Stanghellini, an Italian
psychiatrist, aims to take the reader into the world of schizophrenics and
manic-depressives.  His approach is, broadly, phenomenological.  He aims to comprehend
the life-world and illuminate the subjective experiences of sufferers from
psychopathology.  Perhaps inevitably, given that this is his goal, he has
written a difficult and allusive book. Those who want an explanation of
schizophrenia, or a guide to its treatment, should look elsewhere. This is a
book which seeks to communicate the experience of the sufferer, not, primarily
at least, to explain it.

Schizophrenia is a disorder of
common sense, Stanghellini argues. Common sense has two meanings; it refers
both to the set of taken-for-granted rules and tacit understandings by and
through which each of us grasps the social and natural world, and also the
cross-modal sharing and binding of the reports of the senses. Stanghellini
argues that these two meanings are related, and that both are disrupted in
schizophrenia.

The idea seems to be this:
Schizophrenics, as it is now widely recognized, seem to suffer from some kind
of deficit in action and thought monitoring. Hence their susceptibility to
passivity experiences and to delusions of control and thought insertion: they
think and act in the normal way, but because they fail to experience their
thoughts as caused by themselves, they attribute them to someone or something
else. As a consequence of their deficits in sensation, Stanghellini seems to
suggest, schizophrenics suffer from a deficit in theory of mind. Since they
cannot monitor their own mental states effectively, they have great difficulty
in simulating the mental states of others. Without this ability, schizophrenics
are at a loss to decode the ‘rules’ of the social game. If this story is on the
right track, schizophrenics difficulty in attributing the outputs of their
senses to themselves is causally responsible for their difficulty in understanding
the social world, and the two senses of ‘common sense’ are indissolubly linked.

The problem with this account,
which I have attempted to reconstruct from Stanghellini’s allusive and
difficult prose, is that it is straining somewhat to call the difficulty
schizophrenics have in monitoring their own thoughts and actions a problem of
common sense. Granted it might have sensory consequences, but it is equally,
and perhaps even basically, a difficulty with monitoring thoughts and
intentions, not the outputs of the senses. Moreover, a parsimonious explanation
of schizophrenia will account for all the difficulties encountered by
sufferers, and it seems that this explanation fails this test. Rather than
accounting separately for schizophrenics’ difficulties with the social world
and their difficulties with language, for instance, we should a unified
explanation of both.

Perhaps, however, this objection
misses the point. Perhaps Stanghellini does not aim to explain schizophrenia at
all, even when he offers an account of it. Instead, perhaps the account itself
is in the service of the overall goal of communicating to us the experience of
schizophrenia. This suggestion makes sense of a number of otherwise puzzling
features of his work, such as the constant references to works of art, and
especially to the paintings of René Magritte (at one point, Stanghellini even
suggests reading his work with a volume of Magritte paintings in hand). Perhaps
he believes that the comparisons, metaphors and accounts he offers of schizophrenic
delusions and hallucinations will prove a better guide to the experience of
sufferers than will rivals, regardless of whether they are true.

If this is its goal, does it
succeed? That is a question that only present or former sufferers from schizophrenia,
their close family and the clinicians who treat them are well placed to answer.
However, it is worth recording here one strange feature of about Stanghellini’s
approach. Despite avowed commitment to a phenomenological methodology, the
schizophrenic and other sufferers from psychopathologies remain largely
offstage. With the exception of a brief prologue, which purports to present the
voice of a patient (though the writing is so self-consciously literary that I
have no doubt that the voice has been carefully edited and reworked; indeed, I
suspect that the patient is actually an ideal-type, not an individual), we
barely encounter a schizophrenic. Phenomenology is supposed to return us to "the
things themselves", but in Stanghellini’s hands it is largely a
theory-driven enterprise.  It is art and philosophy which gives us privileged
insight into the world of the schizophrenic, not the words and deeds of
sufferers themselves.

© 2004 Neil Levy

Dr Neil Levy
is a fellow of the Centre
for Applied Philosophy and Public Ethics at Charles
Sturt University, Australia. He is the author of two mongraphs and over a dozen articles and
book chapters on Continental philosophy, ethics and political philosophy. He is
currently writing a book on moral relativism.

Categories: Philosophical