The Man Who Wasn't There: Investigations into the Strange New Science of the Self (14 page)

“He was an extreme, and from any normal point of view insane, devotee of autonomy. I’m not trying to say it’s a better way to live, obviously, but it offends me deeply at some ethical level, and at some aesthetic, intellectual level as well, that these things would not be recognized for what they are,” said Sass. “Scientifically, it’s a failure to recognize the true nature of the phenomenon, in all its sometimes paradoxical complexity.”

What Sass, then, is arguing for—and he’s not the only one—is for psychiatry to move away from describing schizophrenia so exclusively in terms of deficits—lacking this, lacking that—and to think of it positively. By “positive,” he does not mean good. He means to recognize what it feels like to be schizophrenic, to understand its phenomenology, not just to note the failure to conform to cultural standards.

One way to understand schizophrenia, Sass argues, is to look toward modernism in art (the cubism of Picasso, the dadaism of Marcel Duchamp, and the surrealism of Giorgio de Chirico and Yves Tanguy, for example) and literature (Franz Kafka and Robert Musil, T. S. Eliot
and James Joyce, to name a few). Such art can give us a sense of what the schizophrenic experience might entail. In the various traits of modernism, as well as postmodernism, Sass sees threads of what he termed “hyperreflexivity” (a kind of exaggerated self-consciousness that takes what would normally be the implicit medium of our experience and turns it into an explicit target of excessive focus and attention) and also of alienation. “Instead of a spontaneous and naïve involvement—an unquestioning acceptance of the external world . . . and other human beings, and one’s own feelings, both modernism and postmodernism are imbued with hesitation and detachment, a division or doubling in which the ego disengages from normal forms of involvement with nature and society, often taking itself, or its own experiences, as its own object,” he wrote.

Laurie can recall the feeling of her first major encounter with schizophrenia. It was Bonfire Night, during the fall of 2005. Across the country, fireworks were being lit to celebrate events of November 5, 1605, when the police thwarted a plot to blow up the parliament building in London. Laurie was seventeen, in boarding school in Canterbury, England. She watched the fireworks display and then came back to her room and sat down in her chair. She felt strange. As if something were controlling her, possessing her, an outside force. She sat for a couple of hours, doing nothing, just preoccupied with the strangeness. Then she picked up an art knife and cut her left hand. And she went to sleep. She woke the next morning and cut herself again, this time a lot deeper. The bleeding wouldn’t stop. “Somehow I just snapped back to reality, and realized, Oh, gosh, I have cut myself,” she told me. She and a friend rushed to seek medical help.

That incident was the first serious realization that something was amiss. The Bonfire Night incident brought into focus something she had begun to feel a few months earlier: paranoia that she would be deported from the UK back to her home country, though there was no cause for concern in real life. Until then, she had dismissed those fears. But the thoughts became more frequent and insistent. They had an almost acoustic quality, an “external physical quality,” as they crowded her head. They were linked to deportation. Their refrain was unfailingly familiar. “‘Nobody will miss you if you go, you are useless, you are a failure,’ that kind of thing,” she told me.

By March 2008, Laurie had cut herself more than a dozen times. That was when she and Peter, then her boyfriend, took a trip abroad to meet her parents. One night, when everyone else had gone upstairs to bed, Laurie showed Peter the scars on her hand.

“‘Oh, dear,’ I think were my precise words,” Peter told me while we all sat down for dinner at the Hole in the Wall pub in Bristol.

“You said, ‘Oh, Jesus,’” Laurie corrected him.

“Fair enough,” said Peter.

Soon after her talk with Peter, Laurie began hearing voices. She remembered the month: May 2008. It was unclear whether it was the voice of one person or three, for the voices seemed to echo inside her head. But it was a middle-aged voice speaking in a British accent. The woman or women spoke directly to her, telling her to cut deeper, to kill herself. These voices, speaking in the second person, as it happened, delayed Laurie’s diagnosis of schizophrenia, for which she blamed Kurt Schneider, an early-to-mid-twentieth-century German psychiatrist. Schneider had cataloged a set of what he called first-rank symptoms for diagnosing schizophrenia. Among these are third-person auditory hallucinations, in which the voices talk to one another
about the patient. Though Laurie displayed some other first-rank symptoms (thought insertion, or the feeling of alien thoughts in her head, and primary delusion, a delusion that appears unbidden and without precursors, which in Laurie’s case was the feeling that her surroundings had an inexplicable strangeness), her psychiatrist, idiosyncratically and mistakenly sticking to Schneider’s old ideas, regarded the presence of second-person voices as uncharacteristic of schizophrenia, and more an indication of psychotic depression (even though we now know that many people with schizophrenia do hear voices speaking to them directly).

The staggering array of symptoms in schizophrenia complicates diagnosis. The symptoms are usually classified as positive (delusions, hallucinations), negative (apathy, emotional flatness), and disorganized (such as jumbled-up speech). Diagnosis often involves ruling out other disorders before settling upon schizophrenia. In Laurie’s case, it meant being diagnosed first as suffering from depression, then from borderline personality disorder. Meanwhile, her attempts at suicide got more serious. She once overdosed on eighty tablets of acetaminophen, and suffered two weeks of vomiting. Soon afterward she tried to jump off the eight-story parking garage. And around that time, a psychiatrist diagnosed her with schizophrenia.

Sometime in early 2009, her condition worsened. She tried to kill herself again, this time with an overdose of her antipsychotic medication. Even her very sense of being a person was threatened. “During that period of intense symptoms, I thought my whole self disintegrated and dissolved; I didn’t have one,” she said. For instance, if she held out her hand, she would feel it going farther and farther away. “My sense of self, bodily self or psychological self, or a combination of the two, was just permeating outwards,” she said. “Even when I was
just sitting, I’d think I was just transparent, almost. Not physically, obviously, metaphorically.”

Sass and his colleague Josef Parnas, a psychiatrist at the University of Copenhagen, Denmark, think that the answer to the conundrum that is schizophrenia lies in the self. Scientists have long struggled to come up with a unifying hypothesis for schizophrenia. What possible common mechanism could underlie the diversity of positive, negative, and disorganized symptoms? Could it be a disturbance of the very underpinning of our being, a disturbance of our sense of self?

To explain schizophrenia, German psychiatrist Karl Jaspers coined the term
Ich Störungen
, which literally translates to “ego disturbances.” Jaspers used the term to signify how the core symptoms of schizophrenia all have something to do with a disturbance of the boundary between the self and the other, the self and the outside world.

Sass and Parnas think that schizophrenia is the result of an even more basic disturbance of the self. The duo’s thinking owes much to a long tradition of mostly European phenomenologists—phenomenology being “
the study of ‘lived experience.’” These phenomenologists include, notably, Edmund Husserl, Martin Heidegger, Maurice Merleau-Ponty, and Jean-Paul Sartre. It’s through the analysis of the lived experiences of patients that Sass and Parnas arrived at their thesis: schizophrenia involves the disruption of a basic form of selfhood. To understand their point of view, we need to treat the self as a layered entity. There is the by-now-familiar narrative self—the stories we tell ourselves (and others) about ourselves, an identity that spans time, from the past to the future. But even before the emergence of the temporal storyteller within us, there’s the self-as-subject that
is able to reflect upon aspects of itself, these aspects constituting the self-as-object (our narrative would be one such aspect, or object, for the self-as-subject). Sass and Parnas are targeting the self-as-subject: it’s “the fact that I feel that I exist now in this moment, that I feel a sense of being a [subject], a sense of being the thing to which things are happening, and from which acts emanate,” said Sass. They call this
ipseity
(
ipse
is Latin for “self” or “itself”).

During our meeting, Sass displayed extemporaneous literary eloquence as he described the concept further. “Ipseity is that from which the fiats of the will emanate, and toward which perceptions come. It is the implicit sense of feeling that you are here. But of course, you don’t think about that directly. It’s a feeling, and it’s of its essence that it
not
be the object of awareness,” he said. “You might say that it’s the nowhere from which will emanates, the nowhere to which perceptions arrive; that’s more or less how William James described it.”

“That it
not
be the object of awareness . . .” It’s this assertion that holds the clue to Sass and Parnas’s idea of what happens during schizophrenia. The disorder, they argue, involves a kind of hyperreflexivity, an undue amount of attention paid to aspects of oneself that otherwise just exist without being the focus of attention. “It’s a subtle but crucial phenomenological difference between moving your arm and taking the movement of your arm as the object of your attention,” said Sass. “Those are very different things.”

Sass and Parnas posit another seemingly contradictory disturbance of ipseity that they think is present in schizophrenia. It’s what they call “diminished self-affection”: a reduced sense of being an entity to which things happen, of being an entity that is the subject of awareness. Sass writes, “
This experience of one’s
own
presence as a conscious, embodied subject is so fundamental that any description
risks sounding empty or tautological; yet its absence can be acutely felt.”

Laurie could attest to that. In the days leading up to her suicide attempt from the top floor of the garage, she felt an intense emptiness. “When I was in that state, I just thought there was so much nothingness around me, inside of me, I couldn’t function,” she told me. “I thought if I couldn’t function, what’s my worth? I might as well be dead.”

Sass and Parnas argue that when ipseity is disturbed, the basis of our very being is eroded, making it fertile ground for psychosis and releasing all sorts of strange experiential possibilities.

During the early phase of her psychotic break, Sophie remembered noticing subtle changes too. Sophie told a friend, who was French, about how she was seeing the world as particles, and how it felt as if the mere act of blowing on a building would disperse it into thin air. “To this day, I don’t know where the mistranslation occurred, whether it was on her end, or her expressing that in her French-English to a professor, but somehow they decided that I was planning to blow up a building,” Sophie told me. She was banned from the philosophy department where she was a student, and threatened with arrest if she showed up on campus. Sophie went to the campus anyway to see her adviser, who refused to meet her and slammed the door in Sophie’s face. Sophie was initially temporarily suspended, but a year and a half later she was permanently expelled from the department.