Phenom Cogn Sci (2013) 12:131143

DOI 10.1007/s11097-010-9173-z

Vulnerability to psychosis, I-thou intersubjectivity

and the praecox-feeling

Somogy Varga

Published online: 14 September 2010

# Springer Science+Business Media B.V. 2010

Abstract Psychotic and prodromal states are characterized by distortions of

intersubjectivity, and a number of psychopathologists see in the concrete I-You
frame of the clinical encounter the manifestation of such impairment. Rmke has
coined the term of praecox-feeling, designated to describe a feeling of unease
emanating in the interviewer that reflects the detachment of the patient and the
failure of an affective exchange. While the reliability of the praecox-feeling as a
diagnostic tool has since been established, the explanation and theoretical framing of
the phenomena is still lacking. By drawing on enactivist approaches to social
cognition, the paper will attempt to provide such an explanation. This is relevant, since
such an explanation could contribute to a more precise understanding of the
phenomena in question and possibly add to our knowledge regarding the link between
experiential vulnerability to psychosis and disturbed I-Thou intersubjectivity.

Keywords Psychosis . Praecox-feeling . Second-person . Intersubjectivity .

Enactivism

The onset of psychosis and diagnostics

The term psychosis was applied as a synonym for terms such as mental disorder or
insanity, and it was not till Bumkes work in the 1920s that the term officially
received the meaning that has remained valid until today (Brgy 2008, 1201). It is

S. Varga (*)
Institute of Cognitive Science, University of Osnabrck, Albrechtstrae 28, 49069 Osnabrck, Germany
e-mail: svarga@uos.de

S. Varga
Center for Subjectivity Research, University of Copenhagen, Njalsgade 140-142,
2300 Copenhagen S, Denmark
email: varga@hum.ku.dk
132 S. Varga

usually applied to describing a range of non-pathognomonic symptom (i.e. not

exclusively belonging to a specific disease or condition) and as such, it refers to a
nonspecific cluster of symptoms that may occur not only in psychiatric conditions,
but also as a consequence of a wide variety of medical and neurologic disorders,
pharmacologic treatment, or substance abuse. Psychosis is ascribed to a person
who has critically transgressed the intersubjective bounds of rationality and
engages in a form of thinking that breaks from reality. Besides such a break, the
symptoms may include false, diluted ideas about the state of things that cannot be
shaken by the application of a logical argument. Of course, the criteria required by
the label of psychosis cannot be specified in advance and as an a-historic constant,
since it depends on the contextual understanding of such slippery issues as
rationality and reality.
In schizophrenia, nonspecific symptoms characterize the prodromal phase prior
to the first episode of psychosis (Yung et al. 1996). Such prodromal symptoms are
manifest as subtle experiential changes with behavioural consequences. Patients
might just report that something was basically changed, not quite right, or
definitely wrong (Mller and Husby 2000, p. 227). The changes are described by
the patients as feelings of unreality, various dissociatitive phenomena, decreased
ability to make everyday decisions, increased intolerance of normal stress,
decreased energy, amplified emotional reactivity that often leads to quarrels, and
inability to uphold previously important social bonds, which results in withdrawal
(Bota and Ricci 2007; Bota et al. 2005). During the second wave, the condition
typically worsens, and the perceptual disturbances become the starting point of
delusional beliefs. An improved understanding of prodromal features would have
substantial effects: they may be used to develop early therapeutic interventions,
which could have a positive effect on the quality of life for persons suffering from
schizophrenia. Also, it has often been pointed out that early treatment interventions
may delay or prevent the debut of schizophrenia (Falloon et al. 1998; Haas et al.
1998; Wiersma et al. 1998; McGorry et al. 2002). Of course, having said this,
early, prodromal intervention strategies must take into consideration that a person
diagnosed as having a high risk to develop schizophrenia may cause social stigma
and augment stress that can worsen through the side-effects of pharmacological
intervention. However, it seems there is evidence of the overweighing positive
effect of early intervention of the development of psychotic states (McGorry et al.
2002; McGlashan et al. 2003; Cornblatt et al. 2007; Hafner et al. 2004).
While task of early identification seems critical, initial prodrome seems to
have been particularly elusive to systematic characterization (Mller and Husby
2000). The picture is blurred even more given the fact that the schizophrenia
prodrome usually occurs in the young adult years, which are commonly saturated
by turbulent changes and occasionally by engagement in unusual ideas. Also,
Bleulers pessimism regarding early diagnosis might still be around in research
milieus, along with his view that prodromal stages are nothing but mild morbid
symptoms (Bleuler 1924). Another issue might be that such early detection must
study the patients subjectivity, which is to a certain extent shunned as an
epistemological dogma (Parnas et al. 2005). So an important question remains:
how does one capture these incipient experiential changes for a pre-onset
diagnosis?
I-thou intersubjectivity and the praecox-feeling 133

The praecox-feeling as a diagnostic tool

As Grube (2006) points out, for such diagnosis, intuitive reasoning is often
indispensable, because the standardized classification criteria of the to ICD-10 or
DSM-IV are not always suitable in highly complex and unstable settings. In this article
I will deal with a specific diagnostic tool that focuses not so much on the examination
of the patients experience, but on the quality of the emphatic relation between patient
and interviewer. The idea of recognizing the specific schizophrenic clusters in an
intuitive way goes back to the Dutch psychiatrist Rmke, who used the term praecox
feeling to describe the experience of inability of the therapist to establish emphatic
contact with schizophrenic patients. Such a feeling is described as a kind of bodily
unease emanating in the interviewer that reflects the detachment and alienation of the
schizophrenic patient (Ungvari et al. 1997, 3). In a paper from 1941, Rmke argued
that the praecox-feeling was crucial to diagnosing schizophrenia. The idea is that the
diagnoses should be based upon a broad array of indices, which also include the
praecox-feeling of the psychiatrist. In his words this: ...implies that a feeling, induced
in the clinician, is the final and most important guideline... (Rmke 1941, 336): Since
the symptoms alone do not count as sufficiently reliable, a basis for diagnosis must
include the psychiatrists identification of the symptoms as schizophrenic through the
praecox feeling. While Rmke was well aware of the difficulties in finding the
adequate expression for such experience, he attempted to describe it as the
psychiatrists inability to empathize with the patient the investigator examining a
sufferer from schizophrenia notices something out of the order within himself (Ibid.,
336). The interviewer notices the breakdown of what Rmke also calls the affective
exchange (Ibid., 339), which usually functions smoothly when two people
communicate. So the interviewer establishes a schizophrenic psychosis not on the
basis of the individual symptoms, but rather based on a bodily feeling arising from the
particular interaction with the patient (Peters 2000; Grube 2006). Similarly, Tellenbach
(1968, 1978) has envisaged an atmospheric diagnostic that takes the dissonance
between the two atmospheres proper to each partner as its starting point. The
atmospheric means that in interaction something always exceeds the factual and
remains unexpressed, but that we nevertheless feel it as a certain atmospheric quality
(Tellenbach 1968, p. 47). So an analysis of psychotic disturbances has to proceed from
such an in-between that is constituted by interaction (Tellenbach 1978).
Importantly, departing on Minkowskis (1968) intuition, Rmke does not see this
intersubjective impairment as in any way limited to the clinical setting, or even to
certain types of interaction. He seems to draw a more global picture, involving not
only the patients relation to concrete others, but also to the world.

One becomes acutely aware that this (the praecox feeling, SV) is caused by
something in the patient; the directedness toward other people and the
environment is disturbed. Somewhat pathetically, one could say: the
schizophrenic is outside the human community. This lack of intercourse with
people is not merely an affective disturbance; something is affected that
determines the relationship between people, and this cannot be exhaustively
described by the conventional mental state examination, which after all deals
with patients who are observed in isolation (Rmke 1941, 336).
134 S. Varga

So Rmke really puts forward two claims. It is not just the case that the
schizophrenic fails to engage in concrete communicative encounter. Rather, he also
considers the schizophrenic being outside the lived and shared world, which
manifests itself among other symptoms in the impaired ability to establish the
smooth affective exchange that is constitutive of a communicative encounter. A
few years later, Wyrsch (1946) has similarly interpreted the praecox-feeling as
closely tied to the recognition of not just the inability of communicative encounter,
but as a wholly different modus of being-in-the-world.
One could argue that prior to Rmke, Jaspers has already emphasized the lack of
empathic interaction and understanding (Verstehen) as a significant element in
diagnosing schizophrenia. In his early paper from 1912, Jaspers emphasizes the
difference between the method of natural sciences that rely on sensory perception,
whereas phenomenological psychopathology must rely on an understanding (Ver-
stehen), which in a clinical setting involves experiencing along with the other person,
thus an indefinable and non-reflective immediate understanding (Jaspers 1968
(1912), 1313; also 1963/1913, 2628). In an important paper, Schwartz and Wiggins
(1987) make exactly this point, maintaining a quasi-identity between Rmkes view
and Jaspers notion of the experience of the un-understandable. While both
emphasize the role of affect and second personal interaction, it seems important not
to overstretch this parallel. Jaspers is preoccupied with the understandability of
manifestations, like speech, behaviour (singing in the middle of the night etc.) and it
seems that his notion of understandability is much more specific, involving notions
of rationality, reasons, beliefs etc. This is a different and higher level of understanding
than the one Rmke aims to address. The smooth affective exchange that Rmke
takes to be the epicentre of schizophrenic symptoms, is a more primitive form of
empathic understanding. Here Rmke is in line with Mller-Suur (1962) and Kraus
(2007) who held that the un-understandability of specific manifestations does not
preclude an intuitive and more holistic understanding of the patients embeddedness in
the world. Additionally, Rmke does not seem to fail to notice the bodily dimensions
of such exchange and holds that the praecox-feeling can be triggered by the lack of
bodily expressivity in the patient, due to stiff and rigid body-posture, facial expression
and motor behaviour (Rmke 1941, 337).

Implications

Having sketched Rmkes account one could still ask whether such an approach
could be scientifically validated as a relevant clinical tool. Rmke himself has drawn
attention to a potential problem: due to the vague andper definitionsubjective
nature of the praecox-feeling it might be considered unreliable. At the end, it can
always be the case that the deficient empathic relation occurs due to a failing
engagement from the interviewer/psychiatrist side. Carl G. Hempel (1965, p. 142)
has rejected the praecox-feeling as a scientifically acceptable indication of
schizophrenia, since its occurrence is not independent of the examiner. Obviously,
this is a sound way of reasoning and it seems impossible ensure that other examiners
would have the same experience when confronted with the same data. Hempels
methodological criticism is surely on the mark: scientific knowledge must be
intersubjective and verifiable, independently of individual opinion. Therefore a
I-thou intersubjectivity and the praecox-feeling 135

feeling cannot stand as a basis for scientific judgment. Yet, it seems that there is a
way of proving the scientific relevance of the praecox feeling: an early study
(Carpenter et al. 1973) suggests that a deficient relation with a patient is indeed a
decidedly reliable (indeed the second most reliable discriminatorreliability=0.86),
valid and thus legitimate foundation for diagnosing schizophrenia. More recent
findings also indicated the acceptability of the praecox-feeling in the diagnostic
process. In order to evaluate the diagnostic reliability of the praecox-feeling as an
intuitive clinical approach, Grube (2006) has investigated 67 previously unknown
patients, all displaying symptoms that belong to the schizophrenic spectrum.
Compared with the standardized diagnostic classification the precision of the
intuitive reasoning was remarkably high (sensitivity, 0.85; a specificity, 0.80). The
percentage of correct assignment for schizophrenia diagnosis was 86.6 (according to
ICD-10) or 83.6 (according to DSM-IV). The praecox-feeling was reported
perceptible even before the exploration of particular psychopathological characteristics
that are typical for schizophrenia. Significantly, there were important correlations:
cognitive impairment, affective disturbances, disturbed self-perception, reduced
communication skills and hereditary predisposition to schizophreniaall correlated
with the intensity of the praecox feeling. Crucially, the psychopathological variable
affective disturbance has obtained the highest impact on the intensity of the praecox
feeling (Grube 2006, pp. 209, 214).
In all, it seems that the lack of affective exchange felt below the reflective threshold is
indeed empirically reliable evidence and this has been confirmed in non-western
patients (Ungvari et al. 1957). This empirical state of things does however not close the
case; rather, from a philosophical point of view, it opens the case and leads attention to
a lack of theoretical framing for such findings. The question arises: due to what
mechanism does the praecox-feeling work? As a backdrop of such an explanation,
Rmke himself relies on the anthropological idea of the rapprochement instinct, an
instinctive inclination to establish contact with others usually below the level of
consciousness (Rmke 1941, 336337; Villagrn 2003). The praecox-feeling is in his
view a direct consequence of diminution of such an instinct in the patient.
Nonetheless, such an anthropological feature seems like a very week basis for
theoretically framing the phenomenon, and since Rmke provides no further evidence,
it remains a postulate. Thus, an adequate theoretical framing and explanation of the
phenomenon is needed, not just in order to retrospectively explain the occurrence of
the phenomenon, but also because such an explanation could shape and make more
precise the way we think of the phenomenon in question. This is very much in line
with what Tatossian (1979) has been called as making explicit. The aim of the next
sections will be to provide such an explanation and thereby to make apparent (or
explicit) some potentially hidden factors that are nevertheless involved in establish-
ing diagnoses. The paper thereby seeks to contribute to the ongoing dialogue on
diagnostic practices pertaining to the schizophrenic spectrum.

Social cognitionthe view from enactivism

Due the nature of the impairment, an adequate explanation of the praecox-feeling

must address the mechanisms involved in social cognition and intersubjective
136 S. Varga

understanding. So, a satisfactory answer could only be given, if the relevant

intersubjective processes that make such phenomenon possible in the first place are
made apparent. When consulting current theories of social cognition, the
predominance of the representational view is not difficult to spot. The basic
assumption of such a view is that we understand the behaviour of others by
representing their mental states. There have been several and opposing models of
how such a general view can be operationalized: concepts such as the theory-
theory of mind, simulation or mentalisation have appeared, and common to them
is the preference of a third-person paradigm of social cognition. Roughly, they hold
that in order to understand others, we put into operation a theory about the way
people act and that our understanding is the outcome of an inferential, simulative or
projective process. The theory-theory approach claims that socially understanding
another persons inner states or behaviour, relies on our acquired theory (of usual
behavioural patterns and patterns of causation between mental states and behaviour)
and on our ability to make inferences about the mental states of others on this basis
(Premack and Woodruff 1978; Baron-Cohen et al. 1986). As a second option,
simulation-theory claims that we use our own mind to simulate another persons
mental states. We understand beliefs and intentions of others, because we simulate
them as if we were in their situation (Goldman 2006; Gallese and Goldman 1998).
However, in the last few years, the representationalist approaches to social cognition
have been increasingly criticized. Main targets of criticism include over emphasis on
cognitive aspects and the exaggerated focus on the individual (Hutto 2004), while
there is a deficiency of attention to embodiment (Gallagher 2001; Gallagher and
Hutto 2008). What is more significant when considering the topic of this paper,
representationalist approaches have been criticized for their lack of attention to the
second personal interaction process (Gallagher 2001; Gallagher and Hutto 2008),
and thus for neglecting the possibility that interaction in itself could be constitutive
of our understanding of others (Fuchs and De Jaegher 2009; De Jaegher and Di
Paolo 2007; Hobson 2002). This criticism is effective: representationalist approaches
to social cognition understand interaction as something that only happens after we
decode or predict intentions and behaviours of others on the basis of inference or
simulation. Alternative, non-representational directions are emerging: Gallagher
(2001, p. 203) has suggested an interaction theory by which he proposes that in
second-person interactions, the mind of the other is not entirely hidden or private,
but is given and manifest in the other persons embodied comportment. In the
following, this paper will draw on the so-called enactive approach in order to
understand the nature of social understanding and to provide a coherent framework
within which the phenomenon of the praecox-feeling can be explained.
From the enactivist point of view, understanding cannot be reduced the solitary
deciphering or simulating mental states or behaviour of another person. Instead, it
always involves a process of embodied interaction that is constitutive of and to a
certain extent generates understanding. Before mind readingin terms of theorizing
or simulating the mental states of others (which indeed can be necessary)the
dynamic process of participatory sense-making, mutual incorporation and thus
the interaction and coordination of two embodied agents is already taking place
(Fuchs & De Jaegher 2009). The point is that the interaction pertinent to social
cognition does not just lie at the end of a cognitive process, but might be already be
I-thou intersubjectivity and the praecox-feeling 137

at the core of intersubjectivity. In such a non-representational view, social

understanding arises in the moment-to-moment interaction of persons. The basic
assumption grounding the enactivist approach is quite straightforward: We actively
participate in the generation of meaning, instead of just being passive agents who
receive environmental input and convert it into internal representations (Di Paolo et
al. 2008). We are essentially cognitive agents and our appearing world is not
something like the internal representation of a pre-existing entity, but the outcome
of an interactive process between our activity and environmental feedback (Varela
et al. 1991; Thompson 2007; Di Paolo et al. 2008). In this view, the same basic
ideas also apply to social cognition: it is the result of a social interactive process
that involves the circular-dynamical coordination between agents; social under-
standing emerges from a skilful social interaction, in which the process of
interacting itself plays a leading role for the understanding (De Jaegher 2009).
Such interaction involves coordination, thus the non-accidental correlation
between the behaviours of two or more systems (De Jaegher and Di Paolo
2007, p. 490). When examining the structure of everyday interactions, an ongoing
and mostly unconscious coordination (variable in strength) is observable. Such
coordination involves mirroring and anticipating each others movements and
gazes. There is an ongoing flow of interactive coordination: Listeners tend to
coordinate their movements with the changes in speed, direction and intonation of
the movements (Schmidt and OBrien 1997) and utterances (Grammer et al. 1998;
Issartel et al. 2007) of the other. Such interaction-generated coordination includes
bodily resonance; affect attunement; coordination of gestures and gases; expres-
sion; rhythmic co-variation of gestures; eye contact (Bavelas et al. 2002) and even
observable heart-rate coordination (Neugebauer and Aldridge 1998). The intrinsic
link between perception and action is also clearly manifest in the so-called
chameleon effect that refers to the unconscious coordination and mimicry of the
postures, facial expressions and other behaviour of ones interaction partners, such
that behaviour changes to match that of others. Coordination ranges from basic
resonance to the coordination of intentions.

Affect exchange

Significantly, such coordination encompasses mutual affect regulation that has been
described in developmental psychology and has been connected to the early
interactions between the infant and the caretaker (Reddy 1996; Stern 1985/1998).
Affective bodily based attachment processes are interactively regulated within the
motherinfant dyad (Schore and Schore 2008). Children are engaged in patterns of
proto-conversation, a coordination of motion, vocalization and affect that enable
mutual regulation. The subtle timing of the interaction matters: Murray and
Trevarthen (1985) have shown the interaction of mother and baby via a double
TV monitor. When the live footage of the mother is suddenly replaced with a
recording of her behaviour earlier in the same interaction, the child shows signs of
agitation and distress, which were not the case under earlier interaction through the
video-link. It seems that the positive and expressive behaviour the mother towards
the infant is not enough: her behaviour is not modulated to encompass the childs
affectively engaged activity. Both the infant and the mother are shown to be sensitive
138 S. Varga

to such failing of the ongoing flow (Murray and Trevarthen 1986). Indeed, not only
in the enactivist outlook, but such exchange or empathic resonance is known as a
phenomenon that involves unconsciously mirroring the motor actions as a basis of
emotional expressions. Understanding the mental states is of others is loop-like,
since instead of merely involving cold cognition, the interaction includes the
affective experience of the other persons emotional state. Such an idea of the affect
exchange is confirmed in Daniel Sterns (2005) recent of work on the microanal-
ysis of analystpatient encounters and patient, but also in (neuro)scientific studies
into the so-called mirror-neuron system (MNS). Departing from the observation that
the same brain areas are active when one performs an action and when one observes
another perform the same action (Rizzolatti et al. 1995), the study of MNS has
offered a new possible account of empathy. The human MNS plays a key role in
social cognition. This has been addressed in several studies and an ongoing low-
level mechanism of neural mimicry is found to be constitutive in understanding
others (see Iacoboni and Dapretto 2006). The same resonance mechanisms are
activated when a subject inhales disgusting odorants and when observing disgust-
expressive faces (Wicker et al. 2003), and when feeling pain and observing another
in pain (Singer et al. 2004). In both these accounts, in Rmkes work and the
empirical data presented by Guber, the affective aspect of social cognitionthe
interactive affective exchangeseems to be the most central issue in understanding
others.

Broad-view enactivism

While the enactivist approach to social cognition opens up promising alternatives, in

order to provide an explanation of our issue in this paper, it needs to be
supplemented by an aspect that proponents of enactivism tend to neglect. It seems
to me that their focus on the concrete encounter, results in a somewhat narrow view
of intersubjectivity. I agree that social understanding is generated in interaction, but I
want to add that interaction cannot be reduced to the concrete interaction with the
other. Firstly, prior to interaction, we always already live in and interact with an
intersubjectively constituted space, in which such an encounter takes place. A
concrete encounter presupposes a more fundamental form of intersubjectivity that is
rooted a priori in the very relation between subjectivity and world (Zahavi 2001,
p. 165). It is not just that our perceptions immanently refer to the possible
perceptions of an infinite number of possible subjects: they are somehow present in
perception as co-subjectivity, regardless of their actual presence (Varga, in press). As
Husserl has noted, our (horizontal) intentionality already entails a reference to inter-
subjectivity (Husserl 1950, Hua I, p. 148). This is the level of intersubjectivity that
Husserl attempts to convey in the term open intersubjectivity, on which such
concrete encounters depend a priori. In other words, interaction requires a sense of
co-awareness, or the sense of being in an open horizon of co-subjects (Husserl
1973, Hua XV, p. 497). This is not the place to provide a rich account of the deep
level of intersubjectivity. The point is that the kind of understanding interaction in
question cannot be reduced to the concrete interaction between two persons, but
needs to take into account interaction within the space of open intersubjectivity. An
enactivist view that also encompasses the level of open intersubjectivity could be
I-thou intersubjectivity and the praecox-feeling 139

called a broad-view enactivism. This idea is actually not very far from the idea of
between-ness that Buber has defended. In correspondence with this enhanced
enactivist view, Buber considered the I-Thou relation not only as an ontic event
that actually occurs between two human beings and which cannot be reduced to the
sum of two experiences. Buber also believed, that humans are created with an
inborn Thou (Buber 1971, pp. 7879), an innate ability to know and be known.
Each particular I-Thou relationship mirrors and shows glimpses the transcendental
relationship with the eternal Thou (Ibid., 24) who is God. Without involving the
theological issues, we can say that Buber also thought of the concrete I-Thou
encounter as embedded within a transcendental relation: In the beginning, there was
relation (Buber 1971, p. 69). Such a view, then, is very close to the idea of the
transcendental intersubjectivity that we have seen in Husserl.
To summarize this section, the enactivist view recognizes the constitutive role of
the process of interaction in social cognition. I have suggested a broad-view
enactivist approach to social cognition, arguing that interaction must be expanded to
encompass the level of open intersubjectivity. In this view, the interaction process
conceptualized as taking place in the open horizon of co-subjectsacquires a kind of
autonomy that cannot be reduced to the sum of the acts of the persons involved.
Patterns of interaction emerge and acquire meaningfulness beyond the meaning
of the individual actions. Having outlined essential features of the enactivist
approach to social cognition, let us now return to our main issue and attempt to
make sense of the praecox-feeling within this framework.

The praecox-feeling from an enactive perspective

Both Jaspers and Rmke seem to agree that what is recognized in the praecox-
feeling simply cannot be put into words: it is an encounter with the incomprehen-
sible. Yet, the case might be that the sense of inability to convey a certain meaning is
just the result of inadequate vocabulary. Indeed, what Rmke attempts to express is
very convoluted. On the one hand, he wants to convey the lack of resonance and the
impaired bodily and emotional coordination. In the enactivist perspective, this is
explicated as the breakdown of social understanding, which arises from a mutual and
implicit experience of commonly generated meaning patterns. This is why the
therapist cannot establish genuine emphatic contact with the patient. So the praecox-
feeling is the experienced inability of realizing such patterns and affective exchange.
But the lack of empathy cannot merely refer to the lack of Einfhlung, since the
patients emotions still reverberate in the interviewer. Instead, the breakdown of this
smooth affect-exchange means that the interviewers self-relation changes. As
Rmke (1941, p. 336) notes: As interpersonal relations are not one-sided, the
investigator examining a sufferer from schizophrenia notices something out of the
order within himself. What is wrong is then not just the emanating feeling, but a
sort of destabilisation: when establishing an encounter, we usually lean into a
relation, which is stabilized by the process of interaction and reverberation that
usually gains its own autonomy. We project ourselves and create a common space
and our mode of self-relation that characterizes such projection depends on the
autonomy of the smooth-exchange. In this sense, the praecox-feeling is the
140 S. Varga

unbalanced result when we lean into an encounter that is not stabilized by an

emerging, mutual and autonomous process of sense-making. Such a reaching out
towards the other has a strong affective dimension and we immediately sense what
De Jaegher and Di Paolo (2007, p. 490) have called varying degrees of
connectedness with the other. Importantly, the praecox-feeling is then not a
secondary manifestation of frustration over the lack of connectedness (this would be
the view from the representationalist accounts), but is simply the manifestation of
disconnectedness. So in all, having connected these dots I think it is safe to say that
at least this part of Rmkes idea can understood with and theoretically underpinned
by the broad-view enactivist approach.
On the other hand, Rmke claims more than just that: the emanating feeling in the
interviewer reflects not merely the lack of direct contact, but the general detachment
and alienation of the schizophrenic patient. Rmke (1941, p. 336) emphasizes that
the skilled interviewer also notes the directedness toward people and the
environment and that the schizophrenic is outside the human community. But
this does not really follow. From the concrete distorted encounter, one could argue,
there is no way of inferring the complete alienation of the patient from the broadest
sense of intersubjectivity. Also, if it were the case, it could not have been explained
only by relying on the standard-account of enactive social cognition. Yet, if we call
into mind the broad-view enactivist account that I have proposed, Rmkes claim no
longer seems inconsequent and it can indeed be made sense of as simply referring to
another level of explanation. I have said that prior to our interaction, we always
already live in (and interact with) an intersubjectively constituted space, in which
such an encounter takes place and which presupposes a more fundamental form of
intersubjectivity that is rooted a priori in the very relation between subjectivity and
world. Rmkes claim could then be understood if we took the human community
to refer to this basic level of constitutive and transcendental intersubjectivity.

Conclusion

This paper noted that while it is commonly accepted thatin schizophrenia

nonspecific symptoms and subtle experiential changes characterize the prodromal
phase prior to the first episode of psychosis, it is still a great challenge to capture
these incipient experiential changes for a pre-onset diagnosis. Also, many hold that
psychotic and prodromal states are characterized by distortions of intersubjectivity
and a number of psychopathologists see in the concrete I-You frame of the clinical
encounter, the manifestation of such impairment. Tying these two aspects together,
the paper dealt with a specific and seemingly reliable diagnostic tool: the praecox-
feeling that focuses not so much on the direct experience of the patient, but on the
quality of the emphatic relation between the patient and the interviewer. Rmkes
claimsthat the schizophrenic fails to engage the smooth affective exchange of a
concrete communicative encounter and the schizophrenic being outside the lived
and shared worldwere underpinned and substantiated by drawing on and
modifying an enactivist approach to social cognition.
A conclusion usually represents an accepted fact (the existence of the praecox-
feeling), while the reason (that I aimed to provide) usually represents a cause of that
I-thou intersubjectivity and the praecox-feeling 141

fact. Its purpose is to help us understand how or why that fact occurs. If we say that
the praecox-feeling was the phenomenon to be explained (explanandum), the slightly
enhanced broad-view enactivist account of social cognition figured as a set of
interlocking statements designed to shed light on the phenomenon (explanans). But
strictly speaking, the explanandum-explanans continuum also harboured an
epistemic surplus, namely a contribution towards a more precise understanding of
the phenomenon in question, which is not passive but performative: firstly, it
changes the way we think of the phenomenon and secondly it might add to our
knowledge of the link between experiential vulnerability to psychosis and disturbed
I-Thou intersubjectivity. In addition, the explanation also involved a more general
argument, thus a set of statements designed to provide a rational basis for
establishing the truth or probability of an idea. In other words, the aim to help us
understand why it is the case, was paired with and motivated by the effort to
convince the reader that in order to understand the ways of our mental lives, we
need to pay attention to the concrete, second personal encounter and its
transcendental conditions. This of course means that we cannot exclusively rely on
merely third or first personal approaches.

References

Baron-Cohen, S., Leslie, A. M., & Frith, U. (1986). Mechanical, behavioural and intentional
understanding of picture stories in autistic children. British Journal of Developmental Psychology,
4, 113125.
Bavelas, J. B., Coates, L., et al. (2002). Listener responses as a collaborative process: The role of gaze.
The Journal of Communication, 52, 566580.
Bleuler, E. (1924). Textbook of psychiatry. Translated by A.A. Brill. New York: The Macmillan Company.
Bota, R. G., & Ricci, W. F. (2007). Empathy as a method of identification of the debut of the prodrome of
schizophrenia. Bulletin of the Menninger Clinic, 71(4), 312324.
Bota, R. G., Munro, J. S., & Sagduyu, K. (2005). Identification of the schizophrenia prodrome in a
hospital based patient population. Missouri Medicine, 102(2), 1548.
Buber, M. (1971). I and thou. New York: Charles Scribners Sons.
Brgy, M. (2008). The concept of psychosis: historical and phenomenological aspects. Schizophrenia
Bulletin, 34, 12001210.
Carpenter, W. T., Jr., Strauss, J. S., & Muleh, S. (1973). Are there pathognomonic symptoms in
schizophrenia? An empiric investigation of Schneiders first-rank symptoms. Archives of General
Psychiatry, 28, 847852.
Cornblatt, B. A., Lencz, T., Smith, C. W., Olsen, R., Auther, A. M., Nakayama, E., et al. (2007). Can
antidepressants be used to treat the schizophrenia prodrome? Results of a prospective, naturalistic
treatment study of adolescents. The Journal of Clinical Psychiatry, 68, 546557.
De Jaegher, H. (2009). Social understanding through direct perception? Yes, by interacting. Consciousness
and Cognition, 18(2), 535542.
De Jaegher, H., & Di Paolo, E. (2007). Participatory sense-making: An enactive approach to social
cognition. Phenomenology and the Cognitive Sciences, 6, 485507.
Di Paolo, E., Rohde, M., & De Jaegher, H. (2008). Horizons for the enactive mind: Values, social
interaction, and play. In J. Stewart, O. Gapenne, & E. Di Paolo (Eds.), Enaction: Towards a new
paradigm for cognitive science. Cambridge: MIT.
Falloon, I. R., Coverdale, J. H., Laidlaw, T. M., Merry, S., Kydd, R. R., & Morosini, P. (1998). Early
intervention for schizophrenic disorders. The British Journal of Psychiatry, 172(Suppl 33), 3338.
Fuchs, T., & De Jaegher, H. (2009). Enactive intersubjectivity: Participatory sense-making and mutual
incorporation. Phenomenology and the Cognitive Sciences, 8(4), 465486.
Gallagher, S. (2001). The practice of mind: Theory, simulation or primary interaction? Journal of
Consciousness Studies, 8, 83108.
142 S. Varga

Gallagher, S., & Hutto, D. D. (2008). Understanding others through primary interaction and narrative
practice. In J. Zlatev, T. Racine, C. Sinha, & E. Itkonen (Eds.), The shared mind: Perspectives on
intersubjectivity. Amsterdam: John Benjamins.
Gallese, V., & Goldman, A. (1998). Mirror neurons and the simulation theory of mind-reading. Trends in
Cognitive Sciences, 12, 493501.
Goldman, A. (2006). Simulating minds. The philosophy, psychology, and neuroscience of mindreading.
Oxford: Oxford University Press.
Grammer, K., Kruck, K. B., & Magnusson, M. S. (1998). The courtship dance: patterns of nonverbal
synchronization in opposite-sex encounters. Journal of Nonverbal Behavior, 22, 329.
Grube, M. (2006). Towards an empirically based validation of intuitive diagnostic: Rumkes praecox
feeling across the schizophrenia spectrum: preliminary results. Psychopathology, 39(5), 209217.
Haas, G. L., Garratt, L. S., & Sweeney, J. A. (1998). Delay to first antipsychotic medication in
schizophrenia: Impact on symptomatology and clinical course of illness. Journal of Psychiatric
Research, 32(34), 151159.
Hafner, H., Maurer, K., Ruhrmann, S., Bechdolf, A., Klosterkoetter, J., Wagner, M., et al. (2004). Early
detection and secondary prevention of psychosis: facts and visions. European Archives of Psychiatry
and Clinical Neuroscience, 254, 117128.
Hempel, C. G. (1965). Aspects of scientific explanation. New York: The Free Press.
Hobson, R. P. (2002). The cradle of thought. London: Macmillan.
Husserl, E. (1950). Cartesianische Meditationen. In: Husserliana Vol. I, Haag 1950 [Hua I], (Husserl
1973, Hua XV, 497).
Husserl, E. (1973). In I. Kern (Ed.), Zur Phnomenologie der Intersubjtivitt. Texte aus dem. Nachla.
Dritter Teil. 19291935, (Hua XV). Dordrecht: Kluwer.
Hutto, D. D. (2004). The limits of spectatorial folk psychology. Mind and Language, 19(5), 548573.
Iacoboni, M., & Dapretto, M. (2006). The mirror neuron system and the consequences of its dysfunction.
Nature Reviews. Neuroscience, 7, 942951.
Issartel, J., Marin, L., & Cadopi, M. (2007). Unintended interpersonal coordination: can we march to the
beat of our own drum? Neuroscience Letters, 411, 174179.
Jaspers, K. (1968 (1912)). The phenomenological approach in psychopathology. The British Journal of
Psychiatry, 114, 13131323.
Jaspers, K. (1963/1913). In J. Hoenig & M. W. Hamilton (Eds.), General psychopathology. Manchester:
Manchester University Press.
Kraus, A. (2007). Schizophrenic delusions and hallucinations as the expression and consequence of an
alteration of the existential a prioris. In M. C. Chung, K. W. M. Fulford, & G. Graham (Eds.),
Reconceiving Schizophrenia (pp. 97111). Oxford: Oxford University Press.
McGlashan, T. H., Zipursky, R. B., Perkins, D., et al. (2003). The PRIME North America randomized
double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally
symptomatic for psychosis. I. Study rationale and design. Schizophrenia Research, 61(1), 718.
McGorry, P. D., Yung, A. R., Phillips, L. J., et al. (2002). Randomized controlled trial of interventions
designed to reduce the risk of progression to first-episode psychosis in a clinical sample with
subthreshold symptoms. Archives of General Psychiatry, 59, 921928.
Minkowski, E. (1968). Le temps vu, tudes phnomnologiques et psychopathologiques. Neuchtel:
Delachaux et Niestle.
Mller, P., & Husby, R. (2000). The initial prodrome in schizophrenia: searching for naturalistic core
dimensions of experience and behaviour. Schizophrenia Bulletin, 26, 217232.
Murray, L., & Trevarthen, C. (1985). Emotional regulation of interaction between two-month-olds and
their mothers. In T. M. Field & N. Fox (Eds.), Social perception in infants (pp. 101125). Norwood:
Ablex Publishing.
Murray, L., & Trevarthen, C. (1986). The infants role in motherinfant communications. Journal of Child
Language, 13, 1529.
Mller-Suur, H. (1962). Das Schizophrene als Ereignis. In H. Kranz (Ed.), Psychopathologie heute (pp.
8193). Stuttgart: Thieme.
Neugebauer, L., & Aldridge, D. (1998). Communication, heart rate and the musical dialogue. British
Journal of Music Therapy, 12(2), 4652.
Parnas, J., Handest, P., Jansson, L., & Saebye, D. (2005). Anomalous subjective experience among fi
rstadmitted schizophrenia spectrum patients: empirical investigation. Psychopathology, 38, 259267.
Peters, U. H. (2000). Lexikon der Psychiatrie, Psychotherapie, klinischen Psychologie. Mnchen/Jena:
Urban & Fischer Verlag.
I-thou intersubjectivity and the praecox-feeling 143

Premack, D., & Woodruff, G. (1978). Does the chimpanzee have a theory of mind? The Behavioral and
Brain Sciences, 4, 515526.
Reddy, V. (1996). Omitting the second person in social understanding. The Behavioral and Brain
Sciences, 19, 140141.
Rizzolatti, G., et al. (1995). Premotor cortex and the recognition of motor actions. Cognitive Brain
Research, 3, 131141.
Rmke, H. C. (1941). The nuclear symptom of schizophrenia and the praecoxfeeling. Translated by
Neeleman, J. History of Psychiatry, 1, 331341.
Schmidt, R. C., & OBrien, B. (1997). Evaluating the dynamics of unintended interpersonal coordination.
Ecological Psychology, 9, 189206.
Schore, J. R., & Schore, A. N. (2008). Modern attachment theory: the central role of affect. Regulation in
development and treatment. Clinical Social Work Journal, 36, 920.
Schwartz, M. A., & Wiggins, O. P. (1987). Typifications: the first step for clinical diagnosis in psychiatry.
The Journal of Nervous and Mental Disease, 175(2), 6577.
Singer, T., Seymour, B., ODoherty, J., Kaube, H., Dolan, R. J., & Frith, C. D. (2004). Empathy for pain
involves the affective but not sensory components of pain. Science, 303, 11571162.
Stern, D. N. (1985/1998). The interpersonal world of the infant: A view from psychoanalysis and
developmental psychology. New York: Basic Books.
Stern, D. N. (2005). The present moment in psychotherapy and everyday life. New York: Norton &
Company.
Tatossian, A. (1979). Phnomnologie des psychoses. Paris: Masson.
Tellenbach, H. (1968). Geschmack und Atmosphre. Salzburg: O. Muller.
Tellenbach, H. (1978). Zeitschrift fr Klinische Psychologie und Psychotherapie, 26(2), 1428.
Thompson, E. (2007). Mind in life: Biology, phenomenology, and the sciences of mind. Cambridge:
Harvard University Press.
Ungvari, G. S., Chiu, H. F. K., et al. (1997). Conceptual issues in the diagnosis of schizophrenic
psychoses. Hong Kong Journal of Psychiatry, 7(2), 38.
Varela, F. J., Thompson, E., & Rosch, E. (1991). The embodied mind: Cognitive science and human
experience (6th ed.). Cambridge: MIT.
Varga, S. (In press) Depersonalization and the sense of realness. Philosophy, Psychology and Psychiatry.
Villagrn, J. M. (2003). Consciousness disorders in schizophrenia: a forgotten land for psychopathology.
International Journal of Psychology and Psychological Therapy, 3, 111140.
Wicker, B., Keysers, C., Plailly, J., Royet, J. P., Gallese, V., & Rizzolatti, G. (2003). Both of us disgusted
in my insula: the common neural basis of seeing and feeling disgust. Neuron, 40, 655664.
Wiersma, D., Nienhuis, F. J., Slooff, C. J., & Giel, R. (1998). Natural course of schizophrenic disorders: a
15-year followup of a Dutch incidence cohort. Schizophrenia Bulletin, 24(1), 7585.
Wyrsch, J. (1946). ber die Intuition bei der Erkennung des Schizophrenen. Schweizerische Medizinische
Wochenschrift, 46, 11731176.
Yung, A. R., McGorry, P. D., McFarlane, C. A., Jackson, H. J., Patton, G. C., & Rakkar, A. (1996).
Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin, 22(2),
283303.
Zahavi, Dan. (2001). Beyond empathy: Phenomenological approaches to intersubjectivity. In E. Thompson
(Ed.), Between ourselves: Second-person issues in the study of consciousness (pp. 151167). Thorveton:
Imprint Academic.