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World Futures, 65: 133140, 2009 Copyright c Taylor & Francis Group, LLC ISSN 0260-4027 print / 1556-1844

online DOI: 10.1080/02604020802595086

SECOND PERSONS: THE EXAMPLE OF A PSYCHIATRIC EMERGENCY UNIT: E.R.I.C.


FREDERIC MAURIAC
H opital Charcot, Service durgence psychiatrique ERIC, Plaisir Cedex, France

NATALIE DEPRAZ
Universit e de Rouen, Rouen, France Universit e de la Sorbonne (Paris IV), Paris, France The goal of this article is to put to the fore the importance and the relevance of the second persons in the framework of the relational ethics where the person has being related as a primacy over the individual as an isolated subject. While using the psychiatric team of an emergency unit (E.R.I.C.) as a leading thread we seek to show the anthropology of being related, which underlines the practical ethics of such emergency team. KEYWORDS: Intersubjectivity, phenomenology, resonance, second person.

We take as leading thread the psychiatric work of an emergency unit named E.R.I.C. (Equipe Rapide dIntervention de Crise), which is located at the Charcot Hospital (South Yvelines/78). We seek here to bring forth the relational anthropology that underlies the practical ethics at work in the psychiatric emergency intervention of such a unit. Our leading question will be the following: What is the part played by the second persons within the framework of a relational ethics in which the person as relational subject has a primacy over the individual as isolated subject? The clinical focus of our investigation, the second persons, results in a compulsory addition to the cognitive research that already puts to the fore the link between the rst-person and the third-person approaches. Such an anthropology relies on a change of epistemology that is supported in poch` turn by the very method of phenomenology: the e e. The latter amounts to a radical modication of attitude: I suspend my spontaneous orientation toward the object (the isolated individual), in order to pay attention to my own personal way of orienting myself toward it. While so doing, I let emerge my way to relate myself to such an individual, that is, its very quality of subject as person: whereas the individual is characterized by an experience of separation, the person as such is a related subject. But such an experience of being related does not involve
Address correspondenc to Frederic Mauriac, H opital Charcot, Sedrvice durgence psychiatrique ERIC (Plaisir), Unit e ERIC eps Charcot, 30 rue Marc Laurent 78370, Plaisir Cedex, France. E-mail: frederic.mauriac@eps-charcot.fr 133

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as such anything else as a horizontal structure of immanence. In order to pave the way for the possibility of a vertical relation, we contend that a dynamic of self-transcendence alone is able to reveal the person in her whole amplitude. Hence the necessity, so as to prove the epistemological relevance of such a phenomenology of the (second) person(s), to detail as a starting point the methodology proper to the cognitive sciences, which puts to the fore the co-generative link between the rst-, second-, and third-person approaches and lets emerge the key relational part played by the second-person approach. Thanks to such a taking into account of the importance of the second-person approach it results in the possibility to let arise the singularity of the relational ethics that is the specicity of the post-psychiatric work of the emergency unit E.R.I.C. In clinical practice as well as in psychiatric theory, the doctor is interested in the subject who is considered as pathological and identied as such by her or his pathology (schizophreny, melancholy, mania-depression delirium). At the very best, the pathological subject is seen as a subject in its full meaning and the clinician/psychiatrist involves her- or himself in the intersubjective relationship with the patient: here is the path that is followed by the phenomenological or existential psychiatry (Daseinsanalyse) from Binswanger onward till Tatossian and Kimura. We rely on such an existential and intersubjective path (quite opposed to the still commonly shared classical psychiatry, which remains largely objectivist) in order to suggest the possibility of a psychiatric phenomenology founded on a relational practice: in such a framework we have no longer to do with an individual subject in relationship with another individual subject, but with an ethical dynamic of mutual attention and co-presence of the different persons with one another. We will proceed in two steps: (1) we will describe the epistemological framework within which we situate our conception of the psychiatric practice as relational ethics, namely the co-generative neurophenomenology, which puts to the fore the irreducibility of the second person as an intersubjective validation of objectivity; (2) we will show how the practical ethics at work in E.R.I.C.s clinics is fruitfully grounded in such an epistemology but lets also arise its crucial limitation: hence our shift from an immanent circularity toward an ethics of self-transcendence. THE PRACTICAL NEUROPHENOMENOLOGY OF THE SECOND PERSON A disciplined method of gathering rst-person data is necessary in order to study consciousness in a scientic way (Varela and Shear 1999). Beyond any isomorphism, which merely correlates experiential subjective accounts and their neural counterparts, Francisco Varelas neurophenomenological research program (Varela 1996, 1997) puts to the fore the contention according to which both analyses (neuro-dynamic and phenomenological) are generated through each other: they give way to new neuronal data and to other aspects of the subjective phenomenon on the one side; they reciprocally produce dynamic categories and renewed experiential concepts on the other side (Varela and Depraz 2000, 2003).

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While relying on such a rst co-generative step, we wish to show that the thirdperson protocols are not neutral, that is, independent from the intersubjective situation of each subject in its own individuated spacetime (Bitbol 2002). Taking into account reports is required: not only rst-person but also second-person reports. We therefore suggest to take seriously the multifarious types of commitments of the second-person activities all along the whole process of experiential validation. For example, in the framework of a scientic experiment that uses the neurophenomenological method, the different subjects who are experimenting and are descriptively accounting for their experience are co-researchers from the start: they actively contribute to the production and to the description of the experiment and of the experience, the former being then precisely correlated to the neuronal third-person account; another kind of involvement of the second-person approach is at work in the activity of the research supervisor, who takes part (as a coach) in the ongoing research of the student; the authors of the referential texts for the research nally, by interacting with the experiment, play the part of rst-hand reecting actors for the researcher, namely of so many (each time different) second persons. A rst step was already walked in this direction (Depraz, Varela, and Vermersch 2003): we contended the plastic continuity of the three approaches (rst, second, and third person) rather than their polar opposition, thus paving the way for a gradual dynamic of intersubjective validations. Here the second person is not a formal instance, but a relational dynamic of different gures in mutual interaction. We thus question the methodological framework of the so-called hard problem as it was rst stated (Nagel 1974; Levine 1983; Chalmers 1995). Starting from the irreducible distinction between a third-person (experimental and quantied) and a rst-person (experiential and qualitative) methodology and then trying to ll in the gap leads actually nowhere. If the second person is less another pole than a continuous and plastic texture of exchanges, it is problematic to carry on calling such a relational dynamic a second person, as if (1) we had to do thereby with a separated and isolated entity (a particular individual), and (2) such a distinct entity was secondary with regard to another one (which would have the primacy): we therefore chose to speak of second persons in the plural. As a result, we are also led to question in turn the polar component of the so-called rst and third persons. While putting to the fore a renewed understanding of the second-person methodology, which does not lie in the formal primacy given to a You as opposed to an I and to a He/She, we bring forth a plurality of methods as intersubjective practices. In that respect, the Husserlian empathy is a key concept of such a methodology. More than a mere central condition of possibility of the science of consciousness (Thompson 2001), empathy corresponds to an actual practice that articulates from within the scientic research. In the same way as the Husserlian concept of Einf uhlung requires to be adapted to the practical experimental framework, the latter also is enlightened by the phenomenological intersubjective method (Depraz and Cosmelli 2003). On the basis of such a critique of the solipsist and/or theoretical approach, the ethical component of the experience may emerge: it gives way to a series of

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attitudes related to such a care for the other. Be it M. Buber and his understanding of the You, E. Stein, who stresses the person as a unity of body, soul, and spirit, E. L evinas with his unconditional openness to the Other, or again G. Marcels approach of the person as mystery, all these approaches insist on the primacy of the other understood as an individual singularity. The question is then: Is the very relationship with such an other put to the fore, or merely the other as a singular individual put to the fore? How can we understand the empathetic relationship while starting only from the singularity of the other person? As a matter of fact, such personal ethics remain individualist insofar as no relationship is thematized as such but only the relationship between one individual person and one other individual person: never do you experience the relational linkage if you are primarily interested in the individual persons themselves, be they understood as subject (ipseidentity) or as object (idemidentity), according to P. Ricurs distinction in Soi-m eme comme un autre. In contrast, if the relational experience is dened as a circular dynamic where the persons are mutually coupled without any primacy given to the one or to the other, circularity appears as a relational mutuality, where experiences are given as symmetric or reciprocal, and does justice to multifarious experiential contexts. In that respect, the person as a singular instance is put to the back and the intersections between persons to the fore, insofar as they become the very places of experimentation of the relational dynamic (Wittezaele 2003, 31101). The irreducibility of the person then disappears and the very linkage of the relationship emerges (Elka m 1989). Again, it is necessary to keep the personal component because it is the only way not to shift into the horizontal and anonymous immanence of an ethics of nature; the latter, however, needs to unfold its multifarious facets in order to avoid the other way round a tendency to abstraction linked to the absolutization of the Other as a unique and irreducible singularity. A PRACTICAL RELATIONAL ETHICS: E.R.I.C.S POST-PSYCHIATRIC ANTHROPOLOGY The thrust of neurophenomenology lies in its taking into account the validity of the second person. It makes it possible, then, to appreciate its inner limits, namely its difculty to integrate the ethical relational component and, more specically, intersubjectivity understood as a pluripersonal experience. Why? Because the only genuine experience is the in-between between a non-relational thought of the singularity of the person (the You seen as an Absolute) and a relational immanent thought that erases and tendentially forgets the irreducibility of the person. Now, the psychiatric eld and, in particular, the specic practice at work in the home-emergency unit E.R.I.C. stresses the primacy of the relationships between the different persons: such a stress renews the epistemology of the second person, which nevertheless grounds it (Robin et al. 1998). The relational anthropology that is brought to light with its specic ethical orientation underlines the operative plurality of the multifarious second persons. In short, shifting from the second person to the second persons is not only an s-addition: it denes the very epistemology of such a relational ethics.

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The psychiatric emergency unit E.R.I.C. (Equipe Rapide Intervention de Crise; Depraz 2005; Boszromenyi-Nagy 1987; Michard 1991) was founded in 1994 by S. Kannas (2000) in order to tackle the problem of the chronicity of the hospitalization of the patients. As a matter of fact, the goal of this 24-hour working unit was to try each time to avoid hospitalizing the patients (actually, for the time being half of them are not), the alternative being to help them stay at home. How? The doctor and the nurse are committed to intervene together to the patients house according to the relational method of coupling a doctor and a nurse for each care. Now, the crisis situation creates a context where the family as well as the family physician are helpless. Given such a shared feeling of helplessness both the doctor and the nurse work together in order to provide the family, the educators, and the psychologists who already take care of the family with renewed functional skills (as parents, as wife and husband, as professionals) within the critical situation itself. Rather than increasing the feeling of powerlessness of relatives and despising a patient who is already in a precarious situation, the caring team restores the feeling of self-condence of relatives and of the patient. While furnishing them with a one-month-follow-up after the rst care, the doctor and the nurse endeavor to conrm the lived inner competence of the close relatives of the patient, that is, help them becoming condent about their own ability to truly relate to each other and above all to the so-called patient. Now, what is striking in this kind of practice is not only the professional deontology, which thwarts the frequent objectivization of the ill person and leads to the taking into account of the person itself, but also its seeing paradoxal therapeutic efciency. The leading motto is: How not to be efcient in order to help the relatives and the patient to be efcient? The crisis situation is an outstanding time that leads the family to the outburst of its usual markers: contrary to what claims the family, namely a homeostatic return to the previous family system, we decide to use such a time in order to let emerge the multifarious relational problems by naming them, in order to make reemerge the organic functionality of the family, whereas the latter had been destroyed by the dysfunctional dimensions that brought about the critical state: E.R.I.C.s practice lies in intensifying the outburst of the links, namely, in developing the going out of the frame. Of course, such an intensifying process does not aim at being destructive. On the contrary: it creates a letting-go of some inner resistances, which will help each person name more genuinely what is responsible for her or his suffering. Consequently, the aftermath of the crisis does not necessarily amount to returning to the previous precritical situation. On the contrary: the immediate feeling of our own sufferings and the ability to name them with certain persons produces a radical transformative effect. The dynamic of resonances is therefore used in each crisis intervention: the doctor and the nurse are involved in the different talks with and within the different members of the family because they listen through the talks of the latter to the way they relate to their own lived experiences (their personal history, their inner sufferings). They experience again their own history as mirroring the history of the family, and such a cross-mirroring experience provides them with a surprising mostly affective know-how to enter anew the suffering of the family: as a matter

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of fact, their own suffering is directly emerging through the way they talk to the family, that is, handle the whole situation. Such an affective immersion is a fulledged method that enables them to ask the right questions, because they know from inside what they talk about because they went through it already. Far from presenting themselves as neutral external observers, they use their own affective life as a methodical indicator of their therapeutic action toward the family. As a result, it appears that the dynamic of questioning is common to the poch` affect-laden resonances and to the phenomenological method of e e; the latter, poch` however, illuminates the former by embedding the local gesture of e e into the whole set of practical resonant moves. Correlatively the resonance is enlightened poch` by the e e insofar as the latter stresses the specic quality of its suspending time. Because of the resonant setting, the family is immersed into the dynamic and begins to resonate with the other systems; because of the time-suspension poch` of e e, the family is invited to get a broader view of the situation. Observing poch` distance (e e) and affective adherence (resonance) might appear at rst sight contradictory. As a matter of fact, they are fully complementary. There is even a kind of conjunctive functioning of resonance and suspension: rst for the family who is able to suspend its prejudices of powerlessness and to recreate its own relational ability; second in turn for the emergency team who suspends its competence by resonating with the family and thus helps provide each member of the family with its functional competence of father, mother, and child. The interplay of such relational couplings reveals the ethical component of the whole functioning: the cross-process of suspending and resonating enables each one to be re-established in ones own skill whereas each might have been discredited had the social or care hierarchies been put to the fore (Depraz and Mauriac 2005). By joining suspension and resonance it is thus possible to avoid the risk of the horizontal immanence of relational circularity and to open up the possibility of understanding the person as being fully conscious of the relational component. So we have neither to do with a joint dialectical circularity where the three persons are homogeneously situated on the same level (in contextual systemic therapies, for example), nor with an exclusive primacy given to the second person (in psychoanalytic care, for example). Here each person acts at one and the same time unanimously with the others but differently for each (Kovalesky 1982, 163 187). In that respect, the relational cell is not the smallest common denominator: it would suppress irreducible aspects, for what is common is what is shared while being only partially included in each perspective (Kovalesky 1982, 29). In short, in contrast with the phenomenological transcendence, which amounts to an intentional dynamic of relatedness with an object, the movement of selftranscending corresponds to the emergence of a subjective inner dimension that is in a sense trespassing each individual subject and nonetheless fully involved in each one. Each person thus arises in her or his own dynamic while relating both to the others and to her or his personal vitality. It is truly what Maxim the Confessor early called the tropos of the person: her or his quality, style, manner, changing aspects, in short, her or his alterity, energy, in contrast with her or his logos (her or his unchanging essence, or nature) (Larchet 1996, 141151; Yannaras 1983; Zizioulas 1981). In other words, the energy of each person is part of the whole

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relational dynamic without being fully absorbed in it, all the same.1 It resonates with such a dynamic while nourishing it from inside and and while nding in it a suspension that allows it to remain oneself through it. Such a process is frequently at work in the practice of many professionals dealing with a relational therapeutic work. The unit E.R.I.C. chose (because of its organization, its dynamic, and the history of its constitution) to make use of such an energy in order to be able to deal with the context of crisis and emergency: in this regard the term second persons is meant to describe a lived experience that is the common ground of such a practice but is usually never taken into account for it is not easily describable.

NOTE
1. Yannaras (1986) where the energy is seen as a common ground situated beyond the still one-sided distinction between the Husserlian intentionality and the Heideggerian extasis.

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