In this new edition of Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought, Louis Sass carefully revises and clarifies his argument regarding the illuminating parallels between schizophrenia and modernist forms of thought and art. His central thesis is that both schizophrenia and modernism ought to be understood in terms of a hyperreflective or overly self-conscious form of awareness. To make his case, he draws on exegetical evidence from a wide variety of sources, including first-hand accounts from schizophrenic individuals, modern philosophy, modernist literature, art, and theatre, as well as the various postmodernist worldviews to which these modernist pictures naturally lead. He argues that in both schizophrenia and modernism, elements of conscious experience that are normally tacit, for example, the position of one’s body in space and the particular muscular-skeletal operations that underlie its movements, the feel of saliva in the mouth, the way words sound or look on the page, the multiple perspectives one might take on the same experience, and the somewhat arbitrary nature of social conventions, are brought into explicit focus. Throughout the text Sass draws enlightening analogies between this disposition towards various hyper-conscious forms of subjectivity and the idealist trends in modern philosophy, beginning with Descartes and taking off with Kant’s transcendental idealism, which eventually conceive of the world as emanating entirely from the subject, and view consciousness as the ultimate source of the world itself.

Sass’s goal is to adopt a purely phenomenological perspective on the modes of consciousness he sees as characteristic of both schizophrenia and modernism. He demonstrates the importance of phenomenological descriptions of altered world-experience and, in that sense, follows Karl Jaspers’ strategy in a way, but also sharply disagrees with him regarding the question of whether schizophrenia is understandable or merely explainable. Sass sees the view that describes schizophrenia as being beyond human understanding, as involving modes of perception, thought, and speech that are devoid of meaning and therefore not worthwhile to interpret, as being a sort of self-fulfilling prophesy. Once the contrary presupposition is adopted, that there is some meaningful thought and experience to interpret, meaning thereby emerges (at least to the one gifted in interpretation). Sass executes this project skillfully by following the Husserlian injunction: “To the things themselves!” Throughout the text, he exposes the reader to phenomena of schizophrenic experience, indicates traditional psychoanalytic or cognitive-behavioral interpretations of those phenomena, and then tests these interpretations against the phenomena themselves.

Sass argues for the necessary priority of phenomenological investigations of pathological experience — the need to answer “what?” before attempting to answer “why?” or “how?” He shows the reader that failing to ask this first question can have two sets of undesirable consequences: first, the phenomenon in question becomes grossly misunderstood as, for instance, when it’s interpreted as indicating a primitive form of consciousness as opposed to a hyperaware, overly abstract, metaphysical one; secondly, the misunderstanding prevents the therapist or interviewer from interacting with the schizophrenic patient on her own terms or in her own world, a problem which at the very least leads to negative consequences for the therapeutic setting and at most makes therapeutic intervention itself all but impossible. But he also argues that phenomenology is not a merely descriptive science. It can also be explanatory once we allow for the possibility that experience plays a genuinely causal role in pathogenesis, either in the form of the subject’s reactions to pathological experience or in the shaping of brain circuitry itself through the as-yet-little understood processes of neural plasticity. He shares this view with those proponents of neurophenomenology, who argue that phenomenology and cognitive neuroscience (or biological psychiatry) ought to mutually inform and constrain one another.

The text is a comprehensive journey throughout the schizophrenia spectrum, beginning with an exposition of schizoid or schizotypal personality disorder and ending with full-blown psychosis. Sass reveals throughout that his expertise extends way beyond the boundaries of schizophrenic world-experience into a penetrating understanding of modernist and postmodernist art, as well as the modern philosophical roots of these later aesthetic developments. These modernist forms of thought, literature, and art are so curiously yet astutely tied together with psychotic world-experience that the reader almost seems to be placed within the realm of madness herself, i.e., in the realm of what Jaspers famously described as lying beyond comprehension. Sass paints the lives of modern authors, painters, playwrights, and philosophers so vividly that the reader thinks she is being given an account of the great creators of the past centuries from one of their dear friends, or, perhaps even more voyeuristically, their therapist. The book is dense, profound, enlightening, and almost impossible to put down except in defense against the uncanny feeling that one is going mad oneself. Sass makes the inconceivable conceived, and the act of conception puts the reader in an altered state: not one of psychosis itself, of course, but one of understanding the play-acting at psychosis, of understanding the mockery which the schizophrenic — and the modernist — makes of his world, of others, of the reader (and, presumably, of the author) himself.

          While Sass’s book is primarily a positive exposition of his own view, and not a critique of other prevailing accounts, he does situate his position in contrast to two competing approaches in modern psychiatry. The first is the medical model of psychiatry, sometimes also associated with certain cognitive-behavioral accounts, which views mental illness primarily through the lens of deficits of proper functioning caused by certain abnormalities in the brain. While Sass is not arguing against the significance of neurobiological aspects of mental disorder, especially in the form of exposing subjects to certain predispositions, for instance, to schizoid or schitzotypal personality traits, he resists this medical model view based on two shortcomings: its contention that schizophrenia amounts to certain deficits in cognitive functioning, and its insistence on the priority of the (neuro)biological over the phenomenological. By contrast Sass suggests that schizophrenia is better understood in terms of an overabundance of certain cognitive faculties, namely the capacity for reflection upon oneself, one’s perceptual contents, one’s bodily sensations, the purposeful behavior of others, and the social context generally speaking, including taken for granted modes of behavior, thought, and values. Of course, a constant theme throughout is how these altered forms of subjectivity are mirrored in the social context of modern art and literature. The claim is not a causal one, but the relationship is not entirely devoid of determination relations either. Sass makes clear that human beings are both creatures and creators of culture, echoing his broader theme regarding the elements of passivity and agency in both schizophrenic and neurotypical forms of being-in-the-world.

          Sass’s other primary target is the psychoanalytic view, which, while countenancing the power of psychological processes themselves, is bound to always cast schizophrenic forms of world-experience in terms of regression towards some infantile mode of consciousness. Sass associates this approach with the traditional view that madness is a type of Dionysian release into emotional and instinctual forms of behavior. He argues against this position by appealing to evidence from first-hand accounts of schizophrenia patients, who will often exhibit a lack of emotional response, indicating that far from being immersed in a world of passionate release, people with schizophrenia often have less emotional modes of being than their “normal” counterparts. He also points to the bizarre content of schizophrenic delusions and hallucinations, which tend to have a metaphysical or ontological bent, demonstrating a tendency toward the Apollonian extreme of the Nietzschean dichotonomy, i.e., one of extreme abstraction, of universal forms of thinking, those descriptions which apply to Being itself in the broadest sense of the term.

Perhaps the only underdeveloped aspect of Sass’s vastly encompassing exposition is the specifically embodied aspects of living with schizophrenia. At the outset, Sass commits himself to elucidating the schizophrenic world-experience by means of two overarching theses: that of the hyperreflexivity of schizophrenic consciousness, which is well-developed over the course of the text, and that of diminished self-presence. The latter is intended to reflect the “decline of the experienced sense of existing as a living subject of awareness or agent of action — of the very sense of being a first-person perspective or lived grounding of the ‘I see,’ ‘I know,’ and ‘I do'” (xii). While Sass admits that this tacit and pre-reflective sense of one’s own agency, of the orientation towards the world in terms of possibilities for action as opposed to possibilities for knowing, is grounded in the lived experience of the body, he describes it more in terms of an altered form of cognition rather than an altered bodily experience. This may have more to do with the fact that what occurs in schizophrenia exactly is a shattering of this unified first-personal awareness, and hence involves rather a lack of awareness of the body rather than an altered awareness. Nevertheless, he spends more time on thorough descriptions of the cognitive elements of the condition without giving any systematic treatment of, for instance, the manner in which pragmatically oriented emotions are thoroughly embodied, or that perception itself is structured by the body’s motor capacities. Sass’s account has more than enough room to treat these issues in more depth, by examining the relations between pathological and nonpathological lived bodily experience, and we may see him do so in the future.

Aside from this rather minor shortcoming, Madness and Modernism is undoubtedly one of the most profound and perspicacious treatments of an illness that is utterly baffling to most laypersons and academics alike. Sass artfully brings together two obscure, complex, and unnerving realms — the schizophrenic and the modern and postmodern aesthetic — into mutual enlightenment. The comparisons between the schizophrenic loss of ego boundaries, perspectival switching, and world catastrophe with modern literature and art is so adroit that it is almost eerie. The reader finds herself peering into a borderline incomprehensible realm with increasing levels of clarity, by which she gains insight into the utterly chaotic, confused, and bizarre. The lucidity Sass brings to the obscure and confused is a reflection of the many contradictions he introduces to his readers as being entirely paradigmatic of both madness and modernism: that of desiring human contact but also shunning it entirely, of being both afflicted by disease but also exercising a sort of agency, and indeed, an ideal intellectual freedom within the confines of such an affliction, of moving both towards an objectifying materiality of the external world and a total subjectivization of perception, of the tendency towards the hyperabstract and the utterly concrete (between being too “far away” or “too close,” respectively). Sass is able to make sense of a world in which these contradictions exist side by side simultaneously, and the disconcerting confusion this causes is palpable to the reader.

In Madness and Modernism, Louis Sass demonstrates not only his penetrating intellect, but also his unwavering patience and empathy, both in the treatment of the subject matter and the treatment of the subjects suffering from this extraordinary illness. The book is required reading for anyone interested in phenomenological psychiatry, or even psychiatry more generally. It’s also an absolute delight to read. I cannot recommend it highly enough.

© 2018 Laura Matthews

Laura Matthews, Ph.D Candidate, Dept. of Philosophy, University of Georgia