Philosophy, Psychiatry, & Psychology

Thomas Fuchs' excellent paper describes the disorders of lived embodiment, and of the self–world relationship, found in depression and schizophrenia. It says little about the causative factors that provoke such disorders, nor the modes of treatment most appropriate. The focus of the paper, as a work of phenomenology, is more descriptive than etiologic and prescriptive. Nonetheless, these concerns necessarily arise for clinicians, and for philosophers like myself interested in conceptualizing what has long been called the "mind–body relationship."

Indeed, a paper such as that by Fuchs, as well as the work of phenomenologists like Merleau-Ponty and Straus, calls into question whether there is such a thing. To speak of a "mind–body relationship" is to image the self as composed of two distinctive parts that somehow interact with one another. Descartes posited two substances, res cogitans and res extensa, one immaterial, rational, and immortal (mind), the other pure extension governed by mechanical law (body and the physical universe), which nonetheless causally influence one another through the movements of the pineal gland. Needless to say, this dualistic "solution" is highly problematic, difficult to explain and support metaphysically, physically, and phenomenologically.

Equally problematic is the attempt to take one or the other side of this dualism and to grant it metaphysical hegemony. Descartes' notions of mind and body were constructed by splitting up the experienced world into two different entities and discourses. Mind is the repository for consciousness, thought, desire, and will. The residue that remains when the above is conceptually subtracted from the universe—a realm of pure "objects," devoid of anything but material, mechanical, and mathematizeable properties, is conceived of as the physical universe. The post-Cartesian "idealist" or "materialist" then takes half of this divided world and tries gamely to subsume all phenomena within it. The world is naught but pure idea, or, more typically in our materialistic age, mere matter in motion obeying physical laws. Yet such monisms do not work anymore than their dualistic progenitor. Each one must deny aspects of the subject–object relationship that gives rise to an experienced world, where intentionality and materiality, perceiving and perceived, are always inextricably intertwined and mutually dependent.

Knowing this, it is yet hard for Fuchs, as for all of us, to escape the language of dualism, or of its monistic progeny. For example, he speaks of the "loss of transparency in mental illness." Although "mental illness" is the conventional way to refer to depression and schizophrenia, Fuchs has shown us that these are not really "mental" disorders, but altered ways of living out one's [End Page 109] body and its relationship with self and world. We need a new terminology for such illnesses that has not yet been invented.

Then, too, perhaps more importantly to the clinician, we may need new ways of understanding their etiology and treatment. Describing the sense of alien control experienced by many schizophrenics, Fuchs discusses the role of the right inferior parietal cortex in monitoring both one's own actions and those of others, and how scientists have found unusual patterns of brain activation in schizophrenic patients."Ah-hah!" we may feel tempted to exclaim (although Fuchs, to his credit, never explicitly does), "We have now found the true substance and cause of schizophrenia. And this brain abnormality should be the focus of our treatment."

But this would be a lapse into materialist monism that does not work metaphysically and may not lead to clinically optimal results. To avoid reductionism we must remember that this image of the brain is itself derivative from a taken-for-granted experiential life-world (Leder 1990). The brain and its functions were examined by thinking, perceiving human beings who supplemented the perceptual capacities of their lived bodies through the construction of elaborate technologies (such as positron emission tomography scans) and conceptual systems (such as those that govern the discipline of "neurobiology"). The scientists to whom Fuchs refers—Farrer and Frith, Ruby and Decety, Spence, Done, and...