Must Out of Sight Mean Out of Mind? Levinas,Language,and the Schizophrenic Other

Introduction

“Language as an exchange of ideas about the world . . . presupposes the originality of the face without which . . . it could not commence” (Levinas, 1979, p. 202). Emmanuel Levinas spoke out passionately against reductionist language. In therapeutic terms, reductionism translates into letting the diagnosis speak instead of the patient. Even now, mainstream psychology holds Karl Jaspers’s view that diagnoses and terms are a necessary template; that we must label schizophrenia and its symptoms in terms of form rather than content because such individual characteristics of the content mean there is no truth in such experiences for a therapist to understand (1913/1997). I contend that Levinas offers an ethical alternative to this rather dehumanizing point of view by reminding therapists that only the Other human being knows the truth of his own individual experience, and this holds true for schizophrenics just as much as for therapists, or anyone else for that matter.

Furthermore, Levinas’s view is not merely theoretical. It is practical in that he absolves therapists from comprehending the patient fully by seeking one universal truth or template to contain them. However, it is the job of the therapist to understand the nature of patient’s struggle. Levinas can help therapists here as well. He reminds us that language (the primary tool of a psychotherapist) can be both a bridge and a barrier for communication between unique individuals, especially therapist and patient. Psychological language is liberating when it gives words to those who do not yet have their own vocabulary, but terminology can still their voices if it reduces their experience to generalizations.

Levinas and the Schizophrenic Other

Levinas writes of the limitless distance between all individuals in his Totality and Infinity. Behind the face of the Other person, the physical features and affect, is the vast reach of interiority. He writes that “The face is present in its refusal to be contained. In this sense it cannot be comprehended, that is, encompassed” (1979, p. 194). This is because for Levinas, the human face was much more than a membrane stretched over a bony casing. For Levinas, the face was the manifestation of transcendence. The infinite uniqueness and Otherness of the person not only shows in their face, but always overflows their mere appearance. The face is not just flesh. It is the way the Other presents himself while always exceeding not only his own form and image but also any idea I have about him and his character. It is “the infinite in the finite, the more in the less” (p. 50). The infinity of the interior is constantly being produced so that it is in a perpetual state of beyond. It is beyond comprehension, beyond summary, beyond any boundary or template imposed upon it no matter how much of it might be discovered.

Before we go any further, it is important to note that I do not intend to reduce the full complexity of Levinas’s Other–I relationship to that of patient–therapist. According to Levinas, the Other comes from a transcendent height, and I am forever below. The dimension of height is noteworthy and its application or lack thereof to the therapeutic relationship has been long debated among philosophers and psychotherapists. However, this paper will focus on Levinas’s dimension of distance as applied to the therapist and patient, as well as the benefits and deficits of language to bridge that distance. The various angles of therapeutic height will not be discussed here.

Levinas’s insights into the dynamic of relation versus totalization are particularly useful when a therapist is faced with a schizophrenic patient, for two reasons. First, the interiority of a schizophrenic Other is unique, as are those of all Others with whom we come in contact. Second, schizophrenic patients have marked difficulties relating across the distance that separates each person from everyone else. However, Levinas’s insight is even more important in that it helps therapists to remember that the second does not negate the first. No matter what his words or lack thereof, the schizophrenic patient is an Other with an infinite internal landscape and his face, in Levinas’s sense, is beyond our totalization or comprehension.

By “comprehension,” I mean that we can never know a schizophrenic patient fully, not that we can never understand them at all, the way Karl Jaspers maintained (1913/1997). He was so impressed with the idiosyncratic nature of the schizophrenic person that he proposed that hallucinations be classified according to form rather than content, for the content itself was so unique from case to case as to lack pathognomic finality; he wrote that hallucinations were basically empty and meant nothing, and thus could never be understood by a reasonable person (1913/1997).

Nothing could be further from the insight Levinas offers: that the schizophrenic is an Other coming from his own viewpoint with his own meanings—not that his meanings, however bizarre, do not exist simply because we cannot comprehend them. “Madness is, after all, defined by its very difference from reason,” writes Brendan Stone (2004), “. . . generally Speaking it is characterized variously by fragmentation, amorphousness, entropy, chaos, silence, and senselessness” (p. 18). In the past century we reasonable ones have grown skittish of the chaos of madness, especially that of schizophrenia. Although it is the second-oldest defined mental disorder, schizophrenia defies categorization. It is both amorphic and polymorphic in that no one is sure whether it has no form at all or whether it is actually several different things. Either way, its vague outline does not sit easily with the Age of Reason. We tend to turn away from the possibility of meaning in schizophrenia. “Hence an abyss yawns in the middle of confinement; a void which isolates madness, denounces it for being irreducible, unbearable to reason” (Foucault, 1965/1988, p. 228). Levinas, with his ethics of relation between two infinitely distant, irreducible, Other beings, absolves the therapist from knowing the final, static truth about a schizophrenic patient. A therapist does not have to set the patient to a template in order to sit with him. Antonin Artaud declared, “I am not of your world / mine is on the other side of all that is, knows itself, is / consciousness, desires and acts. / It’s entirely another thing” (1965, p. 201). Levinas’s ethics allows room for both the therapist’s world of reason and the world of the schizophrenic patient in all its amorphous, alien, unreasonable Otherness.

Relation Versus Totalization

“How can the same . . . enter into a relationship with an other without immediately divesting it of its alterity?” (Levinas, 1979, p. 38). In other words, if Levinas demands that an ethical therapist not totalize the schizophrenic patient, then what is the therapist to do? Levinas can help here as well. Instead of attempting to comprehend, he advises the therapist to relate. “The relation between the same and the other—upon which we seem to impose such extraordinary conditions—is language” (p. 39). Dialogue is not only the primary tool of a therapist, but it is also a form of relation that does not totalize. Levinas writes that language is the universal: it takes the individual into the general. It allows people to relate, draws them together into a common world, while also allowing them to remain separate. All therapeutic conversation is the patient informing the therapist of their meaning.

Reba M. was a former client of mine, a 62-year-old woman who did not endorse her diagnosis of schizophrenia. Moreover, she was caught in the borderland between semifunctioning and psychosis. When lucid she presented well, from fashionable sandals matching her earrings to her tasteful pale lipstick to her sophisticated hairstyle. Reba could be charming and expressive, both with her body language and her vocabulary, when she was having a few good months.

Yet Reba’s problems were many. She was homeless and preferred to view me as someone who could help her find a place to live instead of a therapist or mental health counselor. After an all-too-brief summer, the fog would close in. Within one month her tone flattened. Her body language changed too, her arms dangling slack from slumped shoulders and her strides carefully measured, testing the floor with each. Her hair became snarled and oily and her facial expression flattened until she stared, glassy-eyed, into space.

She became verbally abusive and occasionally threatening.

During one of her periods of relatively high functioning she had informed me that her mother had been diagnosed and treated for schizophrenia. “I had to watch her drooling. She had to wear a bib.” Reba was adamant that she herself did not have a mental health diagnosis, and often reminded me that I did not know what was going on in her head.

Reba occasionally mentioned her son, usually in connection with where she wanted to live. She informed me her son did not want her to live too far away from him. When she grew less able to function she demanded of me, “Are you bothering my son?” she asked. “Have you called him?”

I truthfully denied having contacted her son in any way.

“You had better not be bothering my son,” Reba told me, apparently ignoring my words. A moment later she informed me that she knew I was bothering her son. At one point she started forward in her chair, eyes wide and teeth bared in my direction.

She did not strike me, but her meaning did. She had no words for what was going on other than the dreaded terminology of diagnosis, which for her came with many meanings including her mother’s tardive dyskinesia, perceived loss of cognitive ability, and drooling onto a bib. As her own cognitive chaos closed in, Reba’s concern was not for herself but for her son. She did not want mental health to be an issue for her son. If mental health bothered him (or read another way, if his mental/emotional state caused him problems), then he might be forced to deal with the symptoms and circumstances she did, or what her own mother had dealt with, or both.

Reba’s “system of paranoid delusions” in fact offered a fleeting glimpse of a world fraught with complex history, emotion, and intergenerational relationships. “For in the patient’s insane words there is a voice that speaks; it obeys its own grammar, it articulates a meaning” (Foucault, 1965/1988, p. 188). Patients thematize the world as they speak about it, and their way of thematizing what they notice about the world of phenomena, is different from anyone else’s. This is especially so with schizophrenic patients, whose perception of the world is often radically different from those around them.

Communications Breakdown

The objection to such a statement regarding a schizophrenic patient is immediately apparent in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-1V-TR; American Psychiatric Association, 2000). Classed as a negative symptom, alogia “is manifested by brief, laconic, empty replies. The individual with alogia appears to have a dimunition of thoughts that is reflected in decreased fluency and productivity of speech” (p. 301). Certainly, most of what we can observe of a schizophrenic patient is their lack of facial expression and dearth of speech. DSM-IV-TR attempts to be objective and impartial. After all, it is describing phenomena that exist and are extremely problematic. Yet its definitions for such symptoms as “alogia” and “flat affect” spill over from describing an outward appearance to making assumptions about the person’s internal state. Alogia originally comes from the Greek α-, “without,” and λόγoς, “speech.” The original meaning of the word was not specifically directed toward capacity for thought. If we cannot see expressions and do not hear words, Western (behavioral) medicine tends to assume that emotions and thoughts do not exist. Antonin Artaud, a diagnosed schizophrenic who suffered greatly from his lack of words, wrote that “a man possesses himself in flashes, and even when he does possess himself he does not quite overtake himself. . . . Is he to be condemned to nothingness on the pretext that he can give only fragments of himself?” (1965, p. 20). Out of sight is out of mind, especially when those we observe are apparently out of theirs.

Levinas’s contemporary, Ernest Becker, took the view that a person’s actions matter most in creating the self, and that the alogia and demotivation of schizophrenia are intertwined. For Becker, this is the crux of why the schizophrenic’s “preference” for fantasy or delusion is problematic. If it is true that “Action, then, is a process of self-creation,” (1964, p. 27) then a schizophrenic person with severe negative symptoms appears to lack a self. Indeed, Becker writes that schizophrenics are “semi-symbolic selves”—as are all of us who use abstract language—but such patients “have to make ingenious efforts in fantasy to fill themselves with experience” and thus “cannot initiate action” (p. 43). If all behaviors take place in an internal fantasy world, then the person has little basis to join in intersubjective meanings and thus has difficulty acting in the world shared by most of humanity. According to Becker, this is a vicious cycle. “The nonperformer condemns himself to being a nonperceiver” (p. 45). If a person does not act, they do not properly perceive and internalize meanings from the world around them. Thus they drift further into isolation, thus meanings continue to fade, thus action becomes more difficult, thus isolating them further, and so on (p. 64).

Becker offers valuable insight into the lonely nature of schizophrenia, and into the fact that part of the therapeutic relationship with a schizophrenic client is to welcome them into the world of others. However, like the DSM-IV-TR, he moves from describing a behavioral phenomenon such as alogia and lack of observable action to making assumptions about a person’s internal state when he opines that as a result of this isolation, a schizophrenic person has an “inability to experience emotion,” (1964, p. 53) because they have difficulty establishing ties to the world through physical action.

In this case, the “idealist” Levinas is actually the voice of moderation and reason; he points out again and again that people are infinitely more than their physical forms and observable behaviors. He reminds therapists that the affect we can see is only part of the human face. The vast majority of what goes on lies behind the plastic form. Indeed, the narratives of schizophrenic patients document hyperreason, excesses of thought and hypersensitivity. Sass and Parnas write that while a catatonic person certainly has a diminished capacity for action, “Earlier reports indicated that patients displaying catatonic withdrawal are usually acutely conscious of surrounding events and may show heightened arousal . . . asocial behavior is often accompanied by an underlying yet fearful yearning for contact” (2003, p. 433). As is typical for Sass, the article also points the way to other research about the intense emotions and alienation underlying negative symptoms in schizophrenia.

In a previous position I worked with severely, chronically mentally ill adults in specialized housing. My client Chhaya N. was known around my agency for her lack of ability to communicate well. She typically sat curled in on herself, arms around her knees, head down. Occasionally her eyes would dart up to meet mine, and then quickly back to the floor. A case manager who had worked with her previously advised me to encourage Chhaya to write, and write she did. Chhaya informed me that “My room is intense! My physical is equivalent to the underworld. Like to enter the dream?” There was much more going on with Chhaya and her perception of her world than anyone could have guessed from her near-catatonic presentation. I did like to enter the dream, and did so while engaging with her in everyday activities such as sweeping her floor or tidying the kitchen. Chhaya was aware enough of her surroundings to enjoy cleanliness, which made things less intense for her.

Mark Vonnegut writes about his first schizophrenic break, “Holy shit, my mind is running. The coffee isn’t even cold yet. I’m thinking about a million miles an hour, spinning fantastic webs. It’s a gas. Cramming whole lifetimes of thinking in between sips of coffee” (1975/2002, p. 139). Yet Vonnegut also demonstrated alogia such that “my voice came out all funny. It was too fast or I had said it backward or something. I couldn’t make my voice sound right . . .” (p. 134). At times such as these Vonnegut could barely speak at all, let alone tell anyone else what was happening to him. His alienation, like Chhaya’s and many others’, stemmed from his compromised ability to communicate with others. However, a diagnostician who used the term “alogia,” with its “dimunition of thoughts,” might miss the greater part of this patient. Levinas, who was not a therapist or psychologist, would likely have seen more of Vonnegut and of Chhaya N. than the type of behavioral psychologist who insists that out of sight must remain out of mind.

Levinas held the view that ethics is a matter of optics. So, in many ways, is psychotherapy. The way a therapist looks at a patient determines to a great extent how the patient is treated. Instead of looking at alogia as reflecting a dimunition of thought, which reflects an interior state that we cannot observe and thus can never know for certain, a therapist is better served by looking at “the thing itself,” αλόγoς, that is, a patient’s loss of language. In other words, alogia might be more ethically (and accurately) seen as a failure of vocabulary to describe the schizophrenic experience of cognitive chaos than a dehumanizing lack of thought or emotion.

Form and Transcendent Meaning

Again and again we see accounts of schizophrenics who are distressed by their loss of words that, both Becker and Levinas would agree, contributes to alienation. Becker in particular calls attention to the rest of humanity’s mental and emotional disturbance when we attempt to describe people whose symbolic meanings are so different from our own (1964, p. 43). He writes that “in each individual there will be a difference in the range of experience that finds intimate alliances with words” (p. 51). He meant that meanings of words are unique to each individual, yet most people apprehend the other’s meaning through shared experiences that take place in the physical world.

Schizophrenia has been called a disease of isolation, so much so that another contemporary, Gendlin (1964), felt the need to clarify his criteria of positive interaction for a therapist and a schizophrenic client. “I do not mean by positive ‘good’ or ‘nice’ . . . Rather, I mean completed as an interaction between two human beings” (p. 177). Yet how are we to connect with human beings whose vocabulary for what happens to them is so fragmented that even we, the reasonable ones, cannot comprehend them? How are we to complete this interaction when neither party can be sure of what the other means?

Levinas’s distinction between the form and transcendent meaning can help therapists understand at least part of what is happening when a schizophrenic person uses isomorphic language. For example, Renee, a young schizophrenic girl, notes that during one of her earliest hallucinations, she cries, “Stop, Alice, you look like a lion, you frighten me!” (Sechehaye, 1979, p. 23). Her schoolmates tell her that she does not know what she is talking about. Renee appears to be distressed by the fact that she could not communicate almost as much as by the experience itself. “But actually, I didn’t see a lion at all: it was only an attempt to describe the enlarging image of my friend and the fact that I did not recognize her” (p. 23).

Renee’s words take form: “Alice, you are a lion!” Yet she is also trying to express her terror at her perceived transformation of her little friend. In fact, her transcendent meaning is more even than this. All words and expression overflow their form just as the presence of the face does. They transcend beyond anything a patient could ever tell a therapist or anyone else. It is extremely important that the therapist understand this distinction, for a schizophrenic patient’s hyperreflective meaning will transcend faster and more strangely than most Others’. A schizophrenic patient is not trying to deceive when this happens. Renee was trying as best she knew how to communicate. The trouble came because her friends’ understanding of a word differed so greatly from the meaning she was trying to give it. Therapists run into the same difficulty with all patients, but schizophrenic patients in particular tend to seek apparent synonyms, which turn into isomorphs such as Renee’s “lion.”

We cannot reliably substitute one word for one image either—that is just another way to “code” or “translate.” A schizophrenic client, Chez C., once opened with, “I will cut your head off with a chainsaw.” When I asked whether he had such a thing in his possession, he admitted that he did not, but he “could steal a machete. From the hardware store. I would hide it in my coat.” He spoke quietly while he described the violence that would take place once he had acquired his weapon.

When asked if this was serious, he chuckled. “It is a deadly joke. All my ducks in a row. It will happen when you least expect it.” Chez produced a collection of kitchen knives from his coat pocket and set them on the table. They were held in a group with rubber bands. “You will keep these for me.”

I asked Chez to wait a moment while I made a phone call. He nodded to indicate that he would wait. It was tempting to attempt to analyze the form of his words and actions. Why give me his knives if he planned to harm me, for example? Why tell me beforehand if this was supposed to be an ambush? What do these things symbolize, and what do they say about his intentions?

According to Becker, the difficulty with “schizophrenic language” (1964, p. 51) comes in because schizophrenic experiences take place in the isolated realm of the person’s own brain. Without the benefit of action in the world, the person is doomed to a dearth of both words and meanings. It is true that shared activities are an excellent way to connect with a schizophrenic person such as Chhaya N. Yet Becker makes another, deeper implication that Levinas would disagree with. Existential phenomenologists such as Levinas posit that human beings are primarily meaning-making beings. Thus to condemn someone to an existence outside meaning is to condemn them not just to being a nonperceiver of the world, but also to being less-than. Indeed, Becker refers to schizophrenic individuals as “at the same time naturally more-than-human [hyperreflective] and individually less-than-human” (p. 43).

Levinas (1979) offers the grounding, phenomenological insight that “The primordial essence of expression and discourse does not reside in the information they would supply concerning an interior and hidden world” (p. 200). Levinas meant that over and above the information that is or is not conveyed by a patient’s words, discourse is about the call to responsibility manifested by the patient who expresses himself. This is essential for mental health workers, who tend to think “that if we can only say what is wrong, we will have done our work. But the objective is not to know what is wrong, or to know anything; the objective is to aid the person” (Gendlin, 1974, p. 270). Levinas would say that the task of the therapist is not to comprehend the patient’s interiority, but to offer support for the individual struggling with this problem and guidance toward the patient’s own responsibility. In practice, this is similar to Gendlin’s (1964) view that even dysfunctional behaviors—even more dysfunctional than Chez’s—can initiate a positive interaction as long as both human beings are participating.

Chez was diabetic. He had obliquely mentioned dizziness and nausea but refused to see a physician. According to agency regulations, I could now make him go to a hospital and hold him there: agency protocol dictated that in response to a direct threat, I had to call 911 and ask them to take Chez. He was well aware of this. Beneath the semicontradictory words and behaviors was a plea for assistance and an expression of trust. I could send him to jail or to Psychiatric Emergency Services at the hospital, and despite the form of the verbalized threat I knew where Chez should go.

Note that this section was not titled “Form versus the Transcendent.” Both are needed. There is no such thing as communicating the transcendent meaning directly, without the benefit of forms, that is, words. If there were, there would be no dialogue. We would exist en masse, in comprehensive unity. There would be no need for language, no infinite distances, and no individuals. Madness and misunderstanding would be nonissues. There would, literally, be no word for them.

Thus by its very nature language is a bridge for the therapist and patient, but it is also a barrier. For most philosophers and psychotherapists, this means that a patient’s language is a series of symbols to be translated. Levinas is unique in that he looks at both the words that are said and the transcendence of the face as an expression of meaning. For Levinas, language can be a barrier because it reveals and conceals, not because it is merely symbols that require our translation. For example, Renee’s schoolmates did not understand her. Their widely agreed-upon meaning for “a lion” was completely different than Renee’s isomorphic one. Meanwhile, Chez was trying as best he could to communicate with me and on one level he probably meant what he said. He was likely frustrated with me and with the fact that he felt physically ill and something had to be done about it. However, it would have been a mistake to try to pick at his words or to translate them one by one into an orderly semblance of reason.

However, we both knew I had a responsibility to him. My sending him to the hospital via 911 was not an ideal way to get treatment—he and I would discuss this later—but it was a step forward for him in more ways than one.

If a therapist looks at language this way, as meanings expressed instead of a sort of concretized “code” that we must decipher, then speaking with a schizophrenic Other is less nerve-wracking. Working via Levinasian ethics, therapists are absolved from having to interpret a chain of loosely related thoughts. They do not have to translate unreason into reason or struggle to make the patient’s fragmented statements fit into theories.

If Renee had said, “I am having a very frightening visual hallucination,” her playmates would probably have known what she meant. There is no guarantee that they would have believed her, and they might not have been very understanding even if they did believe, but they would have known what she was trying to communicate. The general public has agreed upon what the word “hallucination” entails. However, the trouble with such terminology is that it is general, and the particular trouble with terminology and schizophrenia is that the expressed meanings of schizophrenia are idiosyncratic. Another of my clients, Frances J., cheerfully predicted gruesome acts for me but her meanings were idiosyncratic and completely different from Chez’s. For Frances, repetitive descriptions of abortion, rape, and violence visited on another person was making casual conversation; she would call my office to tell me these things and to occasionally pause to hear my voice in return. For this, Becker offers the useful insight that “for the schizophrenic person, sex may be a desperate handle” (1964, p. 82). When a person’s inner life is chaos and most of their vocabulary is inadequate, referring to sex (or violence) may be the one desperate ground they have to communicate with other human beings. “Sex is a vocabulary for those who may be very poor in words to describe their fears and cravings,” writes Becker (pp. 81, 82). Levinas would agree that we are all creatures of context, and that a person must use whichever words are available to them. Still, the form of this vocabulary rarely indicates similar meaning across schizophrenic individuals, which is where the communications breakdown comes in. Although many of the forms that Frances used were similar to Chez’s it would be a mistake to class their meanings together.

In order to form a relation across infinite distance, it is critical for the therapist to have at least some understanding of what the schizophrenic patient is “saying” in the words he has “said.” It is difficult for even the most ethical therapist to help a patient if she cannot understand his experience at all. While language provides a way to relate, therapists are absolved from having to comprehend totally via language. Levinas reminds us that speech does not arise where there is already knowledge and agreement, but that “speech proceeds from absolute difference” (1979, p. 194). This is the case with any Other, even two brothers who grew up in the same household at the same time with the same parents. They speak when they need a better understanding of the way the other brother views the world. This is especially so for a schizophrenic patient. This also means that avoiding reductionist language is extremely important.

Terminology: A Barrier

All language reveals and conceals. The more general a word is, the more it tends to conceal about the specificity of the patient’s meaning. Antonin Artaud (1965) wrote with great irritation that all terms were “for me really TERMS in the proper sense of the word—veritable terminations. . . . I’m completely paralyzed by my terms, by a chain of terminations” (p. 36). Artaud’s thoughts overflowed his words so quickly that his letters are dizzying, rife with his own frustration at the way words for his ever-transcendent meanings do not capture them alive, but instead deaden them. Artaud actually wrote and spoke aloud with flair exceeding that of many reasonable people, but he was very angry when his transcendence appeared to stop in the terminal of form. Hence, “I no longer have the gift of the tongue” (p. 39). He felt that he could not make his meanings understood. It might have helped his psychologist to adopt Levinas’s attitude. “Better than comprehension, discourse relates what remains essentially transcendent” (1979, p. 195). There is always more to the patient and more to their words than what they have said. If a therapist tried to get a sense of the meaning Artaud expressed, instead of attempting to translate him into reason by picking at his words, both therapist and patient might have been a great deal less frustrated. As it is, Artaud (1965) accuses his therapists of being “dogs, I mean you go around barking, I mean you rabidly persist in not understanding” (p. 37). They let his diagnosis speak for him, which this rather brilliant patient did not appreciate. He felt that he was being totalized.

Reba M. bared her teeth when she perceived anything resembling this kind of totalization. She could barely speak the words “mental health” or “schizophrenia.” If I broke into a lengthening alogic silence by simply saying her name she would say, with flat tone and loud volume, “Stop! Stop talking like that! Don’t say that!” To this day I am not sure what she heard or thought when a representative of the mental health system spoke her name, but she certainly did her best to terminate my words before I could even attempt to use psychological terminology. It took much time, firmness, and reassurance before we were able to converse at all.

At the other end of the terminological spectrum I shall examine an Anonymous account that deals much with “anxiety in the early catatonic stages of disorganization” (1964, p. 110). Anonymous uses the very ideological language Artaud despises. She gives great respect to the science of psychology by using its terms and by writing an ode in the form of a poem called “A Vision of Science.” Anonymous’s narrative is “as clear a picture of schizophrenia as one can find anywhere” (p. 89) because she uses terms that anyone who has taken Psychology 101 can recognize. At the level of the words that are said, she communicates what happened to her much more easily than Artaud does. Yet Van Kaam (1966) offers a disconcerting insight to Anonymous’s penchant for psychoanalytic language. “Instead of exploring the intimate structure or meaning of experience itself, he simply accepts the scientific interpretation which I hand to him and continues his alienation from his true self in a more sophisticated way than before” (p. 155). Anonymous’s neat terminology and explanations very likely stem from exactly the same loss of words as Artaud, Reba, Vonnegut, and many others experienced. She not only borrows from the language of psychoanalysts, she also borrows words from poets: Swinburne, Shakespeare, Emerson, and others. “Poetry could be counted on not to lead me astray,” Anonymous writes. When she was “unable to think coherently or plan [her] next action” (1964, pp. 96-97), she sought refuge in the words of others. The preset meaning of words such as “guilt feelings” and “anxiety” kept her own meanings from coming unmoored from any words she herself chose.

An ethical psychotherapist can see that although Anonymous has many problems, she does not suffer from lack of thought or lack of sensitivity. She has, as she writes, a “sense of discovery, creative excitement, and intense, at times mystical, inspiration” (1964, p. 98). It is true that not much of this creative inspiration comes through in her narrative, which is quite dry. She uses reductionist language to the point of obscuring her own meaning. A therapist can easily get a general idea of what is going on, but it is very difficult to know Anonymous herself from this account. Again, “Man seeks to explain, and he employs the only vocabulary he has learned” (Becker, 1964, p. 81). Anonymous’s vocabulary included the terms of psychoanalysis and poets, but it was to express her own unique meaning. Thus it is important to remember that Anonymous’s personal experience has just as much meaning as Artaud’s or Reba’s or any other. She is no less a unique Other because she is using psychoanalytic terminology to communicate instead of original description.

Terminology: A Bridge

It is tempting for a therapist who sees through the optics of Levinas’s ethics to denounce all terms and terminology as psychagogy, conformist and useless, nothing but a Procrustean bed which chops off bits and pieces of highly individual schizophrenic patients to make them fit into a very general psychopathology. Did not R. D. Laing (1965) correctly point out that “it is just possible to have a thorough knowledge of . . . just about everything that can be known about the psychopathology of schizophrenia without being able to understand one single schizophrenic” (p. 30)? Yet let us remember again the high level of cognitive chaos endured by these particular patients. Not all of them have words for what they are going through, let alone words that a therapist will understand. Levinas would never wish for the excision of terminology at the cost of further isolation of the patient. In some cases, terminology can build a two-way bridge from patient to therapist that allows them both to form an idea of what is going on.

Anonymous found a way to communicate in the language of psychoanalysis. This is a good step, but she would be best served by gently exploring her own “intimate structure,” for it does exist. Out of sight is not out of mind for the ethical therapist. Just because someone cannot speak (or write, or put up appropriate expressions on their face like a signpost), that does not mean that personal experience is not there. It does not mean they do not feel or think. It does not mean that they have no meaning that they are trying to express. A therapist must always remember this transcendence. Anonymous was more than a collection of psychologisms. She loved poetry, after all. She could recall verses during severe mental anguish. Poetry was her link to the world. It was her way of deciding a course of action and of expressing herself; Anonymous also wrote poetry. Perhaps it is not great poetry in an artistic sense, but it is a great step in expressing her own sentiment in her own words—something neither Levinas nor a therapist nor a schizophrenic person would take for granted.

The Passivity of the Hostage

Levinas writes that I am made an individual by fulfilling a call to responsibility from the Other. “The call to me, signifying me as responsible, gives me meaning” (1978, p. 13). He differs from Becker in that while experience and gaining meaning from an intersubjective world are important to Levinas, he writes that my identity is not created from actions in themselves but from my actions in responsibility to the other person. “The other is in me and in the midst of my very identification” (p. 125). I am unique in that I am the one called to action. However, that relationship is not reciprocal. This requirement for action does not go back the other way, that is, the other does not have to act in any way (responsible to me or not) before he becomes an individual human being.

All the other person has to do is show his face and I am called to help him as a person who is in distress. Chhaya N. or Chez C. do not need to have actions or even words, those abstract sound-symbols signifying “help me,” in order to call; they merely have to present themselves. Regardless of their use of language or lack thereof, the face is enough. It is “wholly sign, thus signifying itself” (Levinas, 1978, p.15). The face instantly qualifies the alogic schizophrenic person as an Other in need.

No—not instantly.

Never instantly, for that implies- that I am the initiator of this responsibility. Levinas stated that this kind of responsibility exists prior to me (Robbins, 2001, pp. 215, 216). According to Levinas, I am not the one triggering an event. No, in the face of this alogic call, I am passive. I am more passive than one who accidentally pulls a hidden tripwire. “Responsibility for the other, in its antecedence to my freedom, its antecedence to the present and to representation, is a passivity more passive than all passivity, an exposure to the other without this exposure being assumed” (Levinas, 1978, p. 15). In other words, I am not even choosing to come onto this scene. In this I am utterly passive; according to Levinas, I neither allow nor assume nor commit to this responsibility. It does not come about with my decision. After all, “Commitment presupposes a theoretical consciousness, as a possibility to assume, before or after the event, a taking up that goes beyond the susceptiveness of passivity” (p. 136). I can certainly choose whether or not to act upon my responsibility and I choose how best to act—how to react to Reba’s shouting, whether to send Chez to jail or to the hospital—but I am utterly passive in that I do not choose whether or not I am responsible for them.

I am in fact held “hostage” by this total yet passive responsibility. This means that the mere fact of my client’s presence, verbal or not, “commands me and makes me approach him . . . it provokes this responsibility against my will, substituting me for the other as a hostage” (Levinas, 1978, p. 11). I, the therapist, am in fact a hostage: someone who is “found responsible for something he has not done” (Robbins, 2001, p. 216). Although I have not engaged in any of the activities, or lack thereof, of my client, I am held responsible for him. In the case of a schizophrenic person especially, I am even responsible for his responsibility, as an adult is responsible for the responsibility of a child who kicks at the shin of his playmate.

Levinas is unique among his contemporaries. In using Levinasian ethics, we do not have to comprehend a schizophrenic person with our terminology. Indeed, the therapeutic relationship, for someone who uses Levinas as their guide, is “not reducible to the relationship that leads from the index to the indicated. That would make it a disclosure or thematization. It is the bottomless passivity of responsibility and thus, sincerity. It is the meaning of language, before language scatters into words” (1978, p. 151). My client is always more than his actions, more than his expression or lack thereof, and more than his highly idiosyncratic terms. Whether or not he has the words to communicate his need, and before he ever does so, I am responsible for him.

Conclusion

Levinas reminds therapists that the loss of words is not mere silence. It is also isolation. If a patient lives in a world for which there are no words, let alone words that others will understand, then it is extremely difficult to relate across the infinite distance that separates all human beings. Sometimes the best a schizophrenic patient can do is present amorphous fragments to a therapist. Instead of concentrating solely on the forms of the words themselves, a therapist should also explore expressed meaning. All words reveal and conceal this meaning, but some words conceal more than others, especially if they are very general. Thus while psychiatric terms can give words to someone who has no vocabulary for what is happening to him, terminology can be just that, a termination which totalizes and obscures by speaking for the patient. Whether the language is unique or general, a therapist must “be constantly aware that language can never be the experience itself of my counselee but only a limited inadequate expression of this experience” (Van Kaam, 1966, p. 158). Although some schizophrenic patients may have limited capacity for language, their interiority is beyond mere comprehension. Just because we cannot grasp the extent of their experience and meaning does not mean these things do not exist. For Levinas, out of sight is definitely not out of mind.