In the foregoing chapters we have often had occasion to mention the existential analytical approach and treatment of neurotic cases. Although we have not systematically delineated a theory of the neuroses, we have seen how logotherapy works in the case of so-called Sunday neurosis or various forms of sexual neurosis. While we still do not intend to proceed systematically, we wish to discuss in fuller fashion the special existential analysis of the neuroses and psychoses, with particular emphasis upon case histories. We shall see to what extent the ground for a logotherapy of the neuroses unfolds—a therapy “in spiritual terms,” as we formulated the problem at the beginning of this book, where we made the point that consciousness of responsibility is the foundation of human existence and that existential analysis was the method for bringing out that consciousness. By way of introduction, however, we want to present some general psychological and pathogenetic considerations.
We have already pointed out several times that every neurotic symptom has a fourfold root, being grounded in the four basically different layers (or “dimensions”) of man’s being. Thus neurosis appears in four forms: as the result of something physical, as the expression of something psychic, as a means to an end within the societal field of force, and finally as a mode of existence. The last-named form alone offers a point of approach for existential analysis. For only where neurosis is understood as a product of decision can there be the freedom to which existential analysis attempts to appeal. On the other hand, this freedom disappears in increasing measure as we descend the ladder from man’s spirit—the locus of attack for logotherapy or existential analysis—to his body, from the realm of the spirit to the realm of physiology. There is no foothold for man’s spiritual, existential freedom in the physiological bases of neurosis. Psychotherapy in the narrower sense of the word can also scarcely reach them, scarcely reshape them. In general the only possible and effective therapy for the physiological base is drug treatment.
Insofar as a neurotic symptom can be interpreted as an “expression” and as a “means,” it is primarily a direct expression and only secondarily a means to an end. The so-called purposiveness of a neurotic symptom does not explain the origin of a neurosis; it explains only the fixating of the particular symptom. Knowledge of the purpose the neurosis serves does not, that is, tell us how the patient happened to acquire the neurosis; it tells us at most why he clings to a particular symptom. Here we take a contrary position to the views of individual psychology. According to individual psychology, neurosis is “used” to keep a person from getting on with his life task. According to existential analysis, neurosis does not have this purposive function; nevertheless, existential analysis aims to bring the person to an understanding of his true life task, for with such understanding he will find it all the easier to cast off his neurosis. This “freedom to,” the “decision for” the life task, therefore comes before the “freedom from.” The more we can from the start link this positive (logotherapeutic) factor with the negative (psychotherapeutic) factor, the more quickly and surely will we reach the goal of our therapy.
In the following section we intend to examine, in the light of selected cases, the psychological structure of anxiety neurosis. Our examples will show the extent to which the neurosis is also rooted in layers not actually psychic.
One case is that of a young man who suffered from constant fear of dying of cancer. Nevertheless, it was possible to achieve some beneficial effect by existential analysis. In the course of the existential analysis of this case the patient’s continual preoccupation with the future manner of his death turned out to be essentially a disinterest in his present mode of life. For he was oblivious of his obligations, not conscious of his responsibility to life. His fear of death was ultimately the sting of conscience, that fear of death that a person must have when he disdains what life offers him. His existence must necessarily appear meaningless to himself. The disinterest our patient showed for his own most personal potentialities was paralleled by the neurotic counterpart, his lively and exclusive interest in death. By his fear of cancer he punished himself because of his “metaphysical frivolity” (Scheler).
Back of such neurotic anxiety, then, there is an existential anxiety which is made specific, so to speak, in the phobic symptom. The existential anxiety is condensed into a hypochondriacal phobia, the original fear of death (uneasy conscience) concentrating upon a particular fatal disease. In hypochondriacal anxiety, then, we have a condensation or derivative of existential anxiety applied to a single organ. Death, feared because the person has a guilty conscience toward life, is pushed out of the mind—and the fear centers instead upon a particular organ of the body. In fact, every inferiority feeling about a particular organ is probably only a making specific of the primary sense of not having realized one’s own value-potentialities. If that is so, the concentration of this feeling upon a single organ or a particular function is a secondary phenomenon.
The condensation of existential anxiety, which is fear of death and simultaneously fear of life as a whole, is something we encounter again and again in neurotic behavior. The original total anxiety apparently seeks some concrete content, some objective representative of “death” or “life,” a representative of the “border situation” (Jaspers), a symbolic representation (Erwin Straus). In a case of agoraphobia, for example, this symbolic function is assumed by “the streets,” or in a case of stage fright by “the stage.” Often the very words in which patients describe their symptoms and complaints—words which they apparently mean only in a figurative sense—can put us on the track of the real, the existential reason for the neurosis. Thus, a patient suffering from fear of open places expressed her anxiety as: “A feeling like hanging in the air.” This was in fact an apt description of her whole spiritual situation. In fact, her entire neurosis was ultimately the psychic expression of this spiritual condition. The paroxysms of anxiety and giddiness which attacked our agoraphobic patient when she went out on the street were, shall we say, “vestibular” expressions of her existential situation. Quite similar are the words in which an actress suffering from stage fright once described the sensations she felt when in the grip of her anxiety: “Everything is huge—everything is pursuing me—I am terrified that life is passing.”*
Insofar as neurotic anxiety is not only the direct psychic expression of general anxiety about life but is also in individual cases a means to an end, it is such a means only secondarily. Sometimes, but not always, it serves to tyrannize a member of the family or is used to justify oneself to others or to the self—as individual psychology has brought out in countless cases. Antecedent to and coeval with this indirect use of anxiety as a means, before and along with this secondary quality of neurotic anxiety as “arrangement,” it always has a primary significance as expression. Freud rightly speaks of “neurotic gain” as a “secondary” motive force of illness. But even in cases where such a secondary motive force is actually present, it is not advisable to put this fact frankly before the patient. No good comes from “throwing it up” to him that he is only using his symptoms in the hope of binding his wife to him or dominating his sister, etc. Or else we are engaging in a kind of blackmail of the patient. We keep at him with arguments to show that his symptom is only a weapon he is employing to terrorize members of his family, until at last he summons up all his remaining reserves of strength and somehow conquers the symptom—solely in order to avoid being morally condemned, to escape our criticism. This kind of psychotherapeutic treatment, though it may be successful, is essentially unfair. Instead of forcing a cure by pressuring the patient into “sacrificing” his symptom, it would seem far more sensible to wait until the psychologically relaxed patient himself realizes that he has been exploiting a symptom as a means for imposing his will to power upon his social environment or his family. The spontaneity of confessions and insights into the self are what bring about true therapeutic effects.
Insofar as existential analysis of a case of anxiety neurosis interprets the neurosis as ultimately a mode of existence, a sort of spiritual attitude, the groundwork has been laid for logotherapy as a specific treatment. Let us take as an example a case of climacteric-anxiety neurosis. Disregarding the glandular imbalance which is the somatogenic substructure of the illness, the real root of the neurosis is to be found in the existential layer. The patient experiences this critical phase of her life as an existential crisis; she feels threatened because she finds a spiritual deficit when she draws up the balance sheet of her life.
The patient in question was a beautiful woman, the darling of society. Now she had to face up to a new period in her life in which her physical charm would no longer count; she had to be able to “bear up” in spite of her vanishing beauty. Erotically this woman was finished. She found herself without aim or purpose in life, without a content for her life; her existence seemed meaningless to her. “I get up in the morning,” she said, “and ask myself: What is happening today? Nothing is happening today.…” Naturally she grew anxious. And since there was no content to her life, since she had no resources for building up a full life, she had to incorporate her anxiety into the structure of her life. It was necessary for her to seek some content for life, to find the meaning of her life, and thereby to find herself, her self, her inner potentialities. Erotic success and social status no longer counted; she could only reach for moral status. It was necessary to induce this patient to turn away from her anxiety and toward her tasks. This positive aim of existential-analytical logotherapy can be attained even before the negative goal of psychotherapy in the narrower sense of the word is achieved. In fact, the attainment of the positive aim will in some circumstances clear up the neurotic anxiety—since the existential basis of this anxiety will have been withdrawn. As soon as life’s fullness of meaning is rediscovered, the neurotic anxiety (to the extent that it is existential anxiety) no longer has anything to fasten on. There is no longer room for it and, as our patient spontaneously remarked, “no time.”
What had to be done here was to lead this particular person in her concrete situation to the unique and singular task of her life. It was up to her to become what she was going to be; before her there stood an image of what she ought to be, and as long as she had not become that she could not be at peace. The climacteric crisis had to be reshaped into a spiritual rebirth—that, in this case, was the task of logotherapy. The therapist took the part of a midwife in the Socratic sense. It would have been a distinct blunder, as we shall see, to attempt to impose any particular tasks upon the patient. On the contrary, existential analysis must aim at leading the patient to independent responsibility. And if it is successful, the patient finds “his” life task—as the patient in question did. Having turned wholeheartedly toward new content in her life, devoting herself to the newly acquired meaning of her existence and the experience of fulfilling her own personality, she was reborn as a new person—and at the same time all neurotic symptoms vanished. All the functional cardiac sensations from which the patient had suffered—palpitation, a feeling of uneasiness around the heart—vanished, even though the climacteric basis of them remained. Evidently these neurotic cardiac reactions, this “uneasiness,” were ultimately the expression of uneasiness of the spirit. “Restless are our hearts …” says Augustine. Our patient’s heart was restless, too, as long as it could not rest in the consciousness of her singular and unique task, in the consciousness of responsibility and obligation to perform her own life task.
Like all other neurosis, obsessional neurosis also has a constitutional basis. Wexberg and others, whose interests lie mainly in the fields of psychogenesis or psychotherapy, have assumed that a somatic substructure ultimately underlies obsessional neurosis. A number of clinical pictures had been observed in which postencephalitic behavior showed striking similarities to obsessional neurotic syndromes. The mistake was made of confusing similarity in form with identity in nature.
An “anankastic syndrome” was considered to be the hereditary element in obsessional neurosis; it was believed to have a special genetic radical which was supposedly dominant. Finally it was proposed that the term “obsessional disease” be used instead of “obsessional neurosis,” in order to stress the constitutional quality of the illness.
As far as therapy is concerned, these various views strike us as largely irrelevant. Moreover, to make much of the constitutional factors underlying obsessional neurosis does not relieve psychotherapy of its obligation, nor deprive it of its opportunities. For anankasm consists of nothing more than a mere disposition toward certain characterological peculiarities such as meticulosity, exaggerated love of order, fanatical cleanliness, or overscrupulousness—traits which, in fact, must be recognized as culturally valuable. They do not seriously incommode the person who has them or those around him. They are only the soil in which the actual obsessional neurosis can grow, though it does not necessarily do so. Where such a constitution does give rise to neurosis, human freedom is involved. Revealing the psychogenic nature of the particular neurotic content need not be therapeutically effective, nor is it indeed even indicated. On the contrary, detailed treatment of symptoms in obsessional neurotics would only give encouragement to their compulsion to brood over their symptoms.
We must, however, distinguish carefully between such symptomatic treatment and palliative treatment by logotherapy. The logotherapist is not concerned with treating the individual symptom or the disease as such; rather, he sets out to transform the neurotic’s attitude toward his neurosis. For it is this attitude which has built up the basic constitutional disturbance into clinical symptoms of illness. And this attitude, at least in milder cases or in the early stages, is quite subject to correction. Where the attitude itself has not as yet taken on the typical obsessional-neurotic rigidity, where it is not yet infiltrated, so to speak, by the basic disturbance, a change in its direction should still be possible.
Anticipating a logotherapeutic principle to be discussed more elaborately in a later, clinical chapter, we can say that in dealing with obsessional neurosis, even psychotherapy in the narrower sense of the word has the problem of inducing a change in the patient’s attitude toward the neurosis as a whole. Therapy of obsessional neuroses should aim at relaxing the patient and relieving the tension in his total attitude toward the neurosis. It is well known that the very tension of the patient’s fight against his compulsive ideas only tends to strengthen the “compulsion.” Pressure generates counterpressure; the more the patient dashes his head against the wall of his obsessional ideas, the stronger they become and the more unbreakable they appear to him.
There is one prime prerequisite, however, for not fighting against obsessional ideas. We must assume that the patient is not afraid of his obsessions. But all too frequently patients overestimate their obsessional-neurotic symptoms, considering them harbingers or actual signs of a psychotic illness. In that case they cannot help fearing their obsessions. It is necessary, then, first of all to dispose of this fear of imminent psychosis, which otherwise may mount until it becomes a pronounced psychotophobia. In cases where such a fear of psychosis does occur, it is well to go into the problem quite matter-of-factly. We might call the patient’s attention to the works of Pilcz and of Stengel, which suggest a certain antagonism between obsessional neuroses and psychotic illnesses and which indicate that the obsessional neurotic in spite of, or in fact because of, his obsessional fears seems to be all but immune to psychoses.
Another fear of obsessional-neurotic patients is that their suicidal or homicidal impulses may some day be translated into action; consequently, they are engaged in a perpetual struggle with these impulses. In such cases we must instruct them to stop fighting, in order to avert the unfortunate effects of combatting obsessional impulses. When the patient stops fighting them, the impulses may very well cease to obsess him. In no case, however, will they be translated into acts. To be sure, obsessional neurotics do carry out compulsive acts; but these are always so harmless in nature that they offer no grounds whatever for psychotophobic fears in the patient.
In removing from the patient his unfounded fear of psychosis we are achieving a significant relief of the psychic pressures upon him. We bring about a cessation of that counterpressure which in itself was intensifying the pressure of the obsession. If we want to relieve this pressure, which task comes before all further psychotherapy, and logotherapy as well, it is important to bring about a complete change in the patient’s attitude toward his illness. That is, insofar as his illness does have some constitutional core, the patient should learn to accept the character structure as fate, in order to avoid building up around the constitutional core additional psychogenic suffering. There is a minimal constitutional basis which in fact cannot be influenced by psychotherapy. The patient must learn to affirm this minimum. The more we train him to a glad acceptance of fate, the more insignificant will be the residues of symptoms which are beyond help.
We recall the case of a patient who suffered for fifteen years from a severe form of obsessional neurosis. In search of treatment he left his home town and came to the big city for a few months’ stay. Here he underwent psychoanalysis, which was unsuccessful—if only because of the short time at the analyst’s disposal. The patient decided to go home—but only to set his family and business affairs in order. That attended to, he planned to commit suicide—so great was his despair because there seemed no hope that his illness would ever be cured.
A few days before his departure he yielded to the urging of his friends and visited a second psychiatrist. This doctor, since there was so little time in which to work, had to discard any idea of analyzing the symptoms and concentrate on the problem of revising the patient’s attitude toward his obsessional illness. He tried, so to speak, to reconcile the patient to his illness, basing his efforts on the fact that the patient was a deeply religious person. The doctor asked the patient to accept his illness as “the will of God,” something imposed upon him by destiny against which he must stop contending. Rather, he ought to try to live a life pleasing to God in spite of his illness. The inner change these arguments produced in the patient had so amazing an effect that the doctor himself was surprised. After the second therapeutic session the patient stated that for the first time in ten years he had just spent a full hour free of his obsessional ideas. Thereafter he had to leave, since all the arrangements for his homeward journey had been made. But he reported to the doctor in a letter that his condition was so tremendously alleviated that he could call himself practically cured.
In correcting our patients’ misguided efforts to fight desperately and tensely against their obsessions we have to make two points: that on the one hand the patient is not responsible for his obsessional ideas, and on the other hand that he certainly is responsible for his attitude toward these ideas. For it is his attitude which converts the embarrassing ideas into torments when he “gets involved” with them, when he carries them further in his thoughts or, fearing them, fights them back. Here, too, positive logotherapeutic components must come into play in addition to the negative psychotherapeutic (in the narrower sense of the word) components. The patient will finally learn to ignore his obsessional neurosis and lead a meaningful life in spite of it. It is obvious that his turning toward his concrete life task facilitates his turning away from his obsessional thoughts.
In addition to such general logotherapy we may treat obsessional neurosis by a special logotherapy which deals with the obsessional neurotic’s characteristic world-view, which we shall shortly discuss. Special existential analysis of obsessional neurosis will help us to understand this world-view. That analysis must start from an unprejudiced phenomenological examination of obsessional-neurotic experience.
What goes on in an obsessional neurotic when, say, he is plagued by doubts? Suppose he reckons: two times two equals four. In every concrete case it can be demonstrated that before the doubts crop up he does know that his reckoning is correct. Nevertheless, he promptly begins to doubt. “I shall have to figure it out again,” such a neurotic will say, “though I know I have done the example well.” Emotionally, that is, he feels there is a troublesome remainder. The normal person is satisfied with the given results of his acts of thinking and does not question them any further; but the obsessional neurotic lacks that simple feeling of satisfaction which follows the thought, and which in the case of the arithmetic example “two times two equals four” would be followed by: “Of course that’s right.” The normal person experiences the sense of certainty that comes from obviousness; the obsessional neurotic has no normal sense of obviousness. Even when dealing with far more difficult arithmetic examples or more complicated thought processes in other fields, the normal person disregards that irrational residue which necessarily attaches to all the results of thinking. But the obsessional neurotic cannot get around this irrational residue; his thoughts cannot go past it. Along with his inadequate sense of obviousness, he has an intolerance for that irrational residue. The obsessional neurotic simply does not succeed in disregarding it.
How, then, does the obsessional neurotic react to the irrational residue? By launching out on a fresh process of thought he tries to overcome it, but in the nature of things he can never wholly eliminate it. Therefore he is forced to repeat the process of thought again and again, each time trying to annihilate the irrational residue. At best he can only succeed in diminishing it. The game resembles the functioning of a vacuum pump, which can never create an absolute vacuum; it can remove from a vessel to be emptied of air only a certain percentage of the air each time. The first piston stroke reduces the air content to a tenth, the next to a hundredth part, and so on. Ultimately the piston strokes go on and on in vain repetitions—corresponding to the repetition compulsion in obsessional neurosis. With each revision of the results of his thinking the obsessional neurotic will feel a bit surer, but some residue of uncertainty will still remain and will continue to remain, no matter how often the neurotic obeys his repetition compulsion and tries to eliminate that residue. He continues his efforts until he is exhausted, then pulls himself together to murmur a vague credo, finds temporary absolution in a round sum, and leaves off brooding until the next time.
This disturbance of the sense of obviousness in the sphere of cognition corresponds to a disturbance of instinctive certainty in the sphere of decision. Further phenomenological analysis shows that the obsessional neurotic’s instinctive certainty has been shattered—that very certainty of instinct which in the healthy person guides conduct in daily life and relieves him of the burden of trivial decisions. The instinctive certainty of the normal person saves his awareness of responsibility for the crucial moments of life, and even then that responsibility operates in somewhat irrational form: as conscience. The obsessional neurotic, however, must compensate by special alertness and special conscientiousness for the twin thymopsychic defects with which he is cursed: disturbance of the sense of obviousness and of instinctive certainty. Such over-conscientiousness and overconsciousness amount, therefore, to noöpsychic overcompensation (I avail myself here of Stransky’s well-known pair of opposites: noöpsyche—thymopsyche). The shattering of emotional self-confidence in cognition and decision leads, in obsessional neurotics, to forced, artificial self-scrutiny. It engenders in them, by way of compensation, the desire for absolute certainty in cognition and in decision, and a tendency toward rigid moral decisions. The obsessional neurotic mails a letter or locks his door with the same gravity and care that a normal man might employ in choosing his profession or his wife. It is obvious that such excessive awareness and intensified self-observation must in themselves be disturbing. Because of the overdeveloped awareness that accompanies the obsessional neurotic’s acts of cognition or decision, he lacks that “fluent style” in which the healthy person lives, thinks, and acts. A pedestrian will stumble as soon as he focuses his attention too much on the act of walking instead of keeping his eye on the goal. A person may at best initiate some act with excessive awareness, but he cannot carry it out in the same spirit without that awareness being itself a disturbing factor.
The excessive consciousness and excessive conscientiousness of the obsessional neurotic, then, represent two of his typical character traits, the roots of which we can trace to the thymopsychic substructure of the personality. It therefore follows that one task of therapy is to help the obsessional neurotic to find his way back to the buried sources of instinctive certainty and the sense of obviousness, which sources lie in the deep emotional layers of the personality. The method for doing so may be re-education: the person should be trained to trust those remnants of certainty and the sense of obviousness which can still be discerned even in obsessional neurotics.
The obsessional neurotic seeks, as we have said, absolute certainty in cognition and decision. He strives for hundred-percentness. He always wants the absolute, the totality. The obsessional neurotic suffers profoundly from the limitations of all human thought and the dubiousness of all human decisions.
The obsessional neurotic is characterized by intense impatience. He is troubled not only by intolerance of the irrational residue of thought, but also by intolerance of the tension between what is and what ought to be. Underlying this may be that striving toward “godlikeness” of which Alfred Adler has spoken, which to our mind is the counterpart to admitting creatural imperfection. This admission amounts to recognizing the tension between what is and what ought to be.
From the existential-analytic point of view, then, the ultimate essence of obsessional neurosis is the distortion of a Faustian urge. In his will to absolutism and his striving for hundred-per-centness in all fields, the obsessional neurotic is like a frustrated Faust.
We have seen that in anxiety neurosis metaphysical anxiety is condensed in the phobic symptom. Something similar takes place in obsessional neurosis. Since it is impossible for the neurotic ever to realize his totalitarian demands, he concentrates upon a special area of life. Since he perceives that hundred-per-centness cannot be realized always and in everything, he restricts this insistence to a definite field where it seems more likely to be achievable (for example, cleanliness of the hands: washing-compulsion). Areas in which the obsessional neurotic succeeds in imposing his ideal—at least halfway—are, for example: for the housewife, her household; for the brain worker, the orderliness of his desk; for the man who likes to work things out on paper, careful itemizing of schedules and notations on experiences; for the bureaucratic type, absolute punctuality, and so on. The obsessional neurotic always restricts himself to a definite sector of existence; in this sector, as a “part for the whole,” he tries to realize his totalitarian demands. The two processes are similar: in phobia (on the part of people of a more passive type), fear of the universe as a whole is given concrete content and fixed upon a single object; in obsessional neurosis, the will (of people of a more active type) to shape the world after the person’s own image is directed toward a single sphere of life. But even in this one sphere the obsessional neurotic can accomplish his purpose only partially, or only fictively, and always at the price of his naturalness, his “creaturalness.” Thus all his strivings have an inhuman quality.
Characteristic of both the obsessional and the anxiety neurotic is that their striving for security is “deflected,” tortuous, and has a distinctly subjectivistic, if not psychologistic, quality. For a better understanding of this we must start with the normal person’s striving for security. The content of that striving in the normal person is security in itself. The neurotic, however, is far from content with any such security; he considers it too vague. For the neurotic person is usually in a state of alarm, and hence there is a forced and artificial quality about his striving for security. There arises in him consequently a desire for absolute security. In the anxiety neurotic this desire is expressed in a need for security from all disasters. But since absolute security of this sort is impossible, the anxiety neurotic is forced to content himself with the mere feeling of security. Thereby he takes leave of the world of objects and objective reality and seeks refuge in subjectivity. The anxiety neurotic ceases to live his existence in the ordinary world where the normal person finds a measure of tranquillity because he recognizes that disasters are relatively improbable. Demanding to be insured against any possible disaster, the anxiety neurotic is compelled to make a virtual cult of his security feeling. His flight from the world engenders a guilty conscience. That in turn demands compensation, which he can find only in an inhuman exaggeration of his subjectivistic striving for security.
The obsessional neurotic, on the other hand, seeks a different kind of security—security in cognition and decision. But for him, too, this striving for security does not take account of the approximation and provisionality of human existence. For him, too, the striving for security takes a subjectivistic turn and ends in an obsessive striving for the mere feeling of “hundred per cent” security. Tragic futility is the outcome. For if his “Faustian” striving for absolute security is doomed to failure, the striving for a feeling of absolute security is all the more doomed. The moment the mind is directed toward this feeling as such (instead of the feeling’s arising naturally as a consequence of intentional acts), the feeling is dispelled. Man, therefore, cannot achieve perfect security—not in living, not in knowing, not in making decisions. But least of all can he obtain that feeling of absolute security which the obsessional neurotic so desperately pursues. (Man can achieve a true sense of safety only in very different terms; see note on this page.)
To sum up, we may say that the normal person desires a halfway-secure world, whereas the neurotic seeks absolute security. The normal person desires to surrender himself to the one he loves—while the sexual neurotic strives for orgasm, aims at that in itself, and thereby impairs his sexual potency. The normal person wishes to know a part of the world approximately—while the obsessional neurotic wants a feeling of obviousness, aims at that, and thereby finds himself being carried away on an endless moving belt. The normal person is ready to take existential responsibility for actual existence, while the neurotic with his obsessional scruples would like to have only the feeling (though an absolute one) of a conscience at peace with itself. From the point of view of what men should desire, the obsessional neurotic wants too much; in terms of what men can accomplish, he wants too little.
The obsessive neurotic despises reality, which those who do not suffer from obsessional neurosis use as a springboard to existential freedom. He anticipates solution of his life task in fictive form. Allers says: “Meticulosity is nothing more than the determination to impose the law of one’s own personality upon trivialities in the environment.” And yet this determination, like the obsessional-neurotic will to orderliness in general, can still be called human in the best sense. “The Eternal’s thought comes to fulfillment through order, and through order alone man lives up to his being the image of God” (Werfel).
Obsessional neurosis beautifully exemplifies the counterplay of freedom and constraint within neurosis in general. We do not think the characterological development into pronounced obsessional neurosis unavoidably destined. Instead, we consider a kind of psychic orthopedics perfectly feasible. The importance of introducing the neurotic to those character traits he so badly lacks—humor and calmness—must be stressed. Straus deserves credit for being one of the first to see the existential aspects of obsessional neurosis, but he overlooked the possibility of treating obsessional neurosis in spiritual terms. Obsessional neurosis is not a psychosis; the sick person’s attitude toward it is still relatively free. In any given case, “attitude” would mean the spiritual position taken toward the sickness of the psyche. The spiritual attitude of the person to psychic illness provides the starting-point for logotherapy. We have already discussed general logotherapy of obsessional neurosis (changing the person’s attitude toward psychic illness) and special existential analysis of obsessional neurosis (interpretation of the neurotic as a caricature of the Faustian man). We will now deal with special logotherapy of obsessional neurosis, with the possibilities for correcting the obsessional-neurotic world-view.
Obsessional neurosis is not a mental disease, let alone a disease of “the spirit”; the position the person takes on the disease is independent of the disease. He remains free to change his attitude. It is imperative for the therapist to make use of this freedom. For obsessional neurosis “seduces” the obsessional neurotic to a particular philosophical position, namely that world-view of hundred-per-centness of which we have spoken above. A case that shows the obsessional-neurotic world-view in its incipient stages is that of a young man in late puberty. Amid the labor pains of adolescence it became plain that an obsessional-neurotic world-view was setting in.
The young man in question was filled with a Faustian urge to know the roots of everything. “I want to get back to the origin of things,” were his words. “I want to be able to prove everything; I want to prove everything that is immediately obvious—for example, whether I am living.”
We know that the obsessional neurotic’s sense of obviousness is defective. However, even the normal sense of obviousness has its limitations. For one thing, it is out of reach of intentionality: if we try, for epistemological reasons, to depend solely upon our sense of obviousness, we fall into an endless logical progression. The psychopathological counterpart of this is the obsessional neurotic’s repetition compulsion.
The ultimate—or, if you will, the first—question of radical skepticism is about the meaning of existence. But to ask the meaning of existence is meaningless in that existence precedes meaning. For the existence of meaning is assumed when we question the meaning of existence. Existence is, so to speak, the wall we are backed up against whenever we question it. Our patient, however, wanted to prove intuitive data. He had to be shown that it is impossible to “prove” such data—but that it is also unnecessary, since as intuitive data they are obvious. His objection that he nevertheless doubted was completely pointless. For the logical impossibility of doubting intuitively evident, immediate data of existence is reflected in psychological reality: such doubting represents empty talk. In actuality the most radical skeptic behaves in both thought and action precisely the same as the person who accepts the laws of reality and of thought.
In his book on psychotherapy Arthur Kronfeld has remarked that skepticism negates itself—a common philosophical view which, however, we see as faulty. For the dictum “I doubt everything” implies always: “everything except this particular dictum.” When Socrates said: “I know that I know nothing,” he meant: “I know that I know nothing except—that I know nothing.”
Like all epistemological skepticism, the obsessional neurotic’s seeks to find an Archimedean point, an absolutely solid basis from which to start out and on which to build up, with logical consistency and uncompromising truthfulness, a complete world-view. A radical beginning is being sought. Such an “ultimate philosophy” would ideally take for its first premise a statement which would, epistemologically, be its own justification. The only kind of statement which could meet this requirement would be one affirming the inescapable necessity of employing conceptual thinking in spite of its dubious nature—in other words, an idea that is self-sustaining because its very content is the dependency of thought upon concepts (that is, upon something other than self-evident intuitions).
Any such self-justification of rationalism would be tantamount to its self-elimination. Logotherapeutic treatment of our obsessional-neurotic patient therefore had to aim at overthrowing his exaggerated rationalism (which is what underlies all skepticism) by rational means. The rational way is a “golden bridge,” which we must build for the skeptic. One such bridge might be the suggestion: “The most reasonable procedure is not to want to be too reasonable.”*
Our patient should have remembered Goethe’s “Skepticism is that which endeavors incessantly to overcome itself.” The logotherapist therefore had to take this neurotically skeptical world-view and enlarge it to include this form of skepticism. By rational means the patient fought through to a recognition of the ultimately irrational nature of existence. The original complex of problems now appeared to him in a new light. Originally he had been seeking a theoretical axiom to be his new, radical basis of thought. Now he posed the problem differently and looked for its solution in a realm antecedent to all philosophical thought, a realm in which the origins of action and feeling lie: an existential realm. What has to be achieved is what Eucken calls the “axiomatic deed.”
Combatting and overcoming typical obsessional-neurotic rationalism by rational means must be followed through by a pragmatical counterpart. For the obsessional neurotic with his hundred-per-centness is seeking absolute certainty in decision as well as in cognition. His overconscientiousness is as much of a handicap to his acting as overconsciousness is to his knowing. The other half of his theoretical skepticism is an ethical skepticism; along with his doubts of the logical validity of his thinking run doubts of the moral validity of his actions. From this stems the obsessional neurotic’s indecisiveness. An obsessional-neurotic woman, for example, was tormented by continual doubts as to what she ought to do. These doubts mounted to such proportions that finally she did nothing at all. She could never decide on a single thing; even in the most commonplace matters she did not know what choice to make. For example, she could not make up her mind whether to go to a concert or go walking in the park, and so she stayed home—having spent in interior debates the entire time in which she might have been doing either. Such indecisiveness is characteristic of the obsessional neurotic when facing the most trivial as well as the most important decisions. But by special logotherapy even this obsessional-neurotic overconscientiousness can be made to eliminate itself, just as exaggerated rationalism can be. Although Goethe has said: “Conscience is for the man who reflects, never for the man who acts,” this maxim was never intended for our type of overscrupulous obsessional neurotic. For him we must build our golden bridge. We need only supplement the Goethean maxim with a little common sense: It may be unconscionable to act in this way or that, but it would be outrageous not to act at all. The man who can decide on nothing, can make up his mind about nothing at all, is undoubtedly making the most unscrupulous of decisions.
Endogenous psychoses are also susceptible to treatment by logotherapy: not the constitutional components themselves, of course, but the psychogenetic components resulting from them. We have already said that man is free to take a position on his psychological destiny, that here is a “pathoplastic” factor involved—meaning that he can shape his destiny and decide how he will react to the constitutional disease. In this connection we cited an organic depression which might have been treated pharmacologically, psychotherapeutically, or logotherapeutically. And we have said that the latter type of treatment aimed to change the patient’s attitude toward her disease as well as toward her life as a task.
It is clear that the “pathoplastic” factor already contains an attitude toward the psychotic disease—even before logotherapy has brought about any change of attitude. To this extent, then, the psychotic patient’s manifest behavior is already something more than the mere direct consequence of the fated, “creatural” affliction; it is also the expression of his spiritual attitude. This attitude is free. Understood in this light, even psychosis is at bottom a kind of test of a human being, of the humanity of a psychotic patient. The residue of freedom which is still present even in psychosis, in the patient’s free attitude toward it, gives the patient the opportunity to realize attitudinal values. Even in and in spite of psychosis, logotherapy makes the patient see chances for the realization of values, though these may be only attitudinal values.
In the following section we will attempt to understand melancholia—that is, psychotic or endogenous depression—in existential analytical terms, as a mode of existence. Special existential analysis of melancholia deals first of all with the most prominent of melancholic symptoms: anxiety. From the somatic point of view, melancholia represents a vital low—no less, but also no more. For the fact that the melancholiac’s organism is in a vital low by no means explains the whole complex of melancholic symptoms. It does not explain melancholic anxiety. This anxiety is primarily fear of death and of the stings of conscience. We can only understand the melancholic sense of anxiety and guilt if we consider it a mode of human existence, an aspect of being human. Something beyond illness itself is required to produce the melancholic experience; the human element is what transforms the mere disease, what takes the primary vital low and makes of it the melancholic mode of experiencing, which is nothing less than a mode of human existence. The underlying disease in melancholia leads only to symptoms such as psychomotor or secretory inhibitions; but the melancholic experience itself comes about as the result of the interplay between the human and the morbid elements in the human being. Thus, we could easily understand how some kind of depression state might occur in an animal on the basis of an organic low. But true human melancholia with its characteristic guilt feelings, self-reproaches, and self-accusations would be inconceivable in an animal. The “symptom” of conscientious anxiety in the melancholiac is not the product of melancholia as a physical illness, but represents an “accomplishment” of the human being as a spiritual person. Conscientious anxiety can be understood only in human terms, without recourse to physiological explanations. It is understandable only as the anxiety of a human being as such: as existential anxiety.
What the vital low, the physiological basis of melancholia, produces is solely a feeling of insufficiency. But more than the physiological illness has come into play when this insufficiency is experienced as a feeling of inadequacy in the face of a task. An animal, too, can have anxiety, but only a human being can have conscientious anxiety or guilt feelings. For only the human being is faced with obligations that arise out of the responsibility of his being. Human psychoses are inconceivable in an animal: hence the element of humanity, of existentiality, must be crucial to these psychoses. The organic condition underlying psychosis is always transposed into the properly human sphere before it becomes the psychotic experience.
In the case of melancholia, psychophysical insufficiency is experienced in uniquely human fashion as tension between what the person is and what he ought to be. The melancholiac exaggerates the degree to which he as a person falls short of his ideal. The vital low aggravates that existential tension, which is part of human existence as such. In melancholia the insufficiency feeling magnifies the gap between what is and what ought to be. For the melancholiac that gap becomes a gaping abyss. In the depths of this abyss we cannot help seeing what lies at the bottom of all humanness insofar as it is responsibleness: conscience. It becomes clear that the melancholiac’s anxiety of conscience arises out of an intrinsically human experience: that of heightened tension between the need and the possibility of fulfillment.
This melancholic experience of radical insufficiency, of being unable to cope with a task, appears in various forms. In the melancholic delusory fear of impoverishment typical of the premorbid middle-class person the insufficiency feeling is directed toward the task of earning money. In terms of Schopenhauer’s distinction of “what one is, what one has, and what one seems,” the conscientious anxiety and the guilt feeling of this type of person, when he becomes a sufferer from melancholia, revolve about the question of “what one has”; that is, the morbid condition brings out fears which were present in the premorbid condition. The premorbidly insecure person who fears death is applying the melancholiac feeling of insufficiency to the task of preserving life; and in the conscientious anxiety of the premorbidly guilty or overscrupulous person the sense of inadequacy is focused on the question of moral righteousness.
When the underlying vital disturbance of melancholia increases the existential tension to an extreme degree, the person’s life goal seems to him unattainable. Thus, he loses his sense of aim and end, his sense of future. “I lived my life backwards,” a melancholiac woman remarked. “The present was done for—I lost myself in living backwards.” This loss of a sense of the future, this experience of “futurelessness,” is accompanied by a feeling that life is over with, that time has run out. “I looked at everything with different eyes,” another patient said. “I no longer saw people as they are today or were yesterday; rather, I saw every single person on the day of his death—no matter whether he were an old man or a child. I saw far ahead, to the end of life, and I myself no longer lived in the present.” In such cases of melancholia we may call the underlying mood a “Judgment Day” mood. Kronfeld has characterized existential experience in schizophrenia as the experience of “anticipated death.” Similarly, we may say of melancholia that it is the experience of a “permanent Judgment Day.”
(The affect of grief in the melancholiac is paralleled by the affect of joy in the maniac. The experience of melancholic anxiety is paralleled by the experience of manic high spirits. While the melancholic person experiences his abilities as insufficient to cope with his obligations, the manic person experiences his abilities as far surpassing his obligations. Thus, the manic delusion of power is the correlative of the melancholic feeling of guilt. And just as melancholic anxiety is, above all, fear of the future [fear of disasters, of a catastrophic future], so the manic person actually lives in the future; he makes plans, draws up programs, is always anticipating the future and assuming that its possibilities are realities.)
Steeped as he is in a feeling of his own insufficiency, the melancholiac becomes blind to the values inherent in his own being. This valuational blindness is later extended to the world around him as well. That is, while at first blindness may be called central, affecting only his own ego, it can progress centrifugally and lead to the blotting out of the valuational shadings of the whole of reality. But as long as the person’s ego alone is affected, the melancholiac feels a drastic drop in his own value compared to that of the world. This explains the violent inferiority feeling of the melancholiac. The melancholiac feels himself as worthless and his own life as meaningless—hence the tendency toward suicide.
There is a further development in the nihilistic delusions of melancholia. Along with the values are prestidigitated away the things themselves, the carriers of values; the very substratum of possible valuation is negated. Here, too, the person’s ego itself is first affected; depersonalization results. “I am not a human being at all,” a patient confessed. She added: “I am nobody—I am not in the world.” Later the world itself comes in for this nihilistic treatment; unreality results. Thus, a patient declared, when the doctor introduced himself: “There are no doctors—there never have been any.”
Cotard has described a melancholic syndrome which includes “ideas of damnation, ideas of non-existence and of not being able to die.” Melancholic ideas of damnation obviously spring from the nihilistic depersonalization mentioned above. The delusion of immortality is also encountered in isolated form in certain types of melancholia. These clinical pictures may be called “Ahasuerian melancholias.” How are we to interpret this type of illness in existential analytical terms?
The melancholiac’s guilt feeling resulting from his intensified existential tension can swell to such a point that he feels his guilt to be ineradicable. The task which he feels unable to cope with, due to his sense of insufficiency, then appears unfulfillable even if he had all eternity at his disposal. Only in this manner can we understand why patients make such remarks as: “I shall have to live forever in order to make amends for my faults. It is like purgatory.” For such melancholiacs the task quality of life assumes colossal dimensions. “I must bear up the whole world,” one such patient commented. “The only thing that is still alive in me is conscience. Everything is so oppressive. Everything around me of this world has vanished; I can only see the hereafter now. I am supposed to create the whole world and I cannot. Now I am supposed to replace the oceans and the mountains and everything. But I have no money. I cannot dig out a mine with my fingernails and I cannot replace vanished nations, and yet it has to be. Everything is going to be destroyed now.”
The devaluation not only of himself, but of the whole world, engenders in the melancholiac a general misanthropy. He is disgusted by himself and by everyone else also. He can no longer recognize values in anything. As Mephistopheles has it in Goethe’s Faust: “For all that is deserves to be wholly reduced to nullity.” This sentence conveys something of the idea of universal doom in which the melancholiac gives vent to his life-feeling of anxiety. Looked at from an existential analytical point of view, his guilt feeling seems to arise out of his exaggeration of his life task (because of his sense of insufficiency) to superhuman proportions. The wild excessiveness of this guilt feeling can be expressed only in such delusional utterances as: “Everything is going to vanish and I am supposed to create it again—and I know I can’t do that. I’m supposed to make everything. Where shall I ever get enough money for it, from eternity to eternity? I cannot create all the foals and all the oxen and cattle that have been since the beginning of the world.”
Just as pseudo-movements occur in giddiness, so anxiety (which Kierkegaard has called the giddiness that overcomes us on the peaks of freedom) is characterized by mental pseudo-movements. In the case of melancholia—when the gap between what is and what ought to be is experienced as an abyss—there is the sense of the falling away of the self and the world, of beings and meanings.
In discussing the psychology of schizophrenia, and proposing the existential analytic interpretation of that illness, we will start with certain clinical observations. In our dealings with large numbers of schizophrenic patients, a peculiar psychological phenomenon has come up again and again. The patients stated that they sometimes felt as if moving pictures were being taken of them. After suitable exploration it developed, remarkably enough, that this feeling had no hallucinatory basis; the patients did not claim that they heard the turning of a crank or—in cases where they felt they were being still-photographed—the click of a shutter. They averred that the camera had been invisible and the cameraman hidden. Nor were there paranoid ideas from which the photography delusion might have flowed—thus making it a secondary delusion, a carry-through of persecution feelings. There were, to be sure, cases with a delusional substructure; patients would assert, for example, that they had seen themselves in the newsreel. Others maintained that their enemies or persecutors were spying on them by secretly taking pictures. But from the start we excluded such cases with a paranoid basis from our investigations. For in these the sensation of being filmed was not experienced directly, but subsequently constructed and attributed to the past.
Having thus set aside the cases with extraneous causal features, what we were left with might be termed purely descriptively a “film delusion.” This film delusion constitutes a genuine “hallucination of knowledge” in Jaspers’s sense; but it might also be classed among the “primarily delusional feelings” as defined by Gruhle. When a patient was asked why she thought pictures were being taken of her when she had noticed nothing to suggest that this was happening, she answered characteristically: “I just know—I don’t know how.”
This delusion may take on various related forms. Some patients are certain that phonograph records of them have been made. Here we have simply the acoustic counterpart to film delusion. Still other patients believe they are being eavesdropped on. Finally, there are cases of patients who insist that they have a definite feeling of being sought for, or an equally irrational certainty that somebody is thinking of them.
What is the common element in all these experiences? We may put it this way: that the person experiences himself as an object—as the object of the lens of a movie camera or still camera, or as the object of a recording-apparatus, or the object of someone’s eavesdropping or even seeking and thinking—in sum, then, the object of a variety of intentional acts of other people. All these patients experience themselves as the object of the psychic activity of other persons, for the various types of apparatus involved are simply symbols, the mechanical extensions of others’ psyches or a mechanical extension of the intentional acts of seeing and hearing. (Thus, it is understandable that the mechanisms in question retain for the schizophrenics a kind of mythical intentionality.)
In these cases of schizophrenia, then, we are dealing with a primarily delusional feeling which may be called the “experience of pure objectness.” All the phenomena that come under the headings of “sense of being influenced” or “observation delusion” or “persecution delusion” can be thought of as special forms of the more general experience of pure objectness. The schizophrenic experienees himself as the object of the observing or persecuting intentions of his fellow men.
This experience of pure objectness we consider to be an aspect of that central disturbance of the ego which Gruhle counts among the “primary symptoms” of schizophrenia. We can reduce the various forms of the experience of pure objectness to a general law of schizophrenic experience: The schizophrenic experiences himself as if he, the subject, were transformed into an object. He experiences psychic acts as if they were being rendered in the passive mood. While the normal person experiences himself thinking, watching, observing, influencing, listening, eavesdropping, seeking, and persecuting, taking still or moving pictures, etc., the schizophrenic experiences all these acts and intentions, these psychic functions, as if they were being rendered in the passive; he “is being” observed, “is being” thought about, etc. In other words, in schizophrenia there takes place an experiential passivizing of the psychic functions. We consider this to be a universal law of the psychology of schizophrenia.
It is interesting to see how the experiential passivity of such patients leads them even in speech to use transitive verb forms in the passive mood where active intransitive verbs would be more appropriate. Thus one schizophrenic woman complained that she did not feel as if she ever awoke, but always that she was being awakened. This passivistic tendency is the explanation for the well-known schizophrenic avoidance of verbs and preference for substantive constructions—since by its nature the verb assumes and expresses an active experience.
The typical language of autistic schizophrenics—that is, those who are wrapped in their own fantasies and thus “inactive” with respect to the outer world—has another characteristic: that of being predominantly expressive rather than representational. That is why we can explain, and in fact even understand, the artificially created languages of a good many schizophrenics who have ceased to respond to normal language, by confining ourselves to the expressive elements of language, by talking to the patient as we “speak” to a dog. The significant thing is intonation rather than words.
Our interpretation of the schizophrenic mode of experience as a passivizing of psychic activity approaches Berze’s theory of schizophrenia. Berze speaks of an insufficiency of psychic activity in schizophrenics. He considers the chief symptom of schizophrenia to be “hypotonia of consciousness.” If we consider this hypotonia of consciousness along with what we have called experiential passivizing, we arrive at the following existential-analytic interpretation of schizophrenia: in schizophrenia the ego is affected both qua consciousness and qua responsibility. The schizophrenic person is limited in respect to these two existential factors. The schizophrenic person experiences himself as so limited in his full humanity that he can no longer feel himself as really “existent.” These are the qualities of the schizophrenic experience which made Kronfeld call schizophrenia “anticipated death.”
Berze has drawn a sharp line between the process symptoms and the defect symptoms of schizophrenia, and it is upon the process symptoms alone that all phenomenological-psychological interpretations of schizophrenia are based. The existential-analytic interpretation of the schizophrenic mode of experience also takes the process symptoms as its point of departure. To our mind, a similar cleavage to that between schizophrenic process and defect symptoms exists between two modes of experience in normal persons: the experiences of falling asleep and of dreaming. C. Schneider in his study of the psychology of schizophrenia has wisely taken somnolescent thinking as his model, rather than dream-thinking—the latter being singled out by C. G. Jung, who interprets the schizophrenic as a “dreamer among wakers.”
In what way does the normal experience of falling asleep resemble the schizophrenic mode of experience? The thing is that somnolence also exhibits hypotonia of consciousness or, to use Janet’s phrase, an “abaissement mentale.” Löwy has pointed out the “half-done products of thought,” and Mayer-Gross speaks of “empty husks of thought.” All these phenomena are to be found both in normal somnolescent thought and in schizophrenic thinking. Moreover, the school of Karl Bühler speaks of “thought patterns” and the “blank form quality” of thinking. The research of Löwy, Mayer-Gross, and Bühler agrees strikingly in this respect. We may put it this way: the somnolent person falls asleep over the blank form of thought instead of filling it out.
Dream-thinking differs from somnolescent thinking in that dreams employ figurative language. In the course of falling asleep the consciousness drops to a lower level—what we have referred to as hypotonia of consciousness. Once this process is completed and the bottom, so to speak, of consciousness is reached, dreaming begins immediately. Dreaming, that is, takes place upon this lower level. In accordance with the functional changes that take place during the transition from waking to sleeping, the sleeper “regresses” to the primitive symbolic language of dreams.
For the moment, however, let us put aside the fundamental distinction between process symptoms and defect symptoms in schizophrenia and ask ourselves to what extent other schizophrenic symptoms besides those we have discussed (disturbance of the ego and of thinking) fall into the theory we have presented: a thoroughgoing experiential passivizing of psychic events. In this connection we shall not discuss the extent to which the motor system of the schizophrenic is also subject to this passivizing—although our theory would seem to throw light on catatonic and cataleptic forms of schizophrenia. We shall limit our discussion to the psychological problem of acoustic hallucination in schizophrenia. If we start with the phenomenon of “thinking aloud,” the passivizing principle offers the key to the mystery. The normal person’s thinking is accompanied by more or less conscious “internal speech.” These acoustic elements are experienced in passive form by the schizophrenic; he feels that his thoughts come from outside himself and so “hears voices,” experiences his thoughts as if they were perceptions. For what is hallucination if not experiencing something personal and internal as if it were foreign to the personality, as if it were a manifestation of something outside oneself?
Unfortunately, there is no way to use this discovery of experiential passivizing in practical therapy. But practice yields ample empirical confirmation of the theory. For example, a young man came to us with a severe delusion of reference. Cure consisted in training him to pay no attention to the imaginary observers and not to watch his supposed watchers—à la “persécuteur persécuté.” (The question of whether there were any grounds for his belief that he was surrounded by spies was excluded from discussion right from the start.) His feeling of being under observation disappeared. As soon as he had relaxed his own close watch on his environment, his constant state of alertness to detect the imaginary observers, the miracle happened—the spies took themselves off. As soon as he stopped his own watching, there was a cessation of the corresponding passive experience of feeling that he was being watched. To our mind this can be explained only by the assumption that the underlying disturbance had produced an inversion of the experience of watching, had converted it into the passive mood.
Special existential analysis need not confine itself to cases of severe schizophrenic disturbance. Much may be learned of schizophrenic experience by analysis of borderline cases—such as the above-mentioned young man with his delusion of reference. For this reason we will deal with those forms of schizoid character structure which were formerly comprehended within the term “psychasthenia.” The chief characteristic of this illness is what used to be described as “sentiment de vide”; there is a conspicuous lack of the “sentiment de réalité.” One of our patients tried to describe his sensations by comparing himself to a “fiddle without a sounding-box, utterly without resonance”; he felt about himself “as if” he were “merely his own shadow.” This lack of “resonance” he complained of produced in him a sense of depersonalization.
Haug has written an interesting monograph to prove that a sense of depersonalization can be provoked by exaggerated self-observation. We wish to add a few comments. Knowledge is never only a knowledge about something, but also a knowledge of the knowledge itself—and, furthermore, a knowledge that the knowing proceeds from the ego. “I know something” means all at once: “I know something,” and “I know something,” and simultaneously “I know something.” The psychic act of knowing or thinking gives rise, as it were, to a secondary, reflexive act, the object of which is the primary act and the ego as the starting-point of the primary act. In other words, the act of knowing makes the subject into an object. The primary act reflected by the secondary, reflexive act becomes a psychic datum, is qualified as a psychic act; the experiential quality of “being psychic” therefore arises only in and through the reflection.
Let us try to see these connections in terms of a biological model. Suppose that the primary psychic act corresponds, in our biological parallel, to the pseudopodium of an amœba which reaches out from its cell nucleus toward some object. Then the secondary, reflexive act would correspond to a second, smaller pseudopodium which is “turned back” toward the extended one. We can then very well imagine that this “reflexive” pseudopodium, if it is overstrained, will lose its syncytial connection with the plasma of the amœbal cell and break off. This is somewhat the process by which exaggerated self-observation produces depersonalization. Exaggerated self-observation is over-straining; the connection with the observing ego is snapped and the psychic functions seem to be taking place by themselves. The exaggerated reflexive act of self-observation may be likened to screwing the strings of intentionality too tight—until they snap and there is no longer felt to be a connection with the primary act and the active ego. There necessarily follows from this the loss of the sense of activity and personality; the disturbed ego feels itself depersonalized.
This must be borne in mind: as a result of the concomitant reflection of a psychic act, it is itself present as a bridge between subject and object, and moreover the subject itself is present as the carrier of all psychic activity. In “having something,” I have, along with the something, the having itself, and also the ego as the self. The “self,” then, is the ego having itself, the ego that has become conscious of itself. For this becoming conscious via self-reflection there is also a biological model, namely the phylogenesis of the prosencephalon: the forebrain is folded around the brain stem, “bent back” as the inhibiting function of consciousness is “reflected” back upon the instinctual reactions of the diencephalic centers.
We have said that in case of depersonalization the “strings of intentionality” are screwed so tight that they may snap, and that this is the reason why exaggerated self-observation makes for a rift in the ego’s self-awareness. It is then clear that the hypotonia of consciousness in schizophrenia may lead to the same kind of ego-disturbance as the hypertonia of consciousness in psychasthenia. The difference between schizophrenic ego-disturbance and psychasthenic depersonalization consists only in this: in the former the strings of intentionality are too slack (hypotonia of consciousness), while in the latter they are so tight that they snap (hypertonia of consciousness).
Along with the lower level of consciousness to which a person regresses in sleep there goes non-pathological hypotonia of consciousness. We may therefore expect it to be expressed in a lowering of the tendency toward reflection. We may assume that in the dream the reflexive cilium of the mental act is, as it were, more or less withdrawn. The effect of this withdrawal is that the perceptual elements of “freely emerging images” can weave their hallucinatory patterns unchecked by the operations of the higher faculties.
If in conclusion we survey the findings of special existential analysis concerning the essential differences among the obsessional-neurotic, melancholic, and schizophrenic modes of experience, we may sum up as follows: The obsessional neurotic suffers from hyper-awareness. The schizophrenic suffers from hypotonia of consciousness. The schizophrenic experiences a restriction of the ego both qua consciousness and qua responsibility (experience of pure objectness or principle of passivizing). This is a basic distinction between the schizophrenic and the melancholiac. For the morbidity of the melancholiac could be understood in existential-analytic terms only as a shaping of the disease process by the human person—that is, as a mode of humanness. In the schizophrenic, however, existential analysis has shown that the person’s very humanness is also affected, is itself shaped by the disease process. Nevertheless, even for the schizophrenic there remains that residue of freedom toward fate and toward the disease which man always possesses, no matter how ill he may be, in all situations and at every moment of life, to the very last.
* Another patient described her agoraphobic experience, quite without any prompting, in these words: “Just as I often see an emptiness before me in my soul, I also see this emptiness in space.… I don’t know at all where I belong—where I want to go.”
* Cf. Leo Tolstoy: “The intellect, like an opera glass, should only be turned up to a certain point; if you screw it any farther, you see more hazily.”