Definition Essay Schizophrenia
Schizophrenia is a brain disease that interferes with normal brain functioning. It causes affected people to exhibit odd and often highly irrational or disorganized behavior. Because the brain is the organ in the body where thinking, feeling and understanding of the world takes place (where consciousness exists), a brain disease like schizophrenia alters thinking, feeling, understanding and consciousness itself in affected persons, changing their lives for the worse.
Schizophrenia symptoms include difficulty thinking coherently, interacting with others normally, carrying out responsibilities and expressing emotions appropriately. Even simple everyday tasks like personal hygiene can become unmanageable and neglected. The disease can thus impact every aspect of affected people's work, family, and social life. Though not affected directly, family members also frequently become distressed and overwhelmed by the difficulties involved in providing care and in coming to terms with the transformation of their loved one into a patient with a serious chronic illness.
Psychosis and the loss of reality
A defining feature of schizophrenia or paranoid schizophrenia is psychosis. Psychosis occurs when a person loses the ability to discriminate between real and 'imagined' experiences, and therefore loses touch with reality.
People with schizophrenia commonly experiencehallucinations, which are phantom sensations that only they perceive (such as voices speaking to them that only they can hear), and delusions, which are fixed, mistaken ideas (sometimes quite outlandish and illogical ideas) concerning themselves and their surroundings.
Both hallucinations and delusions are involuntary in nature, occurring spontaneously and without premeditation on the part of the patients who experience them. Typically, attempts to correct patients' delusions are met with resistance and defensiveness. From their internal perspective, patients' delusions seem to be true.
While the hallucinations and delusions characteristic of psychosis are 'imagined' in the sense that they do not have a solid, consistent basis in reality, they are nevertheless unavoidable and appear as real as other more reality-based perceptions to the people who experience them.
Schizophrenic persons have little choice but to take their hallucinations seriously as their malfunctioning brains cause them to experience hallucinations uncontrollably with the force of real sensations. Hallucinations are thus a sort of 'virtual reality' that schizophrenic people become trapped within, and the delusions that form around these hallucinations are a natural response to this unintentionally altered perception.
People with schizophrenia tend to think and act differently than other people because the occurrence of hallucinations, delusions and other symptoms characteristic of schizophrenia causes them to experience reality very differently than other people. This loss of reality can be terrifyingfor both schizophrenic people, who struggle mightily to make sense of their inner perceptual chaos, and for the people around them who grapple with trying to understand why their loved ones are acting in such odd and seemingly disorganized ways.
Given that the term ‘schizophrenia’ was coined by Bleuler in the beginning of the 20th century, it would be anachronistic to say that Kant provides us with an account of schizophrenia. In this section, however, I will show that the symptoms that Kant discusses under the header ‘mental derangement’ correspond to what we nowadays regard as the positive symptoms of schizophrenia.11 Kant explains mental derangement primarily in terms of the impairment of cognitive faculties, but this is not to deny that it is caused by physical processes in the brain. In fact, Kant thinks that the ‘roots’ of mental derangement ‘lie in the body’ (VKK 2: 270).12 According to Kant’s account of the causal genesis of the disorder, mental derangement occurs when hereditary biological factors are triggered by social circumstances (Anth 7: 217; VKK 2: 269).
One of Kant’s reasons for focusing on the ‘appearances in the mind’ (VKK 2: 270) rather than on the physical causes of mental disorder is his awareness of the limits of his scientific competence. But more importantly for our aims, Kant holds that whether a mentally disordered agent can be held responsible for an action is ‘a wholly psychological question’; to be precise, it is a ‘question of whether the accused at the time of his act was in possession of his natural faculties of understanding and judgment’ (Anth 7: 213f.). Since facts about psychological states and capacities of agents bear on questions of responsibility, close observation of the ‘appearances in the mind’ of the disorder is a first step to answering the question why mental disorder can make blame inappropriate.13
The ingenious aspect of Kant’s discussion of mental derangement is his explanation of its symptoms in terms of the impairment of the cognitive faculties necessary for experiential cognition that he laid out in the Critique of Pure Reason. Kant distinguishes four different types of mental derangement. They are related to the impairment of respectively the faculty of the understanding, the power of imagination, the power of judgment and the faculty of reason. I will discuss them in a somewhat different order. I will first discuss two symptoms that are associated with the so-called paranoid type of schizophrenia and then proceed to two symptoms associated with the so-called disorganized type.
Let us start with persecutory and referential delusions, both of which are well-known symptoms of the schizophrenia spectrum. Kant is familiar with these symptoms. He observes that some mentally deranged patients ‘believe they are surrounded by enemies everywhere, [and] consider all glances, words, and otherwise indifferent actions of others as aimed against them personally and as traps set for them’ (Anth 7: 215). He assigns the symptoms to a type of mental derangement that he labels ‘dementia’ and points out that they are best explained by an impairment of the power of imagination (Anth 7: 215).14
In the Critique of Pure Reason, Kant defines the power of imagination as ‘the faculty for representing an object even without its presence in intuition’ (B151). In its reproductive function, it enables us not only to bring to mind past experiences but also to make up representations of non-existent objects. The distinguishing feature of the reproductive imagination is the fact that its activity is subject only to psychological laws of association (B152). This characteristic enables us to distinguish representations that correspond to objects given in intuition from representations that lack such corresponding objects. These differ not so much in their content or intensity as in the way they are connected: whereas the former are connected primarily through their content under subjective laws of association, the latter are synthesized into a unified experience by the formal and objective laws of the understanding.15 In Kant’s view, persecutory and referential delusions are explained by the patient’s inability to distinguish between these two types of representation. Due to this cognitive impairment, the delusional patient experiences the objects of her self-made representations as if they were really given: ‘owing to the falsely inventive power of imagination, self-made representations are regarded as perceptions’ (Anth 7: 215).
A further class of symptoms that psychiatrists count among the key symptoms of the schizophrenia spectrum is the class of so-called ‘bizarre delusions.’ Familiar kinds of bizarre delusions recounted in contemporary psychiatric literature are thought insertion and delusions of control. Patients experiencing thought insertion may report things like, ‘The thoughts of Aemonn Andrews come into my mind. He treats my mind like a screen and flashes his thoughts on it like you flash a picture’ (Frith and Johnstone 2003, 36).16 Patients experiencing delusions of control may say things like, ‘It is my hand and arm that move, and my fingers pick up the pen, but I don’t control them’ (Frith and Johnstone 2003, 37). In this context, Kant refers to patients who claim to have comprehended ‘the mystery of the Trinity’ or to have invented things like ‘the squaring of the circle’ or ‘perpetual movement’ (Anth 7: 215f.). However different from thought insertion and delusions of control these symptoms may seem at first sight, some important similarities will become apparent if we assess Kant’s explanation of the symptoms.
Kant assigns the symptoms just named to a form of mental derangement that he refers to as ‘vesania.’ Vesania consists in ‘the sickness of a deranged reason’ (Anth 7: 215). In the Critique of Pure Reason, Kant defines reason as ‘[the faculty] of drawing inferences mediately,’ that is, as the ability to draw conclusions from premises by using syllogisms (A299/B355). In this function, reason is guided by the principle of non-contradiction (A150/B189f.). But Kant uses the word ‘reason’ in a second way. Regularly, he uses ‘rational cognition’ [Vernunfterkenntnis] to refer to knowledge attainable a priori, that is, to knowledge of the conditions for the possibility of experience. In keeping with this twofold use, reason demarcates the realm of meaningful propositions in two ways. Firstly, reason restricts the realm of meaningful propositions to logically possible propositions, that is, to propositions that conform to the principle of non-contradiction. This restriction rules out from the realm of meaningful propositions the proposition that God is both one and three at the same time and in the same respect. Secondly, reason restricts the realm of meaningful propositions to empirically possible propositions, that is, to propositions that conform to the forms of intuition (i.e., linear time and Euclidean space) as well as to the rules of the understanding (roughly the general laws of pure Newtonian natural science). Whereas the former aspect of this restriction rules out the possibility of squaring the circle, the latter aspect, in conjunction with some basic facts about the world, precludes the possibility of perpetual movement.
Kant’s explanation of the symptoms of vesania in terms of an impairment of reason adequately captures the distinguishing feature of bizarre delusions. Persecutory and referential delusions are generally logically and empirically possible – though of course not therefore true. Bizarre delusions, on the other hand, are defined as beliefs that are ‘clearly implausible and not understandable to same-culture peers’ or as beliefs the content of which ‘the person’s culture would regard as physically impossible’ (American Psychiatric Organization 2013, 87, 819). True, the writers of the DSM neither purport nor want to be transcendental philosophers, but the similarity between the beliefs referred to by Kant and the beliefs that today’s psychiatrists call ‘bizarre delusions’ is clear: both express ideas that are (or that same-culture peers take to be) logically or empirically impossible.
I now turn to the symptoms associated with the disorganized type of schizophrenia. A first key symptom is a form of disorganized speech commonly referred to as ‘derailment’ or ‘loose association.’ In a conversation, individuals exhibiting this form of disorganized speech may suddenly switch from one topic to another (American Psychiatric Organization 2013, 88). Being acquainted with this symptom, Kant assigns it to a class of mental derangement that he labels ‘insania.’ Insania is due to a ‘deranged power of judgment’ (Anth 7: 215). In the Critique of the Power of Judgment, Kant defines the power of judgment as ‘the faculty for thinking of the particular as contained under the universal’ (KU 5: 179). To take a concrete example, the power of judgment enables us to subsume particular dogs under the general concept ‘dog’ and to subsume the concept ‘dog,’ together with other concepts like ‘cat,’ ‘cow,’ and ‘fox,’ under the more general concept ‘animal.’ Kant points out that due to an impairment of this cognitive capacity ‘the mind is seized by analogies that are confused with concepts of similar things, and thus the power of imagination, in a play resembling understanding, conjures up the connection of disparate things as universal’ (Anth 7: 215).
As an illustration of this form of disorganized speech, consider the following example. In a study of nearly 300 schizophrenic patients conducted by Christopher Frith and his colleagues, different groups were asked to perform a verbal fluency task. The task was to name animals. Whereas the group of patients with poverty of speech tended to commit errors of omission, the group of patients with the disorganization syndrome tended to make errors of commission. As an example of the latter type of error, Frith and Johnstone quote a patient who produced the sequence, ‘emu, duck, swan, lake, Loch Ness monster, bacon …’ (2003, 63). This strongly suggests that Kant’s explanation of derailment and loose association in terms of an impairment of the power of judgment is correct.
A last key symptom of disorganized schizophrenia is commonly referred to as ‘word salad.’ In contrast to derailment, the incoherence in word salad occurs within rather than between clauses, which results in speech that is ‘so severely disorganized that it is nearly incomprehensible’ (American Psychiatric Organization 2013, 88, 823). Kant is familiar with the symptom and observes that some patients speak in such a way that ‘no one grasps what they actually wanted to say’ (Anth 7: 215). Assigning the symptom to a class of mental derangement labeled ‘amentia,’ he points out that the symptom is explained by ‘the inability to bring one’s representation into even the coherence necessary for experience’ (Anth 7: 214). Since the understanding is constitutive of experience by synthesizing representations, this suggests that Kant takes word salad to be explained by an impairment of the understanding.
In the first Critique, Kant defines the understanding as ‘a faculty for judging’ (A69/B94). For Kant, to judge is to join two concepts together in such a way that one forms a proposition that is either true or false. ‘Categorical’ judgments provide the typical example. In a categorical judgment, a predicate is ascribed to a subject by means of the copula ‘is’ (e.g., ‘This table is brown’). ‘Hypothetical’ judgments of the form ‘if x, then y’ provide another example. To see how the impairment of the patient’s ability to judge explains the word salad, consider the following case report. In a study in which patients exhibiting the symptom were asked to explain the difference between courage and recklessness, a patient answered,
Courage can only arise from that which he is himself, therefore I can [pause] on the contrary is recklessness, he wants to establish something, launch something, but he doesn’t really have it inside, consequently the truth doesn’t fully stand behind it, recklessness, that is risky things, yes, as opposed to courage.17
When trying to explain the difference between courage and recklessness, most of us would start either by giving definitions (‘Courage is…, whereas recklessness is…’) or by giving conditional statements (‘If someone is courageous, she…; if someone is reckless, she…’). The patient’s inability to distinguish between the two concepts and the resulting word salad can thus plausibly be explained by an impaired ability to employ categorical and hypothetical judgments.