In this complex and intriguing book, Stanghellini explores what it means to be a person and how this influences the subjective experience of abnormal mental phenomena. He then moves beyond the theoretical, to discuss the practical implications for the clinical encounter between patient and therapist. In truth, the complexity of his thesis is as much to do with the use of new terms to describe genuinely innovative concepts, but sometimes the terms merely rename well-established concepts.
Stanghellini makes the case for a distinction between selfhood and personhood. In this account, selfhood is lived in a first person perspective ‘as an embodied, self-present, single, temporally persistent, and demarcated being, who is the subject of his perceptions, feelings, thoughts volitions, and actions’. However, personhood is conceived as pre-reflective self-awareness that is ‘structured as an embodied and situated experience inextricably entangled with an experience of a basic otherness [italics in the original]’. This is where one of Stanghellini's neologisms is introduced: alterity. This term seems to stand for our encounter as human beings with everything that is not self, that is other, including material objects and other subjects of experience. In many respects, it is a restatement of Martin Buber's notion that we become human through our transactions with other living beings.
Stanghellini uses the terms ‘affect’ and ‘mood’ in surprising ways. He says, for example, that ‘Affects are focused and intentional, and possess directedness’. Also, that ‘affects are felt as motivated; they are more determinate than moods and more articulated’. Traditionally, affect is regarded as a broad term that encompasses mood, feeling, attitude, preferences and evaluations. In psychiatry, its use is restricted to the expression of emotion as judged by the external manifestations that are associated with specific feelings such as laughter, smiling and crying. Mood is simply the more prolonged, prevailing state or disposition. So, when Stanghellini says that ‘moods … are unfocused and non-intentional’ and that they do not ‘possess directedness and aboutness’ he is straying from the accepted or consensual understanding of the term.
Another neologism is ‘heterology’ which is ‘the logic that posits the Other as radically other, in contrast to a conception of the relationship with the Other based on the category of analogy’. This appears to mean that other subjects of experience are ultimately unknowable. But in this scheme mental disorder arises from the intolerability of the impossibility of knowing the other. In effect, Stanghellini proclaims ‘psychopathological symptoms are the outcome of a disproportion between the person and the disturbing experiences that stem from her encounter with alterity’.
The ideas propounded in this book are radical, often surprising and always interesting. It cannot be read as a text on postpartum depression, erotomania, schizophrenia or borderline personality disorder, even though there are chapters dealing with these conditions. What it does is challenge our common and ordinarily accepted notions, thereby expanding the possible theoretical frameworks that we use. I do not recommend it for everyone: it is one for a specialist audience.