SOURCE: Sass, Louis A. “On Delusions.” Raritan: Quarterly Review 9 (spring 1990): 120-41.

[In the following essay, Sass discusses Schreber's Memoirs in the context of traditional interpretations of schizophrenic delusions.]

You must always be puzzled by mental illness. The thing I would dread most, if I became mentally ill, would be your adopting a common-sense attitude; that you could take it for granted that I was deluded.

—Ludwig Wittgenstein

Insanity is generally assumed to involve perceiving things that do not exist and believing things that are not true. As Karl Jaspers (an influential psychiatrist before he became a philosopher) put it, “Since time immemorial, delusion has been taken as the basic characteristic of madness. To be mad was to be deluded.” This remains true in contemporary psychiatry and clinical psychology, at least in America, where “disturbance in or failure of reality testing” is considered to be the criterion for the diagnosis of a so-called psychotic condition.

According to the usual interpretation of “poor reality testing,” the psychotic is one who fails to distinguish adequately between the realms of the real and the imaginary since he treats the imaginary realm as if it were real. Such a manner of imagining the inner world of insanity is widespread in psychology and psychiatry as well as among the general public. It supposes that, whereas there is disturbance in the content of the patient's world (what he believes and perceives is unrealistic or illogical), the form of the patient's world (its structure or feel, the way in which he believes what he believes) is essentially normal. That is, the patient is assumed to believe in the content of his delusions—or, at least, to want to believe in this content—with the same sense of objective reality that normal people ascribe to the facts of their actual and consensual worlds. “What objectively are hallucinations and delusions are to him unassailable truth and adequate motive for action,” wrote the superintendent of the asylum in a legal brief arguing for the continued involuntary incarceration of Daniel Paul Schreber, the paranoid schizophrenic whose bizarre experiences are my focus in this essay.

The origins of this now orthodox conception of insanity can be traced to the mid-seventeenth century, a time when the rationalism of the Enlightenment was beginning to replace the religious world view of the Renaissance. During the Renaissance, the figure of the madman (or that of the fool, for the two were inseparable) had roused profound ambivalence: the madman was an object of ridicule but also of fascination and respect. While he was, on the one hand, an innocent or an instrument of vice, he was also imagined as having access to a truth more profound than that available to normal men. Michel Foucault has argued that, with the dawning of Enlightenment rationalism, insanity came to be viewed as mere unreason, a simple condition of mistakenness, of failure to reason and perceive accurately. Madness was silenced, its claim to wisdom dismissed, when it came to be viewed as a kind of “quasi-sleep” that lacks “the consciousness of deluded consciousness,” the awareness of the illusory nature of its illusions. The contemporary poor reality-testing formula is the perpetuation of this view which considers madness and insight to be as antithetical as error and truth.

In general, the psychoanalytic schools have interpreted poor reality testing as a manifestation of the patient's regression to primitive modes of consciousness that are dominated by instinct and characterized by a weakened ego. Medical-model psychiatry has usually viewed it as a bizarre manifestation of some biological dysfunction that cannot be empathically understood (or else, is not important to understand). The psychoanalytic and medical-model approaches agree in accepting the poor reality-testing formula and, more generally, in emphasizing the schizophrenic's supposed lack of higher cognitive capacities for self-conscious awareness and for reflective distance from experience.

This essay is a critique of these notions that for so long have dominated our understanding of madness. The delusional worlds of at least some patients with schizophrenic (or, “schizophreniform”) types of psychosis can, I believe, be better understood in a very different light. As I shall show—with the aid of some writings by the philosopher Ludwig Wittgenstein—such patients often manifest a certain solipsism, a felt subjectivization of the experiential world that is associated with a stance of passivity and hyperconcentration and exaggerated self-consciousness. Such a mode of experience does not, in fact, seem to involve deficient reality testing, at least as this is traditionally understood, nor does it seem readily explicable as a manifestation of regression to primitive modes of consciousness.

I will be considering in detail the nature of reality testing in the delusions of the paranoid schizophrenic Daniel Paul Schreber—perhaps the most famous and influential patient in the history of psychiatry. If schizophrenia is the prototypical form of madness, Schreber is, in a sense, the prototypical madman. His special significance derives from his autobiographical book, Memoirs of My Nervous Illness, an account that provided the material for the only case study Freud ever wrote of a psychotic patient, and that served as a central example of schizophrenia for Karl Jaspers, Eugen Bleuler, and other European psychiatrists who developed our modern conceptualization of this disease early in the twentieth century. His delusional world can, as I will suggest, be understood as the antithesis of standard images of madness—namely, as a condition involving not diminution but exaggeration of a kind of self-conscious awareness. Before turning to Schreber, however, it is first necessary to consider in more detail the traditional interpretations of schizophrenic delusions and then to mention some common schizophrenic symptoms that are difficult to square with these interpretations.

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The most recent diagnostic systems of the American Psychiatric Association (instituted in 1980 and 1987) define delusion as a “false personal belief based on incorrect inference about external reality and firmly sustained in spite of what almost everyone else believes and in spite of what constitutes incontrovertible and obvious proof or evidence to the contrary.” A “bizarre delusion” is defined as “a false belief whose content is patently absurd and has no possible basis in fact.” The express purpose of these diagnostic systems is to be atheoretical—to base diagnosis on unambiguous and publicly observable features that require a minimum of interpretation. In fact, however, their vocabularies of description (like all such vocabularies) are fraught with theoretical baggage. Terms like false, incorrect, and absurd implicitly invoke a particular “form of life” (what in a phenomenological vocabulary might be called a horizon), for they implicitly treat the patient's assertions as unsuccessful attempts to refer to the kind of external reality to which normal canons of obvious proof or evidence and consensual agreement apply. In this way they imply that in some crucial sense the patient lives in the same commonsense world as the rest of us.

Delusions have also been assimilated to familiar modes of experience by interpreting them as unusually intense but essentially normal wish-fulfillment fantasies that are entertained in a state of diminished critical judgment. In his famous paper of 1913 on “Autistic Thinking,” Eugen Bleuler compared the schizophrenic's delusions to the dream of a youngster playing general on a hobbyhorse or the fantasies of a poet in love: “All these,” he wrote, “are but points along the same scale.” In psychoanalysis, the poor reality-testing and wish-fulfillment notions are joined together and subsumed under the concept of developmental “primitivity.” In accordance with the Freudian regression/fixation model of psychopathology, schizophrenic and other psychotic delusions are interpreted as a pathological revival of what analysts have called the “original infantile story”; according to this view, the schizophrenic is like the child of age five or younger to whom everything is real. Schizophrenia also tends to be understood as a sort of triumph of the id—a Dionysian condition in which unmodulated desires, hallucinatory wish-fulfillment fantasies, and the wild meanderings of the primary process overwhelm all capacity to reason, to reflect on the self or on immediate experience, or to distinguish the real from the imaginary.

Oddly enough, however, certain prominent characteristics of many schizophrenic patients do not seem to be consistent either with the notion of poor reality testing as a failure or deficiency of the ego or with the interpretation of the delusional state as a manifestation of infantile or Dionysian regression.

First, it is difficult to square the standard interpretation of poor reality testing with the commonly observed fact that many schizophrenics who seem to be profoundly preoccupied with their delusions, and who cannot be swayed from belief in them, will nevertheless treat these same beliefs with what seems a certain distance or irony—as if they did not in fact consider their delusions to have a truly objective reality. Eugen Bleuler, for example, describes a hebephrenic patient who would make fun of himself because he, the “Lord and King of the Whole World,” had been accustomed to making the weather right after teatime, yet did not know how to get out of the hospital; indeed, the patient asked himself “whether all this did not sound rather fantastic.”

Also, it is remarkable to what extent even the most disturbed schizophrenics may retain, even at the height of their psychotic period, a quite accurate sense of what would generally be considered to be their objective or actual circumstances. Karl Jaspers pointed out that the attitude of such patients toward the content of their delusional beliefs is “peculiarly inconsequent at times.” Rather than mistaking the imaginary for the real, they often seem to engage in a kind of double bookkeeping—as if they lived in two parallel but separate worlds, consensual reality and the realm of their hallucinations and delusions. A patient who claims that the doctors and nurses are trying to torture and poison him, for example, may nevertheless happily consume the food he is given.

Another way in which standard conceptions of poor reality testing seem to misconstrue the lived world of many schizophrenics concerns the content of the delusions. The delusional world described by Bleuler and others evokes a realm which, though brighter and more satisfying than the everyday world, is still relatively close to that of normal human life and therefore is easy for the normal person to imagine. In actuality, however, the delusions that are widely recognized as being the most characteristic of real schizophrenics do not simply exaggerate but fundamentally distort, contradict, or call into question the most basic assumptions of human existence. Such patients may, for example, feel and believe such things as that what appear to be other human beings are actually phantasms or cleverly designed machines quite devoid of any real consciousness or that the whole universe is responding to each peristaltic movement of their own intestines or even that the entire universe is in imminent danger of ceasing to exist. Delusions like these are not explicable as wish-fulfillment fantasies—or, at least, not readily so—for even if such delusions do, at some level, involve intense wishes, these themselves would seem to be in need of considerable elucidation before they could be emphatically understood or could play an explanatory role.

Nor is the characteristic tone or atmosphere of many such delusions really consistent with the psychoanalytic interpretation of regression to a primitive or Dionysian form of consciousness. For one thing, the famous flat affect observed in so many schizophrenics, as well as the devitalized or derealized quality that often permeates their experiential world, hardly suggests a regressed state charged with the energy and vitality of the primary process. Thus one schizoaffective patient describes the unreality feeling that plagued her during much of her psychosis:

It is more like gray. It is like a constant sliding and shifting that slips away in a jellylike fashion, leaving nothing substantial and yet enough to be tasted, or like watching a movie based on a play and, having once seen the play, realizing that the movie is a description of it and one that brings back memories and yet isn't real. … Even a description of it is unreal and tormenting, for it is horrifying and yet seems mild and vague, although it is acute. It is felt in an unreal way in that it isn't constant torture and yet never seems to leave and everything seems to slip away into impressions.

Similarly, the schizophrenic patient Renee, author of Autobiography of a Schizophrenic Girl, speaks of experiencing “the pasteboard scenery of Unreality” during her psychosis, and says that “even the sea disappointed me a little by its artificiality.” Going along with these illusions of inauthenticity are what might be termed delusions of disbelief. Indeed, it has not been sufficiently noted how often schizophrenic delusions involve not belief in the unreal but disbelief in something that, in the view of most people, is true. Schizophrenic patients may speak disbelievingly of “my so-called children and the so-called hospital,” or, in Schreber's case, of “the supposed patients” and “a man who was supposed to be the Medical Director of the Institute.”

Karl Jaspers maintained that the delusional world of schizophrenia was so completely alien to normal experience (of the adult or the child) that it must always remain enigmatic. In fact, according to his central axiom of the “abyss,” the very quality of incomprehensibility is itself the best diagnostic sign of schizophrenia, a condition that supposedly involves some total alteration of the whole personality and lived world, probably on a physiological basis, “the nature of which we are so far unable to describe, let alone formulate into a concept.” One of the features of the schizophrenic delusional world that Jaspers emphasizes and that in his view defies comprehension and gives the normal observer a sense of radical otherness is the quality of the patient's belief in his delusion. This involves what he calls a “specific schizophrenic incorrigibility” which is quite unlike the normal dogmatism of fanatical people or that of psychotics who are not schizophrenic (manic-depressives, for instance). In delusion proper, as Jaspers called the schizophrenic symptom, belief is absolutely unshakeable, quite beyond argument. “Well, that is how it is,” the patient will say. “I have no doubts about it. I know it is so.” Yet, by a seeming paradox, the patient's attitude toward his delusion is, according to Jaspers, “peculiarly inconsequent at times.” Despite the certainty with which they are held, such delusions do not usually lead to any action; nor are they accompanied by emotions appropriate to their content.

In the clinical psychology and psychiatry of the present day, essentially the same approaches to the world of schizophrenic delusion still prevail. The medical-model approach implicitly follows Jaspers's lead in downplaying the possibility and the importance of seeking a psychological interpretation of the inner world of schizophrenia, an understanding from within, while the contemporary psychodynamic approaches nearly always interpret schizophrenic delusional states as indicating regression to archaic modes of feeling, thought, and perception. Given the problems with the poor reality-testing, wish-fulfillment, and regression interpretations, one might well ask if any other interpretation of such phenomena is possible. Is there another way of understanding the delusional state of schizophreniform psychoses that might better account for their phenomenological peculiarities? Or, is one forced to accept, as did Jaspers, the unbridgeable alienness of the schizophrenic world?

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In the following passage from Schreber's Memoirs of My Nervous Illness, the delusion in question is a central one of his psychosis, his belief that he is being transformed into a woman:

When the rays approach, my breast gives the impression of a pretty well-developed female bosom; this phenomenon can be seen by anybody who wants to observe me with his own eyes. … A brief glance however would not suffice, the observer would have to go to the trouble of spending 10 or 15 minutes near me. In that way anybody would notice the periodic swelling and diminution of my bosom. Naturally hairs remain under my arms and on my chest; these are by the way sparse in my case; my nipples also remain small as in the male sex. Notwithstanding, I venture to assert flatly that anybody who sees me standing in front of a mirror with the upper part of my body naked would get the undoubted impression of a female trunk—especially when the illusion is strengthened by some feminine adornments.

A careful reading of this passage makes it clear that Schreber is not describing a delusion as that term is generally used in accordance with the poor reality-testing formula. He does not claim that there has been any actual anatomical change in his torso, and he only says that under certain circumstances his breast “gives the impression” of being a female bosom. He even takes care to emphasize that the amount of hair and the size of his nipples remain as before, and he refers to the impression of femininity as an “illusion.” This is not an atypical example.

In general, Schreber's delusions lack the literalness that schizophrenic delusions are so often assumed to have. He does not make claims about literal characteristics of the objective, external world—the sort of statements that could be shown to be false by reference to evidence independent of the experiences in question. Thus, when he describes a delusional belief about himself, he typically says not “I am x or y” but rather, “I am represented as x or y”—or else he talks about a process called picturing. In another passage, Schreber talks about the “lower God” who creates “by representing the impression of a person bellowing because he is demented” (my emphasis). Such modes of expression suggest that Schreber's “delusional” experiences retain for him a quality one might call a coefficient of subjectivity—as if whatever is experienced has an aura that labels it not as reality but as an experience. The intentional objects of such a mode of experience seem to be recognized as phenomenal in the sense of being encompassed by, or dependent for their existence on, some consciousness which conceives or perceives them. They exist not in a public or objective realm but only, as Schreber himself often says, “in the mind's eye.”

Dr. Weber, a psychiatrist who served as medical examiner when Schreber brought suit to be released from the asylum to which he was confined, stated that Schreber's delusions and hallucinations involved “unshakable certainty and adequate motive for action.” In his expert's report, he describes Schreber as having “real hallucinations,” whose characteristic is “that they are taken for factual and real and have the same acuity as other sensations.” Schreber in his response insists, however, that such beliefs—he calls them “my so-called delusions”—refer to a separate realm, one that does not motivate him to act and where the usual criteria of worldly proof or belief do not apply. The combination of incorrigibility and inconsequentiality which Jaspers described (and considered to be incomprehensible) could hardly be stated more clearly:

I have to confirm the first part (a) of this [Dr. Weber's] statement, namely that my so-called delusional system is unshakable certainty, with the same decisive “yes” as I have to counter the second part (b), namely that my delusions are adequate motive for action, with the strongest possible “no”. I could even say with Jesus Christ: “My Kingdom is not of this world; my so-called delusions are concerned solely with God and the beyond; they can therefore never in any way influence my behavior in any worldly matter. … Whoever thinks this is possible has not entered into my own spiritual life.”

That Schreber's claims were in large measure true is confirmed by the assessment of the judge, who said he could not find “a single fact which could give well-founded grounds for anxiety, that the patient would allow himself to be led astray under the compulsion of his delusional system.”

We see, then, that schizophrenic delusions do not necessarily involve mistaking the imaginary for the real. It seems, however, that they may involve the converse. Much of the time Schreber maintained a belief in the unreality of virtually all the activity and people around him, even when these were, in fact, objectively real:

Having lived for months among miracles, I was inclined to take more or less everything I saw for a miracle. Accordingly I did not know whether to take the streets of Leipzig through which I traveled as only theatre props, perhaps in the fashion in which Prince Potemkin is said to have put them up for Empress Catherine II of Russia during her travels through the desolate countryside, so as to give her the impression of a flourishing countryside. At Dresden Station, it is true, I saw a fair number of people who gave the impression of being railway passengers.

(My emphasis)

At times Schreber was convinced that all the people he saw had been “miracled up” or “fleetingly improvised” by “rays” in order to deceive him, and that, rather than having a separate existence in themselves, they appeared and disappeared like pictures. In another remarkable passage, Schreber describes himself as sitting in a park where wasps or other insects would repeatedly appear before his eyes. He was convinced that these apparent insects were brought into being at the very instant his eyes fell upon them and that they disappeared when he looked away. During this experience, which he referred to as “the wasp miracle,” the world seems to have felt to him like something that had existence only when he experienced it, and solely for the purpose of being seen by him. What would to the normal person have the quality of reality—existence independent of that of the self-as-subject—seems to have had for Schreber the ephemeral quality of something merely phenomenal.

These examples of delusional experience hardly seem consistent with the usual notion of poor reality testing, which implies that an objectively inaccurate perception or belief is held by the patient as real. What is distinctive about such delusional worlds is, rather, that the patient accords his delusions great importance while nevertheless experiencing them as pervaded by a quality of unreality or subjectivization.

The subjectivized worlds of these patients is, in fact, strikingly reminiscent of solipsism, the philosophical doctrine which claims that the whole of reality, including the external world and other persons, is but a representation appearing to a single, individual self—namely, the self of the philosopher who holds the doctrine. When patients experience such solipsistic or quasi-solipsistic feelings of subjectivization, they have generally been interpreted by psychoanalytic writers as manifesting a primitivization of consciousness—a regression to early infantile grandiosity and to immature forms of experience that precede development of a sense of self, a capacity for self-critical meta-awareness (consciousness of consciousness), or differentiation between subjective and objective, inner and outer. I want now to suggest an interpretation of Schreber's solipsistic experiences that is, I think, more consistent with the phenomenological peculiarities of his actual lived world. This will involve viewing Schreber's delusions in the light of Ludwig Wittgenstein's treatment of the philosophical doctrine of solipsism.

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“This world is my world,” was Wittgenstein's succinct summary of the central intuition of the metaphysical vision of the solipsist. It is a vision of reality as a dream, but with awareness of the fact that one is dreaming. Solipsism was, in his view, “a serious and deep-seated disease of language (one might also say ‘of thought’),” a metaphysical illness to which he himself had been, and perhaps always remained, susceptible.

What, asks Wittgenstein, is the frame of mind in which one must be in order to feel profoundly struck with the truth of the notion that “this world is my world”? Or, to put it differently, what is the sort of experience of the world to which this doctrine seems to correspond, out of which it is likely to arise? As was typical of Wittgenstein, he did not concern himself with the truth-value of solipsism as a metaphysical doctrine. Indeed, he wanted to wean philosophy from idle speculation about such unanswerable issues and to move it toward more useful questions that would allow people to dissolve such metaphysical speculations or worries. One method of doing this was to consider what one might call the experiential counterpart to the metaphysical doctrine. (One might think of this as a contextualizing or even a psychologizing of metaphysics.)

Wittgenstein mentions two aspects of the experiential stance corresponding to solipsism. The first is absence of activity:

To get clear about philosophical problems, it is useful to become conscious of the apparently unimportant details of the particular situation in which we are inclined to make a certain metaphysical assertion. Thus we may be tempted to say “Only this is really seen” when we stare at unchanging surroundings, whereas we may not at all be tempted to say this when we look about us while walking.

The second aspect is an abnormal intensity of one's way of looking at something:

1. The phenomenon of STARING is closely bound up with the whole puzzle of solipsism.
2. Ask yourself: what does the word “feeling”, or still better “experience”, make you concentrate on? What is it like to concentrate on experience? If I try to do this I, e.g., open my eyes particularly wide and stare.

Moving about the world, one is forced to observe the multifacetedness of objects, and thus to recognize that their total being can never be captured by their phenomenal appearance at any given moment. Interacting with the world—for example, by picking up an object—forces one to recognize the world's otherness. The very weight of the object and the resistance it offers to the hand testify to its existence as something independent of will or consciousness. At the same time, however, the act of moving something that lies out there in the world confirms one's own sense of activity and efficacy.

But, in a passive state, it is possible for the world to look quite different. The more one stares at things, the more they may seem to have a coefficient of subjectivity; the more they may come to seem things-seen. When staring fixedly ahead, the field of awareness as such can come into prominence. Then, it is as if the lens of awareness were clouding over and the world beyond were taking on the diaphanous quality of a dream. At this point a person can be said to experience experience rather than the world, to have the impression of seeing not, say, an actual and physical stove, but a “visual stove,” the stove-as-seen-by-me (to use one of Wittgenstein's examples). In this situation, the object tends to feel as if it depends on me in some way, belonging to my consciousness as a private and somehow inner possession. Wittgenstein explains that this experience is not likely to occur when you are interested in some object in the world but, rather, when there is a certain disengagement and introversion—when, as he puts it, “you concentrated on, as it were stared at, your sensations,” rather than seeing right through your sensations to a world filled with real objects of interest and use.

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The circumstances of Schreber's delusional experiences correspond precisely to those which, according to Wittgenstein's analysis, give rise to the metaphysical vision of solipsism. Schreber explains that “I considered absolute passivity almost a religious duty”; God seemed to make “the monstrous demand that I should behave as if I were a corpse.” In fact, the very preservation of his own existence, as well as that of God and the universe itself, sometimes seemed to depend on his remaining still. Accordingly, he spent much time in a state of extreme inactivity, sitting motionless on a chair for nearly the whole day and moving “only occasionally [when] urged by the attendants to walk about, really against my will.” Observers reported that he was often to be seen standing motionless in the garden, staring into the sun and grimacing.

Also, Schreber was frequently in a state of heightened awareness in which he scrutinized the world and his awareness of the world. Far from being incapable of concentration or self-monitoring, he was unable to perform the most trivial act—like, say, watching a butterfly flutter past—without obsessively reflecting on his own experience and checking on whether he was really doing what he thought he was doing. As the following passage from his Memoirs suggests, his hallucinatory voices were often the expression of this self-scrutiny:

Whenever a butterfly appears my gaze is first directed to it as to a being newly created that very moment, and secondly the words “butterfly—has been recorded” are spoken into my nerves by the voices; this shows that one thought I could possibly no longer recognize a butterfly and one therefore examines me to find out whether I still know the meaning of the word “butterfly.”

It seems that the experience of the “miracled-up” insects—his sense of being the conscious center before whom and for whom events appear—did not occur unless he was in a state of immobility. Schreber explains that if he walked about in the garden, the miracle would not happen, but if he sat down and waited, he could actually provoke this “wasp-miracle.” Such withdrawal from action is common in schizophrenia (not only in catatonic patients), and it often seems to be a precondition for the onset of certain symptoms, including auditory and kinesthetic hallucinations and certain profound delusions of reference.

We have seen how obsessed Schreber was with the need to stare, to scrutinize every passing thought or perception. It is significant that the impression of the feminization of his body occurred at a time when he combined such intense concentration with passivity—when he stood still in front of a mirror staring at himself for an extended period of time. And, as we saw, under these circumstances he did not have the experience of watching a literal or objective change come over his body. The experience was rather one of seeing his body as if from a certain point of view—one that, while rendering the body as feminine, was still recognized as a point of view. Let us call this the attitude of quasisolipsism (since the experience is not accompanied by a full and explicit awareness in philosophical terms of the doctrine of solipsism).

We see, then, that the stance of passive concentration gave rise, in perfect accordance with Wittgenstein's analysis of solipsism, to a pervasive sense of subjectivization (of experiencing experience rather than the external world) and to a feeling that, as Schreber put it, “everything that happens is in reference to me.” (Incidentally, Wittgenstein believed that solipsism contains within itself certain contradictions, ways in which it denies its own fundamental claims; these contradictions also have very close parallels in Schreber's lived world, but I will not have space to treat them here.) But such experiences of delusional and subjectivized reality seem to be embedded in a form of consciousness that is hyperacute, hyper-self-conscious, and highly detached, qualities not at all characteristic of early stages of cognitive-emotional development. Indeed, a lived world that foregrounds awareness of subjectivization and innerness, of the mind's role in constituting the world, would seem to be, if anything, highly advanced from a cognitive-developmental point of view.

It would not, by the way, be absurd to read Wittgenstein's philosophy as being motivated, in part, by a desire to ward off madness of the sort that afflicted Schreber—though this in no way gainsays the philosophical validity of his arguments and analyses, which is, of course, an entirely different matter. As a young man, Wittgenstein was very strongly attracted to the idealist doctrines of Schopenhauer, which he later saw as having a strong solipsistic element, and he subsequently described his later thought as a reaction against this temptation he knew so well. That Wittgenstein himself sensed the danger of insanity is also suggested repeatedly in his private, nonphilosophical notes, where he wrote that “if in life we are surrounded by death, so too in the health of our intellect we are surrounded by madness.” Wittgenstein, it would seem, well understood the dilemma of a mind that risks driving itself insane through its own relentless lucidity.

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A number of the characteristics of the schizophrenic delusional world which Jaspers considers inexplicable can, in fact, be comprehended as aspects of such quasisolipsism. Take, for example, the specific schizophrenic incorrigibility of what Schreber calls his so-called delusional system—with its absolute imperviousness to argument or external proof and its strange, seemingly paradoxical combination of certainty with inconsequentiality. It is natural that solipsistic claims cannot be adjudicated in any public domain. To claim that one is represented as a female is not the sort of claim to which corroborative or disconfirmatory evidence could possibly be relevant. No imaginable fact—not the roughness of a beard, the breadth of hips, nor even the anatomical presence of male genitalia—could possibly refute the fact of the experience of the representing, this occurrence in a private mental space of this image of a body's femininity, this instance of “seeing-as” (in Wittgenstein's phrase).

The agreement of others will also be irrelevant to an experience that, paradoxically enough, feels in one way absolutely private and in another way quite universal (since no one else can share my consciousness, yet my consciousness is All). Others are experienced either as unbridgeably apart or as nonexistent—with sometimes a rapid oscillation between these two alternatives. And, in both these cases, consensual proof and agreement are not relevant. Thus, Schreber claims that “for myself I am subjectively certain that my body … shows such organs to an extent as only occurs in a female body.” Though he realizes that to other people the miracles enacted upon his body may sound like “only the product of a pathologically vivid imagination,” he insists on the certainty for himself of his own experiential reality: “What can be more definite for a human being than what he has lived through and felt on his own body?”

At the same time, however, the solipsist may well not act on those indubitable experiences which are felt to be constituted by his own consciousness alone (the “so-called delusions,” in Schreber's phrase). In a solipsistic universe, to act might feel either unnecessary or impossible—unnecessary because external conditions are at the mercy of thought, the world as idea; impossible because real action, action in a world that can resist my efforts, cannot occur in a purely mental universe. (Schreber, for example, said he would not try to harm himself or commit suicide because he believed that even the most serious injuries to his body could not affect him.) Indeed, as Wittgenstein's discussion of passivity and staring shows, the very looming-up of the solipsist's vision depends on inaction; real activity would threaten to dissipate this dream universe.

An understanding of this quasi-solipsistic world also helps to account for the affectless, devitalized, or otherwise derealized atmosphere so often characteristic of schizoid and schizophrenic lived worlds. Such signs and symptoms have often been interpreted as indicating either an incapacity for profound emotional experience or a defensively autistic turning of attention away from awareness of the surrounding social world toward experiences described as inner. But one person who should know, a schizophrenic patient named Jonathan Lang, disputes such views as too simplistic. According to Lang, the innerness of the schizophreniform world is not so much a matter of the content as of the form of experience: it involves not a turning away from one object, an external one, to another, an internal one (whatever that would be), but rather a shift of attitude or perspective. As he puts it, the schizophrenic's withdrawal “is not so much a withdrawal from society as it is a withdrawal from sensorimotor activity. A considerable proportion of his ideological activity [his thinking] is devoted to other humans.” Lang also denies that patients like himself are unaware or devoid of emotions. It is just that their concerns with feelings, as with people, are experienced in the context of (in the perspective of) what he calls “the ideological domain”—a realm in which everything is felt to be merely mental or representational.

Perhaps the best evocations of such an experiential world are to be found in the works of Samuel Beckett, where the protagonists so often have a schizoid orientation and the physical setting serves as a metaphor for their quasisolipsism. The hero of Murphy, for example, pictures his mind “as a large hollow sphere, hermetically closed to the universe without. This was not an impoverishment, for it excluded nothing that it did not itself contain.” Murphy finds himself in a padded cell where “the tender luminous oyster-grey of the pneumatic upholstery, cushioning every square inch of ceiling, walls, floor and door, lent colour to the truth, that one was a prisoner of air.” Here the setting perfectly expresses the paradoxical mood-tone of quasisolipsism—that feeling of being both imprisoned and protected by a pervasive mental atmosphere which inserts itself between reality and the self.

Schreber's attitude toward his own physical being seems to have had this dereified and affectless quality—a fact that makes it possible to understand how he can be so calm and matter-of-fact about events that, to the reader, seem fantastic, contradictory, or horrifying. He claimed, for example, that his body was undergoing all sorts of serious injuries and radical transformations: internal organs “were torn or vanished repeatedly”; for long periods of time he lived without a stomach, intestines, or bladder. Yet much of the time he was strangely unworried by these seemingly drastic events and found nothing unusual in the fact that an organ which had been destroyed might reappear intact: “I existed frequently without a stomach. … Sometimes immediately before meals a stomach was so to speak produced ad hoc by miracles.” But, as he says of such events, “All this without any permanent effect.”

Schreber does not speculate about objective or physical explanations for such fantastic events. He appears to have experienced them as occurring in a special realm distinct from the natural or actual world, with its constraints and its consequentiality. And this special realm is, apparently, purely experiential—an “ideological” domain where “miracling up” is implicitly felt to involve not spectacular processes of a physical or biological kind but only mental feats, acts of imagination. The delusional world of many schizophreniform patients is not, it seems, a flesh-and-blood world of shared action and risk but a mind's-eye world where emotions, other people, even the patient's own body exist as purely subjective phenomena, figments of an abstract imagination. As we have discussed, this pervasive subjectivization can sometimes keep schizophrenic patients from acting in the real world, perhaps because real action feels irrelevant to them. At other times, however, the delusional experiences of schizophrenics do have consequences for their real-world behavior. (At times this is true even of Schreber, contrary to his claims; after all, did not Schreber actually sit still in the garden in order to comply with God's demands and to make the “wasp-miracle” occur?) But when such an intermingling of the imaginary with actuality occurs, we should not necessarily assume what the poor reality-testing formula implies—that is, that both realms are taken as real. It may be that both the delusional and the actual world are felt to be purely mental phenomena, that both are pervaded by that cushioning subjectivization which Beckett describes.

It is, in fact, only through imagining such a lived world that one begins to understand how schizophrenics can perform certain real-world actions that, to the normal person, would be unimaginably horrible. In extreme cases, such patients will seriously mutilate themselves, even, for example, cutting off their own genitals or putting out their eyes. Though their sensory organs still function, and they are cognitively aware of their actions, they do not appear to experience any pain, nor to register the significance and irreversibility of what they have actually done. When one talks to such patients, it almost seems that, for them, everything involved in the action—the body part, the cutting, even the pain itself—was a purely theoretical phenomenon, as if the action had been but a thought-experiment, a removal of idea-of-penis or idea-of-eye rather than of the actual organ of flesh, blood, and screaming nerve.

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The traditional psychiatric and psychoanalytic interpretations usually emphasize change in the content of experience as the essential motivation for the development of the delusional world. Supposedly, the patient withdraws from a malevolent and unpredictable external world by believing in an unrealistic fantasy world of benevolent objects and blissful satisfactions—thus denying an unwanted state of affairs in order to replace it with one more satisfying or more flattering. According to the usual view, the delusional world is in fact unreal, but the patient experiences it (or, at least, wants to experience it) as real. The quasi-solipsist interpretation turns on its head this psychoanalytic view of the motivation for delusions, arguing that the delusional world is chosen not in spite of but because of its felt unreality. The so-called delusions of what Sartre called the “morbid dreamer” may thus involve an escape not from the content so much as from the form of the real, from its ultimate, frightening unknowability and its tendency both to demand and to resist real-world action. By focusing instead on the subjectivized quality of an unreal world, a world felt to be constituted by oneself, the patient can escape the anxieties inherent in experiencing the limits of one's actual knowledge and power.

Despite its devitalization and isolation, this solipsistic realm might almost be serene—were it not for a peculiar sense of responsibility, and an attendant anxiety, that creep in to fill the vacuum left by the departure of normal sources of fear, sadness, pain, and passion. The anxiety of this quasi-solipsistic universe is ontological and totalistic, however. It occupies itself not with this or that concern within the framework of the real—Will I succeed? Am I loved?—but with something more bloodless and abstract: the sense of the flimsiness of a universe that depends for its existence on a constituting consciousness. “Everything seems to slip away into impressions. … For what is, is, and yet what seems to be is always changing and drifting away into thought and ideas, rather than actualities,” said one schizoaffective patient.

Abstract and cerebral, even theoretical, as such ontological concerns may sound, they can be intense, immediate, and experientially very real. “The world must be represented, or the world will disappear,” as another schizophrenic patient said, expressing the sense of ultimate risk that inevitably poisons the atmosphere in the haven of solipsism. Unlike the skeptical philosopher who can leave his metaphysical speculations behind in his study, many schizophrenics live the solipsistic vision with a certain literalness, which may express itself in a feeling of awesome responsibility or in the well-known delusions of world catastrophe. “The whole world turned in my head. I was the axis,” said one schizophrenic. Another patient, a catatonic schizophrenic, explained why she had to hold herself immobile for hours in an uncomfortable position: “If I succeed in remaining in a perfect state of suspension, I will suspend the movement of the earth and stop the march of the world to destruction.” The prisoner of her own unimaginable power, she seems to have been afraid to give up the solipsistic stance of rigid and passive hyperconcentration for fear of upsetting the cosmos.

Far from a stuporous waning of consciousness, there often appears, in such patients, to be a hypertrophy of consciousness and the conceptual life. The psychoanalyst Robert Waelder interpreted the schizophrenic emphasis on the inner life in schizophrenia as “a libidinization of thought.” To me it seems more to the point, at least in many cases, to talk of a cerebralization of instinct and the body. It is significant in this regard that many schizophrenic patients describe the world of psychosis as a place not of darkness but of relentless light—the standard metaphor for conscious awareness. Thus, the schizophrenic patient Renee spoke of becoming mad not as a descent into the depths or the darkness, but as entering the “Land of Enlightenment” (which is also the “Land of Unreality”), “a country, opposed to Reality, where reigned an implacable light, blinding, leaving no place for shadow.” In describing his “nervous illness,” Schreber speaks of his head as being “illuminated by rays,” rays that can be read as manifestations of his own self-conscious awareness. It is also significant that the schizophreniform world fits Wittgenstein's description of solipsism so closely, since solipsism was, for Wittgenstein, the quintessential example of the illusions of bad philosophy—that reification of abstract, contemplative thought which, in his view, has lost contact with the true sources of wisdom that are to be found in an engaged and active life. Such a condition is, surely, less a Dionysian than an Apollonian disease—a matter of the mind's perverse triumph over the instincts, the emotions, and the external world.