Andrzej Kapusta
Engaged epistemology: the limits of understanding in philosophy and psychiatry
The concept of engaged epistemology reveals some limitations of contemporary
cognitive theories of delusion. By exposing the role of implicit dispositions and abilities in
formation of mental disorders I explicate a thesis that emergence of delusions is accompanied
by a very radical change in the structure of our experience. Such radical alteration of the
Background - nonrepresentational, non–rule-governed, dispositional structure of everyday
understanding that strengthens our perception and reasoning - is crucial for a development of
mental disorder. The concept of engaged epistemology, was introduced to the philosophy of
psychiatry by Richard GT Gipps and Bill Fulford (2004). The project appears to be consistent
with the analysis of such notable philosophers as Martin Heidegger and Maurice MerleauPonty, and contemporary researches: Hubert Dreyfus and Charles Taylor. Moreover, the
elements of this theoretical approach are similar to the concept of embodied mind, developed
in current cognitive sciences.
Understanding psychopathology
Modern psychiatry, fully articulated by the German philosopher and initially also
psychiatrist - Karl Jaspers, defines psychosis as an incomprehensible medical condition. The
question about the possibility of expanding the frontiers of understanding of insanity is
generally associated with a challenging the widely accepted biomedical model. Such model is
the effect of adaptation of a reductionistic and dualistic attitude towards the body-mind
problem. In medicine it is manifested either in the radical separation of mind from the body
and treating disorders of the mind as something quite different from somatic diseases, or as a
reduction of one of the part of such connection - mainly mental disorders - to brain diseases,
and ultimately - psychiatry to neurology.
In new philosophy of psychiatry, many researches try to criticize and overcome
Jaspers’ “incomprehensibility thesis”. They search for various strategies for expanding the
limits of understanding of madness. The possibility of understanding of delusions (and also
disorders of identity and the difficulty in communicating with patients) might be especially
effective by revealing the hidden elements of the experience, looking for a very primitive,
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preconceptual relationship with the world. Some disorders may be more understandable if it is
shown that they are part of a hidden area of the "space of thinking" (Thornton 2007).
They are shown - says Thornton – to lie already within what is available to reason and hence,
to some extent at least, to empathy (Thornton 2007, p. 100).
Other theoretical strategies of broadening our understanding of psychopathology,
especially the bizarre delusional beliefs, explain them as the effect of a "rational" response to
the original anomalous experience. Psychotic states of mind are interpreted as a reasonable
reaction to strange anomalous sensations, the response, which might be largely understood
and expressed to others.
More holistic engaged approach is to clarify the structure of the background of broadly
defined experience. It not only gives the possibility of revealing hidden elements of
experience, but also presents the dynamics and structure of pathological experience.
Psychopathology and engaged epistemology
Observations of atypical forms of experience can help us to bring to light ordinary
(normal) types of consciousness and everyday activities. Understanding of mental disorders
may reveal the general structure of our experience, help in reconstruction of our ways of
thinking and action. The concept “engaged epistemology” was introduced to the philosophy
of psychiatry by Richard GT Gipps and Bill Fulford (2004). They presented the nature of
delusions in terms of living experience and our engagement in the world. Engaged
epistemology is part of a broader phenomenological and hermeneutical tradition, which brings
XXX with it a number of consequences in the form of philosophical critique of certain
assumptions of traditional epistemology. According Gipps and Fulford,
"[...] in my experience itself that the world is first made intelligible to me. [...] affect is not
some mere inner colouration of experience but rather a basic comprehending relation to other
people."(Gipps, Fulford 2004, p. 230).
Such perspective is critical to the traditional forms of epistemology, named by the
authors an “estranged epistemology”. A content of beliefs is defined here as a kind of internal
state and process (whether spiritual, as in Descartes, or material) and is similar to cognitivist’s
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approach to meaning (Thornton 2007). Estranged epistemology gives us illusion of naked
sensory data (brute facts) which are presented to the mind. According Gipps and Fulford such
epistemology is based on a false conception of understanding, where
“[...]my understanding and knowledge of the world are products of reflection on my
experience, which precedes such reflection. That I may be completely unaware of any such
reflection is supposedly not to the point; the cognitive processes, which mediate from
perceptual input to comprehension of what is seen, are typically near automatic and running
completely outside of conscious awareness”. (Gipps, Fulford 2004, s. 229–230).
Such concept of knowledge may seem inadequate from the perspective of engaged
epistemology, being too abstract, formalized and overintelectualized form of description of
our mental activity. In preffered in this article epistemology understanding is the immanent
part of the experience.
“Experience on this view is not typically a precursor of understanding, but itself one of
the media of our comprehension. The fact that we may sometimes not understand what we see
or hear reveals not that all experience is composed of separate sensory and comprehending
components, but that sometimes our natural way of comprehending the world can break own
to be replaced by a more provisional grasp”. (Gipps, Fulford 2004, p. 230).
Engaged epistemology reveals important features of delusional experience and is
critical to contemporary cognitive models of delusions. Gipps and Fulford (2004) see in the
delusion the "profound failure of that contact with reality" (p. 229) or " a failure in experience
to make sense of the world" (p. 233). Classical definition of delusions as false and rigid
beliefs is not able to clarify many important dimensions of delusional thoughts, delusional
feelings, perceptions and moods.
The project of engaged epistemology is not a new insightful approach which seems
especially useful in the area of philosophical psychopathology. It also corresponds to the
broader phenomenological-existential tradition, represented by Merleau-Ponty, whose thought
was inspired by Husserl’s phenomenology and Heidegger’s hermeneutics1. Writers on
phenomenological philosophy of psychiatry characterize crucial epistemological assumptions
of psychopathology, which stress the role of practical engagement with objects.
1
Contemporary scholars such as Hubert Dreyfus (2004) and Charles Taylor (1995), refer to the critical project of
epistemology inspired by the work of Heidegger and Merleau-Ponty.
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Gipps and Fulford believe that Jaspers’ classical distinction between primary and
secondary delusions are often falsely read because of the adoption of narrow, detached
approach to understanding. Within engaged epistemology a concept of experience is broader
than in modern epistemology and science where it is restricted to perceptual access to the
world. Phenomenologial investigations have the purpose to give an accurate account of
subjective life. According to the view presented here experience is a sphere of individual
conscious life, which mediates the relationship with the self and the world. It is individual
component mediating relationships with the world. What is experienced is expressed and can
be communicated to others.
It should be noted that this sort of phenomenological account to psychopathology can
be found in statements by Erwin W. Straus (1958), whose "aesthesiology", the theory of
sensual cognition, describes the nature of everyday experience (the axioms of everyday life),
and reveals the specific characteristics of hallucinations. To fully describe a pathological
experience, one must first comprehend the basic structure of ordinary sense of reality.
According to the German pioneer of phenomenological and existential psychiatry, "the
prelogical sphere of the immediate experience of reality had been eliminated” what represents
"a tremendous loss for psychiatry, because most psychotic experiences, such as hallucination
and delusions, belong in this very realm” (Straus 1958, p. 142).
A sense of reality is directly given, it is not added to the facts, inferred, deduced, nor is
some kind of subjective projection on reality. The author criticizes the approach described
earlier as an "estranged": the separation of mind and body, the ego from the world and passive
perception from the motor activity. Other people are not isolated objects of our perception.
[...] I experience the "alter ego" as partner of my intentions; we meet on the same path in
meaningful cooperation or in meaningful opposition” (Straus 1958, p. 156).
The limits of delusions understanding
Contemporary cognitive theories of delusion are to broaden the possibility of its
understanding. Such mental symptom is explained by rational reaction on anomalous
experience or the as a fault of in inferential reasoning (Maher, Davies). However, it seems
that the attempt to interpret delusions and simultaneously to lay an emphasis on their
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strangeness and weirdness seems to be inconsistent. An analysis of delusions may not be
designed to make it fully comprehensible, but rather to demonstrate why they are
incomprehensible to us, why the patients lose their contact with common sense reality.
Delusions are deeply irrational beliefs, but it is difficult to describe them in terms of
procedural (logical inferences and coherence of beliefs) or epistemic (ir)rationality (good
ways to create a belief, an appreciation of facts and events). Lack of a rigorous constraint on
rationality is part of our more common false statements or prejudices, and religious beliefs
(Bortolotti 2010). The term "inclusive rationality" used by José Luis Bermúdez (2001)
expresses the conviction that, despite the irrationality of psychosis (criteria not met in
procedural and epistemic rationality) delusions seem to be largely understood (Kapusta
2010a). They are probably the result of compensatory psychological mechanisms and
adaptation of disturbed agent. Bermúdez points out that a number of psychotic symptoms help
to maintain a "mental stability". In my opinion, engaged epistemology and phenomenological
tradition of philosophy better identifies non-epistemic determinants of the formation of
delusions, than cognitive analysis. It gives a broader approach to the formation of beliefs and
our relationship with the world and sense of reality. These are in fact situations where an
natural way of understanding the world - establishing meaningful and rational behavior - is
closely related to the maintenance the structure of the background, or some kind of preepistemic attitude. Cognitive theories of delusions seem to ignore important dimensions of
human experience (Bortolotti 2010). In such perspective symptoms are explained as the result
of perceptual dysfunctions and lack of appropriate logical thinking. Cognitive theories do not
recognize the radical change in patient’s existential condition: feeling of unfamiliarity,
disorders of self, loss of a grounding sense of existing as a conscious and acting subject. The
Background structure is a kind of stable field that allows distinguishing between what is
personal and impersonal, what is imaginary and real, making a difference between me and
others.
In opposition to the cognitive view that localizes the "minor" changes in patients’
perception and reasoning (but those that lead to significant instability), the classical biological
approach concentrates on damaged biological mechanisms, which generate incomprehensive
phenomenon - meaningless biological disorder (“empty speech acts”). It should be obvious
that delusions cannot be considered as the variant of the normal type of beliefs or as the
hidden sense which need careful interpretation. A person with schizophrenia does not totally
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lose the structure of the background, patient’s basic pre-epistemic attitude is so changed, that
he or she is not able to maintain restrictive conditions necessary to keep an engaged
relationship to the world. There are also many secondary compensatory strategies, which
make sense of anomalous experience. On the one hand, delusional experience takes the form
of gestalt changes, radical switch in an attitude to events and things. On the other hand, there
is a feeling of estrangement and alienation which makes relation to the world distorted and
fragmented. In contrast to widely accepted pre-cognitive “framework beliefs” (Wittgenstein),
delusional beliefs takes on a very personalized, weird character. Patients themselves,
immersed in social norms and common forms of expression, recognize the uniqueness of their
own experience and behavior. They do not share the common background (“bedrock”) with
other members of their community and are not able to ascribe the content of delusions to
themselves and cannot support their content on intersubjectively acknowledged good reasons.
This state of affairs results in a feeling of unreality of their own experience 2. There is,
therefore, the question of whether delusions, in general, are kind of belief, or - as propose
Gallagher (2009) - an "alternative reality".
A contact with a schizophrenic patient challenge our own way of making sense of
experience. Such person has a difficulty to share feeling of the self, the sense of reality and
follow the “axioms of everyday life” (Straus). Incomprehensibility of schizophrenic
experience doesn’t give us legitimate reason to give up efforts to understand and concente
only on biological dysfunctions of the brain. We cannot know in advance that the patient do
not has anything in common with our background assumptions. From the therapeutic
perspective, it seems that our attitude or properly created human environment may
significantly support the deranged structure of patient’s experience.
Background capacities which condition our understanding of the world have bodily
and social dimensions. Our know-how consists of bodily and mental dispositions such as
feeling of reality, sense of the self and social attunement – a kind of non-propositional social
competences. Disorder results in changing the structure of the patient's way of experiencing
himself and others. These changes were also accompanied by a disorder of a common sense
inability to follow social rules (Stanghellini 2004). Delusions are not solely the objects of
cognition, but reveal the structure of our own worldview and attitudes. Theoretical
2
What is sometimes described as "double bookkeeping" (Bortolotti 2010).
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assumptions and practices also determine the nature of social perceptions of human
pathological behavior. The change has so complex and total character, that reveals:
1. Bodily capacity of synthesis of experience (space and time unity of objects and
experiences),
2. Attunement - ability of sharing a common world with others,
3. Ability to follow social games and relationships.
Clinical and scientific approach develops within a certain paradigm or style of
thinking. It has its own history, tradition, a number of "prejudices" which determines the basic
horizon in which scientific objects appear; it is a platform from which events are recognized
and interpreted. Engaged epistemology reveals that affective and bodily involvement in the
world is a necessary condition for meaningful human activity, regardless of whether we are
dealing with everyday, simple activities, or with sophisticated scientific practices. Research
on delusional beliefs describes the elementary change of experience which some trends in
cognitive sciences (embodied mind) are trying to explain. However, these changes in
experience are always entangled in the wider socio-cultural practices.
Psychiatry and hermeneutics
Our thoughts and feelings are rooted in everyday ways of dealing with the world.
Understanding the background ("background structure") is a prerequisite condition for the
comprehension of more sophisticated meaningful activities. Engaged perspective changes the
traditional epistemological viewpoint. It undermines all forms of epistemological
fundationalism – a search for the elementary base for our thinking and knowledge (which, like
a house should be built on solid foundations.) Involvement is necessary; even highly
reflective conceptual thinking gains its sense within the context. Engaged epistemology
announces the impossibility of full articulation of the background knowledge. Merleau-Ponty
showed how our cognition is deeply embodied, and locates basic sources of activity in bodysubject. Lived body is a source of our intentionality and can’t be totally explained and
objectified. Charles Taylor criticizes the basic assumptions of modern epistemology:
“Instead of searching for an impossible foundational justification of knowledge or hoping to
achieve total reflexive clarity about the bases of our beliefs, we would now conceive this self7
understanding as awareness about the limits and conditions of our knowing, an awareness that
would help us to overcome the illusions of disengagement and atomic individuality that are
constantly being generated by a civilization founded on mobility and instrumental reason”.
(Taylor, 1995, p. 14).
This stance coincides with the hermeneutical perspective. Its purpose is not only to
explicate a sense of human behavior, but also presenting a critical attitude to science and
psychiatry (see Gadamer 2004, and Kapusta 2008). Hermeneutic perspective in psychiatry
reveals hidden assumptions existing in psychopathology and scientific practice, a
"background" - a network of indeterminate beliefs and practices, the horizon which
determines our self-understanding. Critical potential of hermeneutics is particularly directed at
biomedical models that do not appreciate the interpretive nature of scientific activity (see
Phillips 2002).
Involved approach is not able to reach all aspects and peculiarities of psychiatry. First
of all because it concentrates on elementary features of human experience - a sense of self
(ego), a sense of reality and the basis of interpersonal relationships. Forms of embodiment and
the deep bonds between the body and the world allow for a description of actual dimensions
of psychosis and for a deeper analysis of specific mental symptoms. Engaged epistemology
does not exclude, however, a broader hermeneutic perspective. Moreover, the hermeneutical
approach also refers to the hidden background, network of indeterminate beliefs and practices.
In addition to elementary understanding, which gives us a sense of obviousness and
embedness in the world, human action needs more complex strategies of interpretation. The
idea is different from that which was presented by Michel Foucault. French philosopher, in
his early studies on mental illness concentrated on phenomenological and social aspects of
mental illness and gradually focused on cultural and historical experiences of madness. He
analyzed how discourses and power relations created something identified as madness or
mental illness. In the spirit of hermeneutic conception of science, I assume that psychiatry
always has stylish and paradigmatic assumptions, starts with hidden suppositions and adopts a
priori worldview and the concept of human being. In my analysis I reach for very primary
aspects of human experience, which largely ignores the socio-historical background, and is
underpinned by neuro-biological conditions of mental disorder.
From the engage epistemology perspective mental illness is a very specific state of
alienation, loss of familiarity of experience. Such condition reveals many implicit patterns of
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action and forms of expression imposed by the social structure. At the individual level it is
expressed in the form of radical changes in the experience of the self, the world and
relationships with others. The transformation appears to be so serious and deep, that points to
a defect in a very elementary level – disembodiment. This results in loss of primary
relationships with the world, changes in the sense of reality and lack of harmony with other
people. Such research on madness appears to be important not only for psychopathology,
because the analysis of problems and experiences of patients can allow for a richer description
of the actual dimensions of human experience. Such an approach can fulfill the task that Eva
Syristowa set herself - making the world of psychosis (schizophrenia) more accessible,
understandable, and "the understanding of normal psychological spheres, which are otherwise
completely inaccessible to us " (Syristowa 1974).
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