The Concept of Mental Illness as «Expropriation» and its Relevance for Clinical Diagnosis in Psychiatry

publicado en: Destacado, English Texts | 0

The concept of “expropriation” is essential for categorizing any life process or structure as pathological. In fact, it is the experience of estranging of what is one’s own that constitutes the experience of illness.

What is ill appears as something that has detached itself from the constructive harmony of life or threatens to disintegrate life from within life itself. But, at least initially, the disintegration process is not perceived by anyone, but only its products, alien to that life.
Today’s psychiatrist, because of his epistemological approach and eagerness to objectify illness, tends to pay more attention to pathological products than to the pathological processes which produce them.

A living organism is a self-organising, self-constructing or autopoietic system. It is a dynamic system which builds up its own identity as a structural and functional coherence. This “autopoietic” system creates its own identity as a self-contained structure, distinct from the environment, which sets its internal medium apart from its external one. Organic health always shows this kind of dynamics.

Organic illness is any structure or process which operates, from within the organism, against the production and preservation of the whole structure. This process constitutes an “expropriation” of what is one’s own. This is exactly what happens with the loss of a border between the internal and the external medium in skin burns; also, in the case of hypothermia as a loss of one’s temperature; and in the case of the functional loss of the immune system, which defends one’s organism against the invasion of alien bodies; and, again, in the case of tumoral cells, which become alien to the organism, which they tend to invade from the inside.

Ultimately the illness leads to the death of the organism, which becomes disorganised and homogeneous with the environment. The organism loses its “autopoietic” dynamics, that is to say, the capacity of constructing and preserving, against entropy, its own distinctive identity.

Yet, an organism is not merely a closed, self-contained structure, but a system open to the environment, with which it communicates in order to incorporate and assimilate matter, energy and information. In actual fact, an organic system has a relationship with the medium which is mutually co-operative and differentiating at a time. This sharing relation with the environment is what we call a living being’s behaviour. A behaviourless organism is an abstraction.

As all we psychiatrists know, there are also behaviour disorders, although this may be exclusively human. Behaviour is diseased when it significantly destroys one’s proper structures. This happens when behaviour is “self-expropriative”. Drug addictions are a clear example of this.

Incorporating/excorporating behaviour as a communication/differentiation process is actually informational interchange, or at least depends completely on information. If the latter is suitable for the organism and the environment, so will differentiation and appropriation. If informational communication with the environment is inadequate or inappropriate, a pathology of both incorporation/excorporation and identity differentiation will take place. A clear example of this is anorexia nervosa.

Communication distortion due to the disturbance of one’s own informational level seems to be an exclusively human characteristic. Animals in the wild do not show pathological thinness or fatness, since their behaviour responds to stimuli which are informational signals, whose vital meaning is always appropriate, adjusted to the behavioural structure.

In human beings, on the other hand, informational communication has become symbolic due to their specific intelligence, and also because their creative imagination.

Man’s symbolic level, basically made up of meanings and senses, allows him to go beyond given facts, in order to both unveil and discover the intimate structure of reality. However, this may prove deceiving for man — he may get trapped in his own fictions, which would prevent him from having a realization of his intentions, and cause his self-unfulfilment.

The primary thesis of this presentation is that, at the personal level of life, every psychopathological process is a dis-appropriation or disownment behaviour which makes a personal dimension impersonal or non-personal. This is an exclusively human kind of expropriation, by which not only is something that previously belonged to oneself no longer one’s own, but it is oneself, with his own behaviour, that alienates and expropriates a dimension of his own, or does not appropriate something that is indispensable for his continuing to be oneself. This estrangement behaviour (Entfremdung in German), in which own is made strange and foreign (Fremd), also produces the derangement or alienation (Entäusserung) of one’s self as being something objective, taken out of (ausser), in front of (Latin ob) the subject; it is self-objectification.

In order to have his own personality and a healthy personal life, a person has to actively appropriate the dimensions of his living. This is what Gadamer accurately alludes to when he points out that “We experience (...) health (...) as the measurably appropriate.” The personalisation of human life is carried out by active appropriation from one’s own autonomy, from one’s own criteria, as opposed to any heteronomy. This issue was very well set by Castoriadis in connection with human freedom, the proper field of psychopathology, as so many authors have pointed out.

Whereas personalisation is a fruit of appropriation, de-personalisation is a product of dis-appropriation. This is the personal mode of the expropriation of life as behaviour, the self-estrangement of mental illness; in other words, the unfulfilment of personal self, which is de-personalised and transforms personalness in impersonalness or nonpersonalness. “Illness objectifies itself; health does not”, Gadamer stated again with profundity.

Now, what is property at psychic level? At this level, something is own when the subject avails himself of it for the subject’s sake. The core of psychopathology is the process of not availing oneself of what is personal, that is to say “dis-appropriation”.
Let us see now a few examples.

Alienation of “mine” (what is mine)

  • In a “phobia of object”, the phobic subject cannot make use of the object (say fire or a knife); therefore, he does not avail himself of it, cannot appropriate it and make its power his own.
  • In a “phobia of situation”, the subject cannot make free use of space as abode (be at ease in it) or transit (go towards, access).
  • In both types of phobia, it is primarily space — especially the third dimension — that is alienated. The phobic does not make distance his own, he does not place the object inside his own pragmatic space, as a resource for the fulfilment of his own action.
  • In “depressive humour”, the subject feels he cannot make use of his own world, which has become inaccessible at the same time as he has lost his appetite for the world.
  • In “anxious mood”, the subject lacks time of his own; time is not his, is not at his disposal. In fact, the passing of time urges him and takes him out of the present, the only time when realization is possible.

Alienation of the self

  • In “anguish”, one’s own self loses his essential condition of being a proper openness to the world, from one’s identity, which is menaced with disappearances.
  • In “obsession”, it is the axiological self that is alienated. This is a serious pathology in which the person lacks all autonomy, does not exercise his own free capacity of setting value from himself on the things in his life.
  • In “psychotic delusion”, one loses the formal condition of being the subject of one’s acts. The patient experiences that somebody else says his words or thinks his thoughts.
  • And, last, in “catatonia”, there disappears the active subject of body, the shaper of movement as one’s own behaviour directed to aims.

So far a few brief examples (In my book on general psychopathology — “Fundamentos Antropológicos de Psicopatología” — all the spectrum of psychopathological alienations are dealt with.) These examples show the loss of what is personal , which is no longer at the subject’s disposal, and/or the loss of the personal subject’s proper condition of freely making use of his life from himself. What is never lost in psychopathology is the condition of it affecting me what happens to me. That experiencing condition is never lost, except in neuropathology. Even in delusion, the psychotic patient says, “They steal my thoughts from me”. If there did not exist the experience that one’s own self — one’s own identity — is affected, there would not really be alienation.

Nevertheless, this process of self-alienation of the personal subject produces the appearance of personalness as something de-personalised, alien to the subject, as something being an object with its own structure, beyond the subject himself, as though it were a real, objective thing. This is a hypostatisation or reification process — in Berger and Luckmann’s sense — which transforms intimate personalness into something impersonal and external, reifying or personifying a mere personal element detached from the personal wholeness, while the person gets, at least partly, de-personalised or de-realized.

These products alienated, reified and objectified by the subject himself constitute the patient’s objective symptoms, to which he ascribes his suffering. But the psychiatrist, too, usually mistakes the symptoms for the disease in present-day descriptive objective psychopathology.

The following are the symptoms in the aforementioned examples: in phobias, one’s resources appear as menaces, as strange, hostile objects, and life space becomes the object’s property, as a threatening room, where the subject gets trapped. Claustrophobia is paradigmatic here. In depression, the life world is no more an embracing spot, but appears foreign and distant, like an unachievable landscape, making the person feeling helpless and desolate in the void of life. In anxiety, one’s own aims appear as demanding, unattainable goals, always beyond (meta in Greek).

As for the examples of alienation of the self, in anguish, the self is no more an active subject opening his life space, but has become a mere impotent object, immobilized within his chest, oppressed by the threat of disappearance; in obsession, the axiological person  appears as a mere object of moral demands and obligations, being always in debt; in psychosis, the self has lost not only his condition of elective personal freedom, but also his condition of being the formal subject of his own experiences — he has become a mere, even grammatical, object of them (“They think for me; they move me”), or — in catatonia —gets reflexes moved by sheer stimuli, as was demonstrated by Straus long ago.

The symptoms do not define a mental disorder  —they are just the data that appear objectified by and for the patient, as well as for the semiologist. In psychiatry: starting from given data or objective symptoms (semioses) —, one must attempt to disclose the psychopathology as a process de-structuring personal life. For this, the hermeneutic phenomenological method is essential. Thus, a psychopathological diagnosis is achieved, on which the clinical diagnosis and the aetiological and therapeutically research can be solidly based.

The so-called “objective psychopathology” is actually objectivistic, that is to say, it regards the symptoms, which are the patient’s reifications, as though they were the alienating process of the mental disease. This current situation of the epistemological process of psychiatric diagnosis can be understood if we bear in mind the influence of neo-positivism on the 20th century, with its attempt to eliminate all subjectivism.

Furthermore, alienation was considered to be, in the 20th century, a social process, not a personal one. The concept of alienation disappeared altogether from psychopathology in the last century, firstly because the concept was monopolized by Marxist-biased political sociology, secondly because there did not exist, either in psychopathology or in anthropology, its antithetical concept of appropriation as the essence of the personalizing process of life. This concept of appropriation is little by little becoming established in today’s anthropology as an essential feature of the person and his life. This is manifestly the case of Levinas, Gehlen, Henry, Habermas and Jonas, for instance.

All of this allows the understanding of psychopathology as disappropriation and self-alienation on the part of life’s personal subject, instead of a taxonomic set of symptoms objectified by the Psychiatry in the way of positivistic substantialism, as it happens in patient illness.

The appropriation of life as the personal subject’s self-constitution is the nucleus of Xavier Zubiri’s anthropology, which has enlightened my perception of all psychopathology.

Thematic Conference on “Diagnosis in Psychiatry” of World Psych. Assoc. (Vienna, June 2003, Symposium 07: Theoretical Fundaments of Clinical Diagnosis in Psychiatry.)