You can't spell schizophrenia without an ‘I’: how does theEarlyIntervention inPsychosis approach relate to the concept of schizophrenia as an ipseity disturbance?

Abstract

Operational approaches to psychiatric diagnosis have increased reliability, but the cost has been the reduction of diagnostic concepts to tick-box lists of objective symptoms. Some blame this for growing disillusionment among younger clinicians in mental health. A renewed emphasis on the human subject and subjective experience could be one way to remedy this. While true for psychiatry in general, it is particularly true in psychiatry's 'sacred symbol' of psychiatry, schizophrenia. Greater understanding of schizophrenia will be of most relevance to those who have yet to develop the disorder, such as those targeted by Early Intervention in Psychosis services. A promising direction in the understanding of schizophrenia is the notion of fundamental disturbance in the sense of self ('ipseity disturbance'). I intend to examine the relationship between the concept of schizophrenia as an ipseity disturbance and the Early Intervention in Psychosis service model through consideration of three main areas: symptoms of schizophrenia as understood by the ipseity disturbance concept; implications of the ipseity disturbance concept for the notion of a schizophrenia prodrome; and the ways in which the Early Intervention in Psychosis service model reflects or could be informed by the ipseity disturbance concept. I argue that explicit consideration of schizophrenia as an ipseity disturbance could lead to better identification of those at highest risk, and more appropriately tailored interventions.