A BREAK WITH REALITY AND THE LOSS OF MEANING: "I WAS LIVING IN A WORLD THAT I DIDN'T UNDERSTAND."
According to Alexa, her journey into subjective darkness began suddenly and without warning. It took the form of what she characterized as “paranoia,” but at its core it seemed to be a disintegration in her capacity to make meaning that was the result of a shift in her perception of reality. Alexa was overcome with confusion, and this made it difficult for her to make sense of her experiences. Her first episode occurred one night when she was out with a group of friends listening to a live band. As she listened to the ebb and flow of the conversations around her, Alexa began to feel that all of them were addressing her. She felt as if everyone—including the singer—was insulting her and saying nasty things about her. “I was out with friends . . . and out of the blue I started getting paranoid.” She continued,
The conversations were all over you know people were- and I had a feeling that every conversation was being directed at me and putting me down and really like in ah insulting me and and calling me names, but I didn’t know what was going on.
Alexa was not hallucinating or hearing voices or variations of what was actually being said; it was that her mind interpreted all of the statements she heard as derogatory. She explained, “I was interpreting it as insults you know like somebody can say hi how are you but if you are . . . out of it, I wasn’t hearing any different words . . . but interpreting them in a negative way. Everything was black everything was bad everything was negative.” From that point on, Alexa’s confusion regarding the distorted shifts in her world began to feel persecutory. It was as if the negative self-appraisals that commonly occur during depressive states had been projected outside and Alexa experienced them as attacks from others rather than as products of her own mind.
I continued with this paranoia and and just I was living in a world that I didn’t understand but the- what I looked at was the same physically, the world was the same but in my mind it was something different but I didn’t know what it had become. What it had become. It was whole torture. Pure torture.
Everything had changed, even though it remained the same. In essence, the world had been flipped about so that Alexa could no longer take for granted that things were what they seemed. Fuchs (2005) describes a phenomenon that is common in melancholic depression and schizophrenia in which cor- porealization of the body serves to distort the subject’s relationship with the world. The body serves as the medium between inner experience and external reality. Through the body, we learn about the world and the ways in which we are affected by it. The difficult task for the body is to establish and maintain firm boundaries between self and other while not over-encumbering the subject’s experience of the world with bodily awareness.
In melancholia, the body loses its lightness, fluidity, and mobility of a medium and turns into a heavy, solid body that puts up resistance to the subject’s intentions and impulses. Its materiality, density, and weight, otherwise suspended and unnoticed in everyday performance, now come to the fore and are felt painfully. Thus, melancholia may be described as a reification or corporealization of the lived body. (Fuchs, 2005, p. 9)
Fuchs (2005) likens this to the process of becoming a living corpse; it is as if the person is trapped within the confines of a dead body. In contrast to the cumbersome hyperawareness of the body commonly found in depression, in schizophrenia “a disembodiment of the self’ occurs, which is “caused by a loss of the basic self-awareness in which all intentional acts are normally embedded” (Fuchs, 2005, p. 105). This is evident in Alexa’s narrative, as she could no longer take for granted the sense of identity and agency that results from this self-referential process of embodied awareness. Boundaries became fluid: between herself and others, between thoughts and feelings and objective reality. Alexa’s confusion grew stronger with each passing day, which exacerbated her sense that she was living in a state of “torture.” She said,
Something happened that I didn’t understand—everything was not the same it was different yet it- yet it was the same. I didn’t know who I was even though I knew that my name was supposably Alexa. I didn’t- I was- I said is this life after death? Did I die? I was preoccupied with with creation and with with good and evil. I said did this- and I believed in the devil and hell then. I said is this hell? Am I in hell? The devil possessed me? Did I do something wrong, what’s going on? What’s going on?
Alexa’s concern that perhaps she had died or that her existence was not a living one but a persecutory experience of hell can be better understood in terms of Cotard’s syndrome. Although it cannot be demonstrated conclusively one way or another as to whether Alexa had Cotard’s syndrome, it is still a helpful tool for understanding some of the elements of her subjective experience. Cotard’s syndrome, commonly found in psychoses and schizophrenia—especially when accompanied by depressive symptoms—is characterized by a negation of existential states. According to Young (2012),
The belief that one is dead or does not exist perhaps best typifies what Cotard (1882) later came to refer to as nihilistic delusions (delire des negations) on account of which the patient may come to deny everything including, at its most extreme, self and world. (p. 127)
Young (2012) suggests that people experiencing Cotard and Capgras delusions (in which familiar people are believed to be impostors, because they do not trigger an affective experience of recognition) are struggling with trying to make meaning of an experience of unfamiliarity that should be familiar. He posits that the presence of paranoia or suspicion in Capgras patients may lead them to attribute external changes for the shift in their perceptions; the other is the impostor. He suggests that depression in a Cotard patient will increase the likelihood of attributing the perceptual change to the self; it is not the others who are impostors but the self that is dead. Alexa experienced a blend of both of these shifts in her perceptions: Family members began to have an unfamiliar quality just as she also suspected that she had died and gone to hell. To complicate matters further, the confusion that Alexa experienced due to the fluidity in boundaries—what Young (2012, pp. 128-129) refers to as a “misplaced being”—led to a breakdown in her capacity to trust. Even the act of having a conversation became a potentially violating experience:
I would think that people are putting thoughts into my head and I feel that they’re reading my thoughts . . . and I really sometimes think that people can read our thoughts because they can- they finish my sentences or they say they might say- I have a thought in my head and then they verbalize it in so many words and sometimes I really feel like even even when I’m well, you know I say- you know did he did he just read my thoughts because they said just what I was thinking. And it could be . . . not even somebody that knows me very well. . . . And and that’s upsetting. That’s upsetting. And that really makes me wonder. You know? Maybe there are aliens (laughing) in this world! And they’re beyond what the human beings are. You know. And I believe there might be aliens around us.
I really believe that. But I’m r- I’m not afraid of it. I’m not afraid of it. But it’s upsetting that I can’t- I don’t want to read anybody’s thoughts but I can’t read their thoughts but they can read my thoughts. That’s that’s that’s also upsetting.
Not only was it difficult for Alexa to trust the intentions of others, but it also made it nearly impossible for her to trust herself. Alexa had become a stranger to herself (Kristeva, 1991). She became preoccupied with good and evil, probably because she could no longer hold herself accountable for her actions; Alexa could not be sure that she would not commit some unthinkably evil act. Consequently, she became concerned about salvation, which inherently depended on the goodness within her winning out over evil.
When I wasn’t feeling uhm s- uhm well, or sane, ah I felt that evil would overtake me and that I would start doing evil to others and that I have to die and kill . . . myself I could kill myself. So that I wouldn’t have to do evil to others and that I would die so mostly good and that’s the reasons that I tried attempting suicide.
Because she could not take her own bodily existence for granted, Alexa could not be sure that she was not, in fact, already dead or in hell. The collapse of meaning manifested itself as feelings of persecution from all directions:
I really thought for the longest time that I had died and this was life after death. And that I was going- and then I thought I was in purgatory. . . . So this was my purgatory and for the longest time I thought this was hell. And this was hell and that I’m going directly to hell.
Alexa’s fears led her to flee from her familiar surroundings in order to find a safe place where no one could harm her. She spent many months planning a trip across different countries. However, the torment followed her wherever she went. Alexa recounted, “I would just walk and walk and walk and think and think and think and is this life after death?” She ended up living in a hut in a public park for many days. During this time, Alexa became preoccupied with the idea that she had to die, so she began starving herself and keeping track of the passing days. She needed to escape. “I couldn’t sleep, and I wouldn’t eat and I have to die and I have to die of starvation and I and I don’t deserve to eat I don’t deserve this I don’t deserve that it was horrible.” While Alexa was living in the park, she began to draw a crowd, as people came to check in on the distressed woman who was not eating. Eventually, the police picked Alexa up and interrogated her in an attempt to discover something about her identity and where she had come from. However, Alexa no longer knew the answers to any of these questions. “I still knew that A- I was called at one time Alexa (middle and surname) but my world was not what it was. And I really did not know if this was real if this was life after death.” I asked whether she thought she might have been dead, and Alexa elaborated:
Yes. Yes and that my family was not my family and that maybe that was really a dream and this was the reality. It was SOO confusing so so d- ah- in convoluted, in and out I couldn’t figure it- and was getting myself more and more confused.
Psychotic and depressive experiences are similar in that both have the potential to lead to a dissolution of meaning. When we can no longer symbolize what we have experienced in a meaningful way, we lose the capacity to have others understand something core about our existence. What is even worse, we can lose the ability to recognize and understand ourselves. Davoine and Gaudilliere (2004) cite the work of Claude Barrois, when speaking of this collapse in the capacity to symbolically convey traumatic experiences to an Other who refuses recognition:
What we are trying to name here is . . . the existence of a response to a tragic misfortune, to the meaninglessness that has befallen the world, to an existential threat that reifies the subject. It is as though each psychic victim embodied the gap in the social fabric. If there is no other to whom to speak, the trauma reduces the individual to an interiority invaded by annihilation anxiety and terror. An object among objects, he is doomed to aloneness, to an absolute abandonment, to a break with all communal and cultural bonds. Nothing in contemporary culture is available to help reintegrate the victim into the world of the living. Psychoanalysis has the merit of being the only discipline that can really do something: find the trace of the breaking point and of a prior time in which fantasy and dreams had their place. For death, one’s own, that one has looked in the face, has no representation. (pp. 129-130)
Alexa experienced this disintegration in her capacity to make meaning of her experience, and it was indeed annihilating. She described the sensation of this breakdown by saying it was “Like my mind just went ‘whoosh!’ ” In addition to the contextual confusion she felt, the process of her “illness” was equally perplexing; not only was Alexa unable to understand what had happened to her reality, she also had no explanation for why this sudden shift had occurred. Her resultant search for a purpose, a “why” in all of her struggles, added an additional layer of frustration. Doctors tended to see Alexa as her label, and to treat her based on previous history, with complete disregard for her own perspective of what was happening. This was naturally very upsetting because the way she was treated negated the validity of her personhood. Alexa said, “One of the reasons that I was so so angry, angry because something was happening to me that I could not understand and to for me to deal with something I have to understand it.”
The darkness that engulfed Alexa stole an aspect of the familiar subjectivity she once knew, and this served as a traumatic blow. She experienced a loss of identity and a loss of self, and this prevented her from continuing along the trajectory that she had initially planned for her life. During episodes of psychic distress, Alexa lost the capacity to work and to autonomously care for herself. She had lived independently and had begun a very successful career, both of which were negatively affected by her psychiatric symptoms:
It would seem to come out of nowhere. I would be fine and it would come out of nowhere and it would overwhelm me so quickly and then the that I would that I would not be able to help myself and that was frustrating because I’m a capable person and resourceful person and that would be even more r- you know that would push me even more down.