Real persons ’ experience of contamination obsessions : Hypotheses from a Strausian analysis

The last two decades have witnessed a growing interest in the relation between philosophy, psychiatry and psychology (PP&P), to the extent that their kinship is now widely recognised. Erwin Straus* was a forerunner in this field. As one of the central scholars of the phenomenological approach to psychology and psychiatry in the 20th century, he acutely confronts the major thinkers of classic philosophy as well as his contemporaries. Through a profound reflection on philosophers (mainly Aristotle, Descartes, Husserl, Freud, Heidegger, Merleau-Ponty) and an engaged dialogue with the most important psychiatrists in his time (such as Binswanger and Minkowski), Straus came to elaborate an original theory whose fundamental basis is the phenomenological recognition of the inconsistency of Cartesian philosophy, of ‘experimental’ psychology (as originally described by Pavlov) and of psychoanalysis.

The last two decades have witnessed a growing interest in the relation between philosophy, psychiatry and psychology (PP&P), to the extent that their kinship is now widely recognised.Erwin Straus* was a forerunner in this field.As one of the central scholars of the phenomenological approach to psychology and psychiatry in the 20th century, he acutely confronts the major thinkers of classic philosophy as well as his contemporaries.Through a profound reflection on philosophers (mainly Aristotle, Descartes, Husserl, Freud, Heidegger, Merleau-Ponty) and an engaged dialogue with the most important psychiatrists in his time (such as Binswanger and Minkowski), Straus came to elaborate an original theory whose fundamental basis is the phenomenological recognition of the inconsistency of Cartesian philosophy, of 'experimental' psychology (as originally described by Pavlov) and of psychoanalysis.
As Straus says, the undeniable relation between philosophy, psychiatry and psychology must be rendered explicit in order to understand the origin and development of the leading interpretative paradigms in clinical practice.The following analysis of the world of persons affected by contamination obsessions, inspired by Straus's writings, serves the purpose of a reconstruction of the origins and scope of PP&P and may set the agenda of a methodology for present and future research in clinical phenomenology and its link to the neurosciences.
Straus applies the method called 'structural analysis' to contamination obsessions and points out that the basic phenomenon in this psychopathological condition is the emotion of disgust.The basic tenet of structural analysis is that in order to understand a given psychopathological phenomenon one has to find its essential or central element and confront it with the corresponding phenomenon in normal psychology.Disgust is the basic emotion in people with contamination obsessions and it is evoked by the perception of decay -what Straus calls aneidos, i.e. the loss of form of a given thing in the world.Disgust occurs when things lose their integrity, as in the case of putrefaction or when a part is separated from its whole.In obsessions most of the world is perceived along with the physiognomy of decay.For the obsessive person the world is not inhabited by living things that appear as opportunities in the process of life, but by mere matter destined to decompose and die: 'The world in which the obsessives live has such a structure that their behaviour is dominated by horror and dread, not because of fear of death which may hit them in the near future, but because of the presence of death in sensory immediateness, warded off in disgust.' 1

Obsession and the existentialia: time, space and materiality
In order to trace back the condition of possibility of the metamorphosis of the lived world that occurs in persons with contamination obsessions, we direct our attention, rather than on symptoms or pathogenetic mechanisms, to first-personal experience, and more in detail to the way persons with contamination obsessions live space, time, and the materiality of things to obtain a faithful description of the world they live in.The condition of possibility of a given psychopathological lived world is a metamorphosis of the relation between man and the world, more precisely of the mode consciousness is set up in order to experience things in that given way.Of special relevance for contamination obsessions is lived distance as the key feature of the spatial structure -the relation between man and things in space.In contamination obsessions, the person experiences a lack of distance from anything and feels attacked, surrounded, besieged.This extreme proximity to things is accompanied by a metamorphosis of materiality -the way things appear to the person.The excessive nearness of things to the person with obsessions makes him 'see' on the surface of things what would normally be invisible: contamination substances like microbes and germs.Contamination can be so rapid because distance between things is so small.Microbes can rapidly invade such a space because there is no distance to cover.Thus acceleration is the key-character of lived time in the obsessive world.Things are not perceived as stable; instead they conceal rapid biological processes that cause decay.Following Heidegger's 2 distinction between categories (referred to objects) and existentialia (referred to man), all phenomenological investigations on man have paid a preliminary attention to decide which characters should be considered fundamental for a correct understanding of human beings and their relation to the world.Lived experiences are always situated within the ground of existentialia -primarily in this paper lived time, space and materiality -and only if these grounds are described experientially is it possible to develop a first-person, descriptive psychopathology in which human experience is the central focus. 3hese 'forms' of human experience are neither the causes of certain symptoms, nor their psychological motivations; rather, they serve as the guidelines to describe the mode consciousness is configured in order to experience things in a given way.

Lived time.
Lived time is the way each person experiences time.Cosmic objective time and the subjective experience of time do not coincide.The latter is not homogeneous, e.g.youth and health diminish distance between present and future, whereas old age and fatigue expand it. 1 editorials editorials experience of becoming over time), limits/choices (how we cope with limited amounts of time) and fast/slow (the tempo of our doings and experiencing).Many authors agree upon the general idea of a lived time blockage in obsessive-compulsive disorder. 4,5he current of time stops, and the person with obsessions is entrapped in the eternal fight against the irregular and decaying world.It is because lived time has come to a standstill that things begin to decompose.Stagnation and putrefaction are the two facets of the same coin.
Lived space.Lived space is primarily a lived distance which 'binds me to the things which count and exist for me, and links them to each other.This distance measures the scope of my life at every moment.' 6We are not referring to distance as a geometric unit: lived distance is referred to as the lived space that connects a person to his environment.In fact, it is the modulation of the lived distance what allows man to interact with his world or, if the case, to defend himself from the 'aggression' of a threatening world.A 'homely' lived space is characterised by a balanced relation between distance and proximity, able to keep things 'at hand' but not too close -'a certain amount of play (Spielraum), which ensures that my freedom is preserved while the events do not cease to concern me' (Merleau-Ponty 6 p. 286).Closeness would mean the impossibility of utilising objects and would soon turn into an impediment.
Lived space in obsessions has been considered in terms of confinement, restriction, annihilation.The need for a shrinking space would come from the obsessive person's obligation to avoid contamination: there is a correlation between the amount of effort the obsessive person put into trying to avoid contamination and the limitation of space.
Materiality.Materiality expresses the idea of a linkage between things, their qualities and man's emotional attitude to them. 1 The form of the matter was named 'physiognomic' by Straus: it is the appearance of the world as a physical entity; subsequent to a physiognomy there is always an emotional reaction.Thus 'physiognomic' means matter's exterior and the corresponding human emotional reaction.For these reasons the 'physiognomic' is a descriptive means useful to a better comprehension of man's relation to his environment.† The physiognomy of things in obsessions is characterised by fragmentation and decay, and the emotional response is disgust.In the obsessive world, matter has lost its unity: it is constantly decaying, dying, in the process of decomposing.This phenomenon is related to an original stagnation of time, whose physiognomy is that of rottenness and putrefaction. 4,7It is a world in which everything appears without a neat shape.Such a matter causes a repulsive response, the emotion of disgust.

Two psychopathological cases and a literary example of reduction of distance and the appearance of decay
In 'The case of Lola Voss' Binswanger 8 describes a case of contamination obsession turning into a full-blown psychosis.
Lived space in Lola's world is altered: things are too close to each other and this proximity is the origin of their being lived as evil.As time is discontinuous, being shaped by the momentary presence of the Terrible, of what she fears in a moment, space too is discontinuous being organised around 'infectious focuses'.Lola interprets everything on the basis of spatial vicinity: objects pass their terrifying qualities on to what is next to them.Lola cannot keep things at a distance.Sometimes she tries to artificially enlarge space by closing her eyes, to keep the contagion of things away from her.The ultimate consequence is that she does not inhabit space, but she must 'read' space: she is compelled to interpret space according to magic, oracular rules (e.g.she endlessly looks for 'signs' to sort out what can be touched and what cannot be touched) to save herself from the contagion of things.
In a similar vein, Calvi 9 reports: 'Between the surface of the body and that of objects, in the place where they consume each other, there is a category of invisible and omnipresent things, jumping from one surface to the other and being absolutely ungraspable.Nobody has seen germs but, if they truly exist, they clearly demonstrate there are things which are mobile, unreliable, unsafe, although they could pretend to be inoffensive.Nobody can really demonstrate that all this is not true for all things' (our translation and italics, p. 92).
A passage from Giacomo Leopardi, 10 one of Italy's most influential poets, can shed light on the metamorphoses of lived space, time and materiality described above.Leopardi's philosophy is commonly considered pessimistic: in fact, what really matters to the poet is objectivity.In the following text Leopardi describes what could happen to anyone entering a garden which is apparently flourishing and gorgeous: 'Enter a garden with plants, herbs, and flowers.It can be as lovely as you like.It can be the mildest season of the year.In every part you look you will find suffering.The whole vegetable family is in a state of souffrance to some degree.Here a rose is injured by the sun that gave it life; it wrinkles, languishes, wilts.There a lily is cruelly sucked by a bee in its most sensitive, vital parts' (Zibaldone p. 4175).† Physiognomic characters are always determined by social and cultural factors: today's theoretical attitude toward things is dominated by the scientific approach that reduces any thing to objects, and objects to 'samples'.Since science cannot consider the emotional relation to matter, through the scientific approach worldly things lose the complexity of their physiognomy and are transformed into objects far different from what we really and mostly experience in our everyday life.

Volume 13 No. 3 August 2007 -SAJP
What makes a flourishing garden turn into a real hell?The phenomenon Leopardi illustrates is a modulation of gaze; a modulation of gaze is a modulation of distance.It brings things closer, and turns the eye into a microscope to find the truth and to see the real face of nature.Leopardi is concerned with the relationship between the human condition and pleasure.In his philosophical system, pleasure is related to imagination to the extent that imagination is the only cause of pleasure.An essential feature of human imagination is that it is made possible by the increase of distance from the world; distant things in a landscape are more beautiful and desirable than proximate ones.In consequence, pleasure will grow or diminish according to the growth or decrease of distance between the person and the world.A close approach to things is necessary to the understanding of reality but it also brings suffering.What is brought out through the approximation to things is the disintegration operated by violent natural agents.Accordingly, if imagination is inhibited by proximity to things, pleasure is gradually restrained and turns into suffering.In the end, pleasure and suffering depend on distance.

The microscopic
Obsession comes from the Latin 'obsidere', which means to besiege.Hence, obsession originally has a spatial significance: a person who is obsessed is literally besieged, a person who feels that space is lessening, that things are getting too close.We can portray, along with persons with obsessions' self-descriptions, the reduction of lived distance, that getting very close to things, in the following way: 1. Things are too near to the person.This has three main effects: 1a.Because of their extreme vicinity, things are not manageable.They cannot be handled.In spatial terms, compulsions related to contamination obsessions can be seen as a strenuous endeavour to organise one's space. 11All that appears irrational is actually the attempt of regaining control over one's everyday environment.
1b. Extreme proximity origins the loss of the object's entirety.An example about the decrease of distance and its consequences is what happens when we enjoy a beautiful landscape.When we look at the entire landscape, we are able to see from the sky to the mountaintops, from the clouds to the grassy valleys, we can take pleasure in the view, and the landscape itself seems a perfectly harmonic whole.If an obstacle or any other obstruction impeded the view of even just a small part of the entire landscape, we would not sense the same beauty: one detail can contribute to the creation of a beautiful landscape but cannot arouse any sense of beauty.The sense of beauty, as well as meaningfulness, find their origin in completeness, entirety, unity.Loss of entirety here means that a thing is not seen as a whole: it has no more beauty, no meaning, no functionality.Its sense is lost.Persons with obsessions are not able to see completeness.Their concern with details is not a ritual or a compulsion.They do not see whole things: they focus on portions, parts, details.Their world has lost its unity, things are not integrated in one environment, everything is fragmented, and fragments attain greater importance than the whole.1c.The third effect is the emergence of the microscopic dimension of things.Things, that cannot appear as a whole, appear as they would appear in a microscope: polluted with germs, microbes, etc. Obviously, this is not a real perception of microbes; its phenomenal status is puzzling.It is like a concretistic representation of the fleeting, occult, uncontrollable and menacing nature of what goes on inside things.We name the reduction of lived distance and its effects in obsessions 'the microscopic approach' because it reveals to the gaze of the person with contamination obsessions the microscopic life, which is unperceivable from a distance.The essential outcome of the microscopic approach is the simultaneous loss of significance and the finding of the biological aspect in anything.In fact, the microscopic view notices the invisible process of material, physical, biological transformation, sees the minuscule and complex life on any surface, becomes aware of the imperceptible life that goes on even though unseen.The corollary of the microscopic approach is that the microscopic shows the process of decomposition to be active everywhere.What was stability and steadiness now is endless alteration and uncontrollable decay.Life should appear and be felt as a whole, something that 'naturally' happens, and not as the result of a multitude of microscopic processes.
Compulsions are necessary in relation to this major character of the obsessive space that causes things to be as if they were living beings.Objects are turned into subjects: they move as if they were alive (subject to decay).The obsessive person's experience is permanently altered by the emotion of disgust: this emotion is related to matter, which has lost its functional, aesthetic and economic value.Matter is just repulsive.Things are not unified and organic, but substances in the process of decay, eternally perishing.This attribute pervades the entire reality and forces the obsessive person to relentlessly try to free herself from the corresponding disgust.
2. Space between things is too small.Contamination can be extremely fast thanks to the reduction of distance: any contaminated thing can pass the contamination over to other things.The outcome is that this process of contamination is 'acceleration'.Acceleration, another essential attribute of the lived world of persons with contamination obsession, regards both extension of contamination and intensity of psychological suffering.Space in which everything accelerates becomes a frightening chaos, unless a ritual manages the purification.This system of disorder must be opposed systematically.Order, established through rituals that become compulsive, would impede contamination.Therefore, it is crucial to organise a space editorials where things cannot circulate freely.Even when the circulation is commenced by someone else, a well organised space would end the movement, slow down the dangerous run.Borders, limited areas, confines: these are the spatial elements contrasting contamination, since they can bring things to a halt.

3.
The remaining space grows to infinity.Obsessive approximation to things renders space immense.The obsessive interest in the smallest things makes the amount of space virtually infinite.Elements are magnified if we approach them; by consequence their dimension, the space they occupy, gets bigger.The closer we get to an object, the bigger its space gets.An example of this phenomenon is what everyone experiences when working to a drawing, a computer-aided design or any other work of precision: we tend to magnify single small parts to make them perfect, and we do not proceed with the work until we get those done (even if we know the imperfection will not even be visible in the final result or noticed by anyone).Eventually, the dimension of the work will be much bigger than what it should actually be.One could see in this attitude also a moral component: the obsessive person cannot do anything else unless the imperfection is solved.This could also explain the association between obsessions and sense of guilt.

Conclusions
A careful description of the phenomenal world of people with contamination obsession allows to trace fear of contamination back to a metamorphosis of lived space, time and materiality.We saw how a major feature of contamination obsession is the reduction of distance from things: distance can be diminished until it becomes microscopic.Accordingly, microscopic aspects of reality emerge to visibility and things develop into vehicles for microscopic life which otherwise would stay unknown.Objects are 'biologised'.In contamination obsessions life is perceived where and when it should not be.Whereas for a 'sane' individual, things are just inanimate tools whose function is determined by the social and cultural context, for the person affected by contamination obsession they are 'alive' and, as such, contaminating.In this perspective, disgust is the emotional attempt to regain that distance which is functional to life.This microscopic distance gives shape to the obsessive world: space, time and materiality depend on the excessive nearness of things to the person.Paradoxically, this closeness to things renders the world immense.In such a threatening enormous world, contamination can be so rapid because distance between things is small.Spatial order is characterised by 'contiguity': anything is contiguous to anything else (and to the person too).Germs can rapidly invade such a space because there is no distance to cover: according to the mathematical formula, velocity increases when distance decreases.Subsequently, the endless and despairing effort of the obsessive person will be to redefine confines and distances.The only obstacle to contamination would be space, but in the obsessive world space has no void distances, there is no empty space.
A key character of lived time in the obsessive world is 'acceleration'.Things are not perceived as stable; instead they conceal rapid biological processes that cause decay.There is a sort of vibration in any substance.All matter, even things that should be seen as just 'tools', becomes 'organic' because it is seen as if through a microscope.Under the action of microscopic beings matter is ruined, decomposed, destructed.The obsessive person cannot see the whole things but just the microscopic parts of them.The obsessive relation to the world is decided by the operation of separation: persons with obsessions disintegrate the unity of things and sees fractions of things.All these parts coming from the disintegration of things become wastes, disgusting bits and pieces.Anything becomes disgusting when separated to what it belongs to, when it loses the harmony of completeness.Following Straus's suggestions, our conclusion is that decay and the corresponding emotion of disgust originate in the reduction of distance between things, the extreme approach to things and the corresponding microscopic view of those things.This looks promising for linking phenomenological analyses with the research on the neurological mechanisms of space perception, and of materiality and the emotions elicited by it (as for instance was done by Phillips et al. 12,13 ).

Department of Biomedical Sciences University G d'Annunzio Chieti Italy
Essential aspects of personal experience of time are for instance change/continuity (our Real persons' experience of contamination obsessions: Hypotheses from a Strausian analysis *Erwin Walter Maximilian Straus was born in Frankfurt in 1891 of a Jewish family.He studied medicine in Berlin until 1911, then moved to Munich where he attended the lessons by Emil Kraepelin and (during summer terms) to Zurich where he attended seminars by Jung and Bleuler.He became Professor of Psychiatry in 1931 in Berlin.In 1938 he left Germany and moved to the US where he first taught psychology at Black Mountain College and finally at Lexington (Kentucky).He died in 1975.