In order to explain further how our beings are determined by our world-relatedness and our self-enclosure, we must introduce another cardinal component of human existence: the component that Helmut Plessner has called eccentric positionality (Plessner 1982, 1981, 1970).
The eccentric positionality of human beings means that the person both coincides with his own being and fails to coincide with his own being. The human being is both centered in its being and not centered in its being: I am both identical with myself and different from my self.
Take my relationship to my own body, for example. To a certain extent, I am my body; I coincide with my body; mybody and I are one. But in other ways my body is something different from me: it is an object or thing which I use.
For example, I use my hands to type on my computer. When I type, I am unaware of my hands. In this case I am my hands; I do not distinguish between my consciousness, which thinks the thoughts, and the hands, which type these thoughts. My consciousness and hands are one reality; they perform together as an indivisible unit. But my hands could not always type on a computer. Years ago I had to teach myself, i.e., my hands, how to type. My hands were then objects about which I had to think, and I had to consciously guide them in each movement. Now that my hands have learned how to type, I do not think about them and I do not consciously direct them. They have become so thoroughly unified with my thinking that my thoughts immediately appear as words on the computer screen. But, of course, this immediate appearance of the words my mind thinks is mediated: it is mediated by my typing hands. Hence Plessner speaks of my relationship to my own body as one of "mediated immediacy."
Or take the emotions I feel as another example. When I am feeling certain strong emotions, I simply am those emotions; my being is enveloped in those emotions. But I can also decide to "get a hold" on my emotions and change them. I may tell myself to calm down or to not get so excited. Of course, I may not succeed entirely when I try to control my emotions. But this partial success perfectly demonstrates the eccentric positionality of human beings. My emotions are not identical with me because I can control them, but they are to a certain extent identical with me because I cannot completely control them; I am compelled to simply be them.
The biodynamic vectors are enclosed within the human being's eccentric positionality. To a certain extent, I simply am my own form of world-dependency: my relationship to the world is to some degree given and unalterable; it is who I am; it is my very mode of personal existence. But to a certain extent, I can control and change my world-dependency. It is not entirely given once and for all because I can modify it. My dependency on the world is something toward which I can take a stand. And I can take a stand toward it because I am not identical with it.
The biodynamic vectors, then, are part of the eccentric positionality of human life: our lives coincide with our own personal forms of world-relationship and self-enclosure. Yet we can also take a stand toward these and change them. We can thus speak of the "bounded freedom" of human beings. Our biodynamic vectors have been shaped by biology and culture. From the point of view of the individual, these vectors are given: they define and determine who that individual is. They are given to the individual, forged by biology and culture. But, nevertheless, the individual can take a stand toward them, attempt to control and modify them. Because these vectors are determined by biology and culture, the choices are bounded. But because the individual can-to some extent-control and change those choices, the individual to some degree remains free. Each individual's relationship to their own biodynamic vectors is a relationship of bounded freedom (Plessner 1982, 1981, 1970).
Biology, culture and freedom shape people differently. For example, some people enjoy playing social roles, and they are able to conform their behavior to the requirements of these roles easily and comfortably. Such people are able to identify themselves with their roles, at least during the times they are playing them. Other people, however, feel uneasy and awkward while enacting social roles. These people experience considerable "role-distance," even when they force themselves to play the role. These alternatives, role-identification and role-distance, are the result of biological, cultural and personal determinants. These determinants shape us differently, so we each have different attitudes toward our social roles.
Notice, however, that we humans, unlike nonhuman animals, can play social roles, and we can play them because of our eccentric positionality. When I am playing a social role, the role is both something I am and something I am not. When I am teaching, I am a teacher. And yet I am also manipulating my role. I adjust it and modify it; I shape it and mold it. I have control over how I play the role, but I do not have complete control because the role is also something I am.
We suggest that role-identification and role-distance manifest possible directions in the biodynamic vectors we mentioned earlier, namely, world-dependence and world-independence. Role-identification manifests the individual's world-dependence. Role-distance evinces the person's world-independence. Many people, in their daily role-performances, are able to balance role-identification with role-distance. They play the roles naturally enough but they do not entirely identify their personal being with the roles. Such an equilibrium in each individual's relationship to their social roles manifests an equilibrium in their world-dependence and world-independence. Of course, such an equilibrium is rarely constant in human life. Vacillating, the individual is able to identify with those roles sometimes but feels deeply alienated from them at other moments. The vectors, as tendencies in human life, change: they move the person in different directions at different times. But precisely in this change and vacillation is disclosed the unfixed and plastic character of human existence. Indeed it is in the change and vacillation that we must come to terms with ourselves and make a decision that selects one alternative from the open range of possibilities confronting us.
Personal life thus emerges as a broad spectrum of possible ways of being human. This spectrum is broad because our biology leaves us world-open, and our culture, supplementing biology, shapes us in a vast variety of ways. And even after biology and culture have placed each of us in different regions along this wide spectrum of humanity, the indeterminacy that remains must rely on individual free will to decide finally how each of us shall live.Philosophical Anthropology
This broad spectrum of humanity includes those we are accustomed to referring to as mentally ill. We would first like to note that it is the world-openness of human beings that makes it possible for those who behave in ways we call mentally ill to survive. Human life can assume many different individual forms and continue to exist in the world because each form inherently retains the indefiniteness and lack of fixity that allow it to adapt to its surroundings. If a "deviant" form of nonhuman animal appeared in the world, it could probably not survive. Its "deviant instincts" would lead it to behave in ways that, because of their fixed structure, remained too maladaptive. Deviant forms of human behavior, however, remain sufficiently open to adjust to a variety of situations.
We shall now draw upon the anthropology we have sketched to indicate some central components of four different mental disorders. We shall contrast these components in people suffering from manic-depressive illness, schizophrenia, sociopathy/histrionic personality disorder and obsessive-compulsive disorder. We wish to set aside any pathological conception of these types of human being, however. While they clearly have biological, genetic, social and psychological determinants, we shall not address these at this time. We shall characterize these human types as particular kinds of being-in-the-world, referring to them as existential types (Kraus, 1977).
The individual who is prone to manic-depressive illness often identifies powerfully with established social roles and values. In the depressive subtype-even when depression is absent-this determined striving will always succeed. In fact, such an individual will overidentify with society's norms. Following Tellenbach and Alfred Kraus, we shall call this overidentification with established social values hypernomia. Hypernomia manifests an excessive dependency on the established social world as well as too little independence from this world. In manic phases, such individuals often rebel against established roles and values. But the very vehemence and determination of their rebellion demonstrates how dependent they remain on the values against which they rebel (Tellenbach, 1961; Kraus, 1977).
Unlike the person with manic-depressive illness, the person with schizophrenia is characteristically unable to identify with society's established values and roles. Such people end by negating or perhaps transcending society's norms. These individuals may even open up a new world. We shall call this inability to conform agonomia. Agonomia evinces an inability to connect to the established social world (Kraus, 1977; Dörr, 1992).
Those prone to sociopathy or histrionic personality disorder are less concerned about identifying with society's values than with manipulating these values in the service of their own self-interest. This underidentification with social norms we label hyponomia. Hyponomia manifests too weak a connection with the shared social world (Dörr, 1992).
Individuals suffering from obsessive-compulsive disorder have no choice but to adhere strictly to their own idiosyncratic values. Because these personal values contradict established social norms, they may feel ashamed of their enslavement to those values and try desperately to conceal this enslavement from others. We call this over-identification with one's own idiosyncratic values and rules idionomia. Idionomia exhibits an extreme form of self-enclosure (Dörr, 1992).
We therefore recognize at least four possible ways to relate oneself to the social world: hypernomia, agonomia, hyponomia and idionomia. In the existential types sketched above, these modes of world-relatedness are fixed and unchanging. Those with manic-depression are unable to act otherwise than to strive determinedly to identify with established social norms. Individuals with schizophrenia are also unfree: they cannot identify with society's values and roles. Quite independently of any choice on their part, human beings with sociopathy or histrionic personality disorder remain under-identified with social values. People with obsessive-compulsive illness cannot choose to stop adhering absolutely to their own idiosyncratic rules. In short, people who have manic-depressive disorder must be hypernomic; those with schizophrenia must be agonomic; individuals with sociopathy or histrionic personality disorder must be hyponomic; and people with obsessive-compulsive illness must be idionomic.
This necessity to maintain these forms of world-relatedness arises from both biological and social causes. Scientific research in neuroscience and cognitive neuroscience has begun to explicate crucial biological determinants in individuals who instantiate these types (Spitzer, 1999). Such determinants have left these people less world-open than others who experience more flexibility and malleability in their forms of value-relatedness. Most people can identify with their culture's values to a significant degree while at other times feeling alienated from the accepted societal norms. Individuals who exemplify the mentally disordered types, however, have biological structures that render one form of value-connectedness dominant and pervasive. Other kinds of value-relatedness are relatively unavailable to these individuals. With regard to their forms of value-relationship, they are inflexible and unchangeable.
Of course, what we have just said must be qualified to some extent. People of these existential types do feel drawn to some degree in contrary directions. For example, those prone to manic-depression, dominated as they are by their hypernomia, still experience some inclination to negate established values. In other words, they may, to a degree, gravitate toward agonomia. And they may also experience an impulse toward idionomia. But it is hypernomia that ultimately controls the active self: the pull of hypernomia remains too strong to be resisted. Other forms of value-relatedness may exert some pull on all such people. We may, therefore, see transitional types such as the individual with schizoaffective illness.
A second qualification that must be emphasized is human freedom, however deficient it may appear in these existential types. Even people who grapple with this kind of personal fixity remain capable of acting and reacting in unpredictable ways.
These four existential types should be viewed, therefore, as simply four different ways of being human. Depending on how they are shaped by biological, cultural and personal factors, many people may approximate these types to some degree. However, the types described lie at the extremes of the broad spectrum of humanity mentioned previously. Therefore, their voices-together with the voices of those of us whose vectors bring us closer to the human center-should be heard. All of us together constitute a plurality of forms of world-relatedness, enabling humans to inhabit this world as well as countless and unfathomable past and present worlds.
Indeed these existential types may and do have crucial and even essential roles to play in human history. The hypernomic type performs an invaluable conservative function in maintaining social standards and in disapproving of deviations from those standards. Deviations from the culture's values are seen by the hypernomic individual as shortcomings and therefore, requiring redress. Hypernomic individuals provide strong and selfless support for social norms and institutions. Without them, the inherent flimsiness of cultural standards could easily lead to social breakdown.
In times of social breakdown, however, the agonomic type can play a crucial, even a revolutionary, historical role. Agonomic human beings envision innovative value systems. In their alienation from accepted norms, their intense authenticity, their capacity to perceive details that others miss and their metaphysical preoccupations, they may expound other and newer values. They may see themselves as having the "saving knowledge" that can deliver humankind from its deepening crisis. More than once in human history the agonomic's vision of a "new heaven and earth" has rescued communities from the deadends into which their traditional values have led them.
Hyponomic individuals, on the other hand, are supremely adaptable to the rapid shifts in values and mores that characterize times of change and crisis. Outstanding performers, they may pick up the values of the moment and express them passionately and perfectly. And with equal gusto, they undermine the old as they embrace the new.
Finally, idionomic people may retain for all of us what appears to be no longer of value in the present but which may regain value in the future. With seriousness of purpose, devotion to their tasks, a strong capacity for work and scrupulous attention to detail, they preserve that which is of value and would otherwise be obliterated.
We certainly recognize that extraordinary suffering is often associated with these types. Nonetheless, if we are right about the important historical functions performed by the individuals who embody them, it would be a grave mistake to seek elimination from the human gene pool of the genes that produce such people. Indeed, if we are right, these genes need to remain in order to continue to give rise to people of these types. The search for these genes and genetic mechanisms constitutes a central project of present-day psychiatric research. We caution that the eradication of such genes, if they exist, would be a grave mistake. Humanity needs hypernomic individuals to strive forcefully to maintain its existing standards. It also needs agonomic people who envision radically new ways of life as well as hyponomic individuals who undermine the old and make way for the new and embrace it. In the meantime, idionomic people preserve that which is of old but unnoticed value: tomorrow such value may once again become essential to us. Without hypernomic people, our traditional social structures will lack their main human support and will be threatened with collapse and, without agonomic individuals, we will lack the new vistas needed when our traditional institutions do inevitably collapse. Hyponomic people can facilitate this collapse while idionomic individuals hold back the tide and preserve that which may prove useful again in the future. The human race needs such extreme qualities-our continued existence may even depend on them.Toward Regaining the Personal
Present-day psychiatry lacks an adequate conception of the person because it possesses only disconnected elements and fragments of such a conception. In order to regain the personal we need a comprehensive notion of human life that incorporates and integrates biological, social, psychological and other perspectives. We do not deny that fruitful work has been done in mainstream psychiatry in recent decades. But this work, in order to focus on its chosen domain, inherently abstracts from other features of the patient. Hence it is not surprising that these investigations produce only parts of a whole. And misconceptions arise when the parts are not recognized for what they are: separate parts. When one perspective on the person is taken in isolation and treated as if it were somehow the main or the central aspect of personhood or mental illness, error follows. The numerous perspectives on human existence need to be comprehended from within a larger philosophical anthropology that includes them all. We have sought to sketch such an anthropology.
But more is needed. The values that undergird psychiatry need to be explicated and grounded so that the field can protect itself from misuse by large economic, political and social forces. Such an ethic would require that patients be treated in ways that address their full and equal humanity as they deal with the illnesses that can cause so much suffering.