Some Suggestions to Integrate the Self-Disorder Hypothesis of Schizophrenia

Abstract

Some Suggestions to Integrate the Self-Disorder Hypothesis of Schizophrenia Giovanni Stanghellini (bio) Keywords hermeneutic, person, phenomenology, self-disorder, schizophrenia A significant cluster of complaints of persons affected by schizophrenia, for example, their feeling ephemeral, lacking core identity, being affected by a diminished sense of existing as a self-present subject, point to the disruptions of structural aspects of the core self. These and similar disturbances aggregate significantly and selectively in the schizophrenia spectrum disorders, occur and are detectable in adolescents at risk of future schizophrenic disorder, and have a tendency to persist. All this led to the proposal that the generative disorder in schizophrenia is a disorder of the self (Parnas and Sass 2011). The phenomenological notion of the self serves to investigate the fact that we live our conscious life in the first-person perspective. This basic form of self-experience is implicitly, pre-reflexively, immediately, non-conceptually, non-observationally manifest. Such a core sense of self refers to a crucial sense of self-sameness, of existing as a unified, unique, and embodied subject of experience that is at one with oneself at any given moment. When this basic sense of self is disturbed, the person is inclined to experience both a kind of exaggerated self-consciousness (hyper-reflexivity; Sass 1992) and a concomitant fading in the tacit, pre-verbal feeling of existing as a living and unified subject of awareness (diminished self-affection). These changes in the basic structures of subjectivity are accompanied by an alteration of the very structure of the field of awareness, that leads to an emergent, particular way of experiencing which is infused by a change in the focus with which objects and meanings emerge from the background context, as well as to an altered emotional and conceptual ‘grip‘ on the world, a mutual amplification of the growing dissolution of the sense of existing as a subject with a disturbing and alienating self-scrutiny, and an increasing morbid objectification of one’s own psychic processes, including thinking, perceiving, and acting. The ongoing empirical validation of the self-disorder hypothesis of schizophrenia represents an important advance in the recent history of schizophrenia research. Yet, there are several features that still need to be investigated. This paper is a sympathetic attempt to focus on those aspects of the psychopathology of schizophrenia that have remained under-described in this perspective. A tentative list includes the pheno-phenotype, emotions, person’s position-taking, and personal history. [End Page 213] Pheno-phenotype The principal instrument that has been developed to investigate changes or abnormalities of phenomenal experience in the context of the self-disorder hypothesis of schizophrenia is called examination of anomalous self-experiences (EASE). This is a symptom checklist for semi-structured exploration of experiential anomalies that may be considered as disorders of basic self-awareness. The EASE does not cover all potential anomalies of experience, but mainly focuses on the disorders of the self. An example is that perceptual disorders are not explored, as well as other crucial domains of the life-world of persons with schizophrenia (e.g., emotionality). Thus, a more comprehensive instrument to assess the schizophrenic phenol-phenotype (Stanghellini and Rossi 2014) is needed. This interview should explore systematically all the fundamental dimensions of the life-world, including lived time, space, otherness, embodiment, materiality, and so on, as well as self-hood, rather than mainly focusing on disorders of minimal self-awareness. Emotions The primacy of disordered mood in the conceptualization of schizophrenia is a Leimotiv in clinical phenomenology (Stanghellini and Rosfort 2013). Anomalous emotions have been considered the core of the life-world, the ‘spatializingtemporalizing’ generative nucleus from which the transformation of the life-world originates, not just one of its features. In classic phenomenological literature, the schizophrenic mood has been variously characterized as perplexity (Ratlosigkeit), stage-fright (Trema), and delusional mood (Wahnstimmung), as well as loss of vital contact with reality (perte du contact vital), loss of natural self-evidence (Selbstverstaendlichkeit), ontological anxiety, and crisis of the vital drive (Lebensdrang). An outstanding example is Conrad’s (1958) ‘das Trema,’ a paradoxical mixture of anguish, hope, despair, and suspicion whereby reality becomes suspended between meaninglessness and the imminent revelation...