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Brain (1972) 95, 413-440.

HENRI EY'S CONCEPTS OF THE ORGANIZATION OF


CONSCIOUSNESS AND ITS DISORGANIZATION: AN EXTENSION
OF JACKSONIAN THEORY1
BY

PHILIP EVANS
(From the National Hospital, Queen Square, London, W.C.I)

INTRODUCTION

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HUGHLINGS JACKSON'S principles of the evolution and dissolution of nervous
function have largely influenced neurological thinking in most countries for the last
hundred years. His impact on psychiatry has also been considerable in France, but
negligible in Anglo-Saxon countries. However Jackson's views on the classification
of the insanities are of particular interest today when this problem is again under
review. Application of his principles to psychiatry has been hampered by the fear
that it seems to transmute psychiatry into neurology, and also that evolution and
dissolution of psychic activity are unreal abstractions. Henri Ey has been applying
Jackson's principles to psychiatry in France for the last forty years, developing his
"organo-dynamic" theory, which represents one of the leading schools of con-
temporary French psychiatry. He makes an holistic synthesis of neurobiological and
psychodynamic mechanisms in the genesis of mental disorder, using the methods of
phenomenology. Such an orientation has necessitated a radically modified view both
of Kraepelinian nosology and of classical psychoanalytical concepts. In Ey's view
the problems of psychiatry can be most profitably pursued by such an inter-
disciplinary approach.
Ey's essential writing has yet to reach most English-speaking workers; apart from
the complexities of his theory his highly individual and rich literary style probably
accounts in some measure for this. A serious difficulty with a popular presentation
of his doctrine is that it runs the risk of over-simplification. This essay attempts an
introduction to new and difficult concepts.

'The author stayed with Professor Henri Ey for four months in 1970 whilst holding a research
grant. The purpose of the visit was to discuss Professor Ey's writings which are in French, and with
his help, to prepare this review.—EDITOR.
414 PHILIP EVANS

PART I: A N HOLISTIC ORIENTATION


The Body-mind Dilemma
Any attempt at formulating a logical and coherent theory of causality in psychiatry
inevitably confronts the problem of the relationship between body and mind. Ey
considers that Cartesian dualism has confused the understanding of mental illness by
introducing a corresponding dualism of physical and mental causation. Ey holds that
mental illness cannot be regarded as either a psychologically determined variation in
behaviour or an aggregate of mechanically determined symptoms. Each of these
viewpoints is incomplete without its complement; otherwise mental illness as a
pathological process loses its meaning, psychiatry its object of study and the psychia-
trist his function. A balanced perspective will avoid the over-simplifications of
psychogenesis and a mechanistic neurology. The fundamental problem then is the
establishment of a theory of the organization of the psyche. Such a theory can then
be judged by its heuristic value, namely its practical applicability and usefulness for
the understanding of mental illness.

Ey therefore substitutes an organo-dynamic in place of a dualist psyche.

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This organo-dynamic psyche is organized with a cerebral infra-structure, and
a suprastructure that is of a higher order and is concerned with the organ-
ization of reality. A concept of the psyche with (evolutionary) levels of organization
postulates that mental illness is in part a process of disorganization and
in part a dynamic reorganization of function at a lower level. This view is in line
with medical concepts of illness consisting of a primary determining process and a
secondary defensive body-reaction, with the psychoanalytical concepts of loss of
repressive activity and release of unconscious forces, and with Jacksonian
hierarchical principles. Ey cannot support only the psychoanalytical or the Jacksonian
positions, but instead requires a reconsideration of each in order to enhance our
understanding of mental illness. Whilst following both Jackson and Freud, Ey adds a
philosophical dimension and is here influenced by Janet's approach and by the
development of phenomenology. By adopting such an interdisciplinary approach an
adequate model of the psychic apparatus may be constructed and psychiatry thereby
restored to its place among the biological sciences.

Ey rejects both the empirical-positivist tradition with its emphasis on objectivity,


and the Cartesian concept of a machine model of the mind elaborated from a theory
of the sensations, in favour of a phenomenological approach with its emphasis on a
reflective exploration of the contents of consciousness.1 Consciousness implies a
process of self-reflection in which one finds oneself thinking. This introspection is a

^heword "conscience" in translation of the French "conscience" would have been etymologically
preferable to "consciousness"; however common usage does not permit the use of the more literal
translation. It is perhaps unfortunate that the alternative meaning of "conscience" namely "self-
knowledge," has become obsolete (Webster's dictionary).
EY AND JACKSONIAN THEORY 415

vivid reality yet cannot be objectified, and behaviourists hold that all that does not
appear in the objective field does not exist. Such a denial of consciousness is refuted
by the evidence of the cogito, the fact that we live out our existence in and through
consciousness. One has only to be conscious of oneself in order to grasp the fact that
consciousness, at the same time corporeal and transcendental1 by reason of its very
activity, is neither an object, nor entirely of the spirit, nor faculty, but a modality of
reality which cannot be conceived of in geometrical terms. Hence the problem of all
schemes, spatial representations and analyses which concern themselves only with a
mosaic of independent functions, or functions dependent only on associatively
stored experience; namely that such schemes break up mental activity into separate
functions. The problem is not to seek to localize the various functions of conscious-
ness, but rather to understand its dynamics in terms of experience, and to ask in what
cerebral structure the activity of consciousness has its organic roots. The Cartesian
model is inadequate for the understanding of relational life, which is the relationship
of the subject to his world of objects and people. An existential philosopher expresses
this by saying that "I am" only by virtue of "being-in-the-world"; and "Dasein"
(literally "being there") is Heidegger's term for the human being as a conscious
existant. Dasein-analysis aims at exploring the activity of consciousness, in contrast

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to psychoanalysis, which is concerned with the exploration of the unconscious.
Psychiatry, therefore, has as one of its objects of study the relationship between an
individual and his world. Mental life is more than mere reflex activity. An individual's
nature enables him to experience, and also to reflect upon his experience. He also
constructs his own individuality through his experience whilst his bodily and nervous
functions are instrumental to his actions and reactions. Existential philosophers,
whatever their differences, are agreed that consciousness is that region of being
which is the instrument of relational life; the means whereby a man confronts
his world, constructs for himself a here-and-now, and through it, his personality.

'"Transcendental"(Webster's dictionary):"Inthe Kantian system, of, or pertaining to, that which


can be determined a priori in regard to the fundamental principles of all human knowledge. What is
transcendental, therefore, transcends empiricism; but does not transcend all human knowledge, or
become transcendent. It simply signifies the necessary conditions of experience which, though
affording the conditions of experience, transcend the sphere of that contingent knowledge which is
acquired by experience. 'Empirical,' by contrast, refers to knowledge which is gained by the
experience of actual phenomena, without reference to the principles or laws to which they are to be
referred. The words are also used in a bad sense; 'empiricism' applying to that one-sided view of
knowledge which neglects or loses sight of the truth or principles referred to above, and trusts to
experience alone; 'transcendentalism,' to the opposite extreme, which, in its depreciation of
experience, loses sight of the relations which facts and phenomena sustain to principles, and hence
to a kind of philosophy, or a use of language, which is vague, obscure, fantastic or extravagant."
When one is considering problems of the mind it is impossible to avoid words having a philosophical
connotation. Though beyond the scope of an objective science, these higher orders are none the less
realities. They also fall short of the divine realities which require an act of faith. It is Ey's logic in
describing these orders which concerns us here.
22 BRAIN—VOL. XCV
416 PHILIP EVANS

Phenomenology
Phenomenology is the descriptive study of conscious mental manifestations; by
a process of intuitive reduction it attempts to reach the raw experience that is obscured
by many factors, in particular by language. The consciousness experienced in
reflecting is one tenet of phenomenology.
Consciousness has an object; one is conscious of something. Thinking of something
or imagining something become perception in its widest sense. Descartes' cogito
becomes cogito cogitata, and the object is inseparable from the act of perception.
A conscious being will recognize himself meeting experiences which affect his being;
he adapts to circumstances; he is able to think creatively; he is aware of his
individuality; he is free to choose—these are his most characteristic phenomenological
activities. Consciousness then is an activity with an intention. In the terminology of
Brentano, "act-phenomena" and "object-phenomena," the subjective and the objec-
tive are aspects of a single process. There can be no consciousness without this
objectification, and the external world is organized by the constructive activity of
consciousness. In these terms we create our world and as it will be seen,
we create ourselves {see Part V: Chronic Mental Disorders). Consciousness is a

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modality of existence, it is not a reality of subject or of object. By concentrating on
the intentional nature of consciousness the clinical interview takes on a new aspect,
and the art of clinical observation is extended by a creative listening. The enumeration
of symptoms and signs yields to the description of the patient's world as he lives it,
which provides facts as real as those obtained from the examination of a somatic
lesion. Phenomenology, by exploring the nature of conscious activity, provides facts
in turn for a structural analysis of pathological states in terms of deficit and reaction.
Concepts of causality in psychiatry rooted in empiricist categories thereby become
radically modified.

The Limitations of Psychoanalytical Theory


With their structure, their rites and their articles of faith, psychoanalytical schools,
like religious sects, promulgate dogma and pronounce excommunications. The
crucial question is whether the contribution of psychoanalysis to psychiatry is so
essential as to warrant such dogmatization. What in psychoanalytical theory is
irrefutable, and what requires an act of faith? Ey accepts the reality of repression and
considers it to be Freud's major discovery. The structure of the psyche implies an
unconscious which manifests itself in symbolic transformation. The rigidity and
exclusiveness of psychoanalytical schools, however, serve only to destroy their own
aims. Psychoanalysis should be assimilated into the general body of medicine
rather than maintain its isolationist position.
Ey's holistic synthesis of neurobiological and psychogenic approaches to mental
illness has the dual object of upholding its basis in cerebral pathology, and of bringing
within its scope that which is essential in psychoanalytical theory. Ey classifies mental
illness phenomenologically as pathological states representing various levels of
EY AND JACKSONIAN THEORY 417

disorganization of consciousness. Mental illness is an organically determined path-


ology of reality, and also necessarily of freedom, inasmuch as the development of
consciousness is the ontogenetical road to freedom by the establishment of a
repressive dominance over an anarchic unconscious.

PART II: THE JACKSONIAN CONCEPTION


Anglo-Saxon psychiatry has been little influenced by Hughlings Jackson's
principles, and yet the notions of escape from control, which imply the double
principles of hierarchy (Jackson's first principle), and dissolution of functions
and structures (Jackson's second principle), are of the very greatest interest.
For Jackson, highest level function was conceived of as the activity of superior
sensorimotor centres. These were the organ of the mind in the sense that they provided
it with its instruments, and not that they represented the cerebral localization
of mind which, for Jackson, remained concomitant with brain activity. This
concomitance hypothesis is the dualist or parallelist position adopted by most
neurophysiologists, and Ey would argue that it affords a comforting attitude free
from the abstract complexities of metaphysical systems.

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For Jackson insanity meant an involvement of a greater or lesser number of the
highest cerebral centres, which he described as the cerebral basis of consciousness.
Dissolution presupposes an evolution, and implies an hierarchy. Lower, more specific
and more automatic reflexes are integrated into and serve instrumentally the purposes
of high level function. Lower level activity has a more clearly defined anatomical
basis and is more specific. Higher level function is less fixed and more labile. Both
levels are hierarchically ordered, but whereas the hierarchy of the first is reflected in
anatomical arrangements of the nervous system, the hierarchy of the second rests
upon more diffuse activity of the nervous system.
In thinking of a regression of evolution in the nervous system Jackson was applying
Darwinism in the Herbert Spencer tradition which extended the concept of evolution
to all order of phenomena; it was Spencer who coined the term "dissolution."
Already, Sir Charles Bell in writing on drunkenness, and Baillarger on aphasia, had
noted the regression from the more voluntary to the more automatic. Evolution,
said Jackson in his first Croonian lecture, progresses from inferior but relatively
well-organized centres to superior and less rigidly organized centres. There is no
paradox between organization and complexity. More complex higher centres organize
themselves progressively throughout the span of life, and the possibilities for permu-
tation between the greater number of elements composing the higher centres become
infinitely more varied. Thus, those highest centres that constitute the cerebral basis
of the mind are the least well organized, the least automatic, the most complex and
the most voluntary. The highest centres, being the least rigidly organized, are there-
fore the most vulnerable, and under the influence of, for example, alcohol, though
the whole brain is subjected to its toxic effects, these highest centres are the first
affected.
418 PHILIP EVANS

For Jackson, even the highest centres were potentially susceptible to separate localiz-
ation, though he considered them to be one in the application of his four factors in the
insanities (depth of dissolution, difference in personalities, rate of dissolution, and
effect of local bodily states and external circumstances). He found himself obliged to
envisage the occurrence of differential dissolution of these centres in order to account
for the various forms of insanity—and he made this his fifth factor of insanity.
However local dissolutions of the nervous system represent neurological disorders,
and uniform dissolutions represent mental disorders.
Jackson was unable to bring his theory of uniform dissolution in psychiatry to
fruition because psychiatry was, and still is, largely based upon mechanistic
explanations which are only adequate for understanding local dissolutions.
Ey conceives of a different order of consciousness, in order to escape Jackson's
parallelist hypothesis. Consciousness cannot be regarded as a faculty to be
localized in the brain because in that case it loses all sense of reality, in
both senses of the word. It must be considered in terms of adaptation to reality,
whilst at the same time maintaining its infrastructural roots in cerebral activity.
Consciousness is not therefore merely the last level, but depends upon the lower
levels which constitute its infrastructure; it is a dynamic elaboration of these and so

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is non-localized.
The structure of consciousness represents a power of legislation, of control, of
order and direction, and these are concepts which are in line with neurophysiology.
There must also be an order, a code, according to which consciousness develops
ontogenetically. A code is built in and directs the adaptation of the organism to
reality. Order is established against disorder, namely, the disorder of the unconscious,
and this process presupposes ideals, i.e. a system of values.
The pathology of mental illness is a process of regression. It is a breakdown of
communication, an alienation from reality, a pathology of freedom and a descent
into a fantasy world of the unconscious. But the process is an organically determined
one in the same way that the symbolic elaboration of dreams occurs in and by sleep.
Man seeks to struggle free from his instinctual drives towards normality or,
expressing it negatively, consciousness is a system for regulating the unconscious. It
is only by a structural organization of one's consciousness that one escapes madness.
Levels of disorganization of consciousness expressed in psychiatric illness contrast
vividly with local neurological dissolutions. Thus the agnosias, apraxias, aphasias,
disorders of body image, etc.—syndromes properly called sensorial or sensorimotor
—present themselves as accidents to awareness and not as delusions, which, being
dependent upon an alteration of consciousness, are lived as events in reality. Uniform
dissolutions are experienced as changes in reality; local dissolutions are experienced
as intrusive even though they have repercussions upon the personality. This distinction
is exemplified by perceptual disorders in temporal lobe disease. Auras of temporal
lobe epilepsy are usually experienced as foreign to the personality and a visual aura
is more properly described as a hallucinosis. A hallucination is a psychic disorder
EY AND JACKSONIAN THEORY 419

because it involves a delusion and delusions carry conviction so that a psychotic would
say "I would be mad not to believe."
Jackson's third principle is the distinction between negative and positive features.
Reduction to a lower level of evolution implies a release of the more organized, the
less complex and the more automatic: The morbid process of mental illness directly
produces only the deficit or negative features, whilst the positive features represent
the reorganization of remaining intact nervous function. Jackson refers to
the work that occurs at the level of dissolution reached, that is, the
adaptation to the defect by the remaining intact nervous tissue and the
process of adjustment that continues in the undamaged parts. This has been
fully exploited in the realms of neurology but its corollary in psychiatry is no less
evident. The organic process of dissolution merely decapitates psychic function and
the enormous work of readaptation is expressed by the positive features of the illness.
Here the findings of psychoanalysis naturally apply. One must rephrase Jackson:
"remaining intact nervous tissue" becomes "the active part played by remaining
psychic activity," for example, in accounting for the content of false perceptions. Ey
holds that all the complex positive features of mental illness are the result of the
release of activity of nervous elements not affected by the pathological process.

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Negative and positive features are divided by what Ey calls the "organo-clinical gap."
The gap is filled by the reactions of a personality. The negative features are a
necessary manifestation of the illness, the positive features may be lacking or vary, the
primary morbid process remaining unchanged. The gap may be a "structural" one
(Bleuler), the positive features representing a distortion of the remaining personality;
or "temporal" (Ey) in the sense that the personality actively readapts. For a delusion
to appear, elements must be "borrowed" from events. The content, as in hallucina-
tions, is inconceivable without reference to external events; without content,
hallucinations and delusions cannot exist. The morbid process determines only the
form. Jackson explains delusional process illogically on the basis of local dissolution,
the direct effect of the lesion and no more.
Ey's centrist theory brings psychiatry and neurology together without subordina-
ting one to the other; each requires its separate discipline. The science of each demands
that attention be given to the relationships between the two. What separates the
domains of neurology and psychiatry is not that neurology is a science of affections
of the nervous system and psychiatry the science of nothing at all; it is that in the
organic pathology of relational life there are dissolutions of function which are
either local and so the province of neurology, or uniform and so the province of
psychiatry.
Jackson emphasized the need for two classifications, one purely utilitarian, which
he compared with the gardener's arrangement of plants, and another to serve the
purposes of science, which he compared with the botanist's arrangement (and here
he had in mind pathogenesis and structure rather than specific aetiology). He
recognized the impracticability of distributing the sick in an asylum according to the
principles of dissolution, just as the juxtaposition of grass and bamboo would seem
420 PHILIP EVANS

absurd to the gardener. For Jackson, however, dissolution was the only principle
according to which mental illness should be scientifically classified.
Ey stresses the importance of reorganizing our thinking in order to lessen the
emphasis on symptom-clustering, which runs the serious risk of leading to impasses
in pathological and nosographical studies. It is the natural history of mental illness
which requires emphasis. Thus in rejecting the notion that the illness is nothing more
than the sum of its signs and symptoms, the importance of the pathological process
takes first place. Symptomatology merely indicates the level of dissolution at one
point in time, and to consider a symptom in isolation from the pathological process
clouds the issue.
An application of Jackson's principles to psychiatry, modified by Ey leads him to
promulgate four theses of a centrist approach to psychiatric illness, as follows:
Psychological: Mental disease is inherent, the evidence for this comes from develop-
mental psychology and a study of the stratification of consciousness; Phenomeno-
logical: The structure of mental disease is regressive, a breakdown in communications
and a disorganization of reality; Clinical: Mental disease represents characteristic
forms of dissolution (or failure of evolution) of consciousness; atiopathogenic:

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Mental disease is organically determined, in its negative component.

PART III: THE FIELD OF CONSCIOUSNESS


Definition
For Positivist philosophers, consciousness has little "reality"; it is an epiphenomenon
of cerebral activity or a simple function of vigilance, which here implies a degree
of clarity, namely more or less confusion on the wakefulness-coma continuum.
If the notion of consciousness is restricted to coincide with vigilance, and disorders
of consciousness with degrees of loss of consciousness, then only confusional states
represent a pathology of consciousness in the strict sense and represent lesions of the
cerebral basis of consciousness. Ey argues that consciousness can neither be reduced in
this way nor expanded to equal global psychic activity including intellect, discursive
thought and ethical judgement. Ey elaborates a dynamic model of consciousness in
terms of the organization of experience. This model provides for a reclassification of
psychiatric disorders as disorders of consciousness and teaches us in what sense no
acute psychotic is "lucid."
Consciousness is derived from "cum scientia," an etymology which implies an
object of consciousness (to be conscious of something). The German equivalents,
"Bewusstein" for consciousness, and "Gewissen" for moral conscience, correspond
to the two generally accepted meanings of the word "conscience" in the French
language. The German language is richer and contains a series of words such as
"Erlebnis," "Lebenswelt," etc., to express other aspects. German philosophy in its
subjectivist (Kant) and phenomenological (Husserl) approaches placed consciousness
at the centre of existence, not as an abstract notion but as the empirical description
of phenomena. The relevance of philosophical reflections on the structure of
EY AND JACKSONIAN THEORY 421

consciousness has been overlooked by psychologists and psychiatrists entrenched in


traditional psychiatric classification. This explains why consciousness is regarded
as an abstraction and at the same time its disorders as precise syndromes.
Ey's definition is best approached by first delimiting the concept. Consciousness
is not the simple behaviourist notion of clarity which "illuminates" psychic life;
though to be fully conscious is to be lucid. Consciousness is less than the sum of
psychic life, which includes perception, awareness of the body, memory, attention,
intelligence, reflection, affect, etc.; it is, however, the part of the psychic apparatus
which is concerned with the process of experience. Since consciousness is concerned
with organizing experience, living in the sense of experiencing reflects its activity
and not merely its nature.
All reflective thought, all creativity are of course "conscious," but consciousness is
not always reflective thought or creation. All reflection, decisions and creative
operations must pass through consciousness, but its activity is transcendental to its
structure. Consciousness is more than memory, imagination, perception or attention;
it is an act in which these various functions participate to a greater or lesser extent.
It follows that an individual who has his reason is not necessarily one who reasons

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well. Consciousness is the form itself of experience. It is inadequate to conceive of
consciousness in terms of mechanical conditions. Behavioural adaptation to the
• environment can be conscious only inasmuch as it occurs in accordance with a
system of personal motives and choices. If learning machines appear to "choose" by
centring, for example, in the case of a mechanical toy, upon this or that object, we
cannot call this an act of consciousness. Consciousness is an activity which surpasses
mechanical automaticity: reflection cannot be reduced to reflex activity.
Ey would have us move beyond the view that describes consciousness as
an empty function receiving sensory data, as both idealist psychologists (who
presuppose the primacy of form) or empiricist psychologists (who presuppose
the primacy of sensory material) would equally have it.
Consciousness is that organizing and integrating activity by which Man grasps
the totality of his phenomenal field. There are two dimensions of consciousness:
to be conscious is to live experiences and to incorporate them into one's fund of
knowledge, and reciprocally the fruits of one's personal history are added to the
material which is "lived." The transverse section of the conscious being is a
synchronic dimension, the here-and-now experience of the present organized into
a field; the field of consciousness—the longitudinal section of the conscious being is a
diachronic dimension, the personality in its historical construction; the "Self."
The field of consciousness is the dynamic organization of actuality; "being
conscious of" in a wider sense than just the identification of external objects. Since it
is dynamic it presupposes an evolution. Existential psychology regards consciousness
as more than a subjective field and as the very act whereby the individual gains
awareness of his world and constructs it for himself. Consciousness is a "way-of-
being-in-the-world" (Dasein).
422 PHILIP EVANS

The movement from sleep to wakefulness implies the following succession of


organizational levels of consciousness: an opening to the world ("presence"), an
ordering of space ("representation") and the control of affect ("present"). These are
the three components for the construction of the field of consciousness and so the
three modalities of actuality. In sleep there is no actualization, the three components
of consciousness being lost. The orientation of Man face-to-face with his world,
subject confronting object is, then, the initial form of organization of the field of
consciousness as seen in drowsiness and in confusional states. Consciousness
becomes a means of communication between organic life and reality. Man constructs
his reality and adapts to it. Consciousness is both a reality and a means of access to
reality, and this ambiguity is an inescapable part of its definition ("this is the speech
I am giving"; "I know when I am day-dreaming").
Because we experience something in the field of consciousness in the here-and-now,
or in other words we make actual an instance, the organization of consciousness neces-
sarily implies time and space dimensions. Disorders of consciousness must therefore
be disorders of time and space. The analogy of a field is appropriate. The field of
consciousness is where the subject's history and present experience meet and articu-
late. A field implies a circumscribed space which has a history, a substratum, and

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which is dynamic. But the field is also a stage upon which is played a re-presentation
of one's world. The subject of this re-presentation is both author and spectator.
Existence is enacted where time and space, objective and subjective, articulate in the
totality of an immediate experience, "that-which-is-here-and-now-for-me."
"Presence," "representation" and "the present" are, then, the fundamental
evolutionary steps and constituents of consciousness. Hence, again, the
definition of consciousness as that form of psychic life which organizes experience
into a phenomenal field of the present which is re-presented. Consciousness is inter-
posed between the vegetative life of the organism and relational life. It is itself
organized and has a certain autonomy in that it organizes experience. It serves as a
model for the comprehension of one's world and it is a model which is of our own
construction.

Ontogeny
Animals and babies do not have a consciousness, and it is not essential to life
(viz. sleep and coma). Its organization evolves to a point where in its fullness it
escapes the unconscious to become a phenomenal field. This vertical movement also
occurs, but in the course of seconds, in waking and the organization of consciousness
is again exposed in states of disorganization; which are regarded by Ey as levels of
arrested sleep.
Consciousness makes its appearance in its most primitive form when the infant
confronts an object of desire. This is the first face-to-face of a desiring subject with a
furtive object. At birth there is no zone of indetermination between stimulus and
response. Any reflection is short-circuited and behaviour is instinctual. There is no
consciousness as defined. The world is one of objects and the infant gains
EY AND JACKSONION THEORY 423

consciousness as he recognizes his mother's face, his bottle, etc. Consciousness opens
into a field but there is as yet no order in this field. This first "presence" is an eyes-
open, looking, facing orientation. His sensory world extends before him as he
familiarizes himself with it (language will provide him with the key to reality). The
problem at this stage is of objects and desires. There is no reflection and no
temporal order, all is pure instantaneity.
The second act of making experience actual is the distribution of existential space
which is the division between subjective and objective, in the sense not of geograph-
ical space but of psychological space. For example, I can look at canvas and paint,
I can look at the portrait it represents and I can "picture" the subject-matter: I can
also close my eyes and represent each of these perceptions for myself. The field of
consciousness becomes composed of heterogenous areas where subjectivity and
objectivity are distributed. In order to enter the phenomenal field, all events have to
be submitted to this categorization. In the infant, a world of objects and blind
desires is replaced by a consciousness which discovers its identity. He begins to face
subjective and objective values. The acquisition of a corporeal reality will clarify
impressions, sensations and illusions. Consciousness then acquires the dimension of
representation; "myself" can then become an imagined "other." The discovery of

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"I," the experience of the mirror, is the "open sesame" of this new experience
of a widened and ordered field of consciousness. Henceforward the place of
the self will preoccupy the conscious being, and he will strive to make more
and more of the stage available to an elastic zone of subjective-objective
indetermination. This component of consciousness is the existential basis of
representational experience.
The field of consciousness is finally orientated in terms of the present. Conscious-
ness ceases to be mere presentation and representation. The child, already present in
his world and having established a spatial order therein, now has to impose an order
of temporality upon the flux of events. The child must emancipate himself from a
world of movement and instantaneity, and face the problem of the present. This is
the "now" of the "here-and-now." Temporalization requires that the "before" and
the "after" be excluded from what is. This moment in time, this necessary pause,
this psychological moment, must be extracted from the succession of events, and held.
The forces of past and future dispute the present for themselves, and temporalization
is the ordering of the present that constitutes a consciousness balanced between
these forces. The present is pondered, considered and deliberated, and mood is
intimately linked to this process of temporalization. This temporo-ethical control of
experience is none other than the repressive control of the unconscious. Thus when
one artificially separates mood from consciousness the latter loses one of its essential
properties which is to equihbrate the forces that orientate the field of consciousness
in terms of temporalization. A well-balanced field of consciousness exercises a
mastery over time and holds at bay an intemporal unconscious which would other-
wise drag the present into the fatality of the past, or into the omnipotence of the
future {see Part IV: Acute Psychoses). A fully matured consciousness is one which
424 PHILIP EVANS

exercises control over its direction; it temporalizes the flux of experience. The
problem of the present involves values of duty, permissibility and desirability which,
as such, for the child, constitute his passage into the age of reason.
The present is in fact not grasped as such, as actuality, an interval torn from what
has already passed and what will come to pass. Actuality presents itself, or is repre-
sented, to consciousness as an on-going and inevitable flux rather than a historical
moment of one's existence. Consciousness exercises discretion in the sense that it
chooses to go back into the past and relive it, or to represent to itself the future and
live it in advance. Alternatively one may choose to "waste" time in day-dream, in
nonchalance or idling, which is a form of absence from the reality of the present: the
present is "set aside." These false "presents" of reminiscence, of anticipation and
imagination are characteristic of a normal field of consciousness and especially of
that of the small child delivered to his mood. It is an essential property of conscious-
ness to be able to be carried on a tide of imagination or reminiscence, or to be a blank,
to pay and focus attention by deliberately excluding distractions or to give itself
up to its distractions, and yet all the while live a real moment of its history. Changes
of awareness are part of the activity of consciousness and not pathology, which begins
when this ability is lost. The highest level of organization of consciousness and its

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greatest degree of maturity, then, is represented by its power of integrating the
present situation.
By orientating actuality and adopting all possible positions with regard to this
actuality, consciousness is an activity adapting to reality. The addition of a temporo-
ethical component is the final stage of development of the field of consciousness,
which is the basis for normal relational life. Its hierarchical position is demonstrated
in pathological states, when this exercise of mastery over time is lost.

The Place of the Unconscious in Relation to the Field of Consciousness


Both classical psychiatry and psychoanalysis have too restricted a notion of the
activity of consciousness. Consciousness implies a power of legislation because it is
that form of psychic life which organizes actuality into a representational field of the
present. To actualize is to enforce an order. Order is established against disorder,
the disorder being that of the unconscious. The structure of consciousness implies an
unconscious which is excluded by repression from the field of consciousness, but
which nevertheless constantly influences and threatens it. Consciousness and the
unconscious are opposed to each other in a dynamic equilibrium. The unconscious
is also regarded by Ey as an automatism with corporeal vegetative roots, and as the
infrastructure of consciousness.
An experience (which is a perception in the widest sense of the word: "what I
perceive," "what I represent to myself") occurs only inasmuch as one brings to it
the background of a fund of knowledge; a reservoir of experience is presupposed and
the process is unconscious. To actualize an event therefore implies a certain "uncons-
ciousness" of experience. But the unconscious is also intentional ("I see what I want
to see") and the unconscious plays tricks. The problem of the subjectivity-objectivity
EY AND JACKSONIAN THEORY 425

division is inherent in experience. Putting it another way we have unconscious


motives and are only aware of manifest content. All these expressions of the
unconscious in daily life, such as motivated forgetting, play on words and mistakes,
reveal the activity of an affective unconscious, and influence perception. The
unconscious expresses itself even more radically in emotional outbursts and in such
things as apparent motivations that are the inverse of their unconscious intentionality
(for example, the pleasure that is linked to the desire to hurt oneself). To admit
these manifestations of the unconscious is to accept the essentials of Freudian theory
of the Unconscious.
Phenomenology, in its study of conscious mental manifestations, reveals the
ambivalence of emotions and the dual forces at play whose aims are inseparable.
Hence all actualization contains a part which escapes awareness. Consciousness is
built upon an unconscious basis; it cannot operate without it. Thus all psychology
of "functions" (such as memory, concentration and perception) should take account
of an unconscious component which is loaded with significance. In this sense
perceptions are "virtualized fantasies" which make up the system of projection of
one's unconscious into the field of consciousness. Emotional experience has its roots
in the corporeal unconscious and vegetative brain. The unconscious polarizes and

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colours, in other words, it figures indirectly and symbolically in consciousness.
With the increasing emphasis on the Freudian Unconscious, the status of
consciousness diminished and the phenomenologists were uninfluential. There was a
choice of directions: Janet emphasized the primacy of a disorder of consciousness
in hysterical dissociation states, subordinating the manifestations of the unconscious
to disorders of consciousness; Freud emphasized the primacy of the Unconscious.
The Freudian concept had the advantage of shedding light on an unconscious hitherto
unnoticed, but his theory remained hampered by the lack of an organized conscious-
ness. There are no disorders of consciousness in Freud's psychopathology, and
consciousness is represented by a mere porthole in his egg-diagram of the psychic
apparatus, in which consciousness is submerged by the thrust of an omnipotent
Unconscious. The psyche defined in terms of the Unconscious minimizes the problem
of consciousness. The problem of the reality and vulnerability of consciousness is
ignored if one emphasizes the pathogenic role of the unconscious without being
aware that mental disorders, even if they are unconsciously determined, are played
out on the level of consciousness. One cannot begin to study the dream without
reference to its determinant, sleep.
For Freud, regression into sleep is only the effect of an exigency of the repressed,
whereas for Ey dream is an imaginary experience, and thus presupposes a modifica-
tion of the organization of consciousness. This would be a regression from the
Freudian viewpoint, but even if this regression is part of a positive need-satisfying
process (to fantasize) it necessarily implies the negative part which is sleep. Freud
could hardly view sleep as a disorganization of consciousness when he held
consciousness for nothing or nearly nothing. To Freud's "sleep allows of dream by
reducing the censure," must be added "by a disorganization of consciousness." The
426 PHILIP EVANS

essential act of consciousness is to organize events. Dream is experience at this level


of disorganization of consciousness. It is a fantasy which presents itself as an
instantaneity without posing any problems. Sleep is below the level of
organization of objectivity and so is lived as a flux of images occurring
in a space without dimensions and in the absence of temporality. The indiffer-
ence of dreams to the rules of reality is the expression of the impotence of
consciousness of the dreamer. The dream can only be grasped by the dreamer in
retrospect. The dream is therefore not totally unconscious but is nevertheless a form
of actuality in the chaos of a disorganized consciousness. Dreams are symbols and
what is lived in dreams is the conflict between drives and their representation figured
in consciousness.
Ey regards the unconscious as that region of the being which does not enter into
the organization of actuality because of the repressive activity of consciousness.
Failure to define it thus led Freud to over-value the unconscious, which then assumed
all the functions of consciousness because consciousness was refused them (thesis
of the unconscious consciousness, namely the unconscious Ego and the unconscious
Super-Ego). It also then determined consciousness because consciousness was only
its surface of projection (thesis of the all-powerful Unconscious and the nullity of

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consciousness).
Thus in redefining consciousness in these terms Ey finds himself diametrically
opposed to Freudian doctrine, not in that he rejects its empirical findings of the
psychopathology of the unconscious, but in that he clears the confusion by putting
the unconscious in its rightful place in relation to the organization and disorganiza-
tion of consciousness. Freud's fundamental observations and deep original insight
are later diminished, in Ey's view, by their integration into a theoretical system which
is incomplete. The degree of actualization of the unconscious, in other words the
degree to which fantasy is admitted into actuality, depends not only on the force of
the unconscious but even more on the weakness of consciousness: the dream is
dependent not only upon unconscious desires but presupposes an organic
disorganization of consciousness.

PART IV: ACUTE PSYCHOSES


The acute psychoses (manic-depressive states, acute delusional and hallucinatory
states, and confusional states) are disorders of the field of consciousness, the
synchronic modality of consciousness discussed above. Consciousness is the
organization of events into a field having dimensions in space and time as the
"here-and-now." The individual constructs his world for himself in terms of a
dynamic consciousness (as is seen both ontogenetically and in the vertical movement
from sleep to wakefulness) through the successive stages of "presence in the world,"
"personal representation of the world" and "the world of the present," in the process
acquiring freedom of operation in a world of reality.
This widened yet delimited concept of consciousness is not arrived at merely by a
metaphysical reflection upon the cogito, it is a theory which also rests upon evidence
EY AND JACKSONIAN THEORY 427

from, and so is validated by, clinical practice. By a process of phenomenological


reduction of clinical material the essential components of consciousness are revealed.
Similarly as consciousness is disorganized the pathological process liberates each
succeeding organizational level.
Classifications are for the most part arbitrary and comprise a juxtaposition of
entities and syndromes which are constantly being revised. The acute psychoses are
sufficiently homogeneous to constitute a group, and yet sufficiently heterogeneous
to admit of types. The common denominator is a disorganization of consciousness.
Epilepsy provides the experimental model for these psychoses, where the whole
spectrum may be displayed and justifies the unitary concept of a continuum of
disorganization across the syndromes and the inadequacy of regarding each as a
radically separate entity, and therefore with presumed separate aetiology.
A study of the natural history of acute psychoses reveals overlapping forms and
fluctuations between different forms. For example, in the periodic psychoses con-
fusional episodes are often encountered, and the clinical spectrum of acute psychoses
may present itself in sequence in toxic states and metabolic disorders. A mistaken
diagnosis of schizophrenia may be made when delusions and hallucinations appear
during the development of a confusional state; a patient's notes may offer different

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diagnoses from attack to attack. These changes are changes in the level of the organ-
ization of consciousness and it is the level which should determine the diagnosis.
The acute psychoses may profitably be rearranged on a graded hierarchical scale
of disorganization of consciousness. Mania and depression are at one end of the
continuum, delusional and hallucinatory states intermediate, and confusional states
at the other end. Lower levels of disorganization necessarily imply disorganization
of higher levels, so that to the lower levels are added the features characteristic of
higher levels. The continuum is therefore saturated with mania and depression;
agitation, elation and anxiety are common to all levels. It is precisely for this reason
that Baillarger refused to distinguish confusion from melancholia. Confusion, on
the other hand, necessarily appears only at the deepest level.

Manic-depressive Level
Mood disorder is not a simple state and exclusive to the affective psychoses, it is
the clinical expression of a global disturbance of relational life and is phenomeno-
logically reducible to a loss of ethical control over time, the ontogenetically latest
acquired component of the field of consciousness. This is not measurable chrono-
logical time but "actualization" time or psychological time. The present is that
form of time which, torn from the past, defers the future in order to establish between
the two an interval of "availability." Acts of human feeling and judgment are
strictly temporalized. An emotionally disorganized consciousness is one that is
abnormal in its temporal structure. To be sad is to cease to be able joyfully to
anticipate the future, it is a suspension in time or even a retrogression into states of
nostalgia, regret and remorse over the past. To be anxious is to want to escape the
intolerable moment; fear is similarly associated with flight. Expressed another way,
428 PHILIP EVANS

the emotional drives are controlled by temporalization in accordance with the


demands of the present. At this first level of disorganization emotions are released
and uncontrolled to the point of disrupting the "present" of consciousness. The
emotion disrupts the "here-and-now-as-it-should-be" by pushing it back on to a
"what-might-be." Emotions are complex phenomena, and because acts of
consciousness are intentional, emotions have content. Fantasy floods into con-
sciousness distorting, exaggerating and over-valuing the object; as Sartre describes it,
"une fascination imageante" and "la conscience qui reve."
A phenomenological analysis of mania reveals the temporo-ethical deficit as a
frantic drive, an irresistible impetuosity which carries this "moment-that-I-am-
living" away from an intolerable present towards a rosy future. This loss of ethical
control shows itself in a propulsion of instincts and affect towards the sole fulfilment
of pleasure. The manic patient is delivered from the present with its constraining
deliberation into the anticipated satisfactions of relentless needs; he "rushes headlong,"
he "goes too far," he "exceeds permitted limits." As an escape from the present the
description "flight of ideas" finds its .real meaning. All roads are open to the manic
patient, the future is already here. Freud's "loss of Super-Ego control with regression
to oral pleasure" may be re-expressed as an insatiable appetite which drives actuality

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onwards without stopping, eating up time and heedless of obstacles, especially that
major obstacle the subordination of gratification; the temperance which demands
that between desire and its object there be interposed a period of "marking time"
so that actions are deferred and always conditional. In this dizzy race towards the
future the present is annihilated. The experience of the patient (content or positive
features) is the elation of being freed from conformity and convention, it is an orgy,
a festivity in which are satisfied the needs to conquer the world.
The phenomenological study of depression reveals the reverse of the same coin.
The manic in by-passing the codes of temporality finds fulfilment, the depressive
experiences only failure. He lives in the past, his past is still there, it is here becoming
his present which stands still. His past was misspent, unhappy but inevitable; his
guilt and self-reproach are secondary. The past draws the intolerable present into an
abyss of remorse and regret, the object of which is submitted to eternal reproach;
the misdeed cannot be undone. The depressive is morally riveted to his past, there
must be no change. Depression is then "arrested time" and "frozen destiny." The
manic patient anticipates endless possibilities, the depressive is immobile in an
eternal impossible and his only release can be death. The depressive temporo-
ethical deficit is experienced by the patient (positive features) as a metaphysical
tragedy, in which all the eschatological themes of the anxiety of existence and the fear
of death are re-enacted. The manic sees no problem, the depressive finds no
solution.
Mania and depression are interchangeable and represent a unitary disorder whereby
the patient has lost that temporo-ethical component which enables him to establish
a field of the present, which is manifested in turn in acts of human feeling and judge-
ment. He has lost the ability to, in a sense, represent time correctly to himself and so
EY AND JACKSONIAN THEORY 429

cannot adapt to the "real present." This is the first level of disorganization of con-
sciousness and is naturally the most labile and vulnerable, thus explaining the greatly
increased chance of recurrence of these states as compared with deeper levels of
disorganization. But loss of this most evolved structure, this fonction de presenti-
fication as Janet called it, causes such an upheaval that it alters the very meaning
of existence.

Delusional and Hallucinatory Level


To the disorder of temporalization, characteristic of the highest level of disorgan-
ization of the field of consciousness, is added a second spatial disorder. This is
a disorder of space orientation, but as with the temporal disorder, this is not
geographical area but a component part of the dynamic consciousness.
Descending through the levels of consciousness there is a loss of cohesion and of
organization of the field of consciousness. Differentiation and perspective are lost.
At this middle level perception still remains intact and the patient is not yet clouded,
but his relative contact with reality coexists with areas of strange experiences, of
impositions and tricks introduced into communication. In depersonalization it is
the subjectivity delimited by the body surface which is disordered. Depersonalization

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is a loss of proprietorship of oneself as a relational being. "My body" is physically
"in the world"; thus disorders of body image such as anosognosia are not depersonal-
izations because they do not involve a disorganization of consciousness. But "my body
is also mine" in the sense that it "makes me what I am." Depersonalization then, is a
higher level disturbance. But "I am also my thoughts"; in other words, the pheno-
menal field of consciousness includes not only the ambiguous subjectivity of corporeal
body but also the subjectivity of thoughts. Existential space (espace vecu) is the area
of exchange with one's world of information in terms of words and intentions, etc.,
but it also remains "mine," "for me" alone containing the asides of verbal exchanges,
the veil of intentions. There is thus a certain autonomy of intimate relational space,
and the clear and distinct boundaries between the domains of subjectivity and
objectivity are blurred in disorders at this level.
As was seen in the discussion of the ontogeny of the field of consciousness, this
second level is the representation of one's world to oneself. To represent something
to oneself is to be where subjective and objective meet and fuse in the process of
objectivity. To represent something to oneself is therefore to symbolize and construct
in images what is real; it is to have the ability to make-believe, namely to treat reality
as a fiction and vice versa; this "dream of action" which is thought (Jackson). So
that a representation of consciousness is not only a metaphor, it is the metaphorical
procedure by which we play with the pretended in order to picture reality. The
disorganization of the order of existential space makes it possible that a represen-
tation becomes a lived reality upon the stage of consciousness. In this failure of
representation the real and the imaginary become confused, and the latter erupts into
the field of consciousness as a lived experience; external events serve to enhance the
content of delusional activity. The patient when disorganized to this level is no longer
430 PHILIP EVANS

in his correct "place-in-the-world," relationally speaking. The stage is in upheaval


and therefore his very identity becomes threatened. What protects a sane person
from hallucinations and delusions is not his critical faculties but the structure of his
representational field. At this level of disorganization of the field of consciousness
there is a loss of the ability to look inwards and analyse one's own thoughts, that
inner world of thoughts which mirrors the outside world and is the basis of communi-
cation. The content of thought becomes detached and projected: "what I say to
myself" becomes "what is said to me," "I talk to myself" becomes "I have voices
in my head." There is a duplication of the person in hallucinatory experiences.
Thoughts are experienced as the thoughts of others and this echoing of speech
manifests the splitting and intrusions which are in turn an expression of a "spatial
change." The representational field of thought and language is disordered. At a
still lower level, events, instead of being verbalized, are experienced as auditory, are
condensed into images and experienced as a spectacle, the patient becoming the
spectator. Thought escapes into the external world {la pense'e tombe dans Vetendue),
and is experienced as a violation, so that what is real for the consciousness that
has lost discrimination is an inextricable amalgam of real and imaginary. Because
he is present in his world, the patient lives his experiences in it, in contrast to the

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situation at the lower oneiroid level where the clouded patient becomes absent from
his world and begins to live his experience in fantasy. The superior level disorder of
temporalization is implied at these lower levels and hence the qualities of ecstasy,
fulfilment or fear and anxiety are frequently experienced in these deeper level acute
psychoses. The clinical overlap between the various acute psychoses within this
middle range makes further theoretical subdivision unprofitable; suffice it to say
that depersonalization and clouding have their hierarchical level and whilst the latter
implies the former, the reverse is not true.

Confusional and Oneiroid Level


This is the deepest level of disorganization of the field of consciousness, with
involvement of vigilance. In a pathological dream state (oneirism), the patient is not
physically asleep but is nearly so mentally. There is a profound negative disturbance
(confusion), psychic processes are hardly differentiated and there is a loss of synthesis
and of co-ordination of ideas. Like the dreamer, the patient cannot take a perspective
upon his experience in order to grasp, and so become present in, his world: effectively,
he cannot create his world. Consciousness has ceased at this level to be able to
construct itself into a phenomenal field. The patient's temporo-spatial disorientation
is truly both chronological and geographical.
At this more extreme point of disorganization, because consciousness has lost its
ability to confront a world of reality, it becomes a confusing world of images,
allegories and metaphors. The patient cannot imagine thingsybr himself, the representa-
tional structural dimension of consciousness is lost and he is left with apparitions.
Having lost a degree of experiencing, he has become a passive spectator in a
mysterious and menacing scenic world that unfolds itself before him. He sees without
EY AND JACKSONIAN THEORY 431

perceiving because there is a confusion of the subjective and the objective. The sensory
world is reduced to presenting itself by facets and profiles in which distances,
intervals and perspectives are lost. All that remains is a vague experience of
being conscious of something, and consciousness desperately attempts to con-
stitute a vestige of the familiar world and thus expresses a deep-seated need to
"be-for-oneself" and remain aware of oneself as a separate object. But at this
level objectivity has failed, and it is the imaginary which floods into con-
sciousness as a kaleidoscopic presentation of images, lived that much more
intensely because they are projected on to a world of nothingness—the world of
everyday ceases to be able to present itself (unlike the dreamer, the confused patient
still has a world of objects). In the absence of reality, it is a world of pictures
expressing the primitive struggle between the principles of pleasure and reality. There
is a regression to the primitive situation of a world made up only of objects and desire.
Thus the confusional-oneiroid level approaches that of the sleeping state and in its
extreme degree merges with sleep itself. Like the sleeper, the patient then has partial
and perplexing recall of the dream; but unlike the sleeper, the patient retains a
certain grasp and he can register and recall. Again, higher levels of disorganization
are incorporated: the confusion of subjectivity as opposed to objectivity makes him
live the experience of duplication, and his is an hallucinatory experience lived to the

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point of annihilation of objectivity; his body escapes from its own ownership and he is
depersonalized; the presence of mania and depression are expressed by the exaltation
and stupor frequently seen in confusional states. But these "higher" experiences are
coloured by an atmosphere of strangeness manifesting the features characteristic of
this level of disorganization.
Consciousness is constituted from an infrastructure of functions which differentiate
and elaborate ontogenetically from a basal level to "disappear" in the "freedom" of
consciousness, for they operate in such a way as to present to consciousness only the
end results of its activity. The building blocks are revealed during the process of
disorganization of consciousness as it loses its autonomy, that is its ability to adopt a
certain perspective in regard to its experiences. The world for the patient (content)
at each level of disorganization reflects a modality of thinking and objectification
which is a disorder (form) hidden from the subject, who then lives his experiences
according to the conditions governing their presentation. Putting it another way,
the change in content which makes up each concrete moment of existence is the
correlate of a physiological change in the formal organization of consciousness. The
pathology naturally obeys Jacksonian principles, because to each level of disorgani-
zation (negative feature) corresponds a mode of experiencing (positive feature).
Acute mental illnesses, then, are pathologies of freedom. In its disorganization
consciousness loses its ability to resist the forces of the unconscious. Disorganization
is a movement towards the actualization of the unconscious because at each lower
level there is a greater degree of actualization of the unconscious. The analogy with
the sleep-dream phenomenon is clear. Sleep is disturbed in all these states, patients
sleep less (suggesting that they are living incomplete sleep-states), and the symptom-
23 BRAIN—VOL. XCV
432 PHILIP EVANS

atology is accentuated on going to sleep and waking up (for instance with early
morning gloom, nocturnal confusion and hypnagogic exaggeration of delusional
experience).
Classical psychiatry has split its object of study into a mass of "functions" such as
memory, affect, perception, intelligence and consciousness. Ey puts the problem in an
entirely different perspective; by rejecting a classification on the basis of symptom
clusters, he isolates, through a study of disorders of consciousness, a hierarchy of
levels of disorganization of consciousness—the acute psychoses.

PART V: CHRONIC DISORDERS


1
Chronic disorders (character disorders, neuroses, paranoid psychoses, schizo-
phrenia2 and dementia) are disorders of the personality, and also forms of pro-
gressive alienation from reality. Integration with reality is developed ontogenetically,
and that part of the personality which ensures this integration is the Self. In Part III
were described the two time-modalities of the conscious being; the synchronic, the
field of consciousness concerned with the experience of actuality, and the diachronic,
the Self concerned with the historical construction of the personality. Chronic
disorders are pathologies on the diachronic dimension, pathologies of the Self, and
represent structural levels of "being," existentially, on a ladder of evolution or
dissolution. The Self, then, is not the organization of the "here-and-now," an organ-
ized field of immediate experience, but the other trans-actual, dimension of that
fundamental structure of the psychic being which is consciousness.

Ontogeny of the Self


Consciousness of oneself is grasped ontogenetically. Consciousness is a bilateral
event, for we objectify something and consciousness consists of this process. But
consciousness is more than making actual an event within the field of consciousness,
it is also the experience of being the someone who is affected by that event; so that in
considering the crying child or the child who sucks his thumb, one must interpose
between the stimulus and the behavioural response the awareness of discomfort or
comfort in addition to the immediate experience. At the earlier stage an infant has
not yet developed his bilaterality of experience. Subject and object are confused and
sensations are automatic so that food is pleasure and the absence of food is pain.
The development of consciousness of oneself, which is the Self, coincides with
maturation of the nervous system. The child takes a perspective upon his world,
acquires a first degree of freedom and begins the development of his Self.
The process of detachment occurs either by out-living the object in memory or by

'Volume IV of Henri Ey's "Etudes" will be devoted to the Chronic Disorders. These are
considered also elsewhere in the section on "Structuration et Destructuration de la Conscience"
in Vol. Ill of the "Etudes," Part III of "La Conscience" and amplified in "Traite de
PHallucination" (in preparation).
'Schizophrenia refers only to the chronic illness.
EY AND JACKSONIAN THEORY 433

opposing it in perception or in an intentional act. In the beginning there is a thwarted


drive and objectivity is born from the obstacle opposed to the drive. Objects cease to be
furtive as the significance of relationships and the discovery of " I " appear. Meanings
become the essence of personality. To control need and disappointment is to accede
to the emancipation of " I " which will assure the preservation of the permanence of
relationships. " I " face-to-face with another immediately engenders the affirmation,
"mine." The body, initially " I , " in turn becomes objective as the ability is gained to
reflect upon "myself" as object of my own subjectivity. The body is then no longer
confused with the body image. The child now begins the process of mastering the
object, which includes mastering his body. As this division proceeds, the trans-
cendental Self is constructed out of the question "what is part of me-myself?"
Having discovered himself face-to-face with his world and then himself the "content"
of his own body, he must now become "container," i.e. take possession of his body.
This stage may be called "becoming subject of one's knowledge" and will serve to
detach the child from his immediacy in order to project him into his on-going
history.
The next step Ey calls "becoming artisan of his world." The child builds himself
a world by applying the rules he has acquired of logical thought and operational
precepts. His ideas, needs and emotions provide him with a representation or a model
of his world, to which he then binds himself by his beliefs and sentiments. This
represents the age of reason; he constructs his personality as he adapts to his world
according to the principles of reason and the fulfilment of his needs.
As he comes to terms with reality he becomes a person in the full sense, that is
one who has taken possession of his body and appropriated his thoughts and his
world. Identity-formation follows. To assume a role is to be "someone" with
qualities, defects and an idealized Self; it is to acquire a moral conscience. Matura-
tion, in terms of style and self-control, goes on throughout life and this is the final
stage in the auto-construction of the Self which is the very axis of Man as a rational
being.

Structure of the Self


The Self, then, is a consciousness of oneself, of one's identity and permanence.
The very concept of an organization of the psyche implies an order. The Self submits
itself to a legislation so as to determine the efficacy of its actions. The Self "con-
tains" his experiences, his past, his capacities and notably his capital of logical and
moral values, all of which characterize him as an individual. But he also has opposing
directional forces in his unconscious. The Self contains his own potentialities and
obstacles, and he is his own agent. The Self is continually compromised by the
unconscious and seeks to free itself from its corporeal infrastructure. The freedom of
Self is not absolute. Man's life-work is the construction of an edifice of originality,
creativity and self-awareness. His personal model of the world provides him with
the ability to know himself, to recognize his place in the world and to control his
434 PHILIP EVANS

behaviour in an orderly fashion according to an acceptable code of ethics. Conscious


activity is measured against this idealized-Self. In other words there is a "somebody"
only when the subject becomes a "person," and identifies himself with a personal system
of auto-determination, which, derived from the inter-personal milieu, returns to it in
order to affirm himself. The goal is uncertain, the direction of the Self is problematical.
The Self, by polarizing its acts, its choices, its decisions, by making itself "take the
responsibility," ceaselessly reviews its ends. The Self deploys itself by objectifying
existence. Full maturation implies the ability to harmonize "what I am," and "what
I want to be." The individual aspires to the status of a reasonable being.
Man's consciousness of himself is his reason, and is also the road to existential
freedom. If there is no freedom there can be no madness, for madness consists in the
abrogation of this freedom. The law of organization of the Self is the law of reason;
chronic psychiatric disorders, as disorganization or failure of evolution of the edifice,
represent a loss of reason. Chronic disorders are arrests of development, malforma-
tions or deformations of the patient's self-awareness. In them there is a certain
unconsciousness of oneself, since the Self loses the ability to grasp itself. In this sense
chronic disorders represent lesser degrees of consciousness. Patients are not masters
of themselves, they are no longer themselves. Like the acute states, chronic disorders
are pathologies of freedom.
Though the antithesis of a conscious field in its fullness is coma, the deepest level
actually reached in acute conditions is a confusional state. Similarly, though the
antithesis of a mature Self (a "someone") is a "nobody" (which is a nothingness),
chronic disorders represent lesser degrees of disorganization on this continuum.
Therefore there always remains at least the infrastructural vestige of a person, and
even the most profound dement in that form of existence at the extreme limit where
differentiation as a person disappears, is not reduced to the state of a mere living
preparation. But what is implied is a dedifferentiation of the personality and a degra-
dation of the very nature of Man. Loss of integration, of identity and of rationality
mean loss of responsibility and so of the ownership of the Self. In the chronic
disorders patients have lost or not gained possession of their being, which is the
most radical way of being neither reasonable nor responsible.

Articulation of the Self with the Field of Consciousness


The Self, that horizontal movement towards an ideal, has its history and its
permanence of personal values at its disposition, and brings them to bear upon each and
every moment of its existence in the field of consciousness, that vertical movement
towards reality. The Self is the transcendental being, conscious of himself relative to
the field of consciousness where experience is lived. We act out our history, but at the
same time we construct it. Actions reflecting human feelings and judgement must
pass through the field of consciousness in order to be integrated into the personality.
This integration is in part measurable by psychologists' psychometric tests of attention,
memory, reasoning-ability, etc., but what is crucial is that these "functions" manifest
EY AND JACKSONIAN THEORY 435

themselves globally and transcendentally as a "taking of possession" of the field of


consciousness by the intentionality of the Self. The Self thus operates upon the field
of consciousness. It creates thought and action and also temporalizes the succession
of events and assures continuity inasmuch as it assumes responsibility for its acts and
projects. It is both orator of its speech and director of its play, for "I am more than
conscious of what I am attending to, I am also conscious of what I am and should be."
Without this ownership over one's own experience, there is no conscious being, for
to be conscious is to live an experience in its actuality and to direct an existence
through the successive fields of actuality. Thus there is a reciprocity between the
organization of experience into a field of actuality and the auto-construction of the
personality. The Self and the field of consciousness coincide at that point of supreme
human activity when the Self reflects upon its own construction. Otherwise the
relationship between them is one of figure and ground: "I apprehend my self riving an
event" and "I know I am playing out and directing my history through the events
that comprise it." A more-or-less continuous fullness of the field of consciousness
is a prerequisite for normal personality construction. Since the Self surpasses the
field of experience, there can be lesser degrees of disorganization of the Self without
interference with the field of consciousness, as in the neuroses. The reverse, however,

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does not hold, for when the field is disorganized, experience can no longer be effec-
tively incorporated. Thus a disorganization of the field of consciousness necessarily
entrains an alteration of one's consciousness of oneself. An acute psychosis is there-
fore "lived" with an altered Self and the consequent interruption of its continuity
may cause irreparable damage in so far as the illness persists. There is, then, a
tendency to self-perpetuation of acute psychoses and one can envisage in these terms
the possibility of reorganization of acute into chronic disorders.
A phenomenological description of chronic mental disorders coincides with, and
so validates, the metaphysical analysis of the Self. As disorganizations and lower
levels of organization of the Self, they reveal the structure of the Self and its
ontogenetic elaboration.

Character Disorders
Man cannot be reduced to a mosaic of elemental character traits, nor character
disorders to a change in distribution of scores for these traits, for in such a procedure
the very problem of Man's essence and alienation is set aside. Symptoms are not a
measure of the disease; psychopaths, for example, are by no means characterized
by the most violent crimes. We all "have" traits, the character-disordered is
condemned by his inability to "be" other than himself. His values are not ours and
he cannot dispose of himself as freely. He has not the normal plasticity of action,
his "way-of-being-in-the-world" is selfishly fixed in its deviation and inexorably
linked to an anomaly of structure. He is predetermined by his pathological written-in
code. The construction of his idealized Self is prejudiced by the abnormality;
fanaticism develops, for example, into violence; introversion into escape from reality.
436 PHILIP EVANS

His loss of freedom of action is shown in primitive or retrogressive behaviour,


where action is short-circuited. The psychopath's "I have a need to do bad" does not
express a freedom of choice but shows an absence of a sense of responsibility
and an ignorance of the motives that drive him. It becomes for him a necessity
to hurt.
At this most shallow level of disorganization, the Self is deprived of an ethical
dimension. This level of consciousness lacks the transcendental ability to take a
long-distance view of the purposes of its existence, and so to realize projects in
accordance with healthy ideals.

Neuroses
These represent a deeper level of disorganization of the Self. To the character-
disordered person's loss of freedom of action is added a loss of identity. In the normal,
there is a stable equilibrium between the repressive forces of consciousness and the
forces of the unconscious that constantly threaten the integrity of consciousness;
there is a certain cohesion, a "oneness" which we perpetually question. Personality
is built in conformity with what one is, what one wishes to be and how one is seen by
others, and so offers us the template of a being that is our ideal. The character-

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disordered person has such unity, he is at one with himself and he has a single history,
albeit frozen. The neurotic lacks this cohesion, his Self is conflictual, hence the notion
of doubling. He recognizes within himself two selves in conflict with each other.
This "other" in conflict with the self is in the nature of a demoniacal possession
which hampers the autonomy of the Self. He finds within himself that which he is
not and that which he does not want to be. The unconscious, which he contains
within himself, cannot be contained. It is a weak Self that is the unwilling captive
of his unconscious and anxiously bound to it by his defence mechanism, rather than
the neurotic defences being escape mechanisms from the ties of the unconscious.
To this doubling corresponds the inauthenticity of the neurotic. He is condemned to
play out his ambiguous role like the actor in search of an author. Freud emphasized
the symbolic nature of the neurotics' symptoms; their emotional blackmail, their
insincerity, their eccentricities and their pretences manifest a need to behave and to be
"as if."

Chronic Psychoses (chronic paranoid psychoses and schizophrenia)


The paranoid psychotic shows a greater manifestation of the unconscious, whilst
still clinging to the law of reason. He carries his world into the neurotic split with
himself. The Self becomes "an-other," in a "way-of-no-longer-belonging-to-one's-
world." In becoming "another" by the process of first becoming a reflection in
another, he preserves his integrity. The persecutor is the negative picture of himself.
He experiences his disorganization as a persecution, and his delusional system
represents explanations and beliefs reflecting a radically false judgement that converts
the opposite of a truth into the truth. The "other" which assumes dominance claims
the right to reason. The paranoid psychotic defends his convictions logically.
EY AND JACKSONIAN THEORY 437

In chronic schizophrenia there is a failure of reason, which is the capacity to


integrate reality into a logical system of values. In this more radical disorder there is a
complete inversion of reason. The most severe picture is that of the patient who takes
himself for another, not metaphorically, but who becomes that other; in this way the
schizophrenic can claim with utter conviction: "I am not mad, I would have to be
mad not to believe." It follows for him that it is the others who are mad. This repre-
sents the fundamental form of delusion—the primary delusion. Truth is no longer
problematical, as it is for the normal. The world is free from doubt and mystery,
there is only absolute conviction; the lucidity is frightening. All is clear to the
psychotic Self, unconscious of itself as a being in its world in accord with
common sense. The world is replaced by the reverse of the world, in autism.
The unconscious usurps the Self and in becoming "conscious," annihilates the
normal relational world. Autism is not an escape from an impossible reality in an
attempt to protect the Self, a strategic retreat, but a modality of existence in which the
question of subjectivity versus objectivity is removed. The language delapidation
expresses this autistic breakdown of communication; language no longer serves as a
means to an end, for it is the anarchic unconscious that speaks. Regression to primi-
tive modes of operation displays both the negative feature of a collapse of relational

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life (of a being no longer master of himself and unable to contain his unconscious)
and the positive feature of a need to construct for himself the semblance of a world
(a world of fantasy and magic free of all logic).

Dementia
The feature that makes schizophrenia a disorganization at a higher level than
dementia is the remaining capacity for the schizophrenic (except perhaps in the
terminal stages of the disease) to construct the vestige of a world from his beliefs,
feelings, aims and behaviour, in which the Self can operate as its own director—hence
the intelligence of the schizophrenic in the face of unreality. On the other hand the
membra disjecta of the dement, his remaining perceptions, automatisms, memories
and habits, can no longer integrate themselves into an evaluating consciousness.
There is no-body and no situation left, only vague reflections of what he once was.
There is a loss of intelligence, by which Ey means the Self, subject and agent of the
intelligibility of his world, his axiological order against which his performance is
tested. For it is insufficient to have intelligence, one must also be intelligent.
Dementia, then, is the incapacity of the Self to operate the logical integration of
its behaviour.
In confusional states the Self is temporarily non-operational by reason of a dis-
organized field of consciousness. In dementia the Self is vigilant although it has lost
its function of judgement. There is a loss of self-evaluation and criticism, and a loss
of moral and logical values; there is a sterile indifference about acts, speech and
ideas. The system of values has decayed. The disorganization of the Self, the aliena-
tion from reality, has reached its most profound level. The dement has no relational
438 PHILIP EVANS

world and no continuum of personality, so that he can no longer construct his world
because he is no longer problem-solving and adapting.

The Position of the Unconscious


The Self has been dismissed by some as an abstraction defying all scientific methods
of observation, and Behaviourism, for example, in conceiving of personality in terms
of conditioned reflexes is opposed to a phenomenology of the Self. Psychoanalysis
arrives (inversely) at an analogous negation of the Self. It describes an Ego that exists
only in the function of its Unconscious ties with the Id and the Super-Ego. It is also
because psychoanalytic theories do not detach a transcendental Ego-Ideal from an
immanent Ego that the Self is more or less dismissed. Both concepts are opposed
to common sense. The one (Behaviourism) ignores what the Self does not show
externally, the other (Psychoanalysis) ignores what the Self does not show as seen
from the inside. In Ey's view the Self is precisely that through which behaviour and
motivation are conscious or unconscious and which, not content with affirming its
reality, makes it explicit.
The negation of the unconscious by behaviourists necessarily implies the affirma-
tion of the homogeneity of psychic life, all or nothing being conscious. The affirma-
tion of the unconscious requires the affirmation of psychic organization. The reality
of the unconscious is guaranteed by the empirical basis of psychopathology, the theo-
retical foundation of which requires this concept. If the infant met no obstacle
between drive and its fulfilment he would meet nothing and nobody in his world
because the object of desire being totally incorporated, he would be unconscious of
the desire itself. The division of consciousness and the unconscious springs from the
conflict which opposes the desire for satisfaction. The unconscious is written into the
very organization of a psychic being, not in the proportion zero (for consciousness)
to infinity (the Unconscious) as psychoanalysis would have it, but according to a
dialectic which assigns to consciousness the role of the integrator and to the
unconscious that of the integrated. The unconscious may escape the proprietorship
of consciousness in order to enter the field of consciousness, but only as a distortion,
that is without ever assuming the right to full reality. It is by disclaiming the
unconscious that consciousness asserts its dominance. The unconscious is repressed
from thefieldof consciousness and is also "another" self. In colouring conscious mental
life the unconscious is allowed a degree of reality. The field of consciousness rejects
unconscious manifestations as "unreal"; the Self disowns the unconscious as "an-
other." Thus the unconscious appears as an anti-reality (fantasy) in acute states of
disorganization, and as the language of the "other" in the chronic disorders of the
Self. The unconscious structure of the being is revealed in states of disorganization
of consciousness, automatism gaining over, proportionally, as consciousness loses.
Examples serve to illustrate the two forms of breakdown corresponding to the
two ways in which we "have" an unconscious by becoming conscious through the
process of submission to the law of reality. The person with epilepsy in the grip of a
confusional state who may kill his mother is subsequently guiltless in his own eyes
EY AND JACKSONIAN THEORY 439

because the act was unintended and not registered by reason of the confusion.
He is also guiltless in the eyes of society which judges him not responsible; his
consciousness was disorganized in its synchronic dimension and he fell prey to his
unconscious incestuous tendencies. In contrast, a paranoid whose aggression was
directed towards his mother and who attempted to rape and shoot her was equally
unconscious of his incestuous desires. He is also guiltless, but in this case because
he fell victim to delusional beliefs. His loss of consciousness of himself (on the
diachronic dimension) had made him unaware that he had become what he wished
to be, namely his mother's lover, that is his own father. The proprietorship of his
person had been alienated. The epileptic acted out his fantasies; the paranoid
became "an-other." The dream and alienation represent the two modalities
of the unconscious corresponding to the two modalities of consciousness, the
field of consciousness and the Self.

The Freudian Ambiguity


The Freudian model is incomplete. It is not the unconscious itself that is in question,
it is the theory of repression. The Id, Ego and Super-Ego are vague conceptions
that fail to provide a coherent account of the hierarchical structure of the person.
In Freud's development of the concept of the Ego, it was a structure of censure, in
other words a legislating force presupposing the reality and even the pre-eminence of
consciousness. Later Freud's psychology became a psychology of the Unconscious
and the function of censure becomes ascribed to the Super-Ego. The Unconscious
is now omnipotent and the absolute master of the psyche, the "subject" disappearing
in the process. Consciousness loses all substance to become a mere surface at which
Unconscious forces are reflected. The Freudian Unconscious includes the Id, the
Super-Ego and the Ego so that in the final analysis the conscious being finds itself
"dispossessed" of all autonomy. Ey brings modification and simplification to the
Freudian Triad by restoring substance to consciousness as the instrument of adapta-
tion to reality. There are in effect two poles, consciousness and the unconscious,
between which is organized the structure of the psychic being. The Self and the
greater part of the Self-Ideal become part of the conscious being which establishes
control over unconscious forces. And it is this passage from the predicative category
(to be an unconscious being) to the substantive category (to have an unconscious),
or precisely, becoming conscious of one's unconsciousness, that clearly defines the
nature of Man. Truly then is lafolie est le contresense de la conscience.

ACKNOWLEDGMENTS
I express my gratitude to Dr. Henri Ey for the extraordinary hospitality and welcome he extended
to me and my family at Bonneval and for all the assistance he graciously offered me in the prepara-
tion of this work. The Ciba Foundation and Institut National de la Sante et de le Recherche
Medicate made the project possible financially. I also thank Dr. R. T. C. Pratt, who encouraged
the idea and helped to define its aims and limits. He, Sir Charles Symonds and Dr. A. Lishman
patiently examined the manuscript and made constructive comments. Finally my thanks are
due to the National Hospital, Queen Square, for agreeing to release me for the period.
440 PHILIP EVANS

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(Received 20 May 1971)