Abstract
Decades ago, several authors have proposed that disorders in automatic processing lead to intrusive symptoms or abnormal contents in the consciousness of people with schizophrenia. However, since then, studies have mainly highlighted difficulties in patients’ conscious experiencing and processing but rarely explored how unconscious and conscious mechanisms may interact in producing this experience. We report three lines of research, focusing on the processing of spatial frequencies, unpleasant information, and time-event structure that suggest that impairments occur at both the unconscious and conscious level. We argue that focusing on unconscious, physiological and automatic processing of information in patients, while contrasting that processing with conscious processing, is a first required step before understanding how distortions or other impairments emerge at the conscious level. We then indicate that the phenomenological tradition of psychiatry supports a similar claim and provides a theoretical framework helping to understand the relationship between the impairments and clinical symptoms. We base our argument on the presence of disorders in the minimal self in patients with schizophrenia. The minimal self is tacit and non-verbal and refers to the sense of bodily presence. We argue this sense is shaped by unconscious processes, whose alteration may thus affect the feeling of being a unique individual. This justifies a focus on unconscious mechanisms and a distinction from those associated with consciousness.
Highlights
Schizophrenia is a severe and disabling disorder affecting more than 1% of the population, and causes tremendous suffering in patients and their families
We present studies below that indicate that spatio-temporal processing may be distorted in schizophrenia patients on an implicit, non-conscious level
We have argued that impairments in time discrimination at an automatic level might contribute to the disruption of time continuity and result in disturbances of minimal self (Martin et al, 2014; Giersch and Mishara, 2017)
Summary
Schizophrenia is a severe and disabling disorder affecting more than 1% of the population, and causes tremendous suffering in patients and their families. As the memory studies described above, the patients were impaired at explicitly reporting information, even though this information influenced their performance at a non-conscious level in the same way as the healthy controls These results once again suggested that patients mainly have a difficulty with mechanisms associated with consciousness. This confirms the hypothesis that mechanisms associated with consciousness are impaired in patients with schizophrenia Still this account remains only partial, and we ask whether there is impetus to study the implicit unconscious processing by using other means. As a matter of fact, similar results have been observed in patients with multiple sclerosis regarding conscious access (Reuter et al, 2007, 2009), suggesting the difficulty in accessing information consciously is shared by several pathologies This would fit with the idea that cognitive disorders are independent from the specific symptomatology associated with schizophrenia (Dominguez Mde et al, 2009). The resolution of this ambiguity is impaired in those patients (Silverstein, 2016; Silverstein et al, 2017), who have significant difficulty in exploring visual information (Obayashi et al, 2003; Minassian et al, 2005; van Assche and Giersch, 2011)
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