Self In Schizophrenia Research Articles

Remembering the self in schizophrenia

Autobiographical memories are a key component of our identity. Here, in the light of Cuervo-Lombard and colleagues' paper in this issue, we review impairments in autobiographical memory in schizophrenia and the association between autobiographical memory and outcome in the disorder. We also discuss whether these deficits are specific to schizophrenia and a possible link with traumatic events.

Role of the Self in Schizophrenia: A Multidimensional Examination of Short-Term Outcomes

The manifestation, course, and prognosis of schizophrenia are extremely variable, raising an interest in the role of personality and self-concept in the illness’ outcome. Building on voluminous research attesting to the fragility and instability of the self in schizophrenia, we examined the role of four self-concept aspects—self-esteem level, self-esteem instability, self-concept clarity, and the perception of the self as ill—in schizophrenia-spectrum disorders. Eighty-nine outpatients were assessed at baseline, and five days subsequently, regarding these self-concept aspects, symptoms, stress, and quality of life. Six weeks later, participants were again assessed using the baseline battery. Self-esteem instability predicted a decrease in quality of life over the study period. Self-concept clarity predicted an increase in quality of life and in positive symptoms, particularly under low stress. Depressive symptoms predicted a decrease in self-esteem levels and an increase in the perception of the self as ill. Thus, all four self-concept aspects were shown to be pertinent to the experience of schizophrenia, albeit in different ways. Special attention should be directed to self-concept clarity, which embeds both risk and resilience.

AS22-02 - Phenomenological psychopathology of the melancholic type of existence

The Self in Schizophrenia: Jaspers, Schneider and beyond. The concept of self-disorders has always played a major role for the psychopathology of the psychoses. In his General Psychopathology, Jaspers distinguished what he called ego-consciousness from object-consciousness and characterized it by the sense of activity, unity, identity and ego-demarcation. On this basis, Kurt Schneider later coined the term “Ich-Störungen” (ego-disorders) for the schizophrenic experience of one's thoughts, actions, feelings or bodily sensations being influenced or manipulated by others. In contrast, in ICD 10 or DSM IV these symptoms are regarded as bizarre delusions, commonly referred to as delusions of control or of passivity. In my paper, I will give a short historical introduction into the problem of self-disorders. Then I will analyse the possible connection of ego-disorders with more basic disorders of self-awareness. I will argue that full-blown delusional convictions of alien control are based on a disturbance of the intentionality of thinking, feeling and acting. This disturbance of intentionality, for its part, may be traced back to a lack of prereflective self-awareness which has been emphasized by more recent phenomenological approaches to schizophrenia.

Self-images and related autobiographical memories in schizophrenia

Schizophrenia is a severe mental illness, which affects sense of identity. While the ability to have a coherent vision of the self (i.e., self-images) relies partly on its reciprocal relationships with autobiographical memories, little is known about how memories ground "self-images" in schizophrenia. Twenty-five patients with schizophrenia and 25 controls were asked to give six autobiographical memories related to four self-statements they considered essential for defining their identity. Results showed that patients' self-images were more passive than those of controls. Autobiographical memories underlying self-images were less thematically linked to these self-images in patients. We also found evidence of a weakened sense of self and a deficient organization of autobiographical memories grounding the self in schizophrenia. These abnormalities may account for the poor cohesiveness of the self in schizophrenia.

Psychotherapy and Recovery from Schizophrenia: A Model of Treatment as Informed by a Dialogical Model of the Self Experience in Psychosis

Since the term schizophrenia was coined, the disorder has been linked to experiences of self-diminishment. This link calls for theoretical work that helps us understand experiences of diminishment wherein persons find themselves less than they once were but nevertheless able to recognize and describe their diminishment. In response this paper describes how dialogical psychology may help us both understand this feature of schizophrenia and inform the practice of psychotherapy. In particular, we suggest that some alterations in sense of self in schizophrenia may proceed from a range of losses in a person’s ability to sustain intrapersonal and interpersonal dialogues. Moreover, we suggest that these losses lead to at least three different forms of disturbed self experience: barren, monological and cacophonous selves. We then explore the unique challenges each poses to psychotherapy and suggest that attention to dialogical deficits may enrich self-experience if it attends to aspects of self-experience that emerge within session.

A Neural Model of the Loss of Self in Schizophrenia

Numerous researchers have pointed out over the last decades that there is a loss of the sense of the inner self in schizophrenia. In particular, the illuminating article of Sass et al. gives an underpinning explanation of the disease along these lines in each of its 3 manifestations, with positive, negative, or disordered symptoms. The crucial component of the analysis of these researchers is that of various disturbances in ipseity (the ongoing sense of "being there" accompanying all conscious experience) that can occur for a sufferer, giving a framework with which to understand the disease. Such analyses of schizophrenia in terms of distortions of the self go back much earlier. However, the more recent work has become more precise and embracing in terms of seeing most forms of schizophrenia as arising from such distortions. It also provides new ways of looking at and diagnosing the disease. In this article we propose to move the whole analysis closer into the brain itself by means of the CODAM neural network model of consciousness (where CODAM is an acronym for the "COrollary Discharge of Attention Movement" model of consciousness creation, to be described later). This allows both a mechanism to be formulated as to the basic brain-based cause of schizophrenia (with varieties of this cause correlated with the 3 main forms of it) as well as open up possible lines of research to be followed to help ameliorate the attention defects exposed in this approach.

Agency, the Sense of Presence, and Schizophrenia

The objective of this work is to evaluate the impact of agency deficiency on presence. We hypothesize that a deficit in agency, such as occurs in schizophrenia, has repercussions on the sense of presence as well as on performance in a sensorimotor test involving the body. Nineteen healthy controls and 19 stable patients with schizophrenia, matched by age and gender, participated in the study. We used new interactive technologies that enable the users to physically interact with a virtual environment and simultaneously sees themselves performing the actions. Two conditions were balanced: the control condition in which the participant see himself or herself doing the test, and the mask condition, in which the central part of the participant's body is hidden. At the end of the test, all participants completed a questionnaire on presence. The results show that control participants performed better than those with schizophrenia in the control condition. On the contrary, in the mask condition, their performance was significantly lower, whereas participants with schizophrenia obtained the same score as in the control condition. Controls also rated higher in the scale of presence than did participants with schizophrenia. Those results seem to corroborate a relationship between agency and presence. The body awareness and the self in schizophrenia are discussed in the light of agency.

Face recognition failures in schizotypy

Introduction. Studies suggest an important role of disturbances of self in schizophrenia and in schizotypy. Based on findings from a previous study (Brédart & Young, 2004), we developed a questionnaire assessing self-face recognition failures in everyday life (Self-Face Recognition Questionnaire; SFRQ) to investigate the relations between dimensions of schizotypy (cognitive-perceptual, interpersonal, disorganised) and self-face recognition disturbances. Methods. A sample of nonclinical participants (n = 170) completed the SFRQ and the Schizotypal Personality Questionnaire. Results. Factor analysis of SFRQ items revealed a clear three-factor structure consisting of: (1) self-face recognition difficulties, (2) unusual perception of own or other faces, and (3) other-face recognition difficulties. Correlational analyses between schizotypy dimensions and the SFRQ revealed that only the cognitive-perceptual and disorganised schizotypy dimensions correlated significantly with the SFRQ. By contrast, the interpersonal schizotypy dimension was not associated with the SFRQ. Conclusions. Findings provide further support that positive (cognitive-perceptual) and negative (interpersonal) schizotypy represent discrete neurobehavioural dimensions. The theoretical implications of these findings are discussed.

A typology of narrative impoverishment in schizophrenia: Implications for understanding the processes of establishing and sustaining dialogue in individual psychotherapy

Following from dialogical theories that conceptualize the self as an ongoing series of conversations within and between persons, the authors hypothesize that diminishments in sense of self in schizophrenia could be the result of disruption in the flow of such conversations. In particular, it is asserted that such a disruption could result in at least three forms of disordered selves and resulting impoverished personal narratives: the barren, monological and cacophonous narrative. These phenomena are discussed and subsequently illustrated with case examples that highlight the ways in which each form of narrative impoverishment differently imperils the establishment of a therapeutic relationship. For each of these situations, alternative therapist responses that may lead to better therapeutic outcomes are also offered.

Insight in schizophrenia: A review

The issue of insight in schizophrenia must be assumed to be one of the most important aspects of the clinical examination. Comprehensive studies have shown that between 50% and 80% of all patients suffering from schizophrenia do not believe that they have a disorder. In recent years, poor insight in schizophrenia has been the subject of increasing interest, as manifested in a number of studies discussed in the present review. Some of these studies focus on insight correlated to various parameters such as psychopathology, neuropsychology, clinical relevance and compliance. Other studies refer to more theoretical implications, among these the issue of defining the concept of insight: whether insight can be seen as a “primary” phenomenon in schizophrenia, and whether insight may be graduated, dimensioned or increased. Several authors have developed rating scales in an attempt to obtain a measure for the degree or dimension of insight. Here, the range of parameters employed gives an excellent impression of the complexity of the concept of insight. In the concluding discussion, a phenomenological aspect is brought in, in an attempt to place the concept of insight in relation to disturbances of the self in schizophrenia and to primary symptoms in schizophrenia, amongst these autism.

Recovering the self in schizophrenia: an integrative review of qualitative studies.

In this paper we review qualitative research on recovery from schizophrenia and summarize how persons' daily activities and experiences reflect mechanisms of recovery of the self. We begin by describing examples of persons' daily activities, suggesting that they have in common a stance labeled by E. Corin (1990) as positive withdrawal, representing negotiation of distance from the social milieu. We note that positive withdrawal may foster the creation of larger life frames, representing broad mechanisms through which to reconsider and ultimately recover a durable sense of self. We suggest that these mechanisms are not specific to people with schizophrenia, and briefly discuss implications of these ideas for models of outpatient treatment.

Perceiving the self in schizophrenia: Abnormalities in the awareness of action

Perceiving the self in schizophrenia: Abnormalities in the awareness of action

Developing an Empirical-Phenomenological Approach to Schizophrenia Research

AbstractSchizophrenia has historically been considered a severe psychiatric disorder with a chronic and progressive course; an assumption that has shaped both clinical research and public policy. Recent studies have suggested, however, that many people recover from this disorder to varying degrees, prompting new research approaches that focus on factors influencing improvement as well as pathology. An empirical-phenomenological approach appears especially promising as an avenue to investigating the active role the person may play in improvement. The dimensions of everyday life that are discussed as providing a conceptual framework for investigations of the active role of the person are intentionality, temporality, and meaning. Within this framework a four-step process of recovering and reconstructing the self in schizophrenia is then delineated, with concrete illustrations of each step drawn from interviews with one young woman with schizophrenia. The findings are taken to represent the kinds of valuable insights that may be garnered from an empirical-phenomenological approach to research built upon a recognition of the importance of the dimensions of intentionality, temporality, and meaning in the everyday life of those afflicied with severe mental illness. There is only the fight to recover what has been lost And found and lost again and again. T. S. Eliot

Schizophrenia and the self: contributions of psychoanalytic self-psychology.

This article explores the unique contribution of psychoanalytic self-psychology to an indepth understanding of the subjective experience of the self in schizophrenia. The author makes the argument that with creative adaptation Kohut's experience-near concept of the primacy of the self--its development and vicissitudes of fragmentation/cohesion--and the salience and legitimacy of self-object needs in all human relationships can be applied to psychotic and schizophrenic experience. When so applied, there is reason to suspect that an important bridge to the subjective inner life of the schizophrenic patient will be achieved.