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PHILIP EVANS
(From the National Hospital, Queen Square, London, W.C.I)
INTRODUCTION
'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
^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
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
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
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.
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:
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
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
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
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.
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
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.
'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
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
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-
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.
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.
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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