Volume 16, No 2, Fall 2021 ISSN 1932-1066

My Way to Lost in Dialogue and Beyond

Giovanni Stanghellini

University of Florence, Italy

Abstract: This essay outlines my path to Lost in Dialogue, a book in which I tried to consistently answer three questions: what is a human being, what is a psychopathological symptom, and what is a care. My purpose in writing this essay was to ground the practice of the clinic of mental pathology on a solid anthropological basis with a phenomenological matrix. In Anthropology of Vulnerability the continually attained, de-centered nature of human beings is described in terms of eccentricity and its consequence for mental pathology and human freedom. In Disembodied Spirits and Deanimated Bodies, drawing on Aristotle, I explored the fleshiness of human existence and the importance of common sense for experiencing oneself as a cohesive, unitary, embodied self that is separated from its environment yet connected and affectively attuned to it. Thereby I concentrated on the de-realization, de-personalization, and de-socialization that schizophrenic persons undergo that throws them into crisis regarding self-other inter-corporeal attunement and resonance. In Lost in Dialogue, I elaborate psychotherapeutic methods of treatment of mental conditions involving dialoguing with otherness within and without oneself.

Keywords: Aristotle; dialogue; schizophrenia; conditio humana; vulnerability; eccentricity; common sense; embodied self; social self; otherness; depersonalization.


I am flattered to accept the invitation of this prestigious Journal and I am grateful for the request that I respond with an essay of my own to the four splendid reviews that are included here. Welcoming this engagement and being motivated by my desire to enrich the psychotherapeutic endeavor, I take this opportunity to recapitulate a quarter of a century of research apropros the theme of the fragility regarding the human condition, the humanity inherent in madness, and the madness inherent in humanity. My attempts at answering these questions had led me to the writing of the book Lost in Dialogue and to further explorations that go beyond it.1 I hope it will be useful for my readers to situate this essay within this train of thought. As the saying goes, if one wants to understand a book, it is useful to ask oneself why its author wrote it— the intentio auctoris—hence, the key to reading Lost in Dialogue will be the central theme that forms through this reading of my own works.

I shall run the risk of seemingly being overly focused on my own work rather than focusing on the work of other esteemed colleagues and mentors who obviously shaped the background for these studies by carving out the space and horizon of what I am about to summarize.

In a nutshell, I can say that my work has consisted of a progressive focus on the condition of possibility of madness as the fundamental character of the conditio humana—and it is well known how success at its most glowing moments coincides with the awareness of its failure.

The fundamental character of the human condition is its vulnerability. I have pursued the goal of understanding this vulnerability, rather than explaining its causes or interpreting its meanings. This attempt at understanding was realized in the continuous tension and dialogue between my knowledge derived from the study of philosophy and my clinical practice—a dialogue mediated by the discipline of Phenomenological Psychopathology.

In 1997 my first book on this topic was published with the title Anthropology of Vulnerability.2 In it, I tried to identify the figure of human vulnerability in its condition of eccentricity. Man is that being that does not coincide with itself. Looking at the philosophical anthropology of the twentieth century, human beings do not have instincts that guide them securely and infallible in their environment, rather their drives are often at odds with each other and with moral principles, and to which human beings can say, "No." This is where all troubles stem from. But this is also the source of human freedom.

For the Renaissance philosopher Giovanni Pico della Mirandola, what characterizes the human condition is its being a work of indefinite or indeterminate nature (opus incertae naturae). In 1486, he writes:

O Adam, I have not given you a definite place, nor a shape of your own, nor some prerogative, so that that place, that shape, those prerogatives which you yourself choose, you may possess as your own, according to your desire and will. The well-defined nature assigned to other beings is enclosed within laws fixed by us. You, who are not enclosed within any limits, will establish your nature according to your own will, into whose hands I have delivered you. I have placed you as the center of the world so that from there you might better observe all that is in the world. We created thee neither heavenly nor earthly, neither mortal nor immortal, in such a way that thou, as a willing and honourable sculptor and moulder of thyself, may mould thyself in the form that thou mayst prefer. You may degenerate into lower beings, that is, into brute animals; or you may, according to the will of your soul, be regenerated into higher beings, that is, into divine creatures.3

Eccentricity means instinctual deficiency and drive excess. This predicament forces human beings into a continual search for identity in one's effort to synthesize and harmonize between one's multiple and discordant drives and one's moral and spiritual practice; and one's effort to negotiate between one's own individuality and the social and cultural context in which one lives and operates. Eccentricity is the root cause of the never-attained attempt of human persons to coincide with themselves and ultimately to become oneself. At the same time, it is at the root of one's possibility to transcend and behold oneself from a different place. This tradition foregrounds the fact that human beings, unlike other animals, can constantly view the commonsensical world from the outside, though they remain tied to it and constantly are reabsorbed by it.

Since depersonalization is intrinsic to human existence, one should not be surprised to recognize its effects both in the highest achievements of human spirituality and in mental pathology too. Within this framework, in Anthropology of Vulnerability I sought to define the roots of mental pathology as a crisis of the dialectic between centricity and eccentricity. Building upon the phenomenological analyses of schizophrenic and manic-depressive conditions, I argued that these can be seen in terms of extreme eccentricity (schizophrenia) and over-centricity (manic-depressive condition). Mental pathology arises when the distance from the center of commonsense world and the questioning of centricity loses its desirable quality of being a healthy exercise of disclosure and degenerates into a merely skeptical or autistic breakdown, dis-anchored from history and culture. Or, vice versa, when one gets caught in the web of common sense without being able, and sometimes without even trying, to lift one's head and look at oneself and one's position in the world from another—that is, eccentric—point of view.

Finally, I tried to ground the concept of mental health and human freedom in the balance, or proportional relationship, or dialectical movement between centricity and eccentricity. Immediacy and mediateness of experience, identity and non-identity, and bracketing common sense and conforming to it were alternative ways to name these two polarities of human existence.

Unsurprisingly, I later focused on the concept of common sense in a book entitled Disembodied Spirits and Deanimated Bodies.4 What I had most at heart, starting with the title, was to ground human existence and its psychopathological ramifications in the dimension of the flesh. Building on and extending Aristotle's concept of koinē aisthēsis (literally: common sense), I argued that this notion was central to human existence in its dual configuration, namely as the sense that allows oneself to feel rooted in the common world as a flesh-and-blood reality, and being attuned to it; and as the implicit and pre-reflexive function that underlies the feeling of my-ness and agency of one's experiences and actions that constitutes the foundation of the feeling of being a cohesive, unitary, embodied self, separated from the environment and of being continuous over time.

In this framework, I sought to redefine the dialectics between centricity and eccentricity as the dialectics between identification and distancing from common sense (passively suffered and/or actively achieved). The crisis of this dialectics was the key to understanding human vulnerability and its psychopathological developments.

Without going here into the philosophical details, my argument regarding Aristotle's koinē aisthēsis had been that it is a concept originally expressing both embodiment and attunement to the social world. My interpretation was that it is not only the basis for the integrated perception of one's physical reality, but also for the meaningful perception of the others' actions in the social world. The bodily and the social selves share the same experiential foundations. Koinē aisthēsis is the basis for the phenomenon of emotional-affective attunement, which is the prerequisite for the emergence of the social self and of inter-subjectivity.

In Disembodied Spirits and Deanimated Bodies I mainly focused on the psychopathology of schizophrenia. Schizophrenic persons undergo a special kind of depersonalization: the living body becomes a functioning body, a thing-like mechanism in which feelings, perceptions, and actions occur as if they were happening in outer space. They also endure a special kind of de-socialization: the interpersonal scene becomes a stage on which the main actor is unaware of the plot, out of touch regarding the role he is playing and unable to make sense of what the others are doing. I tried to show the common root for this twofold experience of derealization and depersonalization: the feeling of disconnectedness that takes place in the realm of the experience of oneself is related to the experience of disconnectedness taking place in the inter-subjective realm.

In the light of koinē aisthēsis I redescribed the disorder of the core (pre-reflexive) self—the vanishing of implicit, pre-reflexive, immediate, non-conceptual, non-objectifying, and non-observational sense of existing as an embodied self which is at the core of schizophrenia. This concept also helped me to redescribe the breakdown of the social self in terms of the crisis regarding self-other intercorporeal attunement. I discussed the mutual constraints between the embodied self and intercorporeal attunement: anomalies of the embodied self may affect the inter-corporeal resonance on which attunement and thus intersubjectivity is based; and vice versa, anomalies of inter-corporeal resonance may affect the development of a core embodied self.

Over-eccentricity in people vulnerable to schizophrenia was re-signified as living at a distance from the shared world of meanings and practices (koinos kosmos) and feeling weakly rooted through koinē aisthēsis in one's embodied self. I also argued that over-centricity—redefined as being enmeshed in common sense and hyper-identified with one's own body—was the core feature of people vulnerable to major depression.

It was when I tried to translate these concepts into useful methods for treatment, and especially for psychotherapy, that I ventured to define the concept of otherness and apply it to the field of psychopathology. The book in which I attempted this feat is entitled Lost in Dialogue. Here the concept of eccentricity was enriched via a greater specification: the human self in its being and becoming cannot prescind from its shadow, that is, its otherness.

To be eccentric means to be constantly and unavoidably in relation with what one is not. The Self can only become who she or he is by becoming a person through the dialectic of selfhood and otherness. Or, to put it differently, the Self must reappropriate itself as a person through otherness in order to come to terms with who or what one is. At the heart of selfhood, there is a normative journey through negativity, that is, through the dialectic of self and other.

Otherness is encountered in two main domains of one's life: in oneself, and in the external world. In the first instance, otherness is in the involuntary dimension of oneself, one's un-chosen character, including needs, desires, emotions, and habits. In the external world, this is encountered in the challenging otherness of the events and in the meetings with other persons that constellate one's life. Human beings are inherently eccentric since one's own Self is constitutionally inseparable from its otherness. One cannot avoid having to come to terms with otherness, and when the dialogue with it is interrupted, it emerges as a psychopathological symptom. Psychopathological symptoms are the expression of otherness that cries out to be heard. The various psychopathological forms emerge as defenses against the intolerability of the failure of the encounter with otherness. Care consists in mending the dialogue with otherness and establishing a relationship of intimacy with it. All four reviewers of my book have noticed that this is the core of my argument.

Reply to Commentaries

Anthony Fernandez correctly notes that my work in Lost in Dialogue differs from much of the research in contemporary clinical phenomenology, since it is not concerned with improving currently accepted categories of mental disorders and clarifying symptoms that are poorly articulated in today's diagnostic manuals. My "enduring concern," as Fernandez writes,5 is psychotherapy as I am primarily motivated to promote the understanding of certain human conditions and ultimately enrich the psychotherapeutic encounter. In Lost in Dialogue, I attempted to find a better balance between the effort of understanding the individual as an individual and as an instance of the general or universal structures of subjectivity and life-world. To this end I overemphasized the former in order to counterbalance phenomenology's more typical concern with the general or the universal with a concern with the individual or the specific.

In other words, I focus on the I-Thou relationship. The icy womb from which mental pathology develops is in the traumatic forms of an I-Thou relationship; and at the same time a healthy I-Thou relationship in psychotherapy can be the warm womb from which one is reborn.

Guilherme Messas hits the core of my argument when he writes,

mental illness is part of the insoluble fissure inscribed in the human condition of inaccessibility to this Other who is, at the same time, the basic object of existence.6

The Other necessarily reveals itself as a concealment. The awareness of the Other's radical alterity is intolerable for some humans. What psychiatrists call "mental disorders" are shelters which defend one from the unbearable suffering generated by the missed encounter with the Other. Departing from much of contemporary clinical phenomenology, I try to ground the understanding of the basic forms of psychopathological existence on a relational—that is, interpersonal rather than intrapersonal—framework. Mental pathologies are miscarried attempts to struggle for a sense of reconciliation, to heal the wounds of disunion, that later develop into fixed forms of missglückten Daseins.

It is in this context that I have developed my understanding of the melancholic type of existence. Otto Doerr is right in noticing that my understanding of the melancholic type of personality—which I will later call homo melancholicus—departs from Tellenbach's understanding.7 Indeed, a great part of my argument in Lost in Dialogue is about distinguishing the concept "love" from the two concepts "solicitousness" and "altruism"—the latter being among the main traits of Tellenbach's typus melancholicus. I may have modified Tellenbach's original concept of typus melancholicus, yet I do not think I have misunderstood it. My clinical experience suggests to me that there are people in search of harmony in interpersonal relationships (orderliness), and particularly conscientious ones, who try to achieve this not so much by asking themselves what the desire of the other actually is, but by trying to apply a certain social representation to the other's desire: the other, rather than being the real individual who she or he is, is seen as social role: the spouse, the boyfriend, the mother, the son, and so on. Homo melancholicus believes to know what all spouses, boyfriends, mothers, sons, and so on desire. I named this phenomenon idioagnosia—which is the incapacity to see the others in their individuality—and I suggested that this is a key feature of homo melancholicus. Idioagnosia is the outcome of being dependent on commonsense representations of the Other and the ensuing assimilation of the otherness of the other via the identification of the Other with an abstract impersonal idealization.

It is also along this line of reasoning that I attempted to make sense of the schizophrenic form of existence. In fact, what motivates my shift of focus from the isolated Self to the Self in relationship is the hope that the therapeutic relationship has curative potential. If one thinks that schizophrenia is fundamentally a disorder of the pre-reflexive, isolated self, it is difficult to think that a psychotherapeutic relationship can have a positive effect on people with schizophrenia. If, on the other hand, one looks at schizophrenia as a condition in which traumatic relational experiences are compounded based on intrapsychic vulnerability, then it is easier to think that a non-traumatic relationship can be helpful. Louis Sass is right in characterizing my understanding of schizophrenia in Lost in Dialogue as a diminishment of the equilibrium between agency and passivity, autonomy and heteronomy, independence and dependence on what lies beyond the Self.8

When observing psychotic symptoms in schizophrenia that imply loss of agency and my-ness, such as delusions of external control or imperative voices, psychiatrists are tempted to characterize schizophrenia simply as a condition of diminished agency or autonomy. This is indeed misleading since persons with schizophrenia also suffer from an exaggerated autonomy as I show elsewhere in the paragraphs entitled "Antagonomia" and "Hyper-tolerance of semantic complexity" (DSD 100-2).

Many of the forms of exaggerated autonomy found in schizophrenia seem to involve a denial of the founding complementarity of autonomy and heteronomy. The over-emphasis on autonomy can be pathogenic just as much as traumatic experiences of heteronomy. What is missing in schizophrenia is, in Sass' words, the

inextricable mix of freedom and constraint, of agency and obstacle, of activity and passivity, that defines the fabric of a more standard relationship to social and objective reality. [AAS 37]

What is absent is the interminable dialectics between Self and Other that defines a healthy dialogue between selfhood and otherness, the voluntary and the involuntary, agency and responsibility, centricity and eccentricity, koinos kosmos and idios kosmos, common sense and the bracketing of common sense.

The Path Forward

In recent times, I have been trying to focus further on the character of otherness. I believed I would benefit for this from a description of the phenomenon of the formless. The two books in which I set out to develop this project have not yet been translated into English. The literal translation of the title of the first book would be Love that Heals: Medicine, Life, and the Knowledge of the Shadow.9 The translation of the title of the most recent book would be Divine Presence: The Erotic, Aesthetic and Mystical Gateways to the Experience of Formlessness.10

In both books I approached the formless not only as a lack of form but also as an excess and as a crisis of the dialectic form-formlessness. As in Anthropology of Vulnerability, here too I start from the idea that what characterizes the human condition is it having no characteristic of its own. Man is a being without a definite form, suspended between heaven and earth, angel and beast. Each human is a being who is charged to choose one's own form. This freedom is also the root of one's fragility. Man has always to decide between the abyss of formlessness and the crystallization into an unchangeable form. Compared to the courage, precariousness, and decisiveness of facing the formless, the unilateral and non-dialectical choice for one form seems like a protective shell that serves to defend one from being overwhelmed by the formless; but, at the same time, it is precisely this choice that limits man's humanity, namely the realization of the full humanity of man, who is called upon to renew the choice between the abyss of heaven and that of hell every time one is faced with one's own formless being.

Arguably the truest and most beautiful form of a human being is the infinite renewal of this experience and this choice: the acceptance of the dialectic between formlessness and form, that is, the recognition of the necessity of form in order not to lose oneself in the abyss of formlessness, and vice versa the recognition of the value of the experience of formlessness in order not to crystallize into a frozen form—rather than the making of a once-and-forever choice of one or the other.

What makes form luminous is its placing itself in a dialectic relationship with the formless. The beauty of form is in its precarious equilibrium with formlessness. Precisely because of this, beauty is apparition; it is not simply the manifestation of formlessness or form, rather it is the apparition of a presence that contains both, in whose form the formless is manifested.

In order to understand this, it is perhaps enough to look at a child that is learning to walk: its movements are full of intentionality, that is, of attention; or to notice the branch of a tree that is covered with buds in spring. In them, a shining form is manifested that remains suspended in a precarious equilibrium with the formless vitality that releases it.

If one were to say that these are manifestations of a superhuman entity this would be inaccurate as it freezes this apparition into a form that is supposed to repeat itself, thus depriving the apparition of the essential emotional state that it arouses: namely, astonishment. What astonishes is not what is repeated but what is improbable and what is improbable is the balance of the living that puts itself at risk and exceeds itself.

1 Giovanni Stanghellini, Lost in Dialogue: Anthropology, Psychopathology, and Care, Oxford, UK: Oxford University Press, 2017.

2 Giovanni Stanghellini, Antropologia della vulnerabilità, Milano, IT: Feltrinelli, 1997.

3 Giovanni Pico della Mirandola, "Oratio (de hominis dignitate)," in De Hominis Dignitate, Heptaplus, De Ente et Uno, Firenze, IT: Vallecchi Editore 1942, pp. 101-165, here pp. 105-6. [my translation]

4 Giovanni Stanghellini, Disembodied Spirits and Deanimated Bodies: The Psychopathology of Common Sense, New York, NY: Oxford University Press, 2004. [Henceforth cited as DSD]

5 Anthony Vincent Fernandez, "From the General to the Particular: On the Challenges of Integrating Phenomenology, Hermeneutics, and Psychodynamic Theory," Existenz 16/2 (Fall 2021), 38-41, here p. 39.

6 Guilherme Peres Messas, "In Between Two Realms of Phenomenological Psychopathology—The Open Perspectivism of Giovanni Stanghellini," Existenz 16/2 (Fall 2021), 27-32, here p. 29.

7 Otto Doerr-Zegers, "Dialoguing with Giovanni Stanghellini's Ideas Regarding Melancholic, Borderline, and Schizoid Personalities," Existenz 16/2 (Fall 2021), 22-26, here p. 23.

8 Louis A. Sass, "Autonomy, Agency, and Schizophrenia: Reflections on Selfhood and Alterity," Existenz 16/2 (Fall 2021), 33-37. [Henceforth cited as AAS]

9 Giovanni Stanghellini, L'amore che cura: La medicina, la vita, e il sapere dell'ombra, Milano, IT: Feltrinelli, 2018.

10 Giovanni Stanghellini, Divina presenza: La porta mistica, erotica ed estetica all'esperienza dell'informe, Macerata, IT: Quodlibet, 2022.