The Meaning and Relevance of Minkowski’s ‘Loss of Vital

Contact with Reality’

Zeno Van Duppen

Philosophy, Psychiatry, & Psychology, Volume 24, Number 4, December

2017, pp. 385-397 (Article)

Published by Johns Hopkins University Press

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 The Meaning and
Relevance of
Minkowski’s ‘Loss of
Vital Contact
with Reality’
Zeno Van Duppen

P
Abstract: Eugène Minkowski is among the most henomenological psychopathology
prominent figures in phenomenological psychopathol- is a research field that aims to investigate
ogy. His notion of the ‘loss of vital contact with reality’ and describe the subjective experience of
remains a key concept in the phenomenological descrip-
mental disorders. By suspending the assumptions
tion of schizophrenia. However, the precise meaning and
relevance of this concept is unclear. Consequently, its
about etiology and causality as much as possible,
use in psychopathological research is questionable. The and by focusing on the subjective experiences of
purpose of this article is to investigate the meaning of the patient, it is supposed to offer a profound
the concept, and to evaluate its relevance in the con- understanding of the patient’s suffering, and of
temporary research on intersubjectivity. The results of the disorder in general. Clarity in the description
this thematic interpretation show that the notion can of these experiences is, therefore, a necessity.
be deconstructed into three building blocks: ‘reality,’
Traditionally, phenomenological psychopathology
‘contact with reality,’ and ‘vital contact.’ Their respec-
tive philosophical and psychopathological meanings
was studied mostly by European, and particularly
are discussed in detail. This interpretation allows us by German and French psychiatrists, such as Karl
to challenge specific ideas on social cognition, and it Jaspers, Wolfgang Blankenburg, and Eugène
sheds a new light on the phenomenological description Minkowski. Today, psychopathologists like Josef
of schizophrenia as a self-disorder. Despite the inher- Parnas, Giovanni Stanghellini, Louis Sass, and
ent limitations, Minkowski’s notion provides tools for Thomas Fuchs represent the most recent move-
investigating the form and specificity of intersubjectivity ment of phenomenological psychopathology.
disturbances in schizophrenia. This article offers the first
One of the exciting results of their research is the
step in this process.
phenomenological description of schizophrenia
Keywords: Phenomenology, Minkowski, vital contact as a disorder of the self (Sass & Parnas, 2003).
with reality, schizophrenia, intersubjectivity, psycho- They explicitly refer to the authors and concepts
pathology
of the first generation of phenomenological psy-
chopathologists, including Minkowski. Today,
Minkowski is especially known for his work on
schizophrenia.

© 2017 by Johns Hopkins University Press

386  ■  PPP / Vol. 24, No. 4 / December 2017

Minkowski was greatly inspired by the French tive components (Fuchs, 2010; Gallagher, 2014;
philosopher Henri Bergson (Urfer, 2001). This Parnas, Sass, & Zahavi, 2013; Stanghellini &
influence can be noted throughout his work. It is Lysaker, 2007). Both in phenomenological phi-
one of the reasons why his psychopathology was losophy and in psychopathology, central research
innovative, compared with his contemporaries. questions today concern intersubjectivity (Fuchs
According to Minkowski, the ultimate goal of phe- & De Jaegher, 2009; Kyselo, 2014; Maclaren,
nomenological psychopathology should be finding 2008; Sass, 2014; Zahavi, 2014). It is a serious
the “trouble générateur” (Minkowski, 1966, p. endeavor to describe a coherent hypothesis on the
53) of an illness, by ‘penetrating’ (Minkowski, disturbances of the self and intersubjectivity, based
1966, p. 461) through the superficial symptoms. on clinical experience. The question is whether
A variety of phenomenological authors have Minkowski’s notion can help us with this. As Urfer
written on Minkowski’s ideas in more detail (Bovet already remarked, Minkowski’s phenomenologi-
& Parnas, 1993 Lysaker & Lysaker, 2010; Passie, cal approach concerns the intersubjective space
1995; Stanghellini & Ballerini, 2007; Tatossian, of “entre deux” (2001, p. 281), and Minkowski
1979; Varga, 2012). Several key concepts in the might indeed prove to be a psychopathologist of
contemporary literature refer directly to his work, the in-between.
for example ‘schizophrenic autism’ (Parnas &
Bovet, 1991), ‘morbid rationality’ (Sass, 2001), Method
and ‘phenomenological compensation’ (Urfer,
2001). The ‘loss of vital contact with reality’ is To determine the meaning of Minkowski’s ‘loss
arguably the most central notion in his work. It of vital contact with reality’ for the contemporary
is often used to elucidate certain symptoms and discussion on intersubjectivity, I present a thematic
experiences of schizophrenic patients. Schwartz, interpretation. The notion is first deconstructed
Wiggins, Naudin, and Spitzer (2005, p. 110) un- into three ‘building blocks.’ These are the most
derstand it as a destruction of the “manifestness basic notion of ‘reality’, followed by ‘contact with
and coherence” of the person’s being-in-the-world. reality’, and lastly ‘vital contact with reality’. They
Louis Sass compares it to patients’ experiences are analyzed with reference to Minkowski’s psy-
of dulling of their subjective lives, and remarks chopathological works, particularly those dealing
that the negative symptoms do not capture what with schizophrenia. These include his most impor-
Minkowski means (Sass, 2001, p. 255). tant books, La Schizophrénie (Minkowski, 1927),
Despite the recent attention for Minkowski’s Le temps vécu (Minkowski, 1995), and Traité de
work, and for his notion of the ‘loss of vital contact Psychopathologie (Minkowski, 1966). The lit-
with reality’ more specifically, it remains unclear erature study includes, furthermore, three articles
what the latter exactly means. Consequently, the that help us to understand the philosophical back-
use of this notion to characterize certain aspects ground of this notion (Minkowski, 1921a, 1921b,
of schizophrenic experiences can be questioned. 1921c, 1926, 1958). The thematic interpretation
Even though two primary articles of Minkowski’s makes use of Minkowski’s own descriptions in
are solely dedicated at elucidating the ‘loss of vital the first place. The present article thus combines
contact with reality’ (Minkowski, 1921a, 1921b, a literature study and thematic interpretation as
1921c, 1995, pp. 58–71), his notion may com- method of inquiry into the meaning and relevance
plicate, rather than clarify, the phenomenological of the concept. A critical consideration of the
investigation. benefits and limitations of the chosen method is
The purpose of this article is to investigate the found in the discussion.
meaning of the notion, and to evaluate the role
it can play in contemporary phenomenological Results
research on schizophrenia. This research field has The Loss of Vital Contact with Reality
recently refocused its investigations of schizophre-
In one of his first noteworthy articles,
nia as a disorder of the self, toward its intersubjec-
Minkowski summarized Eugen Bleuler’s ideas
 Van Duppen / Minkowski  ■ 387

on schizophrenia for the French readers of Reality: Language, Rules, Praxis

l’Encéphale (Minkowski, 1921a, 1921b, 1921c). Reality is a puzzling notion. Reality is some-
Bleuler was of great importance to Minkowski, thing we take for granted; it has to do with the
especially in the time that he worked under immediate being there of the objects and people
Bleuler’s supervision in the Burghölzli clinic in around us, with the world we live in, and with our
Zürich (Urfer, 2001). According to Minkowski, own existence. In our everyday life, it is something
Bleuler’s redefinition of ‘dementia praecox’ to we hardly have to doubt. Without any explicit
‘schizophrenia’ had a remarkable impact on psy- reflection, I am convinced that the experiences I
chiatry (Minkowski, 1927, pp. 256–257). First, have are real and that what I can perceive around
the emphasis on an underlying cognitive deterio- me is reality. On a more reflexive level, the notion
ration was minimized. Second, new therapeutic of reality becomes more complex. Philosophically,
hope arose for schizophrenic patients (Bleuler, it is connected to concepts such as truth or social
1934, p. 412). Minkowski favored these changes, construction, and it has to do with cultural and
and he continued to elaborate the work of his historical ideas that are deeply rooted in our social
predecessor throughout his career. It was in this and individual perspective on the world. It takes
article for l’Encéphale that Minkowski used the only a short reflection on the nature of reality to il-
notion of ‘the loss of vital contact with reality’ lustrate the inherent ambivalence: reflecting on the
for the first time. The notion aimed at unifying ontology of reality and its mediated or doubtful
Bleuler’s pathognomonic symptoms and signs self-evidence, we still experience and live reality in
of schizophrenia (Minkowski, 1921a, p. 248). a direct, unmediated and undoubted manner. My
In Minkowski’s view, these symptoms were the computer, the desk I am working on, or the river
consequence of the loss of vital contact with real- outside did not stop to exist during my reflection
ity, which he conceived as the starting point of on the relativity of reality.
the illness (Minkowski, 1927, p. 198). Later on Minkowski, however, does not take reality as
in Minkowski’s works, it gained different mean- such a self-evident external world (Minkowski,
ings, and it would become an ambiguous notion 1921a, p. 250). Reality is not something that is
that would lose its original connection to Bleuler. out there, and a loss of it does not entail a form
The vagueness of the notion is, however, prob- of interiorization (Minkowski, 1927, p. 159).
lematic. The inflationary use of the concept might According to Minkowski, reality is expressed
give us the illusion of clarity, while hiding our and experienced in different domains. Language
incomprehension. This impedes an appropriate is the first of these. The role of language for the
use of the notion for phenomenology. Questions experience of reality can be described negatively:
can arise concerning each of the words used. First, in schizophrenic autism, a patient might speak
what should the reader think of when reading that “his own language” (Minkowski, 1927, p. 149).
the contact with reality is vital? It seems to indicate The creation of a new, private language goes
that the loss leads to a devitalization of something, hand in hand with the destruction of reality.
but of what? Consequently, what is this ‘contact Symbols and significances may become strange or
with reality’? It is not evident what kind of contact unrecognizable, because these symbols can only
we have toward reality. Is it in our experience, a exist as symbols if they have a relation to reality
sort of sense of reality (Ratcliffe, 2009)? Or is it (Minkowski, 1927). A disturbance of reality leads
rather something we constitute ourselves, do we to the dysfunction of symbols and language in gen-
make contact with reality? Last, what is this real- eral (Minkowski, 1921b, p. 317). Both logorrhea
ity in the first place? Does Minkowski refer to an (“salade des mots”) and mutism can characterize
external and objective world, the sort of reality the disconnection to reality (Minkowski, 1921a,
that we take for granted in everyday life (Schütz, p. 254).
1945)? Or does he refer to an implicit philosophi- Philosophically, this view is comparable to the
cal conception, which transcends the everyday idea of the later Wittgenstein (1953) of reality
experience of reality? The interpretation will start as a language game. Psychopathologically, the
from the most basic building block: Reality. language disturbances can be recognized in the
388  ■  PPP / Vol. 24, No. 4 / December 2017

definition of speech disorganization in the Diag- that is considered beyond reality (“en dehors de
nostic and Statistical Manual of Mental Disorders la réalité”; Minkowski, 1966, p. 156). This pa-
(American Psychiatric Association, 2013), and tient has lost the sense of rules that constitute the
empirical research today is focusing on the specific intersubjective reality.
schizophrenic language troubles as well (Stephan, This brings us to the third domain of reality,
Pellizer, & Fletcher, 2007; Tan, Thomas, & Ros- which is closely related to both language and
sel, 2014). In psychotherapy, finding a common rules, namely praxis. The term ‘praxis’ indicates
language with a patient is one of the earliest goals. the practical involvement of a person in his or
A common language supposes a common ground, her surroundings. In this regard, it is charac-
and, according to Minkowski, this is what the teristic for schizophrenic patients that they can
therapist should search for to bring a psychotic have difficulties to use certain knowledge in an
patient back into reality (Minkowski, 1966, p. 41). adequate way (Minkowski, 1927, p. 559). Not
The second domain of reality concerns rules. the cognitive part of an activity fails, but the use
We find the same phenomenon of vital contact or implementation of this knowledge itself. As
with reality in the feeling of measure and limits we saw earlier, Minkowski favored Bleuler’s idea
which surrounds all of our precepts like a living that schizophrenia should not be characterized
fringe in rendering them infinitely nuanced and as a cognitive deficiency. Rather, the loss of vital
infinitely human (Minkowski, 1970, p. 69). contact with reality can be expressed in particular
We sense the measure of things and the limits practical anomalies. As Minkowski’s example il-
of the possibilities of our actions even before the lustrates: If someone’s house was at the edge of
precepts are made explicit. ‘Vital contact with real- being flooded with water, formally it would be
ity’ is related to the sense of measure that others correct to state that a certain volume of H2O and
experience with regard to our own actions. Actions salts was flowing at a certain discharge. But, of
that are within the limits, or within good measure, course, this judgment would testify for an absence
are thought of as “realistic”, in contrast to the of pragmatic reasoning (Minkowski, 1921a, p.
“autistic” actions of schizophrenia (Minkowski, 254). Praxis, our immediate involvement in the
1927, p. 147; Urfer, 2001). Reality does not only world, is always an interaction. We would expect
depend on the explicit rules of conduct, but also on the person to flee the house, or warn the other in-
unwritten rules, and our implicit sense of them. In habitants, rather than describe the physical quali-
this regard, the attitude of stagnant overthinking ties or the molecular structure of the water. That
and over-structuring of situations that Minkowski means that our actions have meanings, not only to
calls morbid rationalism, is not per se a cognitive us, but to others as well, within a context. What
defect, but the expression of the loss of reality. we can and cannot do depends on this context.
The patient has lost the sense of measure and Minkowski’s idea on the role of praxis for real-
limits, and the rules have lost their dynamic char- ity is again comparable to Wittgenstein’s (1969,
acter, to become static and morbid (Minkowski, §204), who noted that our acting (praxis) lies at
1995, pp. 260–261). Rules, and especially our the bottom of the language-game that is reality.
use of them, define what is in accordance with
reality, and what is not. A prototypical example Reality: Contingency, Irrationality,
illustrates this: a man is impressed by a woman Ambiance
he sees on the street, so he runs home to sit on The three domains of reality are insufficient for
a chair, in the most symmetrical position he can a distinct view of Minkowski’s concept of reality.
find, reflecting on the question why women can We need to add three other notions that help to
have such an effect on men. The answer is clear define ‘reality’. The first is contingency. If a person
to him, because “everything in life, even sexual loses the awareness of contingency in her everyday
sensations, is reducible to mathematics” (Passie, experience of the world of which she is part, she
1995, p. 261). Consequently, he remains seated will lose contact with reality.
in the same position, motionless. This is an act
 Van Duppen / Minkowski  ■ 389

We are quite able to feel a pricking or see a [Imagination] lays a light veil on the hard
spark without relating these phenomena to a reality, in its materialistic sense. By covering it
conversation that we are able to hear at the same and penetrating in all of its parts, [imagination]
softens it, makes it lighter, less concrete, but not
time. We very well conceive of isolated facts and
less real than before. (Minkowski, 1966, p. 550)
objects whose simultaneous coexistence may be
purely contingent. (Minkowski, 1970, p. 425) According to Minkowski, imagination is a
For a schizophrenic patient, this coexistence vital part of reality. It makes the hard reality (“la
may not be so unproblematic, and “a mysterious dure réalité”) bearable. Our reality is not only
force” (Minkowski, 1995, p. 390) might seem contingent, but becomes meaningful through our
hidden behind the phenomena. The loss of con- imagination. We should not understand his views
tingency structures a world where essential parts on reality as the antinomy of rationality and ir-
of reality are excluded, such as the possibility of rationality, but rather as the blending together
chance, coincidence, meaninglessness, or the un- of these two in reality as we live it (Minkowski,
expected. A patient of Fuchs reported persistent 1966). On first sight, psychotic phenomena can
“events of duplicity” (2000, p. 142), that were manifest themselves as irrationalities, in the form
meant to signal him something. One day someone of perspectival rigidity, communicative break-
talked to the patient about a pistol, the next day a down, and existential solitude. However, what is
picture of a pistol was printed in the newspaper. essential to these, rather than the absence of ratio-
The meaning of this event of duplicity was clear: nality, as Parnas (2013a, p. 213) rightly writes, is
He had to shoot himself. the “dislocation from intersubjectivity.”
The overwhelming presence of meanings and The third notion is the ‘ambiance’ (Minkowski,
associations that all seem to point at the patient 1966, p. 75). Minkowski’s reality is not what is
may lead to an attitude of withdrawal and avoid- external to us, the objects and things surrounding
ance (Minkowski, 1966, p. 644). Reality, as us in their materialistic sense. Lived reality, rather,
Minkowski would describe it, thus requires an is what we experience through our contact with
attitude of the subject toward the world that is this ambiance. Minkowski notes that the German
characterized by contingency, rather than by the word ‘Umwelt’ as introduced by von Uexküll
subject’s own centrality. (1909) might fit the description better than ambi-
Second, Minkowski’s reality has to be differen- ance. In this surrounding world, the distinctions
tiated from rationality. Although we already saw dissolve between object and subject, or between
that praxis and rules play a role in Minkowski’s inside and outside. The inner world of a person can
concept of reality, this does not mean that these be just as real as the outer world. However, this
are entirely rational. As Bergson had pointed does not mean that ambiance is restricted to one
out, a distinction between the intellectual and the sole individual or to each individual separately.
instinctive allows us to acknowledge the presence Rather, it is a common ambiance that is relevant
of irrationality in reality (Minkowski, 1926, p. for reality (Minkowski, 1966, p. 107).
555). Time, for example, was famously divided In conclusion, the first building block,
into measurable or objective time on the one hand, Minkowski’s concept of reality, is expressed and
and lived time on the other (Minkowski, 1995, p. experienced in language, rules, and praxis. The
19). These two forms of time are both part of the coexistence of rationality and irrationality makes
reality of time, but are distinct nonetheless. reality a lived reality, which we experience as
Analogously, grasping every aspect of reality partly contingent. Rather than comparing reality
through rationality means excluding a part of it. to a realm of external objects, Minkowski’s reality
Reality is not entirely rational. Our capacity to is a common ambiance where our activities are
imagine the world around us, and to co-constitute meaningful to others.
it in this way, together with others and their
imagination, underlines this co-existence of both
rationality and irrationality in reality (Minkowski,
1966, p. 549).
390  ■  PPP / Vol. 24, No. 4 / December 2017

Contact with Reality: Time, Space, In this context, schizophrenia is thought of as a

Sympathy desynchronization. The patient does not take part
The second step in this thematic interpretation in the collective or ambient becoming any more,
examines the contact with reality. There are three and does not vibrate in resonance with others. Part
modes of contact with reality. The first concerns of the ambient becoming is the necessary future
time. We already know that Minkowski follows orientation. If such an orientation is absent, the
Bergson’s distinction between objective or measur- sharing of the rhythm is impossible. According to
able time, and lived time (Bergson, 1970). Minkowski, it is exactly this orientation toward
According to Minkowski, we are constantly the future that some schizophrenic patients lack
accompanied by a feeling of moving toward the (Minkowski, 1958, p. 132, p. 259). There might,
future, of becoming (‘devenir’; Minkowski, 1995, however, be better examples of desynchronization
p. 17). Every individual basically experiences a than this. For example, schizophrenic patients
personal becoming, in accordance with the move- may actively structure and plan the day or the
ment of time. Bergson’s ‘élan’ is the source of this week with activities that somehow connect them
future-oriented bond between the individual and to other people, and require leaving isolation.
his ambient becoming (Urfer, 2001, p. 280). Fuchs reports patients in different stages of schizo-
phrenia, who develop attitudes or algorithms
It is not only that we feel a general pro-
to compensate for a lack of what he calls “con-
gression, in us as well as outside us, but rather
a unique rhythm common to us and to ambient
temporality” (Fuchs, 2013, p. 93). These can be
becoming that makes me feel that I am advancing understood with Minkowski’s terms as attempts
in my life simultaneously with time beyond this at resynchronization.
attitude as well as beyond those interruptions The second mode of contact with reality con-
whatever my attitude may be with regard to the cerns space. Once again, one has to keep in mind
facts of reality, however, I actually participate, or that Minkowski had great admiration for the ideas
whatever interruptions are imposed on my activ- of Henri Bergson. Parallel to Bergson’s ideas on
ity by unforeseen circumstances. (Minkowski,
time, Minkowski interprets space as both measur-
1970, pp. 69–70)
able or geometrical space, and as lived space.
Contact with reality is first a contact with the
There is a distance which separates me from
ambiance, through a shared rhythm between the life or, rather, which unites me with life. There is
individual and the ambient becoming. This shar- always a free space in front of me in which my
ing of the rhythm determines whether my reality activity can develop. (Minkowski, 1970, p. 403)
can be shared with others. Minkowski calls this
In contrast with geometrical space, lived space
synchronism (Minkowski, 1995, p. 59, p. 63).
is defined by the distance to others, or by the
Historically, this idea stems from Kretschmer’s
distance in between us. Minkowski thinks of this
distinction between schizoidia and cycloidia.
distance as dynamic: at times it may separate us,
Bleuler redefined this distinction into schizoidia
and at times it can unite. There is a free space in
and syntonia, characterizing the vital principles of
between us, that we experience as an openness
life in a non-morbid way. Schizoidia is the prin-
of possibilities (Minkowski, 1995, p. 374). This
ciple of withdrawal and of returning to oneself.
free space makes it possible to live, to interact,
Syntonia refers to taking part in social life, and
but allows us to withdraw in relative isolation
is characterized by openness toward the world
as well. According to Minkowski, what Jaspers
(Minkowski, 1966, p. 534). Rhythm plays an
called the delusional mood (“Wahnstimmung”;
important role in this: A person who shares most
Jaspers, 1948, p. 82) concerns disturbances in lived
of her rhythm with her surrounding tends to syn-
space. The experience of a “vague resemblance”
tonia, whereas a person who has a private rhythm
(Minkowski, 1995, p. 377) is itself a disturbance
tends to schizoidia (Minkowski, 1995, p. 273, p.
in experiencing lived space: Objects may seem to
275). Sharing a rhythm is a possibility of contact
point at the patient, people may become threat-
with others, with the ambiance, which transcends
eningly close, the free space is not experience as
the individual (Minkowski, 1995, p. 59).
 Van Duppen / Minkowski  ■ 391

such (Lysaker, Johannesen, & Lysaker, 2005). A Vital Contact

patient reports feeling an “energetic potential” The last building block to analyze concerns the
passing over from other persons to his own body adjective ‘vital’. When Minkowski suggested his
and entering through his forehead. Another patient concept for the first time in 1921, he explained that
feels the contours and metallic qualities of cars that ‘vital’ distinguished the contact, that he intended,
he sees passing down in the street as vivid bodily from the everyday meaning of contact in a spatial
sensations (Fuchs, 2005, p. 134). sense, such as touching an object (Minkowski,
The relation between space and reality becomes 1921a, p. 249). However, from today’s perspec-
even more complex when Minkowski attempts tive, it is difficult to ignore his later work, and
to describe a psychopathology of space that deals particular the influence of Bergson’s philosophy
with hallucinations and delusions. He describes on the meaning of ‘vital’. In this regard, ‘vital’
both as an opening up of a different world, of a dif- refers to the ‘élan vital’ (Minkowski, 1995, pp.
ferent space, on top of the shared world or space. 34–35). The ‘élan vital’ is a continued dynamism
To clarify this view of two spaces, he distinguishes that directs us and our activities toward the fu-
between the dark and the light world (Minkowski, ture. At the same time, ‘élan vital’ is part of our
1995, p. 393). The light world is the space where self-realization.
lived distance, possibility, and openness remain. It The contact with reality is vital, if it is charac-
is a shared world with others. The patient who is terized by a dynamic shifting between schizoid and
hallucinating or has delusions may partly remain syntonic intentions and activities. Being part of
in this world. But at the same time, the patient can the ambiance, to blend in, is syntonia. As we have
be in the dark world, which is the morbid world seen, it is the experience of vibrating at the same
with disturbed distance and measure, in which the frequency, having the same rhythm as others. But
patient is completely alone (Minkowski, 1995, syntonia is not the only aspect of life, nor is it the
p. 394). Although hallucinations and delusions only healthy or normal one. Equally important is
are only accessory symptoms of schizophrenia the opposite direction: away from the ambiance,
in Minkowski’s view, he does note that they are in disharmony with others, toward self-realization.
expressions of “a brutal isolation” (Minkowski,
1966, p. 15). We do not only want to blend into the
ambiance or have to adapt ourselves to others,
Sympathy is the last mode of contact with
we want to affirm our own personality, we want
reality, albeit a particular reality. It explicitly em- to exteriorize our most intimate self, we want to
phasizes the intersubjective experiencing of reality, leave a personal impression into the moving wave
the reality of the immediate other. of change, we want to force our self upon the infi-
nite world and produce and create. (Minkowski,
I speak here of that marvelous gift which
1927, p. 162)
we have in us of making the joys and pains of our
fellow man ours, to penetrate us entirely, to feel This is the cycle of personal activity. It is the
ourselves in perfect communion, to be one with coexistence of two opposite movements: Toward
them. (Minkowski, 1970, p. 67)
the world and others, and away from them.
Sympathy shows that our contact with reality Schizophrenic patients may not always be able
is a shared one: We participate in the reality of to cycle dynamically between these two terrains.
each other. Difficulties in spontaneous interper- Schizophrenic autism is essentially an absence of
sonal affective resonance impede this participa- syntonic possibilities. Minkowski also recognizes
tion. As Minkowski noticed during his work in this disturbance of the dynamic cycle in what
the Burghölzli clinic, one may indeed experience appear to be empty and meaningless activities in
an absent or disturbed affective contact with the the eyes of the outside world (Minkowski, 1995,
schizophrenic patient (Minkowski, 1921a, p. 255). p. 264). The school teacher protesting against the
Rümke later tried to define this lack of attunement death penalty, and Conrad’s German sergeant who
and reciprocity, and the resulting unease in the takes his troops to visit the cultural highlights of
interpersonal contact, as the “praecox feeling” Paris are illustrations of these “crazy activities”
(1960, pp. 435–436). (Conrad, 1958; Parnas, 2013b).
392  ■  PPP / Vol. 24, No. 4 / December 2017

Discussion nection to reality, illustrated by hearing voices and

believing things that are simply untrue. Rather, the
The purpose of the thematic interpretation of notion captures a whole spectrum of schizophrenic
Minkowski’s famous notion of the ‘loss of vital experiences, symptoms, and behavior. More spe-
contact with reality’ was to investigate its mean- cifically, the notion describes the intersubjective
ing, and to evaluate its relevance for contemporary deficiencies that can characterize schizophrenia.
psychopathological research on intersubjectivity. Language, rules, and praxis, the three major
The notion was split up into three building blocks domains of reality, all explicitly refer to an in-
that each entailed references to mostly implicit tersubjective accordance. Even the additional
philosophical concepts. First, Minkowski’s real- elements of contingency, irrationality and ambi-
ity is expressed and experienced in three major ence are in Minkowski’s descriptions related to
domains. These are language, rules, and praxis. intersubjectivity.
Additionally, his concept of reality is characterized The contact with reality has an undeniable
by contingency, the coexistence of rationality and connection to intersubjectivity, too: both time and
irrationality, and by the interaction with the ambi- space are structures that refer to the presence of
ance. It does not refer to reality as the everyday others. Lived time is characterized by rhythm shar-
material world that is external to us. ing between individuals, and synchronism is one
The second building block in this analysis was mode of contact with reality. Minkowski’s lived
‘contact with reality’. Minkowski’s philosophi- space is partly constituted by the in-between be-
cal (Bergson) and psychopathological (Bleuler) tween individuals, in the same way as the Japanese
predecessors were a major influence on his idea psychopathologist Kimura Bin described schizo-
of temporal psychopathology. Minkowski claims phrenia as a disturbance of ‘Aida’ (the in-between;
that one makes contact with reality through the Kimura, 1982, 1991). Schizophrenic patients may
sharing of a temporal orientation, and a rhythm, experience a disturbance of this space as a threat of
which he called synchronism. Contact with reality fusing with, or penetration by objects and others
also implied an experience of lived space, as an (Fuchs, 2005; Lysaker et al., 2005). At the same
openness of possibilities. Last, a particular contact time, the space in-between dissolves by persistent
with reality was described through the notion of distancing and withdrawal (Corin & Lauzon,
sympathy. All three of these modes of contact can 1994, p. 16; Irarrázaval & Sharim, 2014). The last
possibly be disturbed in schizophrenia. mode of contact, sympathy, explicitly refers to our
The third building block of his notion concerns shared experience of reality, as we participate in
the adjective ‘vital’. With reference to Bergson, each other’s reality. To clinicians, the disturbances
vitality means that a person dynamically cycles in interpersonal affection are often one of the first
between orientations toward and away from the things to notice in contact with schizophrenic
world and others. Traditional concepts of psy- patients. It may refer to the traditional, but con-
chopathology had gained a new meaning when troversial, concept of Rümke of the “praecox
Minkowski described this cycle as the movement feeling” (Rümke, 1960; Varga, 2010).
between two essential vital principles: Syntonia The last building block of the notion, namely
and schizoidia. its vitality, should be understood in relation to
intersubjectivity as well. The cycle of personal
Relevance Today: activity allows us to approach others, resonate
Intersubjectivity with them, but it allows us to withdraw in self-
realization as well. Urfer (2001, p. 281) already
The common factor to all of the elements that
noticed that Minkowski’s phenomenology implies
constitute the building blocks of Minkowski’s
an investigation of the “entre deux”, and from
famous notion is intersubjectivity. ‘The loss of
this interpretation of the ‘loss of vital contact with
vital contact with reality’ does not just indicate
reality’, one can indeed conclude that Minkowski
that schizophrenic patients suffer from a discon-
was, in the end, a psychopathologist of the in-
 Van Duppen / Minkowski  ■ 393

between. “The psychopathology that we are lin- light on the phenomenological ideas on schizo-
ing out is a psychopathology with two voices: it phrenia as a self-disorder. Some of the deficiencies
follows from the human encounter” (Minkowski, and difficulties of intersubjectivity that we have
1966, p. XIII). discussed earlier concern a social and narrative
What this article suggests is that a clarified and aspect of the subject. More concrete, they concern
concise use of Minkowski’s notion can help us, be- the person as a social being. The “crazy activities,”
cause it indicates a kind of disturbance that other for example, are expressions of a disturbance of
descriptions do not grasp. Useful as they may be this person to fit into the rules and expectations of
for other purposes, the Diagnostic and Statistical others. A first question is whether schizophrenia
Manual of Mental Disorders’ negative symptoms only affects intersubjectivity on this higher order
(American Psychiatric Association, 2013) describe of sociality and personality. Let us recall the role
distinct parts of schizophrenia, but they not ac- of contingency in reality. We concluded there
count for the nature of specific intersubjective that reality requires an attitude of the subject
disturbances. Research on social cognition, in toward the world that is not characterized by the
contrast, does explicitly study intersubjectivity subject’s own centrality. The psychopathological
disturbances in schizophrenia. Current prominent examples illustrated how this is not so much a
theories in this field are based on the ‘theory of narrative centrality, but an experiential central-
mind’ model. These theories consider human ity. In other words, already in our experience of
interactions as the results of processes like ‘mind- the world, we incorporate others, and experience
reading,’ ‘mentalization’ and ‘simulation’ (Fuchs intersubjectively (see also Husserl, 1973, p. 479).
& De Jaegher, 2009). Social understanding and The anomalies of intersubjectivity are thus not
interaction are thought of as projections of inner restricted to the social aspect of a person, but also
representations onto others. These ideas seem to involve an experiencing subject.
be confirmed by empirical research, showing that A second question is whether these intersubjec-
schizophrenic patients present dysfunctions of tive anomalies are all secondary to disturbances
particular social skills, such as emotion recogni- of a basic sense of self, of ‘ipseity’(Sass & Parnas,
tion, understanding the thoughts and intentions 2003, p. 428) as an experiential core self. If we
of others, and interpreting social cues (Pinkham, follow Minkowski’s claim that the ‘loss of vital
2014). The question is, however, whether these contact with reality’ is the “trouble générateur”
representational theories succeed in describing of schizophrenia, and, at the same time, we know
the complex disturbance of intersubjectivity in that all of the elements that constitute the ‘loss of
schizophrenia. It can be argued that one only vital contact with reality’ refer to specific inter-
explicitly theorizes about the actions, intentions, subjective deficiencies, then we are to conclude
and thoughts of others in situations of need. For that the original disorder concerns intersubjectiv-
some schizophrenic patients, social encounters ity primarily. With Minkowski one could argue
may indeed be described as such situations of need, that the disorder of ‘ipseity’ is tightly interwoven
in which they explicitly attempt to compensate for with deficiencies in intersubjectivity, or with a
their social difficulties. They may indeed engage particular experience of others. As we have seen,
in social interaction through a theory of mind. empirical research has shown that schizophrenic
This means, however, that the original disturbance patients can lack primary or bodily empathy, in
(“trouble générateur”) does not concern men- other words, that they can have difficulties in
talization or mindreading primarily. Rather, the understanding facial and gestural expressions of
disturbances of intersubjectivity find their origin others (Pinkham, 2014). Fuchs (2015) concludes
in a more basic ‘being-with-others’ that makes that one could say that they experience others’
social encounters problematic in the first place bodies more like objects.
(Van Duppen, 2017). This problem has, of course, already been
Minkowski’s notion does not only challenge the present in phenomenological debates on the
‘theory of mind’ model, but it may also shed new self, others, and empathy (Zahavi, 2001, 2014).
394  ■  PPP / Vol. 24, No. 4 / December 2017

A third significant question could follow from Practically, research on the primary disturbanc-
Minkowski’s thought. Namely, if both thematic es of intersubjectivity in schizophrenia could use
and non-thematic self-experience implies recog- the elements that this analysis has brought forward
nizing and distinguishing experiences as for-me or to examine their clinical correlates. Phenomeno-
mine (Zahavi, 2008, p. 128), then where does this logical psychopathology has always been inspired
distinction come from in the first place, but from by both clinical and philosophical insights. In this
the experience of not-self, of other? Experiencing case, Minkowski’s work can guide us in searching
intersubjectivity would thus be a necessity for for the form and selectivity of these disturbances.
experiencing one’s own subjectivity. Whether one Without this guidance, we might not know what
agrees with this argumentation or not, it is clear to look for. Second, it should evaluate whether
that the ‘loss of vital contact with reality,’ and its these correlates are present during psychotic and
wide recognition in phenomenological descrip- non-psychotic, prodromal, and residual phases of
tions, makes us rethink the role of intersubjectivity the illness. Certainly, the loss of vital contact with
in schizophrenia. reality does not entail a loss of intersubjectivity in
The implicit thesis brought forward by my general, but points out the parts of intersubjectiv-
interpretation of Minkowski’s notion is that ity that may be vulnerable in prodromal phases,
schizophrenia involves a particular disturbance and disturbed in actual morbid stages. If ‘the loss
of intersubjectivity, involving both a higher level of vital contact’ is to remain a noteworthy concept
of sociality that concerns the person, and a more in psychopathology, it will have to prove so in
basic level that relates to the experiencing subject. these investigations.
The original disturbance (“trouble générateur”)
does not concern mentalization or mindreading Limitations to the Notion
primarily, and the original disturbance is not re- Despite the clarity that the notion has gained by
stricted to a basic sense of self-disturbance. The analyzing the building blocks from the perspective
‘loss of vital contact with reality’ indicates, albeit of intersubjectivity, and despite the value the no-
in other terminology, that the original disturbance tion may have for contemporary research, it still
affects both ‘being-self’ and ‘being-with-others.’ It has its flaws. First, one can criticize the use of the
affects a space, which Minkowski would poetically notion by referring to it as a reification. Indeed,
refer to as the “entre deux,” or the in-between, without an investigation of its meaning, the persis-
where self and other originate. tent use of the notion is questionable. Minkowski’s
Complementary to Blankenburg’s ‘loss of description can function as a stop-gap solution for
natural self-evidence’ (Blankenburg, 1971), ‘the complex problems and phenomena that actually
loss of vital contact with reality’ can serve as a require in-depth exploration. A concise analysis
prototype for the exploration of these primary and a precise use in the description of psycho-
intersubjectivity disturbances of schizophrenia. pathological phenomena may, however, prevent
Indeed, Blankenburg’s psychopathology seems such reification.
to confirm Minkowski’s concept. Blankenburg Second, Minkowski’s view is based on a restrict-
specifies the difficulties with common sense (1971, ed form of schizophrenia. Both in his early work,
p. 113), which are comparable to the insights on and in later psychopathological descriptions, he
rules and praxis of Minkowski. He, furthermore, tends to minimize certain symptoms (Minkowski,
describes a temporal (Blankenburg, 1971, p. 90), 1966, p. 95). For some contemporary clinicians,
spatial (p. 124), and linguistic alienation (p. 80). it will be surprising that the positive symptoms of
Minkowski’s notion is thus at the same time firmly schizophrenia, such as hallucination and delusion,
grounded in the phenomenology of schizophrenia, play only an accessory role. In most diagnostic
and original and challenging with regard to the classifications, these two symptoms are considered
current debate on social cognition and intersub- important diagnostic criteria (American Psychi-
jectivity in schizophrenia. atric Association, 2013; World Health Organi-
zation, 1993). Minkowski does not justify this
 Van Duppen / Minkowski  ■ 395

view, but refers to Bleuler’s categorization. Sass disturbed experience of spatiality, whether it is
rightly notices that symptoms of disorganization, expressed in threatening closeness or in social
disturbances of thought, language and attention, distancing and detachment. A clinical application
and Schneider’s first-rank symptoms are hardly of his ideas does not require a vast philosophical
mentioned (Sass, 2001). At the time, Minkowski knowledge, as most of these elements are intui-
stood relatively alone with this view, as psychopa- tively accessible.
thologists like Karl Jaspers, Ludwig Binswanger,
and Kurt Schneider were developing their theories Conclusion
on delusions, and psychosis in general. Despite the
emphasis on positive symptoms in clinical praxis This article presents a thematic interpretation
and classifications, contemporary psychopatholo- of Minkowski’s notion of the ‘loss of vital contact
gists seem to agree with Minkowski’s view that with reality’. It aims at investigating the meaning
the disturbances of the self are more central, or of this notion, and at evaluating its relevance for
closer to the “trouble générateur” (Blankenburg, contemporary research on intersubjectivity. The
1971; Sass & Parnas, 2003; Nordgaard, Arnfred, analysis showed that the building blocks and the
Handest, & Parnas, 2008). more fundamental elements of this notion refer to
Third, this thematic interpretation could not philosophical and psychopathological meanings. A
completely discard the vagueness or obscurity of common factor to all these elements is their con-
the notion. The building blocks have been ana- nection to intersubjectivity. Considering the recent
lyzed into more fundamental elements. Some of refocusing of phenomenological research on the
these remain vague and incomprehensible to those investigation of the disturbances of intersubjectiv-
not familiar with the philosophical backgrounds ity in schizophrenia, this is where Minkowski’s
they stem from, such as the philosophies of notion proves its relevance. ‘The loss of vital
Henri Bergson, Edmund Husserl, and Max Sche- contact with reality’ can serve as a prototype for
ler (Minkowski, 1995). The question is whether the exploration of the primary intersubjectivity
a philosophical clarification could accurately disturbances of schizophrenia. It allowed us to
solve this problem. It may indeed be inherent challenge specific ideas on social cognition, and
to Minkowski’s style (Sass, 2001; Urfer, 2001). it could shed new light on the phenomenological
From today’s scientific perspective, this limits the description of schizophrenia as a self-disorder.
application and relevance of Minkowski’s work. This research is not restricted to phenomenologi-
Furthermore, our approach has limitations of its cal considerations, but it might have its relevance
own. The analytical distance might result in a for individual treatment as well. Patients indeed
lack of overarching coherence, and it might not often suffer from their interpersonal difficulties
do justice to the specific form of reflection that is and from social exclusion. Minkowski’s notion
so typical for Minkowski. Additionally, because can, therefore, provide us with the necessary tools
of our initial research interest in intersubjectivity, to investigate the form and specificity of these
certain elements of his work have received more disturbances. These tools can, furthermore, be
attention than others. I do not claim that this is used for the clinical evaluation of intersubjectiv-
the only correct way to interpret Minkowski or ity disturbances, concretely, of a patient’s experi-
the notion in particular, but I have suggested that ence of ‘being-with-others’. Consequently, once
it can prove its relevance mostly with regard to such clinical and phenomenological correlates
intersubjectivity. of Minkowski’s descriptions are found, they can
Last, these limitations make the clinical ap- function in the shaping and evaluation of phenom-
plication of Minkowski’s concept challenging. enologically based therapy. This article provides
Throughout the article, however, I have added the first step in this process. It is up to future
psychopathological descriptions that confirm research to connect these concepts to clinically
Minkowski’s ideas. With regards to lived space, applicable and empirically testable hypotheses.
for example, there are certainly several clinical Considering the notion’s conceptual richness, this
descriptions that illustrate the importance of a promises to be fruitful research.
396  ■  PPP / Vol. 24, No. 4 / December 2017

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