Medusa’s Stare: A Case Study of Working With Self-Disturbance in the Early Phase of Schizophrenia

Abstract

The present therapeutic case study demonstrates how concepts from phenomenological psychiatry can be applied to treatment of the early phase of schizophrenia. The case described here is of a 22-year-old man seen at a youth mental health service who experienced a catatonic episode with residual cognitive symptoms. The notion of a disturbed basic sense of self— based on the ipseity-hyperreflexivity model and the concept of ontological anxiety—formed the basis of the clinical formulation and treatment. These concepts highlight the patient’s vulnerabilities and difficulties in interpersonal contact. In addition they help to clarify potential dangers inherent in “objectifying” the patient, in stimulating excessive self-reflection, and in encouraging interpersonal engagement that is overly intense. Alternative strategies guided by a phenomenological appreciation of the centrality of a disturbed basic sense of self (disturbed ipseity) are described. These include certain forms of empathic understanding, including use of phenomenological concepts to help the patient comprehend their difficulties, encouraging a “second person” perspective, prominent use of the therapeutic relationship, and strategies that engender a form of immersion or absorption in present activity.