in its purest form. Any other form
of encounter is seen as a fall.
Ilse is a good-
looking, well-
read, divorced woman in her late forties from a well-
Catholic family. Tenaciously You-
oriented. She enters my oce with a grim face, as
spires through her sullen behaviour, patent need to be recognized as someone with
an unhappy life and, this notwithstanding, sensible and cultivated. Restless youth,
dysphoric mood traits punctuated with angry outbursts. An episode of sensitive delu
sion of reference a long time ago. Apreference for clandestine relationships ‘as mar
ried men give their best out of their marriage’, and for ‘dirty souls’, ‘as soul and dirt go
ship and for o-
track love aairs.
at self-
recognition. Emotions are the epicentre of both these passions. ‘All that counts in
life are emotions. Nothing else. Only emotions keep me alive. Iknow they can destroy
me, but it’s worth taking this risk. Without emotions Iwould be simply dead. Imean the
emotions that Ionly nd in my way of being totally in love with someone.’
Experienced, but not unfaithful or promiscuous:‘I can give myself entirely. I’ve
never been unfaithful. You’re right, Iseem to jump from one partner to another. But
Inever had two partners at the same time. Iliterally fall in love. is is the only way Iam
able to love. Isense the desire of the Other with whom I’m in love. Iplunge into it. And
believe me I’m able to totally satisfyit!’
She may seem from time to time seductive, but this is a kind of involuntary habit of
which she is only partially aware:‘One of my previous partners ironically accused me
of being a seducer. at made me think of Odysseus’ Sirens. You know? “Hither, come
hither, renowned Odysseus, great glory of the Achaeans, here stay thy barque, that thou
mayest listen to the voice of us twain.” Was he right? Ido not do that on purpose. It’s
stronger than me. If Iseduce them it’s because I’m able to seduce them with their desire, as
the Sirens seduced Odysseus with the promise to leave their island with a full knowledge
of the gods’ design—
exactly reecting nosy Odysseus’ innermost desire! With me, men
desire, and it’s my nature to become one with it. Do you call this “seduction”? is is my
way to love. In this, Ido not lose myself—
rather Ind my true self. Ilive from this emo
tion. Ilive from recognizing their desire. My life without emotions is not worth living.’
‘And now you tell me Ishould renounce my emotions to survive! You can’t under
I’d ratherdie!’
life what is more alien and inaccessible to it, what in life itself is unstable and
In order to function you have to cut out at least one part of your mind. Otherwise you’d
] at’s your choice:go
mad and die or function but be insane.
at is what British playwright Sarah Kane sarcastically argued in an inter
view released shortly before her suicide (Saunders, 2009, pp.87–
8). ey are
part of “a report from a region of the mind that most of us hope never to visit
but from which many people cannot escape” (Greig, 2001, p.xvii), telling
about “the fragility of love” and “the search for selood” (Saunders, 2009,
p.113). is form of existence postulates the encounter as immediacy, and
not as a patient approach. Being authentically with the Other implies a drastic
aut aut
:‘Love me or kill me’. It desires and demands exactly the same impos
sibility that originally made it y away in desperation:the encounter as an
opportunity for recognition.
Recognition by
the Other is the basic need in
this type of vulnerable existence. is xed idea, this value that drives the
borderline existence itself, undoubtedly opens the gates of perhaps the eri
est relational hell that we could possibly imagine—
a burning hell of desire,
expectation, and disappointment:
And Igo out at six in the morning and start my search for you. If I’ve dreamt a message
You know, Ireally feel like I’m being manipulated.
I’ve never in my life had a problem giving another person what they want. But no one’s
you’ve touched me somewhere so fucking deep Ican’t believe and Ican’t be that for you.
Because Ican’t nd you. (Kane,2001)
At the heart of this drama resides the excruciating experience of the Other. e
Other is needed as a source of recognition. e absence of the Other makes the
oen the reason for feelings of un-
recognition and desperate loss of selood.
e absent Other, or the Other who does not donate his entire self, is an aban
doning Other and an inauthentic Other. e Other is a partner with whom both
loyalty and spontaneity are expected. e bonds of loyalty and the promise of
reciprocal care must be accompanied by its antonym:spontaneity, that is, being
free from social conventions and acting according to the logics of desire in the
present moment. Borderline persons feel these as standard, basic aspirations—
but we all know how unrealistic and almost unattainable they canbe.
Since the otherness of the Other cannot be grasped, possessed, or known, the
good outcome of the relation with the Other expresses itself as a kind of failure.
(Jaspers, 2003, p.22). e borderline person, so to say, ies too high for her
capacity to approach her failure. Her type of desire is apparently an iconoclas
tic one, since it does not accept any sort of compromise and is intolerant of
any kind of reduction of the I–
You relationship to an encounter situated within
Other as historically situated persons, real possibilities and abstract illusions,
the Other’s freedom.
love and the actual relationship with the other person. What the borderline per
son idealizes is not the Other, but Love itself. It is a mystication of the failure
in grasping the Other, overwritten with the jargon of authenticity. It celebrates
immediateness as a reality, rather than as a task that can never be fully accom
plished. It tends to block the autonomy of the Other while it inauthentically
worships an ‘authentic’ relationship. It fulls the visceral need for recognition
with a heroic and empty claim for absolute communion. And, nally, it makes
the non-
ment of which she considers herself to be the only victim.
What the borderline person considers to be her most non-
value is indeed her innermost symptom. e borderline existence is a danger
life what is more alien and inaccessible to it, what in life itself is unstable and
Schizophrenia and
thedisembodiment ofdesire
Until now, we analysed two miscarried modes of being with Otherness:the dis-
identication of the Other, and the glorication of the immediate encounter
with Otherness as a thrilled esh. In contrast, the third relational hell is not
a ery hell but a Dantesque icy lake. It is an out-
world shelter whose
cypher is the dis-
embodiment of Otherness.
And then ctions of a very old and free life, of enormous solar myths and massacres
because of the great force of a barbarous myth, eyes abyss-
like and changing glaring
with dark blood, in the dream’s torture discovering the vulcanized body, two spots two
the board-
branch shack on the lonely elds of the city, a candle throwing light on
the bare ground. In front of me a wild older woman stared me down without batting an
eyelash. e light was weak on the bare ground in the quivering of the guitars. To one
side on the blossoming treasure of a young dreaming girl the woman now clung like a
the wordless wind of the Pampas that sinks you. e wild woman had grabbed me:my
indierent blood had certainly been drunk by the earth. (Campana,2013)
La Notte
e Night
is an emblematic Odyssey-
like search for the Other. Asearch that gradually
immaterial:spirits, shadows, mirages, incorporeal images, or fragmentary,
like, mechanical bodies and purely material gures—
everything one
a deanimated body (“my indierent blood”), or a disembodied mind (“enor
mous solar myths and massacres created themselves before my spirit”). ings,
including other persons, are experienced as mere objects (“the vulcanized body,
nated givenness. ey are stripped of their esh, simply there. ey may lose
their three-
dimensional givenness and appear as two-
dimensional images. Not
encounter with the Other may also take the form of the appearance of persons
alive”). As object-
like entities, or as at representations, others appear as unfa
miliar gures, as a source of enigmatic messages and intimations.
It is like a chilly and uncanny night of disembodied encounters with the
Other. is is how the withdrawal from the intolerable failure of the relation
ship with the Other may appear in the schizophrenic existence. What emerges
in Campana’s odyssey, and that in most schizophrenic narratives may remain
concealed, is that there is a You-
oriented story, although a story of failed
encounters with the Other. Abnormal sociability is not simply one of the symp
toms of full-
blown schizophrenia, or one of the abnormal traits of schizoid per
sonalities. Campana’s journey is emblematic in this sense. It moves from his
desire to encounter the Other and gradually takes the form of a disembodied
encounter with the Other. is form of disincarnated desire seems to grow out
of the defeat of embodied desire, and intensies as frustration increases. In the
case of Campana, such apparitions, visions, or failed encounters with the Other
do not extinguish the hunger for the Other. Rather, they support his journey in
search for a disembodiedOther.
ere are two gures of desire in Campana’s poem. One is “the blossoming
ied, dream-
like desire. She is an evanescent, incorporeal ghost, who is simply
there, and nowhere. She stands side by side with her double—
the “wild woman”.
e latter is a matron, the nightmare of the Mother-
vampire, and that is why
she “clung like a spider”, an insect which can rst immobilize and then devour
stands for the Apollonian beauty that can simply be contemplated. Whereas the
young virgin allows me to desire her at a distance, the matron is the emblem of
the Other who voraciously desires me and destroys me with her desire.
themselves into the silk of their own souls in search of protection for their own
hyperaesthesia. is is the case when autism—
the core symptom of what we
would call nowadays the schizophrenic spectrum, a “painful cramping of the
self into itself” (ibid., p.157)—
is predominantly a symptom of hypersensitiv
ity. is kind of autism is a defence against the “thorn-
bushes on the path of
life, thorns which their tender hands were never made” (ibid., p.193). Quoting
rich in thought” (a kind of existence that in Minkowski’s parlance is named ‘rich
autism’), as “they close the shutters of their houses, in order to lead a dream-
fantastic, in the so mued gloom of the interior” (ibid., p.157). Although next
main character is unfeelingness and lack of aective resonance for the world,
the unsociability of schizoids—
as was the case with Campana—
is seldom mere
unfeeling dullness. It typically is an admixture of hypersensitivity, displeasure,
tion towards life prevail. Indeed these people suer from a kind of emotional
ataxia whose main features are psychoaesthesia or coldness, lack of aective
contact with other persons, mixed with irritability and hypersensitivity to social
cold despotic, the passionate-
insensible, and the unstable vagabond. Campana
Franz Bau, a young artist and student at the Conservatoire, is full of burning aects
full of passion when he came to his terrible love experiences. He describes himself as
an idealist, a tender soul, and a lover of ‘all that is higher’ in search for ‘the little girl’
and it torments him with painful and weird bodily experiences:‘[i]
t storms over me.
me like afear’.
soul. ‘For the rst time Ifelt that someone liked me.’ She runs away from the convent
remains indeed a disembodied and spiritual one. When he kissed her, he felt ‘fearfully
excited physically (
doing. e loveliness of nature made me drunk—
I saw that everything was a terrible
mistake’(ibid., p.189).
Aer several vicissitudes, he realizes that the Sister is not the right person for him
since she does not full his spiritual desire:‘I realized that, spiritually, she was too sim
ple for me (
) Ineeded someone to whom Icould be spiritually bound.’ He begins a
new liaison, and this kindles a psychotic breakdown. He had the feeling that the Sister
knew everything about his new aair and that people were spying on him through the
landlady and the doctor. He is totally desperate. He thinks that his girlfriend does not
understand him, and if she does not understand him then the Sister must come back
again, as he is in need for spiritualhelp.
Franz Bau’s existential trajectory reects the intolerable mixture of his desper
ate need for the Other and his hopeless attempts to orientate in human, and
especially erotic, relationships. As it was the case with Campana, it takes the
form of a disembodied desire that seems to grow out of the defeat of embodied
a burning and aggressive eroticism, plus the fear to be overwhelmed
by the Other from without and by one’s own excitement from within—
him to a series of miscarried attempts to establish an erotic liaison that nally
with the Other. Franz Bau is neither a person who can recognize the Other
one of those persons who can satisfy themselves in distant dreamy love for a
stranger passing by. “An all or nothing ecstatic enthusiasm at one moment, and
overt coldness and umbrage at the next. Aviolent rush forwards, and a violent
catastrophe, again and again” (ibid., p.191). He may resemble the borderline
tragic experience”, unlike the borderline’s, leads him to “a cramped, wounded
withdrawal into himself”. He turns away from actual reality into a mystical-
romantic ideal centred on what he calls “the Higher”—
“a ringing word without
any content at all, but lled with a burning aective value” (ibid., p.192). Sex,
religion, and art are conglobated into ‘the Higher’ like a dim mist protecting
him from the immediate encounter with the realOther.
Two features seem to best characterize Franz Bau’s type of existence. One
is his philosophy of life. He indulges in cramping reections concerned with
spirituality, that is, rectitude, delity, nobility, and purity. Spellbound to ulti
mate questions and never-
ending ontological and anthropological enquiries,
he loses the vital contact with his here and now reality. Minkowski’s (1927)
morbid rationalism precisely captures the deliberate option at work here:an
intellectualistic attitude that disparages all skill to shape knowledge in a contex
tually relevant manner. e search for a real person with whom to establish an
imperfect but factual relationship is taken over by the pursuit for an ideal image
of the Other. In Franz Bau this takes the form of the spiritual quest for ‘the
rial. Each of them abandons his You-
quest becomes more and more disembodied aer each defeat.
e second distinctive feature is indeed disembodiment. In the case of Franz
Bau (and of Dino Campana), the lived body is the theatre of an uncanny tel
eology of desire. Sexual excitement is experienced as a storming, oppressing
Amysterious feeling is tormenting them that is like an emotion (‘a fear’), but
is not totally and incontrovertibly recognizable as that. is distressing feel
ing accompanies the epiphany of the Other, as a esh-
blood person (the
‘Sister’) or as a phantasm (the ‘girl’). It oppresses from within (uncanny bodily
feelings) and from without (an invading Other).
seems to downplay this intolerable feeling and transform sexual excitement
into a disembodied type of desire (see also Dibitonto, 2014). e essential
feature of this type of existence is its being disembodied. e crisis of body-
body attunement or intercorporeality can be a primary phenomenon in schizo
phrenic existence, non-
secondary to traumatic life situations, but with a causal
perspective on the interpersonal world. Due to dis-
attunement, the encoun
ters with other people lose their characteristic as relationships among bodies
moved by emotions, turning into a cool and almost incomprehensible game
from which the schizophrenic person feels excluded, and whose meaning is
sought through the discovery of ‘laws’ and the elaboration of impersonal rules.
e other person is no longer encountered in esh and blood, but as a disem
bodied self. And the self who encounters the Other is also disincarnated.
remembered by clinicians as examples of traumatic interpersonal situations
that may stand as causes or motivations for disincarnation and dis-
Disincarnation and dis-
attunement can arise as secondary, defensive involun
tary strategies in a kind of existence faced with the awareness that the Other
can only be approximated, not appropriated, and that our need for reciprocal
recognition is an unlimited struggle and a spring of frustration.
e disembodiment of desire can be a shelter, although an extremely vul
nerable one, and in its own turn the source for a progressive withdrawal from
social encounters and conicts, as it is the case with Campana’s epiphanies of
the Other as objectied persons looking like mere disincarnated images or
deanimated objects in
La Notte
. Or as a fugue into abstract spirituality and
philosophical abstractions like Franz Bau’s ‘the Higher’, which strips
Therapy:what iscare?
An aged man is but a paltrything,
A tattered coat upon a stick,unless
Soul clap its hands and sing, and loudersing
For every tatter in its mortaldress,
Nor is there singing school but studying
Monuments of its own magnicence
(W. B.Yeats,
Sailing to Byzantium
The portrait ofthe clinician as
Philosopher Martha Nussbaum in her book
Not for Prot. Why Democracy
Needs the Humanities
(Nussbaum, 2010)provides an unintended portrait of the
specialist in mental health care as a candidate prototype of a globally minded
citizen (Stanghellini,2013).
is ideal citizen should be able to care for the lives of Others, to imagine
what it is like to be in the shoes of another person, to view the Others’ actions
Others’ to unfold their stories, and to make sense of them not just as aggregate
behavioural data. is epitome should be the ability to see other persons, espe
cially marginalized people, as fellows with equal rights and look at them with
respect (Nussbaum, 2010, pp.25–
As citizens who are trained to confront human vulnerability, the evidence
dilemmas of autonomy and authority, and the conicts of inclusion and
exclusion, and in general with the encounter with Otherness that character
izes human life, psychiatrists and clinical psychologists are ideal candidates
to embody Nussbaum’s ideal globally minded citizen. To be sure, this is an
overly optimistic portrait of ‘real’ clinicians, who are obviously not so virtu
does mirror the kind of person a good mental health professional should be
trained to become. Indeed, Nussbaum’s representation is far from being an
achievement; rather, it is an ideal educational goal, and as such it is suggested
that it should be taken by the clinicians’ community:a challenge to current
educational curricula.
is issue, exciting and puzzling, is perhaps destined to be a perennial source
of disagreement. On one side, there are those who are convinced that mental
health is simply a branch of the biomedical sciences and thus we, as mental
health professionals, should only aim to rene our scientic knowledge and
technical skills. On the opposite side, there are those who hold that mental
health is part of the humanities. is dispute is childish and sterile as we all
know that both scientic education and humanistic formation are necessary
It is also a matter of fact that training curricula are more and more oriented
towards the rst type of agenda. e growth of the neurosciences, although
classication, and diagnosis of mental disorders, has beyond any doubt con
tributed to cost-
eective biological treatments. Another very important issue
is that published research, which is the second main source of education (and
the rst as continuous medical education), as laboratory rather than clinical
research, is too oen not continuous with the world outside, in general, and
ers rarely actively participate in the growth of knowledge, if one were to judge
seems to grow without control. It is a common experience to hear from prac
titioners that they simply cannot understand, and are thus tempted to deem
irrelevant (or, at least, clinically irrelevant), research published in journals.
One would be tempted to join the Mental Health Care-
sect and polemically attack the Mental Health Care-
Neurosciences team.
As Heidegger (2010) would have armed nearly one century ago, in a time of
dazzling scientic development like our own, science can inform us of all sorts
involved in being human. Practitioners know very well what oen research
of the human as well as a ne-
tuned humanistic culture to cross the territo
Taking for granted that practitioners need a thorough scientic education,
the question is what kind of humanistic learning is needed, and why. e con
cept of
makes a good starting point.
is an almost untranslatable
German word that approximately means cultivation or formation—
rather than
education restrictively understood as skill training—
that cannot be achieved by
any merely technical means.
Bildung zum Menschen
cultivating the human—
is to Gadamer “[t]
he properly human way of developing one’s natural talents
and capacities” (Gadamer, 2004, p.16). It is a process of ‘forming’ one’s self in
accordance with an ideal image of what it is to be human. Cultivating one’s self
is a complement—
a necessary balance—
to acquiring skills, learning procedures,
provides the indis
pensable ground for technical skills to be developed and put to use in a proper
implies participation rather than indoctrination, andquestions
rather than assertions. It is a process of appropriation through which what is
ratherthan acquiring a capacity, the “human gains the sense of himself” (ibid.,
ere are two general characteristics of
. e rst is keeping oneself
open to what is other. is embraces a sense of proportion and distance in
relation to oneself (ibid., p.17). We already admired this virtue in Nussbaum’s
portrait of the globally minded citizen. e second is that it contributes to
developing a sense, rather than acquiring an explicit, cognitive knowledge. An
example of this is
Tact is not a piece of knowledge, but rather a kind of sensitivity, namely the
sensitivity to what is appropriate in dealing with others, for which knowledge
from general principles does not suce. It rst includes the ability to feel an
atmosphere (the elusive and oen almost indenable ‘air’, ‘mood’, or ‘ambience’
that envelops a given situation in which is sited our global awareness of that
situation), rather than to grasp unequivocally what is already explicit. us,
is felt and cannot be said, so that knocking on it can be avoided. Hence, tact
implies an ability to act without oending. Tact helps to preserve distance, but
not averting the gaze from what was felt; rather, minding what was felt about
another person and avoiding intrusion into her intimate sphere.
Also, tact touches upon the very origin of the moral law (Levinas, 1969) as
it expresses a kind of relationship that is not that of physical (take hold of the
Other) or intellectual (grasp the meaning of the Other’s behaviour) possession.
Tact is a kind of grace, to capacity to feel an atmosphere and to wait until the
moment is ripe for making explicit what I felt.
Without tact, the other person is stripped of her possibility to signify her
uniqueness. Tact is the condition of possibility of all politics of inclusion, and
lack of tact is at the basis of any politics of exclusion. Ihave the responsibility to
extend my hand to the other and welcome the dierence and the signication it
brings (Horowitz and Horowitz,2006).
Tact is the capacity to feel the atmospheric and to attune with it. Not to intrude
manifest its uniqueness are essential qualities of the clinician. is ‘dexterity’
(Rümke, 1990), or compliance, or treatment procedures—
although it seems to be a prerequisite for all of them. Rather, its purpose is tact
ful orientation in all those kinds of patient–
clinician encounters that cannot
statu nascendi
and to ne-
tune with it before any kind of
handbook knowledge is possible. We too oen attribute clinical failures to the
patients’ lack of compliance. Indeed, compliance as exibility and plasticity is
ting too close to or too distant fromhim.
Prodromal psychosis is an excellent case study to illustrate this. In times of early diag
nosis, candidates may communicate elusive changes in their existential feelings, a
ineable altered relationship with the world, the failure to express what is ‘really
going on’, and vague complaints of being stripped from the world. ese feelings can
not easily be ‘pinned down’, either by the person who experiences them or by the clini
cian. Also, these persons may become ‘noncompliant’ if the clinician tries to reduce
their complaints to symptoms of an illness, and feel dispersonalized and deprived of
their unique individuality if the clinician wants to objectify their uncanny sensations.
(Stanghellini and Ballerini,2007).
Suspending one’s clinical judgement and preserving a space of ambiguity to
may be the best clinical choice, especially if the clinician does not have enough
clinical data to establish—
or to exclude—
a valid and reliable diagnosis, and
to start any sort of ‘technical’ therapeutic procedure. In this situation, when
based guidelines are unavailable, tact seems to be the principal (if not
the only) resource.
Studying and practising mental health care is a unique opportunity to develop
one’s sensibility for complexity and diversity in human existence, one’s capac
ity for understanding other persons, being tolerant and coexisting with them,
and helping other persons to be tolerant and coexist with the diverse—
and, in
imagine the experience of another.
Bringing the humanities into mental health care is not the anachronistic ar
mation of an elitist ideal of education. We can contribute to the foundation of
and normalization via symptom-
reducing strategies. We can help citizens to see
the world through the lens of human vulnerability, avoid marginalization and
stigmatization, and enhance tolerance and compassion.
To develop these virtues, however, educational curricula based on learning
clinical knowledge and skills may not be enough. Cultivating one’s Self is a
complement to memorizing pieces of professional equipment.
(Jaspers, 1997; Stanghellini and Fuchs, 2013)—
with its emphasis on human
approximate the Other’s subjectivity—
is the
of the humanities in
mental health care, and perhaps in medicine in general. To psychopathology,
being sick is a subjective experience of the person. Psychopathology has as its
centre the experiencing person and subjective experience. e psychopatho
logical discourse is about understanding a given type of experience and the
world in which it is situated.
is obviously does not exclude seeing abnormal phenomena as symptoms
caused by a disease to be cured, but it includes the exploration of personal
meanings next to the hunt for causes. e patient is an active partner in the
able embodied self, on the one side, and the sick person trying to cope with
and make sense of her disturbances and complaints, on the other. ere is no
need to import new disciplines into the training curricula. We just need to give
psychopathology the place it deserves.
old woman reports that since she was about thirty she has been shocked
by inexplicable ‘strange bodily sensations’. She does not know what these mysterious
ey seem to show up in her as if coming from an alien place. ese feelings are
extremely distressing for her and led her to a state of profound somato-
and allo-
psychic depersonalization—
body and self-
world falling apart. is state of
depersonalization recently developed into a full-
blown episode of euphoricmania.
and the ‘orgasms’ she has when ‘telepathically’ in contact with me. She rst wants me
to conrm that when she’s having her ‘orgasm’ Iam thinking of her. She thinks Iam
‘the author’ of these ‘orgasms’, that Iwillingly ‘send’ her these sensations. She texts
me several times to ask me if in that very moment Iam telepathically making love
person perspective her beliefs and feelings as they occur during these crises. e
outcome of my availability is that she soon develops an erotomanic delusion about
me. She mistakes my availability for an erotic interest.
Later she reconsiders her beliefs about telepathic connections when she fears that
her death ‘premonitions’ about me may cause me harm. She asks me to be reassured
that no such things like telepathy are possible at all. Iexplain that she cannot harm
me telepathically, but that she is ‘harming’ me by reducing my freedom with all her
‘projections’ on me. Iexplain that she is attributing to me intents that are not mine
and that she is imposing on me a kind of image with which Icannot identify.
A micro-
narrative linking her uncanny bodily sensations to her arousal in the
presence (or thought) of the therapist is patiently established. At this moment she
realizes that the strange bodily sensations aecting her were from the beginning
emotions taking place in the ‘I–
You’ relationship. Indeed, she realizes that they started
when she fell in love with a boy that she denes as ‘a schizophrenic’ because of his
ambiguous and cold behaviour. Areal relationship was impossible with that boy and
with that boy also happened aer she became emotionally involved in the therapeutic
relationship. She also realizes that she was overwriting on my person a ‘role and
intentions’ that were not my own. Only now she recognizes that what she used to call
‘orgasms’ are strong sensations of emotional arousal. She also recognizes that I(the
therapist) am not the author of her sensations, that they are not ‘made’ or imposed on
her by me. She nally acknowledges that these sensations are her own feelings, that
they arise when she is strongly involved with other people, and that they include a
mixture of excitement andfear.
She recovers a sense of being situated in the world and her experiences of being
telepathically in contact with her therapist gradually disappear.
is case study can be taken as the paradigm of two topics we developed earlier,
and of a third that will be the subject of this last section.
e rst topic is the centrality of alterity in the human condition in general,
internal and external alterity, and its connection with the vicissitudes of self-
and other-
recognition. is person is impaired in self-
recognition. She cannot
recognize the sensations that arise in her body as
her own
feelings. She fails to
recognize her feelings as her own, and to acknowledge that these feelings are
, that is, embodied motivations to act in a given way that arise from
the involuntary side of her person. Emotions (as we saw in the rst part of
experience. It involves a permanent confrontation with the alterity that becomes
manifest in emotional experience, that is an inescapable part of the person that
Iam. Lacking this capacity for self-
recognition, our patient undergoes a state of
profound depersonalization whereby she feels alienated from herself (not only
from her body) and passive with respect to other persons.
is lack of self-
recognition implies the lack of other-
recognition. She fails
to understand that her bodily sensations are emotions. She also fails to recog
nize that these sensations are elicited
the I–
You encounter, and she mistakes
them as voluntarily produced
the other persons. Being unable to decipher
her emotions, she cannot orientate herself in the I–
You encounter. She cannot
recognize the alterity of the other person, that is, the unfathomable complex
ity of the Other and the Other’s
. Hence, she experiences the others
as impersonal entities who behave with each other in a mechanical way. Her
former boyfriend and her therapist are reduced to some sort of machines pro
ducing uncanny feelings, and in particular as ‘orgasm machines’. e thought
ful behaviour of the therapist is mistaken for a sign of erotic involvement. She
nally constructs persons as entities who can only manipulate each other’s bod
ies at theirwill.
Also, this patient’s story is paradigmatic of the importance of the teleology of
tive nosology in the previous chapters centred on the idea that
mental disorders
can be read as failed attempts to come to terms with the wounds inicted by Eros
e discourse about mental disorders can neither simply assume the centrality
of a missed encounter with alterity as an unsexed entity, nor can it reduce the
agony of Eros to an unfullled sexual drive. Eros is the principle of opacity in
human life, the epicentre of human suering and pathology, since it includes
organic as well as spiritual values:the need for sexual satisfaction as well as for
recognition, for lust and for intimacy, for possession and for proximity. In short,
Eros is the principle of human vulnerability, for it bases its aspirations on the
conicting values of identity and of alterity. As Ricoeur putit,
Eros carries in himself that original wound which is the emblem of his mother, Penia.
And this is the principle of opacity. To account for the aspiration for being, we need a
root of indigence, of ontic poverty. Eros, the philosophizing soul, is therefore the hybrid
par excellence, the hybrid of Richness and Poverty. (1987, p.10).
Love is also the hybrid of reality and imagination. e lover’s discourse
adheres to the image like a glove, much more than it adheres to the loved one
its object is not the clinician as a person, but an idol, a phantasm, an unreal
object. Focusing on the image of the Other, rather than on the esh-
Other is not just the case with erotomanic desire, but a general rule of the tel
eology of desire. Desire is directed to an idol fabricated by the mind. is idol
on the esh-
blood Other, disregards the Other’s freedom not correspond
ing to her own desire, and her incapacity to tolerate this. Mental pathologies can
be seen as miscarried attempts to seek refuge in vulnerable shelters as a defence
from the missed encounter with theOther.
Last but not least, this case study is also paradigmatic of the vicissitudes of
Eros that are enacted within the therapeutic relationship. In the previous sec
tions, Ihave argued that to be human is to be in dialogue with alterity, and that
mental pathology is the outcome of a crisis of one’s dialogue with alterity. is
whose aim is to re-
enact one’s interrupted dialogue with alterity. In the next
chapters, Iwill open the toolbox and describe the instruments that are at work
in the therapeutic relationship. As it is clear from this example, these include
devices and practices that belong both to
the Other’s life-
world and to rescue its fundamental structure—
e.g. the readiness to oer oneself as an object for the Other’s manipulations
and the capacity to resonate with the Other’s experience and attune/
the emotional eld. Iwill call these two complementary sides of therapeutic
dialogue ‘logocentric’ and ‘anthropocentric’. Whereas the rst is the search for
the precise description of a given phenomenon of experience and an agreement
about it, the second consists in a shared transcendental commitment to cross
act:the sharing of an intention whose transcendental referent is not a fact, but
the relationship itself.
e person-
centred, dialogic approach Iwill describe is sensitive to the consti
tutional fragility of
we are and thus conceives mental pathology
as the result of a normative vulnerability intrinsic to being a human person.
It also insists that to assist a suering person is to help that person with the
responsibility involved in what she cares about. To help a suering person is
to deal with the obscure entanglement of freedom and necessity, the voluntary
and involuntary, that is the result of the collapse of the dialectic of selood and
e psychopathological congurations which human existence takes on
in the clinic are the outcome of a miscarried hermeneutic of one’s abnormal
experiences and of the transformations of the life-
world that they bring about.
extreme disproportion of experience and understanding, of emotions and
rationality, of
sis of the life-
world; (2)a miscarried auto-
hermeneutics of the transformed
world; (3)the xation in a pathological life-
world in which the dialogue
is understanding of our vulnerability to mental illness contains a frame
work for engaging with this fragility by means of therapy. e aim of such a
therapy is to re-
establish the dialectic of selood and otherness that will allow
the suering person to become who she orheis.
e main principles of this approach can be summed up as follows:
It focuses on the patient’s subjective experience as the point of departure of
any clinical encounter.
It encourages the patient to reect upon his experiences, express them in
a narrative format, and identify a core-
meaning, or meaning-
around which his narrative can become meaningful forhim.
It supports the patient in making explicit his personal horizon of meaning
It suggests the clinician’s making explicit to the patient his own understand
ing of the patient’s narrative (assumptions, personal experiences, beliefs).
assumptions, personal experiences, values, and beliefs explicit (at least, that
part that is relevant for therapeutic purpose).
e clinician promotes a reciprocal exchange of perspectives and emotions
with his patient, as well as the shared commitment to co-
construct a new
meaningful narrative that includes and, if possible, integrates contributions
from both the original perspectives.
e clinician tolerates diversity and potential conicts of values and beliefs.
Finally, the clinician facilitates coexistence, when it is not possible to estab
lish consensus.
e practice of care that derives from this is based on the integration of three
basic dispositives, synthesized in the acronym P.H.D.:
Phenomenological unfolding
(P):e basic purpose is to empower clinicians and
patients with a systematic knowledge of the patient’s experiences. is is done
through a process of unfolding, which means to open up and lay bare the pleats of the
patient’s experiences. What comes into sight is the texture that is immanent in the
patient’s style of experience/
action, although it may remain invisible to or unnoticed
by her. Unfolding enriches understanding by providing further resources in addition
to those that are immediately visible. e main aim of this process is to rescue the
of the phenomena in themselves, which is immanent in the intertwining of phe
nomena. But it also helps to recover the implicit (not necessarily rejected), automatic
(not censored), forgotten (not forbidden) sources that make phenomena appear as
they appear to the patient, his drives, emotions, and habitus—
the three emblematic
components of the obscure and dissociated spontaneity that make up the involuntary
dimension in human existence.
Hermeneutic analysis
of the person’s position-
taking towards her experience
the person and her basic abnormal experiences. As self-
tinuously strive to make a
out of
. Attention is paid to the active role that
the person has in taking a position and interacting with her abnormal, distressing, and
dysfunctional experiences. e patient, with her unique strengths and resources as well
as her needs and diculties, has an active role in shaping her symptoms, course, and
outcome. Rescuing from the implicit the active role that the patient has in shaping her
symptoms is the
via regia
that helps the patient recalibrate her dysfunctional, miscar
ried position-
taking and, nally, to recover her sense of responsibility and agency.
Dynamic analysis
of the life-
history in which experiences and position-
taking are
embedded (D):To make sense of a given phenomenon is nally to posit it in a mean
ingful context, and this context includes the personal history of the patient. e basic
presuppositions of psychodynamics, endorsed by the P.H.D.system, are psychological
psychological events (including those that look inconsistent) are lawful and potentially
meaningful in a particular way for that person. e latter presumes that all psychologi
cal events have at least as one of their causes a psychological cause and can thereby be
explained on a psychologicalbasis.
A phenomenologically–
dynamically oriented framework for
care includes ve steps corresponding to ve levels of meaningfulness.
Unfolding the phenomena of the life-
world and rescuing its implicit structure
:e rst
the explication of the case material. Unfolding means to exposit, open up, or lay
bare the pleats, creases, or corrugations of a text. e opposite of this is to garble, per
vert, distort, or twist/
that is immanent in the text itself, although it may remain invisible to or unnoticed by
the author. Explication enriches understanding by providing further resources in addi
tion to those that are immediately visible. e product of unfolding is a text that reects
the phenomenal world, the world as it appears to the subject of experience, including
logical text, there is much more than what can be mapped using the catalogue of psy
chopathological symptoms (like phobias, formal thought disorders, or delusions). e
aim of this process is to rescue the
of the phenomena in themselves, by “bring
ing unnoticed material into consciousness”—
as Jaspers (1997, p.307) would put it.
that is immanent in the intertwining of phenomena is called sense, i.e. the
nomena found in a given condition of suering. Phenomenological psychopathology
advocates the idea that the phenomena embedded in a given (normal or abnormal)
form of existence are a meaningful whole. is has an important clinical implication.
e standard understanding of the concept of ‘syndrome’ in psychiatry is one which
phenomenological implication, but by their being otherwise unrelated eects of a
common neurobiological cause. is alternative perspective holds that the manifold
(abnormal) phenomena in a syndrome are meaningfully interconnected, that is, they
form a structure. Apsychopathological syndrome is not simply a casual association of
(abnormal) phenomena. To have a phenomenological grasp on these phenomena is to
grasp the structural nexus that lends coherence and continuity to them, because each
phenomenon in a psychopathological structure carries traces of the underlying formal
alterations of subjectivity.
note that this process of unfolding is profoundly rooted in hearing—
or even
kind of seeing implied in this practice is—
to adopt Levin’s (1988) distinction—
inclusionary, horizontal and caring” (Jay, 1994, p.275). Hearing contributes to
knowledge focused on subjective experiences and personal narratives.
Rescuing the implicit structures of the self
:e second stratum made visible by this pro
cess consists of the invisible conditions of possibility of the world disclosed in the rst
level. By rescuing the map of the world that is depicted in the text, we can approximate
the architecture of the mind that projected it. is is an exploration of the implicit
structures of experience, or into the structures of the self as the tacit and pre-
conditions for the emergence of mental contents. It looks for the way the self must
be structured to make phenomena appear as they appear to the experiencing self.
Looking for structural relationships consists in the unfolding of the basic structure(s)
of subjectivity, that is, the way the self appropriates phenomena. e guidelines for
reconstructing the life-
world a person lives in are the so-
, the basic
categories, or categorial characteristics, of the fundamental features of human exist
ence, namely, lived time, space, body, otherness, materiality, and so on (Heidegger,
2010). In this way we can trace back this transformation of the life-
world to a specic
conguration of the embodied self as the origin of a given mode of inhabiting the
world, and perceiving, manipulating, and making sense of it. In order to grasp the
transcendental framework of one’s experience, one must turn one’s gaze away from
one’s ‘mind’, and also from the ‘world’ as it appears in straightforward cognition, and
look for the world’s spatiotemporal architecture which reects it. e reconstruction
of the patient’s life-
world, and of the transcendental structures of his self, allows for
the patient’s behaviour, expression, and experience to become understandable.
Narrating the transcendental origin of the life-
:is kind of practice connect
ing a given experience (abnormal or not) with its transcendental condition of possi
in psychopathology was opened by Jaspers, who described it as the “[i]
nner, subjec
according to Jaspers, is a kind of knowledge that establishes meaningful connections
other in a way that we can immediately understand. For instance, we immediately
understand that attacked people become angry and spring to defence, or a cheated
understanding of morality as connected to weakness:the awareness of one’s weak
in this roundabout way the psyche can gratify its will to power. Jaspers oers several
tions and the development of passions. Jaspers insists on the character of immediate
ness and self-
evidence in grasping meaningful connections in someone’s life. To him,
meaningful phenomena (
) just as the reality of perception and of causality is the
precondition of the natural sciences” (ibid., p.303).
Husserl also developed, beyond static or descriptive phenomenology, another
(Sass, 2010). is is a kind of developmental or diachronic understanding stud
ying the way complex modes of experience are constituted via the synthesis of
more basic modes or lived experiences. e key dispositive of Husserl’s explana
tory phenomenology is motivation or motivational causality. It has been argued
that “analyzing the basic constitution and explicating the implicit structure of
experience, phenomenology oers another way of developmental understand
ing:it allows for a comprehension of the pre-
reective dimension of experience
) from which manifest symptoms arise” (Parnas and Sass, 2008, p.280). In
this way, the dialogue moves beyond pure description and static understanding
towards “an understanding of both the overall unity of that person’s subjectiv
ity and its development over time” (ibid., p.264). is kind of narrative, based
on the understanding of the basic architecture of the life-
world, and on the
structures of subjectivity which allegedly generate them, may allow us to both
make sense of (rescue the personal meaning) and explain (rescue the personal
motivation of) a given symptom, be it an action or a belief.
Appropriation (by the clinician) of the patient’s life-
:e fourth level of meaning
fulness made manifest by this exploration is the world that the text opens up in the
patient when it is appropriated by the interviewer. e clinician appropriates the sense
of the patient’s experience and suggests his view of it. To appropriate a text means to
acknowledge the way the text belongs to the reader, the way the reader could inhabit
as his own, that is, the vantage point from which he sees the patient’s situation. is
in this way, the clinician may become a ‘You’ for his patient. e clinician appropri
ates the patient’s world by means of his own imagination when he tries to reply to the
question:‘To make sense of the patient’s otherwise absurd and otherwise meaningless
behaviour, Imust imagine myself as if Iwere living in a world that has the following
characteristics’. is approximation to the patient’s life-
world is carried out by the clini
cian via as-
Grasping the importance of the patient’s life-
:We have seen that the meanings
that we nd in a text may exceed the intention of the author. is is the case with the
parapraxis, and more generally for any kind of symptom. By unfolding the structures
this process of unfolding, the text lays in front of its author who can adopt a third-
person stance over the text itself—
and in the case of the symptom the patient can take
a reexive stance over the feel and the meaning of his experience, thus reinforcing his
subjective and intersubjective sense of being a self. e importance of a text reaches
beyond this level of understanding and discloses the mode of being in the world of
that individual patient as a universal problem. It reveals the way his existence belongs
to human existence as a whole, to the
condicio humana
. e text may display meanings
that transcend the situation in which the text was produced. To grasp the importance
of a text is to unfold “the revelatory power implicit in his discourse, beyond the limited
horizon of his own existential situation” (Ricoeur, 1981, p.191). e importance of a
text is what “goes ‘beyond’ its relevance to the initial situation” (ibid., p.207). In virtue
of its importance, a text acquires a universal (not merely contingent) meaning, and its
author embodies a universal problem (he stops being a merely contingent suerer).
With all this in place, care focuses on ve basic domains of analysis:
(1) e patient’s personal style of experience and action:It consists in an in-
depth, tactful exploration of the patient’s experiences, perceptions, feelings,
emotions, cognitions, and actions, of the personal meanings that the patient
attributes to them, and of the life story in which they are embedded (it corre
sponds to the outcome of the P.H.D.exploration).
existential crisis or psychopathological decomposition. e notion of situation
shows both the active role (the person actively concurs in creating the situa
tion) and the passive role (the person does not consciously intend or desire
which the housing of everydayness and commonsensical assumptions of the
world are jeopardized and the vulnerable structure of the patient comes
to light. Limit-
situations uncover the basic conditions of existence, that is, its
oer the person the possibility to know and to become herself.
(3) e patient’s vulnerable structure:It indicates a signicant combination of
stable characteristics that make up the ontological constitution or core
around which the vulnerability of the person is organized. e role that the val
ues have in putting the meaning of existence per se into order is stressed. Values
are attitudes that regulate the signicant actions of the person, being organ
ized into concepts that do not arise from rational activity but rather within the
sphere of feelings. ey are organized according to the ontological constitution,
that is, from a certain type of relationship that the person has with him/
with others, and with theworld.
(4) e therapeutic situation:It aims to make visible what happens in the
clinician, in the patient, and in the situation in which both are embedded and
a typical physiognomy for the clinician and for the patient that can be acknowl
edged, described, and analysed. e therapeutic situation may actualize ways
of being with the other in which thoughts, memories, emotions, values, and
expectations of both the clinician and the patient are enacted. It is a protected
experiment of we-
ness during which hidden aspects of being with the Other
can become explicit objects of visioning and discourse.
(5) Finally, the re-
construction of the patient’s world-
project:It is assumed
that psychopathological phenomena are the outcomes of a disproportion
), emotions and
rationality, otherness and selood, and the consequence of a miscarried self-
tional world-
project maystart.
Empathy andbeyond
According to Jaspers, psychopathology has two major aims. First, it oers “clar
into the chaos of disturbing mental phenomena. e second, and perhaps more
important, aim is “psychopathological education” (ibid., p.50), i.e. endowing
with a philosophically sound background for the encounter with their patients.
is second aim involves two basic features:(1)to render clinicians more aware
of the characteristics of the tools they use when trying to grasp, assess, and
make sense of their patients’ experiences and behaviours; and (2)to point out
the limitations of these tools. In Jaspers’ sense, psychopathology is the explora
two distinct but interrelated endeavours:one is empathic understanding, and
phenomena. When combined, these endeavours bring into focus the
object of
, i.e. the patients’ abnormal experiences lived in the rst-
person perspective
and embedded in anomalous forms of consciousness and existential patterns.
Jaspers characterizes his conception of empathic understanding in the fol
lowing way:“Since we never can perceive the psychic experiences of others in
any direct fashion, as with physical phenomena, we can only make some kind
of representation of them. ere has to be an act of empathy [
ein Einfühlen
], of
understanding” (ibid., p.55). Empathic understanding can be characterized as
a particular kind of intentional experience in which my perception of the other
person leads me to grasp (or to feel that Igrasp) his personal experience, and
to feel that—
and how—
he is an embodied person like me, animated by his own
feelings and sensations, and capable of voluntary movements and of expressing
his experience.
Jaspers’ conception of empathic understanding is clearly guided by a phe
our attempt to access the disordered mind:“is phenomenological attitude
a continual onslaught on our prejudices” (ibid., p.5). Nevertheless, empathic
understanding as a phenomenological attitude can, for Jaspers, only be a rst
descriptive step that needs to be combined with a second explanatory attempt
to make sense of the “basic patterns of human life” (ibid., p.31). In other words,
empathic understanding is a necessary but insucient means in our approach
to the mind of other people, and to abnormal mental phenomena in particular.
Phenomenological accounts of empathy are an integral part of the more gen
eral debate in contemporary philosophy about how to understand the mental
life of other people (Gallagher and Zahavi, 2012; Overgaard, 2012; Ratclie,
2007). Empathy is a highly controversial notion with a relatively short concep
tual history (Strueber, 2006). Coined and introduced into the English language
by Edward Titchener in 1909 as the translation of the German word
(‘feeling into’), the notion of empathy has had a rather turbulent life in the phil
osophical discussions of other minds. Having been considered the principal
means of assessing and understanding the mind of others in the initial decades
with renewed force in the contemporary discussions about folk psychological
mindreading and the so-
called mirror neurons.
Two main approaches to interpersonal understanding have dominated the
debate for years:theory-
theory (TT) and simulation-
theory (ST). Although
both theories come in various shapes and forms, it is possible to glean a basic
claim constitutive of each approach. While TT operates with the idea that we
and Stich, 2003), ST argues that we do not theorize about the mental life of
another person but use our own mental experience as a model for what goes
on in the mind of another person (Goldman, 2006). e phenomenological
proposal diers from these two inuential accounts in several ways, but par
ticularly with respect to one basic assumption. ST and TT operate with a sharp
mind and how this internal aair is expressed in external bodily behaviour.
While TT and ST both assume that the mind of another person is entirely hid
den from me and therefore inaccessible to anyone other than the experiencing
person herself, the phenomenological proposal argues that a sharp distinction
rientially unwarranted (Gallagher and Zahavi, 2012), and that such a view is
to our conception of empathy (Gallagher, 2012; Zahavi, 2001). Aphenomeno
logical approach is therefore opposed to TT and ST, and to any theory that
wants to explain our understanding of others as primarily a matter of rst per
ceiving the bodily behaviour, and then theorizing (TT) or simulating (ST) that
behaviour as caused by inner mental states similar to those that cause the same
kind of behaviour for ourselves.
Jaspers’ concept of empathy goes in a quite dierent direction and is based on
three main assumptions.
First, empathy is a matter of direct perception. Rather than relying on cogni
tive processes such as inferences, projections, or simulations, we have a pre-
reective experiential understanding of other people that is constitutive of our
experience of the world and ourselves. at is, seeing other people as intentional
creatures, as opposed to mindless creatures or inanimate objects, is constitutive
of how we perceive the world. is is not to say that we experience other peo
ple as we experience ourselves. First-
person experience of thoughts, feelings,
and desires is basically dierent from second-
(and third-
)person experience of
those psychological states, but my experience of another human being is never
theless perceptually more intimate than my perception of, say, a dog or a coee
table, in that Iperceive the other person as endowed with experiential features
similar to my own. Hence, my experience of other persons is not an experience
of the matter, movements, and interactions of meaningless objects. Rather, it
is an experience of particular expressive phenomena. Isee the expressions of
another person as meaningful human behaviour because “expressive phenom
ena are already from the start soaked with mindedness” (Zahavi, 2001, p.55).
Empathy is the basic dispositive through which we understand the Other’s
mind. When we come to understand the Other’s state of mind, since we cannot
directly perceive their state of mind, we approach it through the Other’s
. In the clinic, empathic understanding relies on a dissection and
explication of the patient’s eld of consciousness as recounted by the patient
himself, the aim of which is to bring into view his subjectivity. e basic pur
pose is to empower clinicians with a systematic knowledge of the patient’s expe
riences as recounted by the patient. is is the task of phenomenology
phenomenology (
actually experience. It reviews the interrelations of these, delineates them as sharply as
possible and creates a suitable terminology. We conne ourselves solely to the things
that are present to the patients’ consciousness. Conventional theories, psychologi
other minds. How successful a genuinely theory-
free approach can be in the
face of arguments as to essential theory-
ladenness of data is a matter of debate
(ornton, 2007). is is the third point of Jaspers’ concept of ‘empathy’. It
described the phenomenological approach to the meaningful expression of
other people as the attitude that clinicians must constantly acquire in their rela
tion to their patients:
As children we rst picture the things not as we see them, but in the way we think
them; likewise as psychologists and psychopathologists we pass from a level on which
we somehow think the mental, to an unprejudiced and immediate understanding of
the mental as it is [
zur vorurteilslosen unmittelbaren Erfassung des Psychischen so
wie es ist
]. And this phenomenological attitude is a constantly renewed eort and
an acquired good which demands a constant overcoming of prejudices. (Jaspers,
1963, p.318)
e condition of possibility of the intuitive experience of the other person’s
mental life is the phenomenological
, that is, the capacity to become
aware of one’s own pre-
existing mental images that aect the way we resonate
with the Other and nally, the way we experience the fundamental emotional
and cognitive features that constitute the Other’s life, such as his beliefs and
desires (Jaspers, 1997, pp.93–
states (ibid., pp.108–
17). Empathic understanding, then, is a way to bring into
“phenomenology actually designates just what is immediately given [
bar Gegebenes
]” (Jaspers, 1963, p.32), and to understand empathically is to
insist on and give radical attention to the irreducible and ultimate character of
this givenness of human existence.
out the core of this conception of empathic understanding. e most basic
form of empathy does not require any voluntary and explicit eort. We may
call this type of empathy, which is at play from the very beginning of our life,
a kind of spontaneous and pre-
embodied selves through which we implicitly make sense of the Other’s behav
iour (Rochat, 2009; Stern, 2000). But in some cases the Other’s behaviour
becomes elusive:while performing this act of imaginative self-
transposal, we
experience the radical un-
understandability of the Other. In some cases—
maybe the most relevant in clinical practice—
we do not feel immediately in
touch with the Other, we do not immediately grasp the reasons and meaning of
his actions, and as a consequence we purposively and knowingly attempt to put
ourselves in his place. While attempting to transpose ourselves into the Other,
we experience the radical otherness of the Other. In this vein, early clinical
phenomenologists (like Jaspers) and early psychoanalysts (like Freud) rejected
empathy as an adequate tool for understanding the subjectivity of patients
aected by severe mental illnesses like psychoses.
In these situations, while we experience the limitations of this mode of under
standing, we deliberately put forward all our eorts to thematically understand
the other person. Whereas nonconative empathy mainly involves the implicit
nating body:it puts into play my personal past experiences and my personal
knowledge of commonly shared experiences (common sense). Conative empa
thy is, then, a more cognitive and reective task than nonconative empathy
as conceived in phenomenology. Here Iactively look inside myself for stored
experiences to make them resonate with those of the Other. It implies a kind
of understanding by analogy. An important epistemological concern arises
here:How do Iknow that Iam not projecting my own experiences onto the
do Iknow that the Other wants to be understood by me, i.e. assimilated to my
own experience?
aspects of the attempt to understand the other person by means of analogy.
His concern for both these aspects of our endeavour to empathically under
stand the other person’s mental life is closely connected to the basic concep
tion of what it means to be a human person developed in the rst section of
this book. In fact, Jaspers, like his favourite past philosophers—
Kant (1996)
and Kierkegaard (1980) (and Levinas (1969) aerwards)—
argues that human
nature must be understood from the normative perspective of an indenable
and restless
(Batthyány, 2011):“Know thyself is not the demand to
look in a mirror in order to see who Iam, but to work on myself so that Ibecome
who Iam” (Jaspers, 1956, p.37). In other words, being an individual person is
not a fact, but a constant task of becoming who Iam (Stanghellini and Rosfort,
2013a). Being a human person is trying to exist as myself in and through the
challenges of all those features that make up what Iam (my facticity, e.g. my
brain, my past, my parents, my nationality, my job), but which cannot dene
who Iam. is philosophical conception of human nature as “an unending
processual movement” (Seubert, 2011, p.69) is part and parcel of Jaspers’ psy
chopathology. e limits, and dangers, of empathy—
nonconative as well as
stem from this ‘original source’ of autonomy that makes the person
in front of me into the unique and irreplaceable individual that he or she is. e
suering of illness that this person undergoes consists, so Jaspers argues, in a
constant “comprehending appropriation of it, relating to the foundations of
the patient’s own true existence” (Jaspers, 1997, p.426). e fact that a human
person is more than what we can describe, explain, or predict ensures that my
understanding of a person—
myself as well as the Other—
basically takes place
against a background of incomprehensibility. is is not to say that our endeav
ours to empathically understand the other person are epistemologically in vain
us human. Jaspers simply insists that without acknowledging the irreducible
autonomy of the other person in our attempt to empathize with her we slide
border that separates respectful care from explanatory patronizing.
the contrary, while discovering the limits of empathic understanding we real
ize that we need to adopt a dierent approach if we want to move towards and
try to understand the patient’s experiences. Jaspers’ attitude towards knowl
edge in general consists in the idea that all knowledge must have an asymptotic
character:“In the instantaneous certainty the humility of an enduring ques
tion is indispensable” (Jaspers, 1950, p.68). In other words, Jaspers’ “theorem
of incomprehensibility” is not a defeat of understanding, but Jaspers’ way of
ensuring that “understanding stays inside the sphere of possibility”, and “oers
itself in a tentative way and remains mere proposition within the cool atmos
phere of knowledge that comes from understanding” (Jaspers, 1997, p.359).
posal for how to conceive of empathic understanding. In the next chapter, Iwill
Understanding severe aberrations of experience requires a kind of training
that goes beyond a conception of spontaneous nonconative empathic skills,
and at the same time avoids the pitfalls of conative empathy based on the
clinician’s personal experiences and common-
sense categories. e achieve
ment of this training can be named
order empathy
(Stanghellini, 2013a,
2013b). To achieve second-
order empathy is a complex process. First of all
Ineed to acknowledge the autonomy of the other person, and consequently
that the life-
world of the other person is not like my own. Second, Imust learn
to neutralize my natural attitude that would make me try to understand the
other’s experience as if it took place in a world like my own. ird, Imust try
to reconstruct the existential structures of the world the other lives in. Fourth,
Ican nally attempt to understand the other’s experience as meaningfully situ
ated in a world that is indeed similar to my own, but also constantly and indel
ibly marked by the other person’s particular existence, and by that person’s
endeavour to become who she or he is. e supposition that the other lives in
a world just like my own—
i.e. he experiences time, space, his own body, oth
Take the example of lived time:existential time—
as Erwin Straus (1967) wrote—
can be lived as growth and fullment, whereas an old man may live it as consumption
and decline. An anxious person may be aicted by a feeling that time vanishes, inexo
rably passes away, that the time that separates her from death is intolerably shortened.
Another patient in an early stage of schizophrenia may experience time as the dawn of a
what is really relevant is not already there, but is forever about to happen.
In order to empathize with these persons, Ineed to acknowledge the existential
dierence, the particular autonomy, which separates me from the way of being
(but we would say, also,
mutatis mutandis
or an old man’s world), will be an obstacle to empathic understanding since these
people live in a life-
world whose structure is (at least in part) dierent from my
own. Achieving second-
reexive, natural attitude (in which my rst-
order empathic capacities are rooted),
including my own way of experiencing time, and to approach the Other’s world
as Iwould do while exploring an unknown and alien country. As Jaspers writes:
cover a continent; every landing on a shore or island will teach certain facts but the
possibility of further knowledge vanishes if one maintains that here one is at the centre
of things; one’s theories are then like so many sandbanks on which we stay fast without
really winning land. (Jaspers, 1997, p.751)
e other person is not simply an alter-
Ego, i.e. someone like me. He or she is
an autonomous person whose existence constantly disrupts my understanding
of who she is. We live in a common world constituted by the basic intersubjective
structures responsible for how we experience and interact with the world. is
remains the rm background against which we should approach the question
of interpersonal understanding. By insisting on the irreducible, and basically
incomprehensible, individual character of every person’s life-
world, Iargue that
the particular life-
world of a person is forever beyond my empathic endeavours,
conative as well as non-
conative. In other words, I—
as did Jaspers, as a phi
losopher and as a psychopathologist—
presuppose dierence rather than resemblance in my endeavour to understand
the risk of reducing the Other to my experience of her, i.e. depriving her of her
status as, and her right to be, an individual person. With Jaspers, incompre
human existence as basically an indenable and restless autonomy that escapes
denitive knowledge.
Jaspers’ ill-
famed theorem of incomprehensibility, if viewed from this per
spective, provides the basis for a respectful attitude in clinical practice, as well as
in human aairs in general, that enables us to care for the Other as another per
the stage for an authentic dialogue as the prerequisite for understanding the
Other’s existence. We named this approach to other people second-
order empa
thy. e achievement of second-
order empathy is a complex process based on
other person’s life-
world. is paves the way for exploring and reconstructing
the implicit, transcendental structures of the other person’s subjectivity under
lying the manifold phenomena and symptoms.
order empathy
A woman in her forties, hospitalised in a surgery ward of a general hospital, behaves
restlessly, and is impatient, irritating, and complaining. She attacked a nurse for
no apparent reason when she tried to give her medication, refuses drugs, makes a
continuously looks for attention, and tries to manipulatethem.
Some qualify her behaviours as ‘acting out’, saying that she behaves thoughtlessly
and impulsively.
You, as a clinician, are asked to interview the patient. During the interview you
exclude all sorts of disorders of consciousness (e.g. lowered, clouded, narrowed, or
psychotic phenomena (e.g. delusions, hallucinations). Feeling more at ease, at a given
point the patient tries to clarify:‘Nobody wanted to explain to me what was going on.
Icould not understand what they were doing to me. Everything was so obscure. Ifelt
nervous, worried about that. Ijust wanted to know. Do Ihave the right to know and to
decide? Or should Igoaway?’
thereof. What is the purpose of this behaviour, if any? What is itabout?
e rst reaction is deeming her behaviour ‘irrational’, ‘illogical’, and ‘unmotivated’,
thus ‘incomprehensible’ and ‘almost crazy’. e majority, aer further reection,
suppose that her intention is ‘manipulating’, ‘controlling’, or ‘manoeuvring’. Someone
more soly assumes that she tries to ‘persuade’ the nurses to act the way she wants. As to
her innermost reasons for behaving in this manner, some conjecture that it is because of
her ‘need to dominate’ the others. Adoctor speaks of ‘sadism’—
from harming the Other. Someone speculates that she may be driven by her ‘fear of the
Other’ and her ‘need to control’ the Other who is supposed to be harmful. ‘Egoism’ is
another nurse’s explanation for the patient’s comportment—
she has no concern for the
In order to answer the question about the motivation or purpose of the patient’s
you explain—
we need to consider the case from another angle:What
kind of experience underpins this behaviour? Does the patient experience that given
being hospitalised in a surgery ward—
as we do, or as we could expect
ourselves, or ‘everyman’,todo?
behaviours is labelled by the term ‘manipulation’, both in clinical and non-
situations. is word is used to stigmatize morally wrong ways of interacting,
relationships, corruption, creating divisions, conning and lying, deceiving, and
threatening (Potter, 2006, 2009). Manipulativity, although not an ocial diag
nostic criterion for borderline personality disorder, is oen used by clinicians
to deplore the way in which these persons interact with others. Manipulation in
people with borderline personality disorder is deemed deliberate and morally
blameworthy rather than ill. Also, it is considered maladaptive since it reduces
the other person’s empathy towards the manipulator, undermining his/
her des
perate search for relationships and attention. us, manipulation is a term that
tends to be over-
inclusive and is aected by conceptual cloudiness, conating
moral values with clinical judgement.
Potter proposes a working denition of ‘manipulativity’ that can be summed
up as follows:it is a behaviour that dramatizes the manipulator’s needs/
order to eect desirable responses by the other in an indirect way, although
the other feels/
thinks that the manipulator is overdoing his/
her own need/
emotion, s/
he (the Other) feels trapped by them (Potter, 2009, p.109).
is denition highlights the alloplastic purpose of manipulativity:produc
ing a belief in or action by the Other. is is only one side of the coin. Acom
plementary aspect of manipulative behaviour is that manipulation can serve
an epistemic, rather than alloplastic, pragmatic motif—
the attempt to establish
contact with the Other in order to achieve a more distinct experience and rep
resentation of the Other. is tentative hypothesis is based on the meaning of
manipulation as touching (
=hand) in infant behaviour where manipula
tion is a means to explore, rather than a way to modify the other’s state ofmind.
Reecting upon these issues produces more questions:Is this behaviour
embedded in a life-
world like our own? Does the patient’s life-
the real
ity she lives in, her experience of the surrounding world—
bear some analogy
with the life-
world we live in? Or is it, in part, dierent from our own life-
world? And in the case that this behaviour was the expression of a dierent life-
world, of a kind of world in its own right but unlike our own, what can we do
world and the Other’s, which makes understanding and communication
dicult, be overcome? Andhow?
‘shock experience’ kindled by the patient’s behaviour, that her conduct must be
situated in a life-
world that does not (at least, in part) overlap with our own.
If so, in what sort of life-
world is this behaviour embedded? Before answer
ing this question, we need to clarify a preliminary issue:What do we mean by
world’, and why is that concept relevant for us? is is the denition of
world’ by Schütz and Luckmann (1973):“e reality which seems self-
evident to men remaining within the natural attitude. is reality is the every
day life-
world. e region of reality in which man can engage himself and that
can change while he operates in it by means of his animate organism”. e life-
world is what each of us takes for granted as the objective reality and meaning
of the surrounding world—
at least until we reect upon the way in which we
contribute to establishing this ‘objectivity’ and meaning. Although the major
ity of people belonging to a given culture are situated in a shared life-
there are several other private life-
worlds that are dierent from the ‘every
day’ life-
world, e.g. fantasy worlds, the dream world, and what we may call
psychopathological worlds. Schütz and Luckmann (1973) further explain that
each life-
world is characterized by a given “pragmatic motive”, by a “meaning-
structure” and a “style of subjective experience”. e pragmatic motive is the
implicit or unconscious reason/
drive that motivates us to experience the world
and to construe its meanings in that given way. As a consequence of this, the
‘objects’ and ‘events’ which a person nds in his/
her life-
world are structured
according to a given style of experience that limits his/
her potential for free
us, the life-
world is a province of practice in which the structure of mean
ing is deeply intertwined with one’s necessity for action. Our previous question,
then, can be rephrased as follows:In what sort of ‘province of meaning’ and
‘style of subjective experience’ is our patient’s behaviour embedded? If we are
able to answer this preliminary question, then we will be able to render her
behaviour meaningful and understandable.
order to rescue its meaning we cannot conne ourselves to standard empathic
understanding (Stanghellini, 2000). We cannot simply rely on our spontane
ous capacity to put ourselves in her shoes, since the eect of her behaviour on
ourselves is rather one of rejection. It seems rather impossible to empathize
with this behaviour, at least in the standard meaning of this term; although
the patient herself said, ‘Nobody wanted to explain to me what was going on.
Icould not understand what they were doing to me’, and that is key to compre
remain dicult to empathize with her inability to grasp and make sense of what
was happening to her. What exactly does she mean by, ‘I could not understand
what they were doing to me?’, and why did she have that kind of experience?
It seems clear that her ‘experience’ of the situation was quite dierent from the
sta’s understanding. Instead, we need to seek another kind of understanding.
We need to rescue the implicit structures of her life-
world in order to make her
behaviour understandable. en, we can also try to empathize with it—
or, at
least, not to blame her forit.
behaviour was ‘manipulative’. Manipulation is usually understood as an allo
kind. As such, usually manipulative people are blamed for that. Anegative feel
ing (antipathy) and a negative-
value judgement (blame) stand in the way and
threaten attunement and understanding.
manipulation in this person is understood as explorative behaviour rather than
tion’. Touch is the primordial source of knowledge and acquaintance—
rough touch, we explore, inspect, scout, check, examine, and scrutinize the
world around us, including other people. Doubtlessly, this is childish behaviour
in a child as comportment that should be blamed or discouraged, since one
knows that this behaviour has a specic pragmatic motive and meaning in that
province of reality and meaning that we call ‘childhood’. Children live in a world
unlike our own; their practical possibilities for action are dierent from our
own. Time, space, and meanings are structured in a way dissimilar to our own,
as everybody knows—
and as masterfully described in the novel
e Child in
usually experience a feeling of sympathy and tenderness.
know the Other, and to make sense of the situation she is in? e related ques
tion is:What sort of experience/
representation of the Other and of the
situation does she have so that she needs to be manipulative?
In truth, we need to revisit what she said about that (although it appeared
quite obscure) before making the hypothesis that the meaning of manipula
tion was not manoeuvring the others, but rather an attempt at establishing
some sort of contact with the others by exploring their behaviour. Now it is
quite easy to see that manipulating for her is not just a strategy to control or
a quite clumsy way for our standards. Handling, laying hands on someone,
ngering, touching, contacting, feeling, stirring, tapping, caressing, sooth
although some of them may be annoying, exasperating, frustrating, and vexing
if performed by an adult and not by a child (or an animal, e.g. a primate) as we
would expect.
Seen from that angle, the manipulative behaviour of our patient stops being a
nuisance that has no clinical relevance. Rather, it becomes the mirror of her life-
ing that she inhabits. It becomes a phenomenon that speaks of her way of being
in the world and paves the way to our understanding of her being situated—
not simply a behavioural symptom to be eliminated.
e tentative hypothesis we explored—
based on the meaning of manipu
lation as touching and on child behaviour—
is that manipulation with some
patients may be more exploration, less modication, of theOther.
Of course, this is neither the only nor the ubiquitous meaning of manipula
tion, since manipulation in ‘healthy’—
and even in some ‘unhealthy’—
may very well be about modication. Although Ido not have the ambition
of establishing a ‘diagnostic criterion’, Isuggest that this side of manipulative
behaviour may be rather typical of people with borderline personality disorder.
Manipulation is oen a kind of behaviour attributed to people with severe
personality disorder, including borderline personality disorder. Of course, it
is not legitimate to make a diagnosis on the basis of one single feature, espe
cially if it is a behavioural one. What is at issue is the style of subjective experi
relevant about this, namely that she was unaware of ‘what was going on’, that
‘everything was so obscure’, and that she felt ‘nervous’ and ‘worried’ about that.
All this is not enough to reconstruct her style of experience. e appearance of
the Other as a dim and fuzzy person or as a tenebrous and suspect one is a key
feature of the life-
world of persons aected by dysphoric mood (Stanghellini,
2000; Stanghellini and Rosfort, 2013, 2013c). Although the term ‘dysphoria’, in
the narrower sense of irritable mood, is oen used to designate mood states in
dierent psychopathological conditions (including several personality disor
ders, aective disorders, organic psychoses, delusional disorders, and schizo
and not only in borderline personality disorder—
the quality and
the consequences of dysphoric mood in borderline persons is rather common.
Dysphoria is an unfocused mood and not intentional; it does not possess
directedness and aboutness. It is felt as unmotivated, rather indenite and
personality disorder exerts a centrifugal force that fragments their representa
tions of themselves and others, thus contributing to their painful experience
of incoherence and inner emptiness, their threatening feeling of uncertainty
and inauthenticity in interpersonal relationships, and their excruciating sense
of insignicance, futility, and the inanity of life. In the befuddled atmosphere
of their dysphoric mood, borderline persons oen experience their own self
as dim and fuzzy, feeling deprived of a dened identity and unable to remain
steadily involved in a given life project or social role. Dysphoric mood brings
about a formless and immaterial sense of one’s ownself.
Also, people aected by dysphoric mood may see others as cloudy, and their
faces as expressionless. e Other is an “expressionless face staring blankly at
my pain”—
as playwright Sarah Kane (2001)wrote.
In the penumbra of dysphoria, the Other may appear as the ‘shade of a
it is Aeschylus speaking here. To use the words spoken by the patients
dened, and out of focus. e following is a clinical example of that:
she lays her inanimate hand in mine and watches me in an interrogative way. During
the therapy session she sits restlessly, remains silent and answers my questions in a
provocative way. During one of the following sessions she explains that she needed to
test my interest in her, seeing if Ireally cared about her, and the extent of my intention
and capacity to understand her on her moodydays.
e indeniteness of the Other is the norm in dysphoria. When the dysphoric
mood turns into anger—
as is the case in people aected by severe personality
disorders like borderline personality disorder—
the Other changes from being
opaque to being tenebrous:he is ambivalent, obscure, puzzling, and suspect.
During another session, the same patient looks at me right in my eyes in an angry way.
She sits in a state of tension, as if she were on the point of attacking me. She remains
silent for the whole session and at the end she accuses me of being the source of her
problem, and being responsible for her feeling sobad.
What is relevant here is that when dysphoric moods fade away (and with them,
representation of the Other as a persecutor.
People aected by borderline personality disorder have biases in mental state
evaluate others as malevolent. Impaired social cognition or decits in ‘mentali
zation’ are hypothesized to underlie disturbed relatedness, a core feature of bor
relatedness, through impaired social cognition, is the outcome of dysphoric
a person in a kind of life-
world dominated by cognitive indecision and a lack
of grasp on the meaning of things and on the intentions of others—
as is indeed
the case with our patient. In this kind of world, the principal ‘pragmatic motive’
is to achieve a more distinct experience and representation of the world and of
other people. Manipulation, as the attempt to establish contact with others and
explore their behaviour, may serve this purpose.
Can we empathize with manipulation? Idescribed manipulation as an anti
manipulate others and this is an obstacle to empathizing with them and to
engaging in understanding the motivations of their behaviour. Rather, we are
tempted to stigmatize their behaviour. e most basic form of empathy does
not require any voluntary and explicit eort. We called this type of empa
thy (Stanghellini, 2007), which is at play from the very beginning of our life,
a kind of spontaneous and pre-
embodied selves through which we implicitly make sense of the Other’s behav
attempting to transpose myself into the Other, Iexperience the otherness of
the Other. If Iremain in the natural attitude, Iam tempted to stigmatize the
Other’s behaviour, which means to experience negative feelings like repulsion
and aversion and to judge it ‘meaningless’ and ‘illogical’—
as is the case with our
clinical example.
In order to empathize with these persons, and to make sense of their behav
‘manipulates’ the others—
will be an obstacle to empathic understanding, since
these people live in a life-
world of which the structure is (at least in part) dier
ent from my own.
In addition to severe aberrations of experience such as those that can be
encountered in schizophrenia, more common phenomena like manipula
tion would also seem to require a rather sophisticated and counter-
kind of empathy and understanding. To achieve this kind of understanding
requires a kind of training that goes beyond spontaneous (non-
empathic skills, as well as standard conative empathy and common-
sense cat
egories. We named this ‘second-
order’ empathy. As shown in the case study,
Irst need to acknowledge that the life-
world of the other person is not like
my own, neutralizing the natural attitude that makes me approach the Other’s
experience as if it took place in a world like my own. In the case of our patient,
if we did not abandon the preconception that her manipulative behaviour had
the meaning that such comportment rst and foremost may have in our own
world, then we would have simply deemed this behaviour inappropriate
and irritating. If we considered it at face value, then we would characterize
it as behaviour aimed at surreptitiously producing a belief in, or action by,
But, if we try to reconstruct the existential structures of the world that the
Other lives in, then his/
her behaviour may emerge as meaningful and appro
priate to the pragmatic motive that dominates his/
her existence—
the epistemic
motive to achieve a more dened representation of the Other. In this way, we
can then nally attempt to understand the Other’s behaviour in the light of his/
her style of experience—
in this case, the experience of the Other as dim and
out of focus—
and, as such, as meaningfully situated in a world that is indelibly
marked by the person’s particular existence.
e case study of manipulation conrms that the supposition that the Other
lives in a world just like my own is oen the cause of serious misunderstandings—
the source of negative emotions and of misleading value judgements and stig
matization that grossly interfere with one’s capacity to care for other persons
and to make sense of their behaviour.
e world the Other lives in is
with respect to mine. What must be
assumed is the dierence, not the analogy. We are accustomed to speaking
of ‘normality’ when it concerns our own home-
world, whereas we ascribe
conditions are fullled, can be apprehended as members of a
foreign normal
(Zahavi, 2003, p.135). us, we must assume a ‘dierent normality’ (i.e.
work of experience. Understanding another person requires reconstructing
her framework of experience.
A fortiori
, understanding a patient’s symptom
requires reconstructing the framework of experience in which it is embedded.
Although the majority of people are situated within a shared experiential
framework, there are several other frameworks of experience. e framework
of experience is the everyday world in which one lives, eats, works, loves, suf
needs a preliminary deconstruction. is deconstruction is made through a
phenomenological unfolding of the experiential characteristics of the life-
inhabited by the other person. We need to identify, beyond the symptoms that
the Other manifests, the fundamental structures of his existence. Abnormal
phenomena and psychopathological symptoms in general are generated within
the framework of an abnormal life-world. e specicity of a symptom is only
graspable at this comprehensive structural level (Parnas, 2004; Stanghellini and
Rosfort, 2013c). is overall change in the ontological framework of experience
transpires through each single symptom. e experience of time, space, body,
self, and others, and their modications, are indexes of this change in the onto
logical framework within which each single abnormal phenomenon is situated
(Stanghellini and Rossi, 2014).
e phenomenological unfolding is the exploration of the implicit structures
of experience, or into the structures of the mind as the tacit and pre-
conditions for the emergence of mental contents. It looks for the way the mind
must be structured to make phenomena appear as they appear to the experienc
ing person. Once the world of the patient has been disclosed with the greatest
from its existential organizers. In this way we can trace back the patient’s nor
mal or abnormal experiences and behaviours to a specic architecture of the
mind as the origin of a given mode of inhabiting the world, perceiving, manipu
lating, and making sense of it. e reconstruction of the patient’s life-
world, and
of the transcendental structures of his mind, allows for the patient’s behaviour,
expression, and experience to become understandable.
e case with manipulation shows that the phenomenological unfolding of
abnormal human subjectivity suggests a shi of attention from mere symp
toms (i.e. state-
like indexes for nosographical diagnosis) to a broader range of
phenomena that are trait-
like features of a given life-
world. ese abnormal
phenomena can be used as pointers to the fundamental alterations of the struc
ture of subjectivity characterizing each mental disorder. rough the process of
tive features, so that these features emerge in their peculiar feel, meaning, and
value for a patient.
e primary object of care is the patient’s subjectivity, the patients’ states of
mind as they are experienced and narrated by them. e focus on the patients’
subjective experiences aims to reveal aspects that other approaches tend to over
tions are minimized and the structures of the patient’s experience are prioritized.
Psychopathological modes of being in the world are not mere aggregates of
symptoms. is holistic approach bears little resemblance to the current atom
istic operational denitions. e fundamental alteration of subjectivity, that is,
the ‘core Gestalt’ of a given life-
world, is the secure ground on which under
standing can be based.
Unfolding starts with words. Phenomenology is the science of subjectivity;
clinical phenomenology is the science of abnormal subjectivity. Its basic con
cerns are the following:Question 1:What is it like to be in a certain ‘mental’ state,
e.g. to be sad or to hear voices? Question 2:What is the personal meaning of that
certain state, e.g. what does it mean to that person to be sad or to hear voices?
e rst question explores the experiential level, the raw feeling of an experi
ence. Experiences do not only have information content, they also have a cer
like of a certain experience. Other frequently used expressions to
address this qualitative and almost irreducible aspect of subjective experience
are qualia, sensory qualities, subjective quality of experiences, experiential prop
erties, subjective character of experiences, phenomenal contents—
but also sim
ply conscious experiences (Varela and Shear, 1999). e relevance of this to the
assessment of a psychopathological state and to its understanding is obvious.
One patient says:‘I feel depressed.’ What exactly does he mean by that? In each inter
view, two kinds of approximations are always implied:one is performed by the inter
viewee, who tries to communicate his raw experience by approximating it to a word
or a sentence; the second is performed by the interviewer, who tries to understand
the meaning conveyed by the interviewee’s words by approximating it to the mean
ing these words have for himself. is double approximation may entail errors and
misunderstandings. In standard interviews, which are devised following the model
of the stimulus-
and interviewee are assumed, not investigated. An interview is a linguistic event
Some patients may use the word ‘depressed’ to describe themselves as feeling sad and
downhearted, but others may use it to mean that they feel unable to feel, or also to
convey their sense of inner void, lack of inner nucleus and/
or of identity, or feelings
of being anonymous or non-
Each psychopathological experience is also accompanied by a personal mean
ing or value that the patient attributes to his abnormal experiences (Wyrsch,
1949; see also Mundt, 1991 and Stanghellini, 1997). e meaning and value
attribution of each patient towards his experiences is obviously a relevant clini
cal feature, since it contributes to shaping distinct clinical pictures and prog
noses. Its knowledge also contributes to attuning treatment plans to individual
patients (and not to diagnostic categories).
For instance, the very same raw experience of ‘depression’ as a sense of inner void may be
valued by dierent persons either as the eect of a change in one’s body and thus explained
ganized behaviour; or may kindle a ‘ght’ reaction leading to dysphoria and auto/
aggressive comportments; or else it may be accompanied by an ‘exalted’ reaction so that
the person will say that this experience revealed to him his true nature as a disembodied
e unfolding involves two further steps that specically address the structure
of the patient’s life-
world (Stanghellini and Rossi, 2014). e rst—
called phe
nomenal exploration—
is the gathering of qualitative descriptions of the lived
experiences of individuals. As lived experiences are always situated within the
grounds of body, self, time, space, and others, we adopt these basic dimensions
of lived experience to organize the data. In order to investigate these dimen
sions, the inquiry will be oriented by questions such as:
How does the patient experience his world? How does he express, move, and dene
space as an embodied subject?

What is the patient’s experience of existential time? Is there a sense of conti
nuity over time, or are there breaks of self-
awareness? Does he experience a
sense of self-
sameness or diachronic identity over time? What is the prevailing
dimension of existential time, the past (e.g. memory), the present moment, or
the future (e.g. hope, expectations)? Is he able to learn from experience? Is he
able to project himself into the future?

Does the patient feel eective as an agent in the world, or rather as being pas
sively exposed to theworld?

Does he feel delimited from the external world? Does he feel submerged or
invaded by objects or events that are usually experienced as existing outside the
boundaries of theself?

Is there a tendency to take an external perspective on one’s experiences and
actions? Do the knowing and the feeling subjects coincide or diverge? Does the
patient feel his own perceptions and actions as hisown?

What is his experience like as an embodied self? Does he feel his body as his
that experience mediated by other senses, like for instance sight, ortouch?

How is space organized for the patient? Are things experienced as distant or at-
hand? Does he feel in a central position with respect to other individuals? Does
he perceive his situation as a coherent scene, or as fragmented? Is space a at
and homogenous extension lacking magnitude and salience, or are there some
points of interestinit?

How is the patient’s ability to empathize with others, to take their perspective?
How does he experience his relationships? What are his feelings when he is
with other persons? Are the others experienced as a source of protection, or of
related to each dimension, for example, temporal continuity/
space at/
lled with saliences, bodily coherence/
fragmentation, self–
permeability, self–
other attunement/
attunement, and so on.
In this way, using rst-
constitution of experience and action is vulnerable and open to derailments.
e second step implies a shi to phenomenology proper that seeks the basic
structures or existential dimensions of the life-
worlds patients live in. Any phe
nomenon is viewed as the expression of a given form of human subjectivity;
abnormal phenomena are the outcome of a profound modication of human
subjectivity. Phenomenology is committed to attempting to discover a common
we can make sense of the relevant lived experience. is is done by nding
similarities among the manifold phenomena and, possibly, the deep or struc
tural change in the form of experience/
action related to that specic existential
dimension (spatiality, temporality, embodiment, and so on) that would oer an
explanation for the various changes that occur in the patient.
A girl in her twenties. Blue eyes and ash-
that she chooses her clothes with great care and attention. e kind of clothes she wears
is reminiscent of ‘grunge’, a rebel style that was fashionable long before her birth. It is
usually dened as the ‘I don’t give a shit’ style. Clothes are ripped and tattered. ‘Grunge’
messy. She has a tidy face and a thin body. No piercings, or tattoos. Highly insecure,
Overt symptoms, spelled in the crude language of diagnostic manuals, include the
following:eating problems, avoidant behaviour, and occupational dysfunction.
indeed a serious problem:‘I don’t feel my body. Idon’t feel myself. My emotions remain
extraneous to me and Iremain extraneous to them.’ She speaks of her own body as
in them gives a sign of attraction, or of repulsion. is is not the case with me. Ilack the
basis to establish my identity.’
In this person, the disturbance of the experience of one’s own body is inter
connected with the process of shaping her personal identity. She reports her
diculties in feeling herself and in perceiving her emotions. Indeed,
is a basic requirement for achieving an identity and a stable sense of
body and emotions involves the whole sense of identity. Indeed, we con
strue our personal identity on the basis of our feelings, that is, of what we
like or dislike. For her, since she can hardly feel herself and her feelings are
discontinuous over time, identity is no longer a real psychic structure that
persists beyond the ow of time and circumstances. She also feels extrane
ous from her own body and attempts to regain a sense of bodily self through
I ask her to describe the way she spends her days, and Ilearn that she avoids contact
with other persons in order to elude their negative judgment. ‘e way Ifeel depends
on the way Ifeel looked at by the others.’ ‘I’m extremely sensible to the others’ judge
ment. It’s like a verdict for me. It can make me change my mind in a second. at’s why
Ispend much of the day in my room. Because of this, I’ve not been able to work in the
last couple of years.’ ‘I feel clumsy in my body’—
she further explains. ‘It is as if it was
a mere aggregate. Like a wobbling liquid. Ihave no boundaries.’ is makes her feel
embarrassed when in front of other persons.
opposite a bar. At that time of the evening a small group of young men sit there to have
a drink. When she passes in front of them, they watch her and say ‘Ciao’ to her. is is
the only time of the day she leaves the house. ‘When Istarted Idid not know why Idid
they were watching me. It was as if their looks were “condensing” me. I“focalize” myself
through theirgaze.’
I tell her that the scene makes me think of a famous snapshot, American girl in
Italy, taken in 1951 by American photographer Ruth Orkin. It portrays a lovely young
playfully gawking at her. is photo perfectly captures the embarrassment of the girl
we look at Orkin’s snapshot. is is her comment:‘Her feelings are apparently like my
rigid.’ is is, she explains, what happens to her too. But in her case, it has a positive
eect on her, since the boys’ gaze helps her to pass ‘from a semi-
liquid state to a semi-
solid one’. She notices:‘We are both harassed and embarrassed, but Iseem to enjoy it
e unfolding of this person’s experiences documents another essential
dimension of her life-
world, namely corporeality and its relationship with the
Other. We realized that she experiences her body as a ‘wobbling liquid’. Also,
we understood that this sensation may change when she is in the presence of
Sartre’s (1986) analyses of lived corporeality. Phenomenology has developed a
) and physical body (
), or body–
subject and body–
object. e rst is the body experienced from within, my own
direct experience of my body in the rst-
person perspective, myself as a spa
tiotemporal embodied agent in the world; the second is the body thematically
investigated from without, as for example by natural sciences as anatomy and
physiology, a third-
person perspective (Husserl, 1989; Merleau-
Ponty, 1996).
One’s own body can be apprehended by a person in the rst-
person perspective
as the body-
primitive experience of oneself, the basic form of self-
awareness, or the direct,
unmediated experience of one’s own ‘facticity’, including oneself as ‘this’ body,
its form, height, weight, colour, as well as one’s past and what is actually happen
ing. First and foremost, we have an implicit acquaintance with our own body
from the rst-
person perspective. e lived body turns into a physical, objective
body whenever we become aware of it in a disturbing way. Whenever our move
ment is somehow impeded or disrupted, then the lived body is thrown back
on itself, materialized, or ‘corporealized’. It becomes an object for me. Having
been a living bodily being before, Inow realize that Ihave a material (impeding,
In addition to these two dimensions of corporeality, Sartre emphasizes that
one can apprehend one’s own body also from another vantage point, as one’s
own body when it is
looked at by another person
. When Ibecome aware that
Ior my own body is looked at by another person, Irealize that my body can be
an object for that person. Sartre calls this the ‘lived-
others’. With the
appearance of the Other’s look, writes Sartre (1986), Iexperience the revelation
of my being-
object. e upshot of this is a feeling of having one’s own being
outside, the feeling of being an object. us, one’s identity becomes reied by
the gaze of the Other, and reduced to the external appearance of one’s own body.
In short:the Other is reduced to its gaze, and the self to a reied body. is
ence of her Self, and then analyse what happens to her experience of theOther.
e basic phenomenon seems to be that this person experiences her own
body rst and foremost as an object being looked at by another, rather than
experience of her body from within, she needs to apprehend her body from
without through the gaze of the Other. is is the source of her exaggerated
concern to take responsibility for the way she appears to Others. Of course, she
is angry and ambivalent about this, and that is probably why she wears ‘I don’t
give a shit’ grunge clothes.
e Others’ gaze may pave the way towards an experience of shame for her
as described by Sartre—
or even of disgust for all her Self being reduced
to her body or to an uncomfortable or disgraceful part of it. is indeed hap
is not always shame and alienation from her body that take place when she is
looked at by other persons. e Other’s gaze is for her the only possibility to
feel herself as a ‘lived-
obscurity, when she strolls in front of the bar crowded by young people
having their drinks and watching each other, she can nally feel herself as a
body being looked at. She usually lacks the possibility of feeling herself in the
person perspective. e Others’ gaze helps her recover a sense of ‘unity’
and ‘condensation’—
though not a full sense of identity. Experiencing her body
person’s being in the world, the powers that constitute her life-
world precisely
seen, the Other is reduced to its gaze. e Other is not a partner with whom
one can dialogue. It is another part of its body, like for instance its mouth or its
hands. e Other is rst and foremost a gaze looking at her. is look only seizes
what is visible, that is, her appearance. Also, it only seizes what is present here
and now. e temporal dimension of the gaze is the present moment. e gaze
does not even expand into the nearest future, as it might in the case of someone
gazing at someone else while the latter replies with her own gaze. Indeed, she
does not look back at the men. ere is no
looks in front of her, just like the girl in Orkin’s snapshot.
What can the Others’ gaze express? It can simply express like or dislike, the
two sides of desire. e Other, then, in our patient’s life-
world is stripped of
all the characteristics of an embodied and situated person and reduced to a
now desiring (or not desiring) gaze. She is a body looking for visual
recognition. e Other is a gaze that may (or may not) recognize her. When she
strolls in front of the bar she gains a sense of identity, since she feels desired.
Although it is her body, and not her entire person, that is the object of the
Others’ desire, this helps her recover a sense of her Self. She feels recognized, at
Post scriptum
. Ironically, Ruth Orkin’s amateur model Ninalee Craig later
explained in an interview that the photo in which she is portrayed is not, to her,
a ‘symbol of harassment’. Rather, it is a ‘symbol of a woman having an absolutely
wonderful time’. She never felt in danger while walking among the admiring
men and ‘none of them crossed theline’.
A human person is both a rationally governed self and a biological organism
subjected to the a-
rational laws of the involuntary. us, human thinking, feel
ing, and actions are shaped and formed by two kinds of causality:an a-
history, and a rational causality (de Sousa, 2007, pp.6–
12). e complexity of
my identity as a person consists in the fact that besides the impersonal changes
that Iundergo as the consequence of the sheer fact of being a developing bio
not choose, Ialso autonomously relate myself to these changes. ese personal
otherness is in every feature of human existence. An example is emotional expe
rience. Emotions are the most embodied and situationally embedded of mental
phenomena. Emotional experience is permeated with feelings and sensations
that constantly
elicit and challenge
our attempts to make sense of and cope with
cognitive contents in the sense that Iassess and comprehend my emotional
experiences by means of intentional and conceptual analysis, there is more to
our emotional experience than is disclosed and explained by intentional and
conceptual analysis (de Sousa, 2011; Prinz, 2004; Rosfort and Stanghellini,
2009; Stanghellini and Rosfort, 2009, 2013a; Wilson, 2002). Moreover, there
is more to the person that one is than the emotions that one feels. To be a per
be a person involves a permanent confrontation with the otherness that is an
inescapable part of the person that Iam. is ontological dialectic of involun
tary and voluntary aspects of personhood discloses the normative challenge
of being a person. is is experienced as the challenge that to be a person is
not a fact, but a continuous
(Grøn, 2004, 2011). We are the same person
throughout our life, but the sameness of our identity as a person is continuously
challenged by the otherness that all persons experience through time. Being a
person is trying to exist as myself in and through the challenges of all those fea
tures that make up
Iam (e.g. my anonymous biology, my past, my present
uncanny experiences, the way Ifeel dened by people while they look at me),
but which cannot describe
While in normal or neurotic forms of existence the manifestations of other
ness are conned to mild forms of otherness (e.g. fears deemed ‘irrational’ by
the person who experiences them, as is the case with phobias), in more severe
pathologies, as for instance schizophrenia, patients are confronted with the
most threatening manifestation of otherness as they entail a profound sense of
alienation from oneself, one’s own body, and the world, as well as uncanny emo
tional experiences. In the case of schizophrenia, these experiences may throw
the patient into a new ontological position that qualies that person’s sense
of reality and existence by producing a new ‘eccentric’ existential perspective
(Stanghellini, 2008), oen with a solipsistic framework, no longer ruled by reli
able axioms of the ‘natural attitude’ (Henriksen and Parnas, 2014). When the
basic sense of self is disturbed, the person is inclined to experience both a kind
of exaggerated self-
consciousness (Sass, 1992)and a concomitant diminished
aection, that is, a fading in the tacit feeling of existing as a living and uni
ed subject of awareness. ese changes in the basic structures of subjectivity
are accompanied by an alteration of the very structure of the eld of awareness.
is, in turn, leads to a particular way of experiencing marked by a change in
the ‘salience’ with which objects and meanings emerge from the background
context; an altered emotional and conceptual ‘grip’ on the world; an amplica
tion of the growing dissolution of the sense of existing as a subject with a more
pronounced, disturbing, and alienating self-
scrutiny; an increasing objecti
cation and externalization of normally tacit inner phenomena, with a morbid
objectication of one’s own psychiclife.
e extreme variability of schizophrenic phenotypes is a paradigmatic
ersonalization and derealization and the attitude of the person who experi
ences them. Why do persons who suer from these kinds of anomalous self-
, and world-
experiences develop either a psychotic (e.g. delusional)
form of schizophrenia or a non-
psychotic, ‘negative’, or “pauci-
(Blankenburg, 1971)type of this illness, or a schizotypal personality dis
order, characterized for instance by magical thinking but not by disorgan
ized speech, delusions, and hallucinations? Why do delusions in people with
schizophrenia take on so many dierent themes, and not only ontological
ones (Kepinski, 1974; Parnas and Sass, 2001; Stanghellini and Fusar-
2012), but also, for example, persecutory, hypochondriac, of reference, of
If we subscribe to the ‘one root–
many branches’ conceptualization of the
manifold of schizophrenia, then we must be able to explain why, arising from
the common root of self-
disorders, schizophrenic phenotypes take on so many
dierent features.
A plausible answer is that self-
disorder, being at the core of the vulnerability
to schizophrenia, is refracted through the prism of the person’s background of
for them. is personal background is a pre-
reective context of meaning and
signicance within which and against which persons understand themselves,
others, and theirworld.
Jaspers was one of the rst authors to introduce this idea in his
. ‘Position-
taking’ (
) is the phrase he uses to
describe the process of ‘working-
through’ and self-
reecting on his anomalous and disturbing experiences, “can see himself, judge
schizophrenia, Jaspers writes that we may nd patients for whom their experi
ences introduce new signicance into their lives, others for whom the content
of their abnormal experiences is linked with their pre-
entirely alien and brings no added signicance. ese dierent attitudes in the
face of their abnormal experiences depend on each person’s history and sense
‘renewal of life’, ‘shutting out’ (as if nothing had happened), ‘conversion’ (the
Delusions are just one attempt to make sense of and explain the aberrant expe
riences taking place during the initial pre-
delusional stages of schizophrenia.
dialectical (PCD) model of schizophrenia (Bleuler, 1911; de Clérambault, 1942;
Huber, 1983; Mayer-
Gross, 1920; Minkowski, 1927; Simkó, 1962). Describing
distinguished four groups of patients:patients who try to objectify their own
suerings and conceive them as symptoms of a somatic illness; patients who
are passive and incapable of any reaction; patients who engage in a ght against
their pathological experiences, displaying a stubborn and oen desperate
attempt to t such experiences into the meaning context of their life-
story; and
a last group who are exalted by the novelty of the psychotic experience, which
acquires for them a cosmic meaning:it is signicant in the world order and not
just for him (Wyrsch,1949).
structural changes of subjectivity are the
core Gestalt
or psychopathological
trait marker of schizophrenia, then we can assume that the manifold, uc
tuating, and state-
like schizophrenic phenotypes are the consequence of the
schizophrenic person’s individual position-
taking in response to this state-
person, as a self-
aberrant experiences that derive from her basic vulnerability (Doerr-
and Stanghellini, 2013; Stanghellini, 1997; Stanghellini and Rosfort, 2013a;
lous experiences are taken from de Clérambault (1942):
Amelia, Roger and Jean-
each of them develops a dierent kind of delusion.
Amelia is a ‘spinster’, a very religious woman who theorizes an ‘incorporeal life’.
Aected by abnormal bodily experiences (another person’s soul inhabits her body) and
psychic depersonalization (speaks of herself in the third-
person). Her emotional
tone is described as ‘optimistic’ and her attitude as ‘imaginative’. Her working-
is ‘rudimental’ and leads her to develop ‘harmless’ mystic and megalomanic delusions’.
tone is characterized by anger. He works through his abnormal bodily sensations devel
oping a stable hypochondriacal delusion and a delusion of inuence.
Baptiste’s abnormal bodily experiences consist in ‘made’ erections. Also, he
feels that his genitals are grasped by claws. He is an ‘intellectually weak’, ‘imaginative’
person, also aected by sub-
punishing and killinghim).
ese three patients develop three dierent forms of delusions starting from
a similar background of abnormal bodily experiences. What dierentiates
them is their position-
taking. ese examples show that the patients are not
passive victims of their abnormal experiences, which immediately generates
symptoms. Rather, each patient has an active role in position-
taking with
respect to her/
his basic anomalous experiences, and thus in shaping their
symptoms, course, and outcome. Each person stamps her autograph onto the
raw material of her basic abnormal experiences, driven by the painful ten
sion that derives from “the drive for the intelligible unity of life-
e concept of position-
taking can be a help in understanding the patho
genesis of full-
blown symptoms and syndromes tracing back their origin to the
patients’ miscarried self-
like derealization and depersonalization phenomena. It allows disentangling
basic vulnerability from full-
blown symptoms and from the person’s attitude
towards her vulnerability. Also, it can help in dealing with the signicant con
cerns regarding therapeutic interventions at a time when an orientation towards
recovery is being advocated for psychiatry (Maj, 2012). is has several thera
peutic consequences.
It contributes to enhancing insight and awareness of illness in patients by shi
ing their focus from full-
blown symptoms (e.g. delusions and hallucinations), to
more basic manifestations of vulnerability (e.g. abnormal bodily experiences).
is change of perspective can become instrumental for prevention and treat
ment. Full-
blown symptoms, like psychotic ones, are experienced by patients
as Ego-
proximal, while basic anomalous experiences (derealization/
alization phenomena) are experienced as Ego-
distal. is means that patients
typically experience and consider full-
blown symptoms, e.g. verbal–
hallucinations or paranoid delusions, as part of their own identity, and as such
not as abnormal phenomena to be diagnosed and treated. On the contrary, basic
anomalous experiences are usually not experienced as parts of one’s own iden
tity, rather as disturbing one’s sense of selood, i.e. unity, continuity, demarca
tion, myness, and agency. ey are spontaneously (or almost spontaneously)
Patients need awareness and insight to recognize experiences that (according to
anomalous experiences than with full-
blown psychotic symptoms. Patients feel
basic anomalous experiences as abnormal phenomena that reduce their quality
of life. As such they can become instrumental symptoms for prevention and
treatment, whereas full-
blown symptoms maynot.
To transmit this type of experience requires that the patient construe the cli
nician as both open for unusual experiences and capable of recognizing that
patient can be achieved. An in-
the patient’s subtle and pervasive changes in life-
world experience, including
this intimacy. All this helps the patient to give his disorder a format, to pre
vent symptom manifestation, and nally, to alleviate it. ese experiences may
may consider their experiences to be uniquely private. Clinicians may use their
knowledge of these subtle experiential changes to help their patients nd a
language capable of expressing their experiences in this therapeutic alliance.
grained knowledge about the patients’ basic experiences (unfolding) and
the way they make sense of them (position-
taking) is an essential prerequisite
for establishing an eective therapeutic relationship. It is a resource in modu
lating distance in the therapeutic relationship, especially in early stages of the
disorder, during which it is essential to avoid stigmatization, social isolation,
and the person’s identication with the role of the patient.
An in-
depth exploration of the patient’s subtle and pervasive changes in
and world-
experience may help the person take a reective stance with
respect to her vulnerability, that is, to articulate it in a more expressive and
communicative format, and to construe it as situated in a personal–
as well as a relational–
interpersonal context. An attentive focus on the
patient’s attitude may help enhance her own eort to modify her position-
taking. Dierent and more eective narratives of illness may derive from this
change in the patient’s perspective and self-
patient’s life-
pathological world as a text. All clinical interventions, including the attempt
to make sense of the patient’s abnormal behaviour and experience, as well as
cal domains in the patient’s narration, take this aspect into account. In
as the source of the delusional transformation of the patient’s life-
e kinds of delusions developed by each patient become understand
phenomena and the way each patient works through them. In the follow
ing example (taken from a quite dierent psychopathological domain),
becoming aware of the way a given patient experiences time helps the clini
cian and the patient grasp the meaning, motivations, and purpose of her
is patient experiences with despair, and then with anger, and then again with per
secutory anger, my refusal to anticipate our session on her request. She turns this
into a conict of values—
feeling that she is on the side of those who defend the ‘right’
values (e.g. the other’s availability)—
and into a chance for recrimination (I, as all
the others, do not behave with her as she would behave with us). All this leads her
to play the role of the victim and to assign to the Other the role of the persecutor.
e generative moment of this series of symptoms (hopelessness, anger, persecutory
feelings, recrimination, victim/
executioner scheme) lies in the temporal experience
of instantaneity.
e patient says:‘Each time it’s like Ihave to jump on a moving train’. is
is the mark of her lived temporality—
that is, of a fundamental structure of
her existence—
revealed by the analysis of the existential structures of her life-
world. Due to this constitutive moment of her existential temporality, she expe
and nally, by the crystallization of the relationship in the victim/
scheme. Note that in this clinical example the sequence of symptoms is gener
ated, not surprisingly, as a consequence of the inability to tolerate the suering
caused by the failed encounter with theOther.
is is an example of a reconstruction of the generative moment of the symp
toms as it manifested itself in the life-
world of the patient. is reconstruc
tion highlights the roots of the symptoms, that is, the patient’s lived temporality
characterized by instantaneousness. Once this awareness is shared with the
patient, it allows her to connect her symptoms to her vulnerability—
that is,
to her way of experiencing the therapist in relation to her way of experiencing
time; and, more generally, to the temporality of the relationship with the Other.
It also allows her to take a position about this generative, structural, involun
tary, implicit moment.
What is the clinical benet of the unfolding of the patient’s life-
world? When
the patient is placed in front of the image of her world generated as part of the
therapeutic relationship, and can clearly see the founding structures of such a
world, she can take a position about the world she lives in. Taking a position
allows her to embed her symptom in its generative moment, to become aware of
its origin and genesis—
that is, to become aware of her own vulnerable life-
In the case of this patient, what makes her life-
world vulnerable is a particular mode
ephemeral, and evanescent. First and foremost, what she experiences as evanescent is
the relationship with the Other. She further explains that she experiences the Other’s
desire for her as momentary. ‘I need to take the chance. In a while, he will give his atten
tion to someone else. As it happened with my father. He used to listen to me intensively,
realizes, is momentarytoo.
Taking a position about her vulnerability allows her to take a
position than
the one which gave rise to the symptoms (despair, anger, persecutory anger), as
vulnerability (Stanghellini and Rosfort, 2013). e generative moment, which
for this patient lies in a specic and typical structure of temporality, represents
an irreducible alterity that inhabits the person.
Alterity, in this case, is her way of experiencing her relations with other per
cent. is is the generative moment, the habitus, the implicit and involuntary
explains her taking on the role of the victim). But what would happen if the
instants, or as nostalgia for the past, or as the premonition of the future)? What
element (rooted in temporality) that over-
e consequence would be that she would be able to see it from a third-
perspective, broadening her perspective on herself that until that moment was
dominated by an over-
identication with her values and habits. She would be
essential (
‘I cannot and Ido not want to be dierent from that. Idon’t want to
suppress my desire and my emotions. Iwould not be myself without them’
) and at
the same time a contingent part of her identity (
‘Yet now Irealize that, although
Idid not decide to be like this, it is time for me to decide whether Iwant to continue
being like this ornot’
only right
way to be, but as
about her way of living time as instantaneous (
‘It is as if Ishould always jump on
a moving train’
) and of conceiving of relationships as necessarily emotionally
intense and unstable. In order to be able to say ‘is is
to take the
of choosing her lot—
that particular way of living time.
To reduce this alterity that inhabits her to a totally external other is as wrong
as to regard it as part of one’s self. e logic of alterity, in fact, contradicts the
principle of the excluded third. e Otherness that inhabits her is at the same
time extraneous to her self and part of it. It is an
indomitable fold
of one’s being,
which, as such, encloses a space that is at the same time external and internal
(Deleuze, 1988). It is external since it belongs to the involuntary dimension
of her being the person that she is, the raw material that constitutes the sedi
a traumatic experience), body (e.g. emotions and desires), and world (e.g. its
rules and values) into which she is thrown. But at the same time, this involun
tary Otherness that inhabits her is part of her Self since she is responsible for it.
Although originally she did not decide to be-
so, at a given moment in her life
she realized she had become-
so, and decided to continue being-
If and only if she takes the Otherness that inhabits her as part of her Person—
to paraphrase Ricoeur—
can what sedimentation has contracted, responsibility
Responsibility is the capacity to be held accountable for one’s deeds. First and
foremost, we are held responsible, thus accountable, for our deeds—

even if we
did not act according to our will. is is the case with the founding myth of our

the myth of Oedipus.
Oedipus, at Colonus, says that he did not really do the things for which he
blinded himself:‘I suered those deeds more than Iacted them’. According
to Bernard Williams, these words express Oedipus’ attempt to come to terms
with what his deeds have meant for his life. e question is:Did the things
that happened come about through Oedipus’ agency or not? e whole of the
Oedipus tragedy—

‘that dreadful machine’—

moves towards the discovery of
just one thing, that Oedipus did them. We understand, and share, Oedipus’
terror of that discovery. e reason for that is because we know that in our lives
we are responsible for what we have done, and not merely for what we have
We can be held responsible for what we have involuntarily done. All con
and the involuntary. Dierent cultures lay dierent weight on voluntary or on
involuntary actions. At the same time, no conception of responsibility connes
it entirely to the voluntary (Williams, 1993, p.66). Oedipus is, indeed, the para
digm of Man in Western civilization precisely because he embodies the tragedy
of responsibility for one’s deeds beyond one’s intendedwill.
As we discussed in the chapter about Hegel’s concept of ‘recoil of action’,
there are two sides to action:that of deliberation and that of result. And there
of unintended
meanings and intentions back upon the actor. e consequences of our actions
and the involuntary, and the answer is the story we can tell about ourselves
when confronted with this entanglement.
In particular cases, we are not held responsible for our deeds. is is the
case with madness. e various forms of madness can be seen as miscarried
attempts to solve the riddle of responsibility. From a third-

person perspective,
to be deemed ‘mad’ is to not be held accountable for my actions. From a rst-
person perspective, to be mad is to feel/
believe that my deeds are not my own,
thus not to consider myself responsible for the deeds that seen from another
perspective are attributed to me. Opposite this, another form of madness
consists in feeling/
believing that Iam responsible for deeds that, seen from
another perspective, are not my own. In both cases, there is a crisis of the
an expulsion of the voluntary into the sphere of the involuntary. In the second
one, there is a attening and collapsing of the involuntary into the voluntary.
e vulnerability to madness, as the cypher of
condicio humana
, imbues
responsibility:loss of responsibility (alienation from oneself) and excess and
distortion of responsibility (delusional guilt) are the extreme polarities of the
dialectics of answerability in human existence. Alienation implies loss of agency
and myness, as is the case with schizophrenia:‘It’s not me who killed her, it was
that knife’. Morbid objectivation and externalization of parts of one’s body or
self, imposed thoughts and drives, and imperative voices are typical examples
of schizophrenic phenomena in which the sense of being the author of one’s
actions and the owner of one’s mental processes and contents is jeopardized.
Vice versa, one can feel/
believe that one is guilty for deeds that are not one’s
own. is is typically the case with guilt delusions in melancholia. Guilt is
not responsibility. Responsibility is a
with alterity, a relation with the
source of one’s actions, and a relation with other persons asking you to respond
for your deeds. Both these relations can be dealt with. On the contrary, guilt
‘becomes a thing or an object the patient is identied with’. e melancholic
patient is identied with his guilt to the extent that he is ‘guilty as such’. ere is
no remorse, recompensation or forgiveness, for the guilt is not embedded in a
common sphere which would allow for that (Fuchs,2014).
Schizophrenia and melancholia represent two opposite polarities of distorted
agency and of responsibility. In the former, the person, while performing a
given action, does not feel that he is the one who is voluntarily acting. He feels
that the source of his actions is external to him. e source is placed beyond the
boundaries of the Self, and thus is out of control. He feels and believes himself
to be passive with respect to the cause of his action. Persons aected by melan
cholia, vice versa, attribute to themselves the cause of eects that, from another
perspective, cannot be attributed to them. But, even more typically, they experi
ence a total passivity with respect to their capacity and possibility for modifying
a given state of aairs. Time has come to a stop, thus ‘What was once done can
not be undone’ (T. S.Eliot).
In order to understand the reasons for these opposite stances with respect to
agency and responsibility we need, once more, to reconstruct the life-
world in
which these distortions take place. e literary case of Robert Musil’s serial sex
murderer Christian Moosbrugger is an excellent case study for this.
In his masterpiece novel
e Man without Qualities
, Musil (1996) subjects leading
gures of n-
siècle Vienna to intense ironic scrutiny. By drawing on his extensive
knowledge of philosophy, psychology, politics, sociology, and science, he works into his
novel essayistic statements which record the state of contemporary European civiliza
tion. It follows through an extraordinary literary experiment in which Musil immerses
Ulrich, his hero, in the inner experiences of a murderer and rapist, called Moosbrugger,
with a campaign to assert the cultural supremacy of moribund Imperial Austria over
ing and doing, and so discover the right way tolive.
A central concern in this novel is what is reality (
). e phase of
Man without Qualities
in which Ulrich is preoccupied with
is also
the phase in which Moosbrugger plays a central part. Moosbrugger is, for the
younger Ulrich, intellectual dynamite to blow up the common-
sense concept of
e judge—
Musil writes—
comes to the conclusion that Moosbrugger was
convincing about a universe. During the trial—
Musil explains—
two strategies
ency. e strange, shadowy reasonings of his [Moosbrugger’s] mind (
) rose
directly out of the confused isolation of his life, and while all other lives exist
in hundreds of ways—
perceived the same way by those who lead them and by
all the others, who conrm them—
his own true life existed only for him. It was
a vapour, always losing and changing shape. Standing before the court, every
thing that had happened so naturally in sequence was now senselessly jumbled
up inside him (Musil, 1996, pp.75–
In a nutshell, the judicial assessment of the accountability of a person is
not responsible for her deeds if and only if they emerge out of an ontological
framework that radically diers from ourown.
Musil’s novel is considered a study on
applied subjectivity
‌‌‌ am concerned [
] with the scientic study of psychology [
] and [Ibelieve] that,
in the ne reports of the French psychiatrist, for example, I[
] can [
] both experi
ence vicariously, and [
] depict every abnormality [
], transporting myself into the
corresponding horizon of feeling, without my own will being seriously aected. (Musil,
world radically dierent from our own. First, Moosbrugger’s lived space is
a non-
Moosbrugger heard voices or music or a wind, or a blowing and humming, a whizzing
and rattling, or shots, thunder, laughing, shouts, speaking, or whispering. It came at him
from every direction; the sounds in the walls, in the air, in his clothes, in his body. He had
the impression he was carrying it in his body as long as it was silent; once out of it, it hid
somewhere in his surroundings, but never very far from him. e important thing was
Second, the way he experiences entities in the world radically diers from what
is customary in ourworld:
try to talk about a tree cat with a straight face!’. ‘In Hesse, on the other hand, it’s called
a treefox.
But oh, how curious the psychiatrists got when they showed him a picture of a squir
Moosbrugger’s experience and conviction were that no thing could be singled out,
ird, the way Self and world are related to each other also diverges from
sense experience:
e table was Moosbrugger. e chair was Moosbrugger. e barred window and the
bolted door were himself. ere was nothing at all crazy or out of the ordinary in what
he meant. It was just that the rubber bands were gone. Behind every thing or creature,
gone. Or was it just the feeling of being held in check, as if by rubberbands?
profound change:
veiled in a mist, there was a rose sticking out of it on a long stem, and the temptation to
take a knife and cut it o, or punch it back into the face, was overwhelming. Of course,
of the temptation any other way. (ibid., p.259)
Moosbrugger’s case study demonstrates on a macroscopic scale that the assess
‘universe’ or life-
world. Our notion of responsibility is tied to our concept of
agency. Aperson’s experience of agency is dependent on the life-
world he lives
as is the case with Moosbrugger, whose deeds emerge out of an ontological
framework that radically diers from ourown.
Is Moosbrugger to be held accountable for his deeds? Does he himself feel
responsible for them? Also, and what is more relevant for us here, how could
one help Moosbrugger recover a sense of responsibility and agency?
Responsibility literally means to be capable of responding for one’s own
deeds, that is, to narrate them as
one’s own
deeds, situating them within a story,
in search of their causes and meanings. Following the perspective Ihave taken
in this book, in order to recover a sense of responsibility and agency one has
to regain a dialogue with alterity. Iargued that this dialogue with alterity can
be regained through a process of unfolding of the life-
world or ‘universe’ one
lives in. Alterity rst and foremost becomes manifest in my deeds, that is, in
the world in front of me, rather than through an introspective search inside
me. Another way to put it is that, in order to recover a dialogue with alterity,
one has to achieve a third-
person perspective on oneself. is means:to see
oneself in the mirror of one’s own life-
world. Quite paradoxically, in order to
recover a sense of intimacy with oneself one has to go through an experience
of estrangement from oneself. In order to feel oneself one has rst to see one
self from without. e condition of possibility for this is an empowerment of
the patient’s capacity to adopt a reexive stance towards the feelings and the
meaning(s) of his experiences, thus reinforcing his subjective and intersubjec
tive sense of being a self. is is achieved through position-
taking. Position-
taking allows the person to embed his experiences/
actions in the vulnerable
world they belong to, and to rescue the generative moment of the life-
world itself.
Even in the case of Moosbrugger, it is very dicult to disentangle respon
sibility from non-
and we may wonder if standard therapeutic
practices are really helpful forthis.
And the temptation to take a knife and cut it o, or punch it back into the face, was
overwhelming. Of course, Moosbrugger did not always go for his knife; he only did
Agency and responsibility reveal a fold in human existence. ere are several
reasons forthis.
First, agency and passivity cannot be easily disentangled on the ontologi
cal level. To be human is to be at odds with agency, that is, with the involun
tary dimension of our being. Not even in the case of Moosbrugger can the
voluntary be fully separated from the involuntary. eir contiguity implies
a struggle. Musil uses the language of dialectics to depict the struggle within
an impulse, especially when it is ‘overwhelming’, and not merely absolute and
encompassing. Moosbrugger is not one with his temptation, and that allows
in some occasion—
not to go for his knife. He did so only in those cases in
which his enormous eorts were insucient to control his temptation, or divert
it in another direction.
Second, responsibility reveals a fold in human existence since it is at the same
person to feel responsible for her deeds. It is a task since responsibility is not an
a priori in human existence; rather it is an achievement to be obtained through
education. As Ricoeur puts it:‘Education is education to responsibility’ to be
achieved via the integration of responsibility and vulnerability.
ird, the fold that unites responsibility and non-
responsibility cannot easily
cannot fully control the involuntary dimension of our existence, and that we
are held responsible for it. at’s why Musil deems the standard forensic notion
of accountability an ‘anaemic concept’. at’s also what we learned from the
himself responsible forthem.
extreme, guilt at the other, are miscarried modes of responsibility since they
attempt to disentangle the fold where the voluntary is in touch with the invol
untary, selood with otherness. Persons with schizophrenia and melancho
responsibility. To recover from these abnormal conditions one has to recover a
is fold is primarily felt and experienced as an obscure and perturbing entan
glement of voluntary and involuntary, selood and otherness. e unfolding
in the process of care reveals the pleat before it unfolds it. e unfolding, before
unfolding the pleat, shows the fold where the voluntary and the involuntary are
continuous with each other. Explication reveals
To fold means to cover or wrap, to conceal. To unfold is to renounce to
‘cleany coined excuses’ (Shakespeare:‘Nor fold my fault in cleany coined
excuses’). erefore, the fold is the
locus geometricus
in its dou
ble meaning—
conscience). Unfolding is both an act that pertains to the domain of knowledge
e seeing of this zone of undecidability generates, depending on position-
or alienated from the source of my actions depends on the side of the fold
that is visible from my perspective. To restore a full sense of responsibility,
that is, to overcome alienation or guilt, Ineed to acknowledge the presence of
the fold, to recognize it as a necessity, to move around the fold and take a dif
ferent perspective on it, and nally, to achieve a panoramic view on the fold.
unfolding no longer simply means tension–
release, contraction–
dilation, but enveloping–
developing, involution–
evolution. To unfold is to
increase, to grow” (Deleuze, 1988, pp.8–
9). Unfolding is thus an act that opens
up possibilities—
developments and evolution—
for the future. Unfolding is a
practice that restores a sense of agency, and with it a sense of responsibility.
consequences, not a mere act of knowledge.
e borderline condition is a paradigmatic case study of the entanglement
of the voluntary and the involuntary, and of the way we may help patients deal
with their fold. In
Emotions and Personhood
, we (Stanghellini and Rosfort,
2013a)have discussed the puzzling manifestation of otherness, in terms of an
involuntary source of one’s actions, in the existence of borderline persons. In
discovering otherness in themselves, borderline persons discover in themselves
an amorphous and untamed presence. is presence is felt as a spring of dis
ordered vitality that is a menace to autonomy in the sense of self-
Otherness is an impossibility for borderline persons. It is both a threat to the
Self and the source of vitality, the vital force that they cannot renounce. us, it
is impossible both to appropriate one’s otherness and to distance oneself fromit.
At the centre of the mindscape borderline persons live in, there is a moral
question:‘Whose fault is it?’; ‘Who is to be held responsible for my own and the
other’s suerings?’. Shame and guilt, the voluntary and the involuntary, fate and
necessity are the folds in which the borderline person is involved. Borderline
persons may see this fold from three dierent angles—
In the traumatic situation, one may identify with the role of the
, and in
this case feel passively involved and totally without responsibility for what hap
victim’. Feelings of abandonment, or lack of attention, acceptance, help, protec
tion, reciprocity, support—
or in short, lack of recognition—
are typical in the
borderline traumatic existence. e borderline person looks primarily in the
direction of the Other. It is the Other who is guilty, since he or she acted out
of voluntary intention. ese feelings may kindle acute emotional states char
acterized by anger, resentment, and indignation. e Self–
Other relationship
may take the form of a transitory persecutory delusion. Usually, the persecutor
is a signicant Other. is makes the persecutory delusions of borderline per
sons radically dierent from paranoid delusions in persons with schizophrenia,
which typically involve anonymous others. Borderline persons, who are more
vulnerable to developing feelings of shame, are probably more prone to assume
the role of the victim rather than other types of traumatic identities, thus to
exhibit persecutory delusions. We may then suppose a habitus, established in
the course of one’s personal history, in making them prone to assume the role
of the victim rather than another type of traumatic identity. Amixture of anger
plus shame may trigger persecutory delusions in borderline persons, and espe
cially delusions of reference, which typically arise in the type of borderline per
sons who are particularly vulnerable to narcissistic rage associated with feelings
of humiliation.
From another angle, one may identify with the role of the
. e
entirely responsible. It was for her a sort of reex, an automatic response she
simply could not control:‘I am bad, but Iam not guilty because it’s not my
fault’. Indeed, borderline persons seldom develop feelings of guilt or guilt delu
sions as melancholic persons do. From this vantage, one may not hold oneself
responsible for one’s actions, since one basically experiences these as re-
If asked about the source of the harm she did, she would respond that it was
a kind of t, or seizure—
like an epileptic seizure, kindled by the wrong she
previously suered. Rather than feeling guilty, she may feel under the spell of
some malignant power coming from within herself. is perspective does not
allow for development, as is typically the case with persons with schizophrenia,
of delusions of alien control (that is, they do not feel under the inuence of an
agency coming from without their Self). e cause of one’s actions is placed
neither on a esh-
blood Other (one’s partner, the therapist, or a friend,
as is the case with borderline persons who identify with the role of the victim)
nor on an anonymous, generalized Other, or a mechanism (as is the case with
schizophrenic paranoid delusions of alien control). Rather, one may experience
the inux in one’s life of an uncontrollable destructive force that comes from
within. Asubpersonal force that cannot be separated from one’s own Self is
responsible for one’s deeds. Borderline persons are the witnesses of an ultimate
truth:they feel the alienating power of the involuntary, that is, of the otherness
that is constitutive of our personhood.
Finally, from another vantage persons may identify with the role of the
, a merely passive spectator of the ineluctable and unpredictable
events. One feels one cannot decide, control, or change the course of one’s
life:‘It always goes like this. is happened again. Ican do nothing to avoid
it’. One feels prone to develop feelings of impotence and helplessness, and to
conceive of life as nonsensical. Oppressed with tedium, one’s mind becomes
a mirror that reects the ineluctability of the world and one’s own powerless
ness, that is, the futility of existence. e world and life itself simply are; they
just happen. Tedium may be interrupted by cynical, sarcastic, or auto-
Self felt as dominated by otherness. e responsibility is on sheer life itself, on
its inescapable as well as unpredictable nature. Existence is a tragic existence.
One feels near to one’s own destiny, so much that one can see it, touch it, nearly
thrown into this without any brakes. e nightmare is the most common para
digm of the tragic. In every nightmare there is always a moment in which pow
erlessly Isee myself being hurled into the jaws of the destructive power from
which Iwas trying to escape. Borderline persons construe themselves as the
bystanders of their tragic destiny.
A common experience with borderline persons is that they feel blamed if the
therapist advocates their responsibility in the course of actions in which they
are involved. e therapist should therefore adopt a stance that we could call
aer Hanna Pickard (2013),
responsibility without blame
. It consists in holding
the patient responsible and accountable for harm or wrongdoing, including
harm, without blaming him for it. Obviously, the idea of responsibility that
sharply distinguishes voluntary from involuntary behaviour is not applicable
as it is not applicable to human existence in general. It leads to miscarried
generalizations, to which the patient himself is prey when he identies with the
with the patient that his choices can be limited and control diminished relative
to the norm, though not as a fault of the patient himself. e clinician’s attitude
and involuntary dimensions in human action, and take seriously the patient’s
tary and the involuntary must be kept in mind to acknowledge with the patient
that given way, so he is at least partly responsible for his deeds. Responsibility is
essential to help the patient restore a sense of self-
cohesion and agency.
e emotional weather in which this process takes place should be free from
blame and reect the therapist’s awareness that he himself undergoes the same
destiny of the patient, although in a milder degree. e fold of voluntary and
involuntary, selood and otherness is the cypher of human existence. In this
zone of undecidability, potentially tragic and despairing, the borderline person
is nothing but the extreme expression. us, the patient is held responsible, but
not blameworthy for his deeds, as we as human beings are responsible but not
to be blamed for our vulnerable condition.
as suggested by Pickard—
the most important counter to blame
within clinical contexts is proper attention to the patient’s past history. Care
can involve helping patients to explore their past and recognize its eects on
the person they are and their present experiences and behaviour. If a fuller
story comes into view, patients in all likelihood come to be seen not only
as people who harm others, but as people who have been harmed by others.
patients and clinicians avoid blame. ‘It requires keeping in mind the whole of
the person and the whole of their story, which undercuts any single attitude or
emotion, forcing any blame to exist alongside other attitudes and emotions,
such as understanding and compassion’.
It is essential to maintain responsibility and to avoid blame in order to enable
the patient to re-
establish a dialogue with himself, that is, with the chiasm of
voluntary and involuntary, selood and otherness that constitutes a human
person. Patients cannot even begin to embark on this dialogue if they and those
who work with them do not believe it is
in their power to do so
that is, in their
capacity for agency. is is why
is essential for engagement and
eective treatment, especially for patients with personality disorders. is can
include encouraging them to see the fold of the voluntary and the involuntary
from dierent and multiple perspectives.
Perspectivism is the counterpart, in the world of human relationships, of what
we have described as position-
taking in the intrapsychic world. In the intrapsy
chic world, the person can take a perspective over her own experiences. is
ways to format one’s experiences. e present Who may take a dierent stance
towards its experiences, and consequently, it may also regard the point of view
of the former Who as a distinct perspective on itself. Position-
taking allows the
person to say of herself:‘at was onceme’.
unknown to Husserl:“Somewhat as my memorial past, as a modication of
my living present, ‘transcends’ my present, the appresented other being ‘tran
scends’ my own being” (Husserl, 1999, p.115). In the world of relationships, it
is the Other in esh and blood that allows me to take a dierent perspective on
Perspectivism is the device through which each one of us, who rst and fore
most sees the world from his point of view, is able to recognize that precisely
just one
point of view, and thereby to change it. Ahealthy mental condi
tion implies the ability to change one’s point of view and temporarily take the
perspective of another person. e stronger the reciprocity of perspectives
the Other’s, the weaker the tendency to perceive my motivations as absolutely
valid and necessary. is implies that the capacity to move from one perspective
to another
me (as Husserl would say) from my prejudice to hold an
absolute and objective stance on the world. But at the same time it allows me
allows me to restore a sense of agency.
e reciprocity of perspectives allows people to interact with each other
since it presupposes that objects of the world are accessible to other people, but
mined situations and purposes. In the reciprocity of perspectives Iassume the
interchangeability of standpoints:if you were where Iam, you would see what
Isee and vice versa. Ialso assume that the practice to momentarily give up my
biographical uniqueness and attend to what is relevant to the present situation
allows me to recognize the Other’s system of relevance.
However, the capacity to take another person’s perspective does not mean
to adopt a dierent point of view, much less the point of view of the Other.
possible and that all truth is relative to a given point of view. Perspectivism is not
relativism. Rather, it is the assumption that truth is
in between us
. Perspectivism
is the condition of possibility for integrating one’s views with other views, which
one learns about precisely by changing one’s perspective, especially through
is is the meaning of Deleuze’s statement:“e status of an object exists only
ism as a truth of relativity (and not a relativity of truth)” (Deleuze, 1988, p.21).
Truth is not relative to a person’s perspective. Rather, truth is found in
the rela
We know that there are some patients, whom we call schizophrenic, who are
unable to adopt the point of view of the Other. In reality, they are also terri
point of view of the Other (Stanghellini, 2008):taking the point of view of the
Other represents for them a serious threat to their fragile ontological constitu
tion, their fragile constitution of the Self (Stanghellini and Ballerini,2007).
the world when we must recognize that the world can also be seen from a dier
ent perspective. e concept of perspectivism has led us back to the foundation
of my argument:the mark of humanity is the awareness of the inaccessibility of
attempt to reduce the Other to the same is unacceptable because it is tanta
mount to depriving the Other of its autonomy by imposing our discourse on
its discourse. But it is equally unacceptable to make him the absolutely Other,
because the Other touches and inhabits us in the very fold of our nitebeing.
it is possible, and what it means, to adopt the point of view of the Other. e
one’s own
perspective. Once again, in order to see things from the
perspective of the Other, it is essential to assume that his view is other than
so that it may unfold his point ofview.
e goal is the realization that there is
nothing but
perspectives. What we have
is only a perspective (or at most a range of perspectives) on the Other to whom
we tend, but who remains noumenally unreachable.
Only the exchange of perspectives renders our perspective, at least in part,
dimensional. is explains why the reciprocity of perspectives is a thera
peutic goal and perspectivism—
the attempt to see things from the point of view
of the Other—
is a therapeutic device.
What is astory?
e last therapeutic device, which Iwill only address briey, recapitulates all
of the availability of an ‘I’ (the clinician) to encounter a ‘You’ (the patient), shar
ing the painful consciousness of the inaccessibility of the Other. e therapeutic
situation inhabits the (narrow) space separating the objectication of the Other
(the reduction of the Other to an exemplar of a category) from his subjectica
tion (the reduction of the Other to an aspect of oneself). e tools one has to
rely on and gradually learns to share (and make do with) are the patient and
respectful (and unending) reconstruction of the point of view of the Other,
and the responsible assumption of one’s own point of view about oneself and
onthe Other. With these tools we move in search of a kind of knowledge that
has the power of truth. Atruth that, in accordance with the premises, is not to
be searched for within the subject, but is part of the relationship—
a truth that
the relationship. It is not the truth
is approach has abandoned the idea that the truth is a form of correspondence
an idea of

truth as
intersubjective accord
looking for a place toshare.
e therapeutic truth comes close to a kind of communicative action, that is,
a project that reconstructs a concept of reason that is not grounded in instru
mental or objectivistic terms, but rather in an emancipatory communicative
act (McCarthy, 1981). e goal is to bring about an agreement [
rather than aiming at a shared construct—
terminates in the intersubjec
tive mutuality of reciprocal understanding, mutual trust, and accord with one
another (Habermas,1979).
Communicative action serves to transmit and renew cultural knowledge, in a
process of achieving mutual understandings “that rests on the intersubjective rec
ognition of criticisable validity claims” (Habermas, 1984, p.17). It then coordinates
action towards social integration and solidarity. Finally, communicative action is
the process through which people form their identities (Habermas,1987).
that disagreement gains a vital constitutive signicance. It allows for the
unfolding of a parliament of forms of understanding whose orchestration is
dialogue itself.
plurality of normalities, each of which has its own notion of what counts as true) does
not merely lead to a more comprehensive understanding of the world, insofar as we are
able to incorporate these dierent perspectives. e disagreement can also
constitution of
objectivity, insofar as we aim toward reaching a truth that will
be valid for all of us. (Zahavi, 2003, p.135)
is statement helps to focus on a long-
standing prejudice:conicts of
truths as well as of values are signs of imperfection, not a normal part of life.
Indeed, we do not need an ideal based on rational consensus, or on the best
way of life, or on reasonable disagreement about it, “but instead on the truth
that humans will always have reason to live dierently” (Gray, 2010, p.24).
Accord is not consensus. e accord does not consist in an empirical search
for an agreement on a particular issue. is truth is not the outcome of a
negotiation, nor is it a shared construct. It is the act of tending to the Other,
puried from itsgoal.
e question that follows, then, is:How can the awareness of this shared ina
bility to understand the Other turn into a therapeutic device, into an eective
therapeutic attitude?
“e other as alter ego signies the other as other, irreducible to
writes Derrida (1967, p.157). ere is, Derrida continues, an “empirical dis
Other becomes an innite, impossible task. Trying to accomplish this task
would mean to reduce the Other to myself—
and this is the source of all misun
him as Other, sees me as Other. e Other, just like me, is about to cross the
desert that separates him from whoever is hisOther.
way to the Other not to possess, use, and abuse it, but—
as Levinas would
] to
ascend into heaven” (Levinas, 1968, p.109). ere won’t be an encounter if
the Other is seen as a destination to be reached. On the contrary, this will be
the source of constant wandering. Care lies in the act of tending, of crossing,
not in claiming to have reached the nal destination. Incidentally, this may
be one of the reasons why one chooses to care:sympathy for those who, like
me, are engaged in the same journey, in the same ‘leap’ (to use Jaspers’ expres
sion) towards the Other. With a bit of arrogance, both (the patient and I) look
down upon those who ignore the problem and seem satised with reassuring
but supercial solutions. is shared
holds a positive value because it
terms:we are on the same boat, and Ias a clinician must be aware that Ican
not understand the patient. Iam not suggesting that this sentence should
be spelled out, since patients are oen motivated to ask for our help, as they
assume we know about them, and about other people in general, more than
of the therapeutic encounter:I, as Other, tend to you, the patient, but Itend to
you knowing that Icannot reachyou.
e therapeutic discourse is that which serves to clarify systematic misun
derstandings, rather than self-
deceptions, inappropriate behaviour, or dysfunc
tional emotional reactions. e ideal aim of care is to become an exchange of
views that admits no external referee, but only the responsibility shared by the
two partners to dene the terms of one’s own discourse. is reciprocal explica
tion of one’s own discourse, the exposition of the values at play in it, and the elu
cidation of the words through which one’s position is expressed, pave the way
to an exercise of cooperation during which no vantage prevails over the other.
Its nal aim is not validation or invalidation aimed at some form of consensus,
rather clarication aimed at coexistence. Perspective-
taking is not one part of
an entire process of care, rather its very essence:an exercise of approximation
logue. e very essence of therapy is this very dialogue, and the manifold tools
in use in the clinics of mental disorders (from empathy to drugs, from compul
sory treatment to voluntary psychotherapy) are just means to the end that is
dialogue itself.
We should recognize, embrace, and take seriously the role of values, along
side symptoms, in the therapeutic process. Values are attitudes that regulate
bestowing and the signicant actions of the person, being organized
into concepts that do not arise from rational activity but rather within the
sphere of feelings. us, grasping the values of a person is key to understand
it is key to understanding her ‘form of life’ or ‘being in the world’, that is, the
structure of the world she lives in, and regulate her style of experience and

Care is the occasion to start a shared project of reciprocal understanding
into account. Also, it is the occasion to acknowledge that each partner has his
own values, and practise how to live with irreducible value conicts. Coexistence,
rather than consensus, is the framework within which this encounter is posited.
argues for the necessity of a cultural self-
assessment on the part of the clinician
as a means of optimizing analyses of the patient’s culture. Conceptualizing the
edge patients’ cultural backgrounds, while remaining aware of their own cultur
ally rooted prejudices. ey should remain open to a hermeneutic dialogue that
aims for the acknowledgement of dierent values and to understand one’s style
of experience and action within the framework of one’s own value-
nologist adopts the history of his own culture as the baseline for his analysis of
the history of the other culture, but while he is engaged in the act of understand
categories. Ethnocentrism is an attitude that develops inside any cultural world.
e tendency to assume that the categories and modes of expression of one’s own
culture are naturally given, obvious in themselves, and universal has its origins
in a human need for identity and for identication (Lanternari, 1983, p.39).
his own cultural models. e individual, however, can exercise control over his
own criteria for knowledge gathering and evaluating. In order to do so, he needs
to be cautious and self-
critical and to have a general—
as well as a particular—
knowledge of the Other (ibid., p.21).
In a cultural encounter, the experience of being faced with a person who has
dierent values, and a dierent perspective of the world, has the advantage of
throwing light on one’s own values and perspective, which normally remain
well as those of others. Arelevant consequence of this is the equalization of
formation from a subject–
object relation into a subject–
subject partnership
(Stanghellini and Ciglia, 2013).
As shown in the rst part of this book, conicts of values go with being human.
Some of them have no satisfactory solution. is view is not a form of scep
ticism, or relativism, that paves the way to some sort of therapeutic nihilism;
rather, it is the starting point for developing an idea of care based on value-
acknowledgement and value-
pluralism. Persons have reasons to live dierently.
And our patients’ values depart from common-
sense values, as they are embed
ded in life-
worlds that are dierent from each other and from our own. is
statement reects the ideal of
modus vivendi
(Gray, 2010), whose aim is not look
ing for consensus about the best values, or sharing common values in order to
life can coexist.
Modus vivendi
“e aim of
modus vivendi
”, Gray writes, “cannot be to still the conict of value.
It is to reconcile individuals and ways of life honouring conicting values to a
peace. We need institutions in which many forms of life can coexist” (ibid.,
are many ways of life. e good is plural. ere is no one good that is right. And
there can be no right solution in such conicts. Rather, there are many” (ibid.,
p.26). e idea of dialogue as a means to universal consensus should be given
up. e project of
modus vivendi
among ways of life animated by permanently
diverging values should take itsplace.
e practice that derives from this supports the patient in the search for value-
acknowledgement, that is, insight, understanding, resilience, and development
of self-
management abilities, rather than merely focusing on symptom assess
ment and reduction. Also, this practice enhances value-
pluralism, that is, an
idea of care that aims towards a relation of coexistence rather than consensus.
Most of our current, supposedly ‘humanitarian’ or ‘dialogic’ therapeutic prac
a woolly kind of ‘dialogic’ value. While it looks for agreement and harmony, it
physical belief that conict of values is just a stage on the way to sharing univer
sal values. In this vein, conicts of values are signs of imperfection, rather than a
constitutive part of human life. is unrealistic idea promotes pseudo-
practices that downplay the person’s subjectivity and surreptitiously endorse
sided values. Examples of this are ‘social rehabilitation’ (which endorses
prevailing social values), or potentially intolerant techniques to enhance ‘com
pliance’ (which endorse the distinction illness/
health based on the clinician’s val
both taking for granted that ‘good’ values are on the side of the clinician.
Coexistence with mental suerers and with the values each of them embodies
a distance. It aims to acknowledge, understand, and respect dierent ways of
negotiate reciprocal recognition.
Personal life-
a technique to be applied in the therapeutic dialogue, or a rigorous device to
attain an objective truth about the patient.
ism. Its real concern coincides with what Gadamer wrote in the Preface to the
second edition of
:“[it] was and is philosophic:not what we
do or what we ought to do, but
what happens
to us over and above our wanting
and doing” (Gadamer, 2004, XXVIII, emphasis added).
the phenomenological analysis of what really occurs when a clinician strives to
apply the dialogic principle to the clinical encounter. It is not just the
a priori
codication of a routine for clinical care, but the consolidation of a practice
shared by a group of clinicians moved by similar principles based on phenom
enology and hermeneutics. It is the bottom-
up eect of a phenomenology of a
kind of practice committed to understanding, rather than a top-
cally established agenda to be applied to psychotherapy.
What actually happens during the kind of practice at issue here can be
described as a process of
progressive decentring
of two partners taking part in a
What is called phenomenological unfolding (P)is in a nutshell the taking of
a third-
person perspective on one’s own experiences. Unfolding is the moving
from the rst-
to the third-
person perspective over oneself. It is a process of
gradual objectication of one’s own facts of consciousness. In order to say ‘You’
to oneself one needs rst to see oneself as an ‘It’. is process engages both part
ners; not just the patient, but also the clinician should be able to describe and
acknowledge his own experiences, while remaining aware of his own histori
cally rooted prejudices.
e hermeneutic moment (H)consists in position-
taking and perspective-
taking with respect to one’s own experiences and their meanings. is is the sec
ond step of self-
objectication. It requires the capacity to distance oneself from
and to make of these very habits the object for reection and for understanding.
e patient and the clinician should also remain open to acknowledging their
To become acquainted with oneself one has to take the path of dispossession.
e psychodynamic moment (D)consists in positing both P and H in a larger
historical context, according great importance to the role of life events, of tradi
tion and prejudice in the development of any form of
one’s experiences, and of boundary situations in jeopardizing one’s defensive
‘housings’ and showing their vulnerability (Fuchs, 2013). is means acknowl
edging and accepting contingency as the necessity of one’s own story. It also
fold of a person’s experiences and self-
person’s life-
history (Binswanger,1928).
riences and self-
necessity in the person’s life-
We call ‘spiritual person’—
writes Binswanger (1928)—
the point from which
experiences spring, and ‘personal life-
history’ the intimate interconnection of
the contents of the person’s experiences.
cuing of an
, a remote cause that is posited in the past. e psychodynamic
moment is not the search for a
big bang
. What is searched for is not a datum, an
that can be chronologically hypostatized, or a fact that has actually happened
(Agamben, 2008, p.93, 2010, p.16). Rather, it is a phenomenon that allows the
a person’s life-
history that helps make intelligible a string of phenomena whose
ence and synchronic comprehensibility of the system (Agamben, 2008, p.93).
Looking into a person’s past has not the purpose of nding a traumatic
event that causally explains (to explain technically means
scire per causas
the following events that have taken place. Rather, the purpose is looking
for the
that can lend coherence to the person’s life-
history. e
is not chronologically original, but hermeneutically so. It may not
be a traumatic event that has taken place in the remote past and gave origin to
. e word
‘paradigm’ comes from Greek and literally means an example (
) that
exhibits, shows, and points out (
(for instance, of a verb) all of which contain a particular element or theme. If
someone (for instance, the student of a given language) knows the paradigm
(for instance, the Latin verb ‘
amo, amas, amavi, amatum, amare
’) he will be able
to recognize and use this verb and all the verbs of the same declination.
A paradigm is the best exemplar of a group of analogous phenomena whose
characteristics are claried by the paradigm itself. For its transparency and
according to the rule ‘one speaks for many’. Following Agamben (2008), a para
digm is a single case (say, a single phenomenon in a person’s life-
history) that
being very perspicuous in its singularity can make intelligible an entire group of
phenomena, whose semantic homogeneousness it has contributed to creating.
If Idiscover the paradigmatic phenomenon in a person’s life-
history, this will
shed light on all other previously opaque phenomena by means of the anal
of meaningfully related phenomena.
A quite ordinary example is the following:an adult person describes an episode of his
life when he started a close romantic relationship. He portrays himself as both desiring
and feeling uncomfortable with emotional closeness. He says he started to distrust his
signs of her intention to end the relationship with him. He develops painful feelings of
unworthiness and tends to suppress all of his feelings, including his desire and need
for intimacy. He discovers that this pattern of self-
other relationship dates back
at least to his childhood and describes episodes that conrm this. He also uses this
including his romantic, parental, and peer relationships—
as well as the transference
relationship with the clinician.
e recollection of my life-
history also helps me to recognize that the position
and the perspective—
in one word:of the H moment of the P.H.D.—
I take over
my experiences are
historically determined
. e awareness of the historicity,
and nally of the contingency, of the stance Itake in front of my experiences
world. is paves the way towards the reciprocity of perspectives and towards
achieving a three-
dimensional view of my experiences. At the same time, it
sense of agency.
As we have seen in the rst part, our identity as a human person is a narrative
we encounter in our life. Narrative identity is the basic form of dialogue with
alterity. Alterity challenges my life not only from without, for instance, as an
unexpected event, but also from within in the form of the sedimented, obscure
rough narratives we are able to articulate the reasons of our character and
the meanings of the events that we encounter in our life. Narratives are patterns
of meanings that contribute to make sense of my character and the via regia to
work through the meaning of a given event in my life. ey moderate the ossi
cation of the character and the traumatic potential of the event. ey make our
involuntary dispositions and the alterity contained in the event a dynamic part
of our personal history.
we know that this encounter may become pathogenic. Avulnerable trait and a
event, respectively, as well as the capacity of the person to dialogue with them.
Vulnerability is the underside of an involuntary disposition, and trauma is the
underside of an event. We called ‘vulnerability’ the alterity that Ind in myself
when Ias a person cannot dialogue with it. We called ‘trauma’ the alterity that
Iencounter in my dealings with the external world when Ias a person cannot
dialogue with it. Failing to dialogue with alterity means failing to
to cope with, modulate, and make sense of it.
Binswanger provides a celebrated example. It is the story of Augustine of Hippo told by
the Berliner theologian Karl Holl. Although Holl’s account is deemed a legend rather
than the true story of St Augustine’s path to Christianity, the way Binswanger reports
it can be considered a classic in the phenomenological understanding of the relation
he became aected by severe lung problems. is ‘storm changed course to his ship and
forced him to take another direction’ (Holl, quoted in Binswanger). He understands
that this event is an end to his professional career as an orator. He acknowledges his
new condition and ‘accepts his disgrace as a liberation’. His decision to meaningfully
integrate this potentially traumatic event into his life-
history paves the way to his con
version, to his new life. Augustine appropriates this event and makes a virtue out of
e condition of possibility for Augustine’s appropriation of the potentially
traumatic life-
event is his acceptance of being decentred by it and transformed
by it. Without this, Binswanger would suggest, Augustine of Hippo would not
have become Saint Augustine, and would have developed a symptom—
instance, a psychogenous reaction.
What is a story? It is the working-
though of a person who accepts being
decentred by an experience. Astory is the eect of a person’s acceptance of
being decentred from a given experience, that is, from the way a given event
previously aected him. To build a story, a given experience must be decentred
from the meaning it previously had for the person who underwent it. Every
noteworthy life-
event requires a
. e power to appropriate a life-
event in one’s life-
history depends on two conditions:the person’s acceptance
that it may change his life, and the person’s capacity to grasp a new meaning in
the event itself. e meaning of the event must change, and the person must
accept that he is changed by his experience. In sum, a story is a discourse of an
Other about an Other.
Clinicians know that when a patient says that he is bored of repeating his own story
over and over again this may be the prelude to a change. e patient who is bored of
the story he used to tell the clinician (and every person) is on the point of accepting
being decentred.
prise. Usually, in a clinical context, surprise is wished for as much as it is feared.
In telling my story Icome to the point at which Irealize that it is not my story.
ere is a feeling of extraneousness that immediately precedes a feeling of bore
dom. In order to avoid boredom Ican only tell another person’s story. Only
when Irealize that, while Ibelieve I’m telling my own story, I’m indeed telling
another person’s story—
either my story told by a person dierent from myself,
or the story of a person who is not me—
my own story may come to me with
surprise. e story Itell about myself becomes itself an event and moves the
dialectics of my identity. It is the point of departure from the
and the leap
to the
Next to a eulogy of narrativity as the dispositive that helps articulate the reasons
for our character and dispositions, as well as the meanings of the events that we
of narratives in relation to the unrepresentability, inscrutability, or inappropri
ability of certain aspects of alterity. Narrativity comes to a zone where alterity
cannot be appropriated, and especially cannot be appropriated through lan
guage. In this twilight zone, narrativity becomes the name of a problem at least
as much as it is that of a solution. Where narrativity ends, intimacy maybegin.
An example of intimacy with the alterity of an Other comes from Martin
Buber in a paragraph entitled ‘e communicative silence’ (1954, p. 110):
Two men are sitting one near the other. In silence. ey do not know each other. ey
do not look at each other. One is a cordial man, aable and jovial; the other is rigid, shy
his heart’ break down. Unexpectedly his rigidity dissolves.
‘Nobody will be able to tell what happened not even to himself. What do they know
of each other? Knowledge is no more necessary. For where immediate communication
of dialogue takes place’.
What is essential here is that during this mute dialogue nothing happens that
can be expressed in terms of explicit knowledge. ‘What happened?’—
‘What did you do?’—
‘Nothing’. ‘What did he tell you?’—
‘Nothing’. ‘What did
you tell him?’—
In order to understand intimacy one needs to understand what an atmos
phere is, as intimacy with a person is a kind of atmosphere. Both happen in the
guage. Rather, they involve the sense of tact as a means for sharing. Intimacy, as
an atmosphere, has a “fragile architecture” (Pallasmaa, 2013)—
or “haptic archi
is has obvious clinical implications. Tellenbach considered that during the
interaction with a patient, the clinician is led to feel certain atmospheric quali
ties that permeate the process of understanding. is led him to develop the
concept of “diagnostic atmosphere” (Tellenbach, 1968). Minkowski used the
diagnostique par penetration
the importance of intuition (the non-
cognitive grasping of the meaning of an
object) in the process of diagnosing (Minkowski,1927).
tic rationalism in order to preserve the phenomenological understanding and
achieve an understanding of the meaning of a clinical situation as felt, rather
than simply assessing objective signs and symptoms. Deleuze and Guattari’s
(2001) concept of
provides an insight on the nature of this in-
that constitutes the atmosphere of intimacy described by Buber. Haecceities
or destination.
e understanding of reality is rst and foremost considered through an
‘estranged epistemology’ as if the subject cognitively delved into his experience.
Recently, Gibbs discussed an ‘engaged epistemology’ which portrays two types
of meaning in any given situation—
a pre-
reexive (which is already imbued
of raw experience) (Gibbs, 2005). rough this epistemology experience itself
is not ‘raw’, that is, meaningless and in need of being understood, but already
imbued with meanings.
Felt meanings
are already present while experiencing
a given object or situation, earlier than the appearance of cognitively appreci
ated meanings. is type of tacit meaningfulness has clear links with the idea
of atmospheres. Minkowski uses the verb
(breathe in) to portray this
distinct mode of being in the world, i.e. the mode of experiencing an atmos
phere, which is close to what Tellenbach calls the atmospheric mode of being
human (Tellenbach, 1968). When a subject is assessing an atmosphere he is
apprehending an emotional signicance in an immediate and self-
evident way.
reexive meaning is not straightforward, as (1)reexive eort cannot replace
our everyday performance it is embedded in such a way that it remains hidden
(clinicians must actively undertake such eort).
e pre-
reexive meaning is a pre-
conceptual assemblage of the assortment
of all sensorial inputs available to the subject. Two consequences arise from the
nature of this type of meaning. First there is a threshold before which sensorial
inputs from the body and from the world are merged as if they were one and
the same. As Merleau-
Ponty (1996) points out, it is as if there was a continuum
the object and my body. Finally, this sound vibrates in me as if Ihad become the
instrument itself (Merleau-
Ponty, 1996). e atmosphere is indeed immedi
ately perceived as an aective tonality that pervades space and simultaneously
permeates the subject’s body. “I felt that Ibreathed an atmosphere of sorrow. An
air of stern, deep, and irredeemable gloom hung over and pervaded all”—
Poe (1984) writes in
e Fall of the House of Usher
. Hence, atmospheres inhabit
what Straus named the ‘pathic’ moment of perception (Straus, 1963), where
object distinction is fuzzy and so the sensorial domains are inchoate.
e merged and pre-
conceptual meaning is the integration of dierent sense
modalities, where one sense mode automatically elicits other sensorial modali
ties. In this moment there are no mono-
sensorial experiences, only a synes
Duchamp’s ‘musical sculpture’ or some of Stockhausen’s pieces entails more
than an acoustic experience—
a kind of visual–
tactile experience is at play,
where sounds are felt as sculpting silence.
e second consequence of this pre-
reexive and pre-
conceptual appraisal
of the meaning of an atmosphere is that the pre-
reexive meaning ultimately
accounts for the global awareness of reality, as the subject is moved by this bod
ily felt transformation. For instance, the scent of a perfume assaults us with
images and forces us to experience the ineable tonalities of the place or situa
tion exceeding the accessible meaning and guiding us to an overall understand
ing. Tellenbach stresses this in the remark that “in nearly all sensory experiences
there is a surplus which remains inexplicit” (Tellenbach,1968).
In order to grasp atmospheres in clinical practice, one must be predisposed
what allows the distanced inuence of atmospheres (Böhme, 1993)and atmos
ating from the ‘natural’ stance towards all objectivity, which is closely related
to the represented objects and the whole environment” (Hümer and Schuster,
2003). Husserl appears to be referring to the suspension of the natural attitude
ing. e former resembles the ‘disinterestedness’ that Kant and more recently
respectively (Fenner, 2008). e latter implies that in order to experience any
Duchamp’s ready-
mades like
e Fountain
or the
In Advance of the Broken
exposed in a gallery and consequently stripped out of their utilitarian everyday
tion. Although the art critic or collector might have a professional intention
Neuroscientic research also supports this observation. Having found that
a particular object and the object is stripped of its usual purpose, so that “the
person is self-
transcending, self-
avoid his intention of nding symptoms in order to allow for the appearance of
has long since been recognized. Tellenbach considered that during the interac
tion with a patient, the clinician is led to feel certain atmospheric qualities that
exceed the factual, but nevertheless permeate the process of diagnosing. is
led him to develop the concept of diagnostic atmosphere. Minkowski’s
tique par penetration
refers to the importance of intuition (the non-
grasping of the meaning of an object) in the process of diagnosing, particularly
referring to the diagnosis of schizophrenia. ese concepts are evidence to the
fact that the two authors acknowledged the role of atmospheres in the under
standing of phenomena. No dierently than in the arts, in the encounter with
a patient it is also through the atmosphere into which the clinician is initially
thrown that he apprehends the ‘world quality’ that will guide his comprehen
sion. While the quest for objectivity might serve as an excuse to perform the
mises the entire understanding. e objectivity of atmospheres depends on
the possibilities of feeling of the participants in the encounter. e clinician’s
world’ is not cancelled in the event, neither is his participation in
the global awareness of the situation.
Heidegger’s concept of
(situatedness) (Heidegger, 2010)seems
useful to further clarify the idea of understanding through atmospheres.
comes from the irregular and reexive verb
sich benden
(to nd
oneself). In his Commentary on
Being and Time
, Dreyfus (1991) relates the
concept of
to a mood, rather than a state of mind, that is neither
subjective nor objective and is itself a source of attunement to the world, con
stituting the way we nd ourselves in situations. Accordingly, while accounting
for the global awareness of a situation, atmospheres have the ability to place us
in that same situation through a sense of proportion and distance that takes
into account the position of the other. is sense that allows us to nd ourselves
while attuning to the other is
. Tact is what Gadamer depictsas
a special sensitivity and sensitiveness to situations and how to behave in them for which
knowledge from the general principles does not suce (
unsaid (
) and it is tactless to express what one can only pass over. (Gadamer,2004)
, which means understanding the environment, comes
from the senses, particularly from the sense of tact (Massie, 2013). Unlike
other senses, tact needs tangibility; the medium is (in) our body. us,
through the sense of tact one simultaneously senses an object (a thing or
another sentient being) and one’s sensing body. Accordingly, tact embodies
both ipseity and alterity, and it is only through the dialectics of the two that
sensing is possible.
Phenomenologically, tact is the sense that is present in the moment of apper
tion of all other senses. When Merleau-
Ponty tells us ‘through vision, we touch
the stars and the sun’ he is showing us how the sensuous quality of the exterior
uum eliciting other sense modes. e relevance of atmospheres in the clinical
haptic foundation as the statement by Merleau-
Ponty suggests. In this sense, the
space of atmospheres is experienced as a tactile space. Meanwhile, the changes
in bodily feelings of the receiver are felt as a shared awareness of the situation
placing him at the right distance, a tactful distance that is tacitly agreed.
Like the sense of touch, atmospheres exist in a dialectic space of resonance
ation, and are also a prelude to knowledge. If on the one hand the whole that is
use to understand a situation, the ineability of the experience shelters a latent
disclosure of a new understanding.
reects the pre-
reexive nature of the experience. e embodied transforma
tions impressed by atmospheres are not directly accessible by existing con
cepts, which means that they can only be indirectly made sense of by a process
atmospheres. On the contrary they enhance atmospheres, amplifying them
experience they enable a self-
sustaining process of ‘understanding and expe
riencing one kind of thing in terms of another’, which has been considered by
Lako and Johnson as the basis of our everyday conceptual system (Lako and
Despite the frenzied concern for reliability that has expanded into the privacy
of the clinical encounter declaring the third-
person paradigm and its outlined
preconceived interviews as the representatives of objectivity, mental symptoms
have not been and cannot be xed in time. ey are neither strictly objective
nor subjective, and rely on a constant negotiation of meaning that forcibly takes
place during the clinical encounter. It is through the clinician’s engagement
in the process of understanding that the accuracy of psychopathology is pre
served. is is due to the fact that the basic process by which meaning is con
structed is linguistic and prior to any
, including the scientic episteme
Interview techniques designed according to the third-
person paradigm focus
the clinician’s attention on the search for specic symptoms. It is this same inten
the clinical encounter and restricts linguistic contexts, risking tautology. If one
learns how to experience atmospheres, one could dodge the bias of this inten
must dodge the scientic dogmatism through Kant´s ‘disinterested pleasure’ in
order to preserve the phenomenological understanding.
from common sense and any preconceptions (including scientic preconcep
tions). Phenomenologically they belong to the pathic moment of perception,
the moment when self and world/
dox is peacefully embodied by the sense of tact. Tact is the sense that is present
when the person nds his limits in the limits of the Other. Hence, atmospheres
oneself and the Other are constantly being dened and redened according to
the present situation, whilst hinting at the global awareness of that situation and
anchoring the process of understanding. Although the experience of atmos
pheres belongs primarily to the pre-
reexive realm, it can be brought to the
generates and regenerates meaning in a permanently unnished task of describ
ing and redescribing that is truthful to the unnished nature of atmospheres,
bringing us closer to the original phenomena. e acceptance of atmospheres
as clinically relevant phenomena is ultimately related to the acknowledgement
of the ambiguous nature of the clinical encounter. e clinical encounter is an
an open event that invites participation, and must remain so in order to pre
encounter might be the means to preserving its nature.
Meares developed a similar argument in his conversational model of psycho
therapy. Intimacy is to Meares a kind of at-
oneness in which both partners feel
a sense of connectedness and a shared understanding. It is not equivalent to
fusion, since fusion is the desperate attempt to ll, with the gure of the Other,
the emptiness le by the absence of the self (Meares, 2004). Meares encapsulates
this in the formula ‘aloneness–
is relatedness is transformational. Transformation is mediated by dialogue
consisting of more than its content, the simple transmission of information.
Language is not only the content of language. Dialogue is not merely a vehicle
for pieces of information. Of central importance is the
of language, that is,
the way words are used, or the tone of voice. Language is non-
linear, associative,
apparently purposeless, and apparently its function is not communicative. It is
enveloped into the implicit atmosphere of intimate relatedness. It is like a kind
they arise in particular forms of relatedness. And to emotions, out of which
‘meanings’ frequentlycome.
is kind of conversation both constitutes and manifests a form of being.
e development of this experience of one’s self cannot be generated by ‘linear’
experience and the responses of the Other. Care through intimacy is directed
towards a jointly created imaginative narrative arising out of play, a non-
mental activity. erapeutic interventions directed at ‘insight’ and the ‘uncon
scious’ risk invalidation and the creation of dependence. is experience is a
form of relatedness that may correct maladaptive forms of relatedness and gen
the restoration of a disrupted sense of personal being. e success or failure of
the evolution of aloneness–
Buber’s descriptions of the life-
world of the I–
You relation) in changes in the
totality of experience of self, bodily feelings, and the sense of spatiality.
If we now look at the other side of alterity, there is an intimacy with oneself
that is the
mute dialogue
with that part of oneself that cannot be appropriated
and mastered. is part, as we have shown in Part One, is the most intimate
and proper and the closest and remotest at the same time. It is my own life in as
much as it does not belong to me. We may call this part the
radical alterity
. It is
To live in the intimacy with this extraneous being is to keep in constant rela
tionship with an unpleasant companion—
In Ingmar Bergman’s movie
, disenchanted knight Antonius Block,
squire Jöns, a realistic, down-
earth man who has a sardonic relationship with his
master. As the two of them travel to the knight’s castle in Sweden in the throes of the
black plague, the knight is challenged by Death (‘I have been at your side for a long
time’). Block oers Death a bargain:they will play chess for the knight’ssoul.
asks:‘Why can’t Ikill God within me? Why does he live on inside me, mocking and
tormenting me till Ihave no rest, even though Icurse him and try to tear him from my
heart? Why, in spite of everything else, does he remain a reality—
a maddening reality
In one scene, Block says that he has to travel with an unlikeable comrade, and his
interlocutor, Mia, responds that she understands the knight’s being disappointed with
such an unpleasant attendant. Antonius Block thoughtfully replies that the unpleasant
comrade he was mentioning is not his squire—
is unpleasant companion with whom Ihave to share my life is not simply
a non-
knowledge zone in myself. It’s not the repressed unconscious. It isn’t
It is my life in as much as it
does not belong to me
. Philosophers have the right to say that the majority of
men ee from this irreducible part of themselves, or hypocritically try to reduce
it to their own minuscular height (Agamben, 2004, 2005). e more Itry to
ignore or suocate it, the more it cries to be heard. It may happen, then, that
this rebellious part reappears as a symptom—
the disjointed and unheard part
of one’s identity. e part of one fold cannot be appropriated by the other part
unless the fold itself disappears.
To live in intimacy with this power is, rst and foremost, to acknowledge
its necessity. It cannot be eradicated, as my being will be eradicated with it.
Second, Ihave to recognize its authority—
its inuence and supremacy. Ihave
no means—
no means that belong to logic, language, or narrativity—
to annex
this part to myself. Ihave to admit that there is nothing that can be under
be cheated, but only respected and honoured. Imust see it as an enemy worthy
of my value, a non-
renounceable piece of my personality, out of which—
as sug
gested by Freud—
things of value for my future life have to be derived.
is irreducible alterity can only be
put to use
. is, as we have seen, presup
poses responsibility and implies a recovery of agency. e good life originates in
the recognition that part of myself cannot be appropriated. Intimacy is the use
of oneself as non-
appropriable (Agamben, 2014, p.129).
‘I am the administrator of my life’
said one of my patients when he came
to acknowledge his being responsible for a part of his life that cannot be
e intimacy with what cannot be appropriated is an everyday mystical prac
tice (Agamben,2005).
Ricoeur, in a conference entitled
Le problème de la volonté et le discours philos
e problem of will and the philosophical discourse
] (2013), roots phe
la méthode dialectique au sens d’Aristote, c’est à dire [d]
’une confrontation d’opinions
arbitrée par le travail de la dénition, peut être considérée comme l’ancêtre de la phé
noménologie (ibid., p.124).
[e dialectic method in Aristotle’s sense, that is, a conformation of opinions refereed by
the labour of denition, can be considered the ancestor of phenomenology].
is denition reects three key characteristics of the phenomenologi
, or the art of conversational discussion;
, or
the ‘labour’ of denition; and
, or the process of reciprocal
Dialectic:the art of conversational discussion.
e phenomenological
tic’ (
just a person who is skilled in conversation. Rather, dialectic is the capacity
to distinguish things according to their nature. Ricoeur underscores that the
aim of dialectic, that is, to obtain a sharper denition, is based on an exchange
versation. Phenomenology, like dialectic, is about a ‘
confrontation d’opinions
about a given phenomenon—
namely, a concept. It is, literally, an
a conversation, a comparison of two (or more) standpoints, pictures, or ideas
about a given phenomenon. Stressing the dialogical nature of phenomenology,
Ricoeur takes distance from all sorts of solipsistic understanding of the phe
nomenological attitude, including the opinion that phenomenology is about
the idiosyncratic discovery of the essence or ‘eidos’ of a given object that takes
place in a private, inner space of a contemplative subject. Phenomenology is not
(or is not
here is an activity that takes place in an open, public, interactive, intersubjective
space. is version of phenomenology, namely
hermeneutic phenomenology
, is
dialectic in nature, as its product is the outcome of a process of ‘confrontation’.
Unfolding:the labour of denition.
is interaction builds on ‘
le travail de
la dénition
of denition. is work is like childbirth and (as we
will see) it requires an ‘art of midwifery’. Denition, like childbirth, is achieved
the case of the labour of denition, what comes to light are one’s assumptions,
including feelings, opinions, and experiences, and the personal meanings that
one attributes to them. Explication (
) means displaying or unfold
ing the manifold of phenomena and their interrelation through language.
Explication enriches understanding by providing further resources in addition
to those that are immediately visible. Its product is a
, that is, a dis
course that reects the phenomenal world, the world as it appears from the
vantage of the subject of experience. e aim of this process is twofold:rst,
“bringing unnoticed material into consciousness”—
as Jaspers (1997, p.307)
would put it. Explication is rst and foremost to bring out or make explicit
what is implicit in the person’s subjectivity. e subject of experience can take a
reexive stance or third-
person perspective in front of the ‘raw material’ of her
e second aim is to oer this material to one’s dialogic partner so that she
can see the world as it appears from your own perspective. Each partner is a
is is a process of reciprocal enlightenment. e purpose is
not to impose one’s own view onto the Other. ‘Confrontation’ here is not simply
a struggle or a battle. Although the art of dialectics was undoubtedly born from
demonstrate whose knowledge is stronger than the other’s (Colli, 1975, p.73),
dialogue is not mere polemics. Rather, it is a mutual maieutic process whose
aim is to lay bare one’s own view, to put it on the table, and submit it to one’s
partner. Also, this process implies that through one’s questions one assists his
partner in laying bare her own views. Self-
phenomenology enhances and assists
phenomenology and viceversa.
Here comes the last, and most striking, of Ricoeur’s declarations:dialec
tic dialogue is ‘
arbitrée par le travail de la dénition
’. To say this with Colli’s
words:“in dialectic no judge is needed to decide who is the winner” (ibid.,
7). Ricoeur is even more categorical in spelling out that the arbiter is the
ciple:this practice
does not admit
any external referee or judge. No authority, no
third party is needed, or invoked, or permitted. While participating in the pro
cess of denition, each partner’s characterization of the phenomenon at issue
becomes more and more explicit in the open space of discussion; it grows into a
public object that can be seen from multiple and oen conicting perspectives.
us, each partner becomes aware of the limitations of his one-
sided discourse
and of the intrinsic aporias of any attempt at overall denition. Being engaged
in confrontation, each partner is driven to provide rectications of one’s own
previous opinions in order to approximate a more appropriateview.
space of dialogue is ideally a horizontal one. e clarity of denition, the non-
ambiguous transparency of language, the eort to approximate the ‘object’, and
the attempt to cooperate with one’s dialogical partner are the only sovereigns
having the right to sit on the throne.
External authority vs sharing of conversational rules.
Ricoeur’s discourse on
implied in this
of dialogue and the
question of the
nature of dialogue.
authority. Two (or more) partners are engaged in a process of clarication of
one’s own assumptions and of the other person’s assumptions. Nobody can and
must decide who is right and who is wrong, since this is not the purpose of
this kind of conversation. e purpose is that of clarication and denition of
one’s own and of the other’s
, that is, as Jaspers would put it,
“the elucidation of the largest possible realm in which the
occur” (Jaspers, 2002, p.123).
e object of clarication, thus, is the
frame of reference
within which the
discourse of the persons engaged in conversation takes place, including one’s
world picture and the implicit patterns of mental existence by means of which
the world is experienced. e former is the world as it is actually experienced
and represented, reality as it appears to the experiencing subject in straight
forward cognition. e latter is the subsoil of pre-
logical and pre-
validities that act as the implicit ground for conscious experiences and explicit
cognitions. e purpose of this process of clarication is to foster possibilities
for reection and to present means of personal re-
is is a collaborative process of self-
and other-
phenomenology, or of
mutual explication. To enter into this process of cooperation, the partners have
to share some basic conversational rules. Grice’s (1975) maxims of cooperation
nicely encapsulate this idea:Make your contribution such as it is required, at
the stage at which it occurs, by the accepted purpose or direction of the talk
exchange in which you are engaged. Gricean conversation rules can be taken
as the gold standard for the dialogic process implied in doing phenomenology.
Indeed, adopting a phenomenological stance, especially in the context of care,
entails a double eort of self-
and other-
phenomenology, i.e. of explicating one’s
own and one’s partner’s assumptions. If we decide to follow Ricoeur’s advice, an
external referee is rejected. From this we derive that for this process to become
includes the following:
:Do not say what you believe to be false/
Do not say that for which you lack
adequate evidence.
:Make your contribution as informative as is required/
Do not make your con
tribution more informative than is required.
:Be relevant.
:Avoid obscurity of expression/
Avoid ambiguity/
Be brief/
Be orderly.
ese conversational rules are totally dierent from the so-
called Aristotelian
fundamental laws of logic that need to be fullled in order to make rational
assertions, e.g. the law of non-
contradiction, of excluded middle, and the prin
ciple of identity. What is at issue here is not logical thinking, but a person’s atti
tude towards conversation. What matters is not rational thinking, but rational
conversational action. One can be totally illogical in his thinking and at the
same time full Grice’s conversationalrules.
e rules of dialogue are established in order to facilitate the process of
explication through which each partner unfolds her assumptions and denes
not to establish whose assumption must prevail. is reciprocal expli
cation of one’s own discourse, the exposition of the values at play in it, and the
elucidation of the words through which one’s position is expressed, pave the
way to an exercise of cooperation during which no vantage point prevails over
the other. e nal aim is not validation or invalidation aimed at some form of
consensus; rather, it is clarication aimed at coexistence.
Symmetric vs asymmetric dialogue.
Before delving into the question con
Incontestably, dialogue is one of the most ancient principles of the search for
is perhaps the constitutive principle of the original structure of all inquiry, and
of the noblest form ofcare.
I concluded the previous paragraph by praising a kind of dialogical practice
cooperation. Although dialectics was undeniably born as an agonistic discus
stronger than the other’s, Ialso contended that at least one of its versions—
namely, the one that is more relevant for us here—
has as its purpose to foster
possibilities for reection and to present means of personal re-
orientation for
both partners.
is is the case with Socratic dialogues. e questions, roughly said, are the
following:Are Socrates and his dialogical partners on a par? Are Socrates and
his partners equipped with a comparable knowledge and dialectical capacity?
partners equals in dialogue?
It is naïf to think that philosophical dialogue takes place in a community of equals,
since this would mean in a community of blind persons among of whom no one is able
to orient dialogue itself in a way that all the others may orientate themselves. e philo
sophical dialogue presupposes someone who has seen. (Sini, 1993,p.76)
One of my patients recommended that Itake a look at this essay, and Iam very
grateful for that. Indeed, Iimagine that what he wanted to tell me is the follow
of our encounters—
and of psychotherapy in general.
mutatis mutandis
Imyself when Iam dialoguing with my
is not on a par with his partners. e kind of dialogue we are describ
ferent from his interlocutors?
rst concerns knowledge, the second responsibility.
In brief, Socrates knows what the art of dialogue is about. Indeed, he seems
to know a lot of relevant things:that he does not know, that his interlocutors
are convinced to know, that remaining open to questioning is more virtuous
dialoguing, but that
truth is the dialogue itself
Logocentric vs anthropocentric dialogue.
e next issue that needs to be
focused on is that of the
of dialogue. Incontestably, dialogue is one of the
at work in Western philosophy.
We may call
this rst version of the dialogic principle, as it is, rst
and foremost, the pursuit of the denition of a concept. Logocentric dialogue
organizes its inquiry around a concept that must be focused, discussed, and
nally, dened. Logocentric dialogue is driven by the subject matter to reveal
stitutive of dialogue. is kind of dialogue functions like Husserl’s phenom
enological reduction:it is the means by which it becomes possible for things to
show themselves to a subject (Vessey,2000).
is seems, at least at rst glance, the principle followed by Socrates while
dialoguing with his disciples. e object of dialogue is, in this case, a
bring this concept into the light of reason and to rescue it from personal preju
dices, the concept itself is
to each participant in the discussion and
lives its life, so to say, in an impersonal space—
the space of ideas. e outcome
ized around well dened, distinct concepts, dialectically discussed during the
sokratikoi logoi
or not. Indeed, Charles Kahn (1996) provides a substantially dierent under
standing. According to Kahn, the principal aim of Socratic dialogues is not to
assert true propositions
but to alter the minds and hearts
. Socratic dialogue is
not meant to “replace false doctrines with true ones but to change radically the
moral and intellectual orientation of the learner, who, like the prisoners in the
cave, must be converted—
turned around—
in order to see the light” (ibid., p.xv).
What Iwant to focus on here is that, next to the logocentric one, there is a
second type of dialogue whose object is not a concept, but the very persons—
the Iand You—
involved in the dialogue itself. Whereas in the rst kind of dia
logical practice concepts are worked out and ‘manipulated’ as an artisan would
manipulate a vase or any other kind of utensil to improve it, in the second type
of dialogue the two partners literally put their hands on each other. e purpose
is to dene oneself, rather than a concept. What is implied is not changing an
opinion, but a
, that is, changing one’s orientation. e scope of this
kind of practice is modifying oneself through the dialogue itself, rather than
In dialogue subjectivity is displaced. When one engages in dialogue, one does
not control the progression of the dialogue; when one enters into dialogue one
is literally unaware of ‘where’ the dialogue may bring one. is process does
it, we will for the moment call
this dialogue in which two or
more partners are engaged in dening themselves and allowing their dialogue
practice would be
, as it aims towards personal formation in
the sense of
. Socrates aimed towards “a research as formation and not
to a path to truth” (Sini, 1993, p.84).
means cultivation or formation—
rather than education—
that cannot be achieved by any merely technical means.
Bildung zum Menschen
is “[t]
he properly human way of developing one’s natu
ral talents and capacities” (Gadamer, 2004, p.16). It is a process of
Self in accordance with an ideal image of what it is to be human.
participation rather than indoctrination, and questions rather than assertions.
As we have seen, there are two general characteristics of
:the rst is
keeping oneself open to what is other. is embraces a sense of proportion and
distance in relation to oneself (ibid., p.17). e second is that it contributes to
developing a
useful for interpersonal relationships.
e Socratic dialogue spins around the question
ti esti;
Socrates raises this question about virtue, his aim is not the denition of ‘vir
tue’, but rather understanding himself and his interlocutor. e purpose of the
dialogue is not dening the ‘what’ of virtue, but understanding the ‘who’ of the
persons engaged in dialoguing (Sini, 1993, p.85). e
of the Socratic dia
logue is not knowing the thing called ‘virtue’; rather, it is to ‘know oneself’ while
authentically engaging in trying to dene the slippery concept called ‘virtue’.
as Sini explains—
is “raising this question” (ibid.).
Socrates was not a person exceptionally skilled in dening the essence of
‘virtue’, or of other moral concepts (indeed, many Socratic dialogues end up
was a virtuous person
. He
was a virtuous person for two principal reasons:rst, he was aware that he
himself, as every other human being and principally those who were supposed
), was not knowledgeable at all. In this consists
of pre-
Socratic thinkers and
as established in the Socratic practice of dialogue:the former is the presup
for knowledge. Socrates does not fall for Oedipus’ tragic mistake when he
answered the Sphinx’s question as he supposed he was able to do so. He under
stands the question as a question and does not respond to it; rather he corre
sponds to it (ibid., p.79).
e second reason is that Socrates knows how to ask questions. He has a
for dialogue—
or, as we call this here, a
, as dialoguing
is the principal means ofcare.
We can rephrase this in the following way:the purpose of anthropocen
tric dialogue does not consist in the search for the exact denition of a con
cept based on the correct application of logic, but in the engagement of two
understand their own ignorance about it and in this way undergo a
With this in place, another angle from which the anthropocentric dialogue
can be enlightened is the following:it is not an empirical search for an agree
ment on a particular issue, but
a shared transcendental commitment to cross the
space between each other
. e aim is neither the denition of a concept based on
the rules of logic (as we have seen), nor the negotiation of a shared construct.
Eternal values are “living realities that are given to men only in the immediacy
of human relation” (Buber, quoted in Münster, 1997, p.49). Anthropocentric
dialogue is a gesture—
the sharing of an intention. Its transcendental referent
is not a fact (to which it is supposed to correspond), but the
relationship itself
It is the act of tending to the Other, puried from its goal. Atruth in which, to
paraphrase Levinas (1969), the approaching of the two messengers is itself the
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indicates a comparison.
abnormal sociability, schizophrenia,102
accidental symptoms,69
text as product,77–8
dialectic of,43–
individuated alterity
transformation of,16–
agnostic way,61
alterity, 1–
anatomy of recognition,50–
centrality of,115
dialogue with, 22–
7, 31, 32, 60, 78, 116,159
emotions as essential feature,46–
encounters with, 26–
extraneous nature,30
mental health,176–
recoil of actions,48–
relations with other people,153
struggle with,25
analogy, in empathy,127–
anthropocentric dialogue, logocentric
of disunion,81
of non-
antipathic behaviour, manipulation,133–
assumptions of psychodynamic thinking,72–
arising of,185
attitude, empathy,126
attunement to others,20–
(momentary god),13
Augustine of Hippo,177
authority, external,191
awareness of alterity,90
Batthyány, P,127–
Bau, F,103–
behaviour, explorative,134–
Bergman, I,186–
Bond, D,48–
Bildung zum Menschen,
personal life-
de Biran,M,28
patient past history,163–
responsibility without,163
borderline existence,98–
recognition by the Other,99
borderline personality disorder,136–
feel blame,163
Bornstein, K,86–
Bourdieu, P, 29,36–
limits of narratives,179
primary world,16
relation, 12–
bystander, identication with,162–
Campana, D,101–
care, 54, 56,121–
object of,123
patient's life-
primary object of,140
reciprocal understanding,171
through intimacy,186
see also
centrality of alterity,115
Charcot, J-
de Clérambault, GG,92–
PCD model,150
as citizens,109
humanistic learning,110–
scientic education,110–
cognitive empathy,127
common sense,58–
communication, purpose of,168
conicts of values,172–
confrontation, dialectic,190
contact with others, manipulation,134–
model of psychotherapy,185–
rule sharing,191
cooperation, maxims of,191–
Crime and Punishment
cynical way,60,90
disembodiment of Other,101
Das Man,
attunement, schizophrenia,105
decisions, gender dysphoria,86
defensive strategies, Other,59
De Jaegher,H,21
delimitation, dialogue,11
De Martino, E,171–
desire, 1–
3, 16, 86, 116,146
disembodiment of in schizophrenia, 104,105
idealization of common-
for reciprocal recognition,89–
for recognition, 34, 50,53,55
suppression of,153–
de Sousa,R,147
diagnosis, denitions,69
dialectic, 1, 3, 28–
9, 31, 39, 40, 150,189–
conversational discussion,189
external authority
conversational rule
frame of reference,191–
hermeneutical reorientationof,10
of identity,22–
model of mental disorders,65–
moods and aects,43–
narrative identity, 45–
person and otherness,147
relationship development,97
rules of,192
of selood,87
see also
dialogue, 9–
11, 86, 97,170–
with alterity, 22–
7, 31, 32, 60, 78, 116,159
therapy as,3–
transformation and,185–
see also
Di Paolo,EA,21
disembodiment of desire, schizophrenia, 104, 105
domestication of alterity,59
Dostoevsky, F,50,95
Dreyfus, HL,183
Dynamic analysis (D),118
dynamic unconscious, involuntary
aects and moods
denition, 39–
as essential feature of alterity,46–
narrative identity
narrative identity
Emotions and Personhood
(Stanghellini &
aberrations of experience,128–
by analogy,127–
with manipulation,137
Other's self description,125
order empathy
theory (ST),124–
Encompassing (das Ungreifende),
encounters with alterity,65–
estranged epistemology,180
evolutionary perspective, symptoms,69–
existential dimensions, life-
aberrations of,128–
feeling of, in unfolding,140–
frameworks of,139
explanatory phenomenology,120–
explorative behaviour, manipulation as,134–
external authority, dialectic,191
Eyes Wide Shut,
e Fall of the House of Usher
feeling of experience, unfolding,140–
unfolding, 3–
8, 169, 187, 189,192
clinical benets,143
feeling of experience,140–
foreign normality,139
normality and pathology,160
revelation of,159–
two sides,30
foreign normality, unfolding,139
frame of reference, dialectic,191–
frameworks of experience,139
psychodynamic theory,72
recognition of alterity,32
Fulford, KWM,25–
Poli, P,148
Bildung zum Menschen,
personal life-
moral value,85
personal experience,85
gender dysphoria,84–
challenge to clinician,87
decisions taken,86
symptomatic phenomena,86
General Psychopathology
A Gentle Creature
Gibbs, JRW,180
goals, desire,19
modus vivendi,
Grice, D,191–
guilt delusions,156
guilt, responsibility,156
health care, humanities,112–
objectication automatization,76–
theory of action,48
common sense,58
idle chatter,58
Henricksen, MG,148
Hermeneutic analysis (H),118
hermeneutic moment (H),
hermeneutic phenomenology,189
homo duplex,
human beings as a juxtaposition,29
humanistic learning, clinicians,110–
humanities, health care,112–
Hümer, G,181–
explanatory phenomenology,120–
sociality connection,165
I and ou
ideal citizens,109–
idealization of common-
sense desire,95–
with bystander,162–
with victim,161–
dialectic of,22–
narrative identity
problems in personhood,24–
idle chatter,58
idolatrous desire,92–
It' experience,15
immoderata cogitatio
inaccessibility of the Other, 55,89–
interpersonal dialogue,21
interruption of dialogue,2
intersubjective accord, truth as,168
neurobiological underpinning,21
interview techniques,184–
intimacy, 30–
1, 32, 81, 151, 159,179–
care through,186
clinical implications,179–
with oneself,186–
with the Other,51
reexive meaning,180–
involuntary habitus, post-
'I,' relation,13
You' relation,12–
world of,15–
aims of psychopathology,123
approach to failure,100
empathy, 123–
4, 125, 126,127–
the Other as failure,90
centred understanding of mental
position taking
partum depression,81
Johnson, M,184
Kane, S, 99,136
Kubrick, S,93–
production of Other,90
La Notte (e Night)
patient relationship,169–
inaccessibility of Other,89–
see also
personal life-
life, philosophy of,104
care of patient,152–
existential dimensions,142–
of 'I–
You' relation,15–
phenomena and structure
transcendental origin narration
limits of narratives,179
logocentric dialogue, anthropocentric dialogue
as displaced feeling,97
madness, vulnerability to,156
contact with others,134–
denition, 134,135
empathy with,137
as explorative behaviour,134–
personality disorder,135
e Man without Qualities
maxims of cooperation,191–
patient active role in position-
centred understanding of mental
McCarthy, TA,168
Meares, R,185–
medical taxonomy,68–
meditation, dialectic,100
melancholic crisis,97
mental disorders/
dialectical model,65–
vulnerability to,117–
mental health, alterity,176–
mental pathology,56,91
modus vivendi,
momentary god
dialectic of,43–
incorporation into identity,46
ontological sentiments
Moosbrugger, C,156–
moral value, gender,85
infant interactions,19,20
Musil, R, 93,156–
mutual understanding
common sense,58
as a misconception,58
mystical way, 60,90
limits of,179
narrative identity, 23–
4, 25, 27,45–
dialectic of, 45–
personal life-
narratives, limits of,179
need, desire
negative schizophrenia,148
dialectical model of mental disorders
nonconative empathy,126–
psychotic schizophrenia,148
recognition, 89–
anthropology of,57–
see also
renounceable value,100
repressed alterity,31
unfolding with pathology,160
normative vulnerability,67
norms, gender dysphoria,88
Not for Prot. Why Democracy Needs the
Nussbaum, M,109
object of care,123
ontological sentiments,42–
ontological status, 'I' and 'You,'16
adopting point of view of,166–
appearance of,144–
defensive strategies,59
empathy as self-
inaccessibility of, 55,89–
intimacy with,51
as source of recognition,100
Overgaard, S,124
explanatory phenomenology,120–
passivity, agency
pathology, fold/
unfolding with normality,160
clinician relationship,151
symptomatic schizophrenia,148
perceived vulnerability,132
personal attitudes,32
personal experience of gender,85
personal identity,45
in gender dysphoria,85–
personal life-
narrative identity,176–
traumatic events,175
see also
centred dialectical model
continuous task,39
gender dysphoria,87–
hermeneutical phenomenology,28
identity problems,24–
perspective, personal life-
reciprocity of,165–
adopting point of view of Other,166–
denition, 165,166
domains of analysis,121–
dynamic analysis,118
hermeneutic analysis,118
hermeneutic moment (H),174–
phenomenological understanding
phenomenological unfolding,118
psychodynamic moment (D),175
steps in,119–
phenomenal unfolding, 141–
phenomenological understanding
phenomenological understanding (P),
of life,104
pleats, text,78–
Poe, EA,181
position taking
emotional experience,147
pathogenesis of schizophrenia,
patient active role,150
personal attitudes,147
in prevention and treatment,151
partum depression,80–
unconscious desire,80–
individuated alterity
Preißler, S,136–
reexive meaning of intimacy,180–
presupposition, responsibility,160
prevention and treatment, position-
primacy of relation,18
primary object of care,140
procedural memory
psychic trauma, symptoms,71
Psychodynamic Diagnostic Manual,73
psychodynamic moment (D),
psychodynamic theory,72
psychodynamic thinking,71
assumptions of,72–
psychomotor inhibition, post-
accuracy of,184
aims of,123
psychotherapy, conversational model
psychotic schizophrenia,148
radical alterity,186
understanding of,180
reciprocal recognition, 2,3,187
desire for,89–
reciprocal understanding, care,171
recognition, 50–
2, 53–
of alterity,58
alterity in,50–
basic need for,53–
desire for, 34, 50,53,55
logic for,55–
see also heterology
need for,96
by the Other,99
of the Other,53
reciprocal recognition
of self
as value, 53,54,89
see also
of actions,48–
reconstruction of world-
representational body,72
responsibility, 49,155–
of care,67
denition, 155,159
individual blame,161–
presupposition and tasks,160
without blame,163
engagement with the world,26
involuntary side of human existence,33
narrative identity,23–
objectication automatization,76–
ontological sentiments,42–
Roepke, S,136–
borderline personality disorder,136–
identity problems with personhood,25
narrative identity,23
PCD model,150
unfolding, 139,141–
(recoil) of actions,48–
Rümke, HC, 111–
lived corporeality analysis,144–
explanatory phenomenology,120–
borderline existence,99
abnormal sociability,102
disembodiment of desire, 101–
manifestation of alterity,148
phenotype stability,148
philosophy of life,104
vulnerability in, 149,150–
Schuster, MO,181–
attunement with the Other,51
common sense,58
scientic education/
order empathy, 128–
awareness, structureof,28
control, post-
partum depression,82
experience, patient,151–
self implicit structures, rescuing of
lack of,115
Seubert, H,127–
e Seventh Seal,
sexual desire,72
shelters, 59–
simulation theory (ST),124–
social adaptation, common sense,58
abnormal in schizophrenia,102
time connection,165
Socratic dialogue, 193,195–
(special god),13
borderline personality disorder,136–
conative empathy,127
empathy with manipulation,137
identity problems with personhood,25
narrative identity,23
PCD model,150
partum depression,82
subject partnership,172
unfolding, 139,141–
position taking
attunement to others,21
patient relationship,169–
therapeutic discourse,170
Strauss, EW, 129,181
subjectivity, dialogue,194–
suppression of desire,153–
symptomatic phenomena in gender
symptoms, 32, 65–
causes, not meanings,69
as cypher,75–
as defects,70
evolutionary perspective,69–
objectication automatization,76–
psychic trauma,71
psychodynamic approach,73–
as text,77
understanding relation,183
tasks, responsibility,160
intimacy, 179–
80, 181,182
partum depression,82
temporal coordination,52
'I' and 'You,'17
narrative identity,23
temporality, sociality connection,165
theory (TT),124–
therapeutic discourse, story,170
therapeutic situation, P.H.D.
training, clinicians,110
transformation, dialogue and,185–
gender dysphoria
personal life-
von Trier,L,97
Troisi, A,69,70
truth, as intersubjective accord,168
e Uncanny
unconscious defence mechanisms,73
unconscious desire
partum depression,80–
undecidability, zone of,160–
mutual understanding
reciprocal in care,171
tact relation,183
Ungreifende (Encompassing),
(e Uncanny),30–
unsaturated cyphers,76
unsociability, schizophrenia,103
Usener, H,13–
value, 3, 16, 32, 33, 65,149
conicts of,172–
desire for recognition, 50, 53,54,89
gender dysphoria,88
partum depression
production of,25–
in therapy,122
Varela, FJ,140
victim, identication with,161–
vision, recognition,146
vulnerability, 3, 4, 26–
borderline existence
to madness,156
to mental illness,117–
in schizophrenia, 149,150–
treatment of,80
relationship, presupposition of
woman, performanceas,87
words, unfolding,140
experience, patient,151–
project, reconstruction of
Wyrsch, J,149
orientation, We-
presupposition of,51–
foreign normality,139
zone of undecidability, 160–

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