A recent article published in the journal Philosophy, Psychiatry, & Psychology argues for an understanding of schizophrenia as a disturbance in selfhood at the level of ongoing embodied social activity. The author, UK psychologist and philosopher Richard Gipps attempts to provide an alternative to both symptom-based psychiatric “constructs” as well as older psychoanalytic ideas of ‘schizophrenia.’ He suggests several possible therapeutic applications of an “enactive” and embodied understanding of schizophrenia.
“The more radical proposal I wish to investigate here, however, is that in schizophrenia, we do truly meet with ontological disturbances of the ego—disturbances in the constitution including the boundedness of self-hood itself—and that such a disturbance is central to the very meaning of schizophrenia. In line with [R.D.] Laing, I propose that rather than misapprehending the placement of their boundary, the person with true ego boundary damage simply lacks any clear boundary to apprehend,” writes Gipps.
Historically, schizophrenia has been understood as a psychological condition marked by a failure to differentiate between self and other, a chaotic “divided self” according to anti-psychiatrist R.D. Laing. Today, questions surrounding schizophrenia as a “fractured” psyche have taken a back seat in favor of symptom-focused psychiatric constructs.
Some approaches, such as those influenced by phenomenology and psychoanalysis, do retain an interest in the philosophy of ‘schizophrenic personhood,’ rather than reducing the experience to observable symptoms.
The current article argues that “schizophrenia,” and specifically its associated “ego disturbances,” should be understood from an “enactive” perspective. Enactive cognitive science stresses the fact that human beings exist foremost as active bodies in the world with other people, rather than passive, detached minds or brains. The author suggests several therapeutic applications for this “re-theorization” of the “schizophrenic” psyche.
Gipps proposes this “enactive” understanding of ego boundaries in schizophrenia against both historical and contemporary understandings. He criticizes historical understandings, such as Freud, as being too “metaphysical.” For example, he believes that Freud and other historical figures took scientific concepts such as the cell membrane and tried to graft them on to psychology. This is problematic because using metaphors from biology to explain the mind can naturalize analogies with questionable scientific accuracy.
On the other hand, Gipps opposes contemporary psychiatry’s focus on “empirical constructs” and lists of symptoms. He believes that treating something like schizophrenia as a mere set of symptoms fails to get at the condition’s depth and seriousness.
Instead, Gipps focuses on schizophrenia’s “significance of disturbances to self-hood itself,” as older psychoanalytic and phenomenological thinkers did. He proposes a more scientific approach, however, guided by enactive cognitive science.
For Gipps, an enactive view of ego boundaries in relation to schizophrenia has four main traits.
The first of these is that the “ego boundary” is “equiprimordial” with experience. A disturbed ego boundary is not what causes someone undergoing psychosis, for example, to fail to understand the difference between themselves and another person. Instead, the disturbed ego boundary and the experience of that failure are “co-arising.” He suggests a poetic metaphor to explain:
“‘Wanderer the road is your footsteps, nothing else; you lay down a path in walking’”
In other words, bodily and psychological habits, repeating throughout one’s life in relation to others, create the psyche’s structure.
The second trait has to do with the body or “corporeality.” Gipps argues that in normal psychological development, the body is the “from-where” center of our experience. It is in many ways invisible to us if it is functioning well, and all of our psychological experience is made possible by a foundation in bodily or “sensorimotor” activity.
For the third trait, Gipps clarifies that the body is not the same as the mind. He gives the example of our “center of gravity” as perhaps a better metaphor for an “ego boundary” than our skin’s actual boundary. A “center of gravity” is not a specific object or a thing, but we recognize it to be real and to have real effects.
The fourth trait is that the “ego boundary is constituted autopoetically.” By autopoiesis, Gipps refers to the fact that the ego boundary is in continuous readjustment/adaptation with our bodily and social activities. So, instead of a disturbed ego boundary creating disturbed experiences, the “placement” of the ego boundary refers to ongoing “actual creation and recreation.”
From these traits, Gipps argues that we can understand schizophrenia enactively. For example, if ego boundaries are created through autopoiesis, then it can help us understand how harmful emotional experiences and confusing bodily experiences, as in emotionally and physically intrusive early life situations, can contribute to a disturbed ego boundary:
“For example, in the complex weave of emotional interactions between parent and teenager, the question of who is to blame for what is a difficult conversation, of ‘who started it,’ of what is and is not reasonable, will constantly be under tacit (and sometimes explicit) negotiation.”
In situations where clear communication and clear understandings of self and other are absent, a disorganized ego boundary may result.
These insights can lead us to novel therapeutic interventions, according to Gipps. He lists body psychotherapy as one example, which can help individuals train their ability to actively differentiate self and others:
“Group-conducted interventions may include self-massage and exploration of the bodily boundary extending into a physical investigation of the personal kineasphere and shared space, simple interaction with simple objects, intercorporeal communication (e.g., patients rolling a ball to one another with an emphasis on the distinct identities of the participants), grounding exercises and somatosensory awareness training, wrapping oneself in cloths, interaction with others to explore peripersonal spatial boundaries, and so on.
These are not to be understood as mere physical exercises, but as intrinsically emotionally charged interactions concerned, for example, with developing the confidence to allow others into one’s ‘space’ without fear of engulfment, intrusion, or collapse, or the confidence to define and protect one’s ‘space’ against the relatively forceful presence of others.”
Other examples include family systems therapy, which can help clear up confusing communicative messages and interpersonal dynamics, and “dialogical” therapy, focused on helping individuals develop greater self-awareness and autonomy by affirming the boundaries between individual and therapist.
The author concludes:
“One of the strengths of therapies such as those listed above, therapies which work to support the enaction of stable ego boundaries in the schizophrenia sufferer, is that effectively they target (what on the enactivist theorization offered here is understood as) the core ego pathology at the root of much of the symptomatology. What we arrive at is a unified psychopathological scheme that exemplifies the validity of the diagnosis and provides a clear remit for therapeutic intervention.
This remit also helps us avoid the pitfalls of therapies which: serve to merely foster cognitive insight, target individual symptoms rather than the psychogenic origins of such symptoms, miss the depth of the schizophrenic self-disturbances, and risk making matters worse by removing such symptoms as they serve anxiolytic functions (e.g., those delusions that make the terror of ego-dissolution more bearable by thematizing it into comprehendible frightening persecution by external agencies) before having stabilized the ego.”
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Gipps, R. G. T. (2020). Disturbance of ego-boundary enaction in schizophrenia. Philosophy, Psychiatry, & Psychology, 27(1), 91-106. (Link)
I doubt if these concepts will induce me to stop taking B3 every day.
Why would they? Did the author propose an “either-or” schema?
I have yet to read the entire article, but the reality is that the so called “schizophrenia treatments” can create both the negative and positive symptoms of “schizophrenia.”
The positive symptoms of “schizophrenia,” like “psychosis” and hallucinations, can be created, via anticholinergic toxidrome.
https://en.wikipedia.org/wiki/Toxidrome
And the negative symptoms of “schizophrenia” can be created, via antipsychotic / neuroleptic induced deficit syndrome.
https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
Thus “schizophrenia” is NOT a valid psychological diagnosis. The psychiatric DSM is not valid. Wake up American psychologists.
Removed for moderation.
That’s my experience!
When I came back to London in 1986 the ‘Irish Social Worker’ I had seen in 1980 asked me if I still took drugs, and I told him I did take a little prescribed medication; he shook his head and said “no, I mean street drugs”.
He was 100% convinced I had been under the influence of illicit substance when I visited him in 1980. “Schizophrenia” had not at all been on his Radar.
Micah: As I read your post this morning, at the Louisville Free Public Library on the last day of being able to read “Jimmy Warde’s Experiences as a Lunatic” who would be a patient in what was then called “The Arkansas Lunatic Asylum”, the questions arise:
Have you considered where the ego-boundary resides in a socio-technical system, where each letter beting typed into the keyboard, sends a message through an e-system that is oscillating in time, to hold data in place? Or is that really so?
Being that you are in Georgia, have you ever wondered over to the University of Georgia’s Ecology Program that was started by Eugene Odum. How ecosystems are understood is articulated in a beautiful and informed manner from within, by Gregory Bateson. The Ecology of the Mind might have had a better title if it read “The Ecologies…. Bateson would experience alcoholism and that aspect might have contributed to some of the struggle, though in Maps of the Mind, his map would be diagrammed as if his thinking were that of a locomotive with governor; the idea is the fuel and the movement into the thought as motion were somehow linked. But know we know the brain is much, much more complex. Hence, to frame the more creative, the most creative state that is bewildering and frightening, as the reality(s) can change so quickly within, how and why must the customer be forced into a space, that is devoid of an aesthetics, is void of learning, but rather is one of survival? The injection and speed at which the meds are forced along with the initial shock of the hospital or even a visit to the doctor, is not a space where the concept of boundaries are understood by one being introduced into the fragmented language and world of a medical practice. What can be realized as a path of self-improvement?
Another question that is occurring when you discuss “group-conducted interventions” might be problem creating? For if one thinks of our race, not too different from the interlock rings of the Olympics, then what happens with the concept of competition, that as Deming realized can be destructive within the organization. But what happens if our culture tends towards the competitive nature in the consciousness, unconsciousness as we learn how rich and varied thinking can be, if only held? “Potentially understood as an expression not in stone, nor even as “stable” as the professional therapist might like? But in teaching one how to discern peace, create a career, and not be lost or considered as an arrogant type, then the idea of what might be lost is found as similar to that pearl in the field. Is the lustre not beautiful, to learn how the inner eye sees more clearly, while finding a word or two for the moment? is this not what you are saying, so to speak, but from a different experience.
Now to discover the a last moment with Warde:
(pg. 98, “Well, this young man who said those words to me was the son of a Baptist Minister who first baptized me. I gave myself up to the men immediately. The words of the young man made an impression on me at that moment which meant a great deal to me.
I have often thought about it since, for those words were the most fitting at the moment of any words that could have been uttered)”
In closing, I also am thinking about this as I type, but to have also read James Cone’s book, “The Cross and the Lynching Tree”, what stays in the memory was his comment that the asylum was more feared than the lynching tree.
To understand one’s individual psyche, to explore self, to understand fear, as one would move around in all the rooms of space, within and outside of the body, but as an active mind. while pausing, reflecting, “seeing” the inner eye as being different from the visual eye, such the whole of body attempts to recover, then what sort of therapeutic sessions can emerge that will command attention?
Even when nation states have bullied their way, the human that fails to stand for justice seemingly at some point will need to atone, not just for self, but for the lives and families who may have not understood, that to speak up, to ease down or up, the speed of a thought is really a joy to realize, perhaps more through the Arts? But also, in how the pure science can be framed.
In this sense, Warde’s experience and the many others may be a reason for change that is meaningful.
Putting quotation marks around “schizophrenia” is pointless if the term is nonetheless taken to refer to something which actually exists.
OLdhead: Learning to write and punctuate by the rules can be something all of us strive for. To write “schizophrenia” quoting from your line which names and references the point you are making is important. If part of the struggle we face is to realize justice while healing, then having the “language” of that moment of where the horrors and injustice of a forced medication against our will is difficult to realize and write/speak the truths to empowerment. Where is the boundary of “schizoprenia” if there are those of us that know the meaning of “Never Forget”, “I will not forget you”. Many have perished and many more have been and are being placed on the medications without appropriate or alternative modalities of care offered. Thus, are we challenged to bring into existence, better protocals for care and intervention?
For me Recovery from “Schizophrenia” involved coming off the strong psychiatric drugs very carefully; and learning how to deal with the “High Anxiety”, the exposure to these drugs had caused!
Micah et al: Re: “From these traits, Gipps argues that we can understand schizophrenia enactively. For example, if ego boundaries are created through autopoiesis, then it can help us understand how harmful emotional experiences and confusing bodily experiences, as in emotionally and physically intrusive early life situations, can contribute to a disturbed ego boundary:
“For example, in the complex weave of emotional interactions between parent and teenager, the question of who is to blame for what is a difficult conversation, of ‘who started it,’ of what is and is not reasonable, will constantly be under tacit (and sometimes explicit) negotiation.”
In situations where clear communication and clear understandings of self and other are absent, a disorganized ego boundary may result.”
As I just finished re-reading the article again, the insights are more profound that one would “normally” realize. For in working on the MFA in Chicago in the summer of 2018, I went into Target to shop and noticed a stand for Koval Bourbon sampling. Three ladies were there and we got to visiting. And so, as we figured out where each were from, she from Arkansas, then from Little Rock, then Oak Street, then the street number!!!!! LOL, she and her husband had bought the house from my Mother. And then she said, are You Billy, for my name seemingly was carved into the front door on the inside. And she explained how my Mother showed her through the house adding the stories that went with raising her children and keeping the house together. Having an older Brother and two younger ones, I explained to her, that I thought it might have been my older brother who inscirbed my name on the inside of the door. Which my Mom would share with us about the earliest stages of how we began to speak. Hence, when Mom was trying to figure out “Who did it?” and my older brother would say, point the finger at me, or perhaps verbalized Billy did it, then my mouth spoke the first words, “He did it”. And the story of suprise, sibling rivialry began towards creating the challenge for moderating of an edge, of concsious and unconscious in the development of a tiny human being.
The context is even before teenager years!
Today, I realize these signature marks are no less than the type shaped by Ghiberti. For the entrance into our house was special, though at times venturing into a unique tempo. Just for the record, and fact of the case, the German Cuckoo Clock kept sending forth the bird to chirp when the older brother decided to try out his throwing art with a potato. The clock ceased to cuckoo after fallling from its perch, though time would later be investigated along with the exploration of the bellows.
Hence, how do We begin to harmonize our voices to identify for others what is cuckoo and not within behavior? Too many brothers have wrestled with each other or create family feuds by which even Wars are started or hips dislocated. And while we could see “Big Rock”, the area on which the Veterans Hospital sits in North Little Rock from the front porch, I can say today that I am grateful that generally speaking, I have rested my head more often than not on a pillow than on a rock.
Perhaps We, a people and this addition to your article can help with understanding what happens in the effort to understand what begins to happen in the gap of the dis-organizing boundaries of human development, spoken, observed and data commodified.
I think the situation may begin much earlier as to how the awareness for beauty, play as work evolve.
Along with the fireworks and Ah-ahhhhhhh!
The author points the way to understanding and helping those who suffer psychosis and this is a wonderful, wonderful thing but the language used is still embedded in the rarefied field of professional expertise. Why?
This is a language that is foreign to the majority of us in society, it builds an imaginary fortification, a ‘boundary’ between the clinical world and the rest of humanity. The author knows this eg. he champions shared experiential and dialogical therapeutic approaches to enable a sense of relationship and shared understanding between those in need of help and those wishing to help them. So the language used, be it verbal or physical, has to be inclusive if to communicate and reach out to those suffering alienation through psychosis.