Abstract
We know a great deal about schizophrenia, but the current state of the art is one of uncertainty. Researchers are confused, and patients feel misunderstood. This situation has been identified as due largely to the fact that the dominant neurobiological perspective leaves out the person. The aim of the present article is to review and integrate a series of clinical, phenomenological, historical, cultural, epidemiological, developmental, epigenetic, and therapeutic phenomena in support of a suggestion that schizophrenia is above all a disorder of the person rather than of the brain. Specifically, we review seven phenomena, beginning with the conception of schizophrenia as a particular disorder of the self. We continue by looking at its recent origin, as a modern phenomenon, its juvenile onset, related to the formation of the self, the better prognosis in developing countries compared to developed countries, and the high incidence of the disorder among migrants. In the context of these phenomena of a marked socio-cultural nature, we consider the so-called “genetic myth,” according to which schizophrenia would have a genetic origin. On reviewing the current genetic emphasis in the light of epigenetics, it emerges that the environment and behavior recover their prominent role in the vicissitudes of development. The seventh reason, which closes the circle of the argument, concerns the role of interpersonal “chemistry” in recovery of the sense of self.
Highlights
Reviewed by: Maria Semkovska, University of Limerick, Ireland João Silva Gonçalves, Centro Hospitalar Lisboa Norte, Portugal
Schizophrenia is conceived as a disorder of ipseity
We have proposed seven reasons, linked together, for a reconsideration of schizophrenia first and foremost as a disorder of the person, not of the brain
Summary
The conceptualization of schizophrenia presented here mainly follows the developments resulting from the work of US psychologist Louis Sass and Danish psychiatrist Joseph Parnas (Sass and Parnas, 2003), among that of many others. The sense of agency is the pre-reflective experience or feeling in which I am the cause or author of the thought or movement From this perspective, schizophrenia is conceived as a disorder of ipseity. Whilst the first two aspects involve a disturbance of the normal pre-reflective sense of self as the center of the experience and action, the third one involves the alteration of normal vital contact with reality. Hyper-reflexivity refers to a type of intensified selfconsciousness, in which aspects of oneself that are normally or functionally unnoticed, pre-reflective, tacit or implicit, are objectivized and experienced as objects of consciousness. The transformation of ipseity just mentioned (hyper-reflexivity and diminished self-affection) is accompanied by a certain alteration of the objects and field of consciousness; that is, some disruption of the normal configuration of things according to their context.
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