Salud Mental 2011;34:491-499Phenomenology of Intersubjectivity in Bipolar Disorder and Schizophrenia
The Phenomenology of Intersubjectivity
in Bipolar Disorder and Schizophrenia
Otto Dörr Zegers1
SUMMAR
SUMMARYY
I. Introduction and Clinical Observations
One of the central features of the group of diseases we call
schizophrenia is the alteration of interpersonal relationships. Autism,
considered by Bleuler (1911) as one of the primary symptoms of the
disease, and contact difficulty, as described by Minkowski (1927),
are two examples of how far the effects of this disturbance reach. But
other symptoms of schizophrenia can also be seen from the same
perspective. Thus, in paranoid schizophrenia the other becomes so
powerful that he can persecute, harass and invade the patient’s
privacy. Auditory hallucinations can also be conceived of as a peculiar
disturbance of the relationship with an anonymous other. As we
showed in a previous work, something similar occurs in instances of
coenesthetic schizophrenia. Thus, one patient suffering from this form
of the disease wrote in his journal, «My failure is to love myself. I
have not yet found the way toward the you.» Later on he writes: «The
world arrives directly to me, there is no distance between the world
and me. And that is true both for people and for things… It can even
happen that in the worst states I consider myself for moments like the
other, at whom I am looking.»
Walter von Baeyer (1955) defined the characteristics of this
abnormal interpersonal encounter of schizophrenics, although based
on paranoid patients: lack of reciprocity, anonymization and
mediatization. In the delusion of being loved, for example, the patient
cannot defend himself from loving voices or from coenesthetic
hallucinations related to the sexual sphere. On the other hand, that
invading you, who in the beginning has a name, gradually loses its
individuality and becomes collective. Finally, contact with the
hallucinated other is mediated through devices such as radios or
television sets.
In the case of depression, even though the complaints of patients
predominantly refer to the feeling of oneself and to bodily changes,
we also observe a deep alteration of the interpersonal sphere. Two
different forms of depression can be distinguished: delusional and
non-delusional. In the first form, the symptomatology is controlled
by delusion (of guilt, ruin or disease) and in the second, by corporal
symptoms, the experience of «being unable» and the alteration of
biological rhythms. Moreover, from the perspective of the encounter,
both forms of depression have something in common: the progressive
disinterestedness in the other and its replacement by the prevailing
subject, the body in one case, delusion in the other.
In mania, what first draws attention is euphoria, hyperactivity,
flight of ideas and insomnia; however, a deep alteration of
interpersonality is also apparent. Thus, it is common to observe that
1
School of Medicine of the University of Chile and Diego Portales University.
Correspondence: Prof. Otto Dörr. Avenida La Paz 841. Santiago de Chile. Chile. E-mail: odoerrz@gmail.com
Received: August 10, 2011. Accepted: October 24, 2011.
Vol. 34, No. 6, November-December 2011
Original article
these patients treat the other with excessive confidence and a loss of
social distance up to the extreme of disrespectfulness.
II. «Apresentation,» Immanent TTemporality
emporality and Intentionality in
the Constitution of Intersubjectivity according to Husserl
How precisely are these three elements of intersubjectivity (apresen-
tation, temporality and intentionality) altered in manic, depressive and
schizophrenic psychoses? Each section in the report that follows will
begin with an introduction explaining Husserl’s understanding of these
concepts. As the theory of «apresentation» is more complex and less
known, a more detailed description of this concept will be offered.
III. Intersubjectivity and Manic PPsychosis
sychosis
Let us recall Binswanger’s example of a manic patient who has left
the clinic, goes into a church where a religious service is being held,
and interrupts the organist’s playing to ask him for lessons. For the
layman, the attitude of the patient appears to be inappropriate and
incomprehensible. A psychiatrist may speak here of facilitation and
of loss of natural inhibitions. But neither of these two interpretations
accounts for what is really occurring. Somatic medicine has a theory
of the organism as a framework within which it can «measure»
deviations with respect to the norm; psychiatry is not able to do this
because its basic science is not sufficiently developed. In our opinion,
that place must be occupied, in keeping with Binswanger, by the
phenomenology of intentional consciousness.
The organist is present for himself as the flow of conscious
contents, the sensations coming from his body, such as that from his
fingers playing the organ. These presentations are accompanied by
the «apresentation» that he is an organist who has been hired to play
in the religious service and he shares that same «apresentation» with
the community attending the service. The patient, on the other hand,
does not share this «apresentation.» For her the organist is certainly
present, playing, but she is not capable of «apresenting» that it is a
concert within the context of a religious service. From Husserl’s theory,
explained above, it is inferred that if one fails in the constitution of
the alter ego, the constitution of oneself (of one’s own ego) also fails.
Binswanger’s patient is unable to «apresentatively» understand the
meaning of the organist (in his context), because she cannot
«apresentatively» experience herself as an ego.
IV
IV.. Intersubjectivity and Depressive PPsychosis
sychosis
The flow of my internal life is, certainly, inseparable from originary
or primary temporality, of which objective time is a mere derivate.
That originary temporality is given as the permanent interspersing of
three instances, referred to by Husserl as retentio (past), protentio
491
 Dörr Zegers
(future) and presentatio (present). To understand the important role
played by these temporal instances both in the constitution of one’s
own self (ego) and that of the other (alter ego), we need only to think
that every person who is talking at a given moment (presentatio) could
not say what he is saying without knowing exactly what he already
said, that is, without retaining the past (retentio) and what he is going
to say, in other words, without anticipating the future (protentio). And
this is not only true in the case of a speech or a lecture, but in any
conversation, however simple it may be.
Now, in psychotic or delusional depression, the alteration of
interpersonality is not found in the failure of the «apresentation,» as in
mania, because we know how attached to norms and respect
personalities prone to depression are (Tellenbach, 1961, 1983; Krauss
1977; von Zerssen, 1982); they would never ignore the meaning of
the situational context in a relationship with another. So, what fails in
the relationship of the depressive case with the other? Firstly, it is the
very confinement within the body and the individual’s inaccessibility.
But there are two other very characteristic phenomena which also could
be interpreted from the perspective of intersubjectivity: self-reproach
and depressive delusional ideas. When a depressive patient reproaches
himself, for example, «if I had not sold the house, then I would not be
in ruin,» what he is doing is placing in the past, immovable by definition,
certain empty possibilities. In other words, the retentio (the past) is
invaded by the protentio (the future), with which one does not arrive at
any actualization in the presentatio (the present). And in depressive
delusions, situations that could be possible in the future, for example,
becoming guilty of something, financially ruined or seriously ill, are
lived as if they had already happened, that is, as if in the past: protentio
or anticipation is invaded by retentio (Binswanger, 1960).
V. Intersubjectivity and Schizophrenia
The most fundamental concept of phenomenology is without a doubt
that of intentionality. In its more general meaning intentionality points
to the fact that every psychic phenomenon is essentially characterized
by being referred to something other than itself. Expressed in the words
of Husserl (1962) himself, «in the simple acts of perceiving we are
directed to the perceived things, in remembering to the remembered,
in thinking to thoughts, in evaluating to values, in desiring to objectives
and perspectives…» (p. 287). Through intentionality and the processes
of perception / aperception or of presentation / apresentation, the Self
constitutes the object in its totality and with it, the common world or
koinos kosmos. In schizophrenia, to the contrary, there would be a
weakening of intentionality, with the following consequences:
1. Objects acquire strange aspects and multiple meanings arise
from them. Example: delusional perception and delusional mood.
2. The weakening of the intentional arc leads to classic loosening
of associations.
3. On occasions, what Fuchs (2005) has recently described as
«reversal of intentionality» can arise. In schizophrenia the
harmonic exchange of intentionalities and perspectives between
the Self and the other is reversed. Thus, the other necessarily
becomes the persecutor, because the intentionality of the patient
is so weakened that he is not able to counteract the force of his
intentionality, so the field of intersubjectivity remains under total
domination by the other.
Finally, such a weakening of intentionality enables us to explain
the typical «way of life» of the schizophrenic patient which is
sad, lonely and unproductive. People with schizophrenia are
not able to go another way because the motor of life itself,
which is intentionality, has failed in its constitution of the other
and of the common and shared world.
It has been the work of phenomenology to discover, in the complex
architecture of the human being, the location of the difficulties which lie
492
at the core of the symptoms and syndromes we face in daily clinical
practice. It will be the work of neurobiology to determine the somatic
mechanisms underlying these fundamental difficulties and of psycho-
pharmacology to find medications which can help to overcome them.
Key words: Schizophrenia, mood disorders, phenomenology, inter-
subjectivity.
RESUMEN
I. Introducción y observaciones clínicas
Uno de los rasgos centrales de la esquizofrenia es la alteración a
nivel de la relación interpersonal. El autismo de Bleuler y la dificul-
tad de contacto de Minkowski son dos ejemplos de la trascendencia
de esta perturbación. Pero también otros síntomas de la esquizofrenia
pueden ser vistos desde la misma perspectiva. Así, en el síndrome
paranoídeo el otro se torna tan poderoso que puede perseguir, ase-
diar e invadir la intimidad del paciente. También las alucinaciones
auditivas pueden ser concebidas como una peculiar perturbación
de la relación con un otro anónimo.
Walter von Baeyer definió las características de este encuentro
interpersonal deformado de los esquizofrénicos, el que se caracterizaría
por la falta de reciprocidad, la anonimización y la mediatización. En
el delirio de amor, por ejemplo, el paciente no puede defenderse de
las voces amorosas o de las alucinaciones cenestésicas vinculadas a
la esfera sexual. Por otra parte ese tú invasor, que en un comienzo
tiene un nombre, va perdiendo su individualidad para hacerse
colectivo. Por último, ese contacto con el otro alucinado se mediatiza,
a través de aparatos como radios o televisores.
En la depresión también observamos una profunda alteración
de la esfera interpersonal. Se podrían distinguir dos formas de
depresión: las delirantes y las no delirantes. En la primera la
sintomatología está comandada por el delirio (de culpa, ruina o
enfermedad) y en las segundas por los síntomas corporales, la
experiencia del «no poder» y la alteración de los ritmos biológicos. Y
sin embargo y desde la perspectiva del encuentro, ambas tienen en
común el progresivo desinterés en el otro y su reemplazo por el
tema predominante: el cuerpo en un caso, el delirio en el otro.
En la manía lo más llamativo es la euforia, la hiperactividad,
el pensamiento ideofugal y el insomnio, sin embargo, aquí también
hay una profunda alteración de la interpersonalidad, p. ej., una
pérdida de la distancia social hasta el extremo de la irrespetuosidad.
II. «Apresentación», temporalidad inmanente e intencionalidad
en la constitución de la intersubjetividad según Husserl
En este capítulo se intenta explicar la teoría de la apresentación de
Husserl y su rol en la constitución de la intersubjetividad.
III. Intersubjetividad y psicosis maníaca
Remitámonos al ejemplo de Binswanger de la paciente maníaca que
ingresa a una iglesia donde se desarrolla un servicio religioso e inte-
rrumpe al organista para que le dé clases. El organista está presente
para sí como el fluir de contenidos de conciencia, las sensaciones
provenientes de su cuerpo, entre otras las de sus dedos tocando el
órgano. Estas presentaciones están acompañadas de la «apresentación»
de que él es un organista que ha sido contratado para tocar en el
servicio religioso y esa misma «apresentación» la comparte con la
comunidad que asiste a la iglesia. La paciente, en cambio, no com-
parte esta «apresentación»; ella no es capaz de «apresentar» que se
trata de un concierto en el marco de un servicio religioso.
IV
IV.. Intersubjetividad y psicosis depresiva
El fluir de mi vida interna es, por cierto, inseparable de la tempora-
lidad originaria, con respecto a la cual el tiempo objetivo es sólo un
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 Phenomenology of Intersubjectivity in Bipolar Disorder and Schizophrenia
derivado. Y esa temporalidad se da como el permanente entrelaza-
miento de tres instancias que Husserl llama retentio (pasado),
protentio (futuro) y presentatio (presente). En la depresión psicótica
o delirante la alteración de la interpersonalidad no se encuentra en
el fracaso de la «apresentación», como en la manía, sino en la alte-
ración de la temporalidad y su rol en la constitución de la
intersubjetividad. El auto-reproche significa una invasión del pasa-
do (la retentio) por el futuro (la protentio), mientras en las ideas
deliroides (una posibilidad, que yo me arruine, p. ej., es vivida como
ya ocurrida) sucede a la inversa: el pasado invade al futuro.
V. Intersubjetividad y esquizofrenia
El concepto más fundamental de la fenomenología es el de
intencionalidad, que apunta al hecho que todo fenómeno psíquico se
caracteriza por estar referido a otra cosa que sí mismo. A través de la
intencionalidad y por medio de los procesos de percepción/apercepción
o de presentación/apresentación, el Yo constituye el objeto en su tota-
I. INTRODUCTION AND CLINICAL
OBSERV
OBSERVAATIONS
No one can debate that one of the central features of the
group of diseases we call schizophrenia is the alteration of
interpersonal relationships, or, expressed in more abstract
terms, the alteration of intersubjectivity. Autism, considered
by Bleuler1 as one of the fundamental symptoms of the
disease, and as the difficulty to make contact, perceived years
after onset, is a topic on which Minkowski2 wrote many
memorable pages, offering just two examples of the tran-
scendence of this disorder. But as it turns out, other
symptoms of schizophrenia can also be seen from this
perspective. Let us consider the paranoid syndrome, for
example, in which the other appears to be infused with an
enormous power, through which the patient is persecuted,
besieged, and finally invaded in the privacy of his own
consciousness through the influence syndrome. But auditory
hallucinations, which may at a cursory glance seem to be a
rather «objective» symptom, and which may even be
attributed to alterations in the complex function of hearing,
can also be seen as a highly peculiar disturbance of the
relationship with the other, transformed here into a virtual
presence, an anonymous, atemporal, aggressive and invasive
being. And this is not only true for paranoid, hebephrenic
and catatonic forms, where the listed symptoms occur (albeit
in different combinations) most often. In a 1965 work,3 later
published as a chapter in the book Anthropological Psychiatry,4
we were able to show how at the basis of the hypochondriac
forms of schizophrenia, fundamentally focused on the body
itself and typically classified within the «simple» forms of
the disease, there was also an alteration of interpersonality,
of the relationship with the other, with the «you.»
The patient we were studying at the time, who was a
very intelligent student with a great capacity for
introspection, during the time just before the onset of
psychosis, wrote very impressive ideas in his journal, such
Vol. 34, No. 6, November-December 2011
lidad y con ello, el mundo común o koinos kosmos. En la esquizofrenia,
en cambio, habría un debilitamiento de la intencionalidad, con las
siguientes consecuencias:
1. De los objetos surgen múltiples significados.
2. El debilitamiento del arco intencional lleva a la laxitud de las
asociaciones.
3. Se produce una «inversión de la intencionalidad» y el otro se
transforma en perseguidor, porque la intencionalidad del paciente
está debilitada y no es capaz de contrarrestar la intencionalidad
del otro.
4. Este debilitamiento explica también la improductividad de la vida
de estos pacientes, porque la intencionalidad ha fallado en la
constitución del otro y del mundo.
Palabras clave
clave: Esquizofrenia, enfermedades del ánimo, fenomeno-
logía, intersubjetividad.
as the following: «My failure is to love myself. I have yet to
find the path to the ‘you.’ Other than a short period at
Waldheim [a school], I have always been shuttered within
myself, deaf to the world outside. What I must achieve is a
disinterested inclination toward that which is outside me...
I need to venture into another phase, that of loving another.»
And at the onset of psychosis he said such strange things,
like that his mind was atrophied, and had strayed toward
the chest, but at any rate it was unable to fill his skull. His
own body became foreign to him; to assure himself that
his arms and legs were his own, he watched them, moved
them and bit them. He felt that his body was flat and that
things came over him and penetrated him. And in his
journal he notes: «The world is very distant, without
meaning and empty. For example, if I see a farm, I see with
great precision the house and the people, but only as
something material. Beyond that everything is poor, desert,
meaningless.» Later he adds: «The world comes directly to
me, there is no distance between myself and the world.
And this is true both for people and for things. The closeness
reaches the point of identification with the things and the
people. It happens at times that in my worst states I even
consider myself as the other, as the person I am seeing.»
He himself describes this concrete difficulty in reaching
the other person, in this case regarding a young girl with
whom he had fallen in love: «It was very sad. When it came
time to see her, I would have needed only to say hello, but
in that moment I closed up completely, like a pocket knife.
I still see her coming toward me. Suddenly everything
became cloudy, as if it had been blurred. I started to tremble,
I turned around and I went on my way.» This inability to
encounter becomes stronger and stronger, until the point
that Federico is no longer able to recognize people as
individual subjects, and so he writes in his journal: «It’s
been some time that I can no longer remember the
individuality of the faces of people I know. When I see them
I see only their legs.»
493
 Dörr Zegers
Walter von Baeyer5 defined with extraordinary acuity
the characteristics of this deformed interpersonal encounter
of schizophrenics, but based fundamentally on cases of the
paranoid disorder. This type of encounter is characterized
by lack of reciprocity, anonymization and mediatization. In
the delirium of love, for example, especially when it acquires
hallucinatory characteristics, the patient cannot defend
himself from loving voices or from kinesthetic hallucinations
related to sexual topics; this is assuredly an encounter with
no reciprocity. It is common that the invasive «you,» that at
the beginning has a name, starts losing its individuality so
as to become collective. They are all the young men in the
city or even all men that harass the female patient. Lastly,
the contact with the hallucinated other, which at first is direct,
is «mediatized» through devices such as radios, televisions,
transmitters, etc. We were able to show that a similar
phenomenon occurs also in this form in a somewhat polar
fashion regarding paranoid schizophrenia, which represents
simple schizophrenia with kinesthetic characteristics,
example for which is cited above. The difference between
one and the other lies only in the fact that in the second the
invasive other appears more and more as a mere body with
no soul, depersonalized.
In the case of depression, and even when patients’
complaints refer generally not to the other, but to their own
feelings and changes in their bodies, there may also be a
fundamental alteration from the perspective of interperson-
ality. We could distinguish two forms of depression that are
essentially different, to the point of having debated more
than once whether it was a matter of different nosological
entities. I am referring to the delirious and non-delirious
forms. The latter, which is the most common, shows as
fundamental phenomena, as we have shown in other
works,4,6-8 the negative change of the experience of the body
(decay, disinterest, distress, pains, feeling of cold, etc.) the
«inability» (to concentrate, to make decisions, to act, to feel
pleasure, etc.) and the alteration, inversion or suspension of
vital rhythms. In the latter, that is the delirious form,
symptoms are guided by the delirium (of guilt, ruin or
disease), even when in a separate plane the same phenomena
inherent to classic depression may be found. The differences
relate not only to the symptoms but also to prior personality,
biography, and triggering situations. However, from the
perspective of the encounter, both have something in
common, which is the progressive disinterest in the other
and its replacement with the predominant theme: the body
in one, the delirium in the other. It is common to observe
how depressive patients cannot shed their bodily symptoms,
be it the lack of strength, decline, anguish, insomnia, pain,
etc. In an old empirical-phenomenological work on nuclear
or melancholic depressive syndrome,4,9 we find that bodily
symptoms were present in 100% of the depressive episodes
of 55 patients who over a period of five years had been
hospitalized for such reason at the Concepción Psychiatric
494
Hospital. In a way, the depressive patient becomes unreacha-
ble behind the body he occupies completely, while at the
same time becoming inalterable. Kraus 10 describes that
particular irritation provoked by the depressed patient in
the examiner, in feeling helpless to have any manner of
influence on the mood of these patients. Meanwhile, Kranz11
sustained many years before that the depressed were «more
autistic than schizophrenics,» pointing thusly to the same
phenomenon we have been discussing: the unreachable and
inalterable that is the depressed other in the encounter.
This incomprehensible characteristic of the depressive
state (unlike what occurs with normal sorrow) acquires its
maximum expression in the stupor. In the above work7 we
sought to make a phenomenology of depressive corporeali-
ty, based precisely on the experience of the examiner in a
case of depressive stupor, a study which we continued later
in another publication.8 In that publication we said: «In a
way, she is not in front of us, as long as there is not that
natural polarized tension between us that occurs in inter-
personal encounters, which the Greeks called antikry» (p.
25). Later we explained this using the following words: «The
patient remains unresponsive to all my attempts at bringing
her to something like a contraposition, that she oppose me
as an other, and it is curious, but the feeling that the patient
provokes in me is further and further from sorrow or
compassion... That impression of unpleasantness or
strangeness makes the experience into a void; there I was
prepared to meet with someone of a vivid and different spirit,
somewhat communicative, familiar, open, kind, or what-
ever.» (p. 25).
The disturbance of interpersonality in depressed non-
delirious patients is observed across all levels of this disease,
from those in which it manifests itself only through the
concern for a symptom (almost always a bodily symptom,
such as insomnia or constipation) to those for whom the
invasion of the spirit by the body is total (process of
«objectification»)7,8 as in the case of a stupor. In cases of
delirious depression we again find ourselves with the closing
off of the patient to any interpersonal encounter, dominated
as it is by this central idea that constitutes his/her delirium.
We have also worked on this topic in the case of a female
patient with Cotard’s syndrome. In this case it was not only
the strong impression of the examiner of the inaccessibility
of the person of the patient, but the fact that she herself,
who was very intelligent, was capable of describing in an
insurmountable way this entrapment within her body and
her inability to arrive at the other: «What’s happening with
me is that everything is dead; I mean, I’m dead, I’m in a
vegetable state from my head to my toes. I cannot feel, nor
smell, nor taste food. My body is so light it’s as if it didn’t
exist... When I hold my children in my arms, I don’t feel
them... If my daughters knew that they loved an artificial
mother... I can’t feel direct contact with things or with others...
Now, when I speak, the words come out of me automatically,
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 Phenomenology of Intersubjectivity in Bipolar Disorder and Schizophrenia
but the words of others don’t enter my head... The only thing
I want is to die, but I’m still alive because, apparently, my
heart is beating, although I can’t feel that either...».12
And what of the case of mania? The most striking feature
of these patients is without a doubt the euphoria, hyper-
arousal, hyperactivity, accelerated thoughts and insomnia.
This being, attracted by all stimuli, including (naturally) the
people nearby, makes us think at first glance that the manic
has an excessive capacity for encounter and communication
with the other, and in fact, the «tuning» of the patient, his/
her capacity to transmit feelings and emotions to the other,
is used as a differential diagnostic criteria with regard to
schizophrenic psychoses. However, if we observe with
greater attention, we are able to see here as well a profound
alteration in interpersonality. In these patients there is an
engagement of the other with excessive confidence and a
loss of social distance to the extreme of disrespect, which is
extremely striking. This taking of the other «by the weak
side,» as it is called by Binswanger,13 this laughing at the
defects of others, as well as the pointing out of any dissonance
in the environment with inappropriate laughter are all
examples of how the manic patient is incapable of building
a harmonious and authentic relationship with the other.
Allow me to offer a personal and recent example. A bipolar
patient, 70 years of age, of a high socioeconomic and cultural
level, after coming out of a deep depression cycled to a light
hypomania, perceived by the family only in her irritability
and due to the fact that she was waking up early. In the
middle of the interview in which I verified her bright look,
greater mobility and excessive makeup, she observed: «The
pen you are using is too ordinary. I’m going to give you a
better one for Christmas.» To be fair, her observation was
correct. The pen I typically use was lost a few days prior at
the airport, and while I found the time to buy another, I was
using an ordinary pen. That being said, no one would hesitate
to say that the patient’s words were in some way
inappropriate. The question then must be, what is it that is
failing here? Her words might have been justified perhaps
if I were her son or her brother, but I am her doctor and we
are in a very serious and important situation, that being the
doctor-patient relationship.
A very good example of this failure to assess what
should be said or done in a certain social situation, the utter
failure in the establishing of an appropriate relationship
with the other, is offered by Binswanger in his book titled
Melancholie und Manie.13 In this example, a female maniac
patient left the clinic where she is hospitalized, wanders
through the streets and enters a church where at the time a
religious service is underway and an organist is playing.
She approaches the organ, congratulates the organist for
how well he plays and asks him foolishly if he would please
begin teaching her to play at that very moment. It is a simple
example, but what a talker! No one can deny that here too
there is something improper, that does not correspond to
Vol. 34, No. 6, November-December 2011
the true context of the situation, which apparently is not
being understood.
II. HUSSERL’S THEOR
HUSSERL’S THEORY
Y
OF INTERSUBJECTIVITY
Up until this point and through clinical observation we have
suggested a hypothesis that behind these mysterious endo-
genous diseases, schizophrenia, depression and mania, there
lies a profound alteration in intersubjectivity. Now our task
is to interpret these facts in light of the phenomenology of
intersubjectivity of Edmund Husserl.14 A similar attempt,
albeit more brief and limited to mood disorders, is owed to
Spanish author Antón Saiz. 15 We will attempt first to
summarize the most important elements of this theory. It
would be, it bears mention, impossible to reproduce here
the entire contents of the fifth Cartesian Meditation, in which
the Husserlian theory on intersubjectivity is found, but we
will linger on one of its fundamental concepts, which is that
of «apresentation.» Husserl uses «apresentation» firstly to
refer to that which is added to the corporeal presentation of the
other and with which then a unit is formed, permitting the
experience of the alter ego. The issue here is of an experience
of the essence of a real entity that is not my own, but is not
added to myself as an integrative part, that is, that transcends
entirely my own being, although «this entity can only acquire
meaning and justification from my being.» It is thus a special
case of the larger Husserlian polemic, of showing how that
which is transcendent in general can become «immanently
transcendent.» The solution to this problem is constitution,
the constitution both of temporal objectivity, of one’s own
world, as well as of the alter ego, of the other and his world.
To clarify the issue of the constitution of the alter ego,
the problem of the constitution of the ego and my own world
must first be clarified. The question posed by Husserl is the
following: What is internal to me in terms of pure self and as
such cannot be exchanged, and what, despite this non-
exchangeable something, can be communicated? Husserl
calls the first sphere the originary or primary sphere. It is the
sphere of my internal vital flow, of my self own and of my
non-exchangeable «internal vital history» (Binswanger).16 In
the order of the constitution of an external world outside the
self, this internal vital flow is in and of itself the first world,
and for this reason is called primary. My body (or body-
subject) is the only soma (or body-subject) there is, and can
be constituted originally as a body or corporeality. Whereas
the other body is made in a similar way to my own, it is
clear that it must receive its meaning from my own. Thus
the question being posed is the following: What is it that
makes this body that I contemplate or that I sense as present
the body of the other and not a second body of my own, a
duplicate? We already know the answer: it is the fact that
nothing from that other body can be integrated into my own
vital flow as mine.
495
 Dörr Zegers
The problem is exacerbated if the question is posed,
«How is it that, despite the inability to actualize the foreign
body, and thereby, the foreign psyche, an experience of the
other can be attained? The answer to this question represents
one of the Husserl’s most brilliant achievements, clearly
showing the constitutive structuring of the experience of the
other from the presentation or perception of a real body,
that is, something belonging to nature, through the
aperception of that body in terms of the body-subject (Leib)
and then the «apresentation» of the body-subject as an alter
ego. These three intentionalities are intertwined in the most
intimate way in the perception of the other. In this
intertwining, the body of the other and the ego of the other
appear in the form of a unitary and transcendent experience.
This, because every experience is provided over other
experiences that fill and confirm the «apresented» horizons.
The result is then that the «apresentation ... presupposes a
presentation nucleus» or, in more precise terms, it is an
actualization associated with the authentic perception (of the
foreign body). Both perception and actualization are present
here in the functional community of a perception that
presents and «apresents» at the same time, creating the
awareness of self-existence for the entire object. This is how
my ego constitutes within itself the alter ego.
Having shown the constitution of the perception of the
other on the basis of intersubjectivity, we will explain the
problem of intersubjectivity or that of the constitution of
the common world. It is often that the layman uses the
expression, «the mentally ill live in a different world from
us,» but it is unclear even to us, as psychiatrists, what
scientific meaning this expression has, and nor do we
understand what the anomaly of the constitution of this
different world of the mentally ill consists of. Szilasi17 has
shown with great clarity that the constitution of the common
world is also conducted through «apresentation» and that
this action is based on the presentation with the
corresponding retentions and protentions. The intentional
references that lead to the «apresentation» are part objective
and part historical/biographical. While presentations, as
we know, belong to our vital flow with their immanent-
transcendent moments in the sense of the primary world
of Husserl, my Ego constitutes a piece of common world
through that which is «apresented.» In this regard, Szilasi17
(p. 109) offers a very enlightened example:
«In as far as my ‘I-Life’ (Lebens-Ich) I am present in all
acts of consciousness. But I can also be present and
accompanied by ‘apresentations.’ For example, right now
I am present to myself, but at the same time, I am ‘apresent’
to myself as a professor of philosophy that is giving a class.
For you, as listeners, I am present in a different way than
that in which I am present for myself, but in the same
‘apresentation,’ namely, as someone who is giving a class.
Our presentations are different, but are accompanied by
the same ‘apresentation.’ That which is ‘apresented’
496
identically by you all, who are for me alter egos, and by me,
for you an alter ego, is what is common, and this is what
constitutes the common world (the objectively
transcendent). While you concentrate on the contents of
the class, that constitutes the topic of your current reflection.
For you the internal world is present and constituting in
multiple retentions and protentions in your own flow of
your respective lives. In this process you are ‘apresent’ for
yourselves as listeners or students. In the same capacity
you are also ‘apresent’ for me (but not present as Egos, for
your mental lives are inaccessible to me).»
III. PHENOMENOLOG
PHENOMENOLOGY OF INTERSUBJECTIVITY
OGY
AND MANIC PSYCHOSIS
PSYCHOSIS
Let us return to Binswanger’s example13 of the manic patient
that enters a church where a religious service is taking place
and interrupts the organist. To the layman, the patient’s
attitude might be judged as inappropriate, inconsiderate,
incomprehensible, etc. A psychiatrist would speak of
facilitation of action and loss of inhibitions. However,
neither of these observations provides a reason for what is
truly happening. Likewise, somatic medicine offers the
theory of the organism as a framework within which the
patient can «measure» deviations from social norms, and
thus, the psychiatrist too should be able. But this basic science
is not sufficiently developed, and it is our understanding, in
keeping with the thinking of Binswanger, that the
phenomenology of intentional consciousness fills this void.
Also, the organist and the patient who interrupts him
both experience something different, namely, their own
internal vital flow, with their own primary world. But these
different presentations are not accompanied here by the
same «apresentation.» The organist is present for himself
as the flow of conscious contents, the sensations coming
from his body, including the sensation of his fingers playing
the organ. These presentations are accompanied by the
«apresentation» in which he is an organist that has been
hired to play at a religious services and that same
«apresentation» is shared by the community attending the
service. The patient, however, does not share this
«apresentation» and in no way «takes part» in it. Present in
her perception is only an organist playing, but she does
not «apresent» that this is a concert within the context of a
religious service. Now, the patient, after leaving the church,
entered a soccer field where several young men were
playing a game, causing them perplexity, anger and hilarity.
Here again she was unable to achieve the same
«apresentation» as the young men, thereby failing to
constitute a common world. The fact that she quickly
changes from one scenario to another is not a simple
consequence of her pathological hyperactivity, but rather
is a result of the fact that she lives in isolated presences,
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 Phenomenology of Intersubjectivity in Bipolar Disorder and Schizophrenia
without a connection between them, which are thus
inexplicable based on her biography, as the patient has been
unable to order these presences in the continuum of her
internal vital history. This also means that her protentions
and retentions have failed. Only by anticipating the future
and retaining the past can we actualize the present. By
loosening this perfect interaction between past, present and
future (between retentio, protentio and presentatio), life itself
is transformed into the consciousness of fragments in a
haphazard world.
Based on Husserl’s theory presented above, it follows
that if one fails to constitute the alter ego, unable to reach a
true understanding of the other, the constitution of oneself
also fails, that is, of one’s own ego. Binswanger’s patient is
unable to capture «apresentatively» the organist (within the
context), because she herself cannot experience herself
«apresentatively» as an ego. Both in the church and at the
soccer field, the patient is present for herself in her primary
world (or internal vital flow), but does not manage to
«apresent» as the person she is, as a wife and mother of four
children, as a well-educated person, as a lady of society, and
even less so as a patient who ran away from a psychiatric
clinic. And this occurs because her life passes from presence
to presence, disconnected from retentions and protentions,
that is to say, due to the total collapse of temporality. This
explains why the manic fails in the constitution of the
common world, even though (and unlike the depressed) the
tendency to turn toward others is observed in such patients.
But this manner of dealing with and addressing others is
not aimed at authentic communication, but rather is the
consequence of an escape from one’s self, and in distancing
oneself from their own ego, the other loses the capacity of
alter ego and becomes an allius, a strange and foreign being.
This is not so different from what happens with my patient,
the one who, unaware of the situation of a psychiatric inter-
view and the peculiarity of the doctor-patient relationship,
makes a reproach that could only exist in a context of greater
familiarity and intimacy: «The pen you’re using is too
ordinary; I’m going to give you a better one for Christmas.»
IV
IV.. PHENOMENOL OG
PHENOMENOLOG Y OF INTERSUBJECTIVITY
OGY
AND MELANCHOLIC DEPRESSION
Now, the flow of my internal life is, of course, inseparable
from the originary or primary temporality, of which ob-
jective time is a mere derivative. And this originary temporal-
ity occurs as the permanent intertwining of three instances
that Husserl14 calls retentio (past), protentio (future) and
presentatio (present). To understand the fundamental role that
these temporal instances play in the constitution of both
one’s self (Ego) as well as the that of the other (alter Ego), it
would suffice to think of the fact that anyone who is
speaking in a given moment (presentatio) would be unable
Vol. 34, No. 6, November-December 2011
to say what they are saying without knowing exactly what
they already said, that is, without retaining the past
(retentio), and what they are going to say, in other words,
without anticipating the future (protentio). And this is true
not only in the case of a speech or lecture, but for any
conversation no matter how simple.
Now, in endogenous depression, the alteration of inter-
subjectivity is not found in the failure of the «apresentation,»
as we saw occur in mania. To the contrary, we know how
respectful of social norms people prone to depression are,
as understood at an early stage by Tellenbach18 and as
shown by von Zerssen19-21 through a series of empirical
studies, in such way that such personalities would never
fail to understand the meaning of the situational context in
relating to others. But from the beginning we described the
way in which the depressive patient encloses himself within
his body or in his delirium, becoming unreachable by the
other. So, what is it that fails in the relationship of the
depressive patient with the other, from a phenomenological
point of view? Firstly there is this closing off within the
body and the inaccessibility that we mentioned in the
introduction. But there are two other very characteristic
phenomena that could also be interpreted from the per-
spective of intersubjectivity, and which have been identified
by Binswanger,13 namely, that of self-reproach and that of
depressive delirious ideas. When a depressive patient
submits to self-reproach, for example, «if I hadn’t sold the
house, then I wouldn’t have ended up in ruin...» or «if I
hadn’t organized that ride when the accident occurred, so-
and-so wouldn’t have died...,» etc., what he is in fact doing
is placing meaningless possibilities in the past, which in itself
is immutable. In other words, what occurs in a depressed
person is that the retentio (the past) is invaded by the protentio
(the future), with which all temporality is ceased, never
arriving at an actualization in the presentatio (the present).
This would explain all the ways in which this most central
symptom of depression occurs (that being inhibition, which
in prior studies6-9 we have characterized as one of the three
fundamental phenomena of «nuclear depressive syndrome»),
while also explaining the fact that the entire existence of the
depressed individual is ceased, as he returns to the moment
prior to the start of his disease, without managing to
incorporate this period in his vital history.
With regard to depressive delirium, we must first say
that, as has always been recognized, the issues to which
we refer are not abstruse, extravagant or impossible, as is
the case of schizophrenia, but are issues of everyday life,
as in the case of the relationship with oneself and in
particular with one’s body in the case of hypochondriac
delirium, the relationship with others in the case of guilt
delirium, and the relationship with society in general in
the case of ruin delirium. Patients claim to have an incurable
disease (and in extreme cases, as in the case of Cotard’s
syndrome, to be dead), or to be guilty of something that
497
 Dörr Zegers
might happen in the future (that the Internal Revenue
Service find a mistake in their annual filing, or that one of
their children suffer some misfortune, etc.) or, lastly, that
claim already to be in ruin, while it may be a possibility in
the future, there is no certainty whatsoever that this will in
fact occur. In all these cases a phenomenon occurs that is
the exact opposite of what occurs in self-reproach, that is,
that situations that are possible in the future are lived as if
they had already occurred, as though they are in the past:
protentions or anticipations are invaded by retentions.
This contamination of the past or retentio with elements
from the future (self-reproach) and of the future with
elements from the past (depressive delirium) would be,
according to Binswager, at the base of each true care of
depression, and would explain the ceasing and isolation of
the depressed patient, a phenomenon also described by von
Gebsattel 22 and defined by him as Werdenshemmung
(inhibition to become).
V. INTENTIONALITY AND SCHIZOPHRENIA
The most fundamental concept in phenomenology is without
a doubt that of intentionality. In its most general meaning,
intentionality points to the fact that all psychic phenomena
are characterized essentially by their reference to a separate
thing outside such phenomena. As expressed in the words
of Husserl himself,23 «in simple acts of perception we address
perceivable things, in remembering to things remembered,
in thinking to thoughts, in assessing to values, in desiring to
objectives and perspectives...» (p. 287). The most demonstra-
tive case of the importance of intentionality is in perception,
be it of an object or of another person. All perception is by
necessity perspectivist, that is, one always perceives only
certain aspects of the object and «aperceives» all others.
«Aperception» is a particular form of «apresentation,» a
phenomenon discussed above, but both are governed by
the same laws. Through intentionality and by way of the
processes of perception/aperception or presentation/
apresentation, the Ego constitutes the object in its totality,
and with this, constitutes the common world, or koinos
kosmos. In schizophrenia, however, there is a weakening of
intentionality, and as a result, objects are not (borrowing
from neologism) «intentioned» or intended with the
corresponding force or intensity. This phenomenon brings
about the following consequences:
1. Objects acquire a strange, foreign characteristic,
implying multiple meanings that do not appear when
intentionality is working properly. This is what is
observed characteristically in the delirious mood and
in delirious perception (Blankenburg).24
2. The weakening of the intentional arc leads, on the level
of thought and discourse, to the classic laxity of
associations, described by classical authors (Bleuler).1
498
3. At times, what Fuchs25 has recently described as «in-
version of intentionality» can occur. In schizophrenia
the harmonious exchange of intentionalities and per-
spectives between the Ego and the other is inverted
and this occurs in the following way: The patient is
unable to put himself in the perspective of the other to
see reality (Blankenburg)26 and the other, due to this
imbalance in intentionalities, becomes by necessity a
persecutor or invader, given that he (the other) «in-
tentions» the schizophrenic, while the latter is no
condition to «intention» the former. In other words, the
«addressing» of the schizophrenic patient is so weak-
ened that he is unable to counteract the «addressing» or
intentionality of the other, leaving the area of intersubjec-
tivity under total control by the other. This phenomenon
we have described is the phenomenological basis for
this common symptom of schizophrenia, that of
persecution delirium.
4. Lastly, this weakening of intentionality, which is at the
foundation of the constitution of intersubjectivity and
the objective temporality of these patients, also explains
the obstruction of the «life path» of the schizophrenic.
Any experienced psychiatrist that has seen serious
patients in intensive care centers, or has followed the
evolution of other patients over decades, will recall the
emptiness and sadness of these lives, lacking drive or
initiative, where the objects of the world fail to attract,
but rather invade from the multiplicity of their
significance, where there is no perseverance and thus
no achievement. But it would be erroneous to call this
laziness or apathy. The schizophrenic patient cannot
do anything else, because the engine of life itself, that
being intentionality, has failed in the constitution of
the other and of the common and shared world.
It has been the work of phenomenology to discover
within the complex architecture of the human the location
of the failure that is the basis of the symptoms and
syndromes we face in everyday clinical practice, and
particularly of the so-called endogenous psychoses. It will
be the work of neurobiology to determine the somatic
mechanisms that underlie these fundamental failures, and
the work of biological psychiatry and psychopharmacology
to find the medications that together with psychothera-
peutic and rehabilitation treatment can help overcome them.
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