Philosophy, Psychiatry, & Psychology

In her commentary, Dibitonto (2020) helpfully compares my (Gipps, 2020) understanding of schizophrenic ego disturbance with that of Blankenburg. His patient Anne described her true schizophrenic difficulty as obtaining in some sense 'before' those experiential disturbances she can articulate. Ordinary conversational modes misleadingly invite her and us to attempt describing her difficulties in terms which presuppose the intactness of, rather than capture the underlying disturbance to, her self-hood. They fail to locate the disturbance deep enough, fail to grasp how it arises 'before' what is readily articulable in the psyche. I believe this is the same 'before' which prompts my own articulation of schizophrenic ego boundary disturbance in transcendental terms. And yet I also wish to describe these disturbances as 'equiprimordial' with schizophrenic alterations in the constitution of the objects of experience. But, as Dibitonto naturally enough sees it, this sense of 'before' appears antithetical to 'equiprimordiality.' To resolve this question I think I should try to state more clearly what I, at least, mean here by 'before.'

One thing I did not mean to imply was that the ego boundary is completely reconstituted in every perceptual act. Looking back at my article, I see I did not make this clear, for there I wrote that the ego boundary 'co-arises with the self's perception of its world and is its co-constituting condition of possibility.' I did not mean to say by this that it enjoys the same temporal character as perceptual acts. As I understand it, the ego boundary is best theorized dispositionally rather than occurrently. Furthermore, ego boundaries are laid down over developmental time and, absent psychotic breaks, act to constrain the possibilities of intentional object constitution as obtain in any actual perceptual encounter. Despite the manifest ontological differences between footpaths and ego boundaries, the enactivist's favorite poetic metaphor helps clarify this: the path cannot be understood as obtaining utterly independently of the walkers' steps. Over time it is developed—worn into place—by these steps; it then largely constrains the routes people take; it can shift if walkers step off it (around a fallen tree/a disowned limb or personality change); sometimes completely new branches are taken (when the previous destinations become unpopular/unbearable); sometimes the path gets partly or fully washed away (in a (psychotic) storm); sometimes people forget about the path and just (incoherently) wander off piste. So in one sense the ego boundary largely obtains before any one instance of walking on it. But yet we still cannot understand the formation and character of the path independently of all the walking happening over time. The footprints make for the path. It is not that the path of the ego boundary is all nicely laid down before any perceptual steps are taken; it develops—I suggest—over developmental time in and through the subject's engagements with her world.

Dibitonto and I should need considerably more space than a commentary and response provide to get on the same page with some of our philosophical [End Page 111] terminology ('ontological,' 'transcendental,' 'level of experience,' 'a priori structuring,' etc.). I will, however, hazard the opinion that an 'ontological vulnerability to alterity' does indeed sound like something that I see as a condition of healthy self-hood, a condition that also makes it so much as possible that one succumbs to that vulnerability in schizophrenic psychosis. I will also take this opportunity to comment on the source of the constraints on coherent ego boundary formation, because it is something that Dibitonto's talk of the 'transcendental ego' brings to my mind, even if I am not yet confident in her meaning. For it is not as if an ego boundary can form anywhere: stray too far off the path and you're not now going for a walk—you are just floundering in the swamp. Or, have an ego boundary placed too far 'off piste' and now we no longer even have to do with an ego in relation to a world. It may seem, then, that there must be some transcendental source of possible routes, one constraining from 'outside' the empirical world the...