I thank Dr. James Phillips for his invitation to participate in the discussion of Dr. Peter Zacher’s book A Metaphysics of Psychopathology.
It is not necessary to insist on the present importance of the thematic field approached by Zacher in his text, both for psychopathology and for all human knowledge. In fact, he explicitly points to it in the war between philosophy and science started at the end of the 19th century, persisting until today.
Zacher’s position throughout his text is always measured, avoiding a fall into the absolutist reductionisms so frequent in the 20th century in all the items included in the field of psychopathology: reality, truth, discourse, experience, certainty, verification, speculation, issues of the concrete and abstract, of being and existence, of the absolute and relative, of description or interpretation, of objective data or theoretical inferences, etc., etc. All that at the end of the last century in which several epistemological revolutions have occurred and in which paradigms have shifted somewhat in all the sciences. All this nonsense becomes even more confusing in the field of psychiatry, a discipline of recent origin in both knowledge and practice, exercised over a system –human behavior– surely the most complex field of things, facts and events of the universe we know. Let me indicate in passing that the study of human life involves physics, chemistry, biochemistry, biology, ecology, semantics, symbolism, social and cultural history (both at the social and individual levels), and evolution of “mentalities” as different forms of grasping the world and oneself. And this last as a maturation process both of humanity and of each individual in his psychologic and cognitive development. This is a theme to which Zacher dedicates several passages.
I emphasize that the maturation of the individual, in the way of understanding, thinking and feeling the world, is the fruit of the maturation of the organism –especially the brain– but also of the maturation of one’s personality, mentality, and attitudes.
No wonder that this new discipline of psychiatry, so diffuse and profuse, of so many well or poorly integrated dimensions, appears even today so confusing. Something that clearly exposes this situation is the fact that we still don’t have a clear concept of mental illness or pathology, at least not one with adequate consensual agreement. This failure accounts for some of the urgent problems facing our specialty at ethical, procedural, and epistemological levels. Thus for example, the ethical problem indicated by Zachar of deciding when a state of sadness or sorrow passes from being a normal fact of human life to constituting a state of illness. Or the enormous, current epistemological problem of comorbidity, also analyzed by Zachar in relation to all the “ontological dualisms” of the different anthropologies underlying in the different psychiatric schools or positions. An example thereof would be Ionesco’s book Catorce enfoques de la psicopatología (FCE, México, 2001). What is the ontologically “dysfunctional” level at which each mental or psychic pathology is originates? There is a serious procedural problem of where to search for the basic alterations of the psychopathologic structures.
This question includes the “mereological” problem of discriminating differential characteristics between the whole and the parts of an entity – a problem highly topical in all the contemporaneous sciences and one that has been very well emphasized for the field of psychiatry in the book about Neuroscience and Philosophy: Brain, Mind, and Language by Bennett, Dennet, Hacker and Searle. I am interested here in highlighting the overarching importance of this theme for settling the character of psychopathological symptoms. Are they “signs”? Mere indications revealing an underlying illness? Or are they rather parts of a deconstructive process that constitutes the psychopathology? This last has been indicated by several authors, for some time now, among them by Juan José López Ibor (Senior), in his book about “Las Neurosis como Enfermedades del Ánimo”, p. 139.
This is also the position I will assume in this commentary, addressing the ontological foundations of psychopathology, along with the “mereological conflicts” that are part of the deconstructions of psychopathology. As an initial clinical/ pragmatic framework for my attempt to clarify the “mentality-ontology”relation as a ground of the psychopathologic deconstructions, and of their comprehensive difficulties, I indicate some data from clinical practice.
Is the destructive aspect of phobias the panic in front of the phobic object or situation? Or is the avoidant behavior based on an impossibility of taking possession of the resources of the world for realizing the own life? The dramatic element in agoraphobia patient is not so much the insecurity experienced in a public space, or the panic attacks that can appear in it! The dramatic element is that the individual cannot take possession of the immense spatial atmosphere available for living well and realizing the major part of her life activities.
On the other hand, is the reason for phobic panic the present factual aggression of the phobic object, or is it the “physiognomic figure” of the object and the ideal concept of the category to which the object abstractly belongs? The answer is obvious from clinical experience. A fear or phobia for dogs is not the panic in the fact of a dog actually attacking one. That is fully normal in life. The phobic experiencing panic in front of a dog, even a photograph of a dog, is reacting to the expressive figure, to the physiognomy that makes imaginarily present the essential threat for him of the species dog.
In another area, is the pathologic element of a manic phase in bipolar disorder perhaps the feeling of total wellbeing, of exaltation of mind, and of expansive mood? Is the destructive element the affective state of happiness, or is it rather the biographic consequences of his unmeasured and inappropriate behavior with respect to his world and with respect to the own resources that occur in the manic phase?
And in a major depression, is it loss of the joy of life that predominates in the melancholic mood, or is it the conviction that one’s personal life is threatened by the inaccessibility of resources or possibilities for realizing them in this world? It is undoubtedly this last, as Glatzel indicated, and that appears confirmed in Cotard syndrome.
Finally, is not anxiety, the most frequent and ubiquitous symptom of psychopathology, perhaps less an experience of “threat to the self” than a destruction of the active subject in constituting his own human identity?
From these few clinical examples, I postulate that mental illness is a destruction or threat of destruction of the identity of the living individual, stemming from a disturbed, ‘in-appropriate’ structure of behavior – understanding that the identity of a human being is the result of selfconstruction through behavior ‘appropriate’ to one’s own reality and to the reality of one’s circumstances. “The emancipation of the biological and psychic functional symptoms in front of the personal whole does not involve, in its becoming personal, a disorder? Perhaps the fundamental disorder of neurosis?” As Gebsattel indicated already in 1953.1
My objective in this text is not to develop this entire field of inquiry. I have already done that in a “general psychopathology” (Fundamentos Antropológicos de la Psicopatología, Ed. Polifemo, Madrid, 2006), as well as in a “regional psychopathology” (now in press). My objective here is only to present this problem in relation to Zachar’s book. For this goal to indicate the origin of psychopathology as deconstruction of behavior, and at the same time as the origin of the problems of exploration and knowledge of psychopathology, I start with what Zachar presented in his Chapter IV about “Psychological and Scientific Essentialism”.
Zachar rightly indicates the relation of the essence of something to its “identity”, to what it really is, what specifically constitutes that something as such. And he shows from his review how this relation of the permanent identity of something with “an empirically non-verifiable essence”constituting it is present not only in philosophy, but also in all the sciences, including current microphysics. In my judgement the problem of essentialism lies in the “type of essentialism”evoked in each type of knowledge, and that implies different ontological conceptions that support different types of identity of the entities of the universe.
Thus Zachar indicates the characteristics of the adult conceptualization of the structure of essentialism, studied by the psychologist Nick Haslam, among which I underline the following: Homogeneous and uniform – Naturally occurring – Has necessary identity–determining features – Possesses inherent, underlying properties – Unchangeable and immutable – Stable across time and culture. These dimensions of essences are the constitutive of the “substantialist ontology” of Western thought from the Greeks up to the 20th century! And it is that of Western adults. It is not even that of children, it is not even that of other cultures, such as the Eastern.
This metaphysic horizon of perception of the being of entities has lived on since the Greeks as a vision of the essential identity of all entities, underlying their sensory appearances. This is a vision of essences as adynamic, permanent, non-material, and eternal vision of the identity of the entities, supported in that non material essence, under all not essential and changing characteristics of the entities in time. This essentialist conception of the being is shared by two variables of Greek thought, the Platonic vision of the essence as Idea, and the Aristotelian vision as Form.
This perception and conceptualization of the being of what appears to us in our surrounding, including human beings themselves, was at origin of the concept of phyysis, nature. This meant that the things were not perceived any more as being manifestations or fruits of the actions of supernatural beings, but as being things in themselves, based on their substantial essences. (Thus was the origin of the substantivation of the verb to be as being, which did not exist in early Greek ). This substantialist ontology of classic Greek thought constituted a great overcoming of the previous “magic-mythic” mentality, and the beginning of the development of the logical knowledge of the onto-logy of the physics, as meta-physics and as episteme. This inquiry into the being of existing things through the instrument of reason, came to be called logos (idea, word, criterion). It was the rise of critical knowledge, in face of the old mythic -religious dogmatism.
This substantialist metaphysical horizon constituted the ontology at the origin not only of philosophy and science, but of western culture itself. It perceived entities of nature not only as being each “for itself”, but also as being something “in itself”, isolated from its environment. This is the perception that supports the experience and the concept of something as real being. From this vision entities would maintain relations with other entities according to the constitutive essence of each type of entity. Essential relations between entities would fundamentally be of two types: causal relations between entities or composite relations among the individual entities, whose properties would be the summatory result of the individual entities. Thus Zachar underlines, quite rightly, the privileged role of causal relations. While such causal thinking might be thought of as an innate tendency of human beings, epistemological criticism has shown that this way of thinking has existed only in Western adults, and only from the 5th century until the end of the 19th century.
This atomistic, objectivist, ontological vision, prevailing in all cognitive theories, whether idealist or empirical, is the origin of almost all the conflicts of the contemporary knowledge as well as of the war between science and philosophy. This is better understood if we realize that this vision is not only applicable to the factual or material relations among the entities, but also to the structure of knowing between humans and things. On the one hand, empiricism has understood the phenomenon of knowledge as the result of the action of objects of the world on the senses of the human being. The organs of the senses would be passive, and the action of things on them would produce data of the objects of the world, creating a representation of the external object within the brain.
In the case of “idealism”, knowledge would be the product of the human spirit or of universal reason, the essence of the human as “rational animal”. The object of consciousness would here be an “abstract creation”, recreating the reality of the external world from the power of reason, without possibility of true access to reality itself. In both cases the objects perceived would be products of a unidirectional causal action, be it material action in empiricism, or action of the thought (the spirit) in idealism. Indeed, the cognitive result in both cases would be an artificial object with the appearance of being something real in itself. In current terminology, this is a reification of the object. In the case of empiricism an inferential reification, in the case of idealism a deductive reification.
This substantialist ontology, applied to the field of somatic medicine, gave rise to the vision of disease as a deterioration of the structure of the organism by an external, environmental cause. Applied to psychiatry, it gave rise to the vision of madness as a loss of the human essence, of reason. And in a materialist vision, it was seen as a loss of the “rational functions” of the brain, necessarily attributed to genetics as the only basis of the neural structure of the homo species. Following from the genetic paradigm in force in the last decades – gene → protein → (brain) function → behavior -- “the gene” of each taxonomical entity has been intensely searched, be it depression, anorexia or alcoholism.
But as the scientific investigation of reality progressed in the 20th century, in intimate contact with philosophy and pragmatically maintaining contact with the real world, it ended up, though not fully, overcoming the substantialist persective. (Scientific investigation at the highest level is today multidisciplinary, integrating different perspectives, including the philosophic. As simple example let me mention in USA the Santa Fe Institute, dedicated to the study of Complexity. An example of this work is S. Kauffman Investigations. Complexity, Self-organization and New Laws for a General Biology. Thus the epigenetic revolution –with the discovery that the “expression” of genes depends on a very complex system of relations among them, together with the rest of the non-genetic DNA and others factors, like a great quantity of cytoplasmic proteins, the cellular position with respect to the organism and the behavioral relation of this with the environment - has overcome the substantialist vision of genes, integrating them into the general living, ecologic system of which they are a part.
This is a changed ontological vision of reality, from the substantialist to a dialectic/ communicational model of the complexity of every system as life systems.2 Life is not something within the organism (be it a functional-mechanical essence as in Cartesianism or be a subtle essence as in vitalism). In his book, Emergence of Life: From Chemical Origins to Synthetic Biology (p. 233), contemporary biologist Pier Luigi Luisi tells us that “Each living system is a complex of circular interactions with its environment, and this whole can be contemplated as a continuous flow of mutual and coherent changes, whose end is the maintenance of the balance of selfidentity. And in his The Phenomenon of Life: Toward a Philosophical Biology, the great philosopher Hans Jonas, knowledgeable in scientific work, tells us: We must “consider organisms together with their environment, as a unique systems” (p. 70).
This “autopoietic” vision of life corresponds to the current ontological vision of the General Systems Theory, in which every local structural unity is a continuous dynamic process of differentiation of that structure with respect to the environmental field. As Niklas Luhmann informs us in this treatise about Complexity and Modernity (p. 35): “The relational theory (among substantive entities) has problems with identity and difference. The theory of systems always starts from the fact that identity is constituted through a difference with the environment”. And this happens “in all complex systems where dynamic systems of formally similar functional organization emerge, although the concrete causal relations be very diverse”, as the Nobel prize winner Prigogine maintains in La estructura de lo complejo. (Nicolis G. y Prigogine I., Alianza Ed., Madrid, 1994). Thus we see this only in the field of human life, but even in the field of consciousness. A. Gurwitsch already indicated this in his book of 1962, El campo de la conciencia. (Alianza, Madrid, 1979, p. 163), writing of “The structure (Gestalt) as a unity that is consolidated and separated from the field”. Contemporary neurobiologists Edelman and Tononi move in the same direction, writing that “integration and differentiation are the fundamental properties of the conscious experience”. 3
This has given rise to an emergence ontology, in which entities are local products of the dynamics of generic processes of the field that create concrete structures, which in turn locally realize the field dynamics. The philosopher Whitehead already maintained this at the beginning to the 20th century in his book Process and Reality (“there are no things, only processes”), in accord with what western science was discovering at the turn of the century. Philosopher of science Mario Bunge articulated this position in his book, Emergenceand Convergence: Qualitative Novelty and the Unity of Knowledge. (University of Toronto, 2003).
This comprehension of essences as dynamic processes shaping the structural identity of entities is fundamental for general medicine and even more for psychiatry. Today allergic illnesses are not seen as an organic effect on the organism caused by allergens, but rather as a disharmony of the informational relation between molecules of the environment and the immune system of the organism. Disharmony that can cause the death of the organism – by an over-reaction of the immune system, as in anaphylactic shock or autoimmune diseases. However, the empiricist thrust of current classifications asserts that stress is a normal reaction of human life to the stressors. This is a reification of the “stressors” as facts or life circumstances that in themselves threaten the individual, ignoring the informational character of the situation, that is “shaped both by the circumstances, and by the interpretation of the experiential subject, conditioned by his personality, his biography, and by his personal ontology”. “Objects of perception are the result of the contributions both of our theories and of the action of the external world over our sensory organs”.4 In contrast, “Empiricism at a epistemological level is usually associated with antirealism at an ontological ambit”, as Wulff H., Pedersen S. A. and Rosenberg R. inform us in their Introducción a la Filosofía de la Medicina (Triacastela, Madrid, 2002, p. 44).
“Disease” is also a reification of the experience of “being ill”, of a destructive way of being in the world in one’s own life. The reification does not take account of the fact that life is a autopoietic, self-constructing process that is based on the appropriation and incorporation of environmental and personal resources. For this reason, the condition of somatic disease is essentially an “alteration”, an “expropriation”, a loss of one’s inherence as an organism in the selfconstructive, dynamic unity of life. But the harmony of this constructive process is based on the informational harmony that distinguishes and integrates the different molecular, cellular, and organic structures of the subsystems that integrate the coherent holistic unity of the organism. To live it requires being integrated into an ecologic system.
In the case of psychopathology, in becoming mentally ill, alteration becomes alienation and expropriation becomes dis-appropriation, as processes of the configuration behavior. I mentioned above phobias as clinical structures. The basic cause of every phobia is feeling threatened by the phobic object. This means that the subject –in the phobic situation– does not perceive the object as within his space of action, but perceives himself as within the reach of the threatening space of action of the object. This situation already implies the alienation of the active subject, transformed into a reified object by the disappropriation or loss of his own space of action and of the things that are in that space. The threat of destruction experienced by the personal subject is already completed, hence the anxiety. This accords with Zachar’s point with respect to the “new scientific essentialism” of a passage from passivity to activity of natural structures, as indicated by Ellis. But Ellis’ activism expressly referred to the “capacities that things have to actively respond to relevant circumstances”. In the new horizon of the general systems theory, essential activism does not mean the capacity to react to circumstances, but rather an active process of differentiating each structure of the environment from the others, constituting one’s own identity and clarifying the identity of the other. As Jonas writes, “The differentiation of sentience, with the central integration of its diversified data, furnishes the beginnings of a true world of objects; the active commerce with this world through the exercise of motility (in turn implying centralization, viz., of control) subjects it to the self-assertion of freedom, which thus answers on a higher plane to the basic necessity of the organism.”
While this is the ontology of the contemporaneous science, product of critical ontological and epistemological investigation, it is not the operative ontology of everyday life. The phobia example shows us that the triggering stimulus is not the real object itself but rather what to the subject is the threatening suggested character of the object. Such character belongs to the ontology of a magical/animistic world, as in the way a phobia of scissors might represent stinging objects with an aim to attack the individual.
This brings me, finally, back to the beginning of my commentary, where I postulated the mental disease is a destruction or threat of destruction of the identity of a living entity, based on a dis -appropriate structure of behavior, on a misuse of the information provided in normal behavior. Regarding the latter, biologist/philosopher has maintained: “Perception and action, sensorium and motorium, are linked together as successfully emergent and mutually selecting patterns”. (Francisco Varela in The embodied Mind, p. 163.) It is the integration of the sensibility and the motor function in the shaping of the perceived forms (Gestalten), magisterially analyzed by Viktor von Weizsaecker in his book Der Gestaltkreis, from 1939, and anthropologically described by Maurice Merleau-Ponty in The structure of behavior from 1942: “The properties of the object and the intentions of the subject (…) are not only intermingled, they also constitute a new totality”. What studies of infant psychology (beginning with Piaget) and evolutionary epistemology (as in the book Mind from Matter?: An essay on evolutionary epistemology, by Max Delbrück) show us is that:
1st.- Activity between the infant and its environment begins to generate a progressive distinction of permanent forms with their operative qualities. In the first months there are not permanent forms. As of 6 months, the child begins to perceive the inter-sensory object, which corresponds to what Aristotle called common sense (Koinos Aisthesis). With this there begins a specification of sensory things, with recognition of their operative qualities - pragmatic objects - along with the rise of an active subject. “Up to now there is a formal structuring of the child/environment pragmatic relation, based on the sensory motor organization”. This period is analogous to the development of the sensory distinction in animals, between stimulus and sensation. “Animals perceive Gestalten (…) men Gestalten and things”. Gemelli A., Introduccion a la psicologia Luis Miracle, Barcelona, p. 213.
2nd.- As of the second year, real human, cognitive development occurs, based on sensory experience. Phenomenalism gives way to perception of relational structures. The object is separated from the pragmatic context and acquires permanent identity in the face changing circumstances. The child begins to designate things with names, beginning denotative language. He recognizes things as independent of his activity with them. The self is recognized as involved in operative matrices with things, including causal relationships. These relations with things do not follow the perception of things but are constitutive of the things themselves. “What we call things only exist in knots of relations,” as Zubiri tells us.5 This is a basic onotology that is pragmatic, pre-linguistic, and prereflectively interpretative of the entities of the world.
The pragmatic interaction constructs both the identitarian permanence of the object and the subject of perception. Another thing is that afterwards the behavior seems to take its origin only from the perception of objects. As Hans Jonas indicates in his indicated book of Philosophical Biology (pp. 48/9): “The apparent constancy of the object of perception in the face of how it is handled constitutes an inversion of the real genetic relations”. It is this pragmatic genesis of the natural, pre-verbal, preconceptual, pre-reflexive object that gives the perceived the character of being something prior to perception, and to the perceived thing the formal character of “being beyond” the subject.
This stage –from 12 to 18 months– constitutes the moment of becoming human, of the apparition of a pre-linguistic, praxic world, a preverbal and pre-conceptual ontology, that will allow the further possibility of a world whose logos becomes expressed, shaped as verbal expression and a world of thought. It is the moment of constitution of what we have been accustomed to call transcendence since the pre-Socratics. It is not the exercise of a faculty of the human spirit of going beyond (metà) the physical things, but the construction of the cognitive duality: the perceived and the act of perception of the perceiver! This pragmatic construction of the world, between the praxis of the child and the power of consistent and persistent structures of the environment over the child, is a coorganization of the perceptual world. In phenomenology, primary consciousness is “I can,” not I am.
This transcendence of a natural ontology, constitutive both of the things of the world and of my own identity as acting on those things, is what is initially lost in schizophrenia, described by Blankenburg as the “loss of the natural evidence,” as well as at the origin of other symptoms such as strange behavior and delusional thinking.
The permanence of the objects of this pragmatic ontology is what enables the denomination (denotation) and the generation of an idea of the thing. As Gehlen informs us in his anthropology (El hombre, 1974, p. 186), “The constancy and the transposability (…) are the conditions for man to be able to see things.” Cognitive deteriorations are manifestations of the loss of the formal capacities of the brain for distinction and synthesis, that generate the ontology of the world.
3rd.- Between the 18 and 24 months the mental sphere is constituted as an articulated and spoken world. In this symbolic domain semantic structures are developed that represent material things that are not sensorially present. Things can be presented as images and concepts, and discussed in words. Initially the child does not differentiate concrete from imaginary reality, nor designate the thing by its name, as Zachar himself indicates, and which we see in many psychopathologic structures.
Starting with this period formal structures of thought and language are developed in progressive levels of maturation up to adolescence. These different formal levels of thought imply different mentalities, with different logical forms, that form different mentalities and life worlds at each maturational stage. In a simplified scheme: in the 1st) stage of infancy the mentality is magical and the world is physiognomic-animist. In the 2nd) stage the mentality is mythic and the world in dogmatic/ideological. In the 3rd stage and into adolescence, there appears a critical mentality, questioning dogmatic beliefs, with the possibility of developing one’s own standards and participating in the structure of one’s life. This is the period of developing one’s own personal identity: at first immaturely, grandiose pretentions of an ideal world, and then maturely, with a more realistic sense of the world and one’s own capability to develop realistic goals.
Psychotic psychopathology develops from disturbances of the global brain networks responsible for shaping the ontological forms of the basic, pragmatic world. These disturbances of the formal fundamental structures of the world and of oneself are responsible for serious psychotic illnesses such as schizophrenia, non-schizophrenic psychoses, and the dementias. They are disturbances of the basic ontology of the individual, originating in its prereflexive and pre-theoretical behavior.
The psychopathologic structures of the neuroses or affective disorders are structures that alter the person and his behavior, for their “affecting sense” of the appropriative realization of the subject life. They are perturbations of the “ways of feeling” affectively the “modal senses” of the things and circumstances of the given world have for the realization of the own life of that person. Senses not only conditioned, but determined by the “type of conceptual world” the person has, depending.
Hector Pelegrina Cetran MD
Member of Medicine Academy of Chile
Published in: AA P&P Association for the Advancement of Philosophy and Psychiatry BULLETIN.